NR571 MIDTERM TEST WITH COMPLETE VERIFIED SOLUTIONS.
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Cardiac enzyme/marker interpretation (troponin, CK-MB, BNP)
Troponin: Troponin is a protein in heart muscle cells that regulates muscular contraction. When the heart muscle is damaged, as in a heart attack, troponin is released into the bloodstream. Troponin levels can become elevated 3-4 hours af...
NR571 MIDTERM TEST WITH
COMPLETE VERIFIED
SOLUTIONS
Cardiac enzyme/marker interpretation (troponin,
CK-MB, BNP)
Troponin: Troponin is a protein in heart muscle
cells that regulates muscular contraction. When
the heart muscle is damaged, as in a heart attack,
troponin is released into the bloodstream. Troponin
levels can become elevated 3-4 hours after a heart
attack and can remain elevated for up to 14 days.
Therefore, it is a highly specific indicator of heart
damage.
CK-MB (Creatine Kinase-MB): CK-MB is a form of
creatine kinase found mostly in the heart muscle.
Levels in the blood can rise within a few hours of a
heart attack and generally peak within 24 hours. A
high CK-MB level often indicates damage to the
heart. However, CK-MB is less specific for heart
damage than troponin, as it can also be elevated in
conditions such as muscle injury, inflammation, or
vigorous exercise.
BNP (B-type Natriuretic Peptide): BNP is a hormone
produced by the heart and blood vessels. The level
of BNP in the blood increases when the heart is
working hard and has more fluid than it should.
High levels of BNP are often associated with heart
,failure. This test is often used to differentiate
between heart failure and other conditions (like
lung diseases) when a patient presents with
shortness of breath.
Additional Laboratory Tests
· Troponin every 8hr
· BNP to assess for heart failure
· CBC provides information needed for thrombolytic
therapy (H/H and platelet baseline)
· PTT, PT/INR to assess baseline coagulation status
· BMP to assess renal function and electrolytes
· TSH, magnesium, and phosphorus as imbalances
can cause dysrhythmias
· echocardiogram to evaluate the ejection fraction
and patency of heart valves
· coronary angiography
Differentials for angina
Unstable angina: acute cardiac chest pain that
comes and goes without relation to exertion along
with ST segment depression or T-wave inversions.
Cardiac enzymes are normal
NSTEMI: elevated cardiac enzymes with acute
cardiac chest pain or/and ECG changes (ST
segment depression or T-wave inversion)
STEMI: acute cardiac chest pain, ST segment
elevations, and elevated cardiac enzymes
,Stable Angina: is a pattern of exacerbation with
physical or emotional stress caused by a supply–
demand mismatch. It lasts several minutes and is
relieved by rest.
Variant/Prinzmetal: Occurs in the presence of
arterial spasm and is unrelated to CAD. More
common in women.
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Risk factors for cardiac ischemia
· Age > 55 years
· Family History of CAD
· Tobacco use
· Diabetes
· HTN
· Hyperlipidemia
, · Vascular atherosclerosis
· Obesity
· Unhealthy diet
· Inactivity
· COVID-19
Appropriate diagnostic testing in PFO(Patent
Foramen Ovale)
An echocardiogram can be done to diagnose a PFO.
If the PFO is not easily seen, a cardiologist can
perform a "bubble test." Saline solution (salt
water) is injected into the body as the cardiologist
watches the heart on an ultrasound
(echocardiogram) monitor.
EKG interpretation in ACS/MI
Inferior wall: II, III, & aVF--RCA & LCx
Intraventricular septum: V1-V2--LAD
Anterior wall: V3-V4--LAD, LCA
Lateral wall of the left atrium and septum: I, aVL,
V5, & V6--LCx
Right atrium: aVR--RCA
Management of chest pain in CAD
The 7 early treatment measures in ACS:
1. Oxygen
2. Nitroglycerine
3. Morphine
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