cardiac diagnostic tests

Question 1

definition

D-dimer

what is it

Answer 1

Checks for the activity of both thrombin (which helps form clots) and plasmin (which helps break them down). It is produced when fibrin (a protein in blood clots) is broken down by plasmin. This test measures how much fibrin is being broken down in the body.

Normally, D-dimer is not found in the blood, so detecting it indicates clotting and breakdown activity

Question 2

normal findings

D-dimer

Answer 2

<0.4 mcg/mL

Question 3

test explanation

D-dimer

explain positive and negative results. explain the use for thrombolytic therapy.

Answer 3

Used to confirm DIC, where small clots form and break down throughout the body. If it’s positive, it ususlally matches the results of other clotting tests.
D-dimer levels also rise when a clot is dissolved during thrombolytic therapy. High D-dimer levels are seen in DVT, PE, and Sickle Cell.
Negative means the pt doesn’t have DVT or PE.
Used to guide the length of thrombolytic therapy:
* After a pt has a DVT, they take anticoagulants (blood thinners) to prevent new clots from forming. But doctors need to decide how long the pt should stay on this therapy; too short = recurrence is higher,** too long** = risk of bleeding.
* The D-dimer test is used to measure levels one month later, if levels are still high then they cont. therapy.

Question 4

interfering factors

D-dimer

lipemia and rheumatoid factor

Answer 4

D-dimer levels can be lower in pts with high levels of fat (lipids) in their blood (lipemia).
If a pt has high levels of rheumatoid factor (more than 50 IU/mL) which is common for rheumatoid arthritis, this can cause D-dimer levels to be higher than they actually are (aka false results).

Question 5

test results and clinical significance

D-dimer: Increased Levels

Disseminated Intravascular Coagulation

Answer 5

Condition where small blood clots form throughout the body’s tiny blood vessels, while at the same time, the body is trying to break down these clots (fibrolysis). This process produces D-dimer, substance created when the enzyme plasmin breaks down a fibrin clot.

Question 6

test results and clinical significance

D-dimer: Increased levels

Deep Vein Thrombosis, Pulmonary Embolism, Arterial Thromboembolism

Answer 6

In these conditions, which involve abnormal blood clotting, the body’s natural but sometimes ineffective fibrinolysis process releases D-dimers into the blood stream as plasmin works to break down the fibrin in the clots.

Question 7

test results and clinical significance

D-dimer: Increased levels

Sickle Cell Anemia (with or w/o vaso-occlusive crisis)

Answer 7

Even though the body tries to dissolve the clots formed during this condition, the process isn’t very effective.Still, plasmin breaks down some of the fibrin in the clots, releasing D-dimers into the blood

Question 8

test results and clinical significance

D-dimer: Increased levels

Pregnancy, Cancer, Surgery

Answer 8

These situations involve varying degrees of blood clotting and clot breakdown. As plasmin acts on fibrin clots, D-dimers are produced and released.

Question 9

procedure and patient care

D-dimer

Answer 9

Fasting? No
Pt recieving anticoagulats/coagulopathies? bleeding time is increased

Question 10

definition

Lipoproteins

Answer 10

Lipoproteins are proteins in the blood whose main purpose is to transport cholesterol, triglycerides, and other insoluble fats. Used as marketers indicating levels of lipids within the bloodstream.

predictor for heart disease
identifies risk for developing heart disease

Question 11

normal findings

Lipoproteins: HDL

Answer 11

Male: >45 mg/dL or >0.75 mmol/L
Female: >55 mg/dL or >0.91 mmol/L
(> is greater)

Question 12

normal findings

Lipoproteins: LDL

Answer 12

Adult: <130 mg/dL
Children: <110 mg/dL

Question 13

test explanation

Lipoproteins: LDL

can be classified by their measured density

Answer 13

Carries cholesterol** from the liver** to cells of the body.
Carries cholesterol and deposits it into the peripheral tissues.

AKA bad cholesterol
High Levels= increased risk for coronary heart disease

Question 14

test explanation

Lipoproteins: HDL

Answer 14

Removes cholesterol from the tissues and transports it to the liver for excretion.
Removing lipids from the endothelium (reverse cholesterol transport) provides a protective effect against heart disease

AKA good cholesterol
High levels= decreased risk for coronary heart disease

Question 15

HDL

Low Levels

Answer 15

<35 mg/dL
increases risk for CAD

Question 16

HDL

High Levels

Answer 16

> 60 mg/dL is protective

Question 17

HDL and total cholesterol ratio

Answer 17

accuracy of predicting CAD is increased.
Ratio should be at least 5:1 with 3:1 being ideal

Question 18

HDL: 5 subclasses

only 2b

the rest are not capable of reverse cholesterol transport and are not cardioprotective

Answer 18

2b is cardioprotective
most efficient form of HDL in reverse cholesterol transport

Pts with low total HDL levels often have low levels of HDL 2b

Question 19

Low levels of HDL 2b

Answer 19

40-60: cardioprotective levels of HDL 2b are minimal.
>60: levels of HDL 2b are predominate and reverse cholesterol takes place (protects coronary arteries from disease)

levels can be increased by niacin supplements but not by statins (HMG-CoA reductase inhibitors [simvastatin, lovastatin])

Question 20

LDL

what is it and what are the risks?

Answer 20

LDLs are also cholesterol rich but most cholesterols carried by LDLs can be depositied into the lining of the blood vessels and is asscoiated with an increased risk for arteriosclerotic heart and peripheral vascular disease.

**high levels of LDL are atherogenic
LDL should be less than 70 mg/dL in pts at high risk for heart disease

Question 21

LDL: 7 classes

whats the most common forms?

LDL I, LDL IIa, LDL IIb, LDL IIIa, LDL IIIb, LDL IVa, LDL IVb

Answer 21

IIIa and IIIb
they’re small enough to get between the endothelial cells and cause atheromatous disease.

IVa and IVb are small; associated with arterial plaques that are vurnable to ulceration and vascular occlusion. levels greater than 10% of total LDL have vascular events within months.
I, IIa, IIb are larger; they cannot get into endothelial cells and are not associated with increased risk for disease

Question 22

LDL patterns

Pattern A and B

Answer 22

A: large LDL particles and no increased risk for CAD
B: mostly small LDL particles and increased risk for CAD

Question 23

LDL: how to lower levels

Answer 23

diet
exercise
statins

Question 24

Goal

Coronary Artery Disease

goals for high risk pts with CAD

Answer 24

LDL lower than 70 mg/dL

Question 25

# interfering factors Lipoproteins: HDL/LDL

Answer 25

**Smoking** and **alcohol** ingestion decrease HDL levels **Binge eating** can alter lipoprotein values HDL values are **age** and **sex dependent**

Question 26

# interfering factors HDL values: Myocardial Infarction | what happens to HDL after an MI?

Answer 26

HDL **decreases** for as long as 3 months following an MI

Question 27

# interfering factors HDL: Hypo/Hyperthyroidism

Answer 27

Hypo: Elevated Hyper: Diminished

Question 28

# interfering factors Drugs that may cause altered lipoprotein levels | BETA BLOCKERS

Answer 28

Increases: Triglycerides Decreases: HDL-C, LDL size, HDL 2b ## Footnote **HDL-C: **this specifically refers to the cholesterol component that is carried by HDL particles **HDL 2b:** most effective at removing cholesterol from the arteries and transporting to the liver for excretion

Question 29

# interfering factors Drugs that may cause altered lipoprotein levels | ALPHA BLOCKERS

Answer 29

Decrease: Triglycerides Increase: HDL-C, LDL size, HDL 2b

Question 30

# interfering factors Drugs that may cause altered lipoprotein levels | DILANTIN

Answer 30

Increases HDL-C ## Footnote HDL-C is the cholesterol component of lipoproteins; its specifically talking about cholesterol

Question 31

# interefering factors Drugs that may cause altered lipoprotein levels | STEROIDS

Answer 31

Increases triglycerides

Question 32

# interfering factors Drugs that may cause altered lipoprotein levels | ESTROGENS

Answer 32

Increases triglycerides

Question 33

# procedure and patient care Lipoproteins | what to educate and when to collect blood samples

Answer 33

Blood levels should be collected after a **12-14 hour fast** Educate pts with high lipoprotein levels regarding diet, exercise, and appropriate body weight

Question 34

# test results and clinical significance Increased HDL | genetics and exercise

Answer 34

Familial HDL lipoproteinemia Excessive exercise: 30 minutes 3x a week

Question 35

# test results and significance Decreased HDL | genetics, disorders, disease

Answer 35

Metabolic Syndrome Familial Low HDL Hepatocellular diasease (hepatitis, cirrhosis)⭐️ Hypoproteinemia (nephrotic syndrome, malnutrition)🏵 ## Footnote ⭐️**HDL is made in the liver**: no liver function = HDL isn't made and levels fall 🏵**loss of proteins**: HDL isn't made and levels fall. when its severe the productions of lipoproteins **rise** though only **late** in the disease.

Question 36

# test results and significance Increased LDL | genetics, diseases, alcohol

Answer 36

**Familial LDL lipoproteinemia** **Nephrotic Syndrome:** no proteins **Hyopthyroidism:** LDL catabolism is gone; common in women **Alcohol** **Chronic liver disease (hepatits, cirrhosis):** liver catabolizes LDL, no catabolism = levels increase **Cushing Syndrome**

Question 37

# test results and significance Decreased LDL | genetics, conditions

Answer 37

**Familial hypolipoproteinemia** **Hypoproteinemia(malabsorption, severe burns, malnutrition)**: ealry phase = low, late phase = high **Hyperthyroidism:** catabolism of LDL is increased and levels fall

Question 38

# normal findings Triglycerides

Answer 38

**Adult/Elderly:** * Male- 40-160 mg/dL or 0.45-1.81 mmol/L * Female- 35-135mg/dL or 0.40-1.52 mmol/L ## Footnote **Critical Values:** >400 mg/dL

Question 39

# indications Triglycerides | what does it identify?

Answer 39

identifies the risk of developing coronary heart disease (CHD) and performed on pts with suspected fat metabolism disorders

Question 40

# test explanation Triglycerides | what are triglycerides?

Answer 40

A form of **fat** in the bloodstream. They are transported by **LDLs** Produced in the liver using **glycerol** and other fatty acids Storage source for** energy** Makes up **most of the fat** in the body ## Footnote when TG levels are **high** they are depositied in the fatty tissues

Question 41

# interfering factors Triglycerides | what causes TGs to

Answer 41

**Fatty meals** cause high levels of TG **Alcohol** may cause high levels of TG by increasing the prodcution of VLDL **Pregnancy** may cause high levels ## Footnote VLDL: very low LDL

Question 42

# interfering factors Drugs that may increase TG levels

Answer 42

cholestyramine estrogens oral contraceptives

Question 43

# interfering factors Drugs that may decrease TG levels

Answer 43

ascorbic acid asparaginase clofibrate colestipol fibrates statins

Question 44

# procedure and patient care Triglycerides

Answer 44

fasting: yes **teach pt:** * not to drink alcohol for **24 hours** before the test * that dietary indiscretion for as much as **2 weeks before** this test will influence results * increased levels of TG regarding diet, exercise, and appropriate weight

Question 45

# test results and clinical significance Triglycerides | INCREASED LEVELS

Answer 45

**Hyperlipidemia:** increds lipids in blood = high TG **Hypothyroidism**:breakdown of TG is slowed **High-carbohydrate Diet:** excess carbs are turned into TG = levels rise **Poorly Controlled Diabetes:** decreased catabolism and increased making of TG **Nephrotic Syndrome:** loss of proteins boosts liver production of LDL so the removal of those fats will be reduced **Chronic Renal Failure**: High insulin levels since the kidneys filter out insulin. Extra insulin promotes fat production raising triglyceride levels. They also lack lipoprotein lipase which helps clears TG from the blood.

Question 46

# test results and clinical significance Triglycerides | DECREASED LEVELS

Answer 46

**Malabsorption Syndrome:** struggles to absorbs fats from food. **Malnutrition:** consumes less fat in their diet **Hyperthyroidism:** breakdown of VLDL is increased

Question 47

# normal findings Troponins

Answer 47

Cardiac Tropinin T: <0.1 ng/mL Cardiac Troponin I: <0.03 ng/mL

Question 48

# indications Troponin | what is the test used for

Answer 48

performed on pts with **chest pain** to determine if the pain is caused by **cardiac ischemia.** ## Footnote indicator for **cardiac muscle injury** predicts the posisibility of **future cardiac events**

Question 49

# test explanation Troponin | what is it used for and what does it assess

Answer 49

Cardiac troponins are indicators for heart disease. Helps evaluate pts suspected of having acute ischemic issues. Useful in assesing risk in unstable angina and predicts future likelihood of heart problems. Evaluates pts with chest pain ## Footnote CTs are specific for cardiac muscle injury CTs are normal in noncardiac muscle diseases

Question 50

# test explanation Troponins | what are they and what are the 2 main Troponins?

Answer 50

**Proteins** found in **skeletal **and **heart muscles** that help regulate how myosin interacts with actin for muscle contraction. You can distinguish cardiac troponins from skeletal troponins using **specific antibodies **or tests like **ELISA.** Two main cardiac troponins: **Cardiac Troponin T (cTnT)** and **Cardiac Troponin I (cTnI)** ## Footnote **cTnT** and **cTnI** are better at detecting muscle injury than CPK-MB which is important whn assesing those with **chest pain**

Question 51

# test explanation Troponins | what happens to troponins after an MI? ## Footnote can you use troponins to detect a second MI?

Answer 51

CTs become elevated as early as **2-3 hours** after an MI. Troponins are checked 2-3 times over a course of a day to indicate myocardial infarction. ## Footnote not useful for detecting a second MI since the levels might still be elevated from the first one

Question 52

# test explanation Troponins: cTnI | cardiac troponin I ## Footnote what happens to the levels after an MI?

Answer 52

levels may remain elevated for 7-10 days after an MI

Question 53

# test explanation Troponins: cTnT | cardiac troponin T ## Footnote what happends to the levels after an MI?

Answer 53

levels remain elevated for up to 10-14 days

Question 54

# test explanation Troponins: Unstable Angina | normal and elevated levels

Answer 54

Normal levels: no MI injury Elevated: * muscle injury has occured * thrombolytic therapy is indicated * risk for subsequent cardiac event (infarction or sudden death)

Question 55

# test explanation Troponins: Detection of reperfusion associated with Coronary recanalization | what does it mean when there is a rise in troponin levels?

Answer 55

treatment of blocked artery in the heart (coronary angioplasty) blood flow returns to the heart (reperfusion). The second rise in troponin levels is a sign that the treatment worked and blood flow has returned to the heart.

Question 56

# test explanation Troponin: Estimation of MI size | what happens with late CT levels?

Answer 56

Late cardiac troponin levels (4 weeks) are related to** left ventricular ejection fraction** ## Footnote These late elevations are related to **degradation** of the **contractile apparatus** (responsible for making the heart contract aka pump blood. With an MI it can breakdown and reduce pumping ability)

Question 57

# test explanation Troponins: Detection of perioperative MI | why are CTs better at detecting an MI after surgery?

Answer 57

**CTs** are perfect for detecting an MI after surgery because they are not affected by muscle injury outside of the heart like CPK-MB ## Footnote Using CPK-MB to diagnose MI after surgery is hard because it often rises due to muscle damage from the surgery itself

Question 58

# test explanation Troponins: Evaluation of the severity of PE | what might this indicate?

Answer 58

elevated levels may indicate more severe disease and the need for thrombolytic therapy

Question 59

# test explanation Troponins: Congestive Heart Failure

Answer 59

high Troponin levels indicate the heart is undergoing stress. ## Footnote Though elevated troponin T levels do not always mean MI. Other conditions can raise Troponin T such as: * **heart injury** (from procedure or device) * **heart failure, high/low BP** (irregular heartbeats) * **blood clots** in lungs * **kidney failure** * **inflammation** of the heart (myocarditis)

Question 60

# interfering factors Troponin | what are they falsely elevated in?

Answer 60

Troponin T levels are falsely elevated in pts on dialysis

Question 61

# procedure and patient care Troponins | education

Answer 61

no fasting discuss with pt need and reason for frequent venipuncture in diagnosing MI Qualiative Immunoassay: * Blood is obtained in a micropipete. * Red or Purple color in the read zone indicates that 0.2 ng/mL or more cardiac troponin is present in pts blood.

Question 62

# test results and clinical significance Troponins: Increased Levels

Answer 62

**MI and myocardial injury:** Troponin appears after myocardial cell death because of **ischemia.** ## Footnote Normally, no troponins can be detected in the blood.

Question 63

# normal findings Electrocardiography (EKG/ECG) | HR

Answer 63

HR: 60-100 beats/min, rhythm, and wave deflections

Question 64

# Indications EKG | what does it record

Answer 64

records the electrical impulses that stimulate the heart to contract.

Question 65

# Indications EKG | what is it used to evaluate

Answer 65

Used to evaluate: * arrhythmias * conduction defects * myocardial injury and damage * hypertrophy (left/right) * pericardial diseases ## Footnote also used for noncardiac conditions like: * electro abnormalities * drug level abnormalities * pulmonary diseases

Question 66

# test explanation EKG: 12-Lead | what does it show

Answer 66

view of the flowof he heart's electrical currents in two different planes.

Question 67

# test explanation EKG: 12-Lead | explain limb and chest leads

Answer 67

6 limb leads (from arms to legs) and 6 chest leads ## Footnote Limb leads: show heart activity from front to back Chest leads: view from top to bottom

Question 68

# test explanation EKG: 12-Lead | LIMB LEADS: standard and augmented

Answer 68

Leads **I, II,** and **III** are **standard** limb leads, measuring electrical differences between arms and legs (below) **aVR, aVL, aVF** are **augmented** limb leads that focus on the heart's electrical potential between the center of the heart and the **right/left arm** and** left leg** ## Footnote **I:** left arm and right arm **II:** right arm and left leg **III:** left arm and left leg right leg is an inactive bround in all leads **R:** right arm **L:** left arm **F:** left foot or leg

Question 69

# test explanation EKG: 12-Lead | CHEST LEADS

Answer 69

precordial leads: six chest leads (V1-V6) are placed at specific locations around the heart ## Footnote **1:** 4th intercostal space (4 ICS) at the right sternal border **2:** In 4 ICS at teh left sternal border **3:** Midway between V2 and V4 **4:** In 5 ICS at the midclavicular line **5:** At the left anteriot axillary line at the level of V4 horizontally **6:** A the left midaxillary line at the level of V4 horizontally

Question 70

# test explanation EKG: 12-Lead | Heart Regions: where do each lead (limb and chest) go?

Answer 70

Leads II, III, and aVF monitor the lower (inferior) part of the heart Leads aVL and I monitor the side (lateral) of the heart Leads V2 to V4 monitor the front (anterior) of the heart

Question 71

# test explanation EKG: P wave | explain what it is

Answer 71

atrial electrical depolarization associated with atrial contraction (electrical activity that causes the atria to contract) ## Footnote represents how the electrical impulse spreads from the SA node (heart's natural pacemaker) thru the atria if P waves are missing or look different it means the electrical signal is starting from somewhere other than the SA node

Question 72

# test explanation EKG: PR Interval | explain what it is

Answer 72

the time it takes for the electrical impulse to travel from the SA node to the AV node ## Footnote **longer than normal:** delay in the signal at the AV node (first degree heart block) **shorter: **the impulse is taking a shortcut to the ventricles

Question 73

# test explanation EKG: QRS Complex | explain what it is

Answer 73

represents the electrical activity that makes the ventricles (lower chambers of the heart) contract. ## Footnote Q: small downward wave R: large upward wave S: small downward wave after R wave wider QRS complex may indicate a problem with how the ventricles are depolarizing (bundle branch block)

Question 74

# test explanation EKG: ST Segment | explain what it is

Answer 74

shows time between the end of the ventricular depolarization and the start of repolarization (when the ventricles relax) ## Footnote changes in ST indicates issues like temporary lackof blood flow (ischemia) or heart muscle injury (Mi)

Question 75

# test explanation EKG: T Wave | expain what it is

Answer 75

shows the repolarization of the ventricles, meaning the heart muscle is returning to its resting state

Question 76

# test explanation EKG: QT Interval | expalin what it is

Answer 76

measures the time from when the ventricles start to depolarize to when they finish repolarizing. ## Footnote the length of this interval can change based on a person's age, sex, heart rate, and, medications

Question 77

# test explanation EKG: U Wave | explain what it is

Answer 77

a small wave that comes after the T wave and represents the repolarization of the special heart fibers (purkinje fibers) within the ventricles ## Footnote **repolarization**: relaxation and resetting of the heart **depolarization**: exitation and contraction of the heart

Question 78

# interfering factors EKG | what problems affect the result of the EKG?

Answer 78

**Inaccurate placement** of the electrodes **electrolyte imbalances** **Poor contact** between the skin and the electrodes Movement or **muscle tremors **(twitching) during the test Drugs that can affect results include **barbiturates, digitalis**, and **quinidine**

Question 79

# procedure and patient care EKG: Before | what does the nurse do before the procedure

Answer 79

Explain procedure Tell pt that no food or fluid restriction is necessary Assure the pt that the flow of the electric current is from the pt; they will feel nothing during this procedure Expose only the pts chest, arms, and lower legs.

Question 80

# procedure and patient care EKG: During | what does the nurse do during the procedure?

Answer 80

Skin areas where the electrodes go are prepared by using** alcohol swabs** or **sandpaper** to remove skin oil or debris. **Shave** if there is large amount of hair. **Prelubricated leads** to ensure electrical conduction. Four limb leads placed by **clamps** that can easily be opened and applied to the extremity. Chest leads are applied **one, two or six **at a time. Tell the pt this procedure causes **no discomfort**, must lie still in **supine position without talking **while EKG is recorded. ## Footnote procedure is performed in less than 5 minutes

Question 81

# procedure and patient care EKG: After | what does the nurse do after?

Answer 81

Remove electrodes, wipe off the electrode gel. Indicate on the EKG strip if the pt was experiencing chest pain during the study (maybe correlated to an **arrhythmia** on the EKG).

Question 82

# test results and clinical significance EKG: Arrhythmia (dysrhythmia)

Answer 82

Starts in the **atrium** or the **ventricle** Causes the heart to **speed up** or **slow down** **Serious: **cardiac output falls signficantly causing pt to lose conciousness (**syncope**) May experience **palpitations**. Many are **asymptomatic**.

Question 83

# test results and clinical significance EKG: Acute MI, Myocardial Ischemia, Old MI

Answer 83

**A-MI**: elevations in ST segment or inverted T waves **Old MI **(areas of dead tissue): deep Q waves EKG should be the **first test** on a pt who complains of **chest pain**

Question 84

# test results and clinical significance EKG: Cor pulmonale, Pulmonary Embolus

Answer 84

Findings: S1, Q3, T3, which means presence of **S wave in lead I**, **Q wave in lead III**, and **T wave inversion in lead III**. Tachycardia with PE

Question 85

# test results and clinical significance EKG: Electrolyte Imbalance

Answer 85

**Increase K+**: narrowed, elevated T waves wide QRS complex **Decrease K+**: prolonged U wave and QT interval

Question 86

# test results and clinical significance EKG: Pericarditis

Answer 86

Widespread **elevations of ST segments** involving most of the leads (not aVR) QRS complex is **normal** When fluid (effusion) is associated with the pericarditis, the voltages will look **weaker** and the voltages across the leads will be **lower** ## Footnote **pericarditis**: inflammation of the sac around the heart

Question 87

# normal findings Pericardiocentesis

Answer 87

less than **50 mL** of **clear**, straw-colored fluid w/o any evidence of any bacteria, blood, or malignant cells

Question 88

# indications Pericardiocentesis

Answer 88

Determines the cause of unexplained **pericardial effusion** (fluid build-up). Used to **relieve** the **intrapericardial pressure** that accumulates with a large volume of fluid and inhibits diastolic filling

Question 89

# test explanation Pericardiocentesis | what is it? therapeutic and diagnostic meaning?

Answer 89

Involves the aspiration of fluid from the pericardial sac with a **needle.** **Therepeutic:** relieve *cardiac tamponade* by removing blood or fluid to improve diastolic filling. **Diagnostic:** remove a sample of pericardial fluid for lab examination to determine the *cause of fluid accumulation.* ## Footnote takes 10-20 minutes pts may feel **pressure** and very** little discomfort**

Question 90

# contraindications Pericardiocentesis

Answer 90

Pts who are **uncooperative**, because of **risk of lacerations** to the **epicardium** or **coronary artery** Pts with a ***bleeding disorder***: inadvertent puncture of the myocardium may create uncontrollable bleeding into the pericardial sac, leading to a **tamponade**

Question 91

# potential complications Pericardiocentesis

Answer 91

* **Laceration** of the coronary artery or myocardium * **Needle-induced** ventricluar arrhythmias (dysrhythmias) * **MI** * **Pneumothorax** caused by inadvertent *puncture* of the lung * **Liver laceration** caused by advertent puncture of that organ * Pleural or pericardial **infection** caused by the aspirating needle * Vasovagal **hypotension** or **arrest**

Question 92

# procedure and patient care Pericardiocentesis | BEFORE

Answer 92

Explain procedure Informed consent Restrict fluid and food intake for at least **4-6 hours** (if its elective procedure) Obtain **IV access** for infusion of fluids and cardiac meds if required. Administer pretest meds. **Atropine** may be given to prevent the *vasovagal reflex* of *bradycardia and hypotension*. ## Footnote **vasovagal reflex:** sudden drop in in heart rate and blood pressure leading to fainting, often in reaction to a stressful trigger.

Question 93

# procedure and patient care Pericardiocentesis | DURING

Answer 93

* **Supine** position * **5th or 6th ICS** at the **left sternal margin** (subxyphoid) is prepared and draped. **Subxyphoid** space is used for access to the pericardium. * After local anesthetic a needle is placed on a **50 mL syringe** and introduced into the pericardial sac. * An **electrocardiographic lead** is often attached by a clip to the needle to identify any **ST segment elevations**, which may indicate *penetration into the epicardium.* **Echocardiography** may be used for guidance of the needle. * Pericardial fluid is apirated and placed in multiple specimen containers. * Pts with recurring cardiac tamponade may require placement of an** indwelling catheter** for continuous draining for **1-3 days**. A surgical **pericardial window** (excision of a small portion of the pericardium) is necessary to **prevent recurrent effusions.** * With certain types of pericarditis, medications (**antibiotics, antineoplastics, corticosteroids**) may be used during PCC to diminish the risk of recuurent effusions.

Question 94

# procedure and patient care Pericardiocentesis | AFTER

Answer 94

Monitor vitals Increased temp = **infection** Pericardial bleeding would be marked by **hypotension** or **pulsus paradoxus** **Lab exam possibilites:** * color, turbity, glucose, albumin, protein, and lactic dehydrogenase levels are obtained. * hematology lab: red and white blood cells are evaluated * bateriology lab: routine cultures, gram stains, fungal studies, and acid-fast stains * when malignancy is suspected, the fluid should be sent for cytologic examination. All test performed on pericardial fluid should be performed **immediately** to avoid **false results** caused by chemical or cellular deterioration. Apply **sterile dressing** to the catheter if one has been left for cont. drainage. Establish a closed system if cont. peri drainage is required; performed via **straight drainage method** Minimize infection: peri caths are removed after **2 days**. After sutures are cut and cathether is removed, apply sterile dressing to site ## Footnote pulsus paradoxus: abnormal decrease in systolic blood pressure during inspiration **Home Care Responibilities:** * check dressing for frequent drainage * increased temp = drainage * tell pt to report any drop in BP. hypoTN = sign of pericardial bleeding.

Question 95

# test results and clinical significance Pericardiocentesis: Pericarditis | what is it and what can it result from

Answer 95

**Inflammation** of the hearts outer lining. Can result from **MI, infections **(viral, bacterial, tuberculosis), **myocarditis**, autoimmune diseases. The fluid that builds up in pericarditis is usually an ***exudate*** (fluid rich in proteins and cells)

Question 96

# test results and clinical significance Pericardiocentesis: Hypoproteinemia, Nephrotic Syndrome | what is NS and what does it have to do with HPE? ## Footnote why would u use a PCC for NS?

Answer 96

In NS the kidneys *lose a lot of protein*, especially **albumin**, which lowers the protein levels in the blood (hypoproteinemia). This leads to lower pressure inside blood vessels, causing fluid to leak into the abdomen. This fluid is usually a*** transudate*** (fluid low in protein)

Question 97

# test results and clinical significance Pericardiocentesis: Congestive Heart Failure | what is CHF and why would u need a PCC for CHF?

Answer 97

A small amount of fluid is present in the pericardial space (around the heart) and its regularly produced and reabsorbed, In CHF, the pressure in the veins **increases** due to **blood backing up**, leading to **fluid buildup** around the heart.

Question 98

# test results and clinical significance Pericardiocentesis: Cardiac Trauma or Ventricular Aneurysm Rupture | why is a PCC needed for a CT or VAR?

Answer 98

If the heart is injured (blunt or penetrating trauma) or if a ventricular aneurysm (a weakened heart wall) bursts, **blood can quickly fill the pericardial space**. This restricts the hearts ability to fill properly, reducing blood output.