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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
Triglycerides | Very High: Highest Risk
>500
26
Cholesterol Ratios
- Total Cholesterol / HDL example: (200 mg/dL) / (50 mg/dL) = 4:1 The lower the ratio, the lower the risk of heart disease
27
Cholesterol ratio recommendation
5:1 or lower
28
Total Cholesterol / HDL predictor for heart disease risk in men
3. 43 = 1/2 avg risk 4. 97 = avg risk 9. 55 = 2x risk 23. 39 = 3x risk
29
Cholesterol Testing: Men
1. screen 20-35 for lipid disorders if increased risk of CHD | 2. Screen all men > 35
30
Cholesterol Testing: Women
1. screen 20-45 for lipid disorders if increased risk of CHD | 2. Screen all women >45
31
Frequency of screening for cholesterol testing
every 5 years (or more based on results/risk)
32
When to test for cholesterol with children and adolescents
1. at least once between 9 and 11 y.o. | 2. again between 17 and 21 y.o.
33
Statin induced myopathy signs x symptoms
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
Niacin
vitamin b3 | used as a supplement to lower cholesterol
35
PCSK9 inhibitors
new class of drugs that lower LDL cholesterol repatha (evolocumab) and Praluent (alirocumab)
36
PCSK9 MOA
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
Creatine Phosphokinase (CPK) timeline after injury
Rises: 4-6 hrs Peaks: 12-24 hours Duration: 4-5 days
38
What is a normal range for CPK?
0-175 IU/L
39
What are the 3 types of CPK?
CPK-MB CPK-MM CPK-BB
40
most conclusive CPK of all 3 types for myocardial injury
CPK-MB
41
Most conclusive CPK for skeletal muscle damage
CPK-MM
42
most conclusive CPK for brain tissue injury
CPK-BB
43
Where is CPK-MB found?
striated muscle (skeletal and cardiac)
44
What CPK-MB finding suggests myocardial injury?
>5% of total CPK
45
when is CPK-MB typically elevated?
1. post surgery | 2. after CPR, especially if defibrillated)
46
Normal Troponin levels
0-3 mg/mL
47
What is troponin?
a group of proteins found in striated muscles and bound to actin filament
48
What are the 3 types of troponin?
TnC TnI TnT
49
TnC
binds to calcium
50
TnI
inhibits interaction between actin and myosin
51
TnT
links troponin complex to tropomyosin
52
TnI & TnT traits
- TnI > 0.1 ng/mL - Onset: 4-6 hours - Peak: 12-24 hours - Returns to normal: 4-7 days
53
TnT traits
- 0.2 ng/mL - Onset: 3-4 hours - Peak: 10-24 hours - Returns to normal: 10-14 days
54
Myoglobin
- heme protein found in all muscle tissue - recent potential diagnostic tool for acute MI - Can be detected 2 hours after injury
55
Myoglobin peak time after injury
3-15 hours
56
Normal myoglobin levels
25-72
57
Which biochemical markers are most sensitive and specific of myocardial cell damage
cTnI cTnT quality of measurement still of concern
58
Where can LDH, AST, and SGOT be found?
present in a number of organs including liver, skeletal and cardiac muscle cells, RBC, pancreas, and kidney
59
Atrial Natriuretic Peptide (ANP)
- peptide hormone of cardiac origin release in response to atrial distention - maintains sodium homeostasis - inhibits activation of renin-angiotensin-aldosterone sysytem
60
Results of increased ANP
vasodilation = dec preload and afterload = dec workload on the heart
61
ANP increases with...
increasing severity of heart failure
62
Brain Natriuretic Peptide (BNP)
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
BNP functions to...
1. maintain stable BP and plasma volume | 2. prevent excess salt and water retention
64
BNP normal values
< 100 pg/mL
65
BNP readings for acute decompensation
>700 pg/mL
66
BNP readings for chronic cardiac compensation
100-700 pg/mL
67
Fibrinogen
- primary function: occlude blood vessels to stop bleeding
68
Increased risk of fibrinogen leads to...
an increased risk for clot formation
69
C reactive protein is _ in inflammatory states
increased
70
inflammatory states with increased CRP
1. atherosclerosis 2. CHF 3. cancer 4. infections 5. liver dysfunction
71
High Sensitivity CRP (hs-CRP)
- more sensitive bioassay for CRP | - available to determine heart disease risk
72
Normal value hs-CRP:
< 1 mh/L | low risk
73
hs-CRP high risk
1-3 mg/L
74
hs-CRP | evaluated to exclude non-CV disease
>10 mg/L
75
Lipoprotein A
- atherogenic and prothrombotic effect - independent risk factor for CAD - risk factor for CHD, stroke, thrombosis
76
High levels of Lipoprotein A strongly associated with:
atherosclerosis
77
Serum Creatinine
- creatine accumulates in the blood - fully filtered by kidneys - blood levels increase as kidney function declines or w/reduced renal perfusion
78
Serum Creatinine | normal reading
< 1.5 mg/dL
79
RF for CHD
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
"quasi" RF for CHD
1. high levels CRP 2. post menopausal 3. uncontrolled stress 4. alcohol use and poor diet
81
endothelial lining can be damaged by:
1. HTN 2. high glucose levels 3. thrombus or embolus that gets stuck leads to atheroma

Cardiopulm (20 decks)

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