Cardiac Patho Summary PDF

Dr Ahmed Abdelsalam Marker of Markers of Plaque Marker Myocardial Ischemia Marker for cardiac necrosis inflammation Destabilization hsCRP PAPP-A IMA: is used as diagnostic cTn sCD...

Dr Ahmed Abdelsalam Marker of Markers of Plaque Marker Myocardial Ischemia Marker for cardiac necrosis inflammation Destabilization hsCRP PAPP-A IMA: is used as diagnostic cTn sCD40L LP-PLA2 criteria for myocardial CK-MB homocysteine necrosis that develops after Myoglobins CABG operation. H_FABP: Normal levels : 1.6—19 ng/ml Marker for hemodynamic stress ➔natriuretic peptides ANP is released primarily in response to atrial wall stretching and intravascular volume expansion. BNP is mainly secreted by the ventricles CNP is found predominantly in the brain and also synthesized by vascular endothelial cells Circulating levels of BNP are raised in patients with cardiovascular or renal disease BNP is More important than ANP in heart failure Greatest proportion of circulating BNP is thought to come from the ventricles (left) Marker of inflammation hsCRP ➔show risk factor and future of morbidity , mortality Clinical Uses 1. screening for cardiovascular risk in otherwise "healthy" individuals 2. Predictive value of CRP levels for disease severity in pre- existing Coronary artery disease Elevated levels are predictive of Long-term risk of first MI Ischemic stroke hsCRP Risk for CVD Less than 1.0 mg/L Low 1.0-2.9 mg/L Intermediate Greater than 3.0 mg/L High Marker of cardiac necrosis Troponin : most diagnostic MI cTNC➔not specific for heart Ctnt➔specific for heart but rised from skeletal muscle cTni➔the most specific for heart  Dr Ahmed Abdelsalam Conditions associated with troponin elevation Arrhythmias Hypertension Pulmonary embolism congestive heart failure Myocarditis Pulmonary hypertension, severe Coronary artery disease Pericarditis Renal failure Coronary vasospasm Sepsis/septic shock Critically ill patient Sepsis-related myocardial dysfunction Systemic inflammatory diseases Trauma Creatine kinase CK-BB (CKI) : is of brain origin, found in blood only when BBB is damaged. CK-MB (CK2) : it is relatively specific for myocardial origin CK-MM (CK3) : it is found primarily in skeletal muscle RI (between CKMB-TOTAL CK) ➔3-6% with Tot CK activity elevated suggests myocardial necrosis Can be used to indicate early re-infarction if level normalizes and then increases again. Future Cardiac Biomarker miRNA Myoglobin Sensitivity Troponins specific 1. A 50-year-old male patient, a heavy smoker and diabetic, came to the emergency department complaining of chest pain and vomiting for 2 hours. The doctor suspects that this patient has a myocardial infarction. What is the earliest cardiac marker that can be detected? a- myoglobin b- troponin c- Ck mb d- LDH 2.What is the "Gold Standard" of Cardiac Biomarkers? a- LDH b- Myoglobin c- Ckmb d- Troponin 3. Cardiac muscle contains which of the following CK isoenzyme? a- BB b- MM and BB c- MM, BB and MB d- MM and MB  Dr Ahmed Abdelsalam 4. A 62-year-old man is admitted to the hospital following myocardial infarction. Four days after admission he develops a further episode of central crushing chest pain. Which is the best cardiac marker to investigate his chest pain? A. LDH B. CK-MB C. Troponin I D. Troponin T True or False 1- AMI is ruled out if the ratio of CK- 2marks))MB total CK is more than 6% 2- A flipped LDH ratio means that LD-1is more than LD-2