CV Labs & Diagnostics Flashcards by Garrett Anderson

what is Troponin an indicator of?

most sensitive indicator of myocardial damage

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what does troponin differentiate between?

cardiac vs non cardiac chest pain

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how long after an MI does a troponin elevate? ___ - ____ hours

when does a troponin level return to baseline? ___ - ____ days

2-3 hours

10-14 days

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what is the lab draw schedule for troponin? (3)

initial occurrence, 12 hours, then daily for 3-5 days

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What is a CK-MB? ______ found primarily in the ________ _______

What does it help diagnose?

an enzyme found primarily in the heart muscle,
helps to diagnose an acute MI

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how long is a CK-MD elevated after an MI? __ hours

when does a CK-MD peak? ___ hours

when does it return to baseline?

3 hours

24 hours
2 days/18-72 hours

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between a troponin and a CK-MB which is more specific to cardiac damage?

troponin

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What does CRP indicate?

acute or chronic?

specific to heart?

is ESR or CRP more sensitive and quicker?

inflammatory illness

acute

(not specific to heart, could be anywhere in the body)

More sensitive and quicker compared to ESR

NONSPECIFIC

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when does a CRP peak?

if a CRP fails to normalize what may it indicate?

18-72 hours

ongoing damage to heart muscle

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what CHD issue is CRP not elevated with?

with angina

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What is a ESR used for?

acute or chronic?

specific to heart?

is ESR or CRP more sensitive and quicker?

infection, inflammation, or tissue infarction

acute OR chronic infection, chronic inflammation

nonspecific

CRP

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how is an ESR useful?

only one that monitors for chronic inflammation

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What is a BNP the main source in?

BNP is a _______ released by the __________ in the _______

BNP is a hormone released by the cardiac ventricles in the heart

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what does BNP aid in discovering for example with dyspnea?

Elevated BNP = ______ issue (specifically which part?)

Not elevated BNP = ______ issue

distinguishing between cardiac vs. respiratory causes of dyspnea

Elevated BNP = left ventricle dysfunction (cardiac issue)

Not elevated BNP = respiratory issue

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when are concentrations higher in a Pro-BNP?

Left ventricular dysfunction

levels are approximately fourfold higher than BNP concentrations

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what is the main lipid associated with CV disease?

(higher the ________ = the higher the risk of CAD)

cholesterol

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what are the two sources of cholesterol?

endogenous and exogenous

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what affects cholesterol?

malnutrition and diurnal variations

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what are two types of lipoprotiens?

HDL,LDL

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are lipoproteins an accurate predictor of heart disease?

is Cholesterol an accurate predictor of heart disease?

yes

no - Cholesterol is part of a lipid profiling test (not totally accurate predictor of heart disease itself)

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what is HDL’s job?

to remove cholesterol

HDL is good cholesterol

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What is LDL’s job?

to deposit cholesterol in peripheral tissues

LDL “low down dirty” bad cholesterol

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what is a normal cholesterol range?
low risk =
normal =
mod risk =
high risk =

< 200 low risk of CAD
150-200
200-400 mod risk of CAD
>240 high risk of CAD

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types of non-invasive procedures for CV disease (4)

EGK/ECG
Holter monitor
Exercise stress test
Echocardiogram
- also consider tele

what is the difference between a 12 lead EKG and telemetry? which one provides a more accurate picture of electroconductivity of the heart? which one records the electrical activity of the heart for a short period, 2-3 minute time frame? which one can diagnose MI? which one can look for abnormal rhythms? which one Monitors cardiac rhythm on an ongoing/continuous basis?

EKG provides a more accurate picture of electroconductivity of the heart EKG EKG only tele tele

What is a holter monitor

ambulatory EKG/ECG monitoring

what do you teach a patient prior to a holter monitor pain? prep? electrodes? activity?

test is painless requires no prep electrodes must stay firm against chest. continue with usual activities

how long do patients wear a holter monitor?

24 hours

what is a holter monitor used for? dx - (1) find out - (2)

to dx atrial fib to find out why someone is syncope or tachycardia

what is an exercise stress/treadmill test used for? when is it indicated? what is used to induce exercise? what are the test results? exercise may unmask symptoms of ______ or ______ in patients with minimal symptoms with normal activity

to evaluate the hearts response to exercise Test is indicated when person has angina w/ exercise and no angina w/ rest So we want to see the heart’s response to exercise can use a treadmill or exercise bike If the person can’t do treadmill/bike they can induce heart stress with meds exercise may unmask symptoms of CAD or dysrhythmias in patients with minimal symptoms with normal activity

what must be continuously monitored during a exercise stress test? (2) is there special prep for an exercise stress test?

heart monitoring and vital signs no, wear comfortable shoes and clothes

what are echocardiograms used for? uses _______ to create ________ of the heart evaluates ________ and ______ of the heart shows anterior or posterior of heart?

uses sound waves to create moving pictures of the heart to evaluate valves and chambers of the heart. Shows anterior of heart

what does an echocardiogram measure?

ejection fraction

what do you teach a patient about an echocardiogram? prep radiation pain where

no prep no radiation is used painless can be done at bedside

what is ejection fraction? indiactes? normal EF low EF < ____% = HF might need a

Percentage of blood pumped out of the left ventricle with each contraction. effectiveness of the heart to pump 55-70% <40% heart transplant

types of invasive procedures of CV disease (3)

trans-esophageal echocardiogram (TEE) cardiac catheterization Electrophysiology study (EPS)

What department is a TEE done in?

vascular lab

a probe with an ultrasound inducer is placed down the throat with the end near the heart. Provides improved images, compared to an echo contrast dye may be used

how is a TEE done? a probe with an ultrasound inducer is placed down the throat with the end near the heart. Provides improved images, compared to an echo contrast dye may be used

what type of sedation is used with a TEE? how long must a patient be NPO before a TEE?

requires IV access local anesthetic or conscious sedation 6 hours

what must be removed from the patient prior to a TEE? What must return before a patient can take anything by mouth after a TEE? what symptom can be expected after a TEE?

dentures gag reflex sore throat

evaluates the electrical health of the heart induces dysrhythmia's confirms the root of the suspected electrical problem of the heart

EPS Electrophysiology study

what must be stopped several days before an EPS? how long must a patient be NPO before a EPS? What type of sedation is used for an EPS? where are the catheters placed during a EPS? (3) what must be checked frequently after a EPS?

anti-dysrhythmics 8 hours IV sedation near SA, AV nodes, and right ventricle VS

what is diagnostic use of cardiac catheterization with angiography "heart cath" used for? (2)

to confirm location and extent of CAD

what is the therapeutic use of a heart cath? (1)

to perform an intervention such as angioplasty/stent placement

what type of information does a heart cath provide? (3)

about heart muscles, blood vessels and valves.

what path does a ____ heart cath follow? 1. aorta 2. RT coronary artery 3. LT anterior descending coronary artery 4. Circumflex coronary artery 5. LT main coronary artery

left

what are the insertion sites of a heart cath? (4)

neck = artery or vein groin = femoral (artery) radial and brachial = artery

done during a heart cath contrast dye injected through catheter and xray images are taken. pt may feel a warm flush

angiogram

nursing pre-procedure responsibilities of a heart cath NPO consent pain dye bladder sedation

``` NPO (some may be allowed morning meds with small sip of water) consent signed pt/family teaching little pain will experience hot flash when dye injected check labs BUN/Cr empty bladder local anesthesia and IV sedation (conscious sedation) likely ```

nursing post-procedure responsibilities of a heart cath where what is d/c monitor ____ before sheath is pulled when sheath removed apply pressure for _____ mins -bed rest for at least ___ hors with affected extremity _____ and HOB below ___ degrees -Frequently assess ________ of the extremity used for artery/vein entrance -check for _____, _____, and ______ (especially of area distal/below entrance site) and compare to unaffected extremity

will occur in cath lab or observation area heparin drip will be d/c and clotting time monitored before sheath is pulled when sheath removed apply pressure for 20 mins bed rest -bed rest for at least 6 hors with affected extremity straight and HOB below 30 degrees -Frequently assess circulation of the extremity used for artery/vein entrance -check for pulses, color, and sensation (especially of area distal/below entrance site) and compare to unaffected extremity

what must be checked before the sheath can be removed following a heart cath? how long must you apply pressure after removing the sheath from a heart cath? how long must a patient remain in bed after a heart cath and what position?

clotting times 20 min at least 6 hours with affected leg straight and HOB BELOW 30 degrees

potential complications of a heart cath? _______ (heparin drip used during procedure, monitor puncture site closely for hematoma) ________ ( monitor for s/s of stroke) infection dysrhythmias damage to heart (cardiac tamponade) allergic reaction to _____ _______ failure (r/t contrast dye "nephrotoxic")

bleeding (heparin drip used during procedure, monitor puncture site closely for hematoma) emboli ( monitor for s/s of stroke) infection dysrhythmias damage to heart (cardiac tamponade) allergic reaction to dye renal failure (r/t contrast dye "nephrotoxic")

AKI occurring within 3 days of contrast dye injection

contrast nephrotoxicity | major cause of AKI in hospitalized patients

what patient populations are at higher risk of contrast nephrotoxicity? (3)

pre-existing renal impairment, diabetic, FVD patients

how do you prevent contrast nephrotoxicity? (2) meds before and after procedure after procedure =

sodium bicarb IV and acetylcysteine PO before and after procedure force fluids

think triponin = think ________ think BNP = think _______

MI heart failure

If _______ is elevated = muscle damage has occurred (anywhere in the body, not specific to heart) So it could be elevated if the patient has had a lot of IM injections or they were in a MVA

CK-MB

in addition to triponin and CK-MB Another lesser used serum lab for monitoring myocardial damage (not specific to heart)

Myoglobin