MARKERS OF INFLAMMATION, HEART FAILURE AND COAGULATION DISORDERS Flashcards
Heart disease
Approximately _______ cases of MI occur annually in the United States.
1.5 million
Heart disease
Increasing prevalence in Nigeria and Africa
In UBTH – __/______ patients (1998 – 2007 V.A Joseph)
In Aminu Kano Teaching Hospital from 2000 – 2005. Prevalence of CVS diseases –___%
4/1,000
20
Symptoms of Heart Disease
There are ——- classic symptoms of heart disease that, if recognized early, can aid in the accurate and early diagnosis of heart disease.
seven
all individuals with heart disease will experience symptoms
T/F
F
It is important to note that not all individuals with heart disease will experience symptoms
all people who experience the 7 seven symptoms will have heart disease.
T/F
F
not all people who experience symptoms will have heart disease.
List the 7 classic symptoms of heart disease
Dyspnea
Cyanosis
Chest pain
Palpitations
Syncope
Edema
Fatigue
Symptoms of Heart Disease
Dyspnea is a medical term used to describe __________
There are three basic types of dyspnea:
________,_________,_________
shortness of breath.
cardiac, pulmonary, and psychological.
earliest and most common symptom of heart disease is ________, aka ___
shortness of breath
Dyspnea
Symptoms of Heart Disease
Angina
Angina pectoris, also known as angina, is ______________
It is described as _______ or ______ felt ______ or _____ within the chest.
chest pain from the heart.
griping or crushing central chest pain
around or deep
_______ is the second most common symptom of heart disease.
Chest pain
all chest pain is due to heart disease
T/F
F
However, not all chest pain is due to heart disease as it may originate from other chest structures, a chest muscle or from organs below the chest.
Angina
The pain may radiate to the ____ or ____ , less commonly to the _____ or ____ , and is associated with pain in _______(usually _____) ______
neck or jaw
back or abdomen
one (usually the left) or both arms.
Angina is most often caused by _____ (restriction of blood supply to the heart) due most commonly to ______ disease.
ischemia
coronary artery
Angina is usually worsened by ______ and relieved by ____.
exercise
rest
Symptoms of Heart Disease
Palpitation is the term used to describe the _____________
awareness one has of their own heartbeat.
Symptoms of heart disease
Syncope is the term used to indicate _______ or the ________.
fainting or the sudden loss of consciousness
Syncope may be caused by a number of conditions that result in the _________________________.
deprivation of oxygen and blood to the brain
The most common cardiovascular cause of syncope is __________(______ ).
Without warning, the patient _______ with a ______________ pulse and, after a ______, recovers.
an irregular heartbeat
arrhythmia
falls to the ground
slow or absent; few seconds
Symptoms of Heart Disease
Edema refers to the _______ around the ankles, legs, eyes, chest wall, or abdominal wall due to the _____ of ______ or _______ in the cells of the tissues.
swelling of tissue
retention of water or lymph fluid
The edema associated with heart disease is often present in the morning
T/F
With reason
F
absent
as fluid is reabsorbed while lying down
The edema associated with the heart is progressively worse during the day.
T/F
T
Symptoms of Heart Disease
Cyanosis is a term used to describe a ________ of the skin and is caused by an increased amount of _________ in the blood due to ______.
bluish discoloration
non oxygenated hemoglobin
dyspnea
Cyanosis becomes apparent when ___g/dl or more of reduced hemoglobin is present.
5
Inflammation and Coagulation Disorders
Markers of inflammation are used for assessment of risk of developing these disorders.
T/F
T
Inflammation plays a role in atherogenesis, atherosclerosis, plaque formation and acute coronary syndrome.
T/F
T
The markers of inflammation include ______________(hsCRP), _______________ (PAPP-A) and ________________ (Lp-PLA2).
high sensitivity C-reactive protein
pregnancy associated plasma protein A
lipoprotein associated phospholipase A2
High-Sensitivity C-Reactive Protein
hsCRP is one of the most extensively studied proposed markers of inflammation
T/F
T
______ marker of inflammation Has some controversy regarding its clinical use, but appears to be the most promising to date.
High-Sensitivity C-Reactive Protein
hsCRP
High-Sensitivity C-Reactive Protein
hsCRP
CRP is _______ protein produced by the ____ in response to _____,_____, and _____
an acute-phase ; liver
injury, infection, and inflammation.
CRP
a (general or specialized?) (specific or nonspecific?) marker of inflammation
Has (low or high?) predictive value for coronary artery disease in the healthy population.
General
Nonspecific
High
Epidemiologic data document a positive association between hsCRP and the prevalence of coronary artery disease.
T/F
T
High-Sensitivity C-Reactive Protein
Elevated baseline levels of hsCRP are correlated with higher risk of ______________________ among those with and without clinical evidence of _______
future cardiovascular morbidity and mortality
vascular disease.
High-Sensitivity C-Reactive Protein
In patients with established vascular disease, each standard deviation increase in baseline hsCRP is associated with a ___% increase in relative risk of _______ or _________ over 2 years of follow-up.
45
nonfatal MI or sudden cardiac death
High-Sensitivity C-Reactive Protein
hsCRP only demonstrates prognostic capacity in those who have a diagnosis of vascular disease.
T/F
also demonstrates prognostic capacity in those who do not yet have a diagnosis of vascular disease.
High-Sensitivity C-Reactive Protein
hsCRP
A mild elevation of baseline levels of hsCRP among apparently healthy individuals is associated with __________________________ events.
higher long term risk for future cardiovascular
High-Sensitivity C-Reactive Protein
hsCRP
It’s predictive capacity offers patients the ability to receive treatment to reduce _____ and, thus, their risk.
inflammation
Pregnancy-Associated Plasma Protein A
PAPP-A is a ____-binding protein found in high serum concentrations of women in ( early or advanced?) stages of pregnancy.
zinc
Advanced
Pregnancy-Associated Plasma Protein A
PAPP-A was recently identified as a major contributor to the progression of ________ by _______et al., who found high levels of PAPP-A in the cells and extracellular matrix of _____ from patients who died suddenly of cardiac causes.
atherosclerosis
Bayes-Genis ; plaques
Pregnancy-Associated Plasma Protein A
PAPP-A
These researchers also found high concentrations of PAPP-A in (stable or unstable?) plaques compared with (stable or unstable ?) plaques.
Unstable
Stable
Lipoprotein-Associated Phospholipase A2
LP-PLA2, also known as ______ factor ________, is an enzyme associated with the (small or large?) , (light or dense?) LDL cholesterol particles, which are pathogenic and readily undergo ____ modification.
platelet-activating; acetyl hydrolase
Small; dense; oxidative
Lipoprotein-Associated Phospholipase A2
circulates mainly bound to _____ and ___, and studies have shown that elevated LP-PLA2 values are associated with an increased risk for _____ and _____
LDL and HDL
heart disease and stroke.
Lipoprotein-Associated Phospholipase A2
When analysed with ____, it was shown to have an ____ effect of increasing risk for CVD.
CRP
additive
INFLAMMATION AND CARDIOVASCULAR DISEASE
Atherosclerosis
Deposition of ______ in the _____ of blood vessels which protrude into and obstruct vascular lumens and weaken the vessels.
fibrofatty plaques
intima
pathogenesis of atherosclerosis
STAGE 1
______ formation.
These are the earliest lesions of atherosclerosis. It is initiated by focal
increases of ____ containing ____ in the ___ of the vessels.
Fatty steak; apo B ; lipoproteins; intima
pathogenesis of atherosclerosis
•
Fatty steak formation.
The vascular endothelium induces cytokine release to the presence of the chemically modified lipoprotein particles within the intima of the blood vessels.
The cytokines; ________ and ______, mediate ________________ to the site of the lesion.
These cytokines also regulate the expression of ________ leading to further leukocyte recruitment.
interleukins 6 and tumour necrosis factor-alpha
mononuclear leukocyte migration
adhesion molecules
pathogenesis of atherosclerosis
Stage2
_______ formation
In the intima, the mononuclear phagocytes differentiate into ______ that take up the ________ particles by endocytosis and transform into _____ laden _____ cells
Foam cell
macrophages
modified lipoprotein
lipid laden foam cells.
pathogenesis of atherosclerosis
Foam cell formation
The foam cells further elaborate _______ and _______ that contribute to plaque evolution.
cytokines and growth factors
pathogenesis of atherosclerosis
Stage 3
______ evolution
Inflammatory cytokines secreted by the modified macrophages;____ and ____ and _______ from activated T-lymphocytes, contribute to atherogenesis.
Atheroma
IL-1, TNF- alpha; interferon-gamma
pathogenesis of atherosclerosis
Atheroma evolution
The evolution of the fatty streak to the complex fibrofatty atherosclerotic lesion is as a result of _______ recruited into the ______ from the ____ of the blood vessel by products of the _________
smooth muscle cells
intima
Media; modified macrophages.
pathogenesis of atherosclerosis
Atheroma evolution
The smooth muscle cells elaborate ______ which contribute to the growth of the atheroma.
extracellular matrix
Testing the Inflammatory Hypothesis of Atherosclerosis
Inflammation plays a major role in heart attack and stroke, and patients with elevated inflammatory biomarkers such as high sensitivity C- reactive protein (hsCRP) have increased vascular risk. Yet, it remains unknown whether ________ will reduce the risk of recurrent heart attack and stroke for our patients.
direct inhibition of inflammation
Markers of Congestive Heart Failure
The natriuretic peptides (NPs) are a group of hormones that include _________ (ANP), ______ (BNP), _________ (CNP), and ________ (DNP).
atrial natriuretic peptide
B-type natriuretic peptide
C-type natriuretic peptide
D-type natriuretic peptide
The Natriuretic peptides play an important role in the regulation of cardiovascular homeostasis.
T/F
T
__NP and the ______ fragment of its prohormone (______) are released on _____ stretch or stress to the myocytes in the (presence or absence?) of necrosis.
B
terminal ; NT-proBNP
ventricular
Absence
Markers of Congestive Heart Failure
Therefore, BNP is _____eased in diseases characterized by an expanded fluid volume (e.g., renal failure, hepatic cirrhosis, primary aldosteronism, and congestive heart failure)
These conditions are characterized by (enhanced or reduced?) renal clearance of peptides or stimulation of peptide production.
Incr
Reduced
BNP and not NT-proBNP work well in diagnosing heart failure
F
Both BNP and NT-proBNP
BNP and NT-proBNP are of prognostic value in patients with acute coronary syndromes.
T/F
T
Markers of Congestive Heart Failure
BNP has a circulating half-life of _______, so it is indicative of a ______ of myocardial function, while NT-proBNP circulates approximately ______, giving a (shorter or longer?) view of myocyte function.
20 minutes; snapshot; 1.5 hours
Longer
Role of Laboratory in Monitoring Heart Disease
The laboratory’s role in monitoring heart function primarily involves measuring the _________ on ________ such as the lungs, liver, and kidney.
effects of the heart on other
organs,
Arterial blood gases measure the patient’s _______ and _____ status and are used to determine the respiratory (acidosis or alkalosis?) and elevated ________ levels that are often seen in
patients with heart disease
acid-base and oxygen
acidosis
carbon dioxide
Role of Laboratory in Monitoring Heart Disease
Decreased cardiac output results in sodium ________ by the kidneys but also causes increased fluid ______
therefore, the serum sodium level generally ____________ or may be _________.
retention
retention
remains within the reference ranges
slightly decreased
Serum electrolyte determinations, including _____,_____,_____ and ______ are important to monitor diuretic and drug therapy in patients with heart disease.
sodium, potassium, chloride, and calcium
Role of Laboratory in Monitoring Heart Disease
Elevations of ____,_______, and _____ are often seen in patients with chronic right ventricular failure, and the - ________value may be twice the
value of the upper limit of the normal range in CHF, suggesting ______ congestion and damage.
AST, alanine aminotransferase (ALT),
and alkaline phosphatase (ALP)
glutamyltransferase (GGT)
liver
Role of Laboratory in Monitoring Heart Disease
Lipid evaluation will assess risk for _______ disease. Maintenance of near-normal ________,________, and _______ levels is highly recommended for cardiac patients.
coronary artery
HDL cholesterol, LDL
cholesterol, and triglyceride
AST is found in the _____ of the liver
ALT is found in the ______ of the liver
Mitochondria
Cytosol
Alcohol affects the _____ of the liver
Viral hepatitis affects the ______ of the liver
Mitochondria
Cytosol
________ ACP is the most tartarate labile
Prostatic
Ig__ is the gamma globulin that can cross the placental barrier
G
Cancer of the _____ can cause obstructive jaundice
Head of pancreas
Which type of diabetes mellitus, is there weight loss
Type1
Classical symptoms of tipe 1 DM is ??
Polyuria
Polydispsia
Polyphagia
Clotting factors test can be used to test the functioning of the liver
T/F
T
Types of headaches
________
_______
__________
Tension
Cluster
Migraines
Clinical features of stroke
______ speech
________
_________ eyelids
_____ levels on __________ scale (less than ____)
Slurred
Paralysis
Drooping
Low; Glasgow coma; 3
Spironolactone causes _______ and _______
Side effects of methyl dopa is _______
Loop diuretic causes _____
Hyperkalemia and gynecomastia
Hemolytic Anaemia
Ototoxicity
CNP is produced in the ??
Ventricle
_______ is the commonest cause of heart disease
_______ is the commonest cause of heart failure
Dyspnoea
Edema
