cardiovascular assessment&diagnosis

1. assessment


2. diagnosis

1) cardiac marker: myoglobin (2hr) → troponin (3hr) → CK-MB (6hr)

2) serum lipids: cholesterol, triglyceride, lipoprotein

  • pre-procedure: low-fat meal, NPO for 12hrs, Avoid alcohols for 24 hrs

3) Electrolyte and mineral imbalances can cause cardiac electrical instability that can result in life-threatening dysrhythmias.

4) BNP

5) chest x-ray film (radiograph)

6) ECG (ElectroCardioGraphy)

  • for detecting cardiac dysrhythmias, location and extent of MI, and cardiac hypertrophy and for evaluation of the effectiveness of cardiac medications
  • An ECG strip consists of horizontal lines representing seconds and vertical lines representing voltage. Each small square represents 0.04 seconds.
  • The P wave represents atrial depolarization. The PR interval represents the time it takes an impulse to travel from the atria through the AV node, the bundle of His, and bundle of branches to the Purkinje fibers. The normal PR interval is measured from the beginning of the P wave to the end of the PR segment. The QRS complex represents ventricular depolarization. Normal QRS complex duration ranges from 0.04 to 0.1 second.

7) Echocardiography (ultrasound)

  • TTE: no NPO
  • TEE (TransEsophageal Echocardiography): care similar to endoscopy, 30분 ∼1시간 소요, 과정 중에 lie on

8) Holter monitoring

  • In this non-invasive test, the client wears a Holter monitor and an electrocardiographic tracing is recorded continuously over a period of 24 hours or more while the client performs his or her activities of daily living.

9) exercise electrocardiography testing (stress test, commonly treadmill test)

  • This non-invasive test studies the heart during activity and detects and evaluates coronary artery disease.
  • Stress testing may be used with myocardial radionuclide testing (perfusion imaging), at which point the procedure becomes invasive because a radionuclide must be injected.

10) digital subtraction angiography (dye)

  • This test combines x-ray techniques and a computerized subtraction technique with fluoroscopy for visualization of the cardiovascular system.

11) myocardial nuclear perfusion imaging

  • Nuclear cardiology involves the use of radionuclide techniques and scanning for cardiovascular assessment. The most common tests include technetium pyrophosphate scanning, thallium imaging, and multigated cardiac blood pool imaging; can evaluate cardiac motion and calculate the ejection fraction.

12) CT

13) MRI

14) EPS (ElectroPhysiological Studies)

15) ★ cardiac catheterization

  • An invasive test involving the insertion of a catheter into the heart and surrounding vessels.
  • Obtain informed consent. Maintain NPO status for 8 hours before the procedures. Assess the client for allergies to dye, iodine, or seafood; if allergic, the client may be premedicated with antihistamines and corticosteroids to prevent a reaction. If a client taking metformin(Glucophage) is scheduled to undergo a procedure requiring the administration of iodine dye, the metformin is withheld 24 hours prior because of the risk of lactic acidosis. The medication is not resumed until directed to do so by the HCP (usually 48 hours after the procedure or after renal function studies are done and the results are evaluated.) Establish intravenous access. Obtain vital signs. Prepare the insertion site by shaving and cleaning with an antiseptic solution if prescribed. Inform the client that he or she may feel fatigued because of the need to lie still and quiet on a hard table for up to 2 hours. Inform the client that he or she may feel a fluttery feeling as the catheter passes through the heart, a flushed and warm feeling when the dye is injected, a desire to cough, and palpitations caused by heart irritability. Administer preprocedural medications such as sedatives if prescribed.
  • Monitor vital signs and a cardiac rhythm at least every 30 minutes for 2 hours initially. Assess for chest pain and if dysrhythmias or chest pain occurs, notify the HCP. Monitor peripheral pulses and the color, warmth, and sensation of the extremity distal to the insertion site at least every 30 minutes for 2 hours initially. Notify the HCP if the client complains of numbness and tingling, if the extremity becomes cool, pale, or cyanotic, or if the loss of the peripheral pulses occurs. Apply a sandbag or compression device (if prescribed) to the insertion site to provide additional pressure if required. Monitor for bleeding,; if bleeding occurs, apply manual pressure immediately and notify the HCP. Monitor for hematoma; if a hematoma develops, notify the HCP. Keep extremity extended for 4 to 6 hours, as prescribed, keeping the leg straight to prevent arterial occlusion. Maintain strict bed rest for 6  to 12 hours, as prescribed, however, the client may turn from side to side. Do not elevate the head of the bed more than 15 degrees. If the antecubital vessel was used, immobilize the arm with an arm board. Monitor for nausea, vomiting, rash, or other signs of hypersensitivity to the dye. Encourage fluid intake; if not contraindicated, to promote renal excretion of the dye and to replace the fluid loss caused by the osmotic diuretic effect of the dye.
  • [Pediatric] discharge teaching for the child and parents: Remove the dressing on the day after the procedure and cover it with a bandage for 2 or 3 days as prescribed. Keep the site clean and dry. Avoid tub baths for 2 to 3 days. Avoid strenuous activity, if applicable. The child may return to school, if appropriate. Provide a diet as tolerated. Administer acetaminophen or ibuprofen for pain, discomfort, or fever. Observe for bleeding, drainage, edema, redness, and fever, and report any of these signs immediately.

16) CVP (Central Venous Pressure)

  • The CVP is the pressure within the superior vena cava; it reflects the pressure under which blood is returned to the superior vena cava and right atrium. Normal CVP is about 3 to 8mmHg. A decreased CVP indicates a decrease in circulating blood volume and may be a result of fluid imbalances, hemorrhage, or severe vasodilation, with pooling of blood in the extremities that limit venous return. An elevated CVP indicates an increase in blood volume as a result of sodium and water retention, excessive IV fluids, alterations in fluid balance, or kidney failure.
    The right atrium is located at the mid-axillary line at the fourth intercostal space; the zero points on the transducer needs to be at the level of the right atrium. The client needs to be supine, with the head of the bed at 45 degrees.