Cardiovascular labs and diagnostic testing Flashcards
What does a CBC consist of
- Hemoglobin
- hematocrit
- WBCs
- Platelts
- RBCs
Hemoglobin
- Normal: 12-18
- Decreased levels = decreased oxygen carry capacity
- <7-8 essential activities only/No exercise
- > 8 symptoms based approach
- low critical values can lead to heart failure
- High critical values can lead to clogging of capillaries due to concentration of hemoglobin
Hematocrit
- 36-45.2%
(37-47 females 42-52 males) - Low values are critical and can lead to heart failure
- High values lead to clogging of arteries
- > 25 - symptom based approach
- <60 symptoms based approach
White blood cells- acute care section guidelines
- 5-10.8 K/uL
- <4,000 with fever = no exercise
- > 4,000 light exercise, symptoms based approached
Platelets
- 140-400 K/uL
- <50,000 - risk of spontaneous hemorrhage
- greater than 1 million = risk of clotting
RBCs - normal range
3.85-5.15
Prothrombin time (PT)
- Warfarin use
- Normal 11-13 seconds
- Increase risk of bleeding with increase PT
- Increase risk of clotting with decrease PT
INR
- Normal: 0.9-1.1
- DVT/clot prevention 2-3
- Post MI/valve replacement 2.5-3.5
- Increase risk of bleeding (>3.6 hold therapy)
aPTT`
- Normal 21-35 seconds
- 2-2.5 upper normal limit with heparin use
- Increase risk of bleeding with increased PTT
- > 100 second - patient should not be mobilized)
- Increase risk of clot formation with decreased
what measures coagulation
- PT
- INR
- aPTT
- D-dimers
- platelts count
Basic metabolic panel
- A lab panel where multiple tests are grouped together in a single profile for ease of ordering
- Monitors:
Electrolyte and fluid states
Kidney function tests
Blood sugar levels/Glucose
Calcium
Sodium
Chloride
Potassium
CO2
BUN
Creatinine
Comprehensive metabolic panel
- BMP + protein albumin and liver function
- ALP- liver
- AST - liver
- ALT- liver
- Bilirubin: liver
- Total protein
- Albumin
- Globulin
- BUN/creatinine ratio: kidney function
Diabetes mellitus type 1
- Occurs when the pancreas is unable to produce enough insulin
- Tends to develop at a young age
- Cannot be prevented
- Requires insulin therapy
Diabetes mellitus type 2
- Occurs due to insulin resistance
- Tends to develop older age
- Can be prevented with lifestyle changes
- Can be managed with lifestyle modifications alone if diagnosed early
Common symptoms of both types of diabetes
Both share symptoms of
- frequent urination,
- increase thirst,
- extreme hunger,
- unintentional weight loss,
- fatigue,
- blurry vision,
- sores or wounds that heal slowly,
- numbness and tingling sensation in hands and feet
What could both types of diabetes benefit from
Both can benefit from lifestyle modifications such as
- a healthy diet,
- physical activity,
- blood sugar level monitoring,
- management of stress and other existing health conditions
Fasting blood glucose
- 99 mg/dL or lower = normal
- 100-125 mg/dL = prediatbetic
- 126 or above is diabetes
- Use caution if < 70mg/dL (supplement with carbs) or > 200mg/dL (use of insulin); and no exercise of >300mg/dL
A1C
<5.7% = normal
5.7-6.5 = prediabetic
>6.5 = diabetic
Blood glucose of diabetes diagnosis goal levels of A1C and preprandial and postprandial
- A1C targets different based on age and health
- More or less stringent glycemic goals may be appropriate for each individual
- A1C less than 6.5-7 typically for people with diabetes
- Before a meal (preprandial): 80-130 mg/dL
- 1-2 hours after beginning of the meal: less than 180 mg/dL
Hyperglycemia causes
too much food, too little insulin or diabetes pills, illness or stress
hyperglycemia onset
often starts slowly; may lead to medical emergency if not treated
hyperglycemia symptoms
Extreme thirst
Need to urinate
Dry skin
Hungry
Blurry vision
Drowsy
Slow healing wounds
Hyperglycemia: type 1 and type 2
- Type 1: insulin needed
- Type 2: antihyperglycemic medication/insulin if prescribed
*If signs of diabetic ketoacidosis call 911- Fruity smelling breath , Confusion
Fatigue
Hypoglycemia causes
- too little food or skipped a meal
- too much insulin or diabetes pills
- more active than usual
hypoglycemia onset
often sudden, may pass out if untreated
hypoglyecmia symptoms
Shaky
Fast heartbeat
Sweating
Dizzy
Anxious
Hungry
Burred vision
Weakness or fatigue
Headache
Irritable
what to do if hypoglycemic
- Provide snack or juice
- Monitor
- Do not exercise until stable
Total cholesterol level
Desirable = <200
moderate/borderline high = 200 - 240
High > 240
LDL cholesterol level
Desirable <100
Near desirable 100-130
Border line high 130-160
High = 160-190
Very high <190
HDL cholesterol level
Major risk: <40
Less risk >60
triglycerides
Standard range <150 mg/dL
150-199 = borderline high
200-400 = high
>499 very high
cardiac enzymes
Troponin: spikes during a heart attack
Troponin T and troponin I
AST
LDH
CKMB: muscle breakdown associated with MI
Natriuretic peptides
ANP - a type natriuretic peptide
BNP - b-type natriuretic peptide
Cardiac testing tools
- EKG/ECG/Holter monior
- stress testing
- echocardiography
- X-ray, Pet, MRI, CT, Angiograms
- Cardiac catheterization
EKG/ECG/Holter monitoring:
monitors the electrical activity of the heart and heart rate - check to see what is happening over a period of time
Stress testing/exercise testing
- Max or sub max
- Activity: treadmill, bicycle, other
- Pharmacological: an injection that elicits a similar response to the activity for those who cannot do the activity
- All involve monitoring response of patient to increased stress on the cardiac, vascular and/or pulmonary systems
- Exercise testing with imaging: use of non-invasive image pre and post exercise for greater diagnostic accuracy
- Usually used to look at cardiac perfusion
- Radioactive isotope
Echocardiography
another way of getting an image of the heart that uses US
Cardiac catherterization
- A procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms
- Dye visible by X-ray is injected into blood vessels using a thin hallow tub called a catheter
- Can go into the brachial artery, radial artery, femoral artery or vein
interventions for blockages of coronary arteries
- CABG: by pass
- Take a smaller vein such as saphenous and use it to reperfuse parts of the heart - Stenting (PTCA ro PCI)
- Use a balloon to squish or scrape plaque and open the artery
types of peripheral vascular testing
Arterial and venous angiography (not done by PT)
Ankle brachial index
Doppler ultrasound
Rubor dependency
Venous filling time
Homans sign
