Cardiovascular Disease Biomarkers
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Questions and Answers

What is the primary function of cardiac biomarkers?

  • To detect congestive heart failure
  • To detect acute myocardial infarction or minor myocardial injury (correct)
  • To monitor high blood pressure
  • To diagnose coronary heart disease

    • What is the main reason for the evolution of criteria for the definition of myocardial infarction?

  • Changes in symptoms of ischemia
  • Increased awareness about cardiovascular disease
  • Advancements in electrocardiogram technology
  • Improvement in detection technologies, particularly biomarkers (correct)

    • What is the term for diseases that affect the circulatory system?

  • Peripheral vascular disease
  • Coronary heart disease
  • Cerebrovascular disease
  • Cardiovascular disease (correct)

    • What is NOT a type of cardiovascular disease?

    <p>High blood sugar</p> Signup and view all the answers

    According to the American College of Cardiology and European Society of Cardiology, what is the recommended biomarker for diagnosing acute myocardial infarction?

    <p>Troponin</p> Signup and view all the answers

    What is the old criteria for diagnosing acute myocardial infarction, according to the World Health Organization (1979)?

    <p>Based on 2 out of 3 of WHO criteria, including symptoms of ischemia, ECG changes, and cardiac biomarker concentrations</p> Signup and view all the answers

    What is the term for heart and blood vessel diseases?

    <p>Cardiovascular disease</p> Signup and view all the answers

    What is NOT a type of cardiovascular disease mentioned in the content?

    <p>Diabetes</p> Signup and view all the answers

    What is the main characteristic of the fourth group of patients who present to the emergency department?

    <p>They have clear ECG evidence of AMI</p> Signup and view all the answers

    What is the ideal characteristic of a biomarker for detecting AMI?

    <p>Rapid release into blood following myocardial injury</p> Signup and view all the answers

    What is the main difference between various biomarkers of myocardial injury?

    <p>All of the above</p> Signup and view all the answers

    What is the function of the troponin complex in muscular contraction?

    <p>Regulation of interaction between actin and myosin filaments</p> Signup and view all the answers

    Why is troponin C not a suitable cardiac-specific marker?

    <p>Its amino acid sequence is identical in skeletal and cardiac muscle</p> Signup and view all the answers

    What is unique about troponin T and I?

    <p>They have amino acid sequences that differ between adult skeletal and cardiac muscle</p> Signup and view all the answers

    What is the significance of the cardiac-specific forms of troponin T and I?

    <p>They are immunologically separable</p> Signup and view all the answers

    What is a characteristic of an ideal biomarker for detecting AMI?

    <p>Blood levels correlate with extent of myocardial injury and prognosis</p> Signup and view all the answers

    What is the molecular weight of Troponin T?

    <p>37 kDa</p> Signup and view all the answers

    What is the nature of the protein of Troponin I?

    <p>Catalytic</p> Signup and view all the answers

    What is the duration of elevation of Troponin T?

    <p>Upto 14 days</p> Signup and view all the answers

    What is the likelihood of ischemic complications in patients with unstable angina who have normal CK-MB and increased TnI?

    <p>30%</p> Signup and view all the answers

    What does an increase in plasma troponin concentration indicate?

    <p>Myocardial injury, but not necessarily MI</p> Signup and view all the answers

    When does Troponin I appear in the blood after myocardial damage?

    <p>Within 3-12 hours</p> Signup and view all the answers

    What is the cutoff for acute myocardial infarction on a Beckman Coulter DXi analyzer?

    <p>0.5 ng/mL</p> Signup and view all the answers

    What is the pattern of release of Troponin I in Myocardial Infarction (MI)?

    <p>Biphasic</p> Signup and view all the answers

    What does a normal TnI and elevated CK-MB usually indicate?

    <p>Skeletal muscle injury</p> Signup and view all the answers

    Why is Troponin I beneficial in detecting infarctions in late presenting patients?

    <p>It is elevated for a longer time</p> Signup and view all the answers

    What is a common non-ischemic cause of elevated plasma TnI concentration?

    <p>All of the above</p> Signup and view all the answers

    What percentage of patients with unstable angina have elevated Troponin I?

    <p>30-40%</p> Signup and view all the answers

    Why is Troponin I a better risk indicator in angina than CK-MB?

    <p>It is more specific to myocardial damage</p> Signup and view all the answers

    What does two normal TnI levels indicate in a patient with unstable angina?

    <p>Dischargeable patient</p> Signup and view all the answers

    What is a likely diagnosis for a patient with elevated TnI and normal CK-MB?

    <p>Unstable angina or late admission after an acute infarction</p> Signup and view all the answers

    Based on the case study, has the 66-year-old man suffered a myocardial infarction?

    <p>Yes, likely</p> Signup and view all the answers

    What does the patient's 2-year history of angina of effort suggest?

    <p>A high risk of acute myocardial infarction</p> Signup and view all the answers

    Based on the elevated CK and CK-MB levels, what is the most likely diagnosis for the marathon runner?

    <p>Muscle damage due to intense physical activity</p> Signup and view all the answers

    What is the primary concern for the 52-year-old man with severe chest pain?

    <p>Ruling out acute myocardial infarction</p> Signup and view all the answers

    What is the significance of the CK-MB percentage in the marathon runner's laboratory results?

    <p>It is a specific indicator of cardiac muscle damage</p> Signup and view all the answers

    What is the relevance of the patient's attendance at the chest pain clinic to the current diagnosis?

    <p>It indicates a history of cardiovascular disease</p> Signup and view all the answers

    What is the purpose of requesting specific tests from the biochemistry laboratory for the 52-year-old man?

    <p>To rule out acute myocardial infarction</p> Signup and view all the answers

    Study Notes

    Cardiovascular Disease (CVD)

    • CVD includes heart and blood vessel diseases that affect the circulatory system.
    • Examples of CVD include:
      • Coronary heart disease (heart attack)
      • Cerebrovascular disease (stroke)
      • High blood pressure
      • Congestive heart failure
      • Congenital cardiovascular defects
      • Peripheral vascular disease

    Cardiac Biomarkers

    • A cardiac biomarker is a clinical laboratory test used to detect acute myocardial infarction (AMI) or minor myocardial injury.
    • Cardiac biomarkers are most useful when patients have nondiagnostic ECG tracings.

    Evolving Definitions of Myocardial Infarction (MI)

    • The criteria for the definition of MI have evolved over the years, partly due to improvements in detection technologies, including biomarkers.
    • The old diagnosis of AMI was based on 2 out of 3 of WHO criteria (1979), including:
      • Symptoms of ischemia (prolonged chest pain)
      • ECG changes
      • Cardiac biomarker concentrations (enzymes)
    • The new definition of AMI is based on documenting an increase in cardiac troponin or CK-MB mass in the context of myocardial ischemia.

    Ideal Marker to Detect AMI

    • An ideal marker should have:
      • High concentration in myocardium
      • Absence from non-myocardial tissues
      • High sensitivity and specificity in circulation
      • Rapid release into blood following myocardial injury
      • Remain in blood for several days to allow detection
      • Blood levels correlate with extent of myocardial injury and prognosis
      • Rapid, simple, and automated commercial assays available

    Troponins

    • Troponins are regulatory proteins in striated muscle responsible for calcium-modulated interaction.
    • There are cardiac-specific forms of troponin, including:
      • Troponin T (TpnT)
      • Troponin I (TpnI)
    • Troponins T and I have different characteristics, including:
      • Molecular weight (37 kDa vs 22.5 kDa)
      • Nature of protein (structural vs catalytic)
      • Kinetics of release (biphasic vs single peak)
      • Duration of elevation (up to 14 days vs 5-7 days)

    Troponin Release Kinetics

    • Troponin release is biphasic, with:
      • Detectable in blood 3-12 hours after MI
      • Peak levels at 12-38 hours
      • Remain elevated for 5-10 days
    • TnI remains elevated longer than CK-MB due to ongoing release of the myofibril-bound fraction.

    Clinical Applications of Troponins

    • Elevated TnI is found in 30-40% of patients with unstable angina and is a better risk indicator than CK-MB.
    • Serial monitoring of TnI over 8-12 hours is becoming common practice in many well-developed institutions.
    • To rule out an acute myocardial infarction, many centers are ordering CK-MB and TnI on admission and again at either 8 or 12 hours.
    • An increase in plasma troponin concentration is indicative of myocardial injury, but not synonymous with MI.

    Non-Ischemic Causes of Elevated Troponin

    • Congestive heart failure
    • Hypertension
    • Circulatory shock
    • Pulmonary embolism
    • Covid-19
    • Mechanical injury
    • Cardiac contusion
    • Cardiotrophic viral infections
    • Chemotherapy
    • Renal failure
    • GI bleed

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    Cardiovascular Disease Biomarkers PDF

    Description

    This quiz covers cardiovascular disease, including heart and blood vessel diseases, and biomarkers. Topics include coronary heart disease, cerebrovascular disease, high blood pressure, and more.

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