p.1
Cardiac Markers Overview
What does an elevated level of cardiac markers indicate?
Possible heart injury or myocardial infarction.
p.2
Lipid Profile Components
What is a lipid profile?
A blood test that measures the levels of specific lipids in the blood.
p.2
Lipid Profile Components
What are the main components measured in a lipid profile?
Total cholesterol, LDL, HDL, and triglycerides.
p.2
Lipid Profile Components
What is the role of HDL in the body?
High-Density Lipoprotein helps remove cholesterol from the bloodstream.
p.2
Lipid Profile Components
Why are triglycerides important in a lipid profile?
They provide information about the body's fat storage and energy use.
p.1
Cardiac Markers Overview
What are cardiac markers?
Substances released into the blood when the heart is damaged.
p.1
Cardiac Markers Overview
Why are cardiac markers important?
They help diagnose heart conditions and assess the severity of heart damage.
p.38
Cardiac Markers Overview
What is the role of CK-MM?
Creatine Kinase-MM, associated with skeletal muscle.
p.47
Cardiac Markers Overview
What is Troponin T?
A cardiospecific protein present in fetal skeletal muscles and damaged adult skeletal muscles.
p.14
Very Low-Density Lipoproteins (VLDL)
What is β - VLDL?
An abnormal lipoprotein that accumulates in type 3 hyperlipoproteinemia.
p.23
Disorders Related to Cholesterol Metabolism
What does familial combined hyperlipidemia present with?
A variety of lipoprotein phenotypes within a family.
p.37
Cardiac Markers Overview
What types of tissues is Creatine Kinase (CK) found in?
Skeletal, cardiac, and brain tissues.
p.8
Very Low-Density Lipoproteins (VLDL)
What is the primary function of Very Low-Density Lipoproteins (VLDL)?
To supply the tissues of the body with triglycerides and cholesterol.
p.7
Chylomicrons and Their Role
What happens to plasma when chylomicrons are present at high levels?
It becomes 'milky' and forms a floating creamy layer when undisturbed for several hours.
p.41
Cardiac Markers Overview
What does the Relative Index (RI) of CK - MB isoenzyme relate to?
It relates the CK - MB isoenzyme mass concentration to the total CK activity.
p.3
Chylomicrons and Their Role
What is the primary function of chylomicrons?
To transport dietary lipids from the intestines to other locations in the body.
p.45
Cardiac Markers Overview
What conditions is Troponin I indicated for?
Acute Myocardial Infarction (AMI), risk stratification of Unstable Angina Pectoris (UAP), therapy decision making, minor myocardial damage, and reperfusion.
p.12
Lipoprotein(a) and Its Implications
What is Lipoprotein(a) similar to in terms of density and composition?
LDL (Low-Density Lipoprotein).
p.15
Abnormal Lipoproteins and Their Effects
How does atherosclerosis relate to lipid metabolism?
It involves the buildup of lipids in arterial walls, leading to cardiovascular diseases.
p.5
Abnormal Lipoproteins and Their Effects
What does LpX refer to?
A minor lipoprotein that can be involved in lipid metabolism.
p.19
Low-Density Lipoproteins (LDL) Characteristics
How does Familial Defective ApoB affect LDL receptors?
ApoB is not recognized by LDLR.
p.15
Abnormal Lipoproteins and Their Effects
What are abnormalities of lipid metabolism?
Disruptions in the normal processing of lipids in the body, leading to various health issues.
p.30
Cardiac Markers Overview
Why are cardiac markers important?
They help diagnose heart conditions and assess the severity of heart damage.
p.44
Cardiac Markers Overview
What is troponin?
A complex found in thin filaments of striated muscles.
p.54
Cardiac Markers Overview
What is Heart Fatty Acid Binding Protein (HFABP)?
A cytosolic protein abundant in the heart involved in fatty acid metabolism.
p.52
Cardiac Markers Overview
What is the significance of the myoglobin to Carbonic Anhydrase III ratio?
It helps determine if the rise of myoglobin is due to skeletal or cardiac muscle.
p.42
Cardiac Markers Overview
What happens to the levels of CK-MB1 and CK-MB2 in myocardial damage?
CK-MB2 rises above CK-MB1.
p.41
Cardiac Markers Overview
What does an RI greater than 6% indicate?
It is indicative of cardiac damage.
p.6
Chylomicrons and Their Role
What happens to triglycerides in chylomicrons?
They are depleted by the action of lipoprotein lipase.
p.9
Low-Density Lipoproteins (LDL) Characteristics
What condition is associated with increased amounts of small LDL particles?
Several common forms of dyslipoproteinemia associated with coronary heart disease (CHD).
p.55
Cardiac Markers Overview
What is the clinical diagnostic value of Heart Fatty Acid Binding Protein (HFABP) in renal failure?
Very limited, as it is completely renally eliminated.
p.19
Low-Density Lipoproteins (LDL) Characteristics
What is Familial Defective ApoB?
An autosomal dominant mutation of the apoB gene on Chromosome 2.
p.33
Cardiac Markers Overview
What are some conditions associated with marked elevations of lactate dehydrogenase (LDH)?
Megaloblastic anemia, untreated pernicious anemia, Hodgkin's disease, abdominal and lung cancers, severe shock, and hypoxia.
p.9
Low-Density Lipoproteins (LDL) Characteristics
How are Low-Density Lipoproteins (LDL) produced?
Through the metabolism of Very Low-Density Lipoproteins (VLDL) in circulation.
p.22
Lipoprotein(a) and Its Implications
What is the role of ApoC - II in lipid metabolism?
It is an activating cofactor for lipoprotein lipase (LPL).
p.31
Cardiac Markers Overview
What is Lactate Dehydrogenase (LD) used for in cardiac assessment?
It is a cardiac marker that helps in diagnosing myocardial infarction.
p.11
Abnormal Lipoproteins and Their Effects
How does the lipid content, size, and density of IDL compare to VLDL and LDL?
It is intermediate between VLDL and LDL.
p.30
Cardiac Markers Overview
What does an elevated level of cardiac markers indicate?
Possible heart injury or myocardial infarction.
p.49
Cardiac Markers Overview
What does an elevated myoglobin result indicate?
It warrants further AMI workup.
p.20
Disorders Related to Cholesterol Metabolism
How do patients with Autosomal Recessive Hypercholesterolemia typically respond to treatment?
They respond to lipid-lowering medications, and LDL apheresis is also done.
p.12
Lipoprotein(a) and Its Implications
What do VLDL receptors of macrophages do in relation to Lipoprotein(a)?
They bind Lp(a), leading to accumulation.
p.48
Cardiac Markers Overview
What is the primary use of myoglobin in clinical settings?
To assist in ruling out an infarct.
p.23
Abnormal Lipoproteins and Their Effects
What is associated with high cholesterol and high triglycerides?
Elevations of LDL and triglycerides (Fredrickson Types 2B and 3).
p.55
Cardiac Markers Overview
In which conditions is the diagnostic value of HFABP limited?
In the presence of renal failure and skeletal muscle diseases.
p.20
Disorders Related to Cholesterol Metabolism
What genetic condition is associated with high cholesterol and high LDL-C?
Autosomal Recessive Hypercholesterolemia.
p.11
Low-Density Lipoproteins (LDL) Characteristics
How can IDL be removed from circulation?
Through interaction with the LDL receptor.
p.3
Lipid Profile Components
What are the major types of lipoproteins?
Chylomicrons, Very Low-Density Lipoproteins (VLDL), Low-Density Lipoproteins (LDL), and High-Density Lipoproteins (HDL).
p.52
Cardiac Markers Overview
What is the pattern of Carbonic Anhydrase III levels in relation to myoglobin?
It has a similar rise and fall pattern as myoglobin.
p.6
Chylomicrons and Their Role
What enzyme acts on chylomicrons at the capillary endothelium?
Lipoprotein lipase (LPL).
p.44
Cardiac Markers Overview
What role does TnI play in muscle contraction?
It inhibits myosin ATPase, blocking myosin movement in the absence of calcium.
p.44
Cardiac Markers Overview
What is the function of TnC?
It is the calcium binding subunit.
p.18
Disorders Related to Cholesterol Metabolism
What is a potential cardiovascular consequence of high LDL-C?
Premature coronary heart disease (CHD).
p.2
Lipid Profile Components
What is considered a healthy level of HDL?
Generally, higher levels are better, with 60 mg/dL or higher being optimal.
p.53
Cardiac Markers Overview
What is the significance of Glycogen Phosphorylase (GP) in cardiac health?
It is an early and specific marker for myocardial necrosis and ischemia.
p.13
Abnormal Lipoproteins and Their Effects
What is LpX lipoprotein associated with?
Obstructive biliary disease and familial lecithin/cholesterol acyltransferase (LCAT) deficiency.
p.32
Cardiac Markers Overview
Where is lactate dehydrogenase (LD) found in the body?
Present in all cells of the body.
p.11
Very Low-Density Lipoproteins (VLDL)
What are Intermediate Density Lipoproteins (IDL) formed from?
The metabolism of VLDL in circulation.
p.37
Cardiac Markers Overview
In which conditions is CK elevated?
Acute Myocardial Infarction (AMI), cerebrovascular accident, myositis, and skeletal muscle diseases like progressive Duchenne muscular dystrophy.
p.34
Cardiac Markers Overview
What is lactate dehydrogenase used for in medical assessments?
Myocardial infarction assessment.
p.44
Cardiac Markers Overview
What is the function of TnT in the troponin complex?
It binds the troponin complex to tropomyosin along actin.
p.18
Disorders Related to Cholesterol Metabolism
What type of disorder is Familial Hypercholesterolemia?
An Autosomal Dominant disorder.
p.42
Cardiac Markers Overview
What is the significance of the CK-MB isoforms ratio?
It is used as a highly sensitive and specific indicator of early AMI.
p.15
Abnormal Lipoproteins and Their Effects
What role do lipoproteins play in lipid metabolism abnormalities?
They transport lipids in the bloodstream, and abnormalities can lead to improper lipid levels.
p.3
High-Density Lipoproteins (HDL) Functions
What is the primary function of High-Density Lipoproteins (HDL)?
To transport cholesterol from the tissues back to the liver for excretion or recycling.
p.2
Lipid Profile Components
What does a high level of LDL indicate?
It may increase the risk of heart disease.
p.14
Abnormal Lipoproteins and Their Effects
What effect does β - VLDL have on cells?
It induces foam cell formation.
p.30
Cardiac Markers Overview
What are cardiac markers?
Substances released into the blood when the heart is damaged.
p.19
Disorders Related to Cholesterol Metabolism
What condition presents similarly to Familial Defective ApoB?
Familial Hypercholesterolemia (FH).
p.20
Disorders Related to Cholesterol Metabolism
What is the characteristic of LDLR in patients with Autosomal Recessive Hypercholesterolemia?
Normal amount but decreased activity.
p.8
Very Low-Density Lipoproteins (VLDL)
Which apolipoproteins are primarily found in VLDL?
ApoB-100, apoC-I, apoC-II, apoC-III, and apoE.
p.7
Chylomicrons and Their Role
What is the significance of the creamy layer formed by chylomicrons?
It indicates high levels of chylomicrons in the plasma.
p.48
Cardiac Markers Overview
What is the primary function of myoglobin?
It is the major protein responsible for oxygen supply of striated muscles.
p.31
Cardiac Markers Overview
What is the purpose of measuring the CK-MB isoforms ratio?
To differentiate between cardiac and non-cardiac causes of elevated CK levels.
p.6
Chylomicrons and Their Role
What is the lipid composition of chylomicrons?
Very rich in triglycerides but relatively poor in free cholesterol, phospholipids, and protein.
p.12
Lipoprotein(a) and Its Implications
What diseases have been associated with increased levels of Lipoprotein(a)?
Coronary Heart Disease (CHD), cerebrovascular disease, and stroke.
p.5
Very Low-Density Lipoproteins (VLDL)
What is β - VLDL?
A subtype of very low-density lipoproteins that may indicate metabolic disorders.
p.45
Cardiac Markers Overview
What is Troponin I?
A complete cardiospecific marker.
p.39
Cardiac Markers Overview
When does CK-MB activity appear after an infarction?
4 hours after infarction.
p.29
Measurement Techniques for Lipids and Cardiac Markers
What effect do chylomicrons (CMs) have on plasma triglyceride concentration?
They can markedly increase it.
p.32
Cardiac Markers Overview
In addition to the heart and liver, which other organs have high levels of lactate dehydrogenase (LD)?
Kidney, Lung, and Red Blood Cells (RBC).
p.41
Measurement Techniques for Lipids and Cardiac Markers
What is the formula for calculating the Relative Index (RI)?
RI (%) = CK - MB (ug/L) / Total CK (U/L) x 100.
p.49
Cardiac Markers Overview
What is the primary use of myoglobin in medical diagnostics?
As a negative predictor of Acute Myocardial Infarction (AMI).
p.54
Cardiac Markers Overview
How specific is HFABP to the heart?
Highly cardiospecific but expressed at low concentrations in other tissues.
p.12
Lipoprotein(a) and Its Implications
What is Lipoprotein(a) composed of?
An LDL particle with a large glycoprotein apo(a) linked to apoB-100 via a disulfide bond.
p.31
Cardiac Markers Overview
What does the CK-MB isoenzyme mass indicate?
It helps in quantifying the extent of myocardial injury.
p.31
Cardiac Markers Overview
What role do Troponin T and Troponin I play in cardiac diagnostics?
They are specific markers for myocardial injury.
p.18
Disorders Related to Cholesterol Metabolism
What is Polygenic (Nonfamilial) Hypercholesterolemia?
A condition characterized by high cholesterol levels due to multiple genetic factors.
p.53
Measurement Techniques for Lipids and Cardiac Markers
What methods are used to measure Glycogen Phosphorylase (GP)?
ELISA and Immunochromatographic methods.
p.23
Disorders Related to Cholesterol Metabolism
What is the most common primary hyperlipoproteinemia?
Familial combined hyperlipidemia (Type 2B).
p.17
Disorders Related to Cholesterol Metabolism
What are the characteristics of disorders with hyperbetalipoproteinemia?
Elevated LDL-C and normal triglycerides.
p.19
Disorders Related to Cholesterol Metabolism
What is the genetic basis of Autosomal Dominant Hypercholesterolemia?
Involves the PCSK9 gene on chromosome 1.
p.6
Chylomicrons and Their Role
What are chylomicrons?
Large particles produced by the intestine that transport dietary lipids to body tissues.
p.22
Lipoprotein(a) and Its Implications
What happens in the absence of ApoC - II?
It creates a functional LPL deficiency, presenting similarly to LPL deficiency.
p.3
Very Low-Density Lipoproteins (VLDL)
What is the role of Very Low-Density Lipoproteins (VLDL)?
To transport triglycerides from the liver to tissues.
p.22
Abnormal Lipoproteins and Their Effects
What is the effect of ApoC - III excess on lipid metabolism?
It interferes with the activity of lipoprotein lipase and prevents lipoproteins from binding to the LDL receptor.
p.9
Low-Density Lipoproteins (LDL) Characteristics
What is the primary utilization of Low-Density Lipoproteins (LDL)?
Mainly utilized by the liver and other cells of the body.
p.6
Chylomicrons and Their Role
Where are chylomicrons mainly metabolized?
In the liver and bone marrow.
p.35
Cardiac Markers Overview
What are the five fractions of lactate dehydrogenase isoenzymes?
LD1 (H4), LD2 (H3M), LD3 (H2M2), LD4 (HM3), LD5 (M4).
p.24
Disorders Related to Cholesterol Metabolism
What is Cholesterol 7-Alpha-Hydroxylase Deficiency?
A recessive disorder of the CYP7A1 gene affecting bile acid synthesis.
p.53
Cardiac Markers Overview
How can Glycogen Phosphorylase (GP) be used in clinical diagnosis?
It can be used in the early diagnosis of Acute Coronary Syndrome (ACS) and reversible myocardial ischemia.
p.38
Cardiac Markers Overview
What are the three isoenzymes of Creatine Kinase?
CK-BB (Brain), CK-MB (Cardiac), CK-MM (Skeletal Muscle).
p.9
Low-Density Lipoproteins (LDL) Characteristics
What is the densest type of lipoprotein containing ApoB?
Low-Density Lipoproteins (LDL).
p.45
Cardiac Markers Overview
Is Troponin I detected in adult skeletal muscle?
No, it is not detected in adult skeletal muscle.
p.7
Chylomicrons and Their Role
What is the effect of high levels of chylomicrons on plasma appearance?
It results in a milky appearance.
p.15
Abnormal Lipoproteins and Their Effects
What is hyperlipidemia?
An elevation of lipids in the blood, often linked to metabolic disorders.
p.16
Disorders Related to Cholesterol Metabolism
What role do lipoproteins play in cholesterol metabolism?
They transport cholesterol and triglycerides in the bloodstream.
p.3
Low-Density Lipoproteins (LDL) Characteristics
What are the characteristics of Low-Density Lipoproteins (LDL)?
LDL is often referred to as 'bad cholesterol' and is associated with the transport of cholesterol to tissues.
p.18
Low-Density Lipoproteins (LDL) Characteristics
What happens to LDL in patients with defective receptors?
They cannot bind or clear LDL from the circulation.
p.10
High-Density Lipoproteins (HDL) Functions
What is the primary composition of High-Density Lipoprotein (HDL)?
Mostly protein, cholesterol, and phospholipids, with only traces of triglycerides.
p.12
Lipoprotein(a) and Its Implications
How does Lipoprotein(a) interfere with thrombolysis?
By binding fibrin and preventing the action of plasminogen.
p.38
Cardiac Markers Overview
What does CK-MB indicate?
Creatine Kinase-MB, associated with cardiac muscle.
p.5
Lipoprotein(a) and Its Implications
What is Lipoprotein (a)?
A type of lipoprotein associated with cardiovascular risk.
p.14
Very Low-Density Lipoproteins (VLDL)
How does β - VLDL differ from regular VLDL?
It is richer in cholesterol than VLDL and results from defective catabolism of VLDL.
p.16
Disorders Related to Cholesterol Metabolism
What is cholesterol metabolism?
The process by which cholesterol is synthesized, transported, and broken down in the body.
p.22
Disorders Related to Cholesterol Metabolism
What deficiency is associated with high triglycerides due to impaired fat metabolism?
Lipoprotein lipase (LPL) deficiency.
p.42
Cardiac Markers Overview
What is the purpose of developing CK-MB isoforms?
To improve the sensitivity of the biochemical diagnosis of Acute Myocardial Infarction (AMI).
p.15
Abnormal Lipoproteins and Their Effects
What can result from abnormal lipid metabolism?
Conditions such as hyperlipidemia, atherosclerosis, and pancreatitis.
p.19
Disorders Related to Cholesterol Metabolism
What role does the PCSK9 gene play?
It is involved in cholesterol homeostasis in the liver.
p.9
Low-Density Lipoproteins (LDL) Characteristics
What is the approximate composition of LDL?
Approximately 50% cholesterol (mostly esterified) and 25% protein (mostly apoB-100).
p.31
Cardiac Markers Overview
What is the significance of CK-MB activity?
It is used to assess heart muscle damage.
p.41
Cardiac Markers Overview
Why is the Relative Index (RI) used?
To evaluate increased total CK activity.
p.24
Disorders Related to Cholesterol Metabolism
What deficiency is associated with hepatic lipase?
Hepatic Lipase Deficiency.
p.36
Cardiac Markers Overview
What indicates a myocardial infarction in lactate dehydrogenase isoenzymes?
A FLIPPED pattern where the LD1/LD2 ratio is greater than 1.
p.2
Lipid Profile Components
What lifestyle factors can affect lipid levels?
Diet, exercise, and smoking can all influence lipid levels.
p.21
Abnormal Lipoproteins and Their Effects
What are some secondary causes of high triglycerides?
Excess alcohol or a high-carbohydrate diet.
p.33
Cardiac Markers Overview
What conditions can cause mild to moderate increases in lactate dehydrogenase (LDH)?
Myocardial infarction (MI), pulmonary infarction, pulmonary embolism, and leukemia.
p.22
Disorders Related to Cholesterol Metabolism
What genetic condition leads to elevated triglycerides?
Familial hypertriglyceridemia.
p.16
Disorders Related to Cholesterol Metabolism
What are the main functions of cholesterol in the body?
To serve as a structural component of cell membranes and as a precursor for steroid hormones and bile acids.
p.11
Low-Density Lipoproteins (LDL) Characteristics
What can happen to IDL after its formation?
It can be further metabolized to LDL.
p.16
Disorders Related to Cholesterol Metabolism
What can result from abnormal cholesterol metabolism?
Disorders such as hypercholesterolemia and atherosclerosis.
p.8
Very Low-Density Lipoproteins (VLDL)
What is the approximate composition of VLDL?
50% triglyceride, 40% cholesterol and phospholipid, 10% protein.
p.7
Chylomicrons and Their Role
Which apolipoproteins are found in chylomicrons?
apoB-48, apoA-I, apoA-IV, apoC-I, apoC-II, apoC-III, and apoE.
p.20
Disorders Related to Cholesterol Metabolism
What role does the ARH protein play in cholesterol metabolism?
It is involved in the internalization of the LDLR-LDL complex.
p.46
Cardiac Markers Overview
What conditions can cause elevated levels of Troponin I?
Viral myocarditis, scleroderma, or cardiac trauma.
p.46
Cardiac Markers Overview
In which conditions is Troponin I rarely elevated?
Musculoskeletal diseases and renal insufficiency.
p.10
High-Density Lipoproteins (HDL) Functions
Where is High-Density Lipoprotein (HDL) produced?
By the liver and intestine.
p.31
Cardiac Markers Overview
What is Myoglobin and its relevance in cardiac markers?
It is an early marker for muscle injury, including cardiac muscle.
p.24
Disorders Related to Cholesterol Metabolism
What is a notable characteristic of patients with Cholesterol 7-Alpha-Hydroxylase Deficiency?
They are resistant to statin therapy.
p.20
Disorders Related to Cholesterol Metabolism
Which gene is involved in Autosomal Recessive Hypercholesterolemia?
The ARH gene, also known as LDLRAP1.
p.45
Cardiac Markers Overview
Is Troponin I present in diseased human skeletal muscle?
It is absent in diseased human skeletal muscle.
p.18
Low-Density Lipoproteins (LDL) Characteristics
What is the primary cause of Familial Hypercholesterolemia?
Mutations in the LDL-receptor gene on Chromosome 19.
p.29
Measurement Techniques for Lipids and Cardiac Markers
What decrease in lipid concentrations can occur after 20 minutes of recumbence?
As much as 10% in TC, LDL-C, HDL-C, apoA-I, and apoB.
p.24
Disorders Related to Cholesterol Metabolism
What type of hyperlipidemia is associated with metabolic conditions?
Acquired Combined Hyperlipidemia.
p.41
Cardiac Markers Overview
What does an RI less than 6% indicate?
It is indicative of skeletal damage.
p.18
Disorders Related to Cholesterol Metabolism
What are common physical manifestations in patients with high LDL-C?
Xanthelasma and xanthoma.
p.53
Cardiac Markers Overview
What is the primary location of the GP-BB isoenzyme?
Present in the brain and myocardium.
p.10
High-Density Lipoproteins (HDL) Functions
What role does HDL play in cholesterol transport?
Involved in reverse cholesterol transport.
p.49
Measurement Techniques for Lipids and Cardiac Markers
What methods are used to measure myoglobin levels?
ELISA, Turbidimetry/Nephelometry.
p.46
Measurement Techniques for Lipids and Cardiac Markers
What methods are used to measure Troponin I?
ELISA and Chemiluminescent Assay.
p.38
Cardiac Markers Overview
What does CK-BB stand for?
Creatine Kinase-BB, associated with the brain.
p.48
Cardiac Markers Overview
Why is myoglobin considered more sensitive than troponins during the first hours after an acute myocardial infarction (AMI)?
Because it is released into the blood more rapidly.
p.12
Lipoprotein(a) and Its Implications
Are traditional LDL-lowering drugs effective against Lipoprotein(a)?
No, they are not effective.
p.24
Disorders Related to Cholesterol Metabolism
What is the role of apoE2 in relation to LDL receptors?
It has a lower affinity for LDLR than E3 and E4.
p.10
High-Density Lipoproteins (HDL) Functions
What mechanisms is HDL suggested to be involved in according to in vitro studies?
Anti-inflammatory, antioxidant, antithrombotic, and nitric oxide-inducing mechanisms.
p.31
Cardiac Markers Overview
What are some other cardiac markers besides those listed?
Other markers may include BNP (B-type Natriuretic Peptide) and C-reactive protein.
p.36
Cardiac Markers Overview
When does the FLIPPED pattern typically appear after a myocardial infarction?
About 12 - 24 hours after infarction.
