Podcast
Questions and Answers
Which marker is primarily used for diagnosing myocardial necrosis that develops after CABG surgery?
What is the primary source of BNP secretion in the body?
Which marker is considered more important than ANP in the context of heart failure?
Which of the following is indicated as a marker of inflammation and future morbidity and mortality risk?
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Which natriuretic peptide is primarily released in response to atrial wall stretching?
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What CRP level is classified as high risk for cardiovascular disease?
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Which cardiac marker is most specific for myocardial infarction?
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Which condition is not associated with troponin elevation?
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What does CK-MB primarily indicate?
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Which of the following describes the relationship between CK-MB and total CK activity?
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What is the significance of elevated CRP levels?
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In which condition would you expect to see a rise in CK-BB?
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A patient with severe traumatic injury could have an elevation in which biomarker?
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Study Notes
Cardiac Biomarkers
- Markers of Inflammation: hsCRP, SCD40L, homocysteine, PAPP-A, LP-PLA2
- Markers of Plaque Destabilization: hsCRP, PAPP-A, SCD40L, LP-PLA2, homocysteine
- Markers of Myocardial Ischemia: IMA (used for diagnosing myocardial necrosis after CABG, normal levels 1.6-19ng/ml)
- Markers of Cardiac Necrosis: cTn, CK-MB, Myoglobin
- Marker for Hemodynamic Stress: Natriuretic peptides (ANP released in response to atrial wall stretching, BNP primarily from ventricles)
- BNP: More important than ANP in heart failure, higher levels in patients with cardiovascular or renal disease, found in brain and vascular endothelial cells.
- hsCRP Clinical Uses: Screening for cardiovascular risk, predicting disease severity in pre-existing coronary artery disease, predicts long-term risk of first MI and ischemic stroke. Low risk <1.0 mg/L, Intermediate risk 1.0-2.9 mg/L, High risk >3.0 mg/L
- Troponin: Most diagnostic for MI, cTn is specific for heart, cTnI is the most specific for the heart.
- Creatine Kinase (CK): CK-BB (brain origin), CK-MB (myocardial origin, specific for heart), CK-MM (skeletal muscle origin). Ratio of CK-MB to total CK can suggest myocardial necrosis.
- Cardiac Enzymes: Myoglobin (onset 2-6hrs, peak 4-6hrs, return 24-36hrs), CK-MB (onset 4-6hrs, peak 18-30hrs, return 3-4 days), LDH (onset 24-48hrs, peak 14-21hrs, return 3-6 days).
- Troponin I: Earliest cardiac marker detected (3-5 hrs post-event)
- Gold Standard of cardiac biomarkers : Troponin
- CK Isoenzymes in Cardiac Muscle: MM, BB, and MB
- Conditions associated with troponin elevation: Arrhythmias, hypertension, congestive heart failure, myocarditis, coronary artery disease, pericarditis, coronary vasospasm, critically ill patients.
Case Example
- A 50-year-old male with chest pain and vomiting: indicates high likelihood of myocardial infarction, with troponin I being the first detectable cardiac marker
- Patient with chest pain after MI: troponin I would be the best cardiac marker to investigate chest pain.
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Description
This quiz covers the essential cardiac biomarkers associated with inflammation, plaque destabilization, myocardial ischemia, and cardiac necrosis. Participants will learn about important markers like hsCRP, BNP, and troponin, as well as their clinical implications in cardiovascular disease. Test your knowledge on the role of these biomarkers in diagnosing and managing heart conditions.
