Cardiology Labs (EXAM 4) Flashcards

1
Q

What is included in a lipid profile?

A

Total cholesterol, triglycerides, HDL, and LDL.

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2
Q

HDL and LDL. Which is good and which is bad?

A

LDL is bad. Think L should be Low.

HDL is good. Think H healthy, you want it high.

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3
Q

Should lipid profile be collected fasting or non fasting?

A

9-12 hour fasting.

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4
Q

What is cholesterol used for?

A

Structural component of cell wall membranes.

Precursor to steroid hormones and bile acids.

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5
Q

Is the majority of cholesterol dietary or synthesized?

A

90% is synthesized by the liver.

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6
Q

Goal cholesterol.

A

<200mg/dl

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7
Q

What are risks of hyperlipidemia?

A

Cardiovascular diseases such as coronary artery disease and peripheral vascular disease

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8
Q

Does pregnancy increase or decrease cholesterol?

A

Increase

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9
Q

What are chylomicrons?

A

A subset of triglycerides that are a marker for dietary fat intake and exogenous triglyceride.

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10
Q

Goal triglycerides

A

<150 mg/dl

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11
Q

T/F? You are not at risk for coronary artery disease if you have normal LDL, HDL, and cholesterol, but have high triglycerides.

A

False! Triglyceride elevations alone are an independent risk factor for coronary artery disease.

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12
Q

Goal HDL (high density lipoprotein)

A

> 60mg/dl

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13
Q

Goal LDL (low density lipoprotein)

A

It depends on your risk factors, but in general <100 is good. Lower for patients at higher risk for coronary artery disease.

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14
Q

How to calculate LDL.

A

LDL=cholesterol-HDL-(triglycerides/5). ONLY WORKS IF TRIGLYCERIDES <400mg/dl.

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15
Q

What are the ACA guidelines for lipid management?

A

ACA focuses on lifestyle modifications (smoking cessation, healthy weight, exercise and healthy diet) and statin usage in higher risk groups.

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16
Q

What class of medications are statins?

A

HMG CoA reductase inhibitors.

17
Q

What time of day should statins be taken?

A

Best taken at night. Much of lipid synthesis is done at night.

18
Q

What are the 4 statin benefit groups according to the ACA?

A
  1. Pt’s with ASCVD
  2. Anyone with LDL >190md/dl
  3. Pt’s 40-75 years with DM and LDL between 70-189 mg/dl
  4. Pt 40-75 with LDL 70-189 and estimated 10 year risk of ASCVD >7.5%
19
Q

What is a CRP used for in cardiology?

A

Predicts cardiac risk factors. CRP is an inflammatory marker and atherosclerotic plaques contain inflammatory cells.
CRP is NONSPECIFIC, so its used in conjunction with LDL.

20
Q

What labs can be used to detect and MI?

A

CK/CK-MB
Troponin
LDH
Myoglobin

21
Q

What types of troponin are specific for MI’s?

A

Troponin I and Troponin T

22
Q

In relation to an MI, when does troponin I and T elevate, peak and return to normal?

A

elevation: 3-12 hours
Peak: 12 hours for Tn I, 2 days for Tn T
Return to normal: 5 days

23
Q

What types of CK are there?

A

CK-MM: skeletal muscle
CK-MB: cardiac muscle
CK-BB: brain tissue

24
Q

In relation to an MI, when does a CK-MB elevate, peak, and return to normal?

A

Elevation: 3-12 hours
Peak: 24 hours
Return to normal: 2-3 days

25
Q

What is an MB index?

A

Percentage of CK-MB relative to total CK. Index >2 suggests myocardial source.

26
Q

In relation to an MI, when does myoglobin elevate, peak, and return to normal?

A

elevation: 1-4 hours first marker to go up after an MI
Peak: 6-7 hours
Return to normal: 24 hours

27
Q

What can interfere with a myoglobin test?

A

Skeletal muscle injury, trauma, and renal failure.

28
Q

In relation to an MI, when does LDH(lactate dehydrogenase) elevate, peak, and return to normal?

A

Elevation: 24-48 hours
Peak: 2-3 days
Return to normal: 8-14 days

29
Q

When is an LDH useful?

A

When a patient comes in with “My chest pain started 10 days ago”. LDH will still be elevated although other labs may have returned to normal.

30
Q

What isoenzymes of LDH are found in the heart? What is an LDH flip?

A

Isoenzymes LDH 1 and LDH 2 are found in the heart.

An LDH flip is when LDH 1 > LDH 2 and is indicative of a cardiac event.

31
Q

What is BNP and what is its function?

A

B natiuretic peptide. Function is to oppose the activity of the RAAS.

32
Q

What does BNP measure?

A

Measures atrial and ventricular stretch.

33
Q

What does high BNP indicate?

A

CHF.

Also increased in MI, HTN, and cor pulonale.

34
Q

What is a normal BNP?

A

in general <100pg/dl.

It naturally increases with age and is higher in healthy women in comparison to healthy men.

35
Q

What medication increases BNP?

A

Natrecor, which is a CHF treatment.

36
Q

T/F. A patient can be discharged after 1 negative troponin if his pain started 3 hours ago.

A

False! it takes time for a troponin to rise, they should have serial troponins every 1-3 hours.
If it started greater than 6 hours ago an MI can be ruled out with a negative troponin

37
Q

T/F. A troponin should not be drawn as an outpatient.

A

True. First off, if you suspect an MI they need to go to the ER, but also troponin is time sensitive and needs to be run quickly after being drawn.

38
Q

What is hemolysis in the setting of blood draws and what lab is one cardiac lab it can effect?

A

Hemolysis sometimes occurs when a patient is a difficult stick and red blood cells are destroyed in the process of drawing the blood.
It can elevate an LDH.