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Clinical Chemistry > Clinical Enzymology Cardiac markers > Flashcards

Clinical Enzymology Cardiac markers Flashcards

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1
Q

Type of cardiovascular disease affecting the heart

A

Coronary heart disease

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2
Q

Manifestation of coronary heart disease

A

Angina/angina pectoris (chest pain), acute myocardial infarction

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3
Q

Type of cardiovascular disease affecting the brain

A

Cerebrovascular diseases

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4
Q

Conditions under cerebrovascular diseases

A

Stroke, transient ischemic attacks (lack of blood supply)

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5
Q

Type of cardiovascular disease associated with ischemic conditions

A

Peripheral arterial disease

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6
Q

Symptoms of peripheral arterial disease

A

Acute localized pain in arms and legs

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7
Q

Type of cardiovascular disease associated with increased blood pressure

A

Aortic Atherosclerotic Disease

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8
Q

Cause of aortic atherosclerotic disease

A

Build-up of fatty streaks or plaques

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9
Q

Complication of aortic atherosclerotic disease

A

Formation of blood clots

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10
Q

Consequence of abnormal weakening of the artery

A

Aneurysm

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11
Q

Condition related to tears in the thoracic or abdominal aorta

A

Aortic dissection

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12
Q

Types of cardiac markers

A

Myoglobin, CK-MB, Troponin I, Troponin T, CK, LDH

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13
Q

Angina also known as

A

Chest pain

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14
Q

Type of angina after strenuous activity without underlying injury

A

Stable angina

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15
Q

Characteristics of stable angina

A

Activity-related, no increase in cardiac markers

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16
Q

Type of angina associated with acute myocardial infarction

A

Unstable angina

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17
Q

Effect of unstable angina on cardiac markers

A

Increases cardiac markers

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18
Q

Classic manifestation of angina

A

Chest pain (squeezing pain), burning feeling, difficulty in breathing

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19
Q

CK isoenzymes

A

CK-BB (CK-1), CK-MB (CK-2), CK-MM (CK-3)

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20
Q

CK-BB (CK-1) characteristics

A

Widely distributed, not detected normally, fastest in electrophoresis

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21
Q

CK-MB (CK-2) characteristics

A

Found in the heart

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22
Q

CK-MM (CK-3) characteristics

A

Present in skeletal muscle and the heart

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23
Q

Tissue sources of CK

A

Brain, Heart, Skeletal muscle

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24
Q

Pronounced elevation of CK (>5x UL)

A

Duchenne’s muscular dystrophy, polymyositis, dermatomyositis, myocardial infarction

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25
Q

Mild to moderate elevation of CK (2-4x UL)

A

Acute agitated psychosis, alcoholic myopathy, severe exercise, delirium tremens, severe ischemic injury, pulmonary infarction, intramuscular injections, hypothyroidism, muscular trauma

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26
Q

Reference range for CK in males

A

15–160 U/L

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27
Q

Reference range for CK in females

A

15–130 U/L

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28
Q

CK-MB normal percentage of total CK

A

<6% of total CK

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29
Q

Main form of CK in serum

A

94%-100% is CK-MM

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30
Q

Cofactor and activator of CK

A

Magnesium Ion

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31
Q

CK isoenzyme with fastest migration to the anode

A

CK-BB (CK-1)

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32
Q

CK isoenzyme found in the heart

A

CK-MB (CK-2)

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33
Q

CK isoenzyme present in skeletal muscle and heart

A

CK-MM (CK-3)

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34
Q

Non-clinically significant CK isoenzyme

A

Macro-CK

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35
Q

CK isoenzyme associated with immunoglobulin and seen between CK-MM and CK-MB

A

Macro-CK

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36
Q

CK isoenzyme detected in extensive tissue damage and poor prognosis

A

Mitochondrial-CK

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37
Q

CK isoenzyme detected in malignant tumors and cardiac abnormalities

A

Mitochondrial-CK

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38
Q

Specimen consideration for CK determination

A

Avoid prolonged storage (CK1 most labile), avoid chelators and gross hemolysis (adenylate kinase)

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39
Q

Total CK analysis method with decreasing pattern

A

Tanzer-Gilvarg (Forward method)

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40
Q

pH for Tanzer-Gilvarg method

A

Alkaline at 9.0

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41
Q

Reaction in Tanzer-Gilvarg method

A

Creatine to creatine phosphate conversion, Diphosphate reacts with phosphoenolpyruvate (uses pyruvate kinase)

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42
Q

Product in Tanzer-Gilvarg method

A

Lactate + NAD

43
Q

Preferred method for CK determination

A

Oliver-Rosalki (Reverse method)

44
Q

pH for Oliver-Rosalki method

A

37050

45
Q

Reaction in Oliver-Rosalki method

A

Creatine phosphate to creatine

46
Q

Product in Oliver-Rosalki method

A

6-Phosphogluconate + NADPH

47
Q

Regulator of calcium dependent interactions of actin and myosin filament; attached to actin via tropomyosin

A

Cardiac troponin

48
Q

Three-protein complex in cardiac troponins

A

TnT, TnI, TnC

49
Q

Preferred sample for cardiac troponins

A

Heparinized plasma

50
Q

High sensitivity troponins

A

Can detect acute myocardial infarction (MI)

51
Q

Reference value for troponins

A

0-10 ng/mL

52
Q

Troponins during heart injury

A

Elevates during/after injury to the heart

53
Q

Marker for cardiac injury

A

Troponin T and I

54
Q

General marker for muscle injury; nonspecific to heart

A

Myoglobin

55
Q

First for muscle injury (rise time)

A

1 to 4 hours

56
Q

Rise time of lactate dehydrogenase

A

8-12 hours or 12-24 hours

57
Q

Rise time of AST

A

6-8 hours

58
Q

Rise time of CK-MB

A

4-6 hours

59
Q

Rise time of troponin I and T

A

3-4 hours or 3-12 hours

60
Q

Rise time of myoglobin

A

1-3 hours

61
Q

Peak time of myoglobin

A

5-12 hours

62
Q

Peak time of troponin I

A

14-20 hours

63
Q

Peak time of CK-MB

A

12-24 hours

64
Q

Peak time of AST

A

18-24 hours

65
Q

Peak time of LD

A

48-72 hours

66
Q

Normalizing time of myoglobin

A

18-30 hours

67
Q

Normalizing time of troponin I

A

5-10 days

68
Q

Normalizing time of CK-MB

A

2-3 days

69
Q

Normalizing time of AST

A

4-5 days

70
Q

Normalizing time of LD for monitoring

A

10 days

71
Q

Cardiac marker similar to myoglobin but more specific to the heart; higher sensitivity but lower specificity

A

Heart type fatty acid binding protein (H-FABP)

72
Q

H-FABP appears _____ after angina

A

3-6 hours

73
Q

Predictor of acute myocardial infarction (AMI)

A

Ischemia-Modified Albumin (IMA)

74
Q

Binding of ischemia-modified albumin

A

Binds copper, not always present

75
Q

Markers of plaque instability

A

Myeloperoxidase (MPO), C-reactive protein (CRP), Myeloid related protein 18/4 (MRP-18/4), Pregnancy associated plasma protein A (PAPP-A)

76
Q

Similar to Troponin in early detection of AMI

A

Markers of plaque instability

77
Q

Used to rule out congestive heart failure

A

B-Type Natriuretic Peptide and C-reactive protein

78
Q

Linked to atherosclerosis and thrombosis

A

Homocysteine

79
Q

Least tissue specific enzyme

A

Lactate dehydrogenase (LDH)

80
Q

Tissue source for LD1 (fastest)

A

Heart, RBCs, Renal cortex

81
Q

Tissue source for LD2

A

Lungs, lymphocytes, spleen, pancreas

82
Q

Tissue source for LD3

A

Liver, skeletal muscles

83
Q

Tissue source for LD4 and LD5 (slowest)

A

Liver, skeletal muscles

84
Q

Normal serum LD ratio

A

LD2 > LD1

85
Q

Flipped ratio LD1 > LD2 indicates

A

MI, hemolytic disease, megaloblastic anemia, renal function issues

86
Q

Significance of LD-6 elevation

A

Arteriosclerotic cardiovascular failure, grave prognosis (impending death)

87
Q

Intracellular ratio of LD

A

LD1 > LD2

88
Q

Pronounced elevation of LD (greater than 5x normal)

A

Megaloblastic/pernicious anemia, renal infarction, systemic shock, hypoxia, hepatic metastases, hepatitis

89
Q

Moderate elevation of LD (3-5x normal)

A

Myocardial infarction, hemolytic conditions, pulmonary infarction, muscular dystrophy, delirium tremens, leukemias, IM

90
Q

Slight elevation of LD (up to 3x normal)

A

Most liver diseases, nephrotic syndrome, hypothyroidism, cholangitis

91
Q

Specimen considerations for LD determination

A

Avoid hemolysis, avoid cold storage (LD5 most cold labile), avoid chelators

92
Q

LDH-5 elevation significance

A

Occurs concurrently with LD6 in severe circulatory insufficiency

93
Q

Role of LD6 in alcohol metabolism

A

Metabolizes alcohol; not normally found in the blood

94
Q

Macromolecular complex of LDH

A

LDH complexed with IgA and IgG; migrates between LDH-3 and LDH-4

95
Q

Condition with highest total LD

A

Pernicious anemia

96
Q

LD elevation in liver disorders, AMI, pulmonary infarction

A

2-3x increase

97
Q

LDH isoenzyme elevated in skeletal muscle disorders

A

LD5

98
Q

Method for LD testing (forward reaction)

A

Wacker method

99
Q

Reaction in Wacker method

A

Lactate + NAD+ → Pyruvate + NADH + H+

100
Q

Product of Wacker method

A

NADH + H+

101
Q

Method for LD testing (reverse reaction)

A

Wroblewski-Ladue method

102
Q

Reaction in Wroblewski-Ladue method

A

Pyruvate + NADH + H+ → Lactate + NAD+

103
Q

Product of Wroblewski-Ladue method

A

Lactate + NAD+

104
Q

Reference range for LD

A

100–225 U/L (37°C)

Clinical Chemistry (35 decks)

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