Exam 2, week 5: Cardiac Biomarker Lab Values

Question 1

CK and CKMB are cardiac enzymes. They are ENZYMES!!! Specifically, Creatine Kinase.

-Ck is found in what 3 places?
-CKMB is what specific?

Answer 1

Ck is found in the heart, brain, and skeletal muscles.

CKMB is heart specific.

Question 2

If you wanted to assess the risk for an MI, which Enzyme lab value would you assess?

-CK
-CKMB

Answer 2

CKMB, because it is heart specific.

Question 3

When looking at CKMB lab values to see if a patient has had an MI, the CKMB values rise and fall over a period of how many days?

When do the CKMB values for MI’s peak during this period?

Answer 3

CKMB values rise and fall over a 3-day period if a patient has had an MI.

CKMB levels peak at about 24 hours during the 3-day period.

Question 4

CKMB levels USED to be the gold standard for checking to see if a patient had an MI, but it is no longer the standard because you had to basically wait for a patient to have an MI. Now, the gold standard Lab value for assessing an MI is the protein known as what?

Answer 4

Troponin

Question 5

Why are Troponin levels used to assess for an MI?

Answer 5

Troponin is not found in healthy people.

Question 6

Troponin is not found in healthy people. What does the presence of troponin represent in a patient’s heart condition?

Answer 6

Troponin represents heart necrosis.

Question 7

Necrosis of the heart is recognized by the presence of what enzyme in the body?

Answer 7

Trick question.

Troponin presence indicates heart necrosis, but Troponin is a protein, not an enzyme.

Question 8

Which Troponin levels indicate Heart Necrosis in a patient?

a.) 0.1ng/mL
b.) 0.4ng/mL
c.) 1.3ng/mL
d.) None of the above
e.) All of the above

Answer 8

e.) All of the above

Any presence of Troponin indicates Heart Necrosis

An amount at or over 0.4ng/mL is considered a Cardiac Event

Question 9

Myoglobin comes from what 2 places in the body?

Answer 9

The heart and bones

Question 10

Myoglobin levels can rise “X”-“Y” minutes after an MI, and then decline after “Z” hours.

Answer 10

Myoglobin levels can rise 30-60 minutes after an MI, and then decline after 7 hours.

Question 11

Serum lipids are found in “X” proteins and in the “Y”, where it is made.

Answer 11

Serum lipids are found in animal proteins, and in the Liver, where it is made.

Question 12

What should these Serum Lipid levels be at?

-Total Cholesterol
-Triglycerides
-HDL
-LDL

Answer 12

Total Cholesterol: Less than 200mg/dL

Triglycerides: Less than 150mg/dL

HDL: Greater than 40mg/dL

LDL: Less than 70mg/dL

Question 13

BNP is a neurohormone that regulates Blood Pressure and fluid volume. BNP Helps diagnose heart failure, and MI’s, and Emboli.

What BNP lab value suggests the possibility of heart failure?

Answer 13

Any number GREATER than 100

Question 14

BNP is a neurohormone that regulates what 2 things?

Answer 14

Blood pressure and fluid volume.

Question 15

A BNP number greater than 100 suggests what?

Answer 15

Heart Failure

Question 16

What symptoms would suggest to a nurse that a patients BNP levels should be checked?

Answer 16

-Swollen ankles
-Lung crackles in the bases
-Jugular distention
-Abdominal pulse/Distention

Question 17

C-Reactive proteins are produced in the “X” and shows what?

Answer 17

C-reactive proteins are produced in the Liver and show inflammation.

Question 18

C-Reactive protein is made in the liver and shows what?

Answer 18

Inflammation

Question 19

CVD is shown in a patient if their C-Reactive proteins are above what number?

a.) 3
b.) 1.2
c.) 2
d.) 0.4

Answer 19

a.) If a patients C-Reactive protein is above 3, it is a risk for CVD.

Question 20

As a side note, since C-reactive proteins show inflammation, an elevated lab value could also be present in which type of patient:

a.) Alcoholics
b.) Diabetics
c.) Smokers
d.) Obese

Answer 20

c.) Smokers also have higher levels of C-reactive proteins

Question 21

Homocysteine is an amino acid that is linked to what artery disease?

Answer 21

Arteriosclerosis

Question 22

Homocysteine levels are used to assess for possible coronary artery diseases. You have a high risk for CAD if your Homocysteine levels are greater than what?

Answer 22

Homocysteine levels greater than 15

Question 23

If your blood levels have higher than normal coagulation, it means that your blood is taking too long to what?

Answer 23

Higher than normal coagulations means that your blood is taking too long to clot.

Question 24

If your blood coagulation is lower than normal, it means that your blood is what?

Answer 24

Lower than normal coagulation means that your blood is not clotting enough.

Question 25

True or False:

Having higher than normal blood coagulation means that your blood is clotting too easily.

Answer 25

True:

Having HIGHER than normal blood coagulation means that your blood is clotting too easily.

LOWER than normal blood coagulation means that your blood is taking too long to clot.

Question 26

What can be the end result of having your blood coagulation levels too high?

Answer 26

-MI
-Stroke

Question 27

Pt stands for Prothrombin Time. Prothrombin Time is a study done for patients taking what drug?

Answer 27

Coumadin

Question 28

What does the drug Coumadin do to the blood?

Answer 28

Thins the blood.

Coumadin is a blood thinner.

Question 29

A patient with Atrial Fibrillation would want to avoid clotting of their blood. What drug would be given to counteract clotting?

Answer 29

Coumadin

or

Warfarin

Question 30

Partial Thromboplastin Time is if the patient is taking what drug?

Answer 30

Heparin

Question 31

Which drug is for PT and which drug is for PTT?

-Coumadin
-Heparin

Answer 31

Coumadin is for PT

Heparin is for PPT

Question 32

PT and PTT both test for the bloods ability to do what?

Answer 32

PT and PTT both test for how well blood clots.

Question 33

What tests would you use to assess for a patient bleeding disorder?

Answer 33

-PT/INR
-PTT

Question 34

PT/INR tests gauge how fast “Prothrombin” turns into what?

Answer 34

-Thrombin

Question 35

What is the main difference between a PT/INR test and a PTT test?

Answer 35

PT/INR, and PTT are tests used to assess the bloods coagulation levels, aka: Its ability to form clots. The differences between the two tests come down to testing how the blood will clot when hit with an External injury, or an Internal injury.

Question 36

PT/INR tests are used to assess for clotting of “X” injuries because they affect pathways called “X” clotting pathways.

PTT tests are used to assess for clotting of “Y” injuries, because they affect pathways called “Y” pathways.

Answer 36

PT/INR tests are used to assess for clotting of External Injuries because they affect pathways called External clotting pathways.

PTT tests are used to assess for clotting of Internal injuries because they affect pathways called Internal clotting pathways.

Question 37

What is the difference in time between normal PT/INR test values, and normal PTT tests values?

Answer 37

PT/INR is 10-12 seconds

PTT is 30-40 seconds

Question 37

BUN/Creatinine/Na+ levels would be elevated with decreased cardiac output.

What would be normal vs elevated levels in BUN/Creatinine/Na+?

Answer 37

BUN-
Normal: 6-20mg/dL
Elevated: >20mg/dL

Creatinine-
Normal: 0.7-1.3(M), 0.6-1.1(F)
Elevated: >1.3(M), >1.1(F)

Na+-
Normal: 135-145mEq
Elevated: >145mEq

Question 38

While BUN/Creatinine/Na+ levels coincide with decreased cardiac output, which electrolytes coincide with cardiac instability?

Answer 38

K+, Mg++, and Ca+

Question 39

If a patient is presenting with an MI, will Leukocyte levels be decreased or elevated?

What are normal Leukocyte levels?

Answer 39

Leukocyte levels will be elevated in an MI.

Normal WBC counts are 4,500 to 11,000.