Week 4-Diagnostic Cardiac Blood Tests Flashcards
PART 1
PART 1
What are some risk factors for CHD (coronary heart disease)? (13)
- ) Age
- ) Family Hx
- ) Male
- ) HTN
- ) Elevated total cholesterol
- ) Uncontrolled diabetes
- ) Smoking/Alcohol
- ) Physical inactivity
- ) Obesity (BMI >25)
- ) Postmenopausal
- ) High C-reactive protein
- ) Uncontrolled stress
- ) Poor diet
A blood lipid profile gives the results for what (5) things?
- Total cholesterol
- HDL
- LDL
- vLDL
- Triglycerides
List the total cholesterol classifications.
- Desireable = <200mg/dL
- Borderline High = 200-239mg/dL
- High = >240mg/dL
What are desirable HDL levels for men/women?
- Men = 40-60mg/dL
- Women = 50-60mg/dL
What are desirable LDL levels?
<100mg/dL (less is better)
What is the difference between LDL and HDL?
- HDL = good, LDL = bad
- This is because HDL carries cholesterol to your liver, where it can be removed from your bloodstream before it builds up in your arteries. LDL, on the other hand, takes cholesterol directly to your arteries.
Can aerobic exercise increase HDL concentrations?
Yes
Describe the process of LDL formation into atherosclerotic plaque. (6)
- ) LDLs can invade tunica interna of vessels (atheroma).
- ) WBCs (macrophages) move into area and establish low-grade inflammatory situation.
- ) Smooth muscle cells proliferate and enter this area.
- ) Fibrous CT accumulates.
- ) Macrophages attracted to the area.
- ) Forms swelling in artery (ATHEROSCLEROTIC PLAQUE)
Is LDL directly measurable? What do we do?
No
-Calculate from (LDL = total - HDL - triglyceride/5)
What are the (2) major types of triglycerides?
- Saturated Fats
- Unsaturated Fats
- __________ Fats = Fat molecules that have no double bonds between carbon molecules because they are saturated with hydrogen molecules.
- __________ Fats = Fat molecules in which there are one or more double bonds in the fatty acid chain.
- Which is liquid at room temp and which is solid at room temp?
- Saturated Fats (solid)
- Unsaturated Fats (liquid)
- Trans and Cis Fatty Acids are 2 types of __________ Fats.
- Which is naturally occurring and generally good for health?
- Unsaturated
- Cis
Triglyceride Ranges:
- Normal = ___
- Borderline High = ___-___
- High = ___-___
- Very High = >___
- Normal = <150
- Borderline High = 150-199
- High = 200-499
- Very High = >500
- What is the formula for cholesterol ratio?
- The lower this ratio, the _______ your risk of heart disease.
- Recommendations are to keep this ratio to _______.
- total cholesterol/HDL
- lower
- 5 or less
Cholesterol Testing:
- Screen all men >___yo.
- Screen all women >___yo.
- How often is cholesterol screening performed?
- Children/adolescents should be checked between __-__ and again at __-__.
- men >35
- women >45
- Every 5 years, or more frequent based on results and risk profile.
- 9-11, 17-21
What are some pharmacological management drugs of blood lipid profile? (3)
- Statins
- Niacin (OTC)
- PCSK9 inhibitors
Statins:
- What is a big side effect of statins?
- Are muscle symptoms more widespread and intense with exercise?
- Do muscle symptoms usually resolve after cessation of statin therapy?
- Statin Induced Myopathy (can lead to rhabdomyolysis)
- Yes
- Yes
Niacin (OTC):
-Vitamin ____ as supplement to help lower cholesterol.
-Vitamin B3
PCSK9 Inhibitors:
- What do they do?
- Do they work better or worse in combination with statins?
- What is the big downside to these drugs?
- PCSK9 is an enzyme that binds to LDL receptors and stops LDL from being removed leading to increased levels of LDL. Inhibitors act to block this enzyme resulting in more LDL receptors to remove LDL from blood. (DECREASE LDL BLOOD LEVELS)
- After 1 year, PCSK9 w/ statins decreased LDL levels 60% lower than just statin group.
- Cost (12k/year)
PART 2: SERUM ENZYMES AND CARDIAC BIOMARKERS
PART 2: SERUM ENZYMES AND CARDIAC BIOMARKERS
List Cardiac Biomarkers. (3)
- CPK (Creatine Phosphokinase)
- Troponin
- Myoglobin
- ANP (Atrial Natriuretic Peptide)
- BNP (Brain Natriuretic Peptide)
- Fibrinogen
- CRP (C Reactive Protein)
What are the (3) types of Creatine Phosphokinase (CPK) and what are each used for?
- CPK-MB (most conclusive for myocardial injury)
- CPK-MM (most conclusive for skeletal muscle damage)
- CPK-BB (most conclusive for brain tissue injury
What are the (3) types of Troponin and their function?
- TnC (binds to calcium)
- TnI (inhibits interaction between actin/myosin)
- TnT (links troponin complex to tropomyosin)
- What may be the preferred biomarker for cardiac muscle damage?
- What are normal levels?
- Troponin
- Normal = 0-3 mg/mL
What is myoglobin?
A red protein containing heme, which carries and stores oxygen in muscle cells.
Myoglobin:
-Heme protein found in all muscle tissue.
-Recent potential diagnostic tool for acute _______.
-Can be detected as early as ________ after injury, peaks __-__ after injury.
What are normal values?
- acute MI
- 2 hours, 3-15 hours
- 25-72ng/mL
- ANP is a peptide hormone of cardiac origin which is released in response to atrial _________.
- It serves to maintain _______ homeostasis and limits activation of the _______ system.
- Results in vasodilation/diuresis leading to decreased preload/afterload which means ________ work load on the heart.
- ________ with increasing severity of HF.
- atrial distention
- sodium, RAAS (renin-angiotensin-aldosterone system)
- decreased
- increases
What is the gold standard measurement of heart failure?
BNP
BNP:
- What is the function?
- Produced in the ________ and released in response to excessive stretch on the heart muscle.
- What is the net effect?
- Maintain stable BP and plasma volume and to prevent excess salt/water retention
- ventricles
- decrease blood volume and BP, promote urine production
BNP Levels:
- Normal = ____pg/mL
- Chronic Cardiac Compensation = ___-___pg/mL
- Normal = <100 pg/mL
- Acute Cardiac Decompensation = >700 pg/mL
- Chronic Cardiac Compensation = 100-700 pg/mL
- What is the main function of Fibrinogen?
- If increased, there is an _________ risk for clot formation and experiencing a hemorrhagic stroke.
- Primary function is to occlude blood vessels (stop bleeding)
- increased
- The level of CRP (C Reactive Protein) is ________ in inflammatory states.
- ______ hs-CRP levels associated with lower survival rates in patients with CAD.
- increased
- elevated
High levels of ______ and CRP related to increased risk of CV events.
-total/HDL and CRP
- Lipoprotein A is a subclass, high levels are associated with ____________.
- Has _________ and _________ effect.
- atherosclerosis
- atherogenic and prothrombic
Serum Creatinine:
1
