cardiovascular diagnostic modalities?

what laboratory tests can be done to diagnose cardiovascular conditions?

-cardiac biomarkers

-coagulation studies

-lipid profiles

-brain natriuretic peptide (BNP)

-C-reactive protein

-homocysteine

what are included in cardiac biomarkers?

-creatinine kinase (CK)

-CK isoenzymes (CK-MB)

-proteins: myoglobin, troponin T and troponin I

what does a CXR do?

-determine size, contour and position of the heart

-can assist with the diagnosis of HF

-confirms placement of pacemakers (PPM) and pulmonary artery catheters

what does a fluoroscopy do?

-XR that allows visualization in real time versus a still image

-shows cardiac and vascular pulsations and contours

-useful in positioning transvenous pacing electrodes and for guiding arterial and venous catheters during cardiac catheterization

what does an electrocardiography do?

-graphic representation of the electrical conduction and contractility of the heart

-standards 12 lead EKG means you can see the electrical activity in 12 different views or circuits

-used to diagnose dysrhythmias, conduction abnormalities, ventricular enlargements and myocardial infarctions

-can also suggest electrolyte disturbances and effects of antiarrhythmic medications

what are examples of continuous electrocardiographic monitoring?

-telemetry

-ambulatory ekg: continuous monitoring, cardiac event records

-cardiac implantable electronic devices: pacemakers and ICDs

nursing interventions for cardiac monitoring?

-must be free of artifact

-use proper skin preparation

-changes electrodes every 24 hours

-thoroughly clean between patients

what is exercise stress testing?

-patient walks on a treadmill while attached to a continuous 12 lead EKG

-Exercise intensity increases progressively in speed and incline

-monitor EKG for heart rate, rhythm, conduction changes, ischemic changes

-monitor BP, physical appearances, physical signs, exertion and symptoms

-test is terminated when the target heart rate is reached or patient experiences signs of myocardial ischemia (chest pain or SOB)

-once the test is completed, EKG is reviewed for changes in conduction or for signs of ischemia

exercise stress testing nursing interventions?

-patient must fast for at least 3 hours prior

-avoid stimulants (tobacco, caffeine, chocolate)

-Medications may be taken with sips of water

-hold beta adrenergic blockers and possibly CCBs

-insert IV catheter

-monitor for 10 to 15 minutes after test

-if patient experiences symptoms during or after stress test, administer appropriate measures and then call the dr

pharmacologic stress testing?

-used of pt who are cognitively impaired or physically disabled

-vasodilating agents sucg as dipyridamole (persantine), Adenosine (adenocard) or regandenoson (lexican) given as IV infusion to mimic effects of exercise

-side effects include chest pain, headache, flushing, nausea, heart block and dyspnea

-effects of drugs can be reversed with aminophylline

-dobutamine is agent of choice - also used for patients with bronchospasms or pulmonary disease who cannot tolerate having doses of theophylline held

nursing interventions for pharmacologic stress testing?

-NPO for three hours prior

-avoid chocolate, caffeine and tobacco for 24 hours prior

-hold aminophylline, theophylline or dipyridamole for 24 to 48 hours prior

-inform patient of flushing or nausea that may occur during test

-take 1-3 hours to perform

radionuclide imaging?

-noninvasive

-sed in combination with stress testing

-Radioisotopes are injected through IV

-camera converts signals from radioisotopes into pictures of the heart

evaluates coronary artery perfusion and ejection fraction

-detects myocardial ischemia and infarction

-may use SPECT or PET

-SPECT is preferred due to its availability and prognostic value

-cannot be used in women who are pregnant

noninvasive imaging?

-CT

-magnetic resonance angiography

-echocardiography-> transthoracic echocardiography

invasive imaging?

-echocardiography-> trans-esophageal echocardiography

-cardiac catheterization -> right and left heart catheterization

-electrophysiologic testing (EPS)