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NP 730 Diagnostic Measures > Cardiac Labs > Flashcards

Cardiac Labs Flashcards

1
Q

Infarction

A
  • The cardiac tissue lacking oxygen long enough until the tissue actually dies
  • IRREVERSIBLE
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2
Q

Ischemia

A
  • Cardiac tissue temporarily lacking oxygen that can be restored without damage to heart
  • REVERSIBLE
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3
Q

Stable vs unstable angina

Main difference

A
  • Stable: CP relieved at rest; only exertion
  • Unstable: CP not relieved at rest; during exertion and rest
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4
Q

When you order an ECG for someone w/ACS and see No ST elevation and you order cardiac enzymes what does it indicate when…

Enzymes DECREASED =

Enzymes INCREASED =

A
  • DECREASED = Unstable angina
  • INCREASED = NSTEMI
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5
Q

What is troponin?

When is it released?

A
  • Protein found in cardiac and skeletal MM that helps w/MM contraction
  • Released when mm cells are damaged
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6
Q

When is Troponin positive?

A

Troponin must be above 99th percentile of upper reference to be considered POSITIVE

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7
Q

When is troponin ELEVATED post cardiac injury? Timing

A
  • ELEVATES 2-3 hrs after any type of cardiac injury (acute MI), peaks at 12hrs
    • Measure AGAIN 3-6HRS later
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8
Q

What does the level of infarct size indicate?

A

Indicator of prognosis; higher the elevation = poorer prognosis

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9
Q

Which conditions elevate troponin?

A
  • Cardiac trauma, CHF, HTN, PE, myocarditis, critical illness (spesis)
  • Chronic renal failure - can determine by looking at steady rise and fall in elevation
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10
Q

Three types of Troponin

A

Troponin I, T, C

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11
Q

Which troponin enzyme(s) is/are ONLY found in CARDIAC MM?

A

I & T

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12
Q

Troponin T
How long does it stay elevated?

A
  • Remains elevated for 10-14d post MI
  • Less sensitive and specific than Troponin I
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13
Q

Troponin I
How long does it stay elevated?

A
  • Remains elevated for 7-10d post MI
  • More sensitive and specific for MI 8hrs after symptom onset
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14
Q

HEART Score ranges
Low risk
Mod risk
High Risk

What composes of the HEART score?

A

0-3: Low risk
4-6: Mod risk
7-10: High risk

History, EKG, Age, Risk factors, Troponin

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15
Q

What is the troponin level after re-infarction compared to initial infarction? When is it best to measure?

A

Troponin level not as helpful in persistent elevation post-MI (not same response); Troponin level beneficial in LATE presentation of MI

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16
Q

CK-MB
Found in? Elevated in?

A

Found in heart and skeletal MM and brain

Elevated w/MM or nerve cell injury

17
Q

CK-MB
Timing of increase w/CP
Compared to troponin

A

Increased w/in 3-12hrs of onset of CP, peaks w/in 24hrs and returns to baseline after 48-72 hrs
- Good for detecting in re-infarction

TROPONIN PREFERRED OVER CK-MB

18
Q

Cardiac Biomarker Timing GRAPH

A
19
Q

STEMI

What? Where do you send a pt w/this?

A

ST elevation in EKG

Send them immediately to Cath lab

20
Q

Cardiac Catheterization

If you visualize coronary artery blockage…

A
  • Measures pressure in heart chambers, blood flow to coronary arteries, and valve dysfunction
  • PCI = percutaneous coronary intervention
    • Coronary angioplasty with/without stenting
    • ONLY IF there’s an occluded artery
21
Q

Lipid labs (list)

Lipid panel (list)

A
  • Total cholesterol: HDL + LDL + vLDL (w/TGs)
  • Lipid panel
    • Total cholesterol
    • HDL,
    • LDL (calculated)
    • TGs
    • vLDL (calculated)
  • Total cholesterol - HDL = non-HDL cholesterol
22
Q

How are TGs affected by non-fasting?

Are the other Lipid labs affected by non-fasting?

A

Falsely elevated if NON-FASTING

NOPE

23
Q

Non-fasting lipid labs vs. Fasting labs indications

A
  • Non-fasting
    • Acceptable for baseline screening
  • Fasting
    • Recommended for high risk, FH, statin therapy (maintenance), hyperTG
    • 9-12h pre-test - overnight fast
24
Q

HDL

A
  • High density lipoprotein
  • Binds w/excess cholesterol released by cells, brings them back to liver to be expelled
  • “GOOD CHOLESTEROL” - helps get rid of bad cholesterol
25
Q

LDL

A
  • Low density lipoprotein
  • Major carrier of excess cholesterol by cells
  • Targets: peripheral tissues, excess burrows into arterial walls
  • “BAD CHOLESTEROL”
26
Q

LDL vs. LDLc

How is it calculated? When is it not valid?

A
  • Direct (LDLc)
  • Indirect (LDL)
    • Calculated by Friedewalde equation
      • Not valid if TGs > 400
      • Tends to underestimate LDL
      • What treatment guidelines are based on
27
Q

VLDL

A
  • Very low density lipoprotein
    • Carries mainly TGs
    • Difficult to measure, calculated from TG levels
28
Q

Triglycerides (TGs)

A
  • Fatty acid chains
  • Transported to tissues for energy
  • Unused calories converted into TGs for storage in fat cells
  • When energy released, transport proteins → cholesterol rich particles
    • ⇡LDL ⇣HDL
  • MOST SENSITIVE TO FASTING
29
Q

Lipid screening in children/Adolescents

A

Risk is low in age group d/t age

30
Q

BNP

Secreted from? When is it elevated? When is it decreased?

A
  • B-Type natriuretic peptide
  • Secreted from ventricles of heart in response to changes in pressure that occur with HF
  • Elevated
    • HF worsens
    • High Cr skews it high
  • Decreased
    • HF improves
    • Obesity skews it low
31
Q

What does BNP help distinguish?

A

Distinguishes between lungs and heart for SOB

32
Q

BNP algorithm for HF

A

NP = BNP

33
Q

D-dimer

What is the lab? Indications for elevated levels?

A
  • One of degradation products released upon clot breakdown
    • Useful in evaluation of those with low to moderate risk
  • ELEVATED levels → recent/ongoing coagulation + fibrinolysis (fibrin breakdown needed for clotting cascade)
34
Q

D-dimer specificity and sensitivity level

A
  • HIGHLY sensitive
  • POOR specificity - elevated levels can be found in different conditions
    • Pregnancy, renal failure malignancy, recent trauma, sepsis
35
Q

Calculating risk for DVT

A
36
Q

Calculating risk for PE

A

NP 730 Diagnostic Measures (11 decks)

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