Wk 6: Cardio + pulm highlights Flashcards
Cholesterol + triglycerides = what?
Lipids
True or false: HDL and LDL are lipoproteins
True
List 4 things included in a lipid profile
1) Total cholesterol (TC)
2) Triglycerides (TGs)
3) High-Density Lipoprotein Cholesterol (HDL-C)
4) Low-Density Lipoprotein Cholesterol (LDL-C)
What is a desirable cholesterol value?
<200 mg/dL
_________removes lipids from endothelium and carries excess cholesterol to liver for elimination
HDL
What is good cholesterol?
HDL-C
1) Most cholesterol carried by LDL is deposited where?
2) What is this called?
3) High LDL-C levels are associated with what?
1) Into the lining of blood vessels
2) Atherogenic
3) Increased ASCVD risk
What is the goal LDL for normal risk pts?
<100 mg/dL
-“Normal” value is <130 mg/dL; however, the lower the better to reduce ASCVD risk
1) LDL-C is often a ___________ value based on formulas using other lipid profile values (sometimes directly measured)
2) What can make LDL calculations inaccurate?
1) calculated
2) High triglyceride levels
What is the goal TG level?
<150 mg/dL
Severe hypertriglyceridemia (>500 mg/dL) can cause _____________.
acute pancreatitis
List the approximate desirable values for most pts (mg/dL):
1) Total cholesterol
2) Triglycerides
3) LDL-C
4) HDL-C
1) Total cholesterol: <200
2) Triglycerides: <150
3) LDL-C: <100
4) HDL-C: >60
Cardiac Enzymes (Cardiac Biomarkers):
1) What are they used to assess?
2) What are some also used for?
1) Used to assess acute coronary syndromes (ACS)/cardiac ischemia
2) Some also used in diagnosis of skeletal muscle disease/injury
What 3 things are included in cardiac enzymes/ biomarkers?
1) Creatine (phospho)kinase (CK, CPK)
2) Myoglobin
3) Troponins
CK is most commonly used to diagnose and follow what?
Muscle disease/injury
Myoglobin is an oxygen binding protein in what muscle?
Cardiac and skeletal
Rhabdomyolysis can be detected by what?
Myoglobin
True or false: myoglobin is also elevated in skeletal muscle injury/ disease
True
Define myoglobinuria
Positive urine dipstick for “blood” (contains heme) but no RBCs on urine sediment microscopy (not hematuria)
“Sensitive”/“contemporary” assays rise when?
2-3 hours after injury
Troponins are:
1) Used to assess ____________ injury
2) Troponins are the preferred blood-based tests for evaluation of patients with suspected ________.
1) myocardial
2) AMI
1) True or false: Troponins have several advantages over CK-MB in AMI diagnosis
2) When do “Sensitive”/“contemporary” assays work?
3) What about “High sensitivity” (hs) TnT”?
1) True
2) 2-3 hours after injury
3) As early as 90 minutes after onset
1) BNP was discovered in brain tissue, but more appropriate name is ventricular natriuretic peptide. Why?
2) What are some effects of BNP?
1) Released primarily by ventricular myocytes when stretch receptors are triggered
2) Diuresis, natriuresis, and vascular smooth muscle relaxation (vasodilation)
1) BNP may be measured as plasma _________ or ____________ (reference ranges/diagnostic cut-offs are different)
2) What does increased BNP indicate?
1) BNP or N-terminal (NT)-рrοΒΝΡ (reference ranges/diagnostic cut-offs are different)
2) too much pressure in the ventricles (especially left)
B-Type Natriuretic Peptide (BNP) & NT-proBNP:
1) Useful as part of the evaluation of suspected_________________ when the diagnosis is uncertain
2) Can also provide ___________ information in pts with CHF/LV dysfunction
1) congestive heart failure (CHF)
2) prognostic
BNP in a dyspneic (SOB) pt in whom you are trying to differentiate CHF from a respiratory cause:
1) BNP <100 pg/mL indicates what?
2) Most dyspneic pt’s with HF have ΒΝΡ value of what?
1) HF is very unlikely as the cause of dyspnea
2) >400 pg/mL
Pleural effusions are categorized as ___________ or __________
transudative or exudative
What are the 4 most common causes of transudative PEs?
1) CHF
2) Cirrhosis (liver disease)
3) Nephrotic syndrome (kidney disease)
4) Hypoalbuminemia
What are the 3 most common causes of exudative pleural effusions?
1) Infection (e.g., bacterial pneumonia, TB)
2) Inflammation
3) Cancer
Are exudative pleural effusions usually bilat or unilat?
Unilat (transudative bilat)
1) Transudative effusions occur due to increased ____________ or decreased ________ pressures (with normal capillaries.
2) Exudative effusions occur due to increased _________________ (e.g., pneumonia, tumors) or impaired _______________ (e.g., sarcoidosis)
1) hydrostatic; oncotic
2) capillary permeability; lymphatic drainage
For transudative pleural effusions, list the:
1) Physiology
2) Local Pleural Disease (i.e., underlying lung pathology)
3) Lung(s) affected
4) Most common causes (4)
5) Typical pleural fluid analysis results
1) Due to increased hydrostatic or decreased oncotic pressures (with normal capillaries)
2) Usually absent
3) Usually bilateral (both lungs)
4) CHF, Cirrhosis (liver disease), Nephrotic syndrome (kidney disease), Hypoalbuminemia
5) Low cell/protein/LDH content, low specific gravity
For exudative pleural effusions, list the:
1) Physiology
2) Local Pleural Disease (i.e., underlying lung pathology)
3) Lung(s) affected
4) Most common causes
5) Typical pleural fluid analysis results
1) Due to increased capillary permeability (e.g., pneumonia, tumors) or impaired lymphatic drainage (e.g., sarcoidosis)
2) Usually present
3) Usually unilateral
4) Infection (e.g., bacterial pneumonia, TB), Inflammation, Cancer
5) High cell/protein/LDH content, high specific gravity
Pleural Fluid Analysis: What should you note first?
Gross appearance and odor
Fluid is considered exudative if at least one of the Light’s criteria is present; what are they?
1) Pleural fluid protein/serum protein ratio >0.5
2) Pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio >0.6
3) Pleural fluid LDH level >2/3 the upper limit of the laboratory’s reference range of serum LDH
If a pt meets Light’s criteria, is it exudative or transudative?
Exudative
