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26 Cards in this Set
- Front
- Back
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Contemporary cardiac biomarkers
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Troponin I or T (I at UNC)
creatine kinase MB B-type naturetic peptide hsC-reactive protein Lipids and lipoproteins |
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Most current universal definition of Acute MI
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detection of rise and/or fall of cardiac biomarker >99th percentile w/1 of folloing
-symptoms of ischemia -EKG (New ST-T changes) -Imaging (new loss of myocardium) -Angiography or autopsy |
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Which troponin is constant for all muscle types?
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Troponin C
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Which troponins are more cardiac specific?
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Trp I and Trp T
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Broadly speaking, what does inc TnT and TnI indicate?
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myocardial injury, does not indicate specific pathology
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Which CK is greatest in cardiac tissue?
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CK-MB (can indicate others, but think cardiac first)
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What is one way to differentiate CK-MB from skeletal injury v. cardiac injury?
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take relative index (CK-MB / CK x 100%)
Should be <5% if from skeletal muscle |
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When should cardiac biomarkers be collected?
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admission and 2-6h later
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What is the first cardiac biomarker seen?
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myoglobin (but not specific)
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Which cardiac-specific biomarker has the shortest half-life?
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CK-MB (clears in 1-2 days)
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How long do TnI/TnT remain elevated?
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extended time, perhaps 5-7 days
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Longest half-life of cardiac biomarkers
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TnT (7 days?)
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What should not be used during serum draw for lipid testing?
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heparin tube (activates lipoprotein lipase and falsely lower triglycerides)
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Serum becomes lipemic when?
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when TG exceed 250 mg/dL (chylos and VLDL refract light)
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Friedewald equation
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LDL = total chol - (HDL + TG/5)
TG must be <400 |
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What are acceptable levels for children for Total Chol and LDL?
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<170 total, <110 LDL
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Which has an inc relative risk for the same lipid concentration (LDL or total)?
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LDL
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How should lipoprotein subclasses be used?
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reserve for pts not clearly defined by routine testing
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Which HDL is more atheroprotective?
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HDL2 better than HDL3
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Which are more common, primary or secondary lipid disorders?
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secondary lipid disorders (like exogenous causes)
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Key biochemical marker of inflammation
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high sensitive C-reactive protein
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Generally, what does CRP do?
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activates classical complement pathway
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What is difference between CRP and hsCRP?
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same protein, difference in testing methods
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For hsCRP measurement, how should you test?
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2 weeks apart (at least 2 weeks after infection)
inc w/ smoking, high BMI, insulin resistance |
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For those unstable angina pts who have measureable cTN and CK-MB, how can you differentiate from STEMI/NSTEMI?
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They have slight to minimal persistent increases.
(level approx equal to risk of adverse event within 6-9mo) |
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Who else can have a measureable cTn?
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patients with renal disease (more pts with chronic kidneys dis die of CVD before developing ESRD)
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