Medsurg m2mFINALmEXAM
CardiacmAssessmentmCardi
acmConductionmSystem
➢ Generatesmand mtransmitsmelectricalmimpulsesmthat mstimulatemcontraction mof mthemmyocardium
➢ SAmnodem mAVmnodem mBundlemof mhism(branchesminto mright mand mleft)m mpurkinjiemfibers
➢ SAmnodemwhich mismthemprimary mpacemakermof mthemheart
o Ampatient mhasma mHRmof m90.mMeans m ThemSAmnodemismworkingmbecausemnormalmHRmism60-100
o If mthemHRmfallsmbelowmthemnormalmvalue,mtheremisma mproblem!
➢ AVmnodemwhich mismthemsecondary mpacemakermof mthemheart
o If mthemSAmnodemmalfunctions.mThemAVmnodemwillmtakemovermwhich mhasma mlowermratemsuch masm40-60 mbpm
CardiacmActionmPotential
Ismthemelectricalmcellsmgeneratemand mtransmit mimpulsesmacrossmthemheart mwhich mwillmstimulatemcardiacmmyocytesmtomcontract.mStimulatio
n mof mthesemmyocytesmoccursmduemtomthemexchangemof melectrically mcharged mparticlesm(ions)macrossmthemchannelsmlocated min mthemcellmmem
brane
➢ In mrestingmormpolarized mstatem
o Sodiummismthemprimary mextracellularmion
o Potassiummismthemprimary mintracellularmion
Termsmof mCardiacmActionmPotential
o Depolarization:melectricalmactivation mof mcellmcaused mby minflux mof msodium minto mcellmwhilempotassium mexitsmcell.mTHISmCRE
ATESmAmPOSITIVELYmCHARGEDmINTRACELLULAR mSPACE mANDm NEGATIVELYmCHARGED mEXTRACEULAR mSP
ACE
o Repolarization:mreturn mof mcellmto mrestingmstatemcaused mby mre-entry mof mpotassium minto mcellmwhilemsodium mexits
o Refractory mperiodsm– mcardiacmcellsmmust mcompletely mrepolarizembeforemthey mcan mdepolarizemAGAIN
o 2 mphasesmof mrefractory mperiodm
o Effectivemrefractory mperiod:mphasemin mwhich mcellsmaremincapable mof mdepolarizing.mItmismcompletely munresponsive mto
mANYmelectricalmstimulus
o Relativemrefractory mperiod: mphasemin mwhich mcellsmrequiremstronger-than-normalmstimulusmto mdepolarize
CardiacmHemodynamics
• HRmx mSVm=mCardiacmOutput
• Cardiacmoutput mrefersmto mthemtotalmamount mof mblood mejected mby monemof mthemventriclesmin mlitersmpermminute.
• Themcardiacmoutput min ma mrestingmadult mism4 mto m6 mL/min mbutmvariesmgreatly mdependingmon mmetabolicmneeds
• Cardiacmoutput mrespondsmtomchangesmin mthemmetabolicmdemandsmof mthemtissuesmassociated mwith mstress,mphysicalmexercis
e,mand millness
o HRmismaffected mby mcentralmnervousmsystem mactivity mand mbaroreceptormactivity.
o HRmismdetermined mby mratemand mrhythm m– mif mit mismregularmormirregular
o If mHRmismaffected mso mismCO
o If mthemheart mismnot mstretchingmenough m– mcardiacmoutput mismaffected
o If mthemheart mismnot mpumpingm– mcardiacmoutput mismaffected
• Strokemvolumemismdetermined mby m mpreload,mafterload,mandmcontractility
o Preload:mrefersmto mthemdegreemof mstretch mof mthemventricularmcardiacmmusclemfibersmatmthemendmof mdiastole.mTheme
nd mof mDiastolemismthemperiod mwhen mfillingmvolumemin mthemventriclesmismthemhighest mand mthemdegreemof mstretch mon
mthe mmuscle mfibersmismthe mgreatest m(when mit mismfilled mwith mmore mand mmore mblood m=mthe mgreatermthe mstretch m=mthe
mgreatermthe mforce mof mcontraction)
o Diastolemismthemrelaxation/fillingmphasemof mthemventriclesmand moncemthesemhavemfilled m mthismismthempreload.mWemcan
malso
refermto mpreload masmthemEVDm(it mismat mthemend mof mthemdiastolicmphase).mPreload mismthemamount mthemventriclemstretched
!
▪ Think mof ma mballoon m(such masmthemmoremairmyou mblowmin,mthemgreatermthemstretch)
o Afterload:mresistancemto mejection mof mblood mfrom mthemventricles.mThismismthempressuremrequired mto movercomemaor
ticmpressure.mThemhighermthemaorticmpressuremthemhardermthemventriclesmhavemto mwork m–
m(the mLVmmust movercome mthe maortic mpressure).mThe mpressure min mthe mventriclesmwork magainst mto mopen mthe mSLmval
vesmto mpump mblood mout mof mthemheart
o Contractility:mrefersmto mthemforcemgenerated mby mthemcontractingmmyocardiumm(themmoremforcefulmthemmorembloodmt
hat mismejected)
• If mtheremismanmissuemwithmcardiacmoutputm=mperfusionmissuembecausemtheremismanmissuemwithmoxygenationma
ndmflowmcomponents
• LowmHRm=mCOmismaffected
• IncreaseminmSVmandmHRm=mincreaseminmCO
AgemRelatedmchangesminmcardiac
,-
Atria,mLV,mValvesm(stiffen mand mno mlongermclosemproperly),mConduction msystem,mSNSm(decreased mresponse),maorta m(stiffen),marteriesm(
stiffen),mbaroreceptormresponsem(moremsensitive)
,History mandmPhysical
Health mHistory mwhich mrefersmto mthempatient’smability mto mrecognizemcardiacmsymptomsmto mknowmwhatmto mdo mwhen mthey moccurmitmisme
ssentialmformeffectivemself-caremmanagement
• Want mCLEAR minformation mwhen mtalkingmto mthempatient m mChief mcomplaint,mHxmpresent millnessm&mpast mmedicalmhistory/
socialmhistory,mHomemmeds,mNutrition,mAllergies
Physical mAssessmentm(Cardiacmspecific)
• Generalmappearance,mSkin mand mextremities
• Blood mpressurem mpulse,mand mposturalmBPm mBelowm30 mismreduction min mCO
• Arterialmpulsesm mrate,mrhythm,mamplitude
• Jugularmvenousmpulsationsm mfluid maccumulation/overload
• Heart minspection mand mauscultation
• Any mdeviationsmfrom mnormal?mMeaningmchangesmin mhowmthempatient mrespondsmto mhowmthey maremfeeling.mSuch masma mpatie
ntmwith mHFmormcirculatory missuesmwillmchangemtheirmshoesmduemto mtheirmfeet mbeingmswollen
o Heart masma mpump
o Atrial/ventricularmfillingmvolumes
o Cardiacmoutput
o Compensatory mmechanisms
▪ What mposition mdoesmthempatient mlay min mwhen mthey msleep?
▪ Tripod mposition m mpatient mismleaningmforward.mThismisman mindication mof mrespiratory mdistress
MOSTmcommonmclinical mmanifestation
• Ask mwhy mthempt mwould mfeelmlikemthis?
• Chest mpain
• SOB,mdyspnea m mfluid moverload/pulmonary missuemcan mlead mto mdyspnea
• Peripheralmedema
• Weight mgain
• Abd mdistention
• Fatigue
• Dizziness,mSyncope,mChangesmLOC mduemto mperfusion mand moxygenation missuesm(brain mlikesmoxygen)
• Wemknowmdiureticmismworkingmif mthemptmismpeeingma mlot mand mthey mfeelmlessmfatigue/dyspnea
ChestmPain
• Identify mQuantity,mlocation,mquality,mradiation,mduration mof mpain m,mAssociated mS/S
• Assessm mformothermcardiacmconditionsmand mformothermsignificant mconditions
• Angina mPectoris:muncomfortable mpressure,msqueezing,mormfullnessmin msubsternalmchest marea.mItmcan mradiatemacrossmchest m
to mthemmedialmaspect mof monemof mboth marmsmand mhands,mjaw,mshoulders,muppermback,mormepigastrium.m(BOOK)
• ACS:m ismthemsamemasmangina mpectoris.mPain mand mdiscomfort mrangesmfrom mmild mto mseveremassociated mwith mSOB,mdiaph
oresis,mpalpitations,munusualmfatigue,mand mn/v m(BOOK)
• Pericarditis:msharp,mseveremsubsternalmormepigastricmpain mwhich mcan mradiatemto mnecks,marms,mand mback.
• Pneumonia,mpulmonary membolismm msharp,mseveremsubsternalmormepigastricmpain marisingmfrom minteriormportion mof mpleura
• Hiatal mhernia,mGERDm msubsternal mpainmdescribed masmsharp,mburning,mormheavy.mOften mmimicsmangina mand mcan mrad
iatemto mneck,marm,mormshoulders.
• Costochondritism mmusculoskeletal mdisorders.mThismisma msharp mormstabbingmpain mlocalized min manteriormchest.mMost mof
ten mismunilateralmand mcan mradiatemacrossmchest mto mepigastrium mormback
• Vascular
Diagnosticm(laboratory mvalues
)mHematologic mStudies
• CBCm midentifiesmthemtotalmnumbermof mwhitemandmred mblood mcellsmand mplateletsmand mmeasuresmthemHgb mandmHct.mThem
CBCmismcarefully mmonitored min ma mpatient mwith mcardiovascularmdisease
• Hct: m45%
• Hgb: m15%
• Platelets: m150,000-450,000
• WBC: m4,500-10,500
• RBC: m5 mCar
diacmBiomarkerm–
• serum mbiomarkersm(can mbemused mforma mdiagnosismof man mMI)
• CK: m22-198 mU/L.mAmhigh mamount m=m damage
• CK-MB: m0-3.m mElevatedmCK-MBmismindicatormof macutemMI;mthemlevelmbeginsmto mincreasemwithin ma mfewmhours.
• Myoglobin: m0-85 mng/mL.m mThismisma mprotein mwhich mcan mtellmif mtissuesmaremdamaged
• Troponin: m0-
0.4.m mThismisma mprotein mthat misma mmarkermformthemheart.mElevated mmeansmthempatient mismhavingma mproblem mwith mtheirmheart
msuch masma mheart mattack
, • Myocardialmcellsmthat mbecomemnecroticmfrom mprolonged mischemia mormtraumamreleasemspecificmenzymesm(mentionedmabo
ve).mThesemsubstancesmleak minto mtheminterstitialmspacesmofmthemmyocardium mand maremcarried mby mthemlymphatic msystem mi
nto mgeneralmcirculation
• Thismbundlembecomesmimportant,mtimingmismimportant.mLookmatmwhen mdo myou mseemthesemlevelsmstart mto mrisem(usually mwi
thin m4-m6hrs),mwhen mdo mthey mpeak m(15-20hrs),mand mwhen mshould myou mstart mto mseema mresolution m(2-3 mdays)
• If mlevelsmaremnot mcomingmdown,mcan mmean mthat minjury mismextending….
BloodmChemistry
• BUN: m10-20 mmg/dL m mAn melevated mBUNmcan mmean mdehydration
• Creatinine: m0.7-1.4 mmg/dL m mThismisma mgood mindicatormformrenal mfunction
• Sodium: m135-145 mmEq/L m mLowmormhigh mdo mnot mdirectly maffect mcardiacmfunction
• Potassium: m3.5-5 mmEq/L m mPlaysma mmajormrolemin mcardiacmelectrophysiologic mfunction
o Hypo: mdysrhythmia,mlife-
threateningmventricularmtachycardia mormventricularmfibrillation mand mpredisposempatientsmtakingmdigitalismpreparations
mto mdigitalismtoxicity
o Hyper:mheart mblock,masystole,mlifemthreateningmventricularmdysrhythmia
• Magnesium m(thismismsometimesmADDED,mitmismnotmalwaysmon mthemblood mchemistry): m1.8-
3.0 mmg/dL m mThismismnecessary mformthemabsorption mofmcalcium,mmaintenance mof mpotassium mstores,mmetabolism mof madenosi
nemtriphosphate.mItmplaysma mmajormrolemin mprotein mand mcarb msynthesis
o Hypo: matrialmand mventricularmtachycardias
o Hyper:mdepressmcontractility mand mexcitability mof mthemmyocardium,mcausingmheart mblock mand mif msevere,masystole
• Calcium: m8.5-
10.5 mmg/dL m mThismismnecessary mformblood mcoagulation,mneuromuscularmactivity,mand mautomaticity mof mthemnodalmcells
o Hypo: mslowmnodalmfunction mand mimpairmmyocardialmcontractility mwhich mcan mputmthempatient matmrisk mforma mheart mattac
k
o Hyper:mventricularmfibrillation
Coagulationmstudies
• Injury mto ma mvesselmwallmormtissuemcan minitiatemthemformation mof ma mthrombus.mThisminjury mactivatesmthemcoagulation mcascade
o PTT: m60-70 mseconds m Measuresmthemactivity mof mintrinsicmpathway mand mismused mto massessmthemeffectsmof mheparin
o aPTT: m20-39 mseconds
o PT: m9.5-12 mseconds.m mThismismused mto mmonitormthemlevelmof manticoagulation mwith mwarfarin
o INR: m2-
3.5 mThismcan mbemused mto mmeasuremwarfarin m(professormsaid mthismismclinical).mIt misma mlaboratory mvaluemused mto mseem
howmlongmblood mtakesmto mform ma mclot
▪ Am1 m mtheremismNOTmenough manticoagulation mmedication
▪ Am2 m mtheremismENOUGH mmedication mon mboard
BNP
• Isma mneurohormonemthat mhelpsmregulatemBPmand mfluid mvolume.mItmismsecreted mfrom mthemventriclesmin mresponsemto mincreased m
preload mwith mresultingmventricularmpressure
• Thismismvery mspecificmformHFm(overm100)
• AmBNPmgreatermthan m100 mismsuggestivemof m
HFmCholesterol:
• Normalm m<m200 mmg/dL
• LDL: m<m130 mmg/dL.mThismismthemprimary mtransportermof mcholesterolmand mtriglyceridesminto mthemcell.mAmhigh mlevelmof mthis
mcan mbe mbad mbecause mit mcan mlead mto mheart mdisease,mdiabetes,mand mCAD
• HDL: m>m40 mmg/d
LmC-reactivemprotein
• Protein mproduced mby mthemlivermin mresponsemto msystemicminflammation
• Peoplemwith mhigh mhs-
CRPmlevelsm(3 mmg/Lmormgreater)mmay mbematmgreatest mrisk mformCVDmcompared mto mpeoplemwith mmoderatem(1 mto m3 mmg/L)morml
owm(lessmthan m1 mmg/L)
Homocysteine
• Linked mto matherosclerosismbecausemit mcan mdamagemthemendothelialmliningmof mthemarteriesmand mpromotemthrombusmformation
• Am12-hourmfast mismnecessary mbeforemdrawingma mblood msamplemforman maccuratemserum
• Elevated mhomocysteine mismindicativemof ma mhigh mrisk mformCAD,mstroke,mand mperipheralmvascularmdisease
• Test mresultsmareminterpreted masmoptimalm(lessmthan m12 mmcmol/L),mborderlinem(12 mto m15 mmcmol/L)mand mhigh mrisk m(greatermt
han m15 mmcmol/L)
ECG
• Electricalmcurrentsmof mthemheart
• 12-
lead mECGmismused mto mdiagnosed mdysrhythmia,mconduction,mabnormalities,mchambermenlargement,masmwellmasmmyocardi
almischemia minjury,morminfarction
ContinuousmECG
• Used mwhen mpatient mismatmrisk mformdysrhythmia
• Detectsmabnormalitiesmin mthemheart mratemand mrhythm
CardiacmAssessmentmCardi
acmConductionmSystem
➢ Generatesmand mtransmitsmelectricalmimpulsesmthat mstimulatemcontraction mof mthemmyocardium
➢ SAmnodem mAVmnodem mBundlemof mhism(branchesminto mright mand mleft)m mpurkinjiemfibers
➢ SAmnodemwhich mismthemprimary mpacemakermof mthemheart
o Ampatient mhasma mHRmof m90.mMeans m ThemSAmnodemismworkingmbecausemnormalmHRmism60-100
o If mthemHRmfallsmbelowmthemnormalmvalue,mtheremisma mproblem!
➢ AVmnodemwhich mismthemsecondary mpacemakermof mthemheart
o If mthemSAmnodemmalfunctions.mThemAVmnodemwillmtakemovermwhich mhasma mlowermratemsuch masm40-60 mbpm
CardiacmActionmPotential
Ismthemelectricalmcellsmgeneratemand mtransmit mimpulsesmacrossmthemheart mwhich mwillmstimulatemcardiacmmyocytesmtomcontract.mStimulatio
n mof mthesemmyocytesmoccursmduemtomthemexchangemof melectrically mcharged mparticlesm(ions)macrossmthemchannelsmlocated min mthemcellmmem
brane
➢ In mrestingmormpolarized mstatem
o Sodiummismthemprimary mextracellularmion
o Potassiummismthemprimary mintracellularmion
Termsmof mCardiacmActionmPotential
o Depolarization:melectricalmactivation mof mcellmcaused mby minflux mof msodium minto mcellmwhilempotassium mexitsmcell.mTHISmCRE
ATESmAmPOSITIVELYmCHARGEDmINTRACELLULAR mSPACE mANDm NEGATIVELYmCHARGED mEXTRACEULAR mSP
ACE
o Repolarization:mreturn mof mcellmto mrestingmstatemcaused mby mre-entry mof mpotassium minto mcellmwhilemsodium mexits
o Refractory mperiodsm– mcardiacmcellsmmust mcompletely mrepolarizembeforemthey mcan mdepolarizemAGAIN
o 2 mphasesmof mrefractory mperiodm
o Effectivemrefractory mperiod:mphasemin mwhich mcellsmaremincapable mof mdepolarizing.mItmismcompletely munresponsive mto
mANYmelectricalmstimulus
o Relativemrefractory mperiod: mphasemin mwhich mcellsmrequiremstronger-than-normalmstimulusmto mdepolarize
CardiacmHemodynamics
• HRmx mSVm=mCardiacmOutput
• Cardiacmoutput mrefersmto mthemtotalmamount mof mblood mejected mby monemof mthemventriclesmin mlitersmpermminute.
• Themcardiacmoutput min ma mrestingmadult mism4 mto m6 mL/min mbutmvariesmgreatly mdependingmon mmetabolicmneeds
• Cardiacmoutput mrespondsmtomchangesmin mthemmetabolicmdemandsmof mthemtissuesmassociated mwith mstress,mphysicalmexercis
e,mand millness
o HRmismaffected mby mcentralmnervousmsystem mactivity mand mbaroreceptormactivity.
o HRmismdetermined mby mratemand mrhythm m– mif mit mismregularmormirregular
o If mHRmismaffected mso mismCO
o If mthemheart mismnot mstretchingmenough m– mcardiacmoutput mismaffected
o If mthemheart mismnot mpumpingm– mcardiacmoutput mismaffected
• Strokemvolumemismdetermined mby m mpreload,mafterload,mandmcontractility
o Preload:mrefersmto mthemdegreemof mstretch mof mthemventricularmcardiacmmusclemfibersmatmthemendmof mdiastole.mTheme
nd mof mDiastolemismthemperiod mwhen mfillingmvolumemin mthemventriclesmismthemhighest mand mthemdegreemof mstretch mon
mthe mmuscle mfibersmismthe mgreatest m(when mit mismfilled mwith mmore mand mmore mblood m=mthe mgreatermthe mstretch m=mthe
mgreatermthe mforce mof mcontraction)
o Diastolemismthemrelaxation/fillingmphasemof mthemventriclesmand moncemthesemhavemfilled m mthismismthempreload.mWemcan
malso
refermto mpreload masmthemEVDm(it mismat mthemend mof mthemdiastolicmphase).mPreload mismthemamount mthemventriclemstretched
!
▪ Think mof ma mballoon m(such masmthemmoremairmyou mblowmin,mthemgreatermthemstretch)
o Afterload:mresistancemto mejection mof mblood mfrom mthemventricles.mThismismthempressuremrequired mto movercomemaor
ticmpressure.mThemhighermthemaorticmpressuremthemhardermthemventriclesmhavemto mwork m–
m(the mLVmmust movercome mthe maortic mpressure).mThe mpressure min mthe mventriclesmwork magainst mto mopen mthe mSLmval
vesmto mpump mblood mout mof mthemheart
o Contractility:mrefersmto mthemforcemgenerated mby mthemcontractingmmyocardiumm(themmoremforcefulmthemmorembloodmt
hat mismejected)
• If mtheremismanmissuemwithmcardiacmoutputm=mperfusionmissuembecausemtheremismanmissuemwithmoxygenationma
ndmflowmcomponents
• LowmHRm=mCOmismaffected
• IncreaseminmSVmandmHRm=mincreaseminmCO
AgemRelatedmchangesminmcardiac
,-
Atria,mLV,mValvesm(stiffen mand mno mlongermclosemproperly),mConduction msystem,mSNSm(decreased mresponse),maorta m(stiffen),marteriesm(
stiffen),mbaroreceptormresponsem(moremsensitive)
,History mandmPhysical
Health mHistory mwhich mrefersmto mthempatient’smability mto mrecognizemcardiacmsymptomsmto mknowmwhatmto mdo mwhen mthey moccurmitmisme
ssentialmformeffectivemself-caremmanagement
• Want mCLEAR minformation mwhen mtalkingmto mthempatient m mChief mcomplaint,mHxmpresent millnessm&mpast mmedicalmhistory/
socialmhistory,mHomemmeds,mNutrition,mAllergies
Physical mAssessmentm(Cardiacmspecific)
• Generalmappearance,mSkin mand mextremities
• Blood mpressurem mpulse,mand mposturalmBPm mBelowm30 mismreduction min mCO
• Arterialmpulsesm mrate,mrhythm,mamplitude
• Jugularmvenousmpulsationsm mfluid maccumulation/overload
• Heart minspection mand mauscultation
• Any mdeviationsmfrom mnormal?mMeaningmchangesmin mhowmthempatient mrespondsmto mhowmthey maremfeeling.mSuch masma mpatie
ntmwith mHFmormcirculatory missuesmwillmchangemtheirmshoesmduemto mtheirmfeet mbeingmswollen
o Heart masma mpump
o Atrial/ventricularmfillingmvolumes
o Cardiacmoutput
o Compensatory mmechanisms
▪ What mposition mdoesmthempatient mlay min mwhen mthey msleep?
▪ Tripod mposition m mpatient mismleaningmforward.mThismisman mindication mof mrespiratory mdistress
MOSTmcommonmclinical mmanifestation
• Ask mwhy mthempt mwould mfeelmlikemthis?
• Chest mpain
• SOB,mdyspnea m mfluid moverload/pulmonary missuemcan mlead mto mdyspnea
• Peripheralmedema
• Weight mgain
• Abd mdistention
• Fatigue
• Dizziness,mSyncope,mChangesmLOC mduemto mperfusion mand moxygenation missuesm(brain mlikesmoxygen)
• Wemknowmdiureticmismworkingmif mthemptmismpeeingma mlot mand mthey mfeelmlessmfatigue/dyspnea
ChestmPain
• Identify mQuantity,mlocation,mquality,mradiation,mduration mof mpain m,mAssociated mS/S
• Assessm mformothermcardiacmconditionsmand mformothermsignificant mconditions
• Angina mPectoris:muncomfortable mpressure,msqueezing,mormfullnessmin msubsternalmchest marea.mItmcan mradiatemacrossmchest m
to mthemmedialmaspect mof monemof mboth marmsmand mhands,mjaw,mshoulders,muppermback,mormepigastrium.m(BOOK)
• ACS:m ismthemsamemasmangina mpectoris.mPain mand mdiscomfort mrangesmfrom mmild mto mseveremassociated mwith mSOB,mdiaph
oresis,mpalpitations,munusualmfatigue,mand mn/v m(BOOK)
• Pericarditis:msharp,mseveremsubsternalmormepigastricmpain mwhich mcan mradiatemto mnecks,marms,mand mback.
• Pneumonia,mpulmonary membolismm msharp,mseveremsubsternalmormepigastricmpain marisingmfrom minteriormportion mof mpleura
• Hiatal mhernia,mGERDm msubsternal mpainmdescribed masmsharp,mburning,mormheavy.mOften mmimicsmangina mand mcan mrad
iatemto mneck,marm,mormshoulders.
• Costochondritism mmusculoskeletal mdisorders.mThismisma msharp mormstabbingmpain mlocalized min manteriormchest.mMost mof
ten mismunilateralmand mcan mradiatemacrossmchest mto mepigastrium mormback
• Vascular
Diagnosticm(laboratory mvalues
)mHematologic mStudies
• CBCm midentifiesmthemtotalmnumbermof mwhitemandmred mblood mcellsmand mplateletsmand mmeasuresmthemHgb mandmHct.mThem
CBCmismcarefully mmonitored min ma mpatient mwith mcardiovascularmdisease
• Hct: m45%
• Hgb: m15%
• Platelets: m150,000-450,000
• WBC: m4,500-10,500
• RBC: m5 mCar
diacmBiomarkerm–
• serum mbiomarkersm(can mbemused mforma mdiagnosismof man mMI)
• CK: m22-198 mU/L.mAmhigh mamount m=m damage
• CK-MB: m0-3.m mElevatedmCK-MBmismindicatormof macutemMI;mthemlevelmbeginsmto mincreasemwithin ma mfewmhours.
• Myoglobin: m0-85 mng/mL.m mThismisma mprotein mwhich mcan mtellmif mtissuesmaremdamaged
• Troponin: m0-
0.4.m mThismisma mprotein mthat misma mmarkermformthemheart.mElevated mmeansmthempatient mismhavingma mproblem mwith mtheirmheart
msuch masma mheart mattack
, • Myocardialmcellsmthat mbecomemnecroticmfrom mprolonged mischemia mormtraumamreleasemspecificmenzymesm(mentionedmabo
ve).mThesemsubstancesmleak minto mtheminterstitialmspacesmofmthemmyocardium mand maremcarried mby mthemlymphatic msystem mi
nto mgeneralmcirculation
• Thismbundlembecomesmimportant,mtimingmismimportant.mLookmatmwhen mdo myou mseemthesemlevelsmstart mto mrisem(usually mwi
thin m4-m6hrs),mwhen mdo mthey mpeak m(15-20hrs),mand mwhen mshould myou mstart mto mseema mresolution m(2-3 mdays)
• If mlevelsmaremnot mcomingmdown,mcan mmean mthat minjury mismextending….
BloodmChemistry
• BUN: m10-20 mmg/dL m mAn melevated mBUNmcan mmean mdehydration
• Creatinine: m0.7-1.4 mmg/dL m mThismisma mgood mindicatormformrenal mfunction
• Sodium: m135-145 mmEq/L m mLowmormhigh mdo mnot mdirectly maffect mcardiacmfunction
• Potassium: m3.5-5 mmEq/L m mPlaysma mmajormrolemin mcardiacmelectrophysiologic mfunction
o Hypo: mdysrhythmia,mlife-
threateningmventricularmtachycardia mormventricularmfibrillation mand mpredisposempatientsmtakingmdigitalismpreparations
mto mdigitalismtoxicity
o Hyper:mheart mblock,masystole,mlifemthreateningmventricularmdysrhythmia
• Magnesium m(thismismsometimesmADDED,mitmismnotmalwaysmon mthemblood mchemistry): m1.8-
3.0 mmg/dL m mThismismnecessary mformthemabsorption mofmcalcium,mmaintenance mof mpotassium mstores,mmetabolism mof madenosi
nemtriphosphate.mItmplaysma mmajormrolemin mprotein mand mcarb msynthesis
o Hypo: matrialmand mventricularmtachycardias
o Hyper:mdepressmcontractility mand mexcitability mof mthemmyocardium,mcausingmheart mblock mand mif msevere,masystole
• Calcium: m8.5-
10.5 mmg/dL m mThismismnecessary mformblood mcoagulation,mneuromuscularmactivity,mand mautomaticity mof mthemnodalmcells
o Hypo: mslowmnodalmfunction mand mimpairmmyocardialmcontractility mwhich mcan mputmthempatient matmrisk mforma mheart mattac
k
o Hyper:mventricularmfibrillation
Coagulationmstudies
• Injury mto ma mvesselmwallmormtissuemcan minitiatemthemformation mof ma mthrombus.mThisminjury mactivatesmthemcoagulation mcascade
o PTT: m60-70 mseconds m Measuresmthemactivity mof mintrinsicmpathway mand mismused mto massessmthemeffectsmof mheparin
o aPTT: m20-39 mseconds
o PT: m9.5-12 mseconds.m mThismismused mto mmonitormthemlevelmof manticoagulation mwith mwarfarin
o INR: m2-
3.5 mThismcan mbemused mto mmeasuremwarfarin m(professormsaid mthismismclinical).mIt misma mlaboratory mvaluemused mto mseem
howmlongmblood mtakesmto mform ma mclot
▪ Am1 m mtheremismNOTmenough manticoagulation mmedication
▪ Am2 m mtheremismENOUGH mmedication mon mboard
BNP
• Isma mneurohormonemthat mhelpsmregulatemBPmand mfluid mvolume.mItmismsecreted mfrom mthemventriclesmin mresponsemto mincreased m
preload mwith mresultingmventricularmpressure
• Thismismvery mspecificmformHFm(overm100)
• AmBNPmgreatermthan m100 mismsuggestivemof m
HFmCholesterol:
• Normalm m<m200 mmg/dL
• LDL: m<m130 mmg/dL.mThismismthemprimary mtransportermof mcholesterolmand mtriglyceridesminto mthemcell.mAmhigh mlevelmof mthis
mcan mbe mbad mbecause mit mcan mlead mto mheart mdisease,mdiabetes,mand mCAD
• HDL: m>m40 mmg/d
LmC-reactivemprotein
• Protein mproduced mby mthemlivermin mresponsemto msystemicminflammation
• Peoplemwith mhigh mhs-
CRPmlevelsm(3 mmg/Lmormgreater)mmay mbematmgreatest mrisk mformCVDmcompared mto mpeoplemwith mmoderatem(1 mto m3 mmg/L)morml
owm(lessmthan m1 mmg/L)
Homocysteine
• Linked mto matherosclerosismbecausemit mcan mdamagemthemendothelialmliningmof mthemarteriesmand mpromotemthrombusmformation
• Am12-hourmfast mismnecessary mbeforemdrawingma mblood msamplemforman maccuratemserum
• Elevated mhomocysteine mismindicativemof ma mhigh mrisk mformCAD,mstroke,mand mperipheralmvascularmdisease
• Test mresultsmareminterpreted masmoptimalm(lessmthan m12 mmcmol/L),mborderlinem(12 mto m15 mmcmol/L)mand mhigh mrisk m(greatermt
han m15 mmcmol/L)
ECG
• Electricalmcurrentsmof mthemheart
• 12-
lead mECGmismused mto mdiagnosed mdysrhythmia,mconduction,mabnormalities,mchambermenlargement,masmwellmasmmyocardi
almischemia minjury,morminfarction
ContinuousmECG
• Used mwhen mpatient mismatmrisk mformdysrhythmia
• Detectsmabnormalitiesmin mthemheart mratemand mrhythm
