Term
|
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 |
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Term
| Cardiac Biomarker Analysis |
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Definition
| Help with the diagnosis of myocardial infarction |
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Term
| creatinine kinase (CK), CK isoenzymes (CK-MB), and proteins (myoglobin, troponin T and I) |
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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 |
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Term
| Cardiac biomarker analysis |
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Definition
| CK, CK-MB, myoglobin, troponin T and troponin I are included in what test? |
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Term
| Lipid profile (cholesterol, triglycerides, and lipoproteins) |
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Definition
| evaluate risk of developing atherosclerotic disease or diagnose specific lipoprotein abnormality |
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Term
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Definition
| formed in combination of cholesterol and triglycerides with plasma proteins in the blood |
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Term
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Definition
| As this ratio increases, so does the risk for CAD |
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Term
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Definition
| What is a normal Cholesterol level? |
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Term
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Definition
| required for hormone synthesis and cell membrane formation; found in brain and nerve tissue; synthesized in the liver |
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Term
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Definition
| Age, gender, diet, exercise patterns, genetics, menopause, tobacco use, stress levels are contributors |
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Term
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Definition
| what is a normal LDL level? |
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Term
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Definition
transport cholesterol and triglycerides into the cell;
one harmful effects is the deposition in walls of aterial vessels |
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Term
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Definition
| Goal of LDL in patient with CAD or diabetes |
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Term
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Definition
| transport cholesterol away from tissue and cells of the aterial wall for liver excretion |
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Term
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Definition
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Term
| smoking, diabetes, obesity, and physical inactivity |
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Definition
| Factors that worsen HDL levels |
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Term
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Definition
| pt w/ CAD/diabetes, secondary goal of lipid management is to increase HDL to? |
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Term
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Definition
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Term
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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 |
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Term
| BNP (brain natriuretic peptide) |
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Definition
| neurohormone that helps regulate blood pressure and fluid volume |
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Term
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Definition
| level increases as ventricular walls expand from increased pressure |
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Term
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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 |
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Term
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Definition
| level of BNP indicative of heart failure |
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Term
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Definition
| venous blood test that measure CRP levels |
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Term
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Definition
| protein produced by the liver in response to systemic inflammation (though to play a role in atherosclerosis) |
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Term
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Definition
| used as adjunct to other tests to predict CVD risk |
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Term
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Definition
| High level of C -reactive protein (greatest risk for CVD) |
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Term
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Definition
| Moderal level of c-reactive protein |
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Term
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Definition
| low level of c-reactive protein |
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Term
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Definition
| linked to the development of atherosclerosis (can damage endothelial lining of arteries and promote thrombus formation) |
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Term
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Definition
decreased level is parallel with diet low in folic acid, vitamin B6 and B12
12-hr fast necessary before blood sample drawn |
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Term
|
Definition
| optimal homocysteine level |
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Term
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Definition
| borderline homocysteine level |
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Term
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Definition
| high risk homocysteine level |
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Term
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Definition
| decreased level can mean fluid excess caused by HF or thiazide diuretics |
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Term
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Definition
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Term
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Definition
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Term
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Definition
Needed for cardiac electrophysiologic function
decreased level can lead to dysrhthmias
increased level can lead to heart block, asystole, and ventricular dysrhythmias |
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Term
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Definition
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Term
|
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 |
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Term
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Definition
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Term
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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 |
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Term
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Definition
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Term
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Definition
| increased level reflects reduced renal perfusion from decreased cardiac output, or are a result of diuretic therapy or dehydration |
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Term
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Definition
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Term
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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 |
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Term
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Definition
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Term
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Definition
| increases in stressful situations |
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Term
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Definition
| Nondiabetic glycohemoglobin (hemoglobin A1C) range |
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Term
|
Definition
| Diabetic Hemoglobin A1C level |
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Term
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Definition
| reflects blood glucose over 2-3months |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| assesses effects of unfractured heparin; intrinsic pathway activity |
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Term
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Definition
Adjustment of heparin dose is required if aPTT =?
(dose needs to be increased) |
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Term
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Definition
Adjustment of heparin dose is required if aPTT= ?
(dose needs to be decreased) |
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Term
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Definition
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Term
|
Definition
| monitors coumadin; extrinsic pathway activity |
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Term
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Definition
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Term
|
Definition
| used with PT to monitor coumadin |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| decreased levels lead to an increased frequency of angina episodes or acute MI |
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Term
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Definition
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Term
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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 |
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Term
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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 |
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Term
| Electrocardiography (ECG) |
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Definition
graphic presentation of electrical currents of the heart;
obtained by placing electrodes on the skin of the chest wal and extremities |
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Term
|
Definition
| used to dx dysrhythmias, conduction abnormalities, chamber enlargement, and myocardial ischemia, injury, or infarction |
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Term
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Definition
| used in early dx of Right ventricular and left posterior infarction |
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Term
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Definition
| used in early detection of myocardial ischemia/injury |
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Term
| Continuous ECG monitoring |
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Definition
used for patient at high risk for dysrhythmias
detects abnormalities in HR and rhythm |
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Term
| Myocardial ischemia/ injury |
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Definition
| Changes in ST segment in continuous ECG monitoring identify? |
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Term
| Hardwire cardiac monitoring and telemetry |
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Definition
| Name the 2 types of continuous cardiac monitoring |
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Term
| Hardwire cardiac monitoring |
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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 |
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Term
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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 |
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Term
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Definition
| dictates the number of electrodes needed in cardiac monitoring |
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Term
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Definition
| lead that gives best visual of atrial depolarization (P wave) |
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Term
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Definition
| lead that gives best visual of ventricular depolarization (good when monitoring for dysrhythmias) |
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Term
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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 |
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Term
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Definition
| used to find the etiology of symptoms and evaluate the effectiveness of cardiac medicines or pacemaker function |
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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 |
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Term
| Wireless mobile cardiac monitoring systems |
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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 |
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Term
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Definition
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Term
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Definition
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Term
| RA, LA, RL, LL, V1 (below sternum (brown)) |
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Definition
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Term
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Definition
| when the coronary arteries dilate less, compromising blood flow to the myocardium and causing ischemia |
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Term
|
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 |
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Term
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Definition
| not an indicator of severe aortic stenosis, acute myocarditis/ pericarditis, severe hypertension, suspected Left main CAD, HF, and unstable angina |
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Term
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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 |
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Term
|
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 |
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Term
| ECG abnormals occur and further testing will be needed |
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Definition
| Exercise stress test is positive when? |
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Term
| Nursing Interventions for an Exercise Stress Test |
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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 |
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Term
| Pharmacologic stress testing |
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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 |
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Term
| dipyridamole (Persantine) and adenosine (Adenocard) |
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Definition
| what two vasodilating agents are administered IV, used to mimic exercise effects by maximizing dialting coronary arteries |
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Term
|
Definition
| last 15-30m; vasodilating agent; side effects include chest discomfort, dizziness, headache, flushing, and nausea |
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Term
|
Definition
| lasts <10 seconds; vasodilating agent; side effect subside rapidly |
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Term
| Theophylline and other xanthines (caffiene) |
|
Definition
| must be avoided because they block the effects of dipyridamole and adenosine |
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Term
|
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 |
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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 |
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Term
|
Definition
measures ejection fraction
able to view size, shape, and motion of heart with a noninvasive ultrasound |
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Term
| Two dimensional or cross-sectional echocardiography |
|
Definition
| provides a spatially correct image of the heart |
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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 |
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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 |
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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) |
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|
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 |
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|
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? |
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Term
|
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 |
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Term
|
Definition
| use of radioisotope thallium to produce a 1 dimensional view of the heart from 3 locations |
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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 |
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Term
| Myocardial pefusion imaging |
|
Definition
| uses the radioisotop TI201 to assess myocardial perfusion |
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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 |
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|
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? |
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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 |
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Term
| Computed tomography, CAT, EBCT |
|
Definition
| x-ray for cross-sectional imaging of the chest to diagnose masses and aorta/pericardium diseases |
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Term
|
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 |
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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 |
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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 |
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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 |
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Term
|
Definition
| provides 3D images of distributed compounds |
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Term
|
Definition
determined by the degree of blood flow vs the glucose metabolism in the myocardium
(ischemic= decreased blood flow, increased metabolism) |
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Term
|
Definition
| glucose must be WNL before this test can be performed |
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|
Term
| Nursing interventions for PET |
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Definition
| -instruct patient that they must refrain from stimulant use for four hours prior to the test |
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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 |
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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 |
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Term
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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 |
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Term
|
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 |
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Term
|
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 |
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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 |
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|
Term
| Prevent contrast agent induced nephropathy |
|
Definition
| pre and post procedure IV infusion hydration of saline, sodium bicarbonate, and antioxidant acetylcysteine (Mucomyst) |
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Term
|
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) |
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Term
|
Definition
| angiography in which a specific heart chamber or blood veseel is singled out for study |
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Term
|
Definition
outlines the lumen of the aorta and major arteries arising from it
introduced thru the translumbar, or retrograde brachial/ femoral artery approach |
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Term
|
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 |
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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 |
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|
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 |
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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 |
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|
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 |
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|
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 |
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|
Term
| Electrophysiologic Testing (EPS) |
|
Definition
| dx serious dysrhythmias (atrial and ventricular tachycardia) |
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Term
|
Definition
continuous
includes CVP, pulmonary artery pressure, intra-arterial BP monitoring
contains: flush system, tubing, stopcocks, flush device, pressure bag, transducer, amplifier/ monitor |
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Term
|
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 |
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Term
|
Definition
monitors left ventricle function and dx shock
fluoroscopy used to confirm placement |
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|
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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