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Laboratory Findings in Heart Disease
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Normal Heart Supra Ventricular Tachycardia Atrial Fibrillation Ventricular Fibrillation
Congenital Heart Disease Rheumatic Heart Disease Coronary Artery Disease & MI Myocardial Infarction
Pulmonary Heart Disease Pericarditis Infective Endocarditis Cardiomyopathies
Myocardial Ischaemia Coronary Disease Atherosclerosis Aneurysm
Heart Valve Disease Syphilitic Cardiovascular Diseases Arterial Thrombosis and Embolism Gangrene
Congestive Cardiac failure Peripheral Venous Disease Shock .
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Normal Heart
Refer to Reference Ranges Page


Congenital Heart Disease


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Laboratory Findings

Right to Left Shunt:


Rheumatic Fever and Rheumatic Heart Disease


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Rheumatic Fever
There are no specific tests for Rheumatic fever. Some tests are useful in confirming the presence of inflammation and the recent occurrence of streptococcal infection.

Nonspecific tests indicating inflammation:


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Coronary Artery Disease and Myocardial Infarction

Distribution of LDH Isoenzymes in Normal Tissues

ISOENZYME NORMAL SERUM (%) HEART MUSCLE (%) LIVER (%) SKELETAL MUSCLE (%)
LDH1 25 40 0 0
LDH2 35 35 5 0
LDH3 20 20 10 10
LDH4 10 5 15 30
LDH5 10 0 70 60
Table 1-2. Distribution of CPK Isoenzymes in Normal Tissues

ISOENZYME NORMAL SERUM (%) SKELETAL MUSCLE (%) HEART (%) BRAIN (%)
CPK1 (BB) 0 0 0 90
CPK2 (BB) 0 0 40 0
CPK3 (BB) 100 100 60 10
Other Laboratory Findings


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Pulmonary Heart Disease


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Pericarditis

LABORATORY FINDINGS

Acute Pericarditis
Table 1.0 Pericardial Fluid: Transudate Vs Exudate
Pericardial fluid (Table 1-3)

Laboratory Findings Transudate (eg Uremia, lupus, rheumatic fever) Exudate (eg Tumour, bacterial infection)
LDH <60% of serum level >60% of serum level
Protein <50% of serum level >50% of serum level
Clot Absent Present
Cells Few Lymphocytes or RBC Many Segmented Neutrophils
Glucose Same as serum Decreased due to consumption by WBC or bacteria


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Infective Endocarditis

LABORATORY FINDINGS


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Cardiomyopathies

LABORATORY FINDINGS


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Congestive Cardiac Failure

LABORATORY FINDINGS

Renal Functions

Table 1-4Characteristics of Transudates
LABORATORY TEST RESULT
Specific Gravity <1.106
Protein <50% of serum level
LDH <60% of serum level
WBC <1000/l
Differential WBC Mononuclear cells predominate
Glucose Same as serum
pH Same as Blood

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Atherosclerosis

LABORATORY FINDINGS

  • Until recently, the major laboratory test used to classify the risk of developing coronary heart disease (CHD) has been a total cholesterol assay. However, only when the serum cholesterol is above 350 mg/dl (which occurs in less than 1 % of the population) is there a significantly increased risk of CHD.
  • Most patients have cholesterol values between 150 mg/dl and 300 mg/dl, whether or not they have CHD. The Framingham Heart Institute Study has shown that if the HDL cholesterol value is less than 45 mg/dl, the rate of CHD is very high.7,lO On the other hand, when the HDL cholesterol exceeds 55 mg/dl, the rate of CHD is very low. HDL appears to have a salutary effect on CHD. It functions to remove cholesterol from atherosclerotic vessels and from other tissues and returns the cholesterol to the liver for excretion in bile. The higher the levels of HDL, the greater the degree of lipid excretion.

  • A statistical analysis of the roles of various lipids in predicting the risk of CHD showed a significant inverse relationship between HDL cholesterol and myocardial infarction.ll HDL cholesterol was shown to be the most sensitive single predictor of a patient's risk of developing CHD by the age of 50; the HDL measurement is eight times more sensitive than measurement of the total cholesterol level. Various combinations of lipid measurements as ratios further increased the predictability of CHD. Probably the best predictor is the LDL-HDL ratio; the tests for this ratio require that the patient be fasting. The total cholesterol-HDL cholesterol ratio is almost as good a predictor.2o The tests for this ratio may be done in a nonfasting patient. HDL cholesterol is determined by first separating HDL from the other plasma lipids, through precipitation or electrophoresis, and then measuring the cholesterol content of the separated HDL.
    The total cholesterol-HDL cholesterol ratio in various populations is shown in Table 1-5.

    Table 1-5

    POPULATION RATIO
    Vegetarians 2.8
    Eskimos 3.2
    Those with average risk of CHD 3.4
    Marathon Runner 3.4
    Female, Normal 4.5
    Male, Normal 5.0
    Those with CHD 5.3 - 5.7
    Those with 2x average risk of CHD 7 - 10
    Those with 3x average risk of CHD 11 - 23

    Aneurysm


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    Peripheral Venous Disease LABORATORY FINDINGS. Peripheral Venous Disease

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    Temporal Arteritis





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    Polyarteritis Nodosa LABORATORY FINDINGS - Polyarteritis Nodosa


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    Arterial Thrombosis and Embolism

    Laboratory Findings of Underlying Disorders

  • Infective endocarditis
  • Rheumatic heart disease
  • Myocardial infarction with mural thrombus

    Laboratory Findings of Embolic Occlusion and Infarction
  • Heart (Coronary Artery Disease and Myocardial Infarction)
  • Kidney (Renal Infarction)
  • Brain (Cerebral Infarction )
  • Intestine ( Mesenteric Infarction)
  • Extremity ( Gangrene)
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    Gangrene

    LABORATORY FINDINGS - Gangrene


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    Hypersensitivity Vasculitis LABORATORY FINDINGS - Hypersensitivity Vasculitis
  • Skin biopsy showing characteristic necrotizing vasculitis; lesions less than 24 hours to 36 hours old may show immunofluorescent deposits of immunoglobulins and complement
  • Presence of circulating immune complexes
  • Decreased serum complement
  • Detection of specific infectious agents, such as streptococci or HB,Ag
  • Positive ASO test indicating prior streptococcal infection
  • Findings of connective-tissue disease, indicated by presence of rheumatoid factor, antinuclear antibody, anti-DNA.


  • Findings of renal involvement, such as proteinuria or decreased creatinine clearance Presence of occult blood in stool, indicating gastrointestinal involvement

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