Basic Laboratory Cardiac Overview Online Training

Continue Continue Main Course Flow Basic Laboratory Cardiac Overview Online Training This online training will provide a basic overview of the normal function of the heart and review some of the cardiac markers used in the laboratory to test patients. Identify the main components of the heart and their function 1 Explain the three biomarkers discussed in this course and their clinical significance 4 List risk factors of those prone to heart attacks 3 Define a heart attack or myocardial infarction 2 Master Template HOOD05162003052540 | Effective Date: 26-Nov-2019 Compare high sensitivity troponin to conventional troponin 5 Welcome Audio File Name: welcomepage Welcome to the Basic Laboratory Cardiac Overview Online Training. This online training will provide a basic overview of the normal function of the heart and review some of the cardiac markers used in the laboratory to test patients. This course will cover the following five objectives. Cardiac Overview The cardiovascular system consists of blood, the heart, and the vessels the blood travels through. The heart is the body’s pump that circulates blood throughout the body to all body tissues via blood vessels. Select the tab arrows for a brief cardiology overview. Anatomy of the Heart Normal Heart Physiology Cardiovascular Disease Cardiac Overview General Heart Introduction - Audio File Name: cardiac_over_intro The cardiovascular system consists of blood, the heart, and the vessels the blood travels through. The study of a normal heart and the associated diseases is known as cardiology. The heart is the body’s pump that circulates blood to all body tissues via blood vessels. Select the tab arrows for a brief cardiology overview. Anatomy of the Heart Tab (A&P Text) - Audio File Name: anatomy_of_heart The heart wall is composed of three layers – the external epicardium, myocardium, and internal endocardium. Myocardium is cardiac muscle tissue that makes up approximately 95% of the heart and causes the heart to pump. The heart has four chambers – two atria and two ventricles each composed of myocardium. As each of one of the four heart chambers contract it either pushes blood into a ventricle or out of the heart into an artery. Valves open and close as a result of pressure changes as the heart contracts and relaxes. Each of these four valves assist in ensuring one-way blood flow by closing after blood has been let through to prevent backflow. The myocardium has its own network of blood vessels – the coronary arteries branch from the ascending aorta and encircle the heart like a crown. When the heart contracts little blood flows through the coronary arteries because they are closed. However, as the heart relaxes the high-pressured blood in the aorta propels blood though the coronary arteries to the capillaries then to the coronary veins. The left and right coronary arteries deliver oxygenated blood to the myocardium or cardiac muscle tissue. Select the orange X to return to the Cardiac Overview Screen Diagram of Blood Flow – Audio File Name: blood_flow_diagram (A&P Text) The right and left atria sit above (superior to) the right and left ventricles. The right atrium receives blood from three veins – the superior vena cava, inferior vena cava, and coronary sinus. Blood passes from the right atrium to the right ventricle through the tricuspid valve – a valve with three leaflets. Endocardium cover the valves of the heart. The right ventricle forms most of the heart’s anterior surface. Blood passes from the right ventricle through the pulmonary valve into a large artery. The left atrium forms most of the base of the heart and receives blood from the lungs via four pulmonary veins. Blood passes from the left atrium to the left ventricle through the bicuspid or mitral valve. This valve has two cusps. The left ventricle forms the apex of the heart. Blood passes from the left ventricle through the aortic valve into the ascending aorta. Some of this blood then flows into the coronary arteries which carry blood to the heart wall. The remainder of the blood passing through the ascending aorta travels up to the arch of the aorta and down to the descending aorta. Branches of the aortic arch and descending aorta supply blood to the rest of the body. Select the orange X to return to the Cardiac Overview Screen CVD Tab – Audio File Name: cvd_tab Cardiovascular disease or CVD, commonly referred to as Heart Disease, refers to a group of diseases of the heart and blood vessels. There are many CVDs including Coronary Artery Disease (also referred to as coronary heart disease), Cerebrovascular Disease, Peripheral Arterial Disease, Rheumatic Heart Disease – due to inflammation and scarring caused by streptococcal bacteria, Congenital Heart disease – due to structural defects in the heart present at birth, and Deep Vein Thrombosis and Pulmonary Embolism or blood clots that travel from the legs to the heart and lungs. According to the World Health Organization, CVD is the number one cause of death globally and while 85% of CVD deaths are caused by heart attack and stroke, most CVDs can be prevented with lifestyle or behavioral changes. Of all of the CVDs coronary artery disease (CAD) is the most common. Diagnosis of a cardiovascular disease often comes after a heart attack, angina, stroke, or heart failure. However, with regular evaluations and laboratory testing CVD can be found early. Select the orange X to return back to the Cardiac Overview Screen References – Not Part of Audio A&P Text Tortora, G. J.,& Derrickson, B. (2009). The Cardiovascular System: The Heart. In Principles of Anatomy and Physiology (12th ed., pp. 717-755). Hoboken, NJ: John Wiley & Sons. WHO - https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) Diagnosis of CVD - https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118 Cardiovascular Disease (CVD) Diagnosis of a cardiovascular disease often comes after a heart attack, angina, stroke, or heart failure2 According to the World Health Organization1 CVD is the number one cause of death globally 85% of CVD deaths are caused by heart attack and stroke Most CVDs can be prevented with lifestyle or behavioral changes Cardiovascular Diseases are a group of disorders of the heart and blood vessels1 Specifically: Coronary Artery Disease Cerebrovascular Disease Peripheral Arterial Disease Rheumatic Heart Disease Congenital Heart Disease Deep Vein Thrombosis and Pulmonary Embolism 1. World Heart Organization (WHO). https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Accessed September 2020. 2. The Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118. Accessed September 2020. Diagram of Blood Flow Right Atrium (Deoxygenated Blood) Right Ventricle Left Atrium Left Ventricle Aorta and Systemic Arteries In systemic capillaries, blood loses 02 and gains CO2 Superior Vena Cava Inferior Vena Cava Coronary Sinus In pulmonary capillaries, blood loses C02 and gains O2 O2 O2 O2 O2 Pulmonary Trunk and Pulmonary Arteries CO2 CO2 CO2 CO2 CO2 CO2 Adapted from - Tortora, G. J.,& Derrickson, B. (2009). The Cardiovascular System: The Heart. In Principles of Anatomy and Physiology (12th ed., pp. 717-755). Hoboken, NJ: John Wiley & Sons. O2 O2 Pulmonary Veins (Oxygenated Blood) Anatomy of the Heart Right Atrium Right Ventricle Left Ventricle Left Atrium Aorta Pulmonary Artery Tricuspid Valve Mitral Valve Aortic Valve Coronary Artery Pulmonary Valve The structures of the heart are referenced from the perspective of how the heart sits in the chest Veins always return blood to the heart Arteries always take blood away from the heart Tortora, G. J.,& Derrickson, B. (2009). The Cardiovascular System: The Heart. In Principles of Anatomy and Physiology (12th ed., pp. 717-755). Hoboken, NJ: John Wiley & Sons. heartvideo1_edited.mp4 heartvideo1_edited.mp4 Epicardium Myocardium Endocardium Heart Attack Heart Attack or Myocardial Infarction (MI) is a complication of heart disease. Select the numbered steps below to learn more about the complications of heart disease. 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 Tortora, G. J.,& Derrickson, B. (2009). The Cardiovascular System: The Heart. In Principles of Anatomy and Physiology (12th ed). Heart Attack Audio File Name: heart_attack_cover Complications of heart disease include heart attack, stroke, and heart failure. Complete obstruction of blood flow in the coronary artery may result in an MI, commonly referred to as a heart attack. Infarction is the death of an area of tissue due to interrupted blood supply. Heart tissue near an obstruction dies and is replaced by noncontractile scar tissue causing the heart to lose some of its strength. Depending on the size of dead tissue area the infarction may cause sudden death in the heart attack victim. However, heart tissue can remain alive if it receives as little as 10-15 percent of its normal blood supply. 1 Select the numbered steps below to learn more about the complications of heart disease. Audio File Name: heart_attack The most common signs of heart attack such as shortness of breath, chest pain, and nausea are often present in men and women. However, women may suffer with additional symptoms including pain or pressure in the upper abdomen, fainting, indigestion, and unusual tiredness or fatigue. Select the next number on the line to proceed or the orange X to return to the Heart Attack Overview Screen. Audio File Name: ischemia_angina Partial obstruction of blood flow in the coronary artery may result in cardiac ischemia. This often causes reduced oxygen supply resulting in weakened cells. The pain associated with ischemia is referred to as angina. 1 Audio File Name: hypertension High blood pressure is known as the silent killer because it can cause considerable damage to blood vessels, heart, brain, and kidneys before it is detected through pain or other symptoms. It is a major risk factor for heart disease and stroke.1 Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high. Blood pressure is written as two numbers. The top (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The bottom (diastolic) number represents the pressure in the vessels when the heart rests between beats. Hypertension is diagnosed if the systolic blood pressure readings is ≥140 mmHg and/or the diastolic blood pressure reading is ≥90 mmHg, when measured on two different days. The ideal blood pressure ranges from 90 over 60 to 120 over 80 depending on age and gender. 2 Prehypertension is a systolic reading ranging from 120 to 139 and a diastolic reading ranging from 80-89. 1 Complications from uncontrolled high blood pressure include angina or chest pain, heart attack, heart failure, and irregular heartbeat. 2 Reducing and preventing hypertension can prevent heart attack, stroke, and kidney damage to name a few. Hypertension can be managed and prevented by reducing salt consumption, eating more fruits and vegetables, being physically active on a regular basis, avoiding tobacco products, reducing alcohol consumption, and reducing both saturated and trans fats. Regularly monitoring blood pressure, managing stress and other health conditions can aid in the management of the condition. 2 Audio File Name: risk_factors 3 Characteristics, symptoms, or signs present in a disease-free person that are associated with a greater chance for developing disease, are considered risk factors. 1) Some risk factors for heart disease include - Age – aging increases the risk of damaged and narrowed arteries in addition to a weakened heart muscle. Gender Family History Using Tobacco Products – smoking is the number-one risk factor in all CAD-associated diseases, almost doubling the risk of death. 1 Audio File Name: atherosclerosis 1 Atherosclerosis is one of the leading causes of heart disease and an important risk factor that can often lead to myocardial infarction. Atherosclerosis is the interaction between lipid particles in the blood and the immune system that lead to inflammatory changes in the vessel walls. This interaction creates cells that are deposited into the vessel walls leading to the narrowing of arteries over time. As this process continues over decades plaque formations are distributed throughout various vessels, becoming calcified and causing the vessel walls to become rigid. Eventually the narrowing of the arteries, or stenosis, may become apparent during increased levels of activity when the cardiac tissue demands more blood and oxygen. This results in an inadequate blood supply that decreases the availability of oxygen, also known as ischemia, as mentioned earlier. References are in red and not part of audio 1. A & P Textbook - Tortora, G. J.,& Derrickson, B. (2009). In Principles of Anatomy and Physiology (12th ed., pp. 717-755). Hoboken, NJ: John Wiley & Sons. 2. WHO Fact Sheet 3. The Mayo Clinic 5 Atherosclerosis is one of the leading causes of heart disease and an important risk factor that can often lead to myocardial infarction. Atherosclerosis Tortora, G. J.,& Derrickson, B. (2009). The Cardiovascular System: The Heart. In Principles of Anatomy and Physiology (12th ed). Risk Factors 4 Risk Factors for developing heart disease Age Gender Family History High Blood Pressure High Cholesterol Levels Diabetes Chemotherapy drugs/Radiation Therapy Tobacco Usage Poor Diet Physical Inactivity Stress Poor Hygiene Obesity The Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118. Accessed September 2020. Hypertension 3 Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries. Hypertension is when blood pressure is too high and is diagnosed if the systolic blood pressure readings is ≥140 mmHg and/or the diastolic blood pressure reading is ≥90 mmHg, when measured on two different days. 1. Tortora, G. J.,& Derrickson, B. (2009). The Cardiovascular System: The Heart. In Principles of Anatomy and Physiology (12th ed). 2. World Heart Organization (WHO). https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Accessed September 2020. Ischemia – inadequate blood supply to the heart tissue Angina – chest pain caused by reduced blood flow to the heart Ischemia and Angina 2 Tortora, G. J.,& Derrickson, B. (2009). The Cardiovascular System: The Heart. In Principles of Anatomy and Physiology (12th ed). Common Signs of Heart Attack Women Shortness of breath ͏Occasional chest pressure/pain Discomfort/tingling in arms, upper back, neck, shoulder or jaw Nausea or vomiting ͏Pain/pressure in lower chest or upper abdomen ͏Fainting ͏Indigestion ͏Unusual tiredness or fatigue 1 Heart Attack Symptoms Men vs. Women. American Heart Association’s Journal. 4 April 2019. Men Shortness of breath Chest pressure/pain Discomfort/tingling in arms, back, neck, shoulder or jaw Nausea or vomiting Tobacco and coronary heart disease: WHO tobacco knowledge summaries/ Ferranda Puig-Cotado, Edouard Tursan d’Espaignet, Simone St Claire, Eduardo Bianco, Lubna Bhatti, Kerstin Schotte, Vinayak Mohan Prasad. September 2020. World Health Organization - https://www.who.int/news/item/22-09-2020-tobacco-responsible-for-20-of-deaths-from-coronary-heart-disease. Accessed October 2020. Smoking and the Heart Smoking and the Heart Audio File Name: smoking Risk of damage to the cardiovascular system increases with duration of smoking, and with the number and type of smoked tobacco products consumed. The risk is substantially increased even at low exposure levels, for example, individuals who smoke only one cigarette per day incur half the risk of coronary heart disease (CHD) of people who smoke at least 20 cigarettes per day. Beyond being a major independent risk factor for CHD, smoking tobacco has a synergistic action with other major risk factors for CHD, including high cholesterol, untreated hypertension, and diabetes. Tobacco is responsible for 20% of coronary heart disease deaths. Every year 1.9 million people die from tobacco-induced heart disease according to the World Health Organization. This includes tobacco use and exposure to second-hand smoke. Smokers are more likely to suffer from a cardiac event at an earlier age than non-smokers. Studies have shown that just after one year of quitting tobacco use, a smoker’s risk of heart disease decreases by 50%. References Not Part of Audio (Tobacco and coronary heart disease: WHO tobacco knowledge summaries/ Ferranda Puig-Cotado, Edouard Tursan d’Espaignet, Simone St Claire, Eduardo Bianco, Lubna Bhatti, Kerstin Schotte, Vinayak Mohan Prasad. September 2020.) (Secondary Source - https://www.who.int/news/item/22-09-2020-tobacco-responsible-for-20-of-deaths-from-coronary-heart-disease) Exercise and the Heart 1. Tortora, G. J.,& Derrickson, B. (2009). The Cardiovascular System: The Heart. In Principles of Anatomy and Physiology (12th ed., pp. 717-755). Hoboken, NJ: John Wiley & Sons. 2. https://wa.kaiserpermanente.org/healthAndWellness?item=%2Fcommon%2FhealthAndWellness%2Fconditions%2FheartDisease%2FexerciseBenefit.html. Accessed October 2020. Exercise and the Heart Audio File Name: exercise It is widely accepted that regular physical activity is beneficial for cardiovascular health. A sedentary lifestyle, where daily duties including job and leisure activities involve little or no physical activity, doubles the risk of dying from heart disease. This is similar to the increased risk of individuals that smoke, have high cholesterol, or high blood pressure. 2 An individual’s cardiovascular fitness can be improved at any age with regular exercise. Three to five sessions of aerobic activities per week are recommended to improve cardiovascular health. Aerobics includes any activity that works large body muscles for at least 20 minutes, elevates cardiac output, and accelerates metabolic rate. Examples of aerobic activities include brisk walking, running, biking, skiing, and swimming. 1 Sustained exercise increases the oxygen demand of the muscles. After several weeks of training a healthy person can increase their maximal cardiac output in turn increasing the maximal rate of oxygen delivery to the tissues. Oxygen delivery also increases due to skeletal muscle developing more capillary networks in response to the long-term training. Regular exercise also assists in reducing blood pressure, anxiety and depression, controlling weight and increases the body’s ability to dissolve blood clots. 1 References Are in Red and Not Part of Audio 1.A & P Textbook 2. https://wa.kaiserpermanente.org/healthAndWellness?item=%2Fcommon%2FhealthAndWellness%2Fconditions%2FheartDisease%2FexerciseBenefit.html Explain the biomarkers discussed in this course and their clinical significance List risk factors of those prone to heart attacks Define a heart attack or myocardial infarction Identify the main components of the heart and their function Course Review Congratulations. You have completed the Basic Laboratory Cardiac Overview course. Select the objectives listed below to review the material before proceeding to the final assessment. Additionally, a full course review is available in the Resources tab. Compare high sensitivity troponin to conventional troponin 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 Course Review Compare high sensitivity troponin to conventional troponin Compared to a conventional troponin assay, high-sensitivity assays are able to detect lower levels of troponin and smaller changes of troponin levels in the patient’s blood. Explain the three biomarkers discussed in this course and their clinical significance Troponin Cardiac troponin is a marker of cardiac injury and the preferred biomarker for diagnosis of acute myocardial infarction, heart attack, on the basis of sensitivity and myocardial specificity. BNP and nt-ProBNP BNP and nt-ProBNP are tests that assist in the detection, diagnosis, and evaluation of heart disease and congestive heart failure. D-Dimer D-dimer laboratory testing is used to rule out a blood clot, it's usually elevated after a clot has formed and is in the process of breaking down. List risk factors of those prone to heart attacks Risk Factors for developing heart disease Age Gender Family History Tobacco Usage High Blood Pressure High Cholesterol Levels Diabetes Poor Diet Chemotherapy drugs/Radiation Therapy Obesity Physical Inactivity Stress Poor Hygiene Define a heart attack or myocardial infarction Complete obstruction of blood flow in the coronary artery may result in a myocardial infarction (MI), commonly referred to as a heart attack. Infarction is the death of an area of tissue due to interrupted blood supply. Heart tissue distal to an obstruction dies and is replaced by noncontractile scar tissue causing the heart to lose some of its strength. Depending on the size of dead tissue area the infarction may cause sudden death in the heart attack victim. However, heart tissue can remain alive if it receives as little as 10-15 percent of its normal blood supply. Identify the main components of the heart and their function The heart wall is composed of three layers – the external epicardium, myocardium, and internal endocardium. Myocardium is cardiac muscle tissue that makes up approximately 95% of the heart The heart has four chambers – two atria and two ventricles each composed of myocardium The left and right coronary arteries deliver oxygenated blood to the myocardium or cardiac muscle tissue The right atrium and right ventricle deliver deoxygenated blood to the lungs The left ventricle and left atrium deliver oxygenated blood from the lungs to the heart Arteries always take blood away from the heart Veins always return blood to the heart Please note that the learning material is for training purposes only! 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A passing score of 80% or higher is required to complete the course and earn your certificate. You may repeat the assessment as many times as needed. Start Assessment Left Ventricle Right Ventricle Left Atrium Right Atrium Which heart chamber pumps oxygenated blood out to the body? Question 1 of 10 Select the best answer. Multiple Choice Question Incorrect The right atrium receives blood from three veins Incorrect Re-oxygenated blood from the lungs enters the left atrium Incorrect The right ventricle receives de-oxygenated blood from the right atrium Correct Re-oxygenated blood from the lungs enters the left atrium and is pumped to the left ventricle and then out to the body High-sensitivity troponin assays are able to detect lower levels and smaller changes of troponin levels Conventional troponin assays are more robust and reliable High-sensitivity troponin assays have been around longer than conventional troponin assays Conventional troponin assays are historically only accurate for men How does the conventional troponin assay compare to the high-sensitivity troponin assay? Question 2 of 10 Select the best answer. Multiple Choice Question Incorrect Incorrect Incorrect Correct Heart Wall Stretching Heart Wall Injury Artery Blockage Blood Clots Troponin is associated with heart wall injury, what is BNP associated with? Question 3 of 10 Select the best answer. Multiple Choice Question Incorrect D-dimer is associated with blood clots. Incorrect Incorrect Troponin is associated with heart wall injury. Correct Troponin BNP, CKMB Troponin, myoglobin NT-proBNP, CKMB Which cardiac marker(s) were discussed in this course? Question 4 of 10 Select the best answer. Multiple Choice Question Incorrect CKMB is not discussed in this course Incorrect Myoglobin is not discussed in this course Incorrect CKMB is not discussed in this course Correct Angina refers to chest pain caused by an inadequate supply of oxygen to heart myocardium Angina refers to inadequate blood supply to the heart tissue Angina refers to the death of an area of tissue due to interrupted blood supply Angina is when blood pressure is too high Define Angina. Question 5 of 10 Select the best answer. Multiple Choice Question Incorrect This is the definition of hypertension. Incorrect This is the definition of infarction. Incorrect This is the definition of ischemia. Correct Ischemia Hypertension Hypotension Weight Gain A buildup of plaque that occurs with atherosclerosis may eventually lead to which of the following events? Question 6 of 10 Select the best answer. Multiple Choice Question Incorrect Incorrect Incorrect Correct Lifestyle and behavioral changes Smoking less Getting tested for heart attack more frequently Switching from tobacco to vaping How can most Cardiovascular Diseases be prevented? Question 7 of 10 Select the best answer. Multiple Choice Question Incorrect Incorrect Incorrect Correct Reducing blood pressure Increasing the body’s ability to make blood clots Increasing weight gain Reducing hours of sleep per night Regular exercise can assist in which of the following? Question 8 of 10 Select the best answer. Multiple Choice Question Incorrect Incorrect Incorrect Exercise increases the body’s ability to dissolve blood clots. Correct 1.9 million 20 million 19 million 2.1 million According to the WHO, tobacco is responsible for how many tobacco-induced heart disease deaths? Question 9 of 10 Select the best answer. Multiple Choice Question Incorrect Incorrect Incorrect Correct 90/60 to 120/80 90/120 to 60/80 60/40 to 80/60 60/90 to 80/120 What is the ideal blood pressure measurement range? Question 10 of 10 Select the best answer. Multiple Choice Question Incorrect Incorrect Incorrect Correct Review Review Retry Assessment Results %Results.ScorePercent%% %Results.PassPercent%% Continue YOUR SCORE: PASSING SCORE: Assessment Results You did not pass the course. Take time to review the assessment then select Retry to continue. Congratulations. You passed the course. Exit To access your Certificate of Completion, select the Launch button drop down on the course overview page. You can also access the certificate from your PEPconnect transcript. You have completed the Basic Laboratory Cardiac Overview Online Training. Completion Cardiac Markers Cardiac Markers Cardiac markers are biomarkers found in the blood that are measured to evaluate heart function and predict and diagnose cardiovascular disease. This section will cover three biomarkers used to assist in the diagnosis of heart disease. Cardiac Markers Audio File Name: cardiac_markers_intro Cardiac markers are biomarkers found in the blood, produced by heart cells, that are measured to evaluate heart function, and to predict and diagnose cardiovascular disease. Cardiac markers are especially helpful in situations of a suspected Acute Myocardial Infarction, or AMI, in which the patient's electrocardiogram (ECG) does not present the typical pattern associated with an AMI. Today, the main diagnostic test for myocardial injury is troponin and the main test for cardiac overload is BNP. In this training Troponin I, BNP and NT-proBNP, and D-dimer will be discussed. While D-dimer is not a cardiac marker it is very useful in the rule in/rule out phase of testing. The Role of the Laboratory Left Ventricular Overload BNP and NT-proBNP Acute Coronary Syndrome Cardiac Troponin I BNP and NT-proBNP Heart Failure Cardiac Troponin I BNP and NT-proBNP Thromboembolic Disease/Platelet Function Status D-dimer Risk Assessment Acute Phase Important Role of the Laboratory Audio File Name: role_of_lab Shown here is the correlation of disease state and the cardiac marker testing that assists in diagnosis. To help enhance assessment, diagnosis, and follow-up care for patients with CVD, clinicians should use appropriate laboratory diagnostic testing. Laboratories play an important role in the assessment of cardiovascular disease. Ideal Cardiac Biomarkers Specific to heart tissue Sensitive to small degrees of heart damage Low concentrations in healthy individuals Rapidly released after myocardial injury Detectable in low quantities Remain in circulation for a sufficient length of time for detection Provide information on the extent of injury Aydin S, Ugur K, Aydin S, Sahin İ, Yardim M. Biomarkers in acute myocardial infarction: current perspectives. Vasc Health Risk Manag. 2019;15:1-10. Published 2019 Jan 17. doi:10.2147/VHRM.S166157 Ideal Cardiac Biomarkers Audio File Name: ideal_biomarkers Ideal cardiac biomarkers have the following characteristics: Specific to heart tissue Sensitive to small degrees of heart damage Have low concentrations in healthy individuals Rapidly released after myocardial injury Detectable in low quantities Remain in circulation for a sufficient length of time for detection and should give information related to the extent of injury The test for the biomarker should be quantitative, cost effective to the organization, and results should be obtained rapidly. Reference (Not Part of Audio): Biomarkers in acute myocardial infarction: current perspectives. Aydin S, Ugur K, Aydin S, Sahin İ, Yardim M. Biomarkers in acute myocardial infarction: current perspectives. Vasc Health Risk Manag. 2019;15:1-10. Published 2019 Jan 17. doi:10.2147/VHRM.S166157 Troponin Troponin Audio File Name: troponin Cardiac troponin is a marker of cardiac injury and the preferred biomarker for diagnosis of acute myocardial infarction, heart attack, based on sensitivity and myocardial specificity. Cardiac troponin testing remains the most widely used and most definitive marker of cardiac tissue injury. There are currently two main offerings when it comes to cardiac troponin testing – conventional and high-sensitivity. The clinical practice of measuring cardiac troponins first emerged in the early 1990s. Compared to a conventional troponin assay, high-sensitivity assays can detect lower levels of troponin and smaller changes of troponin levels in the patient’s blood. The International Federation of Clinical Chemistry (IFCC) task force on cardiac biomarkers defines high sensitivity cardiac troponin assays as those that reliably detect cardiac troponin below the 99th percentile upper reference limit and above the limit of detection in at least 50% of healthy subjects. Total imprecision should be less than or equal to 10% at the 99th percentile of healthy subjects. Additionally, results are to be reported in ng/L or pg/mL providing results in whole numbers. Sex‐specific differences in heart anatomy and pathophysiology are well established. Structurally, among individuals without cardiovascular disease, men have greater cardiac mass compared with women based on cardiac magnetic resonance imaging and echocardiography. As part of the Fourth Universal Definition of Myocardial Infarction (2018) it was determined that sex-specific, 99th percentile upper reference limits are recommended for high-sensitivity cardiac troponin assays due to significantly lower values being observed among women compared with men. The following videos will detail the importance of a high sensitivity troponin test and its impact on patient care. Reference (Not Part of Audio) (Siemens Cardiac FAQ PDF) The Science Behind Heart Attack Detection: The Role of Cardiac Troponin The Science Behind Heart Attack Detection Audio and subtitles are embedded in this video – video developed by marketing The Role of Cardiac Troponin in Myocardial Infarction Diagnosis (Frank Peacock) HOOD05162002835637 New IFCC Task Force on Cardiac Biomarker Guidelines; Impact on Patient Care New IFCC Task Force on Cardiac Biomarker Guidelines Audio and subtitles are embedded in this video – video developed by marketing New IFCC Task Force on Cardiac Biomarker Guidelines; Impact on Patient Care (Fred Apple) HOOD05162002966552 Converting to a High-Sensitivity Troponin I Assay Converting to a High-Sensitivity Troponin I Assay Audio and subtitles are embedded in this video – video developed by marketing Converting to a High-Sensitivity Troponin I Assay (Paul Collinson) - HOOD05162003058385 BNP and NT-ProBNP BNP Audio File Name: bnp_intro Brain or B-type Natriuretic Peptide and N-terminal pro b-type Natriuretic Peptide are tests that assist in the detection, diagnosis, and evaluation of heart disease and congestive heart failure. Natriuretic peptides are substances made by pumping chambers of the heart and normally only small levels are found in the blood. (https://medlineplus.gov/lab-tests/natriuretic-peptide-tests-bnp-nt-probnp/) BNP is associated with heart wall stretching, while troponin is associated with heart wall injury or damage (https://www.acc.org/%2Flatest-in-cardiology%2Farticles%2F2015%2F02%2F09%2F13%2F00%2Fcardiac-biomarkers-and-heart-failure) Although BNP and NT-proBNP are usually used to detect heart failure, an increased level in people who have recently had a heart attack may indicate an increased risk of further heart disease. A healthcare provider may use either BNP or NT-proBNP to evaluate risk of further heart disease in someone who has had a heart attack. (https://labtestsonline.org/tests/bnp-and-nt-probnp) BNP is used to determine the extent of heart failure or the efficacy of treatment if the patient has already been diagnosed. Heart failure happens when the heart is not pumping blood well causing pressure to build in the chambers, releasing BNP. BNP opens blood vessels to relieve pressure in the heart by acting as a diuretic, releasing water and salts from the body. A BNP test accurately shows heart failure 9 times out of 10. (https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=bnp_blood) Without a prior heart failure diagnosis, this test is often ordered if the patient presents with difficulty breathing, coughing or wheezing, fatigue, swelling of the extremities, and loss of appetite or nausea. A BNP test or NT-proBNP test can be used, along with other cardiac biomarker tests, to detect heart stress and damage and/or along with lung function tests to distinguish between causes of shortness of breath. (https://labtestsonline.org/tests/bnp-and-nt-probnp) References are written in red – these are not part of the audio BNP and NT-ProBNP The European View of Natriuretic Peptide Testing. NOV.19.2020. https://www.aacc.org/cln/cln-stat/2020/november/19/the-european-view-of-natriuretic-peptide-testing BNP vs NT-proBNP Audio File Name: bnp_vs_probnp A survey conducted in 2019 of over 300 European laboratories detailed the clinical significance of BNP and NT-proBNP. Of the participants running a natriuretic peptide method, 79% of them are specifically using an NT-proBNP assay. Dr. Paul Collinson as previously seen in the converting to a high sensitivity troponin assay video, believes this preference for NT-proBNP is for several reasons. Partially, due to the wider availability of literature on NT-proBNP and to the fact that it is more stable in the patient’s sample than BNP. Additionally, ProBNP is more standardized across analyzer systems and manufacturers. Reference (Not Part of Audio) (https://www.aacc.org/cln/cln-stat/2020/november/19/the-european-view-of-natriuretic-peptide-testing) D-Dimer Image Courtesy of: AdobeStock_31886079 D-dimer Audio File Name: d-dimer D-dimer is a protein fragment from the breakdown of a blood clot. Blood clots generally start to slowly break down after they are formed, releasing D-dimer into the blood. D-dimer laboratory tests are used to rule out a blood clot. An elevated D-dimer level is not normal. It's usually found after a clot has formed and is in the process of breaking down. If the patient is having significant formation and breakdown of blood clot in the body, D-dimer results may be elevated. A d-dimer test is often performed in an emergency room or other healthcare setting when a patient presents with symptoms of deep vein thrombosis or pulmonary embolism (PE). PE is a common and potentially lethal condition where a blockage occurs in an artery located in the lungs (medlineplus.gov) ; the rapid assessment and treatment of a PE can result in a dramatic reduction of morbidity and mortality. Reference (Not Part of Audio) References are written in red – these are not part of the audio https://www.siemens-healthineers.com/en-us/point-of-care/poc-cardiac-topics/cardiac-assays/d-dimer D-Dimer Symptoms of Pulmonary Embolism Chest Pain Shortness of breath Nausea Abdominal pain Dizziness Fatigue Wheezing Coughing Symptoms of Acute Myocardial Infarction Chest Pain Shortness of breath Nausea Abdominal pain Dizziness Fatigue Wheezing Coughing PE or AMI Audio File Name: pe_or_ami Symptoms of PE often mirror those of a heart attack including chest pain, shortness of breath, and cough. () The ability to quickly determine whether these symptoms could be related to PE or AMI is critical in the early detection, diagnosis, and treatment of the patient. References are written in red – these are not part of the audio HOOD05162003153279 | Effective Date: 22 Jan 2021 Basic Laboratory Cardiac Overview Job Aid 1.1 Welcome 1.2 Cardiac Overview 1.3 Heart Attack 1.4 Smoking and the Heart 1.5 Exercise and the Heart 2.1 Cardiac Markers 2.2 Important Role of the Laboratory 2.3 Ideal Cardiac Biomarkers 2.4 Troponin 2.5 The Science Behind Heart Attack Detection 2.6 New IFCC Task Force on Cardiac Biomarker Guidelines 2.7 Converting to a High-Sensitivity Troponin I Assay 2.8 BNP 2.9 BNP vs NT-proBNP 2.10 D-dimer 2.11 PE or AMI 1.6 Course Review 1.7 Disclaimer 1.8 Assessment 1.20 Completion