DIAGNOSTIC TESTING AND PROCEDURES Flashcards
1
Q
Serum Enzymes to Determine if someone had a myocardial infarction
(*Specific in the event of myocardial necrosis/injury )
A
- Troponin: “Gold Standard: Normal levels: 0.02-0.04
-
Creatine-Kinase MB: Normal levels: 0-3%, so >3% is considered abnormal
*
2
Q
ideal LDL cholesterol
A
less than 100 mg
>130 high
3
Q
ideal total cholesterol
A
less than 200
>240 high
4
Q
ideal HDL cholesterol
A
more than 60
<40 in men, <50 in woman is low
5
Q
hemoglobin normal value
A
12-16 g/100ml
6
Q
what is hematocrit?
A
the percentage of red blood cells (RBC’s) in the blood
7
Q
hematocrit normal value
A
Normal value: 36-44 g/100ml
(36-44%)
8
Q
white blood cells normal value
A
4-12
9
Q
true or false: low hemoglobin can be associated with many diseases and conditions that cause the body to have too few red blood cells
A
true (leukemia, GI bleed, injury…)
10
Q
If your hemoglobin level is lower than normal, you have
A
anemia
11
Q
Leukocytosis
A
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.
12
Q
Leukopenia
A
a reduction in the number of white cells in the blood, typical of various diseases.
13
Q
Low Hematocrit =
may be due to:
A
anemia
- Loss of blood (traumatic injury, surgery, bleeding, and colon Ca)
- Nutritional deficiency
- Bone marrow problems
- Sickle cell anemia
- And more…
14
Q
High Hematocrit may be attributed to
A
high altitudes, chronic smokers, dehydration, blood doping
15
Q
leukopenia may be due to:
A
- bone marrow deficiency (due to chemo, infection, tumor)
- Collagen-vascular diseases (lupus)
- Disease of the liver or spleen
- Radiation therapy
- Neutropenia (low neutrophils WBC)
16
Q
leukocytosis may be due to:
A
- anemia
- bone marrow tumors
- infectious diseases
- inflammatory diseases
- leukemia
- emotional stress
- tissue damage (burns)
17
Q
normal platelets levels
A
Normal: 150-450 x 10³ cells/uL
150,000 to 450,000 platelets per microliter of blood
18
Q
low platelets =
A
thrombocytopenia
– Increased risk of bleeding – Consider limiting activity
19
Q
high platelets levels =
A
- *thromobocytosis**
- Increased risk of clotting
20
Q
PLATELET PRECAUTIONS regarding resistance training
(Vary hospital to hospital, MD to MD)
A
- > 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
21
Q
📣
Partial thromboplastin time (PTT)/Activated PTT (aPTT) normal range:
A
25-39 sec
measures High Molecular Weight Heparin
via IV drip (fast acting)
22
Q
when do clotting times should be measured?
A
whenever a patient is in anticoagulants medication
23
Q
what does Factor Xa look at?
A
Low Molecular Weight Heparin
(usually no lab values)
24
Q
Prothrombin time (PT) normal values
A
Normal: 12-16 sec
WARFARIN AKA Coumadin
25
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**
26
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%
27
Involved with managing cell membrane potential
Electrolytes
Sodium, potassium, BUN and Creatinine, serum glucose
28
normal sodium levels
135-147 mEq/L
29
normal potassium levels
3.5-5.0 mEq/L
30
normal BUN levels
8-23 mg/dL
31
normal creatinine levels
0.5-1.5 mg/dL
32
normal serum glucose
80-110mg/100 mL blood
33
**sodium** function
* Helps regulate H2O levels in the body
* Helps with nerve conduction
34
too high sodium =
caused by what?
(hypernatremia)
• Commonly caused by unreplaced water loss in the body (dehydration)
35
too low sodium =
hyponatremia
One of most common electrolyte disorders in US
36
potassium function
* Works with Na+
* Essential for normal cell function
* Involved in contraction of heart & other muscles of the body
* Helps with nerve conduction
37
to high **potassium** =
(hyperkalemia)
Decreases contractility of the heart
38
too low **potassium** =
hypokalemia
39
**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
40
**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
41
too low glucose levels:
## Footnote
**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
42
too high **glucose levels**
## Footnote
**(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
43
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)
44
**Brain natriuretic peptide** normal value
* *BNP 100-300 pg/mL** → Suggest heart failure is present
* *BNP \>900 pg/mL** → Severe heart failure
45
BNP is secreted by the _______ of the heart in response to pressure changes that occur when heart failure develops or worsens
ventricles
46
* BNP Contribute to \_\_\_\_\_\_\_\_\_\_\_
* __________ sodium and water excretion by kidneys
* Relax \_\_\_\_\_\_\_\_\_\_\_
* vasodilation
* increases
* myocardium
47
Data obtained from catheterization:
* Cardiac Output
* Blockage of coronary arteries
* Heart pressures
* LVEF (Ejection Fraction)
* Muscle function
* Valve Function
48
indications for catheterization
* Cardiac Arrest or Ventricular Fibrillation
* Pulmonary Edema
* Intolerance of medical therapy for angina
* + Exercise/Stress Test
49
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
50
**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)
51
Resting EKG detects
* Abnormal rate & rhythm
* Conduction abnormalities
* Hypertrophy of ventricles
* Myocardial ischemia
* Electrolyte & medication effects
52
Holter monitor
* 24 hr EKG monitoring
* Useful to diagnose and manage arrhythmias and symptoms
53
Single Lead EKG detects:
* Rate & rhythm
* Gross myocardial ischemia
* Conduction abnormalities
54
types of echocardiogram; which one is invasive?
* Transesophageal Echocardiogram (invasive, is used pre/post exercise)
* Transthoracic Echocardiogram
55
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)
56
Chest X-Ray may usefull to evaluate
* CHF
* Interstitial/perivascular/alveolar edema
57
Which diagnostic test is used to assess **heart size,** **pulmonary edema,** and **pulmonary artery size?**
Chest X-Ray
58
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)**
59
Computed Tomography with contrast dye =
coronary CT angiography (CTA)
60
coronary CT angiography (CTA)
CT scan with contrast dye
61
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**
62
Cardiac MRI
* Creates still & moving pictures of heart & major blood vessels
* Get pictures of beating heart to look at structure & function
* Expensive
63
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)
64
Thallium Stress Test Scanned at rest and
**immediately post exercise** and **2-4 hours later**
65
Good at predicting risk of recurrent MI and assesses acute cardiac ischemia during exercise stress test
Thallium Cardiac Perfusion Testing (Thallium Stress Test)
66
# Thallium Stress Test
In order to collect the thallium, cells need to be both
**perfused and metabolically intact**
67
# Thallium Stress Test
which areas have less thallium uptake?
Areas of decreased blood flow
68
# Thallium Stress Test
Areas that are not perfused immediately post-exercise but re-perfuse after 2-3 hours =
**ISCHEMIA**
69
# Thallium Stress Test
Those areas that remain not perfused after 2-3 hours =
**INFARCT**
70
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
71
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
72
2 main types of Cardiac Viability Testing (Nuclear Heart Scans)
– PET (Cardiac Positron Emission Tomography) clearer pictures
– SPECT (Single Photon Emission Computed Tomography)
73
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)
74
Placed in blood vessel as **entryway** for other lines to be placed
**sheath introducer**
Cordis = brand of introducer
75
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
76
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)
77
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
78
Pulmonary Capillary Web Pressure gives you information about....
* Left atrial pressure
* via Swan Ganz Catheter
79
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**
80
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
81
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
82
Central venous pressure (CVP) Catheter reflects...
right sided heart function
83
**Central Venous Catheters** is used to examine:
* Blood volume
* Vascular tone
* Venous return
84
Lines: PT Considerations
85
Additional Diagnostic Testing:
* Peripheral limb measurements
* ABI = ankle brachial index
* BMI = body mass index
