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Cardiovascular Dx Test
Diagnostic Tests
144
Nursing
Undergraduate 4
01/15/2013

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Term
Laboratory Tests
Definition
assist in diagnosing the cause of cardiac-related signs and symptoms; determines a baseline value before and after therapy; screens for modifiable CAD risk factors; ensures therapeutic level of medications; evaluates patient's response to therapeutic regimen; identifies abnormals that affect prognosis of a patient with CVD
Term
Cardiac Biomarker Analysis
Definition
Help with the diagnosis of myocardial infarction
Term
creatinine kinase (CK), CK isoenzymes (CK-MB), and proteins (myoglobin, troponin T and I)
Definition
specific enzymes released from myocardial cells that have become necrotic from prolonged trauma or ischemia;
these substances leak into interstitial spaces of myocardium and are carried into the lymphatic system into circulation

detected in a serum blood sample
Term
Cardiac biomarker analysis
Definition
CK, CK-MB, myoglobin, troponin T and troponin I are included in what test?
Term
Lipid profile (cholesterol, triglycerides, and lipoproteins)
Definition
evaluate risk of developing atherosclerotic disease or diagnose specific lipoprotein abnormality
Term
Lipoprotein
Definition
formed in combination of cholesterol and triglycerides with plasma proteins in the blood
Term
LDL: HDL
Definition
As this ratio increases, so does the risk for CAD
Term
<200mg/dL
Definition
What is a normal Cholesterol level?
Term
Lipids
Definition
required for hormone synthesis and cell membrane formation; found in brain and nerve tissue; synthesized in the liver
Term
Cholesterol levels
Definition
Age, gender, diet, exercise patterns, genetics, menopause, tobacco use, stress levels are contributors
Term
<160mg/dL
Definition
what is a normal LDL level?
Term
LDL
Definition
transport cholesterol and triglycerides into the cell;
one harmful effects is the deposition in walls of aterial vessels
Term
<70 mg/dL
Definition
Goal of LDL in patient with CAD or diabetes
Term
HDL
Definition
transport cholesterol away from tissue and cells of the aterial wall for liver excretion
Term
M 35-70mg/dL
F 35-85mg/dL
Definition
HDL normal levels
Term
smoking, diabetes, obesity, and physical inactivity
Definition
Factors that worsen HDL levels
Term
Increase HDL> 40mg/dL
Definition
pt w/ CAD/diabetes, secondary goal of lipid management is to increase HDL to?
Term
100-200mg/dL
Definition
Normal triglycerides
Term
Triglycerides
Definition
Stored in adipose tissue and are a source of energy

Increase after meals and are affected by stress

Diabetes, alcohol use, and obesity increase levels

In direct correlation with LDL and inverse to HDL
Term
BNP (brain natriuretic peptide)
Definition
neurohormone that helps regulate blood pressure and fluid volume
Term
BNP
Definition
level increases as ventricular walls expand from increased pressure
Term
BNP
Definition
helpful in the dx, monitoring, and prognostic tool in setting of HF

other causes of elevation may be caused by pulmonary embolism, MI, and ventricular hypertrophy
Term
>100pg/mL
Definition
level of BNP indicative of heart failure
Term
C-reactive protein
Definition
venous blood test that measure CRP levels
Term
C-reactive protein
Definition
protein produced by the liver in response to systemic inflammation (though to play a role in atherosclerosis)
Term
C-reactive protein
Definition
used as adjunct to other tests to predict CVD risk
Term
3.0 mg/dL
Definition
High level of C -reactive protein (greatest risk for CVD)
Term
1-3 mg/dL
Definition
Moderal level of c-reactive protein
Term
<1mg/dL
Definition
low level of c-reactive protein
Term
Homocysteine
Definition
linked to the development of atherosclerosis (can damage endothelial lining of arteries and promote thrombus formation)
Term
Homocysteine
Definition
decreased level is parallel with diet low in folic acid, vitamin B6 and B12

12-hr fast necessary before blood sample drawn
Term
<12umol/L
Definition
optimal homocysteine level
Term
12-15umol/L
Definition
borderline homocysteine level
Term
>15umol/L
Definition
high risk homocysteine level
Term
Sodium
Definition
decreased level can mean fluid excess caused by HF or thiazide diuretics
Term
135-145mEq/L
Definition
Sodium Range
Term
3.5-5.0 mEq/L
Definition
Potassium Range
Term
Potassium
Definition
Needed for cardiac electrophysiologic function

decreased level can lead to dysrhthmias

increased level can lead to heart block, asystole, and ventricular dysrhythmias
Term
8.6-10.2mg/dL
Definition
Calcium range
Term
Calcium
Definition
decreased level slows nodal function and impairs myocardial contractility which leads to increased risk of heart failure

increased level increases myocardial contractility which increases the risk for varying heart block degree and sudden death from ventricular fibrillation
Term
1.3-2.3mEq/L
Definition
Magnesium range
Term
Magnesium
Definition
decrease level predisposes patient to atrial and ventricular tachycardias

increase level depresses contractility and excitability of myocardium causing heart block, and if sever, asystole
Term
10-20mg/dL
Definition
BUN range
Term
BUN
Definition
increased level reflects reduced renal perfusion from decreased cardiac output, or are a result of diuretic therapy or dehydration
Term
0.7-1.4mg/dL
Definition
Creatinine range
Term
Creatinine
Definition
more sensitive measure than BUN

increased level with increased BUN is suggestive of renal impairment
normal level with increased BUN is suggestive of intravascular fluid volume deficit
Term
Fasting 60-110mg/dL
Definition
Glucose range (fasting)
Term
Glucose
Definition
increases in stressful situations
Term
4.4-6.4 %
Definition
Nondiabetic glycohemoglobin (hemoglobin A1C) range
Term
<7%
Definition
Diabetic Hemoglobin A1C level
Term
Hemoglobin A1C
Definition
reflects blood glucose over 2-3months
Term
60-70 seconds
Definition
PTT range
Term
20-39 seconds
Definition
aPTT range
Term
PTT
Definition
assesses effects of unfractured heparin; intrinsic pathway activity
Term
<50 seconds
Definition
Adjustment of heparin dose is required if aPTT =?
(dose needs to be increased)
Term
>100 seconds
Definition
Adjustment of heparin dose is required if aPTT= ?
(dose needs to be decreased)
Term
9.5-12 seconds
Definition
PT range
Term
PT
Definition
monitors coumadin; extrinsic pathway activity
Term
2-3.5
Definition
INR range
Term
INR
Definition
used with PT to monitor coumadin
Term
4,500 - 11,000/mm^3
Definition
WBC range in CBC
Term
M 42-52%
F 35-47%
Definition
Hct range in M and F
Term
M 13-18 g/dL
F 12-16 g/dL
Definition
Hgb in M and F range
Term
Hct and Hgb
Definition
decreased levels lead to an increased frequency of angina episodes or acute MI
Term
150,000-450,000/mm^3
Definition
Platelet range in CBC
Term
Chest x-ray
Definition
determines the size, contour, and position of the heart;
reveals cardiac and pericardial calcification;
demonstrates phyiologic alterations in pulmonary circulation;
not used for diagnosis of acute MI
Term
Fluoroscopy
Definition
x-ray image technique that allows visual of heart on a screen;
shows cardiac and vascular pulsations and unusual cardiac contours;
a moveable x-ray source
Term
Electrocardiography (ECG)
Definition
graphic presentation of electrical currents of the heart;
obtained by placing electrodes on the skin of the chest wal and extremities
Term
12-lead ECG
Definition
used to dx dysrhythmias, conduction abnormalities, chamber enlargement, and myocardial ischemia, injury, or infarction
Term
15-lead ECG
Definition
used in early dx of Right ventricular and left posterior infarction
Term
18-lead ECG
Definition
used in early detection of myocardial ischemia/injury
Term
Continuous ECG monitoring
Definition
used for patient at high risk for dysrhythmias

detects abnormalities in HR and rhythm
Term
Myocardial ischemia/ injury
Definition
Changes in ST segment in continuous ECG monitoring identify?
Term
Hardwire cardiac monitoring and telemetry
Definition
Name the 2 types of continuous cardiac monitoring
Term
Hardwire cardiac monitoring
Definition
continuous cardiac monitoring that continuously observes for dysrhythmias and conduction disorders with 1 or 2 leads, can monitor other hemodynamic parameters and respiratory parameters
Term
Telemetry
Definition
type of continuous cardiac monitoring that is wireless (battery changed every 24-48 h)

transmission of radiowaves from a monitor to central bank of monitors
Term
Lead system
Definition
dictates the number of electrodes needed in cardiac monitoring
Term
II
Definition
lead that gives best visual of atrial depolarization (P wave)
Term
V1
Definition
lead that gives best visual of ventricular depolarization (good when monitoring for dysrhythmias)
Term
Ambulatory ECG
Definition
utilizes a Holter monitor for 24h, in outpatient setting, to detect dysrhythmia or myocardial ischemia; patient keeps a diary with the time of symptoms or performance of any unusual activities
Term
Ambulatory ECG
Definition
used to find the etiology of symptoms and evaluate the effectiveness of cardiac medicines or pacemaker function
Term
Transtelephonic monitoring
Definition
method of ECG to evaluate patient at home; patient attaches specific lead system for transmiting signals and places telephone mouthpiece over transmitter box

ECG is recorded and evaluated at a remote location

good for diagnosing dysrhythmias and evaluating pacemaker function
Term
Wireless mobile cardiac monitoring systems
Definition
allows health care professionals to monitor and transmit ECG of patient who is outside the hospital or office

lightweight and monitors 24/7

enhances detection and early treatment of dysrhythmias
Term
RA, LA, LL
Definition
3 Lead placement
Term
RA, LA, RL, LL
Definition
4 lead placement
Term
RA, LA, RL, LL, V1 (below sternum (brown))
Definition
5 lead placement
Term
Athersclerosis
Definition
when the coronary arteries dilate less, compromising blood flow to the myocardium and causing ischemia
Term
Cardiac Stress Testing
Definition
Helps determine:
1. presence of CAD
2. cause of chest pain
3. functional capacity of the heart after MI or heart surgery
4. effectiveness of antianginal or antiarrhythmic meds
5. dysrhythmias that occur during physical exercise
6. specific goals for a physical fitness program
Term
Cardiac Stress Testing
Definition
not an indicator of severe aortic stenosis, acute myocarditis/ pericarditis, severe hypertension, suspected Left main CAD, HF, and unstable angina
Term
Exercise stress test
Definition
includes the patient walking on treadmill, pedalling stationary bike, or using an arm crank
goal is to increase HR to target HR (80-90% maximum HR)
ECG, BP, skin temperature appearance, perceived exertion, and symptoms of chest pain, dyspnea, dizziness, leg cramping and fatigue are monitored
Term
Exercise stress test
Definition
test is terminated when the maximum target heart rate is achieved or the patient experiences chest pain, extreme fatigue, decreased BP/pulse, serious dysrhythmia or ST-segment change
Term
ECG abnormals occur and further testing will be needed
Definition
Exercise stress test is positive when?
Term
Nursing Interventions for an Exercise Stress Test
Definition
-Pt fasts 4 hours prior and must avoid stimulants during that time

-medicines may be taken with sips of water

-clothes and rubber-soled shoes, suitable for exercise, must be worn

-Decribe to the pt how the test is performed, type of monitoring equipment is used, rational for having and IV, and what symptoms they need to report

-after the test the pt is monitored for 10-15 min

-once stable the pt can resume normal activities
Term
Pharmacologic stress testing
Definition
disabled pt may be unable to exercise, so 2 vasodilating agents dipyridamole (Persantine) and adenosine (Adenocard) are administered IV, used to mimic exercise effects by maximizing dialting coronary arteries
Term
dipyridamole (Persantine) and adenosine (Adenocard)
Definition
what two vasodilating agents are administered IV, used to mimic exercise effects by maximizing dialting coronary arteries
Term
Persantine
Definition
last 15-30m; vasodilating agent; side effects include chest discomfort, dizziness, headache, flushing, and nausea
Term
Adenosine
Definition
lasts <10 seconds; vasodilating agent; side effect subside rapidly
Term
Theophylline and other xanthines (caffiene)
Definition
must be avoided because they block the effects of dipyridamole and adenosine
Term
Dobutamine
Definition
may also be used to increase HR, myocardial contractility and BP
agent of choice w/ ECG because of its effects on the myocardial wall
also used if patient can't have theophylline with held
Term
Nursing Interventions for a pharmacologic stress testing
Definition
-patient can't eat/drink at least 4h before the test, caffiene containing meds (anacin and darvon) can't be used either

-pt must stop taking theophyllines or dipyridamole 24-48h before the test (if tolerated)

-inform pt of transient sensations during agent infusion that will disappear quickly

-instruct pt to report any other symptoms, during the test, to the cardiologist/ nurse

-inform patient the test will take an 1h and up to 3 if imaging is performed
Term
Echocardiography
Definition
measures ejection fraction

able to view size, shape, and motion of heart with a noninvasive ultrasound
Term
Two dimensional or cross-sectional echocardiography
Definition
provides a spatially correct image of the heart
Term
Nursing interventions of echocardiography
Definition
-inform patient about test

-test will take 30-45 minutes

-if stress test is included, that information is discussed
Term
Transesophageal echocardiography
Definition
performed by threading transducer thru the mouth into the esophagus to produce a clearer image due to ultrasound waves passing through less tissue
Term
Transesophageal echocardiography
Definition
-topical anesthetic and moderate sedation is utilized

-diagnostic tool for evaluating CVD

-may cause complications (impaired swallowing, respiratory depression, aspiration, gag/ esophageal perforation)
Term
Nursing Interventions of transesophageal echocardiography
Definition
-assess patient for history of dysphagia/ radiation to chest which will increase the risk of complications

-provide education on the procedure

-pt must not eat/drink 6h before the study

-make sure informed consent has been signed

-ensure IV patency

-Monitor LOC, BP, ECG, respirations, and O2 sat
Term
Elevate the bed 45 degrees

Monitor for dyspnea

assess vitals, LOC, O2 sat, and gag reflex
Definition
During recovery after transesophageal echocardiography elevate what should the nurse do?
Term
Radionuclide Imaging
Definition
use of radioisotope for noninvasive evaluation of coronary artery perfusion that can lead to myocardial ischemia and infarction

also assesses for Left ventricular function
Term
Planar Imaging
Definition
use of radioisotope thallium to produce a 1 dimensional view of the heart from 3 locations
Term
Single photon emission computed tomography (SPECT)
Definition
produces 3D images of the heart

patient must lie supine w/ arms above head and the camera moves around the chest in a 180-360 degree arc
Term
Myocardial pefusion imaging
Definition
uses the radioisotop TI201 to assess myocardial perfusion
Term
Nursing interventions for radionuclide imaging
Definition
prepare patient for stressor (drug/exercise) and imaging, reassure that the tracers are safe

Warn the patient in SPECT that arms will be over the head for 20-30 minutes
Term
thallium w/ planar imaging can be used
Definition
if the patient is unable to hold arms over head for 20-30m for SPECT, what can be done?
Term
Equlibrium radionuclide angiocardiography (ERNA)/ multi-gated aquisition (MUGA)
Definition
used to test ventricular function and wall motion;

noninvasive procedure that records images of the heart during several hundred beats

patient must remain motionless
Term
Computed tomography, CAT, EBCT
Definition
x-ray for cross-sectional imaging of the chest to diagnose masses and aorta/pericardium diseases
Term
EBCT "ultrafast CT"
Definition
x-ray scanning techniques used to evaluate bypass graft patency, congenital heart lesions, L and R ventricular muscle mass, chamber volumes, cardiac output, and ejection fraction

from this scan a calcium score is derived that predicts the likelihood of cardiac events
Term
Nursing interventions for computed tomography
Definition
-inform patient that they must lie perfectly still, it is a non-invasive, painless procedure

-educate patient on procedure

-inform that IV will be needed for contrast infusion
Term
Positron Emission Tomography (PET)
Definition
noninvasive scan to study neurologic dysfunction and cardiac dysfunction

-helps to plan patient's treamtent

-evaluates patiency of grafted vessel and the collateral circulation
Term
Positron Emission tomography (PET)
Definition
2 Compounds are used during this
one to determine blood flow in the myocardium and the other determines the metabolic function
Term
PET
Definition
provides 3D images of distributed compounds
Term
Viability of myocardium
Definition
determined by the degree of blood flow vs the glucose metabolism in the myocardium
(ischemic= decreased blood flow, increased metabolism)
Term
PET
Definition
glucose must be WNL before this test can be performed
Term
Nursing interventions for PET
Definition
-instruct patient that they must refrain from stimulant use for four hours prior to the test
Term
Magnetic Resonance Angiography (MRA)
Definition
noninvasive, painless technique that is used to examine both the physiologic and anatomic properties of the heart;

valuable in diagnosing disease of the aorta, heart muscle, and pericardium

images are distorted by respiration, beating heart, and certain implanted devices
Term
Nursing Interventions for MRA
Definition
-screen for contraindications (presence of pacemaker, metal plate, prosthetic joint/ other metalic implant)

-patient must remove jewelry, trandermal patch

-instruct patient that is will lie supine in an enclosed imager/ tube

-patient may be given a mild sedative if they are claustrophobic

-pt must remain motionless
Term
Cardiac Catheterization
Definition
invasive diagnostic prcedure in which radiopaque arterial and venous catheters are introduced into selected blood vessels of the right and left sides of the heart
Term
Cardiac Catheterization
Definition
procedure guided by fluoroscopy

diagnostic tool for CAD, coronary artery patency, extent of atherosclerosis, and to see if PCI or coronary artery bypass surgery may benefit the patient
Term
Cardiac Catheterization
Definition
patient has one or more IV lines in place for sedative administration

-BP and ECG must be monitored

-Resuscitation equipment must be available

-Iodine allergy must be assessed (if present, antihistamine/ methylprednisolone is administered)

BUN, creatinine, INR, PT, aPTT, Hct, Hgb, platelets, and electrolytes must be collected prior to the test
Term
Contrast agent induced nephropathy
Definition
Defined as creatinine baseline above 25% or more within 2 days of the procedure and will require temporary dialysis
Term
Prevent contrast agent induced nephropathy
Definition
pre and post procedure IV infusion hydration of saline, sodium bicarbonate, and antioxidant acetylcysteine (Mucomyst)
Term
Angiography
Definition
contrast agent is injected into the vascular system to outline the heart and blood vessels; regularly used with cardiac catheterization

-makes use of cineangiograms to record the passeage of contrast thru vascular site(s)
Term
Selective angiography
Definition
angiography in which a specific heart chamber or blood veseel is singled out for study
Term
Aortography
Definition
outlines the lumen of the aorta and major arteries arising from it

introduced thru the translumbar, or retrograde brachial/ femoral artery approach
Term
Coronary Arteriography
Definition
introduction of a catheter into the right or left brachial or femoral artery, which is then passed into the ascending aorta and manipulated into the right and left coronary arteries

used to evaluate the degree of atherosclerosis and to determine treatment

also used to study congenital anomalies of the coronary arteries
Term
Right heart catheterization
Definition
usually precedes left heart catheterization; involves the passage of the catheter from the antecubital or femoral vein into the right atrium, right ventricle, pulmonary artery, and pulmonary arterioles (pressures and oxygen saturation levels from each of these areas are obtained and recorded)

complications may include cardiac dysrhythmias, venous spasm, infection of insertion site, cardiac perforation, and rarely cardiac arrest
Term
Left heart catheterization
Definition
performed to evaluate the patency of the coronary arteries and the function of the left ventricle and the mitral and aortic valves

complications may include dysrhythmias, MI, perforation of the heart/great vessels, and systemic embolization

catheter is inserted into the right brachial artery or a femoral artery and advances it into the aorta and left ventricle
Term
Nursing Interventions for Heart Catheterization
Definition
-pt must fast 8-12h before the procedure; someone must be available to take the patient home

-expected duration is less than 2 hours of lying on a hard table

Iv meds are given to maintain comfort

-inform patient of sensations the patient may experience during catheterizations (occasional palpitation) which can be relieved by cough and deep breathing, and flushed feeling
Term
Nursing responsibilities for heart catheterization
Definition
-observe catheter site for bleeding or hematoma formation
-assess peripheral pulses q15m for 1h and q1-2h until pulses are stable
-assess temperature, color, and capillary refill of affected extremity
-assess pt for pain, numbness, and tingling of affected extrimity
-carefully screen for dysrhythmias with cardiac monitoring or assess apical and peripheral pulses for changes in rate and rhythm
-bed rest must be maintained 2-6h after the procedure
-instruct the pt to report chect pain and bleeding/ discomfort
-monitor the patient for contrast agent induced nephropathy w/ increase in creatinine
-ensure pt's safety
Term
Pt education after catheterization (post discharge)
Definition
-don't bend at the waist, strain, or lift heavy objects for the next 24h
-talk w/ MD about returning to normal activities, options if test showed CAD, lifestyle changes, and medications
-take medications as prescribed
Term
Electrophysiologic Testing (EPS)
Definition
dx serious dysrhythmias (atrial and ventricular tachycardia)
Term
Hemodynamic Monitoring
Definition
continuous
includes CVP, pulmonary artery pressure, intra-arterial BP monitoring
contains: flush system, tubing, stopcocks, flush device, pressure bag, transducer, amplifier/ monitor
Term
CVP
Definition
measures pressure in the vena cava/ right atrium and preload (2-6)
may be place in femoral, antecubital, or external jugular
chest x-ray confirms placement
may be used for IV fluids, meds, and to draw blood
Term
PA pressure
Definition
monitors left ventricle function and dx shock

fluoroscopy used to confirm placement
Term
Intra-arterial blood pressure monitoring
Definition
direct and continuous BP monitoring in critically ill patient w/ hypertension or hypotension

-arterial blood gas and blood samples
-allen test performed if placed in radial artery/ ultrasonic doppler study (more accurate)
<6 seconds for blood return
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