CARDIAC MARKERS Flashcards
Cardiovascular disease (CVD) commonly occurs in the general population and affects the majority of people older than ____ years.
60
four major types of CARDIOVASCULAR DISEASE
coronary heart disease
cerebrovascular disease
peripheral arterial disease
aortic atherosclerotic disease
what is common in all major 4 types of cardiovascular disease
they all has atherosclerosis
build up of fats in the arteries and vessels causing disruption in the blood flow
umbrella term of the diseases of the heart –
cardiovascular disease
coronary heart disease manifestations
Myocardial infarction (Heart attack)
Angina pectoris (Chest pain)
Heart failure
Sudden cardiac death
CHD manifest as ___
cardiac ischemia - lost of oxygen delivered to heart
angina pectoris is also known as
stable angina
a chest pain that goes away when at rest is called as
stable angina
cerebrovascular disease is manifested as
stroke or transient ischemic attack
cerebrovascular disease is manifested as stroke or transient ischemic attack which is also called as
short reversible stroke
lost of O2 delivered to brain
cerebrovascular disease
manifestation as
acute localized pain in the arms and legs
intermittent claudication of peripheral arterial disease
aortic atherosclerotic disease is manifested commonly as
aneurysm
aneurysm is caused by either __ or ___ of the artery
either abnormal widening or aortic dissection
how many percent do misdiagnosis constitute
7 million people yearly would visit the emergency dep - 20-30% are misdiagnosed
Biomarkers of Myocardial INJURY
▪ CK-MB Fraction
▪ Myoglobin
▪ Cardiac Troponin
Biomarkers of Myocardial Ischemia
▪ Ischemia-modified Albumin (IMA)
▪ Heart-type acid-binding protein (H-FABP)
BIOMARKERS OF HEMODYNAMIC STRESS
▪ Natriuretic peptides (NPs): Atrial natriuretic peptide (ANP)
▪ N-terminal proBNP (NT-proBNP)
▪ B-type natriuretic peptide (BNP)
the right and left ventricle of the heart are stressed leading to inability of the heart to pump blood
hemodynamic stress - HEART FAILURE
INFLAMMATORY AND PROGNOSTIC MARKERS
▪ High sensitivity C-reactive protein (CRP)
▪ sCD40L
▪ Homocysteine
prognostic markers is all about
low risk or high risk
in the diagnosis of acute coronary syndrome, cTnT/I, _____ is also used
ECG - electrocardiogram
DIAGNOSIS AND PROGNOSIS OF HEART FAILURE
they form the class 1 recommendation
BNP and NT proBNP
DIAGNOSIS AND PROGNOSIS OF ACUTE MYOCARDIAL INJURY
form the class 1 recommendation
TnT/TnI
heart injury -
heart failure -
heart injury - TROPONIN
heart failure - BNP
cardiac ischemia can lead to
cardiac ischemia’s 2 types
activity-related chest pain (stable angina)
or an acute coronary syndrome (unstable angina)
unstable angina is also called as
acute coronary syndrome
stable angina -
unstable angina -
stable angina - angina pectoris
unstable angina- acute coronary syndrome
Frequently occurs unpredictably and does not
respond to cessation of activity
acute coronary syndrome
a more severe form of myocardial infarction
acute coronary syndrome
describe the cardiac biomarkers in unstable angina compared in the setting of myocardial infarction
normal in unstable angina
elevated in myocardial infarction
CLASSIC MANISFESTATION OF
CARDIAC ISCHEMIA
Squeezing of the chest
Heavy Chest pressure
Burning Feeling
Difficulty Breathing
SUPER HBD
NON-CLASSIC MANIFESTATION
OF CARDIAC ISCHEMIA and is most commonly experience by women
stabbing
pulsating
sharp chest pain
Patients with chest pain are initially evaluated by a
physical examination, ECG, chest xray , biomarkers
ATHEROSCLEROSIS starts at what yr
10 y/o will manifest at 20 y/o and above
it contributes in the ___% deaths in western societies
50
Atherosclerosis becomes pathologic with the development of atherosclerotic plaques called as __
atheroma
independent risk factor for atherosclerosis
homocysteine
homocysteine came from
the breakdown of the amino acids called methionine
once the homocysteine became elevated in the blood, it can cause the oxidation of ___
LDL - carrier of the cholesterol
once the homocysteine oxidizes the LDL, here comes the macrophage, what will then happen to it?
it will be taken up by the macrophages - only the oxidized LDL are eaten
the eaten LDL by the macrophage is now called as
foam cells - it will cause lots of lipids in the cytoplasm of the macrophage and cause it to burst and rupture
the rupturing of the macrophage caused by the foam cells will cause damage to ___
endothelial linings of the blood vessels
The rupture and the damage to endothelial linings will attract inflammatory cells such as
T cells - which will release interferon gamma and eventually lead to the attraction of cytokines
once there’s a build up already, the smooth cells will contribute to the plaque, and will then release stabilizing factors such as ___ to further stabilize the atheromas
fibrin, collagen, proteoglycans
fibrin, collagen, proteoglycans are also called as
FIBROUS CAP
the first biomarker used in myocardial infarction
aspartate transaminase (SGOT)
ASPARTATE TRANSAMINASE is also called as
serum glutamate oxaloacetic transaminase
ASPARTATE TRANSAMINASE are widely distributed in tissues but highest levels found in
liver
heart
skeletal muscles
rbc’s
most common method to determine the level of AST
karmin method
The product of SGOT would be __
oxaloacetic
The product of SGPT would be __
pyruvate
normal value of AST -
8-20 U/L
AST will rise within __hr many hrs
6-8 hrs
AST will peak on
18-24 hrs
AST will return to normal within how many days/hrs___
4-5 days
An enzyme that is found in almost all body tissues but only a small
amount of it is usually detectable in the blood.
LACTATE DEHYDROGENASE
Used as a general marker of injury to cells
LACTATE DEHYDROGENASE
method to detect LDH
Wroblewski-LaDue Method
Catalyzes the interconversion of pyruvate to lactate
lactate dehydrogenase
LDH functions as a TETRAMER and is made up of 2 kinds of subunits (what are the subunits)
H and M
6 isoenzymes of LDH
LDH 1 (4H)
LDH 2 - (3H 1M)
LDH 3 (2H 2M)
LDH 4 (1H 3 M)
LDH 5 (4M)
LDH 6
LDH-1 is found in
heart
LDH2 is found in
Reticuloendothelial System
LDH3 is found in
lungs
LDH4 is found in
kidney
LDH5 is found in
liver and striated muscle
LDH6 is called
Alcohol dehydrogenase –
commonly seen in patients with
atherosclerotic and obstructive
jaundice
liver marker of LDH
LDH 5
The normal electrophoretic pattern of LDH would be
2, 1, 3, 4, 5
which means the highest normal elevation of LDH in the body is the LDH 2 and the 5 is the lowest
the phenomenon wherein the electrophoretic pattern of LDH becomes 1,2,3,4,5 during myocardial infarction is called as
flipped pattern
abnormal elevation of LDH 2 is found in
pernicious anemia and megaloblastic anemia
LDH will rise upon MI in how many hrs
24-48 hrs
LDH will peak upon MI in how many hrs
3-4 days
LDH will remain elevated upon post MI in how many hrs/days
10 days
what can u say to LDH as a marker of MI
Useful for determining if a patient has had a myocardial infarction if
they come to doctors several days after an episode of chest pain
directly proportional to the infarction size
LDH level
disadvantage of LDH is it’s non specific, as LDH level can be elevated in other conditions such as
myocarditis and rheumatoid fever
the most important cardiac enzyme we have
CK MB
Catalyzes the conversion of creatine to phosphocreatine degrading
ATP to ADP
CK
CK enzyme consists of 2 subunits
B (Brain type) or M (Muscle Type) making 3 Different
isoenzymes
3 isoenzymes of CK MB
CK -MM
CK - BB
CK-MB
CK-MM – ___ disease
CK-BB – ___disease
CK-MB – __ disease
CK-MM – Muscle disease
CK-BB – Brain disease
CK-MB – heart disease
CK MB will start to rise within
4-6 hrs after MI
CK MB will peak within
12 hrs
ck mb will return to baseline within
24-36 hrs
Can be used to indicate early reinfarction if the level normalizes
and then increases again
CK-MB
method for detection of CK MB
Oliver-rosalki method
The highest elevation / increase of CK-MB is seen in
Duchene’s muscular
dystrophy.
CK MB elevation
Cardiac injury for reason other than MI:
o Defibrillation
o Blunt chest trauma
o Cocaine abuse
earliest protein indicator of MI
myoglobin
Small-size heme protein found in all tissues mainly assists in oxygen
transport.
myoglobin
rise of myoglobin
1-3 hrs
myoglobin peak
6-9 hrs
myoglobin will return to normal within
12 hrs
myoglobin is fast but is not used for MI because?
of non specificity
CONDITIONS FOR MYOGLOBIN INCREASE
▪ Acute myocardial infarction
▪ Skeletal muscle damage, muscular dystrophy, and inflammatory myopathies
▪ Renal failure, severe uremia
▪ Shock and trauma
gold standard for MI
troponin
is a complex of 3 regulatory proteins that is integral to nonsmooth muscle contraction in skeletal as well as cardiac muscle
troponin
Troponin has 3 subunits
troponin C
troponin T
troponin I
this troponin Has calcium binding ability and has
no diagnostic value
troponin C
this troponin binds the troponin tropomyosin complex
troponin T
this troponin is an inhibitory protein
Troponin I
the only troponin that is solely found in the heart
troponin I
troponin I half life
2-4 hrs
troponin I serum increase
2-8 hrs
troponin that is found in fetal skeletal muscle
troponin T
Elevations in troponin-I and troponin-T
o Can persist for up to __ days after MI or greater than __
days
10
CV of ≤____%at decision limit is recommended to reduce false positive
outcomes
less than 10% <10%
BNP came from
NT-proBNP
metabolically active
NT-proBNP
bnp
bnp
metabolically inactive
NT-proBNP
bnp
NT-proBNP
describe the troponin and bnp
heart failure due to Acute coronary syndrome
increase troponin low bnp
describe the troponin and bnp
heart failure NOT due to Acute coronary syndrome
normal troponin increase bnp
bnp MEANS
beta-type NATRIURETIC PEPTIDE
drug of choice for ventricular dysfunction
Nesiritide
Recomended drug of choice for
the treatment of heart failure. This is
from the recombinant tech of
“Scios
Nesiritide
inflammatory marker and prognostic marker for cardiac disease
hs-crp
high sensitive c reactive protein
best inflammatory marker for coronary heart disease
hs crp
normal ref range of crp
less than 1 mg/dl
range of crp in acute coronary heart disease
> 10 mg/L
higher than 10 mg/L in crp signifies
systemic inflammation
A sulfur-containing amino acid
homocysteine
Circulating mass of solid, liquid, or gas
embolism
Initial therapy after diagnoses of pulmonary embolism involve
low molecular weight
heparin, unfractionated heparin, or fondaparinux (trade name
Arixtra)
Crackles or decreased breath sounds are common
pulmonary embolism
test to diagnose pulmonary embolism
d dimer
is a product of plasmin-mediated fibrin degradation that
consists of two D-domains from adjacent fibrin monomers that
are cross-linked by activated factor XIII.
d dimer
The most widely used set of decision rules of PE is the
Wells score
methods do detect d dimer
Enzyme-linked fluorescent assay,
enzyme-linked immunosorbent assay (ELISA), and latex quantitative assay
