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Clinical Chemistry > Clinical Enzymology Cardiac markers > Flashcards

Clinical Enzymology Cardiac markers Flashcards

(104 cards)

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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
Mild to moderate elevation of CK (2-4x UL)
Acute agitated psychosis, alcoholic myopathy, severe exercise, delirium tremens, severe ischemic injury, pulmonary infarction, intramuscular injections, hypothyroidism, muscular trauma
26
Reference range for CK in males
15–160 U/L
27
Reference range for CK in females
15–130 U/L
28
CK-MB normal percentage of total CK
<6% of total CK
29
Main form of CK in serum
94%-100% is CK-MM
30
Cofactor and activator of CK
Magnesium Ion
31
CK isoenzyme with fastest migration to the anode
CK-BB (CK-1)
32
CK isoenzyme found in the heart
CK-MB (CK-2)
33
CK isoenzyme present in skeletal muscle and heart
CK-MM (CK-3)
34
Non-clinically significant CK isoenzyme
Macro-CK
35
CK isoenzyme associated with immunoglobulin and seen between CK-MM and CK-MB
Macro-CK
36
CK isoenzyme detected in extensive tissue damage and poor prognosis
Mitochondrial-CK
37
CK isoenzyme detected in malignant tumors and cardiac abnormalities
Mitochondrial-CK
38
Specimen consideration for CK determination
Avoid prolonged storage (CK1 most labile), avoid chelators and gross hemolysis (adenylate kinase)
39
Total CK analysis method with decreasing pattern
Tanzer-Gilvarg (Forward method)
40
pH for Tanzer-Gilvarg method
Alkaline at 9.0
41
Reaction in Tanzer-Gilvarg method
Creatine to creatine phosphate conversion, Diphosphate reacts with phosphoenolpyruvate (uses pyruvate kinase)
42
Product in Tanzer-Gilvarg method
Lactate + NAD
43
Preferred method for CK determination
Oliver-Rosalki (Reverse method)
44
pH for Oliver-Rosalki method
37050
45
Reaction in Oliver-Rosalki method
Creatine phosphate to creatine
46
Product in Oliver-Rosalki method
6-Phosphogluconate + NADPH
47
Regulator of calcium dependent interactions of actin and myosin filament; attached to actin via tropomyosin
Cardiac troponin
48
Three-protein complex in cardiac troponins
TnT, TnI, TnC
49
Preferred sample for cardiac troponins
Heparinized plasma
50
High sensitivity troponins
Can detect acute myocardial infarction (MI)
51
Reference value for troponins
0-10 ng/mL
52
Troponins during heart injury
Elevates during/after injury to the heart
53
Marker for cardiac injury
Troponin T and I
54
General marker for muscle injury; nonspecific to heart
Myoglobin
55
First for muscle injury (rise time)
1 to 4 hours
56
Rise time of lactate dehydrogenase
8-12 hours or 12-24 hours
57
Rise time of AST
6-8 hours
58
Rise time of CK-MB
4-6 hours
59
Rise time of troponin I and T
3-4 hours or 3-12 hours
60
Rise time of myoglobin
1-3 hours
61
Peak time of myoglobin
5-12 hours
62
Peak time of troponin I
14-20 hours
63
Peak time of CK-MB
12-24 hours
64
Peak time of AST
18-24 hours
65
Peak time of LD
48-72 hours
66
Normalizing time of myoglobin
18-30 hours
67
Normalizing time of troponin I
5-10 days
68
Normalizing time of CK-MB
2-3 days
69
Normalizing time of AST
4-5 days
70
Normalizing time of LD for monitoring
10 days
71
Cardiac marker similar to myoglobin but more specific to the heart; higher sensitivity but lower specificity
Heart type fatty acid binding protein (H-FABP)
72
H-FABP appears _____ after angina
3-6 hours
73
Predictor of acute myocardial infarction (AMI)
Ischemia-Modified Albumin (IMA)
74
Binding of ischemia-modified albumin
Binds copper, not always present
75
Markers of plaque instability
Myeloperoxidase (MPO), C-reactive protein (CRP), Myeloid related protein 18/4 (MRP-18/4), Pregnancy associated plasma protein A (PAPP-A)
76
Similar to Troponin in early detection of AMI
Markers of plaque instability
77
Used to rule out congestive heart failure
B-Type Natriuretic Peptide and C-reactive protein
78
Linked to atherosclerosis and thrombosis
Homocysteine
79
Least tissue specific enzyme
Lactate dehydrogenase (LDH)
80
Tissue source for LD1 (fastest)
Heart, RBCs, Renal cortex
81
Tissue source for LD2
Lungs, lymphocytes, spleen, pancreas
82
Tissue source for LD3
Liver, skeletal muscles
83
Tissue source for LD4 and LD5 (slowest)
Liver, skeletal muscles
84
Normal serum LD ratio
LD2 > LD1
85
Flipped ratio LD1 > LD2 indicates
MI, hemolytic disease, megaloblastic anemia, renal function issues
86
Significance of LD-6 elevation
Arteriosclerotic cardiovascular failure, grave prognosis (impending death)
87
Intracellular ratio of LD
LD1 > LD2
88
Pronounced elevation of LD (greater than 5x normal)
Megaloblastic/pernicious anemia, renal infarction, systemic shock, hypoxia, hepatic metastases, hepatitis
89
Moderate elevation of LD (3-5x normal)
Myocardial infarction, hemolytic conditions, pulmonary infarction, muscular dystrophy, delirium tremens, leukemias, IM
90
Slight elevation of LD (up to 3x normal)
Most liver diseases, nephrotic syndrome, hypothyroidism, cholangitis
91
Specimen considerations for LD determination
Avoid hemolysis, avoid cold storage (LD5 most cold labile), avoid chelators
92
LDH-5 elevation significance
Occurs concurrently with LD6 in severe circulatory insufficiency
93
Role of LD6 in alcohol metabolism
Metabolizes alcohol; not normally found in the blood
94
Macromolecular complex of LDH
LDH complexed with IgA and IgG; migrates between LDH-3 and LDH-4
95
Condition with highest total LD
Pernicious anemia
96
LD elevation in liver disorders, AMI, pulmonary infarction
2-3x increase
97
LDH isoenzyme elevated in skeletal muscle disorders
LD5
98
Method for LD testing (forward reaction)
Wacker method
99
Reaction in Wacker method
Lactate + NAD+ → Pyruvate + NADH + H+
100
Product of Wacker method
NADH + H+
101
Method for LD testing (reverse reaction)
Wroblewski-Ladue method
102
Reaction in Wroblewski-Ladue method
Pyruvate + NADH + H+ → Lactate + NAD+
103
Product of Wroblewski-Ladue method
Lactate + NAD+
104
Reference range for LD
100–225 U/L (37°C)

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