Lab findings in Heart Disease Detection/Management

Question 1

where is ANP found?

Answer 1

in atrium of heart

Question 2

what peptide found in atrium

Answer 2

ANP

Question 3

where is BNP found

Answer 3

in ventricles of heart

Question 4

what peptide found in ventricles of heart

Answer 4

BNP

Question 5

where is CNP found

Answer 5

in endothelium

Question 6

what peptide found in endothleium

Answer 6

CNP

Question 7

when is BNP released?

Answer 7

1) ventricular stretch

2) incr volume in ventricle

Question 8

what do BNP levels correlate with?

Answer 8

1) LV EDP
2) NYHA classif
3) HF dx in 55+ y/o

Question 9

in which patient groups are BNP levels elevated?

Answer 9

1) women, elderly

2) renal insufficiency

Question 10

crackles in lung indicates

Answer 10

1) pulm edema

2) interstitial lung disease

Question 11

3/6 systolic ejection murmur indicates…

Answer 11

mitral regurg

Question 12

DDX for

1) 68 y/o m
2) hx of CAD, HTN, tobacco, CABG
3) 3 mo incr SOB, fatigue, incr edema, sleep on pillow
4) NO CHEST PAIN,
5) 104/60 BP, HR 98
6) crackles, S4+S3, 3/6 systolic apex to axilla
enlarge liver, edema

Answer 12

1) congestive heart disease (pulm edema)
2) mitral stenosis (murmur)
3) aortic stenosis (murmur)

Question 13

Tests for

1) 68 y/o m
2) hx of CAD, HTN, tobacco, CABG
3) 3 mo incr SOB, fatigue, incr edema, sleep on pillow
4) NO CHEST PAIN,
5) 104/60 BP, HR 98
6) crackles, S4+S3, 3/6 systolic apex to axilla
enlarge liver, edema

Answer 13

1) ecg
2) cmp
3) bnp
4) echo

Question 14

pacemaker signs on ECG

Answer 14

atrial = RA
ventricular = RV

Question 15

what does pt have

1) 68 y/o m
2) hx of CAD, HTN, tobacco, CABG
3) 3 mo incr SOB, fatigue, incr edema, sleep on pillow
4) NO CHEST PAIN,
5) 104/60 BP, HR 98
6) crackles, S4+S3, 3/6 systolic apex to axilla
enlarge liver, edema

Answer 15

systolic cardiomyopathy

Question 16

DDX for

1) 42 y/o female
2) hx of SLE
3) dyspnea w/ exertion
4) failed stress test with Bruce 1 y ago
5) BP 98/60
6) 2/6 systolic at left lower sternal border + apex
2/6 early diastolic rumble at apex

Answer 16

1) left heart failure (dyspnea on exertion)

2) valvular defect (tricuspid regurg unlikely)
- mitral regurg –> can cause LV failure but less liekley than mitral stenosis –> most likely

3) emphysema, COPD, PE

Question 17

Tests for

1) 42 y/o female
2) hx of SLE
3) dyspnea w/ exertion
4) failed stress test with Bruce 1 y ago
5) BP 98/60
6) 2/6 systolic at left lower sternal border + apex
2/6 early diastolic rumble at apex

Answer 17

1) echo

Question 18

what does she have?

1) 42 y/o female
2) hx of SLE
3) dyspnea w/ exertion
4) failed stress test with Bruce 1 y ago
5) BP 98/60
6) 2/6 systolic at left lower sternal border (tricuspid regurg) + apex (mitral regurg)
2/6 early diastolic rumble at apex (mitral stenosis)

Answer 18

mitral stenosis caused by rheumatic heart disease

posterior leaflet doesn’t move
anterior leaflet moves like hockey stick

Question 19

if HR response and BP response normal with exercise induced stress test, this indicates what?

Answer 19

negative for exercise stress induced ischemia

Question 20

why would you look at RCA first if you have blockage in LAD

Answer 20

1) see if any additional blockage in RCA

2) look for collateral flow to compensate for lack of anterograde flow on left

Question 21

tests for

1) 26 y/o m
2) hx chronic renal failure, tobacco + FHx
3) chest pain x9 mo
4) stress test

Answer 21

1) exercise stress test

2) coronary angiography if stress abnormal

Question 22

Cardiac enzymes

Troponin (I and T)

Answer 22

proteins in actin-myosin interaction

released into blood with myocyte necrosis

Question 23

when is trop released

Answer 23

myocyte necrosis

Question 24

timeline of trop release

Answer 24

within 3-12 hrs
peak 18-24

elevated longer

Question 25

when can troponin be elevated for prolonged time?

Answer 25

renal failure

Question 26

ddx for

1) 45 y/o m acute onset chest pain
2) squeezing left sided, + SOB, + diaphoresis
3) no radiation, n/v
4) no PMHx
5) smoke 1 pack/day, father had MI in 40s
6) 120/82 BP, normal exam

Answer 26

1) myocardial infarction
2) unstable angina
3) aortic aneurysm/dissection
4) pulmonary embolism
5) pneumothorax

Question 27

plan for

1) 45 y/o m acute onset chest pain
2) squeezing left sided, + SOB, + diaphoresis
3) no radiation, n/v
4) no PMHx
5) smoke 1 pack/day, father had MI in 40s
6) 120/82 BP, normal exam

Answer 27

1) ecg
2) troponin and creatinine
3) cath lab w/n 20 min
coronary angiography

Question 28

if patient’s troponin didn’t rise would that still mean MI?

1) 45 y/o m acute onset chest pain
2) squeezing left sided, + SOB, + diaphoresis
3) no radiation, n/v
4) no PMHx
5) smoke 1 pack/day, father had MI in 40s
6) 120/82 BP, normal exam

Answer 28

yes, because not long enough for sufficient myocyte death for troponin rise

Question 29

DDX for

1) 53 y/o female w/ chest pain x5 become constant
2) worse with move, walk, eat
3) radiate to L arm
4) No PMHX
5) + FHx CAD
6) BP 160/80, HR 101, normal exam

Answer 29

2) unstable angina
3) GERD, ulcer, cholecystitis
4) pulmonary infection, PE, pneumothorax

Question 30

tests for

1) 53 y/o female w/ chest pain x5 become constant
2) worse with move, walk, eat
3) radiate to L arm
4) No PMHX
5) + FHx CAD
6) BP 160/80, HR 101, normal exam

Answer 30

1) ecg- lateral ischemia
2) troponin 1 and creatinine
3) coronary angiography

Question 31

if trop elevated what would you do

1) 53 y/o female w/ chest pain x5 become constant
2) worse with move, walk, eat
3) radiate to L arm
4) No PMHX
5) + FHx CAD
6) BP 160/80, HR 101, normal exam

Answer 31

go to cath lab even if still NSTEMI

Question 32

DDX for

1) 56 y/o m
2) 1 month of exertional chest fullness 3-4x/week
3) fatigue with exertion
4) PMHx HTN, dyslipidemia
5) on asa, HCTZ, statin
6) BP 135/85
7) ECG NORMAL

Answer 32

1) angina or exercise induced ischemia (d/t sx with exercise)
2) could be heart failure

Question 33

tests for

1) 56 y/o m
2) 1 month of exertional chest fullness 3-4x/week
3) fatigue with exertion
4) PMHx HTN, dyslipidemia
5) on asa, HCTZ, statin
6) BP 135/85
7) ECG NORMAL

Answer 33

1) reversible perfusion study with exercise
–> shows decr blood to mid anterior, apical
due to LAD obstruction