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Clinical Chemistry (CC 1) > (F) L2: Markers for Cardiac Damage and Function (Part 1) > Flashcards

(F) L2: Markers for Cardiac Damage and Function (Part 1) Flashcards

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1
Q
  • This disease commonly occurs in the general population and affects the majority of people older than 60 years old
  • Its commonality is that it refers to blocked arteries therefore inhibiting adequate blood supply to tissues
A

Cardiovascular Diseases (CVD)

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2
Q

Types of CVD (acc. to location)

Concerns the arteries that supply blood to the heart muscle

A

Coronary Heart Disease (CHD)

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3
Q

Types of CVD (acc. to location)

Concerns the blood supply to the brain as the point of blockage

A

Cerebrovascular Disease

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4
Q

Types of CVD (acc. to location)

Concerns the extremities wherein a balloning of the aorta (aneurysm) is possible

A

Peripheral Artery Disease

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5
Q

Types of CVD (acc. to location)

Refers to the the gradual buildup of plaque in your aorta

A

Aortic Atherosclerosis Disease

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6
Q
  • A chronic process involving damage to the endothelium and buildup of cholesterol-rich lesions (plaques) that occlude the vasculature
  • Increases the likelihood of ischemia (lack of blood supply)
A

Atherosclerosis

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7
Q

In atherosclerosis, when the diameter of the coronary artery decreases by less than how many percent (range), angina/chest pain may start to develop?

A

< 10-20%

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8
Q
  • A medical disorder that damages the lumen of the arteries due to plaque deposits
  • Is mainly acquired through lipid accumulation due to a high cholesterol diet and poor exercise
  • Can also be acquired through genes (e.g. hyperlipidemia)
A

Atherosclerosis

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9
Q
  • A disease that blocks the artery walls due to aging
  • Genetics is the main cause of this disease
A

Arteriosclerosis

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10
Q

Refers to the cutting-off of blood supply resulting to reduced oxygen in a particular area

A

Ischemia

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11
Q

Ischemia-induced Diseases

  • An activity-related chest pain which occurs with a given amount of activity
  • Can be resolved with rest
A

Stable Angina

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12
Q

Ischemia-induced Diseases

  • It occurs unpredictably and does not respond to when you stop a particular activity
A

Acute Coronary Syndrome (ACS)

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13
Q

What are the 2 classifications of Acute Coronary Syndrome (ACS)?

A
  1. Unstable angina
  2. Severe myocardial infarction (aka heart attack)
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14
Q

TOF: Between unstable anginas and myocardial infarctions, which marker is significantly higher than the other?

A

Myocardial Infarctions

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15
Q

A manifestation that often radiates to the left shoulder, neck, or arm and typically increases in intensity over a period of minutes and gets worse with either physical or psychological stress

A

Angina/Chest Pain

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16
Q

Common or Non-Classical Symptoms of Angina?

  • Heacy chest pressure
  • Squeezing of chest
  • Burning feeling
  • Difficulty in breathing
A

Common Symptoms

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17
Q

Common or Non-Classical Symptoms of Angina?

  • Stabbing and pulsating chest pains
  • Nausea
A

Non-Classical Symptoms

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18
Q

Symptoms not related to ischemia-induced angina

Due to respiratory movements or coughin

A

Pleuritic pain

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19
Q

Symptoms not related to ischemia-induced angina

The sole location is in the abdomen

A

Epigastric pain

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20
Q

Symptoms not related to ischemia-induced angina

Refers to somatoform disorders, panic attacks, and anxiety disorders

A

Psychiatric disorders

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21
Q

Symptoms not related to ischemia-induced angina

  • Sepsis
  • Burns
  • Actute neurological diseases
  • Drug toxicity
  • Cancer chemotherapy
  • Hyperacidity
A

Severe Non-Cardiac Conditions

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22
Q
  • Commonly known as a heart attack which refers to irreversible ischemic damage
  • There is death of cardiac muscle due to ischemia
  • Diagnosis includes the use of electrocardiograms (ECGs) and lab measurements of cardiac markers
A

Myocardial Infarction (MI)

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23
Q

2 types of Myocardial Infarction

Ischemic necrosis involves the full thickness of the ventricular wall with “ST Elevation Myocardial Infarction” (STEMI) on the ECG

A

Transmural MI

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24
Q

2 types of Myocardial Infarction

Necrosis is limited to the inner 1/3 or 1/2 of the ventricular wall with non-STEMI on the ECG

A

Subendocardial MI

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25
Q

MI definitions acc. to different organizations

A typical rise and fall of (troponin/CK-MB) with one value (above/below) the 99th percentile of the (upper/lower) reference limits

A
  1. Troponin
  2. Above
  3. Upper
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26
Q

MI definitions acc. to different organizations

Sudden unexplained cardiac death before samples are obtained or before biomarkers can appear in the (serum/plasma/blood)

A

Blood

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27
Q

MI definitions acc. to different organizations

For Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft Surgery (CABG) patients with a normal baseline troponin, a level (less than/greater than) the 99th percentile of the upper reference limit is indicative of periprocedural myocardial necrosis

A

Greater than

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28
Q

What are the 6 waves present in an ECG?

A
  1. P
  2. Q
  3. R
  4. S
  5. T
  6. U
29
Q

In an ECG, where can the ST segment be found?

A

Between the S and T waves

30
Q

Types of MI

  1. Spontaneous MI
  2. MI related to CABG
  3. MI secondary to ischemic imbalance
  4. MI resulting in death w/o biomarkers
  5. MI related to PCI
  6. MI related to stent thrombosis

Choices: 1, 2, 3, 4A, 4B, and 5

A
  1. Type 1 (plaque rupture with thrombus formation)
  2. Type 5
  3. Type 2 (can be due to vasospasm, endothelial dysfunction, or supply-demand imbalance)
  4. Type 3
  5. Type 4A
  6. Type 4B
31
Q

The pathophysiology of atherosclerosis involves a progressive accumulation of lipids, smooth muscle cells, macrophages, and connective tissue within the large and medium-sized arteries causing luminal (narrowing/widening) and (decreased/increased) perfusion

A
  1. Narrowing
  2. Decreased
32
Q

Refers to a type of atherosclerosis that is acquired wherein there are high levels of LDL and low levels of HDL

A

Dyslipidemia

33
Q

As more LDL diffuses and accumulates across damaged endothelium, it will eventually rupture. This is why (blank) is recommended to greatly aid in collagen formation, resulting to better endothelium tearing

A

Vitamin C (a lack of it will result to fat deposits covering the tear instead of collagen)

34
Q

LDL in the intima will oxidize into lipids that trigger what event causing the recruiting of macrophages into the vessel wall?

A

Chronic Inflammation

35
Q

Once macrophages phagocytose the oxidized LDL they become filled with fat, which are called as what?

A

Foam Cells

36
Q

Foam cells accumulate in the intima to form what which will be surrounded by connective tissue forming a fibrous cap?

A

Lipid Core

Note: The fibrous cap is difficult to remove therefore a stent/bypass is done to enlarge the space

37
Q

Refers to a lipid-filled plaque that can enlarge and eventually impinge on the vessel lumen resulting in atherosclerosis

A

Atheroma

Note: It continues to increase as long as inflammation persists

38
Q

A common complication of the formation of a fibrous cap is that it may also form what which will later on rupture resulting to thrombosis, complete vessel occlusion, or a combination

A

Vascularization

39
Q

When the heart muscles undergo this event, it will excrete biomarkers which may be in the form of an enzyme or a protein

A

Necrosis

40
Q

These are protein molecules released into the bloodstream from damaged heart muscle and have their own characteristic rise and fall patterns

A

Cardiac biomarkers

41
Q

This is a non-specific biomarker, therefore, elevated levels do not necessarily indicate cardiac problems

A

AST/SGOT

42
Q

What are the 3 non-specific cardiac biomarkers?

A
  1. AST/SGOT
  2. LDH
  3. Creatinine Phosphokinase (CPK)
43
Q

What are the 3 initial cardiac markers?

A
  1. AST/AGOT
  2. LD
  3. CK
44
Q

Initial Cardiac Marker

  • Is not that specific since it can be sourced from cardiac tissue, liver, and skeletal muscle
  • Its diagnostic significance is in the evaluation of AMIs, hepatocellular disorders, and skeletal muscle involvement
A

Aspartate Transaminase (AST/SGOT)

45
Q

Initial Cardiac Marker

  • Although found in other tissues, some isoforms may be specific for cardiac function
  • A zinc-containing enzyme that catalyzes the interconversion of lactic and pyruvic acids
A

Lactate Dehydrogenase (LD)

46
Q

Lactate Dehydrogenase (LD)

The LD1:LD2 ratio exceeds by approximately how much 24-48 hours past the onset of MI symptoms and will remain elevated for how long?

(2 answers)

Note: This results to a flipped pattern also seen in hemolytic anemia and renal infarction

A
  1. Ratio exceeds by 0.75
  2. Remains elevated for 2 weeks
47
Q

Initial Cardiac Marker

  • The MB isoform of this provides the greatest specificity and is therefore the first choice as a biomarker compared to AST or LD
  • A very sensitive indicator of AMI and Duchenne disorder
  • A demonstration of levels greater than 6% of the total value of this marker is considered the most specific
A

Creatine Kinase (CK-MB)

48
Q

Rise and Fall Patterns of Initial AMI Biomarkers

What is the cardiac marker?
Elevation post-MI: 4-8 hours
Peak: 12-18 hours
Return to baseline (normalized): 48-72 hours

A

CK-MB

49
Q

Rise and Fall Patterns of Initial AMI Biomarkers

What is the cardiac marker?
Elevation post-MI: 6-8 hours
Peak: 24 hours
Return to baseline (normalized): 5 days

A

AST/SGOT

50
Q

Rise and Fall Patterns of Initial AMI Biomarkers

What is the cardiac marker?
Elevation post-MI: 12-24 hours
Peak: 48-72 hours
Return to baseline (normalized): 10-14 days (remains elevated)

A

LDH

51
Q

These are important for the diagnosis of the severity and presence of MI in a patient

A

The rise and fall patterns

52
Q

If a patient compains of having chest pains that started a week ago, what is the best biomarker to use in this situation?

A

LDH (elevation lasts 10-14 days after the suspected MI)

53
Q

CK-MB Determination

  • An immunometric assay using monoclonal lab technology
  • Proteins are measured as antigens
  • This is determined by a two-antibody “sandwich” assay
A

CK-MB Mass Assay

54
Q

CK-MB Determination

  • This is equal to CK-MB mass assay divided by CK total activity
A

CK Relative Index/Relative Percent

55
Q

CK-MB Determination

In determining CK-MB (mass) per CK (activity), total CK activity is determined by what method wherein phosphocreatinine combined with ADP results in ATP?

A

Enzyme Assay

56
Q

CK-MB Determination (CK Relative Index/Percent Index)

Values (exceeding/subceeding) the reference limit for absolute quantity (5ng/mL) and relative index (2%) is suggestive of MI

A

Exceeding

57
Q

CK-MB Determination

  • These are seen in all types of muscles wherein each source has different make ups of amino acids
  • It is a complex of three proteins that regulate the calcium-dependent interactions of myosin heads with actin filaments during striated muscle contraction
  • They are considered as the most important marker of cardiac injury (AMI) as they are derived from the heart muscle
A

Cardiac Troponins

Note: First 2 bullets refer to Troponins in general

58
Q

Cardiac Troponins

This binds the troponin complex to tropomyosin

A

Troponin T (TnT)

59
Q

Cardiac Troponins

This inhibits the binding of actin and myosin

A

Troponin I (TnI)

60
Q

Cardiac Troponins

This binds to calcium to reverse the inhibitory activity of TnI

A

Troponin C (TnC)

61
Q

Cardiac Troponins

There is little to no difference in troponin C between
what 2 types of muscle?

A

Skeletal and Cardiac

Note: TnI and TnT are different hence these 2 are more commonly used as markers than TnC

62
Q

Cardiac Troponins

TnT and TnI are measured in what specimen by immunoassay?

A

Serum

63
Q

Cardiac Troponins

Reference values of TnI and TnT

A
  1. TnI - 0 to 0.04 ng/mL (0 to 40 ng/L)
  2. TnT - 0 to 0.01 ng/mgl (0 to 10 ng/L)
64
Q

Cardiac Troponins

Troponin I and T can also be measured qualitatively using what principle similar to that of a pregnancy test kit?

A

Antibody-Antigen Binding

Note: (+) for double bands means that cardiac troponins are present

65
Q

Troponin T or I?

  • Tropomyosin-binding unit
  • Assesses early and late MI
  • Monitors the effectiveness of thrombolytic therapy in MI patients
  • Elevated in renal disease and muscle dystrophy as well
  • A sensitive marker for unstable angina
  • Uses plasma for qualitative detection
A

Troponin T

66
Q

Troponin T or I?

  • An inhibitory sub-unit or actin-binding sub-unit
  • The gold standard for AMI
  • Only found in the myocardium (greater specificity)
  • A very sensitive indicator for minor cardiac necrosis
A

Troponin I

67
Q

Troponin T or I?

Elevation: 3-4 hours
Peak: 10-14 days
Decline: 7 days

A

Troponin T

68
Q

Troponin T or I?

Elevation: 3-6 hours
Peak: 12-18 hours
Decline: 5-10 days

A

Troponin I

Clinical Chemistry (CC 1) (22 decks)

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