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Cardiopulm > Diagnostic cardiac blood tests > Flashcards

Diagnostic cardiac blood tests Flashcards

1
Q

Blood Lipid Profiles

A
  1. Total Cholesterol
  2. High Density Lipoproteins
  3. Low Density Lipoproteins
  4. Very low density Lipoproteins
  5. Triglycerides
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2
Q

What is cholesterol?

A

an essential fat:

  • component of cell wall/cell fluidity
  • precursor molecule for vit D, sex steroids
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3
Q

What is a desiriable level of total cholesterol?

A

< 200 mg/dL

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4
Q

What is a borderline high level of total cholesterol?

A

200-239 mg/dL

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5
Q

What is a high level of total cholesterol?

A

> 240 mg/dL

warrants pharmacologic management if lifestyle management won’t reduce.

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6
Q

HDL

A
  • “the good cholesterol”
  • transports fats/cholesterol out of artery walls and back to liver for disposal.
  • transports cholesterol in the blood
  • scavengres fats/cholesterol from blood and returns to liver for disposal
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7
Q

What HDL levels are desirable?

A

M/F: > 60 mg/dL

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8
Q

What HDL levels are “at risk?”

A

M: <40 mg/dL
F: <50 mg/dL

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9
Q

T/F: Aerobic exercise can increase HDL concentrations

A

True

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10
Q

LDLs

A
  • can invade tunica interna of blood vessels and remain (atheroma)
  • WBCs (macrophages) move into this area and establish a low grade inflammatory situation
  • smooth muscles proliferate
  • fibrous conn tissue accumulates
  • forms atherosclerotic plaque
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11
Q

LDL: affects of plaque formation being self propagating

A
  1. increased LDLs and risk for CV disease

2. Increasing LDLs increases risk for atherosclerosis

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12
Q

How do you calculate LDL values?

A

LDL = Total cholesterol - HDL - (triglyceride/5)

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13
Q

Normal fasting Ranges for LDLs

A
  1. 100 mg/dL or less
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14
Q

Triglycerides

A
  • glycerol plus 3 fatty acids

- saturated and unsaturated fats

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15
Q

High levels of triglycerides in the blood stream have been linked to:

A

atherosclerosis
heart disease
CVA

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16
Q

Saturated fats

A

Fat molecules w/o double bonds between carbon molecules because they are saturated w/hydrogen molecules

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17
Q

High levels of saturated fats increase risk for

A

Heart disease

CVA

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18
Q

Unsaturated Fats

A

Fat molecules w/1 or more double bond in the fatty acid chain

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19
Q

What are the types of unsaturated fats?

A

Monounsaturated
Polyunsaturated
Low melting point/fluid( liquid at room temp)
Trans Fatty Acids

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20
Q

Trans Fatty Acids

A

uncommon in nature but commonly produced industrially from vegetable fats.
Increased intake associated w/ increased risk for CVD

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21
Q

CIS fatty acids

A
  • unsaturated
  • generally good for health
  • naturally occurring
  • chains of carbon atoms on the same side of the double bond resulting in a “kink”
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22
Q

Triglycerides

Normal range: Low risk

A

< 150

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23
Q

Triglycerides

Borderline High

A

150-199

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24
Q

Triglycerides

High

A

200-499

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25
Q

Triglycerides

Very High: Highest Risk

A

> 500

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26
Q

Cholesterol Ratios

A
  • Total Cholesterol / HDL
    example:
    (200 mg/dL) / (50 mg/dL) = 4:1

The lower the ratio, the lower the risk of heart disease

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27
Q

Cholesterol ratio recommendation

A

5:1 or lower

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28
Q

Total Cholesterol / HDL predictor for heart disease risk in men

A
  1. 43 = 1/2 avg risk
  2. 97 = avg risk
  3. 55 = 2x risk
  4. 39 = 3x risk
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29
Q

Cholesterol Testing: Men

A
  1. screen 20-35 for lipid disorders if increased risk of CHD

2. Screen all men > 35

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30
Q

Cholesterol Testing: Women

A
  1. screen 20-45 for lipid disorders if increased risk of CHD

2. Screen all women >45

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31
Q

Frequency of screening for cholesterol testing

A

every 5 years (or more based on results/risk)

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32
Q

When to test for cholesterol with children and adolescents

A
  1. at least once between 9 and 11 y.o.

2. again between 17 and 21 y.o.

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33
Q

Statin induced myopathy signs x symptoms

A
  1. myalgias
  2. muscle tenderness
  3. muscle weakness
  4. rhabdomyolysis
  5. renal failure
  6. death

muscle symptoms more widespread and intense w/exercise. generally resolve after cessation of statin therapy

34
Q

Niacin

A

vitamin b3

used as a supplement to lower cholesterol

35
Q

PCSK9 inhibitors

A

new class of drugs that lower LDL cholesterol

repatha (evolocumab) and Praluent (alirocumab)

36
Q

PCSK9 MOA

A
  1. protein PCSK9 binds to LDL receptors which hastens their degradation
  2. Evolocumab blocks this protein and its effects on LDL receptors = longer life of recepors = increased LDL clearance from blood
37
Q

Creatine Phosphokinase (CPK) timeline after injury

A

Rises: 4-6 hrs
Peaks: 12-24 hours
Duration: 4-5 days

38
Q

What is a normal range for CPK?

A

0-175 IU/L

39
Q

What are the 3 types of CPK?

A

CPK-MB
CPK-MM
CPK-BB

40
Q

most conclusive CPK of all 3 types for myocardial injury

A

CPK-MB

41
Q

Most conclusive CPK for skeletal muscle damage

A

CPK-MM

42
Q

most conclusive CPK for brain tissue injury

A

CPK-BB

43
Q

Where is CPK-MB found?

A

striated muscle (skeletal and cardiac)

44
Q

What CPK-MB finding suggests myocardial injury?

A

> 5% of total CPK

45
Q

when is CPK-MB typically elevated?

A
  1. post surgery

2. after CPR, especially if defibrillated)

46
Q

Normal Troponin levels

A

0-3 mg/mL

47
Q

What is troponin?

A

a group of proteins found in striated muscles and bound to actin filament

48
Q

What are the 3 types of troponin?

A

TnC
TnI
TnT

49
Q

TnC

A

binds to calcium

50
Q

TnI

A

inhibits interaction between actin and myosin

51
Q

TnT

A

links troponin complex to tropomyosin

52
Q

TnI & TnT traits

A
  • TnI > 0.1 ng/mL
  • Onset: 4-6 hours
  • Peak: 12-24 hours
  • Returns to normal: 4-7 days
53
Q

TnT traits

A
  • 0.2 ng/mL
  • Onset: 3-4 hours
  • Peak: 10-24 hours
  • Returns to normal: 10-14 days
54
Q

Myoglobin

A
  • heme protein found in all muscle tissue
  • recent potential diagnostic tool for acute MI
  • Can be detected 2 hours after injury
55
Q

Myoglobin peak time after injury

A

3-15 hours

56
Q

Normal myoglobin levels

A

25-72

57
Q

Which biochemical markers are most sensitive and specific of myocardial cell damage

A

cTnI
cTnT

quality of measurement still of concern

58
Q

Where can LDH, AST, and SGOT be found?

A

present in a number of organs including liver, skeletal and cardiac muscle cells, RBC, pancreas, and kidney

59
Q

Atrial Natriuretic Peptide (ANP)

A
  • peptide hormone of cardiac origin release in response to atrial distention
  • maintains sodium homeostasis
  • inhibits activation of renin-angiotensin-aldosterone sysytem
60
Q

Results of increased ANP

A

vasodilation = dec preload and afterload = dec workload on the heart

61
Q

ANP increases with…

A

increasing severity of heart failure

62
Q

Brain Natriuretic Peptide (BNP)

A
  1. gold standard measurement of heart failure (compensated or uncompensated)
  2. produced in ventricles and released in response to excessive stretch on heart muscle
63
Q

BNP functions to…

A
  1. maintain stable BP and plasma volume

2. prevent excess salt and water retention

64
Q

BNP normal values

A

< 100 pg/mL

65
Q

BNP readings for acute decompensation

A

> 700 pg/mL

66
Q

BNP readings for chronic cardiac compensation

A

100-700 pg/mL

67
Q

Fibrinogen

A
  • primary function: occlude blood vessels to stop bleeding
68
Q

Increased risk of fibrinogen leads to…

A

an increased risk for clot formation

69
Q

C reactive protein is _ in inflammatory states

A

increased

70
Q

inflammatory states with increased CRP

A
  1. atherosclerosis
  2. CHF
  3. cancer
  4. infections
  5. liver dysfunction
71
Q

High Sensitivity CRP (hs-CRP)

A
  • more sensitive bioassay for CRP

- available to determine heart disease risk

72
Q

Normal value hs-CRP:

A

< 1 mh/L

low risk

73
Q

hs-CRP high risk

A

1-3 mg/L

74
Q

hs-CRP

evaluated to exclude non-CV disease

A

> 10 mg/L

75
Q

Lipoprotein A

A
  • atherogenic and prothrombotic effect
  • independent risk factor for CAD
  • risk factor for CHD, stroke, thrombosis
76
Q

High levels of Lipoprotein A strongly associated with:

A

atherosclerosis

77
Q

Serum Creatinine

A
  • creatine accumulates in the blood
  • fully filtered by kidneys
  • blood levels increase as kidney function declines or w/reduced renal perfusion
78
Q

Serum Creatinine

normal reading

A

< 1.5 mg/dL

79
Q

RF for CHD

A
  1. Age
  2. family Hx
  3. Male
  4. HTN
  5. elevated total cholesterol ( high LDL low HDL)
  6. Uncontrolled DM
  7. smoking/secondhand
  8. physical inactivity
  9. obesity (BMI>25)
80
Q

“quasi” RF for CHD

A
  1. high levels CRP
  2. post menopausal
  3. uncontrolled stress
  4. alcohol use and poor diet
81
Q

endothelial lining can be damaged by:

A
  1. HTN
  2. high glucose levels
  3. thrombus or embolus that gets stuck

leads to atheroma

Cardiopulm (20 decks)

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