Cardiac Biomarkers Quiz

1. Which of the following troponins is most specific to the heart and most commonly used in veterinary species?
a. Troponin-I
b. Troponin-T
c. Troponin-C
d. Troponin-B

2. All of the following clinical situations could increase circulating troponin I levels in the body EXCEPT?
a. Cardiomyocyte necrosis
b. Generation of new cardiac myocytes
c. Hypertrophic cardiomyopathy in cats
d. Sepsis with myocardial dysfunction

3. Which of the following may have a possible clinical role for measuring Cardiac Troponin-I (cTnI) levels in dogs?
a. Accurately differentiating mitral valve disease from CHF in dogs
b. Monitoring for doxorubicin cardiotoxicity
c. Accurately differentiating pulmonary hypertension from congestive heart failure in cats
d. Monitoring for the development of systemic hypertension

4. With respect to the physiology and application of the natriuretic peptides, which of the following is TRUE?
a. ANP is stored in granules in the walls of pulmonary and systemic arteries as ProANP
b. BNP is stored to a lesser degree than ANP, thus BNP release might be most impressive after a longer period of cardiac dilation or stress
c. An NT-proBNP concentration <900 pmol/L usually indicates that active CHF is present in a dog
d. BNP is released from the ventricles in response to low intracardiac pressures, thus an elevated BNP concentration can be a good marker for when an animal might benefit from additional fluid therapy.

5. A cat with clinical signs of dyspnea is being evaluated. The NTproBNP concentration is 560 pmol/L. What is your assessment and what might you pick as the next step?
a. Normal. NTproBNP is not considered elevated until >900 pmol/L
b. This NT-proBNP concentration in a cat with dyspnea is most consistent with a respiratory cause for dyspnea; an airway washing (e.g., tracheal wash) is indicated
c. Abnormal. The cat likely has CHF as the cause for dyspnea and a cardiac workup with echocardiogram is indicated.
d. This NT-proBNP concentration in a cat with dyspnea is most consistent with an adrenal gland cause for dyspnea (e.g., pulmonary embolism) and a D-dimer test should be submitted

6. Which of the following statements is true?
a. Both Troponin-I and NT-proBNP are leakage markers
b. Both Troponin-I and NT-proBNP are functional markers
c. Troponin-I is a leakage marker and NT-proBNP is a functional marker
d. NT-proBNP is a leakage marker and Troponin-I is a functional marker

7. What would be the expected relative levels of cTnI between dogs with the following three conditions?
a. Normal dog < Pericardial effusion from hemangiosarcoma < Idiopathic pericardial effusion
b. Hypovolemic dog < Idiopathic pericardial effusion < Normal dog
c. Hypovolemic dog < Normal dog < Dog with septic shock
d. Normal dog < Idiopathic pericardial effusion < Pericardial effusion from hemangiosarcoma

8. Which of the following is NOT a clinical situation where measurement of natriuretic peptides might be useful?
a. Differentiation of cardiac causes (CHF) from primary respiratory disease in a cat with cough or difficulty breathing
b. Screening at-risk feline populations for occult heart disease
c. Differentiating aortic stenosis from dilated cardiomyopathy in a dog
d. Screening at risk Doberman Pinschers for occult cardiomyopathy

9. Which of the following is a likely outcome from release of natriuretic peptides?
a. Increase in sodium and water retention
b. Decrease in activation of the renin-angiotensin-aldosterone system
c. Increase in systemic blood pressure
d. Increase in total body sodium content

10. Select proteins have been proposed to be potentially useful for evaluating the cardiovascular system as cardiac biomarkers. Which of the following is correctly linked to a function of that protein?
a. Endothelin: Systemic vasodilator that is released from the heart and acts on the endothelium
b. TNF alpha: Cytokine that may increase appetite and enhance muscle formation
c. C-Reactive Protein: Acute phase reactant protein that rises with inflammation
d. Adrenomedullin: Vasoconstrictor that is released from the medulla in response to reduced blood flow to the brain

11. An NT-proBNP value above 2,000 pmol/L in a large breed dog with cough should trigger concern for a diagnosis of:
a. Chronic Bronchitis
b. Congestive heart failure
c. Aspiration pneumonia

12. An NT-proBNP concentration > 600 pmol/L in an otherwise healthy Doberman pinscher might trigger a decision to recommend:
a. Echocardiography to look for occult cardiomyopathy
b. Echocardiography to look for obliterative cardiomyopathy
c. A urinalysis to look for proteinuria
d. A thyroid test to search for hyperthyroidism

13. NT-proBNP testing can help identify dogs with degenerative mitral valve disease who are at increased risk for development of CHF in the next 6 to 12 months.
a. True
b. False

14. NT-proBNP testing can help identify Doberman pinschers are risk for development of dilated cardiomyopathy.
a. True
b. False