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Fundamentals of P > Laboratory Investigation of Cardiac Disease > Flashcards

Laboratory Investigation of Cardiac Disease Flashcards

1
Q

Analytical Characteristics of ideal biomarkers

A

Analytical Characteristics

  • Measurable by cost-effective method
  • Simple to perform
  • Rapid turnaround time
  • Sufficient precision & accuracy
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2
Q

Clinical Characteristics of ideal biomarkers

A

Clinical Characteristics

  • Early detection of disease
  • Sensitivity vs specificity
  • Validated decision limits
  • Selection of therapy
  • Risk stratification
  • Prognostic value
  • Ability to improve patient outcome
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3
Q

Cardiovascular Disease - list linked pathologies

A

Umbrella term for a number of linked pathologies including:

coronary heart disease (CHD) 
cerebrovascular disease
peripheral arterial disease
rheumatic and congenital heart diseases 
venous thromboembolism
lymphatic disease
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4
Q

Atherogenesis can be divided into five key steps,

describe effect

A

Atherogenesis can be divided into five key steps, which are

1) endothelial dysfunction,
2) formation of lipid layer or fatty streak within the intima,
3) migration of leukocytes and smooth muscle cells into the vessel wall,
4) foam cell formation
5) degradation of extracellular matrix.
- Via these consecutive steps, an atherosclerotic plaque is formed.

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5
Q

The formation of the plaque can be divided into three major stages

A

The formation of the plaque can also be divided into three major stages namely

1) the fatty streak, which represents the initiation
2) plaque progression, which represents adaption
3) plaque disruption, which represents the clinical complication of atherosclerosis

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6
Q

Initiation of atherosclerosis

A

Endothelial activation:
LDL penetrates endothelium + retained in intima = oxidative modification

Proinflammatory lipids released from LDL stimulate endothelial cells to express adhesion molecules

Circulating monocytes adhere to endothelial cells expressing VCAM-1 + other adhesion molecules

.. respond to chemokines and migrate into intima

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7
Q

Consequences of coronary thrombosis

A

Ischaemia
Necrosis
Myocardial infarction

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8
Q

Angina cause

A

Plaque w/fibrous cap

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9
Q

Acute coronary syndrome cause

A

Plaque w/fibrous cap - ruptures

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10
Q

Heart attack cause

A

Blood clot forms around rupture = artery blocked

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11
Q

Some causes of chest pain

A 
Broken rib
Collapsed lung
Nerve infection (shingles)
“Pulled” muscle
Infection
Heart burn (hernia)
Pericarditis
Blood clot in the lungs (PE)
Angina
Myocardial infarction
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12
Q

Assessment of ischemic heart disease (IHD)

A 
Medical history
 Risk factors
 Presenting signs and symptoms
 ECG
 Biomarkers
 Imaging/scans
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13
Q

Biochemical markers of cardiac dysfunction/damage can contribute to:

A 
Rule in/out an acute MI 
Confirm an old MI 
Help to define therapy 
Monitor success of therapy 
Diagnosis of heart failure 
Risk stratification of death
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14
Q

30 minutes of ischaemia effect

A

Irreversible injury typically requires 30 minutes of ischaemia

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15
Q

Cellular content leak dependent on what

A

Cellular content leak out through membrane dependent on size and solubility

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16
Q

What improves detection of early damage

A

Concentration gradient from inside to outside important (high gradient improves detection of early damage)

17
Q

Markers of myocardial damage

A

7-36 h peak after MI
Heart muscle specific markers troponin-T and troponin-I
Creatine kinase (↑ 90% MIs, but less specific as also released from skeletal muscle)
Heart specific isoforms of creatine phosphokinase (CPK-MB
Myoglobin raised early but less specific for heart damage

18
Q

The troponin complex - define

A

The troponin complex is a component of the thin filaments in striated muscle complexed to actin

19
Q

Troponin types

A

Troponin T (tropomyosin binding)
• Troponin I (inhibits actomyosin ATPase)
• Troponin C (calcium binding)
The troponins are three different proteins structurally unrelated with each other

Cardiac troponin T and I differ significantly from troponin T and I found in skeletal muscle

20
Q

Advantages of cardiac troponin

A

An index of cardiac damage
Blood levels related to severity of cardiac damage
Predicts major adverse cardiac events such as myocardial infarction

21
Q

Heart Failure - define

A

“a complex clinical syndrome
that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood”

22
Q

Some major causes of heart failure

A 
Coronary Artery Disease 
Chronic Hypertension 
Cardiomyopathy 
Heart Valve Disease 
Arrhythmias- AF,VT 
Infective endocarditis 
Pulmonary Hypertension- PE, COPD 
Alcohol and Drugs (eg cocaine)
23
Q

Signs and symptoms of congestive heart failure

A 
Shortness of breath
Swelling of feet/legs
Chronic lack of energy 
Difficulty sleeping at night due to breathing problems 
Swollen/tender abdomen with loss of appetite 
Cough with frothy sputum
Increased urination at night 
Confusion/impaired memory
24
Q

Clinical utilisation of cardiac biomarker testing in heart failure

A

Initial evaluation of heart failure
Screening for cardiac dysfunction
Guiding management of heart failure
Assessment of prognosis and survival

25
Q

Natriuretic peptides function

A

Natriuretic peptides as markers of cardiac overload

26
Q 
ANP
Source
Main effects
Secretion stimulus 
Function
A

Synthesised as HMW precursor forms

Source = Atrium
Main effects = CNS effects
Secretion stimulus = atrial stretch
Function = endocrine

27
Q 
BNP
Source
Main effects
Secretion stimulus 
Function
A

Synthesised as HMW precursor forms

Source = ventricle
Main effects = vasorelaxant
Secretion stimulus = ventricular dilatation
Function = endocrine

28
Q 
CNP
Source
Main effects
Secretion stimulus 
Function
A

Synthesised as HMW precursor forms

Source = endothelial
Main effects =

Natriuretic
Vasorelaxant
RAAS inhibition

Secretion stimulus = ?
Function = paracrine

29
Q

Assays available for what forms of peptides

A

Assays available for the active peptides and the N-terminal precursor forms of BNP

30
Q

Advantages of N-terminal precursor forms of BNP

A

Longer half-life
Higher plasma concentrations
Less sensitive to rapid fluctuations

31
Q

Some conditions investigated for possible use of plasma BNP

A

Assessment of severity of congestive heart failure
Screening for mild heart failure
Monitor response to treatment in congestive heart failure
Prognostic outcome/risk stratification

Fundamentals of P (62 decks)

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