UNIT 1: THE CARDIOVASCULAR SYSTEM (pt.5)

High-Sensitivity C-Reactive Protein (hs-CRP)

Marker of systemic vascular inflammation

High-Sensitivity C-Reactive Protein (hs-CRP)

predicts risk of future cardiovascular events

12-Lead ECG, Continuous ECG Monitoring (Telemetry), Ambulatory ECG (Holter Monitor)

Non-Invasive Electrical Assessment

12-Lead ECG

Displays 12 views of electrical activity across 10 physical electrodes.

12-Lead ECG

Essential for detecting ischemia (ST depression, T-wave inversion), injury (ST elevation / STEMI), infarction (pathologic Q wave), dysrhythmias, and conduction delays

Continuous ECG Monitoring (Telemetry)

Monitors HR and rhythm continuously via 3-lead or 5-lead systems.

Continuous ECG Monitoring (Telemetry)

Alert systems notify nurses of lethal rhythms (V-Tach, V-Fib, Asystole).

Ambulatory ECG (Holter Monitor)

Wearable recorder for 24–48 hours to detect intermittent dysrhythmias during daily activities.

Exercise Stress Test (Treadmill / Exercise Bicycle)

Evaluates coronary artery response to increased myocardial oxygen demand

Bruce protocol

Target HR reached via standardized protocols

Positive Test

ST-segment elevation/depression, severe angina, or marked blood pressure drop

Pharmacologic Stress Test:

Indicated for patients unable to exercise (e.g., arthritis, severe peripheral vascular disease)

Vasodilating Agents

Dipyridamole or Adenosine (causes maximal coronary vasodilation)

Dipyridamole or Adenosine

it causes maximal coronary vasodilation

Dobutamine

Inotropic/Chronotropic Agent:

Dobutamine

increases HR and myocardial contractility

• NPO for 3–4 hours before test.

• Hold caffeine

• Instruct patient to report chest pain, shortness of breath, or dizziness

Nursing Responsibilities Cardiac Stress Testing

Echocardiography

Non-invasive ultrasound across chest wall.

Echocardiography

it assesses Ejection Fraction (EF), chamber size, wall motion abnormalities, and valvular function

Transesophageal Echocardiogram (TEE)

Transducer inserted down the esophagus directly behind the heart.

• Fasting (NPO) 6 hours prior.

• Sedation given

• Remove dentures and other oral prosthetics

Transesophageal Echocardiogram (TEE) Nursing Considerations before the procedure:

Place in lateral or semi-Fowler’s position

Encourage to cough

Transesophageal Echocardiogram (TEE) Nursing Considerations after the procedure:

Myocardial Perfusion Imaging

Uses radioisotopes (Thallium-201 or Technetium-99m) injected IV.

Myocardial Perfusion Imaging

Identifies areas of myocardial ischemia ("reversible defect") vs. infarction

Cardiac Computed Tomography (CT) & Coronary CT Angiography (CCTA)

Evaluates coronary artery calcium (CAC) scoring and patency of coronary vessels

Cardiac Computed Tomography (CT) & Coronary CT Angiography (CCTA)

Requires IV iodinated contrast and low, stable HR (often pre-treated with beta-blockers)

Cardiac Magnetic Resonance Imaging (MRI):

High-resolution assessment of myocardial anatomy, congenital heart defects, and tissue viability without radiation

Cardiac Magnetic Resonance Imaging (MRI):

Safety Precaution: Screen thoroughly for metal implants, pacemakers, and claustrophobia.

fluoroscopy

Radiopaque catheter inserted into femoral or radial artery, guided to aorta and coronary arteries under ___

Radiopaque catheter

it is inserted into femoral or radial artery, guided to aorta and coronary arteries under fluoroscopy

Right Sided Heart Catheterization

Done by insertion of a catheter via cutdown into a large vein, e.g. medial cubital or brachial vein

Left Sided Heart Catheterization

Done by passing a catheter into the aorta via the brachial or femoral artery.

• Hemostasis & Access Site Care

• Monitoring & Assessment

• Hydration

• Emergency Watchouts

Post-Cardiac Catheterization Nursing Care

Electrophysiology Studies (EPS)

Invasive catheterization into heart chambers to map electrical pathways

Electrophysiology Studies (EPS)

Used to diagnose mechanism of complex dysrhythmias and evaluate suitability for catheter ablation or ICD implantation

Central Venous Pressure (CVP)

 Measures right atrial pressure (normal: 2–6 mmHg); reflects fluid volume status.

Pulmonary Artery Catheter

Measures pulmonary artery wedge pressure (PAWP) and cardiac output; evaluates left ventricular end-diastolic pressure

Intra-arterial Line

Provides continuous arterial blood pressure monitoring and easy arterial blood gas (ABG) sampling