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Fall 2024 > Cardio Exam 1 CBL > Flashcards

Cardio Exam 1 CBL Flashcards

1
Q

What cardiac labs can be ordered?

A

Enzymes
- CK/CPK
- LDH
- Troponin T/I
- Glycogen phosphorylase isoenzyme BB
B-type natiuretic peptide (BNP)
CBC
Myoglobinemia/myoglobinuria

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2
Q

What is CK/CPK

A

Catalyses the conversion of creatine to create phosphocreatine and ADP

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3
Q

What are the three isoenzymes for CK/CPK

A

CK-MM: skeletal muscle
CK-MB: myocardium
CK-BB: brain

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4
Q

What are the normal CK/CPK values

A

60-400 IU/L

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5
Q

When are low levels of CK seen

A

Alcoholic liver disease
Rheumatoid disease

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6
Q

When are elevated CK levels seen

A

Muscle damage:
-rhabdo
-muscular dystrophy
-myositis
-malignant hyperthermia
-statin meds
Myocardial Infarction:
-peaks in 10-24 hours
-returns to normal in 2-3 days

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7
Q

What is LDH

A

Enzyme that catalyzes the conversion of pyruvate to lactate

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8
Q

Which is more specific, LDH or Troponin

A

Troponin

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9
Q

What are the 5 isoenzymes of LDH

A

LDH-1: heart and RBC’s*
LDH-2: Reiculoendothelial system (typically the predominant form)
LDH-3: Lungs
LDH-4: Kidneys, placenta, and pancreas
LDH-5: Liver and striated muscle

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10
Q

What is notable about LDH in MI

A

LDH-1 > LDH-2
Peaks in 3-4 days (72 hours)
Remain elevated for up to 10 days

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11
Q

What is notable about LDH in pleural effusion/pericardial effusion

A

Exudate: Ratio > 0.6 (Fluid LDH: Serum LDH)
Transudate: Ratio < 0.6

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12
Q

What is troponin

A

Most sensitive and specific test for myocardial damage; virtually undetectable in a healthy patient

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13
Q

What are the subtypes of troponin?

A

Troponin I
Troponin T
Troponin C
(I or T is measured, not both)

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14
Q

What does it mean if Troponin is elevated (cardiac)

A

Myocardial infarction
- released in 2-4 hours
- Peaks at 12 hours
- Remains elevated for up to 7 days
Severe tachycardia, heart failure, cardiomyopathy, defibrillation/cardioversion, cardiac surgery

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15
Q

What does it mean if troponin is elevated (non-cardiac)

A

Critical illness/sepsis (40%)
Chemotherapy agents
Toxins/Venoms
Pulmonary Embolism/Pulmonary HTN

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16
Q

What is myoglobin?

A

Iron and oxygen-binding protein in the muscle tissue; low specificity for MI and least used MI marker

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17
Q

What is the upside of myoglobin?

A

Responds the quickest - peaks in 2 hours
*also elevated in rhabdo

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18
Q

What is BNP - B-type natriuretic peptide

A

Secreted by the ventricle of the heart in response to excessive stretching of heart muscle

19
Q

What are the effects of BNP?

A

Decrease in cardiac output - decrease in SVR
Decrease in blood volume - increase in natiuresis

20
Q

What is BNP mostly used for?

A

Used in the diagnosis and screening of acute congestive heart failure (CHF)

21
Q

What is an interesting fact about BNP

A

It is what makes you feel like to have to pee after getting into a bathtub or a pool

22
Q

Why would you order a CBC if an MI is inspected

A

Rule out anemia which can decrease oxygen supply
Evaluate platelets if a thrombolytic is to be given if heparin was given recently

23
Q

What does a WBC count have to do with an MI

A

Leukocyte count may be normal initially, but increases within 2 hours and peaks in 2-4 days
May remain elevated for 1-2 weeks

24
Q

What is the AMA approved lipid panel used to evaluate the risk of coronary heart disease

A

LDL cholesterol
HDL cholesterol
Total cholesterol
Triglycerides

25
Q

When should lipids be ordered

A

Routine screening for most adults
High-risk for developing coronary heart disease will be ordered more frequently:
- Smoker
- FMHx of early heart disease
- HTN
- Age
- Low HDL

26
Q

Interpreting LDL cholesterol

A

<100: optimal
100-129: Above optimal
130-159: Borderline high
160-189: High
190+: Very high

27
Q

HDL Cholesterol interpretation

A

<40: low
>60: high

28
Q

Total cholesterol interpretation

A

<200: Desirable
200-239: Borderline high
>240: High

29
Q

Interpreting triglycerides

A

<150: normal
150-199: Borderline high
200-499: High
500+: very high

30
Q

What is an EKG

A

a transthoracic interpretation of the electrical activity of the heart over a period of time

31
Q

What are the indications of an EKG

A

Symptoms consistent with acute MI
Symptoms of PE
Complaint of heart palpitations
Murmur
Syncope
Seizure
Routine screening

32
Q

What leads evaluate lateral cardiac areas

A

I, aVL, V5 and V6

33
Q

What leads evaluate inferior cardiac areas

A

II, III, aVF

34
Q

What leads evaluate anterior cardiac areas

A

V3 and V4

35
Q

What leads evaluate septal cardiac areas

A

V1 and V2

36
Q

What does ST depression indicate

A

ischemia

37
Q

What does ST elevation in 2 similar leads indicate

A

Infarction

38
Q

What does diffuse ST elevation indicate

A

Pericarditis

39
Q

What does a QRS>0.12 indicate

A

bundle branch block

40
Q

What do peaked T waves indicate

A

hyperkalemia

41
Q

What do prominent U waves indicate

A

hypokalemia

42
Q

What are the contraindications for EKG

A

none

43
Q

What is a Holter monitor

A

A monitor used to detect at home cardiac arrhythmias
Records heart rhythm continuously for 24-48 hours

44
Q

What is an Event monitor

A

Smaller than a Holter and can be used for weeks
Does not continuously record heart activity, only records when symptoms occur and a button is pushed

Fall 2024 (34 decks)

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