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clinical lab > diagnosis for cardiac diseases > Flashcards

diagnosis for cardiac diseases Flashcards

1
Q

what are the risk factors for cardiac diseases ?

A 
family history 
age 
male sex 
hyper and dyslipidemia 
diabetes 
hemostatic disorders - hyperhomocystinurea , hyperfibrinogenima 
fctor 5 leiden 
arterial hypertension 
overwieght 
stress
smokin
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2
Q

when do the early markers for myocardial infraction rise ?

A

1-3 hours after symptoms appear -myoglobin , glycogenphsophorilase BB , ischemia modified albumin
CK-MB

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3
Q

when do the medium early markers arise ?

A

4-6 hour after symtoms ?
TROPONIN T AND I
ASAT
CK

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4
Q

what are the late markers ?

A

LDH , troponin

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5
Q

where is myoglobin found ?

A

heme binding protein found in skeletal muscles and myocardial muscles

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6
Q

why is myoglobin and early marker and why isn’t it very reliable ?

A

in cytoplasm - comes out easy due to damage
has a short plasma half life
its levels can easily change

low diagnostic specificity - also in muscle damage ,renal elimination can also arise in renal failure

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7
Q

what are the methods to detect myoglobin ?

A

immunoturbidmetric
immunonephelometric

antibodies coated with polystyrene is used

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8
Q

myoglobin is also used to detect what ?

A

effectiveness of thrombolytic therapy
succesful reperfusion rises quickly due to washout

marker comes to normal value in 10-20 hours with thrombolysis
without 24-36 hours

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9
Q

how can we better myoglobin specificity ?

A

myoglobin tother with carbohydrase 3 /low molecular weight protein placed in muscles

ratio between these markers

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10
Q

what are the isoenzymes of glycogenphosphorlase

A

bb- brain and myocardial muscle
mm - skeletal mucle
ll- heptic cells

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11
Q

what methods are used to obtain Glycogenphosproliase bb in blood ?

A

ELSA

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12
Q

glycogen phosprylase BB only comes normal after how much time ?

A

2-3 days

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13
Q

what is the use of glycogen phosphorylase bb

A

used in bypass surgery

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14
Q

problem of glycogen phsoprylase bb ?

A

too sensitive - reacts even to ischemia in stable angina

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15
Q

how is TROPONIN obtained ?

A

ELISA - first determination

3rd way
ECLIA (Electro chemiluminescence Assay). specific for the cardiac isoform with high sensitivity

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16
Q

troponin max levels are ?

A

16-36th hour and stay high 10-12 days.

17
Q

troponin other than to diagnose Mi what else is it used for ?

A

also used to monitor the reperfusion

if successful there is a rise in troponin

18
Q

High sensitivity troponins have a number of significant advantages

A

allow for earlier identification of MI,

negative predictive value,. are a better “rule-out” test than former assays.

predict the risk for the next myocardial infarction and death in a group of patients previously undetected by former Tn assays.

they speed up chest pain triage to 4 hours

Serial samples demonstrating rising or falling levels of hsTn differentiate acute from chronic cardiomyocyte necrosis

19
Q

what rules out MI by high sensitivity troponin ?

A

initial normal hsTn level in a patient with a reliable history of chest pain onset more than 6 hours prior to sampling

20
Q

how should the serial sample of troponin be taken

A

the timing of the 2nd serial sample should be no sooner than 3 hours after the first.

The percentage change (rise or fall) in hsTn levels in 2 samples 3 hours apart, is used to establish a diagnosis of MI when the Tn level is below the WHO cut-off

21
Q

the value of troponin depends on ?

A

size of the affected zone
the blood flow to the area
where the infraction is located

22
Q

from Hs troponin levels, how can that be used to differentiate if it is acute or chronic myocardial infraction ?

A

serial samples of high sensitivity troponin rising and falling

23
Q

for TnI how much change should there be between serial samples for it to be diagnostic indication for myocardial infraction ?

A

50 percent change from the initial value

24
Q

what is algorithm for troponin 1 investigation for myocardial infraction

A

first sample of troponin 1
less than 99 percent – pain is more than 6 hours discharge after stress test
pain less that 6 hours ?– second sample of troponin after 3 hours

in first sample of troponin if it is a 99 percent rise in troponin I
second sample taken after 3 hours

if the change of troponin I is less than 50 percent - discharge
if the change of troponin I is more than 50 percent admit the patient

if the first sample of troponin is more than 99 percent which WHO assizes as a definite Mi - admit the patient , invasive management

25
Q

homocystiene is increased when ?

A

vit B and folate deficiency
enzyme metabolsim defect
renal disease aswell

26
Q

homocystienemia causes what ?

A

endothelium dysfunction and thrombophilia

suppress NO and protein C
activate factor 12 and factor 4

27
Q

is homocysteine free in plasma ?

A

no most of it is bound to albumin only 1-2 percent is free

28
Q

homocystien in plasma is dependant on what ?

A

gender dependance

men and postmenopausal women have a higher value swell

29
Q

what is the function of natriuretic peptides ?

A

antagonist of RAAS
suppress releases of renin and aldosterone
neutralise the effect of angiotensin in vessels

vasodilating effect
rising in water and sodium excretion

30
Q

where is ANP produced ?

A

in the atrial myocytes

31
Q

where is BNP produced ?

A

produced in ventricular myocytes

32
Q

where is CNP produced ?

A

produced by the endothelium cells

33
Q

how is there clearance of these natriuretic peptides ?

A

endocytosis
detsruction in blood by neutral endopeptidases
renal filtration - the main clearance

34
Q

what causes BNP to rise and fall other than heart problems ?

A

renal dysfunction - causes it to rise

overweight causes it to fall

35
Q

why is BNP and pro-BNP not recommended as a screening

A

have biological variation of up to 50 percent they have age and sex defined values

36
Q

high levels of natriuretic peptides are found in individual who have e what mostly ?

A

chronic heart disease , cardiomyopathy , valve disease and ischemic heart disease

mainly considered for left ventricle dysfunction

37
Q

what is the method used to obtain natriuretic peptides ?

A

CLIA-ECLIA

38
Q

when there is dyspnea suggesting cardiac failure what is the algorithm for BNP ?

A

BNP under 100 microgram /l
cardiac damage not possible

BNP - 100-400 microgram /l
grey zone - left ventricular damage and pulmonary embolism

BNP higher than 400 microgram /l
cardiac damage

clinical lab (9 decks)

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