cardiac 3

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cardiac 3
2012-09-22 12:08:00

cardiac 3
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  1. CK-MB (creatine kinase-myocardial bands) in rel to an MI
    • it's a cardiac enzyme detectable 4-8 hours after MI starts
    • CK-MB/total CK > 2.5 indicates MI
    • normalizes 48-72 hours later
  2. myoglobin in rel to MI
    it's the earliest marker for cardiac damage
  3. isoforms of MB2 and MB1 in rel to MI
    • MB2 is released in an MI
    • MB2 then becomes MB1, so the more MB2, the more recent the event
  4. troponin in rel to MI
    • detected in blood within 3 hours
    • if greater than 0.4 indicates an MI
  5. lactate dehydrogenase (LDH) in rel to MI
    • it's a cardiac enzyme released due to MI
    • peaks 3-5 days post, leaves system after 7-10 days
  6. cardiac enzymes and MIs
    CK-MB, the ratio of MB2/MB1, troponin, lactate dehydrogenase, and myogobin can indicate that there was an MI. Look for trends in them to see if there was one, and then exercise the pt with appropriate care and attention
  7. MONA treatments for ischemic heart disease
    morphine, oxygen, nitrates, aspirin

    also - can use beta blockers, ACE inhibitors, thrombolytic therapy
  8. sequential graft (treatment for ischemic heart disease)
    an implanted vessel from the aorta to at least two spots on the heart
  9. PTCA (percutaneous transluminal coronary angioplasty)
    • a medical management technique for MI
    • immediate catheterization and baloon angioplasty of vessel that's stenotic/blocked
  10. intracoronary stent (ICS)
    mesh wire is pressed into a vessel wall to hold it open - if it's not used after a PTCA there's a bigger risk of another event
  11. rotoblader for MI treatment
    • used to break up calcified plaques
    • it's a tiny drill on the end of a catheter
  12. some medical procedures after MI
    • PTCA (percutaneous tranluminal coronary angioplasty)
    • intracoronary stent
    • rotoblader
    • coronary artery bypass grafting
    • off pump bypass (aka the mid-CAB)
    • Drug Eluding stents (impregnated w meds to limit clotting)
  13. problems w stents
    • they're less flexible than tissue
    • can have stent migration
    • clotting
  14. off pump bypass (aka the mid-CAB)
    • done on a beating heart in a blood-filled field
    • good for pts who can't handle bypass (CABG requires the heart to be stopped and the body kept hypothermic)
  15. misdiagnosis/mismanagement of valvular heart disease ---> ?
    intractable heart failure and decreased lifespan (catch and treat it early and you can have a normal life span)
  16. mitral valve regurgitation results from disruption of (list a group of possibilities)
    MV annulus, leaflets, cordae tendonae, papillary muscle
  17. secondary mitral regurgitation
    • when a diseased state (ie CHF) causes vent. dialation w resultant malalignment or dysfunction of valves
    • (in general, "secondary" issues are problems that are results of other problems)
  18. mitral valve prolapse
    mid portion of one or both leaflest buckles into left atria during systole
  19. acute MR (mitral regurgitation)
    caused by what?
    is it serious?
    • caused by rupture of chordae tendonae
    • it's a medical emergency w a high fatality rate
  20. causes of chronic MR
    • congenital,Marfns, SLE, MVP (mitral valve prolapse), infections endocarditis,
    • may've had a slow leak over time that caused increased wall stress, increased oxygen demand, --> atrial defibrillation
  21. chronic MR may lead to...?
    • increased LA pressure --> volume overload
    • LA/LV dilation --> LV dysfunction and CHF
  22. 3 surgeries for MVR or MVP, and a bit about each
    • mitral valve replacement - need to be on anticoagulants for machinery (but not if it's pig/cow)
    • mitral valve repair - suitable for younger pts
    • mitral valve annuloplasty - a type of repair that stabilizes the annulus
  23. risks/problems of MV surgeries
    • heart block,
    • atrial arythmia
  24. most common type of valvular heart disease
    aortic regurgitation / aortic insufficiency / aortic stenosis (AS)
  25. causes of aortic stenosis
    • congenital
    • endocarditis
    • aortic dissection
    • HTN
    • trauma
    • rheumatic fever
    • marfans
    • anorectic drugs
  26. signs/sx of aortic stenosis
    • angina inabsence of CAD
    • sycope (fainting)
    • CHF
    • sudden death
  27. lifespan of prosthetic valves, pros and cons of each type
    • bioprosthesis (pig/cow): ~10 years, pro - low risk for thromboembolism (don't have to take anticoagulants)
    • mechanical: ~20 years, con - requires chronic anticoagulation
  28. complications of MVR surgery
    • left vent failure often follows it bc LV isn't used to the increased work load
    • so, afterload reduction is impreitive ot decrease LV wall tension
    • this should be maintained 2-3 months post surgery til LV remodoling occurs and LV can tolerate the increased load
    • these pts are given drugs to lower BP to decrease pressure in the ventricals to give heart time to remodel
  29. mild, mod, severe classification of aortic stenosis
    • mild: AVA > 1.0 cm^2
    • moderate:  AVA 0.7 - 1.0 cm^2
    • severe: AVA < 0.7 cm^2
  30. earliest cardiac enzyme markers for MI
    troponin and CK-MB
  31. which cardiac enzyme shows if MI happened up to 20 days ago?
    lactate dehydrogenase
  32. lipid values - total, LDL w/wo known heart disease, HDL
    • total: up to 200 mg/dl
    • LDL if no known heart disease <130
    • LDL if known heart disease <100
    • HDL > 35 or 40
  33. when does serum CK start to rise after an MI? Peaks when?
    • 4-8 hours post
    • peaks at 24 h
  34. when do serum levels of LDH peak after an MI (lactate dehydrogenase)
    3-5 days later
  35. what number for triglicerates is defined as elevated?
    • 150 mg/dl
    • it's aassosicated w inceased carbs ingestion
    • may be precursor to DM
  36. don't treat/exercise a pt whose hemoglobin is less than or equal to __?
  37. hemoglobin and hematocrit for men and women (don't memorize, just read)
    • Hemoglobin: men 13-16 g/dl, women 12-14 g/dl
    • Hematocrit: men 40-54%, women 37-47%
  38. hematocrit
    measures how much space in the blood is occupied by red blood cells. It is useful when evaluating a person for anemia.
  39. ranges for WBCs, platelets, and RBCs
    • WBCs - 5000-10,000
    • platelets - 1.5-4.5 x 100,000
    • RBCs - men - 4.8-6.0 x 10^6 women - 4.1-5.1 x 10^6
    • (can vary btwn institutions)
  40. prothombin time
    • 11.8-15.0 sec
    • look at this number if pt is being anticoagulated on drugs
    • 1.5-2x range is generally therapeutic forDVT/PE
  41. ratio of total cholesterol to HDL in women and men and its impact on risk for CAD
    • women
    • 3.27 = 1/2 average risk for CAD
    • 4.44 = av risk
    • 7.05 = 2x av risk
    • 11.04 = 3x av risk

    • men
    • 3.43 = 1/2 average risk for CAD
    • 4.97 = av risk
    • 9.55 = 2x av risk
    • 23.39 = 3x av risk

    note how much more sensitive we are
  42. TT partial thromboplastin time ref range and when you look at this number
    • 21.7-34 sec
    • if pt is being anticoagulated on heparin - generally you want this number 1.5 - 2x the ref range to see the pt is being therapeutically anticoagulated
    • BUT if on low moleculare wt heparin these numbers are out the window
  43. INR
    international normalized ratio -  utilized so that antigoagulation levels can be compared across institutions. Uses a standard solution, and thereby gives you the normal of the solution measured
  44. electrolyte levels
    • sodium 135-145
    • potassium 3.5-5.0
    • choloride 96-108
    • magnesium 1.5-2.5
    • phosphorus 2.4-4.7
    • calcium 8.5-11
  45. BUN/creatine levels indicate what troubles
    kidney function and heart failure
  46. Normal BUN (blood urea nitrogen) level
  47. normal creatine men and women
    •  women .6-1.4
    •  men .6-1.6
  48. ration of BUN/creatine that's trouble
  49. blood glucose ranges for normal, contraind exercise, and risk for ketoacidosis
    • norm 60-120
    • >300 contrain exercise
    • >400 risk of ketoacidosis