Cardio E1: Labs & Diagnostics

What are your cardiac enzymes?

What are your cardiac enzymes?

Creatine Kinase, toponin T and I, myoglobin, Lactic Dehydrogenase

When does CK-MB appear and return normal?

Appears: 6-12 hours

Returns to normal: 3-4 days (limitation)

What cardiac enzyme is the most specific for MI?

Troponin I

When does Troponin I appear and return normal?

Appears: 1-3 hours
Remains: 2 weeks

When does myoglobin level appear and return normal?

Appears: 2 hours, peaks 6-8 hours
Returns to normal: 20-36 hours

Why is myoglobin levels sensitive, but not specific for MIs?

Because it appears within 2 hours but could also be elevated due to damaged skeletal muscle

Why is lactate dehydrogenase not very helpful in the detection of MIs?

It is found everywhere in the body (not specific to heart)

What is a normal BNP level?

< 100

What is a BNP used for?

CHF

BNP has high _______ and low ______

High sensitivity, but low specificity

Does an elevated BNP “rule in” heart failure?

No (low BNP does rule out heart failure)

What is the purpose of an EKG? What is it’s downfall

record electrical activity of the heart; only records what is happening in the moment

What is a CXR useful for?

gives information regarding heart size, pulm vasculature, calcification, HF

What is used to evaluate arrhythmias over a 24 hour period?

Ambulatory cardiac monitoring (Holter monitor)

How does a patient lay for a 2D echocardiogram?

Left lateral decubitus

What would you order to evaluate the hearts valves, chambers, and blood flow?

Echo

Which is invasive, a TTE or a TEE?

TEE

If a Homan test is positive, what is your next step?

Doppler US

A Carotid Intima Media Thickness (CIMT) is used to detect the presence or absence of ______

Atherosclerotic disease

A Carotid Intima Media Thickness (CIMT) can distinguish between _________

Different types of plaque which provides information about stable & unstable plaques

Most post-MI patients once stable have a ______ prior to discharge to stratify their risk for any recurrent MI

Stress test

What is a Stress test used w/?

EKG or Echo or both

What is the Coronary Artery Calcium (CAC) score used for?

Stratify risk of coronary heart disease

Who should you be cautious about ordering a MRI for?

pts w/ devices implanted; avoid in the first 12 weeks of pregnancy

What radioisotope is used in a MUGA?

Tch-99

As the CAC score rises, so does ________

CV risk

What is a CAC score of 1-10?

Mild

What is a CAC score of 11-100?

Moderate

What is a CAC score of 101-400?

high

What is a CAC score of >400?

Severe

What is a tilt table test used for?

Identify cause of syncope

Electrophysiologic studies (EPS) are used to _______

Detect and analyze arrhythmias and their origins

Used as a noninvasive method for detecting blockages in the coronary arteries

Coronary CTA

What 3 major measurements are obtained by cardiac ventriculography?

EF, SV, CO