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Lecture 12
Cardiac Markers
| Question | Answer |
|---|---|
| Historically the clinical diagnosis of an acute MI requires two of what three findings | Chest pain, Characteristic EKG changes, and increased serum enzymes |
| Diseases affecting cardiac muscle cause an increase in what CK enzymes | CK MM and MB (MI, Trauma to the heart) |
| Disorders affecting the skeletal muscle cause an increase in what CK enzymes | CK MM (Dystrophies, trauma, Hypothyroid, stroke, psychoisis) |
| Diseases affecting smooth muscle cause and increase in what CK enzymes | Increased CKBB (labor and delivery, Intestinal infarct, shock) |
| How long after the onset of symptoms (of MI) do CK and CKMB become abnormal | 8 hours (peak within 36 hours) |
| when do CK enzymes return to normal after a MI | within 2-3 days |
| what is the most sensitive and specific marker for a MI | Cardiac troponin I and T |
| When do cardiac troponins increase after symptoms of an MI | about 8 hours after symptoms |
| how long do troponins remain increased after a MI | 7-10 days (continued release not delayed clearance) |
| When do CK markers prove more useful than troponins | when you need to detect re-infarct in the acute >3 <10 day period following a MI |
| How specific are troponins for coronary artery etiologies of myocardial infarction | they are not specific for coronary artery etiologies of myocardial disease they are increased in cardiac conditions that are associated with myocardial injury such as heart failure and cardiomyopathies |
| when are natriuretic peptides A and B increased | in serum in chronic heart failure secondary to enhanced atrial and ventricular synthesis |
| where are B-type natriuretic peptides found | in the brain and ventricles of the heart (released in response to ventricular overload) |
| where are c-type natriuretic peptides found | in the brain and CNS released in response to endothelial stress |
| When is BNP used | in diagnosis of heart failure in ED patients, Monitoring therapy of heart failure, prognosis in acute coronary syndromes |
| Where is CRP produced | in the liver |
| when is CRP increased | with inflammation (used as a nonspecific test for infection) |
| How can CRP be used to assess risk of MI | atherosclerosis increases CRP |
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