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Diagnostic Medicine > Cardiac biomarkers & lipids > Flashcards

Cardiac biomarkers & lipids Flashcards

1
Q

biomarkers for myocardial necrosis

A

creatine kinase, CK-MB, myoglobin, troponin

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2
Q

biomarkers for myocardial ischemia

A

ischemia-modified albumin, heart-type fatty acid binding protein

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3
Q

biomarkers for stress

A

aNP, proBNP, BNP

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4
Q

biomarkers for inflammation and prognosis

A

CRP, sCD40L, homocysteine

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5
Q

What are indications for CK, CPK, CK-MB?

A

diagnosis of myocardial muscle injury, neurological and skeletal muscle diseases

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6
Q

First biomarker to rise in setting of MI is

A

Myoglobin

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7
Q

CK levels rise within _ hours, peaks at __ and returns to baseline in

A

6 hours, peaks at 18, and returns to baseline in 2-3 days

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8
Q

CK-BB

A

brain and lungs

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9
Q

CK Mb

A

cardiac specific

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10
Q

CK MM

A

skeletal muscles

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11
Q

CK-MB rises in _ , peaks __, returns to normal in ___

A

4-6 hours, peaks 12-24 hours, returns to normal 48-72 hours

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12
Q

What enzyme:
- helps differentiate reinfarction in setting of prior infarction
- used in surgery or trauma
- rise mildly in unstable angina and indicates increased risk for occlusive event

A

CK-MB

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13
Q

What can affect CK?

A
  • IM injections, strenuos exercise, early pregnancy, muscle mass
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14
Q

What can increase CK?

A

alcohol, amphotericin B. ampicillin, dexamethasone, furosemide, lithium, llidocaine, propranolol, succinylcholine

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15
Q

Total CK can show

A

injury to heart, muscle, brain

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16
Q

CK-BB can show

A

CNS, SAH, seizures, shock, reye syndrome, pulmonary infarction

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17
Q

CK-MB can show

A

AMI, cardiac aneurysm surgery, cardiac defibrillation, myocarditis, ventricular arrhythmias, cardiac ischemia

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18
Q

CK-MM can show

A

rhabdomyolysis, muscular dystrophy, myositis, IM injections, trauma, crush injuries, hypokalemia, hypothryoidism

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19
Q

oxygen binding muscle protein released rapidly following skeletal/cardiac muscle

A

myoglobin

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20
Q

earliest biomarker to rise after MI (2-3hours)

A

myoglobin

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21
Q

Used to rule out acute MI in early hours of symptoms, instrumental in deciding whether to use thrombolytic

A

myoglobin – less specific than troponin, so can’t be used alone

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22
Q

What interferes with myoglobin

A

IM injections
increase = AMI, myositis, malignant hyperthermia, muscle dystrophy, skeletal muscle ischemia, skeletal muscle trauma, rhabdomyolysis, seizures
decreased = polymyositis

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23
Q

what to test when identify and stratifying patients w/ CHF

A

natriuretic peptides

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24
Q

neuroendocrine peptides that oppose RAA system

A

natriuretic peptidesf

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25
Q

found in cardiac atrial muscle, released as atrial stretch –> vaso-relaxation, inhibition of aldosterone secretion, natriuresis and reduction in BV occurs

A

ANP

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26
Q

found in membrane granules of cardiac ventricle, released as atrial stretch –> vasorelaxation, inhibition of aldosterone secretion from adrenal gland + renin from kidney, natriuresis + reduction occurs

A

BNP

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27
Q

found in nervous system but found to be produced by epitheleal cells

A

CNP

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28
Q

left ventricle releases this in response to increased wall tension and stretching, seen in heart failure

A

BNP

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29
Q

BNP > ___ = HF

A

400

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30
Q

elevated levels of this suggest HF, especially in acute decompensated HF
high levels = worse prognosis
elevated w/ SOB = cardiac
risk stratification

A

BNP

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31
Q

NT-pro-BNP differentiates what

A

heart failure from other causes of dyspnea, but can vary

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32
Q

BNP is higher in

A

women
older patients
patients w/ recent post-cardiac surger

CHF, MI, HTN, heart transplant rejection, cor pulmonale

33
Q

gold standard for pulmonary HTN

34
Q

found in cardiac muscle, highly specific + sensitive for MI.

35
Q

Troponin rises within ___, peaks 12-24 hours, can stay elevated up to ___ weeks

A

3-6 hours,12-24 hours, can stay elevated up to 2 weeks

36
Q

what can be used to determine cardiac ischemia, specific indicator for cardiac muscle injury and can elevate with PE, renal failure, sepsis?

37
Q

____ are more specific for cardiac injury than CK-MB

38
Q

CK-MB can also rise in

A

renal, cardiac, brain, skeletal muscle injuries

39
Q

can troponins be used to determine reinfarction

40
Q

what’s used as a risk stratification tool in patients w/ CAD:
elevated = increased risk of cardiac events such as ACS or stroke
help assess inflammatory component
>2 is considered high risk

41
Q

what contains apoB-48, apoC-II, and apoE?

A

chylomicrons

42
Q

apolipoprotein E is found in

A

chylomicron remnants, VLDL, HDL

43
Q

VLDL is used for

A

transporting endogenous triclycerides

44
Q

What do VLDLs contain

A

apoB-100 (present in VLDL and LDL, binds to LDL receptor to mediate LDL uptake), apoC-II and apoE

45
Q

VLDLs are synthesized in the liver containing __

A

triglycerides and cholesterol

46
Q

IDl is converted to

47
Q

normal VLDL

48
Q

normal troponin

A

T <.1
I <.04

49
Q

normal BNP

50
Q

normal ANP

51
Q

normal NT-pro-BNP

52
Q

normal myoglobin

53
Q

normal CK

A

male 38-174, female 26-140
MM 100%
MB <5%
BB 0%

54
Q

Normal LDL is less than

55
Q

Normal HDL is

A

male >45, female >55

56
Q

LDL contains

57
Q

HDL contains

A

apoA-I (cholesterol efflux and reverse cholesterol transport) and apoC-II

58
Q

75% of cholesterol is bound to

59
Q

Normal TGs

60
Q

Increased or decreased cholesterol:
-malabsorption
-malnutrition
-advanced cancer
-hyperthyroidism
-cholesterol-reducing meds
-pernicious anemia
-hemolytic anemia

61
Q

increased or decreased TGs:
- glycogen storgae disease
- HLD
- hypothyroidism
- nephrotic syndrome

62
Q

lipid profile contains

A

total cholesterol
LDL
HDL
TGs
ratio
non-HDL cholesterol (for risk)

63
Q

General pop normal lipid panel:

A

<200
HDL >45
LDL <130
Non-HDL <130
VLDL 7-32
TGs <150

64
Q

What’s preferred LDL For CVD

A

<100, <70 mostly

65
Q

What’s preferred values for DM

A

LDL<70, HDL>50 for women

66
Q

What’s preferred values for DM and CVD

67
Q

If someone has a very high HDL

A

consider alcoholism - can increase production of apolipoprotein A-I

68
Q

If TGs >400, you will need to order a direct what?

69
Q

HDL can be affected by

A

age, sex, post-MI, hypothyrodism (increases cholesterol), hyperthyroidism (decreases)

70
Q

How can BBs affect your lipid panel?

A

increase TGs, decrease LDL size and HDL

71
Q

How can alpha blockers affect your lipid panel?

A

decrease TGs, increase LDL and HDL

72
Q

Dilantin can increase

73
Q

Steroids and estrogens can increase

74
Q

What can increase HDL?

A

alcohol, exercise, genetics

75
Q

What can decrease HDL?

A

metabolic syndrome, familial low HDL, hepatocellular disease, hypoproteinemia

76
Q

What can increase LDL and VLDL?

A

nephrotic syndrome, glycogen storage disease, hypothyroidism, ETOH, chronic liver disease, multiple myeloma, Cushing disease

77
Q

What can decrease LDL and VLDL?

A

familial hypoproteinemia, hyperthyroidism

78
Q

Statins will pull down all cholesterol levels including

Diagnostic Medicine (8 decks)

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