Cardiac Markers and Heart Structure Quiz
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Questions and Answers

The aorta distributes deoxygenated blood to all parts of the body.

False (B)

The myocardium is the outermost layer of the heart.

False (B)

The pericardial cavity contains pericardial fluid.

True (A)

Blood flows from the left atrium to the left ventricle before being pumped through the pulmonary artery.

<p>False (B)</p> Signup and view all the answers

The tricuspid valve is located between the left atrium and the left ventricle.

<p>False (B)</p> Signup and view all the answers

The human heart consists of six chambers.

<p>False (B)</p> Signup and view all the answers

The epicardium is made up of endothelial cells.

<p>False (B)</p> Signup and view all the answers

The heart is located between the lungs, behind the sternum.

<p>True (A)</p> Signup and view all the answers

The pulmonary arteries contain oxygenated blood.

<p>False (B)</p> Signup and view all the answers

Veins carry deoxygenated blood back to the heart, with the exception of the pulmonary veins.

<p>True (A)</p> Signup and view all the answers

The left atrium receives deoxygenated blood from the body.

<p>False (B)</p> Signup and view all the answers

Coronary arteries supply oxygenated blood to the heart muscle.

<p>True (A)</p> Signup and view all the answers

The aorta is the only artery that carries deoxygenated blood.

<p>False (B)</p> Signup and view all the answers

Systemic circulation begins at the right ventricle.

<p>False (B)</p> Signup and view all the answers

Interruptions of coronary circulation can lead to heart attacks.

<p>True (A)</p> Signup and view all the answers

Capillaries are the blood vessels where oxygen is delivered to tissues and carbon dioxide is collected.

<p>True (A)</p> Signup and view all the answers

CK-BB is predominantly found in the skeletal muscle tissues.

<p>False (B)</p> Signup and view all the answers

The myocardium expresses more CK-MB than CK-MM.

<p>False (B)</p> Signup and view all the answers

Total CK levels in males can reach up to 200 U/L.

<p>True (A)</p> Signup and view all the answers

The concentration of CK-MB begins to rise in the blood within the first hour after a myocardial infarction.

<p>False (B)</p> Signup and view all the answers

Skeletal muscle primarily expresses CK-BB isoenzyme.

<p>False (B)</p> Signup and view all the answers

The highest level of CK-MB in blood occurs around 24 to 48 hours after a heart attack.

<p>False (B)</p> Signup and view all the answers

An AMI can potentially be ruled out within the first 4 hours of symptom onset.

<p>False (B)</p> Signup and view all the answers

Non hemolyzed serum or plasma samples are used for measuring CK levels.

<p>True (A)</p> Signup and view all the answers

Elevations in Troponin-I and Troponin-T can persist for up to 10 days after a myocardial infarction (MI).

<p>True (A)</p> Signup and view all the answers

Troponin-T (TnT) can be detected in healthy individuals.

<p>False (B)</p> Signup and view all the answers

The liver is the primary site of production for creatine in the body.

<p>True (A)</p> Signup and view all the answers

Both Troponin-I and Troponin-T can experience increases in patients with chronic renal failure.

<p>True (A)</p> Signup and view all the answers

The assay range for Troponin I is 0.01-25 ng/mL.

<p>False (B)</p> Signup and view all the answers

Creatine kinase (CK) plays a role in converting phosphocreatine into adenosine triphosphate (ATP).

<p>True (A)</p> Signup and view all the answers

The normal 99th percentile limit for Troponin-T is 0.04 ng/mL.

<p>False (B)</p> Signup and view all the answers

Phosphocreatine serves as an energy reservoir for the rapid buffering and regeneration of ATP in tissues that consume ATP quickly.

<p>True (A)</p> Signup and view all the answers

Troponin C has diagnostic value in detecting cardiac conditions.

<p>False (B)</p> Signup and view all the answers

Cardiac Troponin I (cTnI) is a specific marker for indicating cardiac infarction.

<p>True (A)</p> Signup and view all the answers

Troponin T is the smallest of the three troponin subunits.

<p>False (B)</p> Signup and view all the answers

CTnI levels can remain elevated for up to 6-10 days after an acute myocardial infarction.

<p>True (A)</p> Signup and view all the answers

The molecular weight of Cardiac Troponin I is 24 kilodaltons.

<p>False (B)</p> Signup and view all the answers

Troponin levels begin to rise 8-10 hours after the onset of myocardial injury.

<p>False (B)</p> Signup and view all the answers

Troponin I binds to the actin filament to hold the troponin-tropomyosin complex in place.

<p>True (A)</p> Signup and view all the answers

Less than 15% of troponin is found in the cytosol.

<p>False (B)</p> Signup and view all the answers

Is myocardial infarction caused by a lack of blood flow to the heart muscle?

<p>True (A)</p> Signup and view all the answers

Cardiac markers are solely composed of enzymes.

<p>False (B)</p> Signup and view all the answers

The ECG is always a conclusive diagnostic tool for acute myocardial infarction.

<p>False (B)</p> Signup and view all the answers

Creatine kinase MB and cardiac troponins T and I are commonly used markers for detecting myocardial injury.

<p>True (A)</p> Signup and view all the answers

It can take between 2 to 24 hours for cardiac markers to show increased levels in the blood.

<p>True (A)</p> Signup and view all the answers

Troponin is a single protein that plays a role in muscle contraction.

<p>False (B)</p> Signup and view all the answers

Cardiac markers can be used alone for diagnosing an acute myocardial infarction effectively.

<p>False (B)</p> Signup and view all the answers

SGOT and LDH were the primary markers used for assessing cardiac injury until the early 2000s.

<p>False (B)</p> Signup and view all the answers

Flashcards

Heart Chambers

The four chambers of the heart (right atrium, right ventricle, left atrium, left ventricle) through which blood flows.

Cardiac Cycle

Continuous blood circulation driven by the heart.

Myocardium

The heart's muscular middle layer, containing contractile heart muscle fibers.

Heart Valves

Structures that ensure blood flows in one direction through the heart.

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Tricuspid Valve

The valve between the right atrium and ventricle.

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Pericardium

A membranous sac that surrounds the heart.

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Blood Circulation

The continuous flow of blood through the heart and blood vessels.

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Oxygenated Blood Path

The path of blood which becomes oxygenated in the lungs; from the lungs, travels to the left heart chamber (left atrium) and then to the systemic circulation.

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Pulmonary Circulation

Blood flow from the heart to the lungs and back to the heart.

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Systemic Circulation

Blood flow from the heart to the rest of the body and back to the heart.

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Coronary Circulation

Blood flow to and from the heart tissue (myocardium).

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Arteries

Blood vessels carrying oxygenated blood away from the heart (except for pulmonary arteries).

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Veins

Blood vessels carrying deoxygenated blood back to the heart (except for pulmonary veins).

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Capillaries

Tiny blood vessels where gas and nutrient exchange with tissues happens.

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Oxygenated blood

Blood containing oxygen.

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Deoxygenated blood

Blood lacking oxygen.

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Heart Attack

A condition caused by a blocked artery, restricting blood flow to the heart, leading to damage or death of heart muscle.

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Myocardial Infarction (MI)

Another term for a heart attack, specifically referring to the death of heart muscle due to lack of blood flow.

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Cardiac Markers

Substances released into the bloodstream from damaged heart muscle, used to diagnose heart attacks.

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Troponin

A protein found in heart muscle that is released into the blood during a heart attack.

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CK-MB

An enzyme found in heart muscle that is also released into the blood during a heart attack.

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ECG

A test that measures the electrical activity of the heart, used to diagnose heart attacks.

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Ischemia

Reduced blood flow to a part of the body, often leading to oxygen deprivation.

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Limitations of Cardiac Markers?

Cardiac markers can take time to increase in the blood and laboratory analysis also takes time. This makes them less useful in the acute phase of a heart attack.

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What is TnC?

Troponin-C is a subunit of troponin, responsible for binding calcium ions. It does not have diagnostic value.

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What does TnT do?

Troponin-T binds to tropomyosin, forming a complex that helps regulate muscle contraction.

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What is TnI's role?

Troponin-I binds to the actin filament, holding the troponin-tropomyosin complex in place and inhibiting muscle contraction until calcium arrives.

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cTnI - Cardiac Troponin I

A specific cardiac muscle protein with additional amino acids on its N-terminal, making it detectable only in heart damage.

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cTnI Release Pattern

cTnI is released rapidly into the bloodstream after heart damage, peaking around 4-6 hours like CK-MB but staying elevated longer.

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cTnI Levels in Healthy People

In healthy individuals, cTnI levels are below 0.06 ng/mL, making it a reliable marker for heart damage.

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What is Troponin T's Role?

Troponin T is the largest troponin subunit and binds to tropomyosin, helping to regulate the sensitivity of muscle contraction to calcium.

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Troponin Levels After Myocardial Injury

Troponin levels begin rising 4-6 hours after heart damage, increasing as the heart injury worsens.

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Troponin I and T in Healthy Individuals

Troponin I and T are not detectable in healthy individuals, their presence indicates potential heart damage.

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Troponin Elevation after MI

Elevated levels of Troponin I and T can persist for up to 10 days after a myocardial infarction (heart attack). This indicates extensive heart damage that is healing.

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Troponin-T's Location

While Troponin-I is primarily found in the heart, Troponin-T has been found in skeletal muscles as well. However, these are not the primary sources for Troponin.

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Troponin and Myocardial Necrosis

A significant increase in Troponin levels indicates myocardial necrosis, signifying cell death in the heart muscle.

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Limitations of cTnT Assay

The fourth generation cTnT assay can have cross-reactivity with a protein found in skeletal muscle of patients with primary skeletal muscle disease.

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Troponin Levels in Chronic Renal Failure

Both cTnT and cTnI levels can be elevated in a small percentage of patients with chronic renal failure, with a higher percentage of abnormal results for cTnT.

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Troponin T Reference Range

The normal reference range for Troponin T in healthy individuals is 0.01 ng/mL or below.

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Troponin I Reference Range

The normal reference range for Troponin I in healthy individuals is 0.04 ng/mL or below.

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Creatine Phosphate Shuttle

A process where energy from creatine phosphate in the mitochondria is transferred to the contractile proteins in the muscle fibers, replenishing ATP for muscle contraction.

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CK-BB (CK1)

An isoenzyme of creatine kinase, primarily found in brain tissue and other organs, rarely significant in the bloodstream.

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CK-MM (CK3)

A creatine kinase isoenzyme primarily found in skeletal muscle, making up the majority of the enzyme's activity in this tissue.

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CK-MB (CK2)

An isoenzyme of creatine kinase found in both skeletal and heart muscle, but is significantly higher in the heart, making it a marker for heart damage.

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Total CK Levels

A measure of the total creatine kinase activity in blood, used to assess muscle damage, including heart muscle.

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CK-MB Levels After MI

CK-MB levels in the blood increase after a heart attack as the heart muscle is damaged, peaking within 12-24 hours.

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Sensitivity of CK-MB

The ability of CK-MB to detect a heart attack, which increases over time after the event.

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Importance of CK-MB

CK-MB levels are a crucial indicator of heart muscle damage, particularly in the early stages of a heart attack.

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Study Notes

Cardiac Markers

  • Cardiac markers are biomarkers used to assess heart function.
  • Early markers were enzymes, now other proteins are used.
  • Cardiac markers leak from damaged myocardial cells into the bloodstream.

Heart Structure and Tissues

  • The heart is a vital organ for blood circulation, located between the lungs, behind and slightly to the left of the sternum.
  • The heart has three layers:
    • Innermost: Endocardium - composed of endothelial cells and lines the heart chambers and valves.
    • Middle: Myocardium - the muscular layer consists of heart muscle cells.
    • Outermost: Epicardium - composed of epithelial cells, forming the outer cell layer.
  • The pericardium is a membranous sac surrounding the heart, anchoring it to the diaphragm and sternum.
    • It consists of two layers: fibrous pericardium and serous pericardium (visceral and parietal).
    • A pericardial cavity lies between the layers and contains fluid.

Heart Chambers

  • The heart has four chambers: right atrium, right ventricle, left atrium, and left ventricle.
  • Deoxygenated blood enters the right atrium, travels to the right ventricle, and is pumped to the lungs for oxygenation.
  • Oxygenated blood returns to the heart via the pulmonary veins, enters the left atrium, then the left ventricle, and is pumped to the body.
  • The left ventricle is the largest and strongest chamber, pumping oxygenated blood to the body via the aorta.

Heart Valves

  • Four heart valves ensure one-way blood flow:
    • The tricuspid valve is located between the right atrium and right ventricle.
    • The mitral valve is located between the left atrium and left ventricle.
    • The pulmonary valve is located between the right ventricle and the pulmonary artery.
    • The aortic valve is located between the left ventricle and the aorta.

Blood Vessels

  • Arteries have thick walls with smooth muscle and elastic fibers, carrying oxygenated blood away from the heart.
  • Veins have thinner walls than arteries, carrying deoxygenated blood toward the heart.
  • Capillaries are very thin, single-cell walls, allowing for the exchange of materials between blood and tissues.
  • Blood flows away from the heart in arteries and towards the heart in veins.
  • Arteries have thick walls; Veins have thinner walls; Capillaries are single-celled.

The Circulatory System

  • The heart pumps blood throughout the body delivering oxygen and nutrients and carrying away carbon dioxide and waste.
  • Blood travels through arteries, arterioles, capillaries, venules, and veins.
    • Pulmonary circulation moves blood between the heart and lungs.
    • Systemic circulation moves blood between the heart and the rest of the body.

Coronary Circulation

  • Coronary arteries supply oxygenated blood to the heart muscle.
  • Cardiac veins carry deoxygenated blood away from the heart muscle.
  • Coronary circulation is vital for the heart's health.
  • Interruptions can cause heart attacks.

Types of Heart Disease

  • Various diseases can affect the heart, including valve disease, aneurysm, coronary artery disease, cardiomyopathy, and pericarditis.
  • These diseases can significantly impact heart function.

Heart Attack (Myocardial Infarction)

  • Myocardial Infarction (MI) is a condition caused by blocked blood flow to the heart muscle.
  • Different types of MI exist, with variations in their causes and characteristics.
  • Symptoms of a heart attack can include weakness, chest pain, dizziness, and shortness of breath.
  • Location of the pain can be the area of the stomach.
  • Location to look for discomfort can be back, neck, arms, and lower jaw area.

Cardiac Markers

  • Different types of cardiac markers exist, and each has different uses and limitations.
  • The timing for detection of cardiac markers varies depending on the type of marker being assessed.
  • Until the 1980s, SGOT and LDH were used to evaluate cardiac injury.
  • Currently, CK-MB (a creatine kinase subtype), and cardiac troponins (T and I) are also used for MI detection.
  • An ECG can also diagnose an MI.
  • Note: The perfect cardiac marker test for precise diagnosis does not exist.
  • Various tests are used in combination for accurate assessment.

Troponin

  • Troponin is a protein complex crucial for muscle contraction.
  • Troponin has three subunits: TnC, TnT, and TnI.
  • TnC has calcium binding ability-has no diagnostic value.
  • Cardiac troponin (cTnI) is a cardiac muscle protein used in the diagnosis of myocardial infarction.
  • cTnI is rapidly released into the bloodstream following a heart attack.
  • cTnI levels stay elevated for a longer period and are also evaluated in diagnosis.

Total Creatine Kinase (CK) and CK-MB

  • CK is a naturally occurring enzyme in tissues.
  • CK catalyzes the conversion of creatine and consumes ATP.
  • The most significant result of CK activity is the production of phosphocreatine.
  • CK is also evaluated with respect to the function of muscle tissue.
  • CK-MB is a specific form of CK found in the heart, used for diagnosing MI.
  • Elevated CK-MB levels show evidence of myocardial damage.
  • The level rises in 4-6 hours and reaches peak 12 to 24 hours after MI.

Myoglobin

  • Myoglobin is an iron-containing protein which can bind to and release oxygen.
  • It's released from damaged tissues, and levels in blood rise rapidly after myocardial damage.
  • Myoglobin is not specific to the heart; therefore, it doesn't consistently indicate MI.

Lactate Dehydrogenase (LDH)

  • LDH is an enzyme in all body tissues
  • LDH is released from damaged cells (injury marker)
  • LDH has different isoenzymes with different distributions in tissues.
  • LDH levels rise after the cellular destruction from MI
  • Measuring LDH is a useful tool to detect various injuries
  • In addition to detecting myocardium damage LDH is a good indicator of other conditions

CK - Isoenzymes

  • CK exists as a dimer protein, a combination of two subunits (B or M).
  • Different combinations result in several isoenzymes (CK-BB, CK-MB, CK-MM).
  • CK-MB is specific to the heart, therefore useful.
  • Skeletal muscle expressions of CK-MM.
  • CK-MM expressed in myocardium

LDH Measurement

  • LDH is measured using a serum sample.
  • Elevated LDH levels often suggest tissue damage.
  • Strenuous exercise may cause temporary LDH elevation or falsely increase results.
  • Hemolysis (rupture of red blood cells) during blood collection causes falsely high LDH results.
  • Elevated LDH levels and change in ratio usually indicate tissue damage.

LDH Result Interpretation

  • LDH is used as a marker for myocardial infarction(AMI) and other heart conditions.
  • LDH level is evaluated in relation to myocardial infarction.
  • Elevated levels of LDH and changes in the ratio of the LDH isoenzymes suggest tissue damage.
  • Various conditions besides cardiac disease can cause elevated LDH levels.

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Description

Test your knowledge on cardiac markers and the anatomy of the heart. This quiz covers the essential functions and structures of the heart, including its layers and chambers. Assess your understanding of how heart markers are used in evaluating heart health.

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