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Year 2 CV > Exam 2, CV testing, darrow > Flashcards

Exam 2, CV testing, darrow Flashcards

1
Q

substernal chest pain is indicative of what undderlying process

A

MI or angina

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2
Q

when troponin I is highly elevated with depressed ST segments what is probabl Dx

A

non ST segment elevated MI

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3
Q

which LDH is indicative of heart and RBC damage

A

1 and 2

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4
Q

what LDH is indicative of muscle and liver damage

A

4 and 5

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5
Q

What is so valualv about CK MB

A

back to level by day 3 unlike troponin so if there is a reinfarction, can be detected that way

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6
Q

what are the 3 single chains that make up troponin

A

troponin C- Ca binding troponin I- binds actin to inhibit myosin interaction tropinin T- binds tropomyosin and helps contraction

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7
Q

what is criteria for Dx AMI with biomarkers

A

at least one value above 99th percentile, tropinins preferredl so increased or falling troponin with symptomatic EKG or echocardiographic evidence of MI

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8
Q

which lab test is best for supporting Dx of CV disease

A

cholesterol

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9
Q

what is hsCRP

A

highly senstiive CRP

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10
Q

when is hsCRP increased

A

released by hepatocytes under influence of cytokines IL1 IL6 and TNF-a, so under any type of cell stress

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11
Q

what is best level of hsCRP

A

<1 mg/dL

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12
Q

the liver releases what in response to IL 1 IL6 and TNF-alpha

A

fibrinogen, serum amyloid A, CRP, C3’ and haptoglobin

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13
Q

what is myeloperoxidase

A

WBC enzyme that produces toxic oxygen radicals in a respiratory burst to kill bacteria

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14
Q

what can myelopweroxidase be a marker for

A

plaque vulnerability preceding ACS

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15
Q

What are elevated homocysteine levels associated with

A

vascular injury, ASHD, coagulation and venous thromboembolism

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16
Q

Where on gel electrophoresis do HDL and LDL show up

A

HDL right next to albumin

LDL is the beta wave near gamma (last one)

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17
Q

how do you calculate total LDL-C

A

total cholesterol - 1/5 triglycerides +HDL-C

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18
Q

how do you calculat enon HDL cholesterol

A

total cholesterol- HDL-C

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19
Q

What is LDL-P

A

core lipid surrounded by phospholipid measured by NMR spec

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20
Q

Why is chlamydophylia pneumoniae a marker for CV disease

A

stimulates plaque formation

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21
Q

why is fibrinogen a marker for CV disease

A

binds platelets and sticks RBCs together (sed rate)

22
Q

why is uric acid a marker for CV disease

A

part of metabolic syndrome

can irritate blood vessel wall

23
Q

What is the PLAQ test

A

lipoprotein Phospholipase A2

eleveated levels lead to increased MI and stroke

cleaves oxidized fatty acids from LDL-C

24
Q

What is the best marker for severity of CHF

A

serum Na

25
Q

What is BNP and its effects?

A

Brain naturetic peptide from cardiac ventricles,a ctivates GPCRs

inhibits RAAS, endothelin secretion and SAN

increases renal blood flow and Na excretion

26
Q

What do we use BNP levels for

A

assessing severity in ACS, stable angina, mitral regurgitation and aortic stenosis

27
Q

If patient has dyspnea and a BNP level above 400 what does that mean

A

possible CHF

28
Q

what is NT proBNP used for

A

useful to suggest CHF in patients with dyspnea

29
Q

At age 70 and above, NT proBNP levels are more conclusive, what is criteria for CHF

A

<400 excludes CHF

>2000 suggest CHF when Dx unclear

30
Q

serum Na <135 means what in CHF patient

A

more likely to fall and increase in reoccurance of CHF episodes

related to excess vasopressin (ADH)

31
Q

What are the mechs of hyponatremia in HF

A

increased nonosmotic release of arginine vasopressin from low CO, decreased renal blood flow, baroreceptor stimulation

potent thirst stimulation from low CO and ANGII

diuretics

other drugs like NSAIDs

32
Q

What type of hyponatremia do diuretics and NSAIDs cause

A

hypotonic euvolemic

33
Q

what type of hyponatremia is caused by CHF

A

hypotonic hypervolemic

34
Q

What cardiac marker is most useful in excluding CHF on DDx

A

NT pro BNP

35
Q

What is APO B 48 role

A

transport chylomicron for degradation

36
Q

patient has high cholesterol, normal triglyceride and tendinous clumps of cholesterol, which type of hyperlipoproteinemia is most likely

A

IIa

37
Q

What is the mech behind type IIa hyperlipoproteinemia

A

defective LDL-Reeceptor with LDL-C attacment (defective apo B ligand)

cause high LDL-C

38
Q

what are common signs of type IIa hyperlipoprotenemia

A

corneal arcus, xanthelasma and tendinous xanthomata, premature CAD, aortic stenosis

39
Q

What diseases fall under the type IIa hyperlipoprotenemia category

A

familial hypercholesterolemia (auto dom)

familial defective apo B

polygenic nonfamilial hypercholesterolemia

40
Q

patient has high cholesterol and TGL but no xanthomas

what type of hyperlipoprotenemia is most likely

A

IIb

41
Q

what occurs in type IIb hyperlipoprotenemia

A

increased hepatic secretion of VLDL with ApoB100 and conversion to LDL with ApoB100

42
Q

what type hyperlipoprotenemia is the most common cause of lactescent plasma and primary hyperlipidemia

A

type IIb (familial combined)

43
Q

When patient’s cholesterol and TGL are both extremely elevated and about equal eachother what type hyperlipoprotenemia is most likely?

A

III dysbetalipoproteinemia

44
Q

what mutation causes type 3 hyperlipoprotenemia

A

E2/E2 instaead of E3 E3

or hepatic lipase deficiency mimicks this because plays role in ineffective clearance IDL

45
Q

What are CHD “equivalents”

A

DM, TIA, PAD, AAA, 10 year risk asses of CHD >20%

46
Q

What are other major CHD risk factors that are not equivalents

A

FH, low HDL-C, age, BP, smoking

47
Q

how does reynolds change hsCRP

A

increases amount

48
Q

What is Tx for clinical atherosclerotic CV disease

A

high intensity Tx. atorvastatin 40-80 mg or rosuvastatin 20-40

49
Q

What is Tx for diabetic patients without clinical ASCVD afed 4-75 with LDL-C 70-180 and 1- yr risk >7.5

A

high intensity

atorvastatin or rosuvastatin

50
Q
A

Year 2 CV (31 decks)

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