Cardiac Function Flashcards
CAD
CHF
CVD
ACS
CAD - coronary heart disease
CHF - congestive heart failure
CVD - cardiovascular disease
ACS - acute coronary disease
Describe cardiovascular disease briely
Types?
c
cb
pa
aa
leading cause of death
4types:
CHD
cerebrovascular disease
peripheral arterial disease
Aortic artherosclerotic disease
What are some ways CVD begins?
May begin at birth or childhood
congenital heart defect or rheumatic fever
some develop overtime into adult
CHD overview states
an
m
h
angio pectoris (chest pain)
myocardial infarction (MI)
heart failure
Cerebrovascular disease states
blood supply cut off from brain
stroke/trans ischemic attack (mini)
Peripheral arterial disease (PAD)
blockage in arteries
PAD/DVTs
Aortic artherosclerotic
a
d
aneurysms widening of artery
dissection - tears in aorta
Describe Artherosclerosis
chronic
accum of
veins?
chronic inflammation
accumulation of lipid material in arteries/veins
veins narrow and harden
Describe Ischemia
lack of blood flow
localized in heart 1/3rd of deaths
can see in early as age 10
Describe the damage of endothelial walls in artherosclerosis
t
pl
oc/th/ru
turbulent blood flow
plaque formation in cycle/vessle
occlusions/thrombosis/ruptures/ combos
most common locations of artherosclerosis
plad
plmc
erca
prox. left anterior decending
prox. left main coronary
entire right coronary artery
When is artherosclerosis symptomatic?
with 75% plaque formation
Lack of blood supply in heart leads to?
ischemia
Classic masnifestation of cardiac ischemia/angina/HA
a
s
rad
inc
angina
squeezing of chest/pressure
radiates to left shoulder/neck/arm
increases in intensity
non classical manifestation of cardiac ischemia
more common in women
nausea/short breath/stabbing pain
Do normal ECGs rule out presents of ACS?
no
Eval of chest pain
physical exam:
chest xray
physical. exam: high BP cardiac valv disease
ECG chest xray
Chest xray - non cardiac source
Initial markers of cardiac damage explained
cell death releases..
r
s
d
cell death releases intracellular proteins from myocardium into circulation
1.) released rapidly/steady
2.) several day persistance
3.) detected at low levels
T/F if STEMI is an issue, do the EKG within 10 min
true
First cardiac markers
a/l
ck
AST/LD (non specific)
creatinine kinase in nearly all cells
CK isoenzymes
whats most reliable indicator of MI?
CK MB most reliable
CK-MM muscle
CK-BB brain
What other disease states can CK-MB be elevated in?
can be elevated in chronic muscle disease, end stage renal and intense excersise
What do troponin levels look like if the myocardium is undamaged?
normal
Cardiac troponins
complex of…
TnT
TnI
TnC
complex of 3 proteins, transmit calcium signals to contract muscles
TnT - binds to tropomycin
TnI - inhibits binding of actin/myosin
TnC - binds to calcium to reverse TnI
Briefly describe tissue specific isoforms
slow/fast cardiac muscles
CTnc
same..
same isoform for both slow twitch (T2) and cardiac
CTnI-CTnT
unique
unique isoforms in fast twitch/slow and cardiac
T/F each isoform is encoded in separate genes
true
What is CTnI specific forc
detection of …. in
how many hours after onset? lasts?
widest window for detection post..
high?
cardiac injury
detection of myocardial cell injury acute ischemia/myocard
3-12 hr after onset/for weeks
widest window for detection post MI and high sensitivity/specificity
Specificity/sensitiv of troponin
what kind of release?
slow release may not be detected when pt presents with early pain
rise and fall of troponin indicate AMI
HS-CTn
confirms….at low []
discerns …associated with
can confirm myocardial injury at low concentration
discern small changes in {} delta values associated w probability of risks
Challenges of troponin
chronic un
single rule
other diseases
unstb
struct
arth
chronic unhealthy people w chest pain
single rule out value due to high sensitivity
procedures and other diseases :
unstable angina
struct HD
arhterosclerosis
Pts with kidney disease
prognosis in CKD increases? predicts?
dialysis elevation of? increases?
hemodyalisis involves filt?
prognosis in CKD increase troponin levels predict worse long term cardiac issues
dialysis elev in CTnT increase mortality
hemodylsis involves filt of blood of toxins diff concent of enzymes
Myoglobin
what type of binding
released?
spcificity/half life?
used with?
iron oxy bind in muscles
small protein released when muscles damages
not specific short half life
used along w CK-MB and troponin
HS-Tn can detect before?
myoglobin
Cardiac injury
occurs in?
what happens?
cells removed by?
when energy fails?
reperfusion transfusions?
occurs in MI = cell death
apoptosis or necrosis
apoptic cells removed by macrophages - requires energy
(necorsis when enrgy fails)
Reperfusion transfusions: intravasc baloons, CABG/chem thrombosis
Biomarkers in heart failure
descirbe heart failure
manifestations
heart failure: pathological condition when heart fails to inadequatly supply metabolic needs of body, decreases pumping
manifest:
retention of fluids, shortness of breath, lower extremity edema
Reccommendations of heart failure markers
CTnI, CTnT, excersise stress test, X-ray
Diagnosis and risk stratification of heart failure
most common presence of heart failure sympt?
what distinguishes cardiac vs non cardiac dspnea
what is secreted in response to inc pressure/load on heart?
shortness of breath most common presense of heart failure - very non specific
BNP or precursor NT-proBNP cardiac/non cardiac dyspnea
naturetic peptides secret from heart in response to incr pressure/volume load
Reducing intravasc volume steps
promote n/d/v
inhibit sns
promote natr/diu/vasodilation
inhibit sympathetic nervous system signalling
BNP/NT-ProBNP
released from ….. in response to
in what kind of pts
predicts?
released from myocardial cells in response to incr vol/incr pressure/hypertrophy
Both in pts with ventricular dysfunction
strong predic mortality
BNP/NT-ProBNP continued
what is the same?
optimal?
what is being persued as target?
sensit/spec are same - optimal cut off vals
BNP being persued as target by manufacutures
Cardiac troponins
diagnosis of
who else has elevations
ongoing..
impaired?
diagn of Myocardial injury
heart failure pts have elev as well as ongoing cell death
impaired liver
Detection of heart failure
not diagnostic, stratify risk/prognosis
concomintant elev in multiple markers associated w esclating risk of effects
Is CTnI or CTnT more common in heart failure
CTnI
markers of CHD and plaque instability
m/c indicate presnce of…
predict
provide progn from…
MPO and CRP may indicate presence of inflam to predict mortality and provide progn from clinical risk and Hs-CTnT
MPO
increased in …a/c
released when neuts gather in blood vessles
increased in ACS and chronic CAD
CRP
marker of inflammation
HS-CRP progn marker of artherosclerosis/CHD
<1mg normally
Lipoprotein A
predicts prem..
predict premature cardiovasc disease
Homocystine
what kind of AA
how many forms?
total plasma HC refers to?
normal levels?
linked with?
inc risk with
sulfur containing AA
4 forms
total plasma HC refers to all 4 forms
norm 5-15
linked w high levels and CVD
inc risk with elevation
hyperhomocystemia risk factor of?
inc 5 mol =
CVD
<40% pts w CVD have hyperhomo
increase 5mol = HD inc 20-30%
Pulmonary embolism
embolous
puml embolism
extent?
embolous - mass of solid/liq/gas
pulm embolous: high risk lodged in pulm arteries impares flow
size and location affect extent
Saddle emboli
lodged at bif…
inc h
inc incidence w
whos at higher risk?
lodged at bifuracation of main artery, blocks pulm blood flow
increase heart failure
incidence inc w age
women at higher risk
Use of D dimer
when pretest prob…
cross
indicated coag..
high
when pretest prob of PE is low
cross linked fibrin
indicates coag indirect marker/fibrinolysis
high sensitivty/quant
Abn levels of D dimer
90% of pts with PE
pts w normal levels rule out PE
Troponin and PE
progn val w
short term?
clinic
agr
progn val w PE
short term mortality
clinical management
agression
BNP with PE
evals …
neg pred values?
IDs pts with…
elev vals inc short term mortality
94% neg pred values
ID pts w acute PE and high risk adverse outcomes
CHD w PE
common?
can cause?
uncommon substantial mortality
arhterosclerosis
can cause ischemia
