DIAGNOSTIC TESTING AND PROCEDURES Flashcards
Serum Enzymes to Determine if someone had a myocardial infarction
(*Specific in the event of myocardial necrosis/injury )
- Troponin: “Gold Standard: Normal levels: 0.02-0.04
-
Creatine-Kinase MB: Normal levels: 0-3%, so >3% is considered abnormal
*
ideal LDL cholesterol
less than 100 mg
>130 high
ideal total cholesterol
less than 200
>240 high
ideal HDL cholesterol
more than 60
<40 in men, <50 in woman is low
hemoglobin normal value
12-16 g/100ml
what is hematocrit?
the percentage of red blood cells (RBC’s) in the blood
hematocrit normal value
Normal value: 36-44 g/100ml
(36-44%)
white blood cells normal value
4-12
true or false: low hemoglobin can be associated with many diseases and conditions that cause the body to have too few red blood cells
true (leukemia, GI bleed, injury…)
If your hemoglobin level is lower than normal, you have
anemia
Leukocytosis
is white cells (the leukocyte count) above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, but may also occur following certain parasitic infections or bone tumors.
Leukopenia
a reduction in the number of white cells in the blood, typical of various diseases.
Low Hematocrit =
may be due to:
anemia
- Loss of blood (traumatic injury, surgery, bleeding, and colon Ca)
- Nutritional deficiency
- Bone marrow problems
- Sickle cell anemia
- And more…
High Hematocrit may be attributed to
high altitudes, chronic smokers, dehydration, blood doping
leukopenia may be due to:
- bone marrow deficiency (due to chemo, infection, tumor)
- Collagen-vascular diseases (lupus)
- Disease of the liver or spleen
- Radiation therapy
- Neutropenia (low neutrophils WBC)
leukocytosis may be due to:
- anemia
- bone marrow tumors
- infectious diseases
- inflammatory diseases
- leukemia
- emotional stress
- tissue damage (burns)
normal platelets levels
Normal: 150-450 x 10³ cells/uL
150,000 to 450,000 platelets per microliter of blood
low platelets =
thrombocytopenia
– Increased risk of bleeding – Consider limiting activity
high platelets levels =
- *thromobocytosis**
- Increased risk of clotting
PLATELET PRECAUTIONS regarding resistance training
(Vary hospital to hospital, MD to MD)
- > 50,000 = ok for some resistance
- 20-30,000 = very light resistance (if any)
- < 20,000 = no resistance, +ADLs, walking, etc
- < 10,000 = likely to get transfusion, may hold PT; speak with medical team
📣
Partial thromboplastin time (PTT)/Activated PTT (aPTT) normal range:
25-39 sec
measures High Molecular Weight Heparin
via IV drip (fast acting)
when do clotting times should be measured?
whenever a patient is in anticoagulants medication
what does Factor Xa look at?
Low Molecular Weight Heparin
(usually no lab values)
Prothrombin time (PT) normal values
Normal: 12-16 sec
WARFARIN AKA Coumadin
International Normalized Ratio (INR)
- Method of standardizing prothrombin time results
- Normal range: 1.0-1.5
- if pt is being treated for anticoagulation (afib, DVT/PE, and/or valve replacement pts) 2-4 times normal
Normal blood values for hemoglobin, platelets, WBC, hematocrit
- hemoglobin: 12-16 g/dl
- platelets: 150-450 k/dl
- WBC: 3.4-11.2 k/ul
- hematocrit: 35-47%
Involved with managing cell membrane potential
Electrolytes
Sodium, potassium, BUN and Creatinine, serum glucose
normal sodium levels
135-147 mEq/L
normal potassium levels
3.5-5.0 mEq/L
normal BUN levels
8-23 mg/dL
normal creatinine levels
0.5-1.5 mg/dL
normal serum glucose
80-110mg/100 mL blood
sodium function
- Helps regulate H2O levels in the body
- Helps with nerve conduction
too high sodium =
caused by what?
(hypernatremia)
• Commonly caused by unreplaced water loss in the body (dehydration)
too low sodium =
hyponatremia
One of most common electrolyte disorders in US
potassium function
- Works with Na+
- Essential for normal cell function
- Involved in contraction of heart & other muscles of the body
- Helps with nerve conduction
to high potassium =
(hyperkalemia)
Decreases contractility of the heart
too low potassium =
hypokalemia
BUN function;
Too high?
Too low?
- forms when protein breaks down
- Can indicate Heart or Renal failure
- Too high: may be due to CHF, kidney disease/failure, GIB, hypovolemia, uremia, MI
- Too low: may be due to liver failure, starvation, malnutrition, low protein diet, high-carb diet
Creatinine function:
Too high?
- measures effectiveness of the kidneys
- Too high: may be due to renal failure, eclampsia/pre-eclampsia, dehydration, decreased kidney blood flow (due to shock, CHF), rhabdomyololysis, urinary tract obstruction
too low glucose levels:
hypoglycemia
- Below 70mg/dL = do NOT exercise
- Less than 100mg/dL = wait until glucose is at least 100 before initiating exercise
- headache, sweating, impaired vision, shaking, weakness/fatigue, fast heart beat, anxiety
- not enough fuel for the brain, may become drowsy, unconscious, potential death
- Eat additional carbohydrate
too high glucose levels
(hyperglycemia)
- Type 1 DM: > 250mg/dl → test urine ketones → if (+) avoid exercise.
- Type 2 DM: >300mg/dl → caution with exercise or no exercise.
- extreme thirst, dry skin, blurred vision, drowsiness, nausea, frequent urination, hunger
- chronically can kick kidneys into working harder, potential for dehydration, coma, death
Natriuretic peptide refers to a peptide which induces natriuresis, the discharge of
sodium through urine
Brain natriuretic peptide or B-type natriuretic peptide (BNP) is a polypeptide secreted by the ventricles of the heart in response to excessive stretching of heart muscle cells (cardiomyocytes)
Brain natriuretic peptide normal value
- *BNP 100-300 pg/mL** → Suggest heart failure is present
- *BNP >900 pg/mL** → Severe heart failure
BNP is secreted by the _______ of the heart in response to pressure changes that occur when heart failure develops or worsens
ventricles
- BNP Contribute to ___________
- __________ sodium and water excretion by kidneys
- Relax ___________
- vasodilation
- increases
- myocardium
Data obtained from catheterization:
- Cardiac Output
- Blockage of coronary arteries
- Heart pressures
- LVEF (Ejection Fraction)
- Muscle function
- Valve Function
indications for catheterization
- Cardiac Arrest or Ventricular Fibrillation
- Pulmonary Edema
- Intolerance of medical therapy for angina
- Exercise/Stress Test
Catheterization Procedure
- Catheter insertion into femoral artery
- Catheter is advanced via fluoroscopy
- Contrast dye is released into ventricles or coronary arteries
- Flow of dye is recorded
- 6 hrs of bed rest follow
Electrophysiology (EP) Studies are used to
- Diagnose Arrhythmias
- Evaluate efficacy of medical therapy
- Used to predict risk for sudden death and assess need for pacemakers and ICDs
- Similar Approach as Cardiac Catheterization
- Used as an ablation procedure (the surgical removal of body tissue)
Resting EKG detects
- Abnormal rate & rhythm
- Conduction abnormalities
- Hypertrophy of ventricles
- Myocardial ischemia
- Electrolyte & medication effects
Holter monitor
- 24 hr EKG monitoring
- Useful to diagnose and manage arrhythmias and symptoms
Single Lead EKG detects:
- Rate & rhythm
- Gross myocardial ischemia
- Conduction abnormalities
types of echocardiogram; which one is invasive?
- Transesophageal Echocardiogram (invasive, is used pre/post exercise)
- Transthoracic Echocardiogram
Echocardiography uses pulses of reflected ultrasound to:
- Assess heart’s function and structures
- Assess the patency of the coronary arteries
- Assess SV, CO, EF (at rest and during exercise)
Chest X-Ray may usefull to evaluate
- CHF
- Interstitial/perivascular/alveolar edema
Which diagnostic test is used to assess heart size, pulmonary edema, and pulmonary artery size?
Chest X-Ray
Which expensive and specialized diagnostic test can be used to diagnose heart problems (such as jeopardized myocardium) as well as metabolic functions AND show areas where there is poor blood flow to the heart
Positron Emission Tomography (PET)
Computed Tomography with contrast dye =
coronary CT angiography (CTA)
coronary CT angiography (CTA)
CT scan with contrast dye
MUGA scan
- Multigated Acquisition Imaging
- Shows how well heart is pumping w/each heartbeat
- May be done while resting or exercising or both
- Measures Left Ventricular Ejection Fraction
- Utilizes electrical activity of the heart via EKG
Cardiac MRI
- Creates still & moving pictures of heart & major blood vessels
- Get pictures of beating heart to look at structure & function
- Expensive
in which diagnostic testing a radiopharmaceutical is injected via IV at rest AND once exercising at desired level; assesses acute cardiac ischemia during exercise stress test
Thallium Cardiac Perfusion Testing (Thallium Stress Test)
Thallium Stress Test Scanned at rest and
immediately post exercise and 2-4 hours later
Good at predicting risk of recurrent MI and assesses acute cardiac ischemia during exercise stress test
Thallium Cardiac Perfusion Testing (Thallium Stress Test)
Thallium Stress Test
In order to collect the thallium, cells need to be both
perfused and metabolically intact
Thallium Stress Test
which areas have less thallium uptake?
Areas of decreased blood flow
Thallium Stress Test
Areas that are not perfused immediately post-exercise but re-perfuse after 2-3 hours =
ISCHEMIA
Thallium Stress Test
Those areas that remain not perfused after 2-3 hours =
INFARCT
Thallium Stress Test is used to assess:
- Cause of new chest pain
- Optimal treatment & effectiveness of treatment
- Cardiac function post MI
- Prior to initiating exercise program or having surgery—if at high risk for heart disease or complications
when a patient cannot achieve at least 85% of their predicted max HR or cannot tolerate upright exercise…
Pharmacologic Stress Testing: uses medications to increase the work of the heart
– Persantine
– Adenosine
– Dobutamine
2 main types of Cardiac Viability Testing (Nuclear Heart Scans)
– PET (Cardiac Positron Emission Tomography) clearer pictures
– SPECT (Single Photon Emission Computed Tomography)
which imaging diagnostic testing uses 2 sets of pictures: one right after stress test and the other later while the heart is at rest to assess damaged heart muscle, heart’s metabolism, and feasibility of revascularization interventions?
Cardiac Viability Testing (Nuclear Heart Scans)
Placed in blood vessel as entryway for other lines to be placed
sheath introducer
Cordis = brand of introducer
this type of catheterization is the passing of a thin tube (catheter) into the right side of the heart and the arteries leading to the lungs. It is done to monitor the heart’s function and blood flow. This test is most often done in persons who are very ill in the ICU
Swan Ganz Catheter
Swan Ganz Catheter
- Records/transmits data to the ICU monitor at the pt’s bedside regarding:
- PAP (Pulmonary Artery Pressure)
- PCWP (Pulmonary Capillary Web Pressure)
which type of catheter gives information about PAP (Pulmonary Artery Pressure) and PCWP (Pulmonary Capillary Web Pressure) as well as temperature and oximetry?
Swan Ganz Catheterization
Pulmonary Capillary Web Pressure gives you information about….
- Left atrial pressure
- via Swan Ganz Catheter
Indwelling catheter with a pressure transducer attached to the end of a catheter and commonly placed in the radial artery, but may be placed in other arteries (axillary, femoral)
ARTERIAL LINE
What does the arterial line measures?
- Measures arterial blood pressure
- Obtain ABGs
- Indirectly measures cardiac performance via blood pressure and blood gas information
- Cannot take manual blood pressures on the extremity
Catheter introduced in vein and advanced to the inferior or superior vena
cava or right atrium (May also be placed in femoral vein), and can be used for administration of drugs or parenteral nutrition and monitoring of post operative patients
Central venous pressure (CVP) Catheter
Central venous pressure (CVP) Catheter reflects…
right sided heart function
Central Venous Catheters is used to examine:
- Blood volume
- Vascular tone
- Venous return
Lines: PT Considerations
Additional Diagnostic Testing:
- Peripheral limb measurements
- ABI = ankle brachial index
- BMI = body mass index
