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Clinical Medicine LAB - Professor Sample > Cardiology Labs > Flashcards

Cardiology Labs Flashcards

1
Q

Myocardial Response

A

Loss of critical blood supply to the myocardium

Decreased ATP and increased lactate accumulation

Loss of contractility

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2
Q

Myoglobin indications?

A

Early evaluation of pts with suspected AMI

Also used for disease/injury of skeletal muscle

(< 90 mcg/L)

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3
Q

Myoglobin is an __ binding protein found in _______ and ________ muscle?

A

O2
cardiac
skeletal

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4
Q

Myoglobin is more sensitive than ___________ but it is not as specific.

A

phosphokinase isoenzymes (CPK)

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5
Q

Myoglobin can be found in _____ and can turn it ___.

A

urine
red

use a urine dip stick - its the myoglobin that is turning it positive

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6
Q

Decreased myoglobin levels ?

A

Polymyositis: pts have antimyoglobin ab

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7
Q

Increased myoglobin ?

A

1-3 hrs after MI - soon - elevation occurs first

Peaks 6-9 hours after muscle injury

Skeletal muscle inflammation/ischemia/trauma

Rhabdomyolysis - muscle wasting -
to much exercise

Prolonged seizure - skeletal muscle damage

cells in cardiac muscle or skeletall muscle lyse and release myoglobin

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8
Q

How much time until myoglobin peaks?

A

6-9 hrs after muscle `

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9
Q

Creatine Kinase (CK, CPK) normal Values males and females?

A

Male: 55-170 units/L
Female: 30-135 units/L

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10
Q

Creatine Kinase (CK, CPK) normal Values newborn?

A

68-580 units/L

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11
Q 
Creatine Kinase (CK, CPK)
Isoenzymes?
A

CK-MM: 100%
CK-MB: 0%
CK- BB: 0%

most of CK found in skeletal muscle

BB- brain
MM- muscle
MB - muscle brain - heart

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12
Q 
Creatine Kinase (CK, CPK)
indications?
A

Support the diagnosis of MI

Indicate neurologic damage

Indicates skeletal muscle disease

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13
Q

Hemorrhagic stroke patho?

A

Hemorrhage/blood leaks into brain tissue

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14
Q

Ischemic Stroke patho?

A

Clots stops blood supply to an area of the brain

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15
Q

CK levels rise when _____, _____, or ________ muscle is damaged?

A

brian
heart
skeletal

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16
Q

CK rises within _ hours?

A

6

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17
Q

CK peaks at __-__ hours?

A

18-24

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18
Q

CK normalized - days?

A

2-3

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19
Q

Interfering factors of CK?

A

IM injections

Strenuous exercise

Recent surgery

Large muscle mass - elevated
CK all the time

Drugs (ETOH, AC, ASA, Lasix,
Decadron, morphine)

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20
Q 
Creatine Kinase (CK, CPK)
increased when?
A

Any injury to heart, brain, or skeletal muscle

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21
Q

Increased CK-BB

A

Electroconvulsive therapy

Adenocarcinoma - they do not know why

Pulmonary infarction - small amount in lung tissue

Brain injury (CVA, hemorrhage, seizures, shock, brain cancer)

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22
Q

Increased CK- MB:

A

AMI/cardiac ischemia

Cardiac surgery/defibrillation

Myocarditis

Others: severe skeletal injury, lung injury, or renal failure

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23
Q

Increased CK- MM?

A 
Rhabdomyolysis
MD
Myositis
Skeletal trauma/surgery
IM injections
Myositis

skeletal muscle

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24
Q

Troponin T (cTnT) normal level?

A

<0.2 ng/mL

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25
Q

Troponin I (cTnT) normal level?

A

< 0.03 ng/mL

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26
Q

Troponin are proteins that exist within ________ and _______ muscle that regulate the _______ dependent part of muscle contraction

A

skeletal & cardiac

calcium

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27
Q

Which troponin binds to calcium?

A

Troponin C

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28
Q

What are the two troponin that are cardiac specific?

A

Troponin T & Troponin I

Troponin is so specificc that nothing else can really elevate it besides a MI

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29
Q

Disadvantage with troponin?

A

Falsely elevated in dialysis or renal failure patients

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30
Q

Advantages with troponin?

A

Highly specific to myocardial cell injury

Will be normal with non-cardiac muscle disease

Elevated sooner than CK (within 3 hours)

Remain elevated longer
T: 10-14 days
I: 7-10 days

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31
Q

How long does troponin T stay elevated for?

A

10-14 days

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32
Q

How long does troponin I stay elevated for?

A

7-10 days

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33
Q

Is troponin elevated sooner than CK?

A

Yes , troponin is elevated after 3 hours, CK takes 6 hours

34
Q

Indications for troponin?

A

Unstable angina

Detection of reperfusion after recanalization

Estimation of MI size - troponin will be higher if more damage

Detection of perioperative MI

Evaluate severity of PE - b/c ischemia

Evaluate severity of CHF - damage to the ventricles from continuous heart strain

35
Q

When is troponin increased?

A

MI

Myocardial injury

36
Q

LDH ( lactic dehydrogenase) normal levels?

A

Adult: 100-190 units/L

37
Q

LDH isoenzyme 1?

A

herat, RBC

38
Q

LDH 2?

A

heart lung, reticuloendothelial system

39
Q

LDH 3?

A

lung

40
Q

LDH 4?

A

kidney, pancreas, placenta

41
Q

LDH 5?

A

skeletal muscle, liver

42
Q

When do we see a flipped LDH?

A

when someone is having a HA, LDH 1 is more sensitive and rises above LDH 2 ( usually LDH 2 is grater than LDH 1)

43
Q

A total LDH will include all the isoenzymes which will be ________ with a different process?

A

elevated

44
Q

LDH explanation?

A

During MI cells lyse and spill LDH into the blood stream

When LDH 1 rises above LDH 2 this indicates myocardial injury (“flipped LDH”)

Appears within 12-24 hours

45
Q

When does LDH start to appear?

A

12-24 hours

46
Q

Indications for LDH?

A 
Diagnosis of injury:
Heart 
Liver
RBCs
Kidneys
Skeletal muscle
Lungs
47
Q

What are some factors that interfere with LDH?

A

Hemolysis of blood

Strenuous exercise

Drugs:
Increase: ETOH, ASA, narcotics, procainamide
Decrease: ascorbic acid

48
Q

Drugs that increase LDH?

A

ETOH, ASA, narcotics, procainamide

49
Q

Drugs that decrease LDH?

A

ascorbic acid

50
Q

When will we see increased levels of LDH?

A

MI (LDH1 over LDH2)

Pulmonary disease (LDH 2 & 3)

Hepatic disease (LDH 5)

Skeletal muscle disease

Intestinal ischemia (LDH 5)

Neoplastic states - b/c the way they spread

Pancreatitis (LDH 4)

51
Q

Highly sensitive CRP normal levels with cardiac risk?

A

Cardiac Risk:

Low: <1.0 mg/L

Average: 1.0-3.0 mg/L

High: >3.0 mg/L

52
Q

Indications for hs-CRP?

A

Indicates inflammatory illness

Bacterial infections

used to look for maybe a smoldering infection - follow CRP during treatment and watch it tank if infection is going away - get a baseline

53
Q

When do we see increased levels of hs-CRP?

A

Inflammatory reactions

Collagen-vascular disease

Tissue infarction or damage

Bacterial infections

Malignant disease

Post-operative wound infections

Risk of cardiovascular events

54
Q

Interfering factors for hs-CRP?

A

Cigarette smoking (b/c body is responding to salt)

Medication (estrogens and progesterones)

HTN

Metabolic syndrome/ increased

BMI/DM

Chronic inflammatory conditions

55
Q

Decreased levels for hs-CRP?

A

Fibrates, niacins, statins

ETOH consumption

Endurance exercise

Weight loss

56
Q

CRP and cholesterol ratios?

A

High CRP but LOW LDL then still high chance of HA ( CRP trumps)

57
Q

Is hs-CRP used in acute MI?

A

NO

58
Q

Why is hs-CRP very non-specific?

A

elevated in anyone that has inflammation in the body

C-reactive protein

59
Q

Normal ESR (Erythrocyte Sedimentation Rate, Sed Rate) levels?

A

Male :< 15

Female: <20

60
Q

What does ESR measure?

A

measure the rate the RBC settle or sediment

is it important b/c if we have inflammation we have increased proteins and the RBC stack up faster

61
Q

Is ESR non specific?

A

Yes, like hs-CRP

62
Q

ESR explanation?

A

The rate at which RBCs settle in saline solution or plasma over a specific time period

Increase in protein (fibrinogen) content of plasma making them stack up on each other and increases weight causing them to fall faster

63
Q

Indications to us ESR?

A

Acute/chronic infection

Detect illnesses

Collagen-vascular disease

Advanced neoplasm

Tissue necrosis/infarction

64
Q

Interfering factors for ESR that cause it to decrease?

A

Specimen allowed to stand >3 hours

Drugs (ASA, cortisone, quinine)

Sickle Cell Anemia

Spherocytosis

65
Q

Interfering factors for ESR that cause it to increase?

A

Pregnancy - 2, 3 trimesters when uterus is more stretched

Menstruation

Increased proteins (Macroglobulinemia) - increased RBC content as well

Drugs (theophylline, vitamin A, OCP)

66
Q

True increased results for ESR?

A

Chronic renal failure

Malignant disease

Bacterial infections

Inflammatory disease

Necrotic diseases (MI)

Disease with increased
proteins

Severe anemias (lower RBC volumes) - Fe deficiency and 
Vit. B12 - because they have lower volumes cause lower hemoglobin content
67
Q

what is AST?

A

Aspartate Aminotransferase

68
Q

Normal AST levels?

A

0-35 units/L

69
Q

where is ALT mostly found?

A

liver

70
Q

AST is found in highly _________ tissue

A

metabolic

you can test AST 4 days out and it will still be elevated if you has an MI

71
Q

AST is related to MI and cardiac by?

A

Directly related to how many cells were affected by the injury

> 5x normal levels in MI - and especially when the ALT is not elevated

72
Q

BNP means?

A

Brain Natriuretic Peptide

misnomer - it is not in the brain - its a good marker for CHF cause it is an indicator of muscle wall stretch

73
Q

Normal BNP levels?

A

Normal : <100 pg/mL

74
Q

Critical BNP levels?

A

Critical value: >100 pg/mL

75
Q

Explanation in BNP?

A

Dilates blood vessels

Lowers BP

Responds to volume overload

Released in response to the stretch on the atria and ventricles

Correlates well to left ventricular pressure

early CHF we may not have dyspnea or edema cause the heart is compensating but we can still find an elevated BNP indicating a stretch of the right side of the heart but just has no effect yet case the heart is compensating

Late CHF the heart can no longer compensate so we get edema, and dyspnea and also an elevated BNP

76
Q

Interfering factors with BNP?

A

Higher in healthy women

Higher in older patients

Post-op cardiac surgery

77
Q

When will we see an elevated BNP?

A

CHF
MI
Systemic HTN
Heart transplant rejection

78
Q

AMA means?

A

Antimyocardial Antibody

79
Q

normal AMA is?

A

Negative

80
Q

when is AMA used?

A

Used to detect an autoimmune source of myocardial injury by using indirect immunofluorescence (IFA)

81
Q

When do we get increased AMA levels ?

A

RAC

Rheumatic heart disease - own body attacking tissue

After MI (Dresslers Syndrome) body can attack the damage cause by the MI- swelling and inflammation in pericardium it can also happen after surgery as well ( associated with infarction or trauma)

Cardiomyopathy - not sure why - but ABS are attacking heart tissue

Clinical Medicine LAB - Professor Sample (36 decks)

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