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Residency Exam > Cardiac Markers (Video File) > Flashcards

Cardiac Markers (Video File) Flashcards

1
Q

What are the 3 main monitoring points for acute coronary syndromes?

A
  1. Symptoms
  2. ECG changes
  3. Cardiac markers
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2
Q

What is unstable angina the result of?

A

A non-occlusive thrombus in the coronary arteries

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3
Q

Describe the ECG pattern associated with unstable angina

A

Unstable angina does not have a specific ECG pattern

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4
Q

Describe the cardiac enzyme pattern seen in unstable angina

A

In unstable angina, cardiac enzymes are normal

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5
Q

Describe the typical thrombus seen in an NSTEMI

A

An NSTEMI is the result of an occluding thrombus sufficient to cause tissue damage and mild myocardial necrosis

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6
Q

Describe the typical ECG pattern seen in an NSTEMI

A

ST depression +/- T wave inversion

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7
Q

Describe the typical pattern of cardiac enzymes seen in an NSTEMI

A

In an NSTEMI, cardiac enzymes are elevated

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8
Q

Describe the typical thrombus seen in a STEMI

A

A STEMI is the result of complete thrombus occlusion

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9
Q

The typical ECG pattern seen in a STEMI includes ST elevations or what other feature?

A

New LBBB

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10
Q

The typical ECG pattern seen in a STEMI includes ST elevations or what other feature?

A

New LBBB

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11
Q

ST depression and T wave depression are usually indicative of what cause of cardiac damage?

A

Damage due to ischaemia rather than an infarct

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12
Q

Describe the typical pattern of cardiac enzymes seen in a STEMI

A

In a STEMI, cardiac enzymes are elevated

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13
Q

Describe the severity of symptoms of a STEMI

A

Symptoms of a STEMI tend to be more severe than those of an NSTEMI

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14
Q

Which cardiac patients tend to be candidates for stents and/or thrombolysis?

A

STEMI patients

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15
Q

What does LBBB stand for?

A

Left bundle branch block

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16
Q

What is the aetiology of left bundle branch block?

A

It is caused by the death of parts of the conductive tissue of the heart

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17
Q

Does unstable angina damage the heart?

A

No

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18
Q

If a patient has an ECG with ST elevation or new or presumably bundle branch block, what is this indicative of?

A

This is strongly suspicious for cardiac injury

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19
Q

If a patient has an ECG with ST depression or T-wave inversion, what is this indicative of?

A

This is strongly suspicious for ischemia

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20
Q

What is an example of a nondiagnostic ECG?

A

Absence of changes in the ST segment or T waves

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21
Q

What is a common cause of impaired conduction in the heart?

A

A full-thickness infarct

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22
Q

What are Q waves indicative of?

A

Q waves are indicative of severe damage with conduction issues

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23
Q

Describe the Q wave of normal ECG

A

The Q wave will be small

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24
Q

Describe the R wave of normal ECG

A

High R

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25
Q

Describe the ST segment of a stage 1 fresh infarct (acute stage)

A

Marked ST elevation

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26
Q

Describe the ST elevation of an intermediate-stage infarct

A

Slight ST elevation

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27
Q

Describe the T Wave of an intermediate-stage infarct

A

T wave inverted

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28
Q

Describe the T Wave of an intermediate-stage infarct

A

T wave inverted

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29
Q

Describe the Q Wave of an intermediate-stage infarct

A

Large Q

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30
Q

Describe the Q Wave of an intermediate-stage infarct

A

Large Q

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31
Q

Describe the T wave of a stage 1 fresh infarct (acute stage)

A

T positive

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32
Q

Describe the R Wave of an intermediate-stage infarct

A

Small R

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33
Q

Describe the T wave of a stage 1 fresh infarct (acute stage)

A

T positive

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34
Q

Describe the R wave of a stage 1 fresh infarct (acute stage)

A

Small R

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35
Q

Describe the Q wave of a stage 1 fresh infarct (acute stage)

A

Q still small

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36
Q

Describe the ST segment of a normal ECG

A

ST isoelectric

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37
Q

Describe the T wave of a normal ECG

A

The T wave will be upright (positive)

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38
Q

What are the 4 features of a normal ECG?

A
  • Small Q
  • High R
  • ST isoelectric
  • T upright
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39
Q

Describe the features of an ECG indicative of a stage 1 fresh infarct (acute stage)

A
  1. Marked ST elevation
  2. T positive
  3. Small R
  4. Q still small
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40
Q

Describe the features of an ECG showing an intermediate-stage infarct

A
  • Slight ST elevation
  • T wave inverted
  • Large Q
  • Small R
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41
Q

Describe the T wave of an ECG indicative of a stage 2 old infarct (chronic stage)

A

T wave inverted

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42
Q

Describe the Q wave of an ECG indicative of a stage 2 old infarct (chronic stage)

A

Large Q

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43
Q

Describe the features of an ECG indicative of a stage 2 old infarct (chronic stage)

A
  • T wave inverted
  • Large Q
  • R still small
  • No ST elevation
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44
Q

Describe the features of an ECG indicative of a stage 2 old infarct (chronic stage)

A
  • T wave inverted
  • Large Q
  • R still small
  • No ST elevation
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45
Q

Describe the features of an ECG indicative of a stage 2 old infarct (chronic stage)

A
  • T wave inverted
  • Large Q
  • R still small
  • No ST elevation
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46
Q

Describe the R wave of an ECG indicative of a stage 2 old infarct (chronic stage)

A

R still small

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47
Q

Describe the ST segment of an ECG indicative of a stage 2 old infarct (chronic stage)

A

No ST elevation

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48
Q

Describe the features of an ECG indicative of a stage 2 old infarct (chronic stage)

A
  • T wave inverted
  • Large Q
  • R still small
  • No ST elevation
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49
Q

Describe the Q wave of an ECG indicative of a stage 3 old infarct (chronic stage)?

A

Q still pathological

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50
Q

Describe the T wave of an ECG indicative of a stage 3 old infarct (chronic stage)?

A

T now positive

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51
Q

Describe the R wave of an ECG indicative of a stage 3 old infarct (chronic stage)?

A

Normal R

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52
Q

Describe the ST segment of an ECG indicative of a stage 3 old infarct (chronic stage)?

A

No ST elevation

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53
Q

How long after the onset of chest pain does it typically take for troponin to be elevated?

A

6 hours

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54
Q

What are 4 features of an ECG indicative of a stage 3 old infarct (chronic stage)?

A
  1. Q still pathological
  2. T now positive
  3. Normal R
  4. No ST elevation
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55
Q

What are 6 factors that would describe the ideal cardiac marker?

A
  • Detectable while damage reversible or preventable
  • Cheap
  • Rapidly measured
  • Predicts prognosis
  • Correlates with amount of injury
  • detects only cardiac damage
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56
Q

What are 3 markers indicative of cardiac necrosis?

A
  1. CKMB
  2. Cardiac troponins
  3. Myoglobin
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57
Q

What are 3 markers indicative of cardiac necrosis?

A
  1. CKMB
  2. Cardiac troponins
  3. Myoglobin
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58
Q

How long after the onset of chest pain does it typically take for troponin to be elevated?

A

6 hours

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59
Q

What are 3 markers indicative of cardiac necrosis?

A
  1. CKMB
  2. Cardiac troponins
  3. Myoglobin
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60
Q

Describe the use of myoglobin as a cardiac marker

A

It is highly sensitive, but it is not specific.

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61
Q

What was the first biochemical marker used to detect cardiac damage?

A

AST

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62
Q

What is an elevated AST, associated with elevated creatine kinase and lactate dehydrogenase (LDH) indicative of?

A

Cardiac damage

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63
Q

What is the benefit of CKMB compared to creatine kinase?

A

It is more specific for the heart

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64
Q

What determines the sensitivity of cardiac markers?

A

Cardiac markers are released in response to cell death. Contents leak dependent on size and solubility. Contents with smaller size and greater solubility will be released first.

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65
Q

What is the order of release of AST, creatine kinase and lactate dehydrogenase (LDH) following a myocardial infarction?

A
  1. Creatine kinase
  2. AST
  3. Lactate dehydrogenase (LDH)
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66
Q

Where is CK-BB (CK1) primarily found?

A

In the brain, but also in the prostate and gastrointestinal tract

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67
Q

Where is CK-MB (CK2) primarily found?

A

In cardiac and skeletal muscles

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68
Q

What creatine kinase level is indicative of mild rhabdomyolysis?

A

1,000-5,000 U/L

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69
Q

Where is CK-MM (CK3) primarily found?

A

In muscular injury

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70
Q

What is the clinical significance of mild rhabdomyolysis (CK 1,000-5,000 U/L)?

A

Low risk for kidney injury

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71
Q

Describe the effect of gender on creatine kinase

A

As males typically have greater muscle mass, they have the potential for their creatine kinase to raise higher

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72
Q

Describe the effect of age on creatine kinase

A

As muscle mass decreases with age, creatine kinase will not rise as sharply in older patients

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73
Q

What is a normal creatine kinase level?

A

~40-200 U/L

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74
Q

Is treatment needed for mild rhabdomyolysis (CK 1,000-5,000 U/L)?

A

Possibly, depending on the context

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75
Q

What is the clinical significance of mild rhabdomyolysis (CK 1,000-5,000 U/L)?

A

Low risk for kidney injury

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76
Q

What creatine kinase level is indicative of mild rhabdomyolysis?

A

1,000-5,000 U/L

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77
Q

What is the clinical significance of mild rhabdomyolysis (CK 1,000-5,000 U/L)?

A

Low risk for kidney injury

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78
Q

How long after an acute myocardial infarction does myoglobin begin to rise?

A

1 to 3 hours

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79
Q

Is treatment needed for mild rhabdomyolysis (CK 1,000-5,000 U/L)?

A

Possibly, depending on the context

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80
Q

What creatine kinase level is indicative of moderate rhabdomyolysis?

A

5,000-15,000 U/L

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81
Q

What creatine kinase level is indicative of moderate rhabdomyolysis?

A

5,000-15,000 U/L

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82
Q

How long after an acute myocardial infarction does myoglobin peak?

A

4 to 6 hours

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83
Q

How long after an acute myocardial infarction does myoglobin peak?

A

4 to 6 hours

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84
Q

What is the clinical significance of moderate rhabdomyolysis (CK 5,000-15,000 U/L)?

A

Increased risk of kidney injury

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85
Q

How long after an acute myocardial infarction does CK-MB (CK2) begin to rise?

A

2 to 3 hours

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86
Q

How long after an acute myocardial infarction does CK-MB (CK2) begin to rise?

A

2 to 3 hours

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87
Q

How long after an acute myocardial infarction does total creatine kinase peak?

A

8 to 36 hours

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88
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

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89
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

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90
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms peak?

A

4 to 8 hours

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91
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms peak?

A

4 to 8 hours

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92
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms peak?

A

4 to 8 hours

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93
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms begin to rise?

A

1 to 6 hours

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94
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms begin to rise?

A

1 to 6 hours

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95
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

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96
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms begin to rise?

A

1 to 6 hours

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97
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

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98
Q

How long after an acute myocardial infarction does myoglobin peak?

A

4 to 6 hours

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99
Q

How long after a cardiac event does cTnT reach peak concentrations?

A

12 to 48 hours

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100
Q

How long after a cardiac event does cTnT reach peak concentrations?

A

12 to 48 hours

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101
Q

How long after a cardiac event does cTnT reach peak concentrations?

A

12 to 48 hours

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102
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms peak?

A

4 to 8 hours

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103
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms begin to rise?

A

1 to 6 hours

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104
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms return to normal?

A

1 to 4 days

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105
Q

How long after a cardiac event does cTnT reach peak concentrations?

A

12 to 48 hours

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106
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

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107
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms begin to rise?

A

1 to 6 hours

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108
Q

How long after a cardiac event does cTnT reach peak concentrations?

A

12 to 48 hours

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109
Q

What is cardiac-specific troponin (cTn)?

A

A heteromeric protein complex located along the thin filaments of myofibrils

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110
Q

Which has the largest molecular weight: cTnT or cTnI?

A

CTnT

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111
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms peak?

A

4 to 8 hours

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112
Q

How long after a cardiac event is cTnI first detected?

A

1 to 12 hours

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113
Q

Is treatment needed for moderate rhabdomyolysis (CK 5,000-15,000 U/L)?

A

Yes

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114
Q

How long after a cardiac event does cTnT reach peak concentrations?

A

12 to 48 hours

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115
Q

What is cardiac-specific troponin (cTn)?

A

A heteromeric protein complex located along the thin filaments of myofibrils

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116
Q

What is cardiac-specific troponin (cTn)?

A

A heteromeric protein complex located along the thin filaments of myofibrils

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117
Q

Describe the cTnT and cTnI content of the myocardium

A

The cTnT content per gram of myocardium is roughly twice that of cTnI

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118
Q

What is cardiac-specific troponin (cTn)?

A

A heteromeric protein complex located along the thin filaments of myofibrils

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119
Q

What is cardiac-specific troponin (cTn)?

A

A heteromeric protein complex located along the thin filaments of myofibrils

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120
Q

What are 8 non-myocardial infarction causes of elevated troponins?

A
  1. congestive heart failure
  2. chronic kidney disease
  3. cardiac infections/sepsis
  4. pulmonary embolisms
  5. ventricular tachycardia
  6. hypoxaemia
  7. hypotension/shock
  8. anaemia
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121
Q

What are 8 non-myocardial infarction causes of elevated troponins?

A
  1. congestive heart failure
  2. chronic kidney disease
  3. cardiac infections/sepsis
  4. pulmonary embolisms
  5. ventricular tachycardia
  6. hypoxaemia
  7. hypotension/shock
  8. anaemia
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122
Q

What are 8 non-myocardial infarction causes of elevated troponins?

A
  1. congestive heart failure
  2. chronic kidney disease
  3. cardiac infections/sepsis
  4. pulmonary embolisms
  5. ventricular tachycardia
  6. hypoxaemia
  7. hypotension/shock
  8. anaemia
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123
Q

What are 8 non-myocardial infarction causes of elevated troponins?

A
  1. congestive heart failure
  2. chronic kidney disease
  3. cardiac infections/sepsis
  4. pulmonary embolisms
  5. ventricular tachycardia
  6. hypoxaemia
  7. hypotension/shock
  8. anaemia
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124
Q

What is cardiac-specific troponin (cTn)?

A

A heteromeric protein complex located along the thin filaments of myofibrils

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125
Q

How long after a cardiac event does cTnT reach peak concentrations?

A

12 to 48 hours

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126
Q

What is cardiac-specific troponin (cTn)?

A

A heteromeric protein complex located along the thin filaments of myofibrils

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127
Q

What is cardiac-specific troponin (cTn)?

A

A heteromeric protein complex located along the thin filaments of myofibrils

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128
Q

How long after a cardiac event is cTnI cleared from the plasma?

A

10 days

129
Q

How long after a cardiac event is cTnI cleared from the plasma?

A

10 days

130
Q

How long after a cardiac event is cTnI cleared from the plasma?

A

10 days

131
Q

How long after an acute myocardial infarction does total creatine kinase peak?

A

8 to 36 hours

132
Q

What are the 3 distinct gene products of cardiac-specific troponin (cTn)?

A
  1. cardiac-specific troponin C (cTnC)
  2. cardiac-specific troponin T (cTnT)
  3. cardiac-specific troponin I (cTnI)
133
Q

How long after a cardiac event is cTnT first detected?

A

1 to 12 hours

134
Q

How long after a cardiac event is cTnT first detected?

A

1 to 12 hours

135
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms begin to rise?

A

1 to 6 hours

136
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms begin to rise?

A

1 to 6 hours

137
Q

How long after an acute myocardial infarction does total creatine kinase return to normal?

A

1 to 2 days

138
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

139
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

140
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

141
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

142
Q

How long after an acute myocardial infarction does myoglobin peak?

A

4 to 6 hours

143
Q

How long after an acute myocardial infarction does CK-MB (CK2) return to normal?

A

1 to 2 days

144
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

145
Q

What creatine kinase level is indicative of severe rhabdomyolysis?

A

> 15,000 U/L

146
Q

What is the clinical significance of severe rhabdomyolysis (CK >15,000 U/L)?

A

Increased risk of dialysis

147
Q

Is treatment needed for severe rhabdomyolysis (CK > 15,000 U/L)?

A

Yes

148
Q

What must you remember about troponins when giving thrombolysis?

A

Successful thrombolysis will lead to a higher, faster peak in troponins as you will have unblocked the occluding thrombus

149
Q

How long after an acute myocardial infarction does myoglobin begin to rise?

A

1 to 3 hours

150
Q

How long after an acute myocardial infarction does CK-MB (CK2) begin to rise?

A

2 to 3 hours

151
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms begin to rise?

A

1 to 6 hours

152
Q

How long after an acute myocardial infarction does CK-MB (CK2) begin to rise?

A

2 to 3 hours

153
Q

How long after a cardiac event is cTnT first detected?

A

1 to 12 hours

154
Q

How long after an acute myocardial infarction does myoglobin peak?

A

4 to 6 hours

155
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

156
Q

How long after an acute myocardial infarction does myoglobin peak?

A

4 to 6 hours

157
Q

How long after an acute myocardial infarction does total creatine kinase begin to rise?

A

4 to 6 hours

158
Q

How long after an acute myocardial infarction does myoglobin peak?

A

4 to 6 hours

159
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms peak?

A

4 to 8 hours

160
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms peak?

A

4 to 8 hours

161
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms peak?

A

4 to 8 hours

162
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

163
Q

How long after an acute myocardial infarction does total creatine kinase peak?

A

8 to 36 hours

164
Q

How long after a cardiac event is cTnT cleared from the plasma?

A

14 days

165
Q

How long after an acute myocardial infarction does total creatine kinase peak?

A

8 to 36 hours

166
Q

How long after an acute myocardial infarction does myoglobin return to normal?

A

1 day

167
Q

How long after an acute myocardial infarction do CK-MB (CK2) isoforms return to normal?

A

1 to 4 days

168
Q

How long after an acute myocardial infarction does CK-MB (CK2) return to normal?

A

1 to 2 days

169
Q

How long after an acute myocardial infarction does total creatine kinase return to normal?

A

1 to 2 days

170
Q

How long after a cardiac event is cTnT cleared from the plasma?

A

14 days

171
Q

Which has the largest molecular weight: cTnT or cTnI?

A

CTnT

172
Q

How long after a cardiac event is cTnT first detected?

A

1 to 12 hours

173
Q

How long after a cardiac event is cTnT cleared from the plasma?

A

14 days

174
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

175
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

176
Q

Describe the forms of cTn in the body

A

CTn circulates in various forms and complexes

177
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

178
Q

In an acute myocardial infarction, after how long will CK-MB Isoforms peak?

A

4 to 8 hours

179
Q

Describe the site of release of cTnT and cTnI

A

Both are primarily released from structural proteins

180
Q

How long after a cardiac event is cTnT first detected?

A

1 to 12 hours

181
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

182
Q

How long after a cardiac event does cTnT reach peak concentrations?

A

12 to 48 hours

183
Q

How long after a cardiac event is cTnI first detected?

A

1 to 12 hours

184
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

185
Q

How long after a cardiac event does cTnT reach peak concentrations?

A

12 to 48 hours

186
Q

Describe the usual activity of cardiac-specific troponin C (cTnC) in the body

A

Cardiac-specific troponin C (cTnC) binds calcium

187
Q

How long after a cardiac event does cTnI reach peak concentrations?

A

24 hours

188
Q

How long after a cardiac event is cTnT cleared from the plasma?

A

14 days

189
Q

How long after a cardiac event is cTnI cleared from the plasma?

A

10 days

190
Q

Describe the cTnT and cTnI content of the myocardium

A

The cTnT content per gram of myocardium is roughly twice that of cTnI

191
Q

Describe the forms of cTn in the body

A

CTn circulates in various forms and complexes

192
Q

Describe the usual activity of cardiac-specific troponin I (cTnI) in the body

A

cTnI inhibits actomyosin ATPase

193
Q

What is cardiac-specific troponin (cTn)?

A

A heteromeric protein complex located along the thin filaments of myofibrils

194
Q

What are the 3 distinct gene products of cardiac-specific troponin (cTn)?

A
  1. cardiac-specific troponin C (cTnC)
  2. cardiac-specific troponin T (cTnT)
  3. cardiac-specific troponin I (cTnI)
195
Q

Describe the usual activity of cardiac-specific troponin C (cTnC) in the body

A

Cardiac-specific troponin C (cTnC) binds calcium

196
Q

Describe the usual activity of cardiac-specific troponin T (cTnT) in the body

A

cTnT attaches to tropomyosin on thin filaments

197
Q

Describe the usual activity of cardiac-specific troponin T (cTnT) in the body

A

cTnT attaches to tropomyosin on thin filaments

198
Q

Describe the usual activity of cardiac-specific troponin I (cTnI) in the body

A

cTnI inhibits actomyosin ATPase

199
Q

Describe the usual activity of cardiac-specific troponin I (cTnI) in the body

A

cTnI inhibits actomyosin ATPase

200
Q

Describe the usual activity of cardiac-specific troponin I (cTnI) in the body

A

cTnI inhibits actomyosin ATPase

201
Q

Describe the usual activity of cardiac-specific troponin I (cTnI) in the body

A

cTnI inhibits actomyosin ATPase

202
Q

What is currently the earliest marker of heart damage?

A

Myoglobin

203
Q

What is a limitation of myoglobin as a cardiac marker?

A

It is not cardio-specific

204
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in males in Australia (depending on the assay used)?

A

26 ng/L

205
Q

Which is more sensitive: myoglobin or troponins?

A

Myoglobin

206
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in females in Australia (depending on the assay used)?

A

16 ng/L

207
Q

Which is more specific to heart tissue: myoglobin or troponins?

A

Troponins

208
Q

What are the kinetics of troponins comparable with?

A

Total CK and CK-MB

209
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in males in Australia (depending on the assay used)?

A

26 ng/L

210
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in females in Australia (depending on the assay used)?

A

16 ng/L

211
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in females in Australia (depending on the assay used)?

A

16 ng/L

212
Q

Are troponins cardio-specific?

A

Yes

213
Q

How can we apply the knowledge that myoglobin is very sensitive but not specific to practice?

A

If myoglobin is negative, it is unlikely there has been any cardiac damage

214
Q

Can troponins be elevated due to non-myocardial infarction causes?

A

Yes, but not as high

215
Q

What are 8 non-myocardial infarction causes of elevated troponins?

A
  1. congestive heart failure
  2. chronic kidney disease
  3. cardiac infections/sepsis
  4. pulmonary embolisms
  5. ventricular tachycardia
  6. hypoxaemia
  7. hypotension/shock
  8. anaemia
216
Q

How high may cardiac-specific troponin T (cTnT) be in myocarditis and/or a very large acute myocardial infarction?

A

Over 10,000

217
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in females in Australia (depending on the assay used)?

A

16 ng/L

218
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in males in Australia (depending on the assay used)?

A

26 ng/L

219
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in males in Australia (depending on the assay used)?

A

26 ng/L

220
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in males in Australia (depending on the assay used)?

A

26 ng/L

221
Q

In an acute myocardial infarction, after how long will CK-MB begin to rise?

A

2 to 3 hours

222
Q

What is the 99th percentile used for cardiac-specific troponin I (cTnI) in females in Australia (depending on the assay used)?

A

16 ng/L

223
Q

What is the 99th percentile used for cardiac-specific troponin T (cTnT) in males in Australia (depending on the assay used)?

A

15.5 ng/L

224
Q

What is the 99th percentile used for cardiac-specific troponin T (cTnT) in females in Australia (depending on the assay used)?

A

9 ng/L

225
Q

If the first troponin sample is negative, when should the second sample be taken?

A

3 hours after presentation and at least 6 hours after the onset of symptoms

226
Q

If Troponin is repeated within 24 hours, the report will show what 3 things?

A
  1. The time since the last Troponin
  2. The change in Troponin concentration
  3. The Z-score to indicate whether the change is significant
227
Q

What is the 99th percentile used for cardiac-specific troponin T (cTnT) in females in Australia (depending on the assay used)?

A

9 ng/L

228
Q

In an acute myocardial infarction, after how long will myoglobin begin to peak?

A

4 to 6 hours

229
Q

Describe the magnitude of troponin elevation in STEMIs vs NSTEMIs

A

The patterns are similar, but the magnitude is far greater with STEMIs

230
Q

If Troponin is repeated within 24 hours, the report will show what 3 things?

A
  1. The time since the last Troponin
  2. The change in Troponin concentration
  3. The Z-score to indicate whether the change is significant
231
Q

How does a Z score for cardiac troponins indicate whether the change is significant?

A

Z-score > ± 2.0 indicates a 95% likelihood the change is significant. Z-score > ± 3.0 indicates a 99% likelihood the change is significant

232
Q

What are 2 instances where Z scores for cardiac troponins will be flagged as abnormal?

A
  1. Serum Troponin >10 ng/L in a woman or >20 ng/L in a man
  2. The Z-score for serial tests is > ± 2.0
233
Q

What must you always do with a troponin sample to be able to best assess it?

A

Take repeat samples to evaluate the trends

234
Q

If the first troponin sample is negative, when should the second sample be taken?

A

3 hours after presentation and at least 6 hours after the onset of symptoms

235
Q

In an acute myocardial infarction, after how long will CK-MB Isoforms peak?

A

4 to 8 hours

236
Q

If the first troponin is positive, and the second is also positive, what does this suggest?

A

If there has been significant change, this is suggestive of an acute myocardial infarction, but if there has been no significant change, this is generally due to other causes of chronic troponin elevation

237
Q

In an acute myocardial infarction, after how long will CK-MB Isoforms peak?

A

4 to 8 hours

238
Q

In an acute myocardial infarction, after how long will CK-MB Isoforms begin to rise?

A

1 to 6 hours

239
Q

If the first troponin sample is positive, when should the second sample be taken?

A

At least 6 hours after presentation

240
Q

If the first troponin is negative, and the second is also negative, what does this suggest?

A

Myocardial infarction is unlikely

241
Q

If the first troponin is negative, but the second is positive, what does this suggest?

A

Myocardial infarction is likely

242
Q

If the first troponin is positive, and the second is also positive, what does this suggest?

A

If there has been significant change, this is suggestive of an acute myocardial infarction, but if there has been no significant change, this is generally due to other causes of chronic troponin elevation

243
Q

In an acute myocardial infarction, after how long will Troponin I begin to rise?

A

4 to 6 hours

244
Q

Describe the difference in magnitude of troponin elevation in myocarditis and acute myocardial infarction

A

The troponin elevation in acute myocardial infarction is significantly greater than in myocarditis

245
Q

In an acute myocardial infarction, after how long will myoglobin begin to rise?

A

1 to 3 hours

246
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

247
Q

In an acute myocardial infarction, after how long will myoglobin begin to peak?

A

4 to 6 hours

248
Q

In an acute myocardial infarction, after how long will myoglobin begin to return to normal?

A

1 day

249
Q

In an acute myocardial infarction, after how long will CK-MB Isoforms begin to rise?

A

1 to 6 hours

250
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

251
Q

In an acute myocardial infarction, after how long will Troponin I begin to rise?

A

4 to 6 hours

252
Q

In an acute myocardial infarction, after how long will Troponin T begin to rise?

A

3 to 4 hours

253
Q

In an acute myocardial infarction, after how long will CK-MB Isoforms peak?

A

4 to 8 hours

254
Q

In an acute myocardial infarction, after how long will CK-MB Isoforms return to normal?

A

1 to 4 days

255
Q

In an acute myocardial infarction, after how long will Troponin T begin to rise?

A

3 to 4 hours

256
Q

In an acute myocardial infarction, after how long will CK (Total) begin to rise?

A

4 to 6 hours

257
Q

What are 6 forms of cTn in the body?

A
  1. Free cTn
  2. I-C binary
  3. T-I-C tertiary complexes
  4. Oxidised forms
  5. Reduced forms
  6. Phosphorylated forms
258
Q

In an acute myocardial infarction, after how long will CK-MB begin to rise?

A

2 to 3 hours

259
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

260
Q

In an acute myocardial infarction, after how long will Troponin I begin to rise?

A

4 to 6 hours

261
Q

In an acute myocardial infarction, after how long will Troponin I begin to rise?

A

4 to 6 hours

262
Q

In an acute myocardial infarction, after how long will Troponin T begin to rise?

A

3 to 4 hours

263
Q

In an acute myocardial infarction, after how long will Troponin T begin to rise?

A

3 to 4 hours

264
Q

How long after an acute myocardial infarction does CK-MB (CK2) peak?

A

10 to 24 hours

265
Q

In an acute myocardial infarction, after how long will CK-MB return to normal?

A

1 to 2 days

266
Q

What are 6 forms of cTn in the body?

A
  1. Free cTn
  2. I-C binary
  3. T-I-C tertiary complexes
  4. Oxidised forms
  5. Reduced forms
  6. Phosphorylated forms
267
Q

What is the secretion of B Natriuretic Polypeptide proportionate to?

A

It is secreted from the ventricles and atria in proportion to expansion/preload

268
Q

In an acute myocardial infarction, after how long will CK (Total) begin to rise?

A

4 to 6 hours

269
Q

In an acute myocardial infarction, after how long will Troponin I peak?

A

14 to 18 hours

270
Q

In an acute myocardial infarction, after how long will Troponin I peak?

A

14 to 18 hours

271
Q

In an acute myocardial infarction, after how long will Troponin I peak?

A

14 to 18 hours

272
Q

In an acute myocardial infarction, after how long will Troponin I peak?

A

14 to 18 hours

273
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

274
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

275
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

276
Q

In an acute myocardial infarction, after how long will Troponin I peak?

A

14 to 18 hours

277
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

278
Q

In an acute myocardial infarction, after how long will Troponin I return to normal?

A

3 to 6 days

279
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

280
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

281
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

282
Q

In an acute myocardial infarction, after how long will Troponin T begin to rise?

A

3 to 4 hours

283
Q

In an acute myocardial infarction, after how long will Troponin T return to normal?

A

10 days

284
Q

In an acute myocardial infarction, after how long will Troponin T return to normal?

A

10 days

285
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

286
Q

What is B Natriuretic Polypeptide?

A

A hormone-like substance released into bloodstream with cardiac chamber distention

287
Q

What is B Natriuretic Polypeptide?

A

A hormone-like substance released into bloodstream with cardiac chamber distention

288
Q

In an acute myocardial infarction, after how long will CK (Total) peak?

A

8 to 36 hours

289
Q

What is the turnaround time for a B Natriuretic Polypeptide assay?

A

20 - 30 minutes

290
Q

In an acute myocardial infarction, after how long will Troponin T begin to rise?

A

3 to 4 hours

291
Q

What are 6 forms of cTn in the body?

A
  1. Free cTn
  2. I-C binary
  3. T-I-C tertiary complexes
  4. Oxidised forms
  5. Reduced forms
  6. Phosphorylated forms
292
Q

In an acute myocardial infarction, after how long will Troponin I begin to rise?

A

4 to 6 hours

293
Q

In an acute myocardial infarction, after how long will Troponin I begin to rise?

A

4 to 6 hours

294
Q

In an acute myocardial infarction, after how long will CK (Total) return to normal?

A

1 to 2 days

295
Q

In an acute myocardial infarction, after how long will Troponin I begin to rise?

A

4 to 6 hours

296
Q

What are 6 forms of cTn in the body?

A
  1. Free cTn
  2. I-C binary
  3. T-I-C tertiary complexes
  4. Oxidised forms
  5. Reduced forms
  6. Phosphorylated forms
297
Q

In an acute myocardial infarction, after how long will Troponin I peak?

A

14 to 18 hours

298
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

299
Q

In an acute myocardial infarction, after how long will Troponin I return to normal?

A

3 to 6 days

300
Q

In an acute myocardial infarction, after how long will Troponin T begin to rise?

A

3 to 4 hours

301
Q

In an acute myocardial infarction, after how long will Troponin T return to normal?

A

10 days

302
Q

In an acute myocardial infarction, after how long will Troponin T peak?

A

18 to 24 hours

303
Q

In an acute myocardial infarction, after how long will Troponin T return to normal?

A

10 days

304
Q

Are all acute coronary syndromes myocardial infarctions?

A

No (think unstable angina)

305
Q

What is B Natriuretic Polypeptide?

A

A hormone-like substance released into bloodstream with cardiac chamber distention

306
Q

What is B Natriuretic Polypeptide?

A

A hormone-like substance released into bloodstream with cardiac chamber distention

307
Q

What is B Natriuretic Polypeptide?

A

A hormone-like substance released into bloodstream with cardiac chamber distention

308
Q

What is the secretion of B Natriuretic Polypeptide proportionate to?

A

It is secreted from the ventricles and atria in proportion to expansion/preload

309
Q

What is the main role of B Natriuretic Polypeptide in practice?

A

B Natriuretic Polypeptide has a strong negative predictive value – if they are not elevated, it is unlikely to be heart failure

310
Q

Describe a correlation between B Natriuretic Polypeptide and the symptoms of congestive heart failure.

A

B Natriuretic Polypeptide levels are increased in dyspnoea associated with congestive heart failure

311
Q

Describe a correlation between B Natriuretic Polypeptide and the symptoms of congestive heart failure.

A

B Natriuretic Polypeptide levels are increased in dyspnoea associated with congestive heart failure

312
Q

What is the relationship between B Natriuretic Polypeptide and the class of congestive heart failure?

A

The degree or class of congestive heart failure correlates with B Natriuretic Polypeptide level

313
Q

Describe the relevance of low B Natriuretic Polypeptide levels as a prognostic marker

A

Low B Natriuretic Polypeptide levels have a strong negative predictive value for re-admission

314
Q

Describe the relevance of low B Natriuretic Polypeptide levels as a prognostic marker

A

Low B Natriuretic Polypeptide levels have a strong negative predictive value for re-admission

315
Q

What is the role of B Natriuretic Polypeptide levels post myocardial infarction?

A

Increased B Natriuretic Polypeptide at 48 hours post myocardial infarction is an independent variable for increased mortality

316
Q

What is the role of B Natriuretic Polypeptide levels post myocardial infarction?

A

Increased B Natriuretic Polypeptide at 48 hours post myocardial infarction is an independent variable for increased mortality

317
Q

What is the turnaround time for a B Natriuretic Polypeptide assay?

A

20 - 30 minutes

318
Q

What are 6 forms of cTn in the body?

A
  1. Free cTn
  2. I-C binary
  3. T-I-C tertiary complexes
  4. Oxidised forms
  5. Reduced forms
  6. Phosphorylated forms

Residency Exam (22 decks)

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