Cardiovascular Part 1 Flashcards
Cardiac Biomarkers
- Troponin I - cardiac specific
- Troponin T - more sensitive
- Creatinine kinase CK-MB - cardiac specific
- Myoglobin -
Triponin I and Triponin T - Peak and duration
Troponins will peak between 4 and 24 hrs after a cardiac event - will see them last for at least 24 hrs and then will remain elevated for 1-3 weeks.
Creatinine Kinase - Peak and duration
Creatinine Kinase as a marker of damage of CK-rich tissue such as in myocardial infarction;
CK is an enzyme and it catalyses the conversion of creatine and utilizes adenosine triphosphate (ATP) to create phosphocreatine (PCr) and adenosine diphosphate (ADP).
- peak between 12-24 hrs, but will not stay elevated as long
Myoglobin
Does not stay elevated at all, it peaks in 1-3 hours after a cardiac event
Fasting Lipid Profile
NEED TO EDUCATE PTS TO FAST 12 hrs before
*Drs are going to adjust the target rates based on risk factors for individual pts.
Totals should be
*Cholesterol 40
*Want BNP 300 is correlated to an ejection fraction that is
C-Reactive Protein (CRP)
We draw because it shows if there’s inflammation in the body - it’s not cardiac specific; shows inflammation in muscles too; statin meds also elevate the CRP level (will see muscle aches with statins and drs will order CRP test and to stop statins)
Coagulation Labs
**Coagulation labs - know INR levels
- PT levels - seconds it takes body to clot blood; normal is 12-15 seconds; therapeutic goal may be 1.5-2 x normal; if we see less time than blood is thick and clots easy; if it’s way longer, it’s thin blood and doesn’t clot easy
-aPPT - Norm 23-32; therapeutic level 1.5-2.5 x baseline
-INR - developed globally - tests clotting time that does not vary based on equipment used - can be tested through blood draw or finger stick and measure the INR by seconds; normal value is 0.8-1.1 (a normal person is going to have INR that’s in this range aka. someone not taking drugs); therapeutic range determined by diagnosis
2-3.5 (KNOW THIS) - but 5 (KNOW THIS) is too long for blood to clot - if someone is on Warfarin, we don’t want them to clot fast, so their clotting time is going to be higher! KNOW the therapeutic range for pts, not for “normal” people; PT and INR usually drawn together
Electrocardiogram
- noninvasive way to look at electrical activity of heart;
- can do this with tele-monitor or continuous monitor and 12-lead ECG (but this last one is just a snapshot of that point in time)
How to place leads:
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Stress Test
- Pts should wear shoes with traction, comfortable clothes,
- Test increases speed and incline every 3 mins
- Pt rates how hard they feel they’re working
- we do stress tests to recreate the symptoms that caused the chest pain in the first place
- Pts should not have tea, coffee or chocolate (6 to 4 hrs before); can’t have beta blockers
Types of Cardiac Tests and Procedures
- ECG
- Stress Test
- Echocardiogram - this is an ultrasound! looks at structure, function, and sometimes get a pumping ability reading and ejection fraction reading
- Transesophageal Echocardiogram (TEE) - invasive; give sedative hypnotics; but tube down esophagus and take ECHO closer to heart; good idea to have this before procedures where we shock heart to get it back to regular rhythm. Must have informed consent for this; will give sedative; so we have to get them out of that; also monitor for clear airway and can’t eat or drink for 1st hour after; can’t drive that day! have to have family member
- Magnetic Resonance Imaging (MRI)
- Ankle-Brachial Index (ABI)
- Cardiac Catheterization
MRI
MRI’s use magnets and spins inside tube and they can get good image of what’s going on inside body; can’t have anything metal inside body (aka pacemaker)
ABI
ABI - we’re looking at extent of peripheral artery disease with this test; they put cuffs on ankles and wrists; higher the number, less severe disease because means vessels are less clogged
Normal: > 1.0
Severe Disease:
Cardiac Catheterization Nursing Considerations
- Prior
- NPO (if outpatient, planned procedure)
- Assess Ax: Iodine/Shell fish (cause have to inject contrast dye)
- Labs: Creatinine (we want value less than 1), Coags (PT and INR)
- Consent
- During
- Conscious sedation; pain control
- Monitor for arrhythmias & pain
- Recovery
- Assess for bleeding
- Assess peripheral pulses
- Immobilize site
- Hydration
- Monitor pain
Possible procedures needed during Cardiac Cath
- Angiogram - shows vessels of heart and any blockage
- Angioplasty - balloon to blow out wall and dilate it
- Stent - looks like coils inside pen
If none of these work we have to do open heart
Patient Education & Discharge Planning After Cardiac Cath
Goal: reduce risk of complications
- No lifting, straining or bending at waist x 24 hrs.
- Avoid tub bath but shower as desired
- Avoid hot show or hot bath because it dilates blood vessels!!
- Call if temp 101.5
- Call if back/flank/puncture site pain, bleeding, new bruising, swelling - indicates a bleed
- Cardiac rehab referral
- Lifestyle modification - to deal with coronary artery disease found
- Medications
- Do not stop taking without talking to physician
