CV labs & Dx - medsurg2 Flashcards
if troponin is elevated, think
MI
if BNP is elevated, think
heart failure
troponin
most sensitive indicator of MI & helps differentiates between cardiac & non cardiac pain
-will be elevated 2-3 hrs after MI and will return to baseline in 10 to 14 days
how to draw serial troponin levels
initially -> 12 hrs -> daily for 3-5 days
does angina elevate troponin
no
CK-MB
a less specific indicator of myocardial damage -> could be elevated d/t multiple IM injections or if a person was involved in a trauma b/c it shows muscle damage
C-Reactive Protein (CRP)
non specific indicator of acute inflammation
-more sensitive than ESR
-failure to normalize after 72 hrs may indicate damage to heart muscle
is CRP elevated with angina
no
erythrocyte sedimentation rate (ESR or sed rate)
nonspecific indicator of acute/chronic infection, chronic inflammation & tissue infarction
-best used to monitor chronic inflammation
-less sensitive than CRP
brain natriuretic peptides (BNP)
aids in distinguishing cardiac vs respiratory cause of dyspnea
-main source is found in the cardiac ventricles so if elevated, indicates heart failure/left ventricular dysfunction
Pro-BNP
in healthy patient, usually similar levels compared to BNP but if left ventricular dysfunction, pro will be elevated 4x higher than BNP
what is the main lipid associated with CV disease
cholesterol
is cholesterol an accurate predictor of heart disease
not by itself, take in part of a lipid profile test
what affects cholesterol levels
-diurnal variations (time of day)
-malnutrition (so check albumin levels)
what are the lipoproteins
HDL & LDL
are lipoproteins an accurate predictor of heart disease
yes
HDL
want high
-“good cholesterol”
-removes cholesterol
LDL
want low
-“bad cholesterol”
-deposits cholesterol in peripheral tissues
what noninvasive test can dx an MI
12 lead ekg
EKGs provide info on what
a snap shot of the electrical conduction of the heart w/ a multidirectional view
tele
-monitors cardiac rhythm on a continuous basis
-cannot dx
-unidirectional
if a patient is complaining of chest pain, what is the next best nursing action
get an EKG
holter monitor
a painless, no prep test that attaches electrodes to a person for 24 hours and that person then continues normal activity w/ monitor
ambulatory EKG monitoring
what can a holter monitor dx
afib
reason for syncope
tachycardia
if a person is having weird episodes of syncope at home, what should be ordered
a holter monitor
exercise stress test
evaluates the heart’s response to exercise to unmask sx of CAD or dysrhythmias that may not occur w/ normal activity
requires continuous heart monitoring & VS
if a patient complains of chest pain only w/ exercise, what test should be ordered
stress test
prep for stress test
-VS & EKG step up
-tell pt to wear comfy clothes and good shoes
what is done if a person is unable to perform a stress test d/t mobility limitations
medications can be used to induce similar effects of exercise induced stress on the heart
echocardiogram
uses sound waves to create a moving picture of heart -> evaluates valves & chambers of the heart + measures EF
nursing considerations of an echo
-no radiation
-no prep
-painless
-done at bedside
ejection fraction
amount of blood pumped out of the left ventricle w/ each contraction -> normal is 55-70%
indicator of how effective the heart is pumping
what is considered a low EF and what is it associated w/
<40%, seen w/ heart failure
very low values might indicate need for transplant
transesophageal echocardiogram (TEE)
a probe w/ an ultrasound transducer is placed down the throat w/ the end near the heart -> provides improved pictures to be taken compared to echo
echo shows what side of the heart and TEE shows what
anterior ; posterior
TEE nursing considerations
-contrast may be used
-done in vascular lab
-IV access for local or conscious sedation
-NPO 6hrs before test
-remove dentures
-NPO until gag reflex returns
-educate on sore throat after
electrophysiology study (EPS)
evaluates the electrical health of the heart by inducing dysrhythmias to confirm the root of suspected electrical problems within the heart
where are the the probes in the EPS placed
near the SA node, AV node and right ventricle
EPS nursing considerations
-anti dysrhythmics dc’d several days before procedures
-NPO 8hr before test
-IV sedation
-frequent VS after procedure
cardiac cath + angiography
uses contrast dye and takes pictures of the heart to provide information about the heart muscles, blood vessels & valves
heart cath: diagnostic
confirm location and extent of CAD
heart cath: therapeutic
can preform interventions like angioplasty / stent placement
left sided heart cath
enter an artery (usually femoral) -> works retrograde up to the ascending aorta -> enters coronary arteries
what structures can a left sided heart enter
-aorta
-right coronary artery
-left anterior descending coronary artery
-circumflex coronary artery
-left main artery
right sided heart cath
cannot look at arteries
-can measure EF and look at pressures
-enters through the venous system
left sided heart cath nursing considerations
-contrast used w/ x ray imaging
-pt conscious w/ local aneesthesia so educate on warm flush
heart cath pre procedure nursing responsibilities
-NPO (meds may be allowed)
-consent
-pt/fam teaching
-only a little pain is to be expected
-hot flash w/ dye
-check bun/Cr
-empty bladder
heart cath post procedure nursing responsibilities
-d/c heparin drip & monitor clotting times closely before sheath is pulled
-after removing sheath, hold pressure for 20 mins
-bed rest for at least 6hrs w/ affected leg straight & HOB <30 degrees
-assess circulation of extremity used
-check pulses, colors & sensation
potential complications of heart cath
-bleeding & hematoma at puncture site
-emboli: monitor for stroke
-infection
-dysrhythmias
-damage to heart (tamponade if pericardium is poked)
-allergic rx
-renal failure secondary to dye
what is contrast nephrotoxicity
AKI occurring w/n 3 days of contrast dye injection
who is at risk for contrast nephrotoxicity
preexisting renal impairment
diabetic pts
pts who are volume depleted
how to prevent contrast nephrotoxicity
-sodium bicard IV & acetylcysteine po before & after procedure
-force fluids after
