Cardiac disease

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Cardiac disease

  1. 1. CARDIAC DISEASE CLINICAL BIOCHEMISTRY
  2. 3. Learning Objectives <ul><li>Explain the etiology of Myocardial infarction (MI). </li></ul><ul><li>List out the symptoms of MI. </li></ul><ul><li>Elaborate the tests to investigate the disease. </li></ul>
  3. 4. Myocardial Infarction <ul><li>Heart attack= MI= death of heart muscle from the sudden blockage of a coronary artery by blood clot </li></ul><ul><li>Blockage; injury; chest pain & pressure; muscle death; scar tissue. </li></ul>
  4. 8. Etiology <ul><li>Atherosclerosis with occlusive or partially occlusive thrombus formation </li></ul>
  5. 10. Symptoms of MI <ul><li>1) Chest pain </li></ul><ul><li>Squeezing, aching, burning or sharp pain </li></ul><ul><li>More than 30 min: infarction </li></ul><ul><li>Associated with nausea, vomiting, dyspnea, </li></ul><ul><li>fatigue or palpitations </li></ul><ul><li>Atypical chest pain common in diabetes and </li></ul><ul><li>elderly patients </li></ul>
  6. 11. <ul><li>2) Shortness of breath </li></ul><ul><li>Anginal equivalent or symptom of heart failure </li></ul><ul><li>Due to elevated end-diastolic pressure; lead to elevated pulmonary pressure </li></ul>
  7. 12. <ul><li>3) Atypical presentations </li></ul><ul><li>Common and lead to misdiagnoses </li></ul><ul><li>Abdominal discomfort or jaw pain may present </li></ul><ul><li>Elderly patient may present with altered mental status </li></ul><ul><li>Women present more common atypical symptoms </li></ul>
  8. 13. Physical Examination of MI <ul><li>Low grade fever </li></ul><ul><li>Hypo or hypertension </li></ul><ul><li>4 th heart sound (S4) may be heard </li></ul><ul><li>Dyskinetic cardiac bulge </li></ul><ul><li>Systolic murmur can be heard </li></ul><ul><li>Cool, clammy skin and diaphoresis </li></ul><ul><li>Signs of CHF </li></ul>
  9. 14. Risk Factors <ul><li>1) Non modifiable risk factors </li></ul><ul><li>Family history of premature coronary heart disease </li></ul>
  10. 15. <ul><li>2) Modifiable risk factors </li></ul><ul><li>Smoking </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>Hypertension </li></ul><ul><li>Dyslipidemia </li></ul><ul><li>Obesity </li></ul><ul><li>Sedentary life </li></ul><ul><li>Psychosocial stress </li></ul><ul><li>Poor oral hygiene </li></ul>
  11. 16. <ul><li>3) Non atherosclerotic causes </li></ul><ul><li>Vasculitis </li></ul><ul><li>Coronary emboli </li></ul><ul><li>Congenital coronary anomalies </li></ul><ul><li>Coronary trauma </li></ul><ul><li>Coronary spasm </li></ul><ul><li>Drugs </li></ul><ul><li>Factors that increase O2 requirement & decrease O2 delivery </li></ul>
  12. 17. Lab Investigation <ul><li>Cardiac enzymes </li></ul><ul><li>Troponin levels </li></ul><ul><li>Myoglobin levels </li></ul><ul><li>Lipid profile </li></ul><ul><li>ECG </li></ul>
  13. 18. Cardiac Enzymes <ul><li>Creatine kinase: 3 isoenzymes </li></ul><ul><li>CK-MB: mainly in heart </li></ul><ul><li>Serial measurement of CK-MB for diagnosis MI </li></ul><ul><li>CK-MB: increase within 3-12 hours of onset, peak values within 24 hours, return baseline after 48-72 hours </li></ul><ul><li>High sensitivity & specificity (but not as high as Trop T) </li></ul>
  14. 19. Troponin <ul><li>Greater sensitivity & specificity </li></ul><ul><li>Role in diagnostic and prognostic </li></ul><ul><li>Positive troponin levels virtually diagnostic of MI </li></ul><ul><li>Trop T: increase within 3-12 hours from onset, peak at 24-48 hours, return baseline over 5-14 days </li></ul>
  15. 20. Myoglobin <ul><li>Urine myoglobin: rise within 1-4 hours from onset </li></ul><ul><li>High sensitive but not specific </li></ul><ul><li>Useful in early detection of MI in the ED </li></ul>
  16. 23. Treatment of MI <ul><li>Restoration balance between oxygen supply and demand </li></ul><ul><li>Pain relief </li></ul><ul><li>Prevent and treat complications </li></ul>
  17. 24. QUESTIONS : <ul><li>Discuss in a group; </li></ul><ul><li>(1) Information about Myocardial infarction. </li></ul><ul><li>Discussion must include the etiology, symptoms, physical examination and risk factor. </li></ul><ul><li>(2) Elaborate the tests to investigate the disease. </li></ul>
  18. 25. Thank You

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