Chapter 22: Cardiovascular Disease

Cardiovascular Disease defines myocardial infarction through the lens of rising or falling cardiac biomarkers—specifically troponins I and T—integrated with clinical symptoms of ischemia and electrocardiographic changes such as ST-segment elevation or depression. The discussion details the pathophysiology of acute coronary syndromes, differentiating between various states of arterial occlusion like STEMI, NSTEMI, and unstable angina. A comprehensive evaluation of biochemical markers highlights the superiority of cardiac-specific troponins over traditional enzymes like creatine kinase, lactate dehydrogenase, and aspartate aminotransferase due to their extended diagnostic window and high sensitivity. The text also investigates the clinical utility of myoglobin for early detection and the significance of natriuretic peptides, such as BNP, in identifying and ruling out chronic heart failure and ventricular dysfunction. Beyond acute events, the chapter examines cardiovascular risk stratification, analyzing established factors like hypertension, diabetes, and dyslipidemia alongside emerging indicators like high-sensitivity C-reactive protein (hs-CRP), homocysteine, and D-dimers for venous thromboembolism. Finally, it outlines the biochemical investigation of secondary hypertension—linked to renal and endocrine conditions like Conn’s or Cushing’s syndrome—and emphasizes the necessity of monitoring renal function and electrolyte balance during pharmacological interventions with ACE inhibitors and angiotensin receptor blockers.