CARDIOVASCULAR LABS Flashcards
blood vessel diseases
atherosclerosis, HTN, vasculitis, aneurysms, tumors, DVT, PE, stroke
atherosclerosis
- labs ordered
- lifestyle mods
labs: total cholesterol, LDL, HDL, triglycerides, CRP
lifestyle mods: for elevated LDL–> exercise, smoking cessaation, target BMI, diet
atherosclerosis lab results
8-12 hr fast
total cholesterol: >200
LDL: >200
HDL: target–> get it to >40, >60 REDUCE CARDIAC RISK!!
triglycerides: >190
CRP: <1 low risk, 1-3 intermed risk, >3 HIGH RISK
- CRP inc risk of CV events, represents persistent inflamm process
- use to classify pt who are borderline CV risk
primary prevention for atherosclerosis
age 40-75 w LDL >=190
maximal tolerated statin
primary prevention for atherosclerosis
age 40-75 w LDL 70-189, no DM
if they DO NOT have DM, assess 10 years ASCVD risk
> 20% high risk= high intensity statin
7.5-20% intermed= mod statin
5-7.5 borderline risk= lifestyle changes and mod statin
<5% low risk = lifestyle mods
primary prevention for atherosclerosis
age 40-75 w LDL 70-189, with DM
mod statin
primary prevention for atherosclerosis
age 40-75 w LDL <70
assess lifetime risk
secondary prevention
atherosclerosis
18+
yes vs. no Hx of ASCVD
no Hx major ASCVD events= stable= high/mod statin
YES Hx of major ASCVD event= very high risk= give max tolerated statin
atherosclerosis
what makes up total cholesterol
HDL, LDL, VLDL< IDL, Lp
metabolic syndrome
- requires 3
- triglycerides >150
- HDL <40 men, <50 women
- fasting blood glucose >110
- abdominal obesity
- HTN (>130/85)
high TG, high glucose, high BP, obesity, LOW HDL
CV risk factors
smoking, HTN, DM, obesity, physical inacitivty, fam HX of CAD
HTN
- primary causes
- secondary causes
- stages
primary: obesity, tobacco, sodium intake, ETOH, oral contraceptives, NSAIDS
secondary: renal artery stenosis, pheochromo, hyperaldosteronism, hypothyroidism
stages
normal: <120/80
preHTN: 120-129/<80
stage 1: 130-39/80-89
stage 2: >140/>90
hypertensive crisis: >180 and or >120 diastolic
vasculitis
- what is it
- primary cause
- secondary cause
inflamm of blood vessel wall and necrosis of tissue
- primary: no identifiable cause
- secondary: infection (HIV, hep b, c) or autoimmune (lupus, RA)
vasculitis ss
stroke, reduced visual acuity, MI. HTN, nosebleeds, bloody cough, lung infiltrates, blod stool, abdominal pain, glomerular nephriits, muscle pain, joint pain, livedo reticulartis, palpable purpura, wt loss, fever, HA
vasculitis
- dx
- labs
DX: clin findings, inflamm within particular size blood vessels
- vessel Bx
labs:
- ANA
- ANCA antibodies IgG
- elevated ESR sed rate
- CRP
- end organ damage
DVT/PE
labs
D-dimer
- elevated in DVT/PE (+=clot)
- non specific if negative
- only helps R/O
stroke
- causes
- labs
- tx
causes: atherosclerotic ds, antiphospholipid syndrome (inc thrombosis)
labs: no dx/organ marker
- hypercoagulable work up (lipid profile, atherosclerotic RFs)
tx: antiplatelet therapy
ischemic stroke- blood flow obstructed—blood deprived area
hemorrhagic stroke- ruptured BV leaks into brain—bleeding in brain
TIMI score meaning
low TIMI score: tx with antiplatelet and anticoags
high TIMI score: cardiac cath/revasc
HEART score
0-3 low risk of major adv CV events
4-6 intermed risk
>7 high risk
History
ECG
Age
RFs
Troponin
cardiac biomarkers- troponin
- rise and fall meaning
rise w acute ischemia–> acute myo infarction from clot/rupture or atherosclerotic ds
rise w out ischemia–> acute myo injury (from acute HF or myocarditis)
levels are stable–> chrnic myo injury (structural heart ds, CKD)
troponin only marker used for?
- what can it calculate
- normal value
- inc, peak, normalize/drop
to dx a myocardial INFARCTION!
- can calculate size or evolving MI
normal: <0.01
inc: 2-4 hrs
peak: 10-24 hrs
drops: 1-2 wks
troponin types
T and I
other cardiac biomarkers
CK-MB, myoglobin, LDH, CK, AST
poor specificity due to wide tissue distribution
creatine kinase-MB and CK
CKMB- mc serologic test before troponin
CK:
- rhabdomyolysis= high CK
- damaged skeeltal muscle releases contents, including myoglobin, into bloodstream leading to kidney damage
myoglobin
released from damaged tissue
LDH
increased in MI
not used anymore bc tropnonin is more specific
rises 10 hrs after onset of MI, peal 24-48 hrs, remain elevated 5-10 days
CHF monitoring
- what labs to order?
- when do you order them?
labs - BNP inc (from fluid overload)
when?- pt is SOB, edema, ascites, pulm edema, pleural effusion (signs of HF)
- only CVD that increases with INCIDENCE
- hospitalizations for 65+
BNP
- nl
- goal
- what affects the levels
- when else is it elevated
- when can you not use it to eval HF
normal/not HF: <100
CHF w/dyspnea: >400
differences with age, sex, BMI
elevated in renal failure
better dx CXR and PE
- CANNOT use it to eval HF if pt is on entresto (entresto will inc BNP)
pro BNP
- ages + dx criteria
greater prognostic value than BNP
- difference w age, sex, BMI
age ranges for HF Dx
<50 w HF= 450
50-75 w HF= 900
>75 w HF= 1800
