Weekend 2 lecture 4 Flashcards

1
Q

Clinical Labs

A
  • Serum enzymes
  • Blood Lipids
  • Complete Blood Count
  • Coagulation Profiles
  • Electrolyte levels
  • BUN/Creatinine levels
  • Blood glucose
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2
Q

Serum Enzymes

A

Serum Enzymes

•Troponin

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3
Q

Troponin whatbisbit a good indicator of?

A

Troponin
•Highly specific for MI
•Can be detected in the blood within 3 hours of MI associated chest pain
•Two isoenzymes: Troponin T & Troponin I
•Peaks at about 24 hours

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4
Q

Creatine Kinase-Myocardial Bands what time does it peak and what time does it normalize

Whatbpercent is usually a good indicator of MI what level

A
  • It is common to calculate the ratio of CK-MB/Total CK. It is generally >2.5% if an MI has occurred
  • Serum CK starts to rise at 4-8 hours following an MI and peaks at about 24 hours
  • CK-MB normalizes by 48-72 hours
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5
Q

Isoforms of CK-MB

A

•CK-MB1 & CK-MB2 can also be used as markers
–CK-MB2 is released from infarcted myocardial tissues and is enzymatically converted in the circulation to CK-MB1
–This occurs within just a few hours, an elevated ratio of CK-MB2/CK-MB1 can be a very sensitive marker for MI

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6
Q

Lactate Dehydrogenase what time would you look at this compared to the ck levels

A
  • Serum levels of LDH peak at about 3-5days
  • Important marker for those persons who present to hospital/MD with several days of symptoms. If MI occurred 3 days ago the CK-MB would have normalized; therefore, LDH would be the marker you need to examine
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7
Q

Blood Lipids

A

•AHA cholesterol recommendations
–Total Cholesterol < 200mg/dl
–LDL < 130 mg/dl if no known heart disease
–LDL < 100 mg/dl if there is known heart disease
–HDL > 35 mg/dl

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8
Q

Ratio of Total Cholesterol/HDL
Men 3.43 4.9 what’s the rest

Women is 3.27
4.44 what’s the rest can remember just general like 3-11 might be eaiser

A
•Men
–3.43    =    ½  average risk for CAD
–4.97    =    Average risk
–9.55    =    2x average risk for CAD
–23.39    =    3x average risk for CAD
•Women
–3.27    =    ½ average risk for CAD
–4.44    =    Average risk for CAD
–7.05    =    2x average risk for CAD
–11.04    =    3x average risk for CAD
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9
Q

Elevated triglyceride levels

What’s a dangerous level to be above

A
  • 150mg/dl is defined as elevated triglyceride levels
  • Associated with increased CHO ingestion
  • May be a precursor to DM
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10
Q

Complete Blood Count
What stuff do they look at and what levels of Hgb good for men and women

What about hematocrit ?

What about wBC

Platelets

A
•Hemoglobin
–Men:        13-16g/dl
–Women:        12-14g/dl
•Hematocrit
–Men:        40-54%
–Women:        37-47%
•White Blood Cells
•RBCs
•Platelets
•WBC:        5000-10,000
•Platelets:    1.5-4.5 x 100,000
•RBCs:        
–Men:        4.8-6.0 x 1O6
–Women:    4.1-5.1 x 106

Please note that all reference ranges given may differ slightly from institution to institution

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11
Q

Coagulation Profiles
What’s reference range think pro

When do you look for prothrombin if they are on what meds?

When do you look for partial thromboplastin
If they are on what meds?

A

•PT (Prothrombin time)
–Reference range: 11.8-15.0 sec
–Look at this number if patient is being anticoagulated on coumadin or warfarin
–1.5-2x reference range is generally therapeutic for DVT/PE

•PTT (Partial thromboplastin time)
–Reference range: 21.7-34.0 sec
–Look at this number if patient is being anticoagulated on heparin. Generally you would like to see the number 1.5-2x the reference range to see that the patient is therapeutically anticoagulated

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12
Q

•International Normalized Ratio (INR)

What is this the purpose of this

A

•International Normalized Ratio (INR)
–Utilized so that anticoagulation levels can be compared across institutions. Uses a standardized solution, and thereby gives you the normality of the solution measured
•Eg: INR of 1 = a 1 normal solution

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13
Q

Electrolyte Levels what two are the high ones

A
  • Sodium: 135-145
  • Potassium: 3.5-5.0
  • Chloride: 96-108
  • Magnesium: 1.5-2.5
  • Phosphorus: 2.4-4.7
  • Calcium: 8.5-11
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14
Q

BUN/Creatinine what is this used to measure

whats the normal range for creainine

whats the range for blood urea

A
Measure of Kidney function.  
Elevated levels may also indicate worsening heart failure
Blood urea nitrogen (BUN)
Normal range:	10-30
Creatinine
Women:	.6-1.4
Men:		.6-1.6
Ratio of BUN/Cr >15.5 is considered abnormal
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15
Q

Blood Glucose

what happens if the person is above 300

what is the normal range

what happens if they are above 400

A

Normal reference range
60-120
Blood glucose level > 300 should contraindicate exercise
Blood glucose level > 400 the patient is at risk for ketoacidosis

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16
Q

Cardiac Radiography (CXR) what is the x - ray inversely proptional to ?

A

Recall that penetration of x-rays through the body is inversely proportional to the tissue density
For a boundary to show between two tissues they must differ in density
Views
PA
Laterals

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17
Q

P-A xray view which view gives you better angulation of the clavicles P-A or A-P ???

A

Xrays are transmitted from behind the patient to a film placed against the chest on the anterior side
PA view there is a greater angulation of the clavicles
AP less of an angulation of the clavicles

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18
Q

Cardiac Silhouette How much of the chest space should the heart occupy??? How about a kid and when do you get misreads cause of what conditions???

A

The heart shadow should occupy 50% or less of the maximal width of the thorax as measured between inner margins of the ribs
In children normal cardiac shadow may occupy 60% of the maximal width of the thorax
Situations in which the cardiac shadow inaccurately reflects heart size: elevated diaphragm, narrow PA diameter of chest

19
Q

Echocardiography what is this

A

Use of ultrasonic waves generated by a piezoelectric transducer which travel through the body tissues and are reflected and displayed through the sonography equipment
Non invasive procedure

20
Q

Three Types of Echocardiographic Studies

A

M mode
One narrow ultrasonic beam
2-D mode
Multiple ultrasonic beams through a wide arc
Doppler ultrasonography
Evaluates blood flow direction, turbulence, and velocity, and allows for estimates of pressure gradients

20
Q

Three Types of Echocardiographic Studies

A

M mode
One narrow ultrasonic beam
2-D mode
Multiple ultrasonic beams through a wide arc
Doppler ultrasonography
Evaluates blood flow direction, turbulence, and velocity, and allows for estimates of pressure gradients

21
Q

TTE M Mode this is a type of “M mode” what is it used for????

A

Used for measurement of wall thickness & chamber diameters

21
Q

TTE M Mode this is a type of “M mode” what is it used for????

A

Used for measurement of wall thickness & chamber diameters

22
Q

TEE 2-D Mode this the “2-D mode” what is its purpose

A
Delineates part of a given cardiac structure, optimal evaluation of the entire heart is performed by combining multiple views.
Views
Parasternal long axis
Parasternal short axis
Apical views: 4chamber & 2 chamber
22
TEE 2-D Mode this the "2-D mode" what is its purpose
``` Delineates part of a given cardiac structure, optimal evaluation of the entire heart is performed by combining multiple views. Views Parasternal long axis Parasternal short axis Apical views: 4chamber & 2 chamber ```
23
TEE Doppler mode what is the "doppler mode" good for???
Color flow mapping converts the doppler signal to a scale of colors that represent direction, velocity, and turbulence The colors are superimposed on the 2-D echo images
23
TEE Doppler mode what is the "doppler mode" good for???
Color flow mapping converts the doppler signal to a scale of colors that represent direction, velocity, and turbulence The colors are superimposed on the 2-D echo images
24
What is the pressure of the following RA,RV, PA, PV, LA, LV, Aorta
``` Pressure measurements RA pressure: 0-8 RV pressure: 15-30/0-8 PA pressure: 15-30/4-12 Lungs: PCW 1-10 LA pressure: 1-10 LV pressure: 100-140/3-12 Aorta pressure: 100-140/60-90 ```
25
Measurement of Blood Flow (Fick equation)
Fick method is based on the fact that oxygen consumption is equal to the arterial-venous oxygen difference multiplied by the flow. In other words: VO2 = a-vO2 diff x CO, thus Cardiac output can be determined by: VO2/a-vO2diff = CO Example of Equation: Arterial blood contains 240ml O2/L Venous blood contains 180ml O2/L Measured oxygen consumption =260ml/min CO = 260ml O2/min / 240 –180 ml O2/L The CO = 4.33 L/min
26
Pulmonary Vascular Resistance equation think Left artrium and mean pulmonary artery pressure CO = caridac output
``` PVR = (MPAP –LAP/CO) x 80 MPAP = mean pulmonary artery pressure LAP = mean left atrial pressure CO = cardiac output ```
27
How to determine systemic vascular resistance
SVR = (MAP – RAP/ CO) x 80 ``` SVR = systemic vascular resistance MAP = mean arterial pressure RAP = mean right atrial pressure CO = cardiac output ```
28
Contrast Angiography whats this used for????
Uses radiopaque contrast material to visualize regions of the cardiovascular system. Left ventriculograms Coronary artery angiograms
29
Nuclear imaging this is the one with a tracer and a camera on it where contrast is more used with a dye to see the organs with an xray or MRI
Heart Function can be evaluated using injected radioactive tracers and gamma camera detectors Used to assess Myocardial perfusion Image blood passing through the heart and great vessels Localize and quantify myocardial ischemia Assess myocardial metabolism
30
Radioisotopes used:
Thallium-201 | Sestamibi
31
Blood Pool Imaging
Used to analyze right and left ventricular contractile function Provides information on ejection fraction
32
Exercise Tolerance Testing what types are there??? What is this used
Many protocols for exercise progression Bruce, modified Bruce, McNaughton, Story Measure HR, BP, EKG tracings are continuous, and symptoms May choose from multiple exercise modalities May be pharmacologically induced May be used in conjunction with echo or nuclear imaging
33
Computed Tomography
Uses x-rays to produce a planar image of the heart. Particularly useful for assessing pericardial disease and aortic disease May use serial images for management of aortic dissection and aortic aneurysm
34
MRI what is this good for???
useful when soft tissues need examining
35
Holter Monitoring what is this and what is it used for???
A 24 hour electrocardiogram monitoring of the patient. | Used when patient is experiencing symptoms which could potentially be caused by arrythmias
36
Exercise Tolerance Testing what types are there???
Many protocols for exercise progression Bruce, modified Bruce, McNaughton, Story Measure HR, BP, EKG tracings are continuous, and symptoms May choose from multiple exercise modalities May be pharmacologically induced May be used in conjunction with echo or nuclear imaging
37
Blood Coagulation Tests
Prothrombin Time (PT) International Normalized Ratio (INR) Activated Partial Thromoplastin Time (APTT, PTT)
38
Activated Partial Thromboplastin Time (APPT, PTT) what is this about???
Used to screen for bleeding disorders ad measure effectiveness of Heparin therapy Reference range: 21.7-34.0 sec Therapeutic Range: 1.5-2x the reference range APTT > 100 seconds corresponds with spontaneous bleeding. MD should be notified prior to therapy
39
What can high and low levels of Potassium and Sodium cause????
Sodium (Na+) Low levels: Brain cell swelling High levels: Increased risk for intracranial hemorrhage Both high and low levels can cause a decrease in mental status Potassium (K+) Levels 5.0 are contraindications for exercise due to risk for life threatening cardiac dysrhythmias
40
What can high leveles of CO2, BUN, and Creatinine be an indication of???
Carbon Dioxide (CO2) Low levels may alter mental status Blood Urea Nitrogen (BUN) Patients with renal failure (high BUN) may be anemic limiting exercise tolerance Creatinine (Cr) Patients with renal failure (high Cr) may be anemic limiting exercise tolerance