BIOMED - Lab Values, ECGs, and Cardiac Meds OH MY!

Question 1

What are the three main cardiac markers and which is the most specific?

Answer 1

1. Troponin 2. Creatine Kinase 3. Myoglobin

Question 2

What makes troponin the most important and when should a PT begin working with a patient in regards to their troponin levels?

Answer 2

It’s elevated during MI, we intervene once levels have peaked and have then begun to decline.

Question 3

What are 2 reasons myoglobin levels would be elevated?

Answer 3

Renal failure, skeletal muscle damage

Question 4

What is the normal range for WBC? What is the name for when this is elevated? What causes this and what are the implications for PT? Howsabout if WBC is low?

Answer 4

The normal range is 5k - 10k. If high: leukocytosis, infex or inflamm, if greater than 11k, assess for fever or symptoms (i.e. lethargy). If low: leukopenia, bloodborne cancers, viral infex, HIV, AID, if less than 4K = assess for fever or symptoms (i.e. fatigue, weakness, SOB).

Question 5

What are hemoglobin and hematocrit, and what is the normal range for these? What is the name for when these are elevated and what are the PT implications? What about for when they are decreased?

Answer 5

Hemoglobin - ability of blood to carry O2 (males, 13-18, females 12-16) Hematocrit - fraction of blood that is RBCs (males 41-53%, females 37-47%) Elevated: Polycythemia - due to burns, dehydration, chronic pulmonary conditions, greater than 60% or greater than 20 mg/dL assess for symptoms (i.e. weakness, fatigue, increased viscosity of blood). Decreased: Anemia - hemorrhage, less than 25% or Hgb less than 8mg assess for fatigue, tachycardia, orthostatic hypotension

Question 6

What is the normal range for platelet values? What is the name for when they are elevated? What are the PT implications? Howsabout when they are decreased?

Answer 6

150k vs. 350k Elevated - Thrombocytosis - counts greater than 450k assess for symptoms (i.e. weakness, headache, dizziness) Decreased - Thrombocytopenia - associated w/ risk for bleeding, bruising, fatigue. If less than 50k, light activity with MANDATORY screen for falls risk. IF UNDER 20k, NO ACTIVITY.

Question 7

What is the range of normal values for sodium? What is elevated called and why does it matter? What is decreased called and why does it matter?

Answer 7

135-146 mEq/L Elevated: hypernatremia, excessive salt intake and dehydration can cause this, counts greater than 155 assess for symptoms such as: tacky, seizure, HTN. Decreased: hyponatremia, usually due to diuretics, counts less than 125, assess for symptoms like lethargy, confusion, diminished reflexes, nausea, vomiting, seizure, orthostasis.

Question 8

Range of normal values for K? Elevated and implications? Decreased and implications?

Answer 8

3.5-5.0 mEq/L Elevated: hyperkalemia, renal failure/muscle damage, counts greater than 5 assess for muscle weakness/paralysis, brady Decreased: hypokalemia, diuretic use causes, less than 3.0 assess for weakness, decreased reflexes, paresthesia, cramps, ECG changes, hypotension.

Question 9

Normal ranges for glucose? Elevated and implications? Decreased and implications?

Answer 9

70-110 mg/dL Elevated: hyperglycemia, diabetes, greater than 200 assess for symptoms such as decreased activity tolerance Decreased: hypoglycemia, too much insulin, counts less than 70 assess for symptoms such as lethargy, weakness, shaking, loss of consciousness

Question 10

What are normal values for BUN and creatinine and what do elevated levels of the BUN creatinine ratio indicate?

Answer 10

BUN = 6-25 mg/DL, Creatinine = 0.7-1.3mg/DL 10-20 normal, elevated levels mean impaired renal blood flow.

Question 11

What do we use to monitor heparin? How about Coumadin?

Answer 11

Heparin: We use aPTT, which is the internal pathway for clotting time, we want 25-45 sec, 2x for therapeutic level. Think HEP, home exercise program, internal! Coumadin: PT (prothrombin time), external pathway, 11-15 sec, 2x for therapeutic level INR is a ratio (2-3 being therapeutic) which, if greater than 3.6 will basically demonstrate increased risk for bleeding.

Question 12

What is CPET? What are its indications and what are some reasons to terminate the test? How do we interpret the test?

Answer 12

Graded exercises plus expired gas analysis -> it’s a measure of fxal capacity. Dx, Px for exercise prescription. Terminate for: 1) someone asks, 2) angina, syncope, dizziness, 3) SBP > 250 or DBP > 115. Interpret: WAS IT MAXIMAL? RER > 1.1, Plateau of VO2 despite increased workload, w/in 5 beats of HR max, Blood lactate levels of 8-10 mmol/L VO2 Meak and MET capacity Hemodynamics response and risk stratification Exercise plan

Question 13

Name non-pharmacological ways to manage HTN.

Answer 13

Diet, Exercise, Cease Alcohol and Smoking, Stress Mgmt

Question 14

Name single-agent pharmacological ways to manage HTN.

Answer 14

Diuretic Beta blocker ACE inhibitor Calcium Channel Blocker

Question 15

Name the side effects of diuretics and the three different agents that diuretics can fall under.

Answer 15

Hyponatremia / Electrolyte imbalance Orthostatic HTN -> Increased Falls Risk!!! Compliance Issues Agents: thiazides, loop (furosemide or lasix), k sparing (spironalactone - improves mortality)

Question 16

How do you differentiate between ACE inhibitors and Angiotensin Receptor Blockers?

Answer 16

ACE inhibitors end in “pril”, and Angiotension Receptor Blockers end in “sartan”.

Question 17

What are the side effects of ACE inhibitors?

Answer 17

Allergy (angioedema - basically life threatening swelling of tongue and face) and persistent dry cough, also orthostasis.

Question 18

What qualifies a chest x-ray as showing cardiomegaly?

Answer 18

When the heart is 1/2 the diameter of the thorax.

Question 19

What is the purpose of the ECG? What can we measure and analyze with this?

Answer 19

Chamber dimensions and wall thickness. We can analyze valve structures and functions, cardiac chamber pressures, filling capacities, estimate EF, and ventricular volume.

Question 20

What does ECG monitoring actually reflect?

Answer 20

Electrical activity that precedes mechanical activity.

Normally: electrical activity and mechanical activity are synchronous, but separate events

PEA = dissociation, pulseless electrical activity

Question 21

Answer 21

B

C

A

D

Question 22

What are the 4 basic steps of ECG reading?

Answer 22

Rate, Regularity, Reg/Irreg Rhythm?, Intervals/Waveforms

Question 23

How can you tell the difference?

Answer 23

Premature atrial contraction (L), premature ventricular contraction (R)

One the left, the PR and QRS intervals are normal for the most part, and on the right they are not.

Question 24

True or False: Telemetry is 12 leads and can be used for diagnostic purposes.

Answer 24

False

ECG is 12 leads and used for diagnosis

Telemetry is 3-5 leads and cannot be used for diagnosis

Question 25

A PVC every other beat is called…

Answer 25

Bigeminy

Question 26

Answer 26

The top is trigeminy.

The bottom is bigeminy.

Question 27

What is the rate of each of these rhythms?

Sinus Bradycardia

Sinus Tachycardia

Answer 27

under 60BPM

over 100BPM

Question 28

Answer 28

Ventricular Tachycardia

Question 29

What is a heart block?

Answer 29

Caused by inhibition of electrical activity somewhere in the conduction system - SA node, AV node, purkinje fibers, bundle of his, etc.

Question 30

What is the mechanism of action of a Ca Channel Blocker?

Answer 30

Limit Ca entry into vascular muscle and heart which causes vasodilation, which lowers TPR

Question 31

What are the side effects of Ca Channel Blockers?

Answer 31

Orthostatic Hypotension, LE edema

Also, headache, nausea, problems with HR/rhythm, reflex tachy

Question 32

What do Ca Channel blockers usually end in?

Answer 32

“pine”

Question 33

When does Angina Pectoris occur?

Answer 33

When Myocardial O2 Supply > Demand