Pharm 236 Ch 48

Front 1

_____________ is a complex clinical condition that occurs when the heart cannot pump enough blood to meet tissue needs for oxygen and nutrients.

Back 1

Heart Failure

Front 2

Impaired myocardial contraction during systole is called_____________

Back 2

Systolic dysfunction

Front 3

Impaired relaxation and filling of ventricles during diastole is called _________

Back 3

Diastolic dysfunction

Front 4

HF has also been referred to as congestive heart failure (CHF) because frequently there are congestion and _______ in the lungs and peripheral tissues.

Back 4

Fluid accumulation

Front 5

Most commonly used cardiotonic inotropic agents for short term management of acute severe agents for short term management of acute severe HF that is not controlled by digoxin, diuretics, and vasodilators.

Back 5

Milrinone IV (Primacor)

Front 6

First in its class of drugs to be used in the management of cute HF.

Back 6

Nesiritide (Natrecor)

Front 7

Antidysrhythmic local anesthetic agent used to decrease myocardial irritability

Back 7

Lidocaine

Front 8

The only commonly used digitalis glycoside

Back 8

Digoxin (Lanoxin)

Front 9

Digoxin binding antidote derived from antidigoxin antibodies produced in sheep.

Back 9

Digoxin immune Fab (Digibind)

Front 10

Discuss the primary causes of heart failure.

Back 10

At the cellular level HF stems from dysfunction of contractile myocardial cells and the endothelial cells that line the heart and blood vessels . Vital functions of the endothelial cells that line the heart and blood vessels. Vital functions of the edothelium include maintaining equilibrium between vasodilation and vasoconstriciton coagulation and anticoagulation and cellular growth processes that narrow the blood vessel lumen (ex buildup of artherosclerotic plaque growth cells, inflammation activation of platelets) and leads to blood clot formation and vasoconstriction that further narrow the blood vessel lumen. Theses are major factors in coronary artery disease and hypertension the most common conditions leading to HF

Front 11

Discuss the compensatory mechanism of heart failure involving neurohormones.

Back 11

As the heart fails the low cardiac output and inadequate filled arteries activate the neurohormonal system by several feed back mechanisms. One mechanism is increased sympathetic activity and circulating catechlamines (neurohormones) which increase the force of myocardial contraction increases heart rate and causes vasoconstriction. The effects of the baroreceptors in the aortic arch and carotid sinnus that normally inhibit undue sympathetic stimulation are blunted in patients with HF catecholamines are intensified. Ednothelin a neurohormone secreated primary by endotherial cells is the most potent endogenous vascoconstrictor and may exert direct toxic effects on the heart and result in myocardial cell proliferation.

Front 12

What are the symptoms of heart failure?

Back 12

Cardinal manifestations of HF are dyspnea and fatigue which can lead to exercise intolerance and fluid retention resulting in pulmonary congestion and peripheral edema. Patients with compensated (asymptomatic) HF usually have no symptoms at rest and no edema; dyspena and fatigue occur only with activities involving moderate or higher levels of exertion. Symptoms that occur with minimal exertion or at rest and are accompanied by ankle edema and distention of the jugular vein (from congestion of veins and leakage of fluid into tissues) reflect compensation (symptomtic HF). Acute severe cardiac decompensation (symptoms HF). Acute severe cardiac decompensation is manifested by pulmonary edema a medical emergency that requires immediate treatment. Two models currently exist for classification of HF. The New York Heart Association (NYHA) classifies HF based on functional limitations. A newer system of staging HF proposed by the American College of Cardiology (ACC) and the American Heart Association (AHA)

Front 13

What impact does the renin angiotensin aldosterone system have on congestive heart failure?

Back 13

Renin is an enzyme produced in the kidneys in response to impaired blood flow and tissue perfusion. When released into the blood stream renin stimulates the production of angiotensin II a powerful vasoconstrictor. Arterial vasoconstriction impairs cardiac function by increasing the resistance (afterload) against with the ventricle ejects blood. This raises filling pressures inside the heart increases stretch and stress on the myocardial wall and predisposes to subendocardial ischemia. In addition patients with severe HF have constricted arterioles in cerebral myocardial, renal, hepatic and mesenteric mascular beds. This results in increased diastolic ventricular filling pressures (preload). Angiotensin II also promotes sodium and water retention by stimulating aldosterone release from the adrenal cortex and the release of vasopressin (ADH) from the posterior pituitary gland.

Front 14

Define cardiac or ventricular remodeling

Back 14

Increased blood volume and pressure in the heart chambers; stching of muscle fibers; and dilation hypertrophy and changes in the shape of the heart make it contract less

Front 15

Mrs. White asks if she should administer digoxin 0.125mg daily on an empty stomach. How would you respond?

Back 15

Food my decrease digoxin absorption so should take it on an empty stomach. In addition to drug dosage forms other factors that may decrease digoxin absorption include the presence of food in the GI tract, delayed gastric emptying malabsorption syndromes and concurrent administration of some drugs (ex. antacids, cholestyramine).

Front 16

Mrs. White is stabilized on a tablet formation of digoxin. She asks if the physician can change the formulation to lanoxicaps, which may be easier to swallow. The physician changes the formulation and orders digoxin levels to be drawn at routine intervals. Why did the physician make this order.

Back 16

When digoxin is given orally absorption varies among available preparations . Lanoxicaps which are liquid filled capsules, and the elixir used for children are better absorbed than tablets. With tablets the most frequently used formulation differences in bioavailibility are also important because a person who is stabilized on one formulation may be under-dosed or overdosed if another formulation is taken. Differences are attributed to the rate and extent of tablet dissolution rather than amounts of digoxin.

Front 17

Mrs. White develops chronic renal failure. She returns to the physicians office for a routine visit. the morning before the visit she presents to the laboratory for assessment of her digoxin level. The level is 3. Based on this laboratory result what would you expect the physician to do?

Back 17

The physician will decrease the digoxin dose. Therapeutic serum levels of digoxin are 0.5 to 2 nanograms per mL (ng/mL); serum levels greater than 2ng/mL are toxic. In elderly patients and in the presence of renal failure, theraputic serum levles are 0.5 to 1.3ng/mL. Research in the past decade has suggested that serum levels of 1.0ng/mL or less are more appropiate in those wiht HF (see bridging the Gap with EBP). However, toxicity may occur at virtually any serum level. Dosage must be reduced in the presence of renal failure to prevent drug accumulation and toxicity, because most of the digoxin (60 to 70%) is excreted unchanged by the kidneys. The remainder is metabolized or excreted by non-renal routes.

Front 18

Discuss the teaching you would give Mrs. White concerning her digoxin prescription, including the reason that she is taking digoxin the on onset of action and peak effect of the drug, and the difference between IV and oral digoxin.

Back 18

In patients with atrial dysrhythmias digoxin shows the rate of ventricular contraction (negative chronitropic effect). With IV digoxin the onset of action occurs within 10 to 30 minutes, and peak effects occur in 1 to 5hrs. Digoxin is given orally or intravenously. Although it can be given IM this route is not recommended because pain and muscle necrosis may occur at injection sites. When digoxin is given orally the onset of action occurs in 30 mins to 2hrs, and peak occur in approximately 6hrs.

Front 19

Mrs. Pease digoxin level is 0.125. You understand that this level is which of the following?

a. Normal

b. Elevated

c. Toxic

d. Low

Back 19

d.

Rationale: The normal digoxin level is 0.5 to 2.0ng/mL. Serum levels greater than 2 ng/mL are toxic; however, toxicity may occur at any serum level.

Front 20

_________ toxicity is one of the most commonly encountered drug related reasons for hospitalization, because the drug has a narrow therapeutic index, and the end point of effective therapy is often difficult to define and measure.

Back 20

Digitalis

Front 21

Mr. Zander presents to your ER with signs and symptoms of acute congestive heart failure. Assessment findings and tests confirm the diagnosis. Which type of diuretic would be the drug of choice to treat the client?

a. Thiazide

b. Loop

c. Potassium sparing

d. Calcium wasting.

Back 21

b

Rationale: For acute HF the first drugs of choice may include an IV loop diuretic a cardiotonic inotropic agent (ex digoxin, dobutamine, milrinone), and vasodilators (ex. nitroglycerin and hydralazine or nitroprusside).

Front 22

Mr. Donati is admitted to the hospital secondary to hypoxia and acute congestive heart failure. At discharge the client notes that the physician discontinued his beta blockers. You explain that beta blockers my do which of the following?

a. Cause increased shortness of breath

b. Cause anginal episodes

c. decreased myocardial contratility

d. Increased atrioventricular conductivity.

Back 22

c.

Rationale: Beta blockers are not recommended for patients with actue HF because of the potential for an initial decrease in myocardial contractility.

Front 23

Mr. Roberst age 65 presents to the physicians office with complaints of shortness of breath on exertion, edema in his ankles and waking up in the middle of the night unable to breathe. You suspect that his symptoms are indicative of which of the following?

a. Asthamtic bronchitis

b. Pulmonary edema

c. Heart failure

d. Myocardial infraction

Back 23

c.

Rationale: Cardinal manifestation of HF are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention resulting in pulmonary congestion and peripheral edema.

Front 24

The most common conditions leading to HF are coronary artery disease and __________.

Back 24

Hypertension

Front 25

Heart failure may result from which of the following? (select all that apply)

a. Impaired myocardial contraction during systole

b. Impaired relaxation and filling of ventricals during diastole

c. A combination of systolic and diastolic dysfunction.

d. Impaired conduction from the SA node.

Back 25

a,b,c

Rationale: Heart failure may result from impaired myocardial contraction during systole (systolic dysfunction) impaired relaxation and filling of ventricles during diastole (dystolic disfunction) or a combination of systolic and diastolic dysfunction.

Front 26

Mr. Harbor takes natural licorice for his arthritis. He complains that he is more short of breath. You understand that licorice blocks the effects of spironolactone by causing which of the following?

a. Sodium retention and potassium loss

b. Increased cardiac afterload

c. Renal insufficiency

d. Potassium retention and dysrhythmia

Back 26

a.

Rationale: Natural licorice blocks the effects of spironolactone and causes sodium retention and potassium loss effects that may worsen HF and potentiate the effects of digoxin.

Front 27

Mrs. Beattie drugs include a furosemide, digoxin, and hydralazine. She is unable to afford all of her medications, so she takes them intermittently to make them last longer. As her home care nurse in addition to making a referral to social services, you tell the client which of the following?

a. Different types of drugs have different action and produce different responses.

b. Over the counter drugs may be viable substitutes for the more expensive medications.

c. Her plan is acceptable if the physician is aware and laboratory studies are done more frequently.

d. Changes in doses may be better than alternating medications.

Back 27

a.

Rationale: When patients are receiving a combination of drugs for management of HF the nurse needs to assist them in understanding that the different types of drugs have different actions and produce different responses. As a result the work together to be more effective and maintain a more balanced state of cardiovascular function. Changing drugs or dosages can upset the balance and lead to acute and severe symptoms that may require hospitalization or may even cause death from HF. Therefore, it is extremely important that patients take all of their medications as prescribed. If they are unable to take the medication for any reason patients or caregivers should notify the prescribing health care provider. They should be instructed not to wait until symptoms become severe before seeking care.

Front 28

Mr. King is diagnosed with cirrhosis of the liver. He also takes digoxin for a diagnosis of atrial fibrillation. You would expect the physician to do which of the following?

a. Lower the digoxin dose

b. Increase the digoxin dose

c. Check the clients digoxin level

d. Maintain the current digoxin dose

Back 28

d.

Rationale: Hepatic impairment has little effect on digoxin clearance, and no dosage adjustments are needed.

Front 29

Mr. Billings is diagnosed with renal failure secondary to diabetes mellitus. Based on the new diagnosis the physician may safely reduce the clients digoxin dose to which of the following?

a. 0.25mg every other day

b. 0.125mg every day

c. 0.125 three times a week

d. 0.25mg five times a week

Back 29

c.

Rationale: Digoxin should be used cautiously in reduced dosages because renal impairment delays its excretion. Both Loading and maintenance doses should be reduced. Patients with advanced renal impairment can achieve therapeutic serum concentrations with a dosage of 0.125mg three to five times per week.

Front 30

The pediatric cardiologist orders digoxin for your patient. You understand that during the initial doses, which of the following may occur?

a. The patient may experience an increased heart rate initially then a decreased rate.

b. The patient may be monitored by ECG.

The patient may experience a hypertensive crisis.

d. The patient my experience an exacerbation of congestive heart failure.

Back 30

b.

Rationale: Digoxin is commonly used in children for the some indication as for adults and should be prescribed or supervised by a pediatric cardiologist when possible. The response to a given dose varies with age, size, and renal and hepatic function. There may be a little difference between a therapeutic dose and a toxic dose. Very small amounts are often given to children. These factors increase the risks of dosage errors in children. In a hospital setting institutional policies may require that each dose be verified by another nurse before it is administered. Liquid digoxin must be precisely measured in a syringe, and the dose should not be rounded. ECG monitoring is desirable when digoxin therapy is started.

Front 31

_____________________ is a digoxin binding antidote derived from anti-digoxin antibodies produced in sheep.

Back 31

Digoxin Immune Fab

Front 32

Mrs. Farrell presents to the ER with nausea, vomiting, and a heart rate of 45 beats per min. Her husband states that she takes digoxin, lasix, and nitroglyerin for chest pain. Laboratory results confirm digoxin toxicity. You would expect the physican to order which of the following medications to treat the bradycardia?

a. Atropine

b. Nifedipine

c. Nitroglycerin

d. Nesirtide.

Back 32

a.

Rationale: Atropine or isoproternol used in the management of bradycardia or conduction defects my be administered to clients with digoxin toxicity.

Front 33

Mr. Sweet is diagnosed with heart failure. The physician orders a loading dose of digoxin. Loading doses are necessary for which of the following reasons?

a. Digoxin's short half life increases the risk for toxicity

b. The client is at risk for dysrhymia with titrated doses.

c. Digoxins long half life makes therapeutic serum levels difficult to obtain without loading.

d. Oral digoxin is ineffective for the treatment of heart failure.

Back 33

c.

Rationale: Digoxin dosages must be interpreted with consideration of specific patient characteristics, including age weight gender renal function general health state and concurrent drug therapy. Loading or digitizing doses are necessary for initiating therapy, because digoxins long half life make therapeutic serum levels difficult to obtain with out loading. Loading doses should be used cautiously in patients who have taken digoxin within the previous 2 to 3 weeks.

Front 34

Mr. Ames is diagnosed with chronic heart failure. He is hospitalized for the second time this year for symptoms of hypokalemia. The physician changes his diuretic to one that is which of the following types?

a. Potassium wasting

b. Potassium sparing

c. Sodium sparing

d. Sodium wasting

Back 34

b.

Rationale: In chronic HF, hypokalemia may be less likely to occur because lower doses of potassium sparing diuretics (ex. amiloride, triamterene) and the aldosterone antagonist spironolactone.

Front 35

For chronic heart failure, an ACE inhibitor or ARB and a _____________ are the basic standards of care.

Back 35

Diuretic

Front 36

For acute HF, the first drugs of choice may include an IV loop diuretic a cardiotonic inotropic agent, and _________________.

Back 36

Vasodilators

Front 37

Mr. Levison is diagnosed with HF. He is 6 feet tall and weights 275lbs. By losing weight he will do which of the following?

a. Increase his cardiac contractility and myocardial oxygen demand.

b. Decrease his systemic vascular resistance and myocardial oxygen demand.

c. Decrease his cardiac output.

d. Reduce his risk for hypotensive crisis

Back 37

b.

Rationale: For patients who are obese weight loss in desirable to decrease systemic vascular resistance and myocardial oxygen demand.

Front 38

Administering oxygen to a pt in heart failure will do which of the following? (select all that apply)

a. Relieve dyspnea

b. Decrease pulmonary oxygenation.

c. Reduce the work of breathing

d. Decrease constriction of pulmonary blood vessels.

Back 38

a,c,d

Rationale: Administer oxygen if needed to relieve dyspnea, improve oxygen delivery, reduce the work of breathing, and decrease constriction of pulmonary blood vessels (which is a compensatory measure in patients with hypoxia).

Front 39

_______________ is the most commonly used cardiotonicinotropic agent for short-term management of acute,severe HF that is not controlled by digoxin, diuretics, and vasodilators.

Back 39

Milrinone
IV (Primacor)

Front 40

This drug increases levels of cyclic adenosinemonophosphate (cAMP) in myocardial cells by inhibitingphosphodiesterase, the enzyme that normally metabolizescAMP. This drug also relaxes vascular smooth muscle to produce vasodilation and decrease preload and afterload.

Back 40

Milrinone IV (Primacor)

Front 41

____________ is the first in this class of drugs to be used in the management of acute HF. Produced by recombinantDNA technology, nesiritide is identical to endogenous human B-type natriuretic peptide (BNP), which is secreted primarily by the ventricles in response to fluid and pressure overload

Back 41

Nesiritide
(Natrecor)

Front 42

true or false

Do not take other prescription or nonprescription (e.g.,antacids,cold remedies,diet pills) drugs without consulting the health care provider who prescribed digoxin.Many drugs interact with digoxin to increase or decrease its effects.

Back 42

true

Front 43

Digoxin is eliminated through the ________; it can accumulate and cause adverse effects if dosage is not reduced in patients with this impairment.

Back 43

kidneys

Front 44

When digoxin toxicity occurs, management may include what?

Back 44

1. Digoxin should be discontinued, not just reduced in dosage.Most patients with mild or early toxicity recover completely within a few days after the drug is stopped.

2. If serious cardiac dysrhythmias are present, several drugs may be used, including

Potassium chloride if serum potassium level is low. It is a myocardial depressant that acts to decrease myocardial excitability. The dose depends on the severity of toxicity,serum potassium level, and patient response. Potassium is contraindicated in renal failure and should be used withcaution in the presence of cardiac conduction defects.

Lidocaine an antidysrhythmic local anesthetic agent used to decrease myocardial irritability

Atropine or isoproterenol
, used in the management of bradycardia or conduction defects

Digoxin immune fab
(Digibind) is a digoxin-bindingantidote derived from antidigoxin antibodies produced in sheep. It is recommended only for serious toxicity. It combines with digoxin and pulls digoxin out of tissues and into the bloodstr

Front 45

True or false?

Hepatic impairment has little effect on digoxin clearance, and no dosage adjustments are needed.

Back 45

True

Front 46

True or false?

Natural licorice blocks the effects of spironolactone and causes sodium retention and potassium loss, effects that may worsen HF and potentiate the effects of digoxin

Back 46

True

Front 47

True or false?

Hawthorn should be used cautiously as it may increase the effects of ACE inhibitors and digoxin.

Back 47

True

Front 48

True or false?

Use of ginseng can result in digoxin toxicity.

Back 48

True

Front 49

When administering Digoxin what should you do?

Back 49

With digoxin:

(1) Read the drug label and the health care provider’s order carefully when preparing a dose.

(2) Give only the ordered dosage form (e.g.,tablet,Lanoxi-cap,or elixir).

(3) Check the apical pulse before each dose.If the rate is less than 60 in adults,70 in older children,or 100 in younger children and infants,omit the dose,and notify the health care provider.

(4) Have the same nurse give digoxin to the same patients when possible because it is important to detect changes in rate and rhythm
(see Observe for therapeutic effects and Observe for adverse effects, later).

(5) Give oral digoxin with food or after meals.

(6) Inject intravenous (IV) digoxin slowly (over at least5 min).

Front 50

True or false?

Digoxin formulations vary in concentration and bioavailability and cannot be used interchangeably. Bradycardia is an adverse effect.

Back 50

True

Front 51

When administering Nesiritide what do we do?

Back 51

With nesiritide:

(1) Dilute with 5 mL of 0.9% or 0.45% sodium chloride or5% dextrose solution from a 250 mL IV container; add mixed drug to the container and use diluted solution within 24 hours.

(2) Prime infusion tubing with 25 mL prior to connecting to the patient; withdraw a bolus loading dose from infusion solution.

(3) Give a bolus injection of 2 mcg/kg over 1 minute.

(4) Give the maintenance infusion at a rate of 0.01 mcg/kg/min.

(5) Do not mix with any other drug solution; administer through a separate line.

Front 52

When administering Milrinone what do we do?

Back 52

With milrinone:

(1) Dilute with 0.9% or 0.45% sodium chloride or 5%dextrose solution; use the diluted solution within24 hours.

(2) Give the loading dose by bolus infusion over10 minutes.

(3) Give maintenance infusions at a standard rate of 0.5 mcg/kg/min; this rate may be increased or decreased according to response.

Front 53

When Digoxin given what do we need to look for?

Back 53

When digoxin is given in atrial dysrhythmias,observe for:

(1) Gradual slowing of the heart rate to 70 to 80beats/min

(2) Elimination of the pulse deficit

(3) Change in rhythm from irregular to regular

Front 54

True or false?

When giving Digoxin we need to look for these bad side effects.

(1) Cardiac dysrhythmias:
(a) Premature ventricular contractions (PVCs)
(b) Bradycardia
(c) Paroxysmal atrial tachycardia with heart block
(d) AV nodal tachycardia
(e) AV block (second- or third-degree heart block)

(2) Anorexia,nausea,vomiting

(3) Headache, drowsiness, confusion

(4) Visual disturbances

Back 54

True

Front 55

Digoxin toxicity may cause any type of cardiac dysrhythmia.These are the most serious adverse effects associated with digoxin therapy.They are detected as abnormalities in electrocardiograms and in pulse rate or rhythm._________ are among the most common digoxin-induced dysrhythmias.They are not specific for digoxin toxicity because there are many possible causes.They are usually perceived as“skipped”heartbeats by patients.

Back 55

PVCs

Front 56

With Nesiritide, we need to observe for?

Back 56

1. hypotension
2. headache
3. nausea
4. back pain
5. ventricular
6. tachycardia
7. dizziness
8. anxiety
9. insomnia
10.bradycardia
11.vomiting

Front 57

Drugs that increase
effects of digoxin are?

Back 57

(1) Adrenergic drugs (e.x.,ephedrine, epinephrine, isoproterenol)

(2) Antidysrhythmics (e.x.,amiodarone, propafenone, quinidine)

(3) Anticholinergics

(4) Calcium preparations

(5) Calcium channel blockers (e.x.,diltiazem, felodipine, nifedipine, verapamil)

Front 58

Drugs that decrease
effects of digoxin are?

Back 58

(1) Antacids, cholestyramine, colestipol, laxatives, oral aminoglycosides (e.x.,neomycin)

Front 59

True or false?

Heart failure may result from impaired myocardial contraction during systole (systolic dysfunction), impaired relaxation and filling of ventricles during diastole (diastolic dysfunction), or a combination of systolic and diastolic dysfunction.

Back 59

True

Front 60

True or false?

The most common conditions leading to HF are coronary artery disease and hypertension.

Back 60

True

Front 61

True or false?

Cardinal manifestations of HF are dyspnea and fatigue,which can lead to exercise intolerance and fluid retention,resulting in pulmonary congestion and peripheral edema.

Back 61

True

Front 62

True or false?

Beta blockers are not recommended for patients in acute HF because of the potential for an initial decrease in myocardial contractility.

Back 62

True

Front 63

True or false?

For acute HF, the first drugs of choice may include an IV loop diuretic, a cardiotonic–inotropic agent (e.g. digoxin, dobutamine, milrinone), and vasodilators (e.g., nitroglycerin and hydralazine or nitroprusside).

Back 63

True

Front 64

True or false?

Digitalis toxicity is one of the most commonly encountered drug-related reasons for hospitalization because the drug has a narrow therapeutic index and the end-point of effective therapy is often difficult to define and measure.

Back 64

True

Front 65

True or false?

The normal digoxin level is 0.5 to 2.0 ng/mL. Toxic serum levels are greater than 2 ng/mL; however, toxicity may occur at any serum level.

Back 65

True

Front 66

True or false?

Labs to look for in cardiac patients
Creatine Kinase aka Creatine Phosphokinase (CK) - Levels rise 4 to 8 hours after an acute MI (Myocardial Infarction), peaking at 16 to 30 hours and returning to baseline within 4 days.

Creatine Kinase (male) 25 - 90 U/L
Creatine Kinase (female) 10 - 70 U/L

Back 66

True

Front 67

True or false?

CK-MB CK isoenzyme - It begins to increase 6 to 10 hours after an acute MI, peaks in 24 hours, and remains elevated for up to 72 hours.

Creatine Kinase-MB 0 - 5 U/L

Back 67

True

Front 68

True or false?

(LDH) Lactate dehydrogenase - Total LDH will begin to rise 2 to 5 days after an MI; the elevation can last 10 days.

LDH, serum: 45 - 90 U/L

Back 68

True

Front 69

True or false?

SGOT - Serum glutamic oxaloacetic transaminase is an enzyme that is normally present in liver and heart cells. SGOT is released into blood when the liver or heart is damaged. The blood SGOT levels are elevated with liver damage (hepatitis) or with an insult to the heart (heart attack). There are some medications that can also raise SGOT levels. SGOT is also called aspartate aminotransferase (AST). SGOT will begin to rise in 8-12 hours and peak in 18-30 hours

10-42 U/L

Back 69

True

Front 70

True or false?

Myoglobin - early and sensitive diagnosis of myocardial infarction in the emergency department This small heme protein becomes abnormal within 1 to 2 hours of necrosis, peaks in 4-8 hours, and drops to normal in about 12 hours.

Myoglobin, serum (male): 10 - 95 ng/mL
Myoglobin, serum (female): 10 - 65 ng/mL

Back 70

True

Front 71

True or false?

Troponin Complex - Peaks in 10-24 hours, begins to fall off after 1-2 weeks.

Tropinin I: < 0.1 ng/mL
Tropinin T: < 0.1 ng/mL

Back 71

True