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Questions and Answers
What is the average weight of an adult male heart?
What is the average weight of an adult male heart?
- 350 g
- 325 g (correct)
- 300 g
- 275 g
Which layer of the cardiac wall is most susceptible to myocardial ischemia?
Which layer of the cardiac wall is most susceptible to myocardial ischemia?
- Myocardium
- Pericardium
- Endocardium (correct)
- Epicardium
What primarily generates the 'pumping' work of the heart?
What primarily generates the 'pumping' work of the heart?
- Coronary arteries
- Myocardium muscle fibers (correct)
- Electrical impulses
- Pericardium structure
What are the contractile proteins found in the myocardium?
What are the contractile proteins found in the myocardium?
Which process is primarily controlled by the cardiac conducting system?
Which process is primarily controlled by the cardiac conducting system?
What is recorded by an electrocardiogram (ECG)?
What is recorded by an electrocardiogram (ECG)?
What is the primary function of cardiac markers?
What is the primary function of cardiac markers?
Which of the following chambers is correctly matched with its position in the heart?
Which of the following chambers is correctly matched with its position in the heart?
What best describes the progression of Congestive Heart Failure (CHF) severity?
What best describes the progression of Congestive Heart Failure (CHF) severity?
Which of the following factors can influence the clinical findings in CHF?
Which of the following factors can influence the clinical findings in CHF?
What is the primary role of the New York Heart Association (NYHA) classification in CHF?
What is the primary role of the New York Heart Association (NYHA) classification in CHF?
What is a significant challenge in identifying CHF early?
What is a significant challenge in identifying CHF early?
What characteristic should an ideal biomarker for detecting CHF possess?
What characteristic should an ideal biomarker for detecting CHF possess?
Which of the following is NOT typically a primary characteristic of CHF?
Which of the following is NOT typically a primary characteristic of CHF?
What is the most severe form of acute ischemic disease?
What is the most severe form of acute ischemic disease?
In the sequence of ECG changes after acute myocardial infarction, which statement is true?
In the sequence of ECG changes after acute myocardial infarction, which statement is true?
Acute coronary syndrome (ACS) includes which of the following conditions?
Acute coronary syndrome (ACS) includes which of the following conditions?
What distinguishes NSTEMI from STEMI in terms of cell death?
What distinguishes NSTEMI from STEMI in terms of cell death?
What causes acute myocardial infarction?
What causes acute myocardial infarction?
Which type of angina is characterized by activity-induced chest pain?
Which type of angina is characterized by activity-induced chest pain?
Which of the following statements about ischemic heart diseases in the Philippines is true?
Which of the following statements about ischemic heart diseases in the Philippines is true?
What happens to myocytes when blood supply is blocked for more than a few minutes?
What happens to myocytes when blood supply is blocked for more than a few minutes?
In the case of angina, what is a common symptom associated with the condition?
In the case of angina, what is a common symptom associated with the condition?
What is the relationship between NSTEMI and the ST segment in an ECG?
What is the relationship between NSTEMI and the ST segment in an ECG?
What does NYHA Class II suggest about a patient's condition?
What does NYHA Class II suggest about a patient's condition?
Which cardiac marker is recommended if clinical presentation suggests Acute Coronary Syndrome (ACS)?
Which cardiac marker is recommended if clinical presentation suggests Acute Coronary Syndrome (ACS)?
What is one of the principal reasons cardiac biomarkers are used in clinical practice?
What is one of the principal reasons cardiac biomarkers are used in clinical practice?
Which marker was widely used as the first cardiac marker following its discovery?
Which marker was widely used as the first cardiac marker following its discovery?
What is a disadvantage of using Lactate Dehydrogenase (LD) as a cardiac marker?
What is a disadvantage of using Lactate Dehydrogenase (LD) as a cardiac marker?
What symptoms characterize NYHA Class IV heart failure?
What symptoms characterize NYHA Class IV heart failure?
What does the release of intracellular proteins into circulation indicate?
What does the release of intracellular proteins into circulation indicate?
What is the primary role of Troponin T in cardiac assessment?
What is the primary role of Troponin T in cardiac assessment?
Which of the following describes a key limitation of Aspartate Transaminase (AST) as a cardiac marker?
Which of the following describes a key limitation of Aspartate Transaminase (AST) as a cardiac marker?
Which marker is often replaced by Troponin I or T for better sensitivity in myocardial infarction detection?
Which marker is often replaced by Troponin I or T for better sensitivity in myocardial infarction detection?
What is the typical LD1:LD2 ratio observed after the onset of myocardial infarction (MI)?
What is the typical LD1:LD2 ratio observed after the onset of myocardial infarction (MI)?
Which cardiac marker is considered the most reliable serum maker of myocardial infarction?
Which cardiac marker is considered the most reliable serum maker of myocardial infarction?
Which enzyme is primarily found elevated in the serum after muscle injury?
Which enzyme is primarily found elevated in the serum after muscle injury?
How soon after the onset of myocardial infarction do CK levels typically exceed the normal range?
How soon after the onset of myocardial infarction do CK levels typically exceed the normal range?
Which troponin protein is nearly absent from normal serum and is specific to cardiac muscle injury?
Which troponin protein is nearly absent from normal serum and is specific to cardiac muscle injury?
What is the expected CK-MB level trend after myocardial infarction symptoms begin?
What is the expected CK-MB level trend after myocardial infarction symptoms begin?
What condition does elevated lactate dehydrogenase (LDH) indicate?
What condition does elevated lactate dehydrogenase (LDH) indicate?
What does an increase of plasma CK indicate?
What does an increase of plasma CK indicate?
What is the reference value for cardiac troponins in the serum?
What is the reference value for cardiac troponins in the serum?
Which enzymes are primarily used for the detection of acute myocardial infarction (AMI)?
Which enzymes are primarily used for the detection of acute myocardial infarction (AMI)?
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Study Notes
Cardiac Anatomy and Physiology
- Average human heart weighs approximately 325 g in men and 275 g in women.
- The heart is enclosed by a pericardium and has four chambers: left atrium, right atrium, left ventricle, and right ventricle.
- The cardiac wall consists of three layers: epicardium (outer), myocardium (middle), and endocardium (inner).
- Myocardial muscle fibers contract and relax to generate heart pumping action and contain contractile proteins like actin, myosin, and troponins.
- The cardiac cycle includes systole and diastole, regulated by the cardiac conducting system.
- An electrocardiogram (ECG) records the heart's electrical potential changes.
Cardiovascular Diseases
- Two major cardiovascular diseases diagnosed via biomarkers:
- Acute myocardial infarction (AMI), the severe form of ischemic heart disease.
- Congestive heart failure (CHF).
Epidemiology
- In the Philippines, ischemic heart diseases accounted for 29,442 deaths (18.7% of total) from January to April 2022.
Acute Myocardial Infarction
- Occurs from an imbalance of oxygen supply/demand leading to myocyte injury and death.
- Myocyte necrosis occurs after blood supply is blocked for more than a few minutes.
- Angina is chest pain that may precede AMI; stable angina is activity-induced.
Acute Coronary Syndrome (ACS)
- Comprises ischemic events varying from angina (no cell death) to NSTEMI (partial necrosis) and STEMI (complete necrosis).
- STEMI shows ST segment elevation on ECG, whereas NSTEMI does not exhibit ST segment changes.
Congestive Heart Failure (CHF)
- A condition where the heart cannot pump adequate blood, necessitating external support as the disease progresses.
- Symptoms vary based on various factors, including overall health and heart disease causes.
- Utilizes the New York Heart Association (NYHA) classification to assess patient function:
- Class I: No symptoms during typical activity.
- Class II: Mild symptoms with slight activity limitation.
- Class III: Marked limitations, comfortable only at rest.
- Class IV: Severe limitations, symptomatic at rest.
Cardiac Damage Markers
- Serum biomarkers indicate cardiac damage, helping assess myocardial infarction occurrence, extent, and timing.
Cardiac Markers for ACS
- Initial markers:
- Glutamic oxaloacetic transaminase (SGOT, AST).
- Lactate dehydrogenase (LD).
- Creatine Kinase (CK).
- Current markers: Troponin I (TnI), Troponin T (TnT), and myoglobin.
Troponins
- Troponins are complex proteins critical for muscle contraction regulation.
- TnI and TnT are specific to the myocardium, while TnC is present in both cardiac and skeletal tissues.
- A significant rise in troponin levels occurs after an acute myocardial infarction, making them the most important markers for cardiac injury.
- Reference value for troponin: levels should be < 0.1 ng/mL.
Clinical Implications
- Cardiac troponins are essential for diagnosing acute myocardial infarction, particularly as they may elevate even in the absence of CK-MB increases.
- The transition from initial to current markers represents advancements in cardiac health diagnostics, emphasizing the need for specific biomarkers to enhance patient management.
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