Lab findings in Heart Disease Detection/Management Flashcards
where is ANP found?
in atrium of heart
what peptide found in atrium
ANP
where is BNP found
in ventricles of heart
what peptide found in ventricles of heart
BNP
where is CNP found
in endothelium
what peptide found in endothleium
CNP
when is BNP released?
1) ventricular stretch
2) incr volume in ventricle
what do BNP levels correlate with?
1) LV EDP
2) NYHA classif
3) HF dx in 55+ y/o
in which patient groups are BNP levels elevated?
1) women, elderly
2) renal insufficiency
crackles in lung indicates
1) pulm edema
2) interstitial lung disease
3/6 systolic ejection murmur indicates…
mitral regurg
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
1) congestive heart disease (pulm edema)
2) mitral stenosis (murmur)
3) aortic stenosis (murmur)
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
1) ecg
2) cmp
3) bnp
4) echo
pacemaker signs on ECG
atrial = RA ventricular = RV
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
systolic cardiomyopathy
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
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
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
1) echo
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)
mitral stenosis caused by rheumatic heart disease
posterior leaflet doesn’t move
anterior leaflet moves like hockey stick
if HR response and BP response normal with exercise induced stress test, this indicates what?
negative for exercise stress induced ischemia
why would you look at RCA first if you have blockage in LAD
1) see if any additional blockage in RCA
2) look for collateral flow to compensate for lack of anterograde flow on left
tests for
1) 26 y/o m
2) hx chronic renal failure, tobacco + FHx
3) chest pain x9 mo
4) stress test
1) exercise stress test
2) coronary angiography if stress abnormal
Cardiac enzymes
Troponin (I and T)
proteins in actin-myosin interaction
released into blood with myocyte necrosis
when is trop released
myocyte necrosis
timeline of trop release
within 3-12 hrs
peak 18-24
elevated longer
when can troponin be elevated for prolonged time?
renal failure
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
1) myocardial infarction
2) unstable angina
3) aortic aneurysm/dissection
4) pulmonary embolism
5) pneumothorax
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
1) ecg
2) troponin and creatinine
3) cath lab w/n 20 min
coronary angiography
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
yes, because not long enough for sufficient myocyte death for troponin rise
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
2) unstable angina
3) GERD, ulcer, cholecystitis
4) pulmonary infection, PE, pneumothorax
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
1) ecg- lateral ischemia
2) troponin 1 and creatinine
3) coronary angiography
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
go to cath lab even if still NSTEMI
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
1) angina or exercise induced ischemia (d/t sx with exercise)
2) could be heart failure
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
1) reversible perfusion study with exercise
–> shows decr blood to mid anterior, apical
due to LAD obstruction
