Total Cholesterol
Normal: < 200mg/dL
High: >240 mg/dL
High increases risk of death due to CHD within 25 yrs, atherosclerotic lesions.
Triglycerides
Normal: <150 mg/dL
High: 200-499 mg/dL
- CHD, pancreatitis
LDL
Optimal: <100 mg/dL
High: 160-189
Bad cholesterol- associated with increased risk of CHD & atherosclerotic vascular disease
HDL
Low: 40 mg/dL
High: >60 mg/dL
Good cholesterol. High = cardio protection, low = increased risk of CHD, MI
Chylomicrons
- Release triglycerides to fat depots and muscle- no standard range
- Presence indicates potential for high triglycerides
VLDL
- Normal: <30 mg/dL
- Triglycerides- become LDL particles
- Elevated lease to CHD
Lipoprotein a Lpa
Variation of LDL cholesterol
- Risk factor in premature development of plaque, atherosclerosis
Homocystine
Males: 4-12 mcmol/L
Females: 4-10 mcmol/ L
- amino acid in blood
- High = risk factor for atherosclerosis, CHD< thromboembolism
Creatine phosphokinase (CPK or CK)
- AMI Dx =2 fold risk above normal
- Lacks specificity for cardiac damage
- Rise 4-8 H, peak 24-36 H
- Normal within 48 H
CK-MB
- Subtype of Ck found in cardiac muscle
- Assess reperfusion after thrombolysis
- Sensitive & specific
- Rise 3-4H, Peak: 15-20 H, Normal 24-36 H
- Bad for low muscle mass pts
- May be abn in normal CPK- order separately
Myoglobin
Earliest AMI marker
Rise: 1-4 H, Peak: 4-12, Normal 24 H
- Sensitive, not specific
Troponin
Gold standard
- T, less available
- I commonly used
- Normal 0.0= 1.5ng.mL
Rise: 3-12 hrs, Peak 10-24 H, Normal 7 - 10 days
- Retrospective MI dx
- Low early specificity, increases with time.
C-reactive protein
hs-CRP for cardiac risk
- 1.0-3.0 mg/L = average risk
- > 3.0 high risk
- also elevated in rheumatologic and cancer
d-dimer
Fibrin degradation product- used to dx thrombotic disorders
- Potential marker for aortic dissection?
BNP
- Neurohormone secreted in response to increased ventricular volume and pressure
- distinguish cause of dyspnea- BNP increases in proportion to heart failure
- elevated in other conditions- renal failure, age, endocrine
- Sensative, not specific
CXR
Heart size, inter cardiac calcium deposits,
Ambulatory EKG- Holter/ event monitoring
- Asses rate & rhythm over days to months
- evaluation of syncope, near-syncope, palpitations
EKG
- Rate & rhythm
- Changes associates with MI, angina, syncope,
- Stress- evaluate ischemic heart disease with angina
Cardiac catheterization
Inserted in brachial or femoral artery to assess intracardiac pressure, hemodynamic data, blood flow.
- Used in stent, balloon placement
Cardiac angiography
- Contrast and imaging to asses atherosclerotic lesions
- Indications: angina, aortic valve disease, unidentified chest pain, emergency procedures
