Cardiovascular Inflammatory DIseases

These are the enzymes that are released into the blood stream when heart is damaged or stressed (MI, ischemia, etc.)

Cardiac Biomarkers

Biomarker primarily found in the heart and skeletal muscles.

Creatinine Kinase (CK)

Cardiac Biomarker:

This suggests injury to the heart muscle if elevated.

CK-MB

Cardiac Biomarkers:

These two Troponins are specific to the heart.

Troponin I, Troponin T

Captures oxygen that muscle cells use for energy.

Myoglobin

This test determines the presence of fats and evaluate a person's risk of developing atherosclerotic disease.

Lipid Profile

What are included in the lipid profile?

A. Cholesterol

B. Triglycerides

C. Lipoproteins

D. HDLs and LDLs

E. All of the above

E.

Primary transporters of cholesterol and triglycerides into the walls of arterial vessels.

Associated with CAD when elevated.

Low-density Lipoprotein (

Lipoprotein with a protective action. It transports cholesterol away from the arterial walls.

Decreases with smoking.

High density lipoprotein

cholesterol normal value

HDL normal value

29-77 mg/dl

LDL normal value

60-160 mg/dl

Triglyceride normal value:

12-29 yo

10-140mg/dl

TG normal value

30-39 yo

20-150 mg/dl

TG normal value

40-49 yo

30-160 mg/dl

TG normal value

>50 years old

40-190 mg/dl

What should be considered before cardiac catheterization with fluoroscopy is done?

determine allergy to iodine or shellfish

Diagnoses CAD, assess CA patency, and determine extent of atherosclerosis.

Cardiac Catheterization

Cardiac Catheterization:

T or F

Patient requires 2-6 hours of bed rest before allowed to ambulate

True

Cardiac Catheterization:

T or F

-Avoid lifting heavier than 5lbs

- avoid repetitive movements of the affected hand or wrist for the next 48 hrs

- SIT DOWN if bleeding occurs

T

Cardiac Catheterization:

What do you think should be avoided after insertion in the groin area? SATA

A. Bend at the waist

B. Showering

C. Tub baths

D. Lifting within 24 hours

A, C, D

A noninvasive, painless technique which involves injection of contrast agent into the vascular system to outline the heart and blood vessels.

-selective for specific heart chamber or blood vessels for study

Angiography

What is the test done to assess occlusion or stenosis of the carotid arteries of the neck?

Carotid Artery Duplex Scan

What is the target HR during an exercise stress test?

80-90% of predicted maximum HR

This is done when patient is physically disabled or unable to undergo exercise stress test.

Dipyridamole, adenosine, and dobutamine are given to mimic effects of exercise.

SE: vasodilation, inc. myocardial contractility

Pharmacologic stress test

Inflammation of the outer lining of the heart. May be primary or secondary disease.

Pericarditis

Pericarditis leads to the adhesion of pericardial layers which leads to?

Ventricular filling restriction

What is the most common pathogen of Pericarditis?

Virus

Pericarditis causes:

I. Viral infection

II. Neoplasm metastatis

III. Renal failure. Toxins reach the heart

IV. Radiation therapy which damages tissues

V. Inflammatory Disorders/Autoimmune leading to fluid accumulation

I,II,III,IV,V

Friction rub is heard during auscultation of the heart. This suggests?

Pericardial effusion

Pericarditis exhibits a chest pain aggravated by breathing and relieved by sitting or leaning forward.

T or F

True

Concave ST elevations are a sign of?

Pericarditis

acute compression of the heart caused by fluid accumulation in the pericardial cavity. This a complication of pericarditis.

Cardiac Tamponade

Beck's triad (pericarditis)

pulsus paradoxus, JVD, distant muffled heart sound

Pulsus Paradoxus

drop in blood pressure >10 mmHg with inspiration

Pericardiocentesis

surgical puncture to aspirate fluid from the sac surrounding the heart

Pericardial windowing

surgical procedure to create a window which removes a portion of the pericardium

Inflammatory process involving the myocardium.

Caused by infections, immunosuppression, radiation therapy, autoimmune disease.

Myocarditis

Flu-like symptoms are a manifestation of which cardiac disease?

A. Myocarditits

B. Cardiac Tamponade

C. Pericarditis

D. none of the above

A.

Management for Myocarditis

A. Penicillin

B. Bed rest

C. Limited physical activity

D. Avoid NSAIDs

E. All of the above

E.

Inflammation of the inner lining of the heart including the valves.

Caused by staph. aureus/strep.viridans

Hospital-acquired

Prosthesis of valves, pacemakers

Idiopathic

Endocarditis

Who are at high risk for endocarditis?

A. Tatoo patients

B. Body piercings

C. Immunocompromised patients

D. Patient with pacemakers

E. All of the above

E.

Osler nodes are? (Sign of Endocarditis)

painful erythematous nodules on the finger tips and toes

Janeway lesions (sign of endocarditis)

nontender hemorrhagic lesions - on palms and soles

Inability of the heart to pump blood to meet body's metabolic demand. Lack of cardiac output.

Heart Failure

Patient has:

Coughing

Hemoptysis

Orthopnea

Pulmonary congestion

Paroxysmal Nocturnal Dyspnea

pulmonary edema is present

Left Sided Heart Failure

The patient has the following manifestations

Hepatomegaly

Edema of lower extremities

Ascites leading to possible respiratory distress

Distended neck veins

weight gain

congestion of peripheral and visceral tissues.

We can assume they are experiencing?

Right sided heart failure

Confirmatory diagnosis for HF

1. Cardiomegaly

2. Echocardiogram: determines ejection fraction

3. CVP: elevated RSHF

4. Brain Natriuretic Peptide level are elevated

1,2,3,4

HF managements:

1. ACE inhibitors (-prils)

2. Diuretics (dec. pulmonary congestion)

3. Dilators (-lol, dec.preload)

4. Diet: low salt to control fluid vol.

5. Digoxin decrease contractility. Monitor cardiac rate and toxicity

1,2,3,4,5

Digoxin effects: SATA

1. (+) inotropic effect: inc. force of contraction

2. (-) chronotropic effect: decrease HR (affects the Sinus Node)

3. (-) dromotropic effect: changes rhythm (affects the AV node)

1,2,3

Normal level of digoxin

0.5-2 ng/mL

Before administering digoxin, the apical pulse is assessed for a minute. You noticed the HR is below 60bpm. What will you do?

1. Administer the digoxin as ordered

2. HOLD the medication

3. Inform the physician

2,3

The patient vomited after taking digoxin. Will you give the patient another dose?

T or F

False

Patient is experiencing nausea and vomiting, anxiety, confusion, anorexia. They also mentioned seeing halos around lights. This is a sign of?

Digitalis Toxicity

Antidote for digoxin is? It binds to digoxin molecules and is excreted out of the body.

Digitalis Immune Fab (DIGIBIND)

How does digoxin achieve its positive inotropic effect?

A. Increases the impulse of SA nodes

B. Potassium is promoted to enter the myocardium cells.

C. Sodium is forced out of the myocardium cells.

D. Calcium is promoted to go inside the heart.

D.

Which will further potentiate the effect of digoxin leading to higher risk of toxicity?

A. Hyperkalemia

B. Hypercalcemia

C. Hyponatremia

D. Hypokalemia

D.