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Clin Lab > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the 2 branches of the left coronary artery?

A
  • Anterior Descending Coronary Artery

- Left Circumflex Coronary Artery

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2
Q

What is the branch of the right coronary artery?

A

-Posterior Descending Coronary Artery

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3
Q

What does the Anterior Descending Coronary Artery supply?

A

-Anterior septum and left ventricle

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4
Q

What does the Left Circumflex Artery supply?

A

-Anterior and lateral aspects of the left ventricle

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5
Q

What does the posterior descending coronary artery supply

A

-Right ventricle and posterior part of left ventricle

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6
Q

This is tissue death with necrosis of the myocardium

A

Myocardial infarction

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7
Q

Characteristics of a STEMI

A
  • Transmural
  • Q wave
  • All layers of tissue die
  • BAD
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8
Q

Describe non-STEMI

A
  • Non Q wave
  • Subendocardial
  • Only the inner most layer dies
  • Not as extensive necrosis
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9
Q

The EKG changes after an infarct (like a tattoo)

A

STEMI

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10
Q

The full thickness of the heart is affected in….

A

STEMI

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11
Q

This layer is the furthest from the coronaries

A

Subendocardium

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12
Q

If you have a Non-STEMI, what does the EKG look like?

A

-You cannot tell if the patient ever had a MI

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13
Q

Describe the use of a EKG

A
  • Quick

- All electrical activity of 12 different leads

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14
Q

What happens to the Q wave after a STEMI

A

-You get a significant drop in Q wave

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15
Q

If a person is currently having a STEMI, what changes on the EKG?

A

ST elevation (goes away after the STEMI is done)

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16
Q

What changes to the EKG does ischemia cause?

A
  • ST depression

- T wave inversion

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17
Q

This is a very small protein that enters the blood very quickly, and it is also a muscle oxygen binding protein

A

Myoglobin

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18
Q

Within how many hours is myoglobin detectable?

A

2-4 hours

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19
Q

When does myoglobin peak?

A

8-12 hours

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20
Q

When do myoglobin levels return to normal after a MI?

A

24-30 hours

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21
Q

Describe the sensitivity and specificity of myoglobin

A
  • Very sensitive

- Not specific (because is high during any muscle injury- not specific to myocardial injury)

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22
Q

What is the percentage of patients that have abnormal lab tests when they are initially seen in the ER?

A

25-40%

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23
Q

T/F- Normal results should be used to decide whether to discharge a patient from the ER?

A

FALSEEEEEE

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24
Q

This is the major muscle enzyme

A

Creatinine Kinase

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25
Q

Is CK sensitive or specific?

A

SENSITIVE- due to a large amplitude of change

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26
Q

Describe CKs large amplitude of change

A

They can rise 6-12 times normal

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27
Q

What is the sensitivity rate of CK?

A

98%

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28
Q

Does CK have a high false positive rate?

A

Yes- because there are many causes of increased CK (any type of muscle injury)

29
Q

Where is CK found in high concentrations?

A

Brain and muscle

30
Q

What are CK levels related to?

A
  • Muscle mass

- Muscle activity

31
Q

Who has high levels of CK?

A
  • Males

- African Americans

32
Q

When are CK levels the highest?

A
  • Weight lifting
  • Endurance exercise
  • Contact sports
33
Q

Why is it different to create a reference range for CK?

A

-Wide range of normal CK values (compare the football player to your gramma)

34
Q

What are the 3 CK isoenzymes?

A
  • MM
  • MB
  • BB
35
Q

Where are CK BB enzyme found?

A
  • Brain
  • Prostate
  • Placenta
  • Fetal Tissue
36
Q

When are levels of CK BB high?

A

Stroke

37
Q

Where is CK MM found?

A

Skeletal muscle

38
Q

When is CK MM levels high?

A
  • Trauma

- Falls

39
Q

When are CK MB found?

A
  • Cardiac muscle
  • Primarily but not exclusively
  • Also associated with skeletal and respiratory muscles
40
Q

What are CK MB levels in a normal individual?

A

Less than 1% of normal CK

41
Q

What are CK MB levels in a patient with an MI?

A

Greater than 3% of the total CK in 99% of cases

42
Q

When do CK MB levels begin to rise after an MI

A

3-6 hours after the onset of a MI

43
Q

When do levels of CK MB peak after an MI?

A

12-24 hours after MI

44
Q

When do levels of CK MB return to normal after an MI?

A

24-48 hours

45
Q

Should you do 3 or more sequential samples for tests?

A

Yes- more frequent sampling is more likely to identify a peak value

46
Q

When should the first blood work sample be drawn from the patient?

A

Immediately at presentation

47
Q

How many hours should the subsequent tests be run apart?

A

6 hours during the first 24 hours

48
Q

How is the CK MB index calculated?

A

CK MB/total CK *100

49
Q

When is CK MB diagnostic of an MI?

A

If the CK MB index is greater than 3-4%

50
Q

When is the diagnosis of an acute MI confirmed? (hours)

A

Confirmed by 8-12 hrs

51
Q

Is sampling beyond 24 hours needed?

A

Not really- except to diagnose early reinfarction

52
Q

How should CK MB be recorded?

A

CK MB should be reported in unit as well as a percentage because of injury to both cardiac and skeletal muscle
-CK MB percentage/index may not be elevated

53
Q

This is the gold standard test for cardiac troponin

A

Cardiac troponin

54
Q

Describe cardiac troponin

A
  • Regulatory protein
  • Very little floating around at a given time
  • Small reference range
  • Very sensitive and specific
55
Q

T/F- Cardiac troponin isoforms are completely specific to the myocardium in adults

A

Cardiac troponin

56
Q

How does depolarization spread through the cell?

A

Through the T tubules

57
Q

Where is more calcium released from?

A

Sarcoplasmic reticulum

58
Q

When calcium rises, it binds to

A

Troponin C

59
Q

Once it binds to troponin C, it changes to the

A

troponin complex

60
Q

What happens when the tropomyosin is formed?

A

Causes tropomyosin to be moved out of the way allowing cross binding formation and effective cardiac muscle contraction

61
Q

How can you study troponin even though it is found in skeletal and cardiac muscle

A

-They are structurally different and can be measured separately by immunoassay

62
Q

Why is troponin highly sensitive?

A

The plasma ratio is much higher than for enzymes or myoglobin

63
Q

Is cardiac troponin effected by muscle injury?

A

NOPPPPEEEEEE KIDDDDOOOOO

64
Q

What is the more important measurement of troponin? (Rate of change or the value)

A

Rate of change

65
Q

How many hours after an acute event do cardiac troponin levels rise?

A

4-6 hours

66
Q

When does troponin peak?

A

12 hours

67
Q

How many days can troponin levels be elevated?

A

7-10 days

68
Q

What is 1 pro and 1 con to a long duration of troponin?

A
  • Provides a longer diagnostic window

- Difficult to recognize reinfarction

Clin Lab (23 decks)

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