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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

25
What is BNP and its effects?
Brain naturetic peptide from cardiac ventricles,a ctivates GPCRs inhibits RAAS, endothelin secretion and SAN increases renal blood flow and Na excretion
26
What do we use BNP levels for
assessing severity in ACS, stable angina, mitral regurgitation and aortic stenosis
27
If patient has dyspnea and a BNP level above 400 what does that mean
possible CHF
28
what is NT proBNP used for
useful to suggest CHF in patients with dyspnea
29
At age 70 and above, NT proBNP levels are more conclusive, what is criteria for CHF
\<400 excludes CHF \>2000 suggest CHF when Dx unclear
30
serum Na \<135 means what in CHF patient
more likely to fall and increase in reoccurance of CHF episodes related to excess vasopressin (ADH)
31
What are the mechs of hyponatremia in HF
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
What type of hyponatremia do diuretics and NSAIDs cause
hypotonic euvolemic
33
what type of hyponatremia is caused by CHF
hypotonic hypervolemic
34
What cardiac marker is most useful in excluding CHF on DDx
NT pro BNP
35
What is APO B 48 role
transport chylomicron for degradation
36
patient has high cholesterol, normal triglyceride and tendinous clumps of cholesterol, which type of hyperlipoproteinemia is most likely
IIa
37
What is the mech behind type IIa hyperlipoproteinemia
defective LDL-Reeceptor with LDL-C attacment (defective apo B ligand) cause high LDL-C
38
what are common signs of type IIa hyperlipoprotenemia
corneal arcus, xanthelasma and tendinous xanthomata, premature CAD, aortic stenosis
39
What diseases fall under the type IIa hyperlipoprotenemia category
familial hypercholesterolemia (auto dom) familial defective apo B polygenic nonfamilial hypercholesterolemia
40
patient has high cholesterol and TGL but no xanthomas what type of hyperlipoprotenemia is most likely
IIb
41
what occurs in type IIb hyperlipoprotenemia
increased hepatic secretion of VLDL with ApoB100 and conversion to LDL with ApoB100
42
what type hyperlipoprotenemia is the most common cause of lactescent plasma and primary hyperlipidemia
type IIb (familial combined)
43
When patient's cholesterol and TGL are both extremely elevated and about equal eachother what type hyperlipoprotenemia is most likely?
III dysbetalipoproteinemia
44
what mutation causes type 3 hyperlipoprotenemia
E2/E2 instaead of E3 E3 or hepatic lipase deficiency mimicks this because plays role in ineffective clearance IDL
45
What are CHD "equivalents"
DM, TIA, PAD, AAA, 10 year risk asses of CHD \>20%
46
What are other major CHD risk factors that are not equivalents
FH, low HDL-C, age, BP, smoking
47
how does reynolds change hsCRP
increases amount
48
What is Tx for clinical atherosclerotic CV disease
high intensity Tx. atorvastatin 40-80 mg or rosuvastatin 20-40
49
What is Tx for diabetic patients without clinical ASCVD afed 4-75 with LDL-C 70-180 and 1- yr risk \>7.5
high intensity atorvastatin or rosuvastatin
50

Year 2 CV (31 decks)

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