clinical chem exam 1 heart

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clinical chem exam 1 heart
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clinical chem exam 1 heart
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  1. Congestive heart failure
    • a)
    • Heart unable to pump blood effectively

    • i)
    • Narrowed arteries (coronary artery disease)

    • ii)
    • Past MI with scar tissue interference

    iii) Arrhythmias

    • iv) High
    • BP

    • v)
    • Heart valve disease

    • vi) Primary
    • disease of heart itself (cardiomyopathy)

    • vii) Congenital
    • heart defects

    • viii)
    • Infection of valve or muscle tissue
    • (endocarditis or myocarditis)

    • b)
    • Fluid build up in chest and throughout body

    • i)
    • Called edema

    • (1) Evident
    • in ankles

    • (2) Slow
    • circulation diminishes renal function which cause the accumulation of water and
    • waste

    • c)
    • Fatigue, labored breathing, dizziness, chest
    • pain, loss of consciousness

    • d)
    • Contributing factors hypertension,
    • Anemia/polycythemia, endocrine disorders, malnutrition, drug/alcohol toxicity,
    • abesity, pulmonary disease.
  2. BNP
    • a)
    • Hormone secreted primarily by the ventricles in
    • response to excessive stretching of the heart muscle

    • i)
    • Acts on kidneys to increase fluid excretion

    • b)
    • COPD (chronic obstructive pulmonary disease)
    • will not increase affect BNC concentration

    • c)
    • 0-100pg/ml

    • d)
    • elevation of conc.=elevation of stage=more
    • severe CHF
  3. ischemic heart disease
    • a)
    • restricted blood flow in the heart muscle,
    • causing lack of oxygen to one area causing heart pain

    Causes

    • i)
    • Atherosclerosis = thickening or hardening of
    • artery wall due to calcified cholesterol/lipid plaque in the lining

    • ii)
    • Thrombosis = presence of blood clot in vascular
    • system

    • iii) Embolism
    • = sudden blockage of blood vessel

    • e)
    • Symptoms

    • i)
    • Chest pain, labored breathing, loss of
    • consciousness and angina

    • ii)
    • Angina = sudden chest pain due to inadequate
    • perfusion of heart muscle
  4. acute myocardial infarction (AMI)
    = sudden deprivation in circulating blood and oxygen to heart muscle




    • a)
    • if blood flow stopped completely, cell death or
    • necrosis will occur resulting in acute myocardial infarction (AMI)



    • a)
    • Causes

    • i)
    • Atherosclerosis = thickening or hardening of
    • artery wall due to calcified cholesterol/lipid plaque in the lining

    • ii)
    • Thrombosis = presence of blood clot in vascular
    • system

    • iii) Embolism
    • = sudden blockage of blood vessel
  5. Angina
    sudden chest pain due to inadequate perfusion of heart muscle
  6. Troponin
    • a)
    • 3 components

    • i)
    • TnC = binds calcium

    • ii)
    • TnI = inhibitory component

    • iii) TnT
    • = tropomysin-binding component

    • b)
    • Found in muscle fibers and help regulate
    • contraction

    • c)
    • TnI and TnT released from dying muscle during
    • necrosis

    • i)
    • TnI more specific to heart

    • d)
    • Not released in angina b/c no muscle death

    • e)
    • Measured within 6hrs of AMI

    • f)
    • Remain elevated for 14days

    • i)
    • TnI 5-10

    • ii)
    • TnT 5-14

    • g)
    • Preferred marker for AMI
  7. Enzyme
    • a)
    • Biological protein that catalyzes biochemical
    • rxns without being consumed or changed

    • b)
    • When higher than normal levels are found in the
    • peripheral circulation, indicates cellular damage or injury due to disease or
    • abnormalities
  8. 3 historic enz
    • a)
    • creatine kinase (CK)

    • b)
    • Aspartate amino transferase (AST)

    • c)
    • Lactate dehydrogenase (LD)
  9. typical analysis of cardiac enzymes
    • Cardiac enz are usually analyzed together several times per day over
    • period of time (1week) to observe peak and return to normal
  10. Iso-enzyme
    • a)
    • Different form of enzyme

    • b)
    • Maintain same catalytic function

    • c)
    • Diff found in sub-unit strux

    • d)
    • Measured based on physiological properties

    • e)
    • Sum of iso-enzyme concentrations is equal to the
    • total parent enzyme concentration
  11. Creatine kinases
    • a)
    • CK-MM

    • i)
    • Mostly skeletal muscle

    • ii)
    • Large increase when skeletal muscle trauma or
    • disease like dystrophy

    • b)
    • CK-BB

    • i)
    • Brain and nerve, and embryonic form in serum of
    • newborns

    • ii)
    • Also found in embryonic malignancies

    • c)
    • CK-MB

    • i)
    • Mostly in cardiac muscle

    • ii)
    • Released by necrotic heart muscle

    • iii) Detect
    • AMI 6-8hrs

    • iv) Rises
    • faster and returns to normal faster than total CK

    • v)
    • Rises 3-4 hrs

    • vi) Normal
    • 2 days
  12. CK-MB
    • a)
    • Peak 18 hrs

    • b)
    • Decrease by degradation mech until no longer
    • detected

    • c)
    • Normal by 48 hrs

    • d)
    • Use % CK-MB b/c total CK can be influenced by
    • other isoenzymes

    • e)
    • MB index using total CK and CK-MB
  13. LD
    • a)
    • 5 iso-enzymes

    • i)
    • LD1 – heart muscle, RBCs, kidney

    • ii)
    • LD2 _ Heart, RBCs, kidney

    • iii) LD3
    • – lung, lymph, sleen, pancreas

    • iv) LD4
    • – Liver, skeletal muscle

    • v)
    • LD5 - Liver, skeletal muscle

    • b)
    • Normal LD1 < LD2

    • c)
    • AMI LD1 > LD2 (typical of heart muscle
    • damage, but not specific)

    • d)
    • Rises slow but remains for 4-7 days

    • e)
    • Hemolysis can increase concentrations
  14. Markers of cardiac risk
    • a)
    • High sensitivity C-reactive protein (HS-CRP)


    • a)
    • Lipoprotein (a)



    • a)
    • Ischemia-modified albumin (IMA)
  15. High sensitivity C-reactive protein (HS-CRP)
    • i)
    • Acute phase that increases rapidly in response
    • to inflammation, infection, or tissue damage

    • ii)
    • High sensitivity allows for detection of small
    • increases seen in cardiac disease

    • iii) Increase
    • in baseline HS-CRP = higher risk for coronary artery disease
  16. Lipoprotein (a)
    • i)
    • Variant of LDL with extra apoprotein called
    • apoprotein (a)

    • ii)
    • Homology btwn apoprotein (a) and plasminogen
    • causes competition btwn the two for binding sites

    • iii) If
    • Increase in concentration of lipoprotein (a) will promote clot formation
    • because more plsminogen will be unbound

    • iv) Increase
    • levels of Lp (a) = increased risk for coronary artery disease
  17. Ischemia-modified albumin (IMA)
    • i)
    • Albumin undergoes conformational change when it
    • contacts ischemic muscle

    • ii)
    • Increases in IMA = increased probability of AMI

    • iii) Very
    • early marker, drops rapidly after peaking in less than 8 hrs

    • iv) Use
    • in conjunction with troponin
  18. Myoglobin
    • a)
    • Released from striated muscle when damaged

    • b)
    • Rises fast 2hrs. peaks 6-8 hrs. normal 18-24 hrs

    • c)
    • Positive marker early

    • d)
    • Not conclusive by itself. Must confirm with
    • increased troponin

    • e)
    • Timing of test important

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