CARDIOVASCULAR DIAGNOSTICS TESTS & DYSRHYTHMIAS
Cardiac Enzymes & Lipid Profile
• Cardiac Enzymes (for MI detection):
o Myoglobin: < 90 mcg/L; rises in 2–3 hrs; lasts 24 hrs
o CK (Creatine Kinase): Peaks at 18 hrs; returns in 2–3 days
o Troponin T: < 0.1 ng/mL; lasts 10–14 days
o Troponin I: < 0.03 ng/mL; lasts 7–10 days
• Lipid Panel:
o Total Cholesterol: < 200 mg/dL
o LDL ("bad"): < 130 mg/dL
o HDL ("good"): > 55 mg/dL (females), > 45 mg/dL (males)
o Triglycerides: 40–160 mg/dL (males), 35–135 mg/dL (females)
o Nursing Consideration: 12–14 hr fasting before sample
Diagnostic Labs
• BNP (> 100 pg/mL): Marker for heart failure
• CRP:
o < 1.0: Low risk
o 1.0–3.0: Moderate risk
o 3.0: High risk for CVD
• Homocysteine:
o < 12 µmol/L: Optimal
o 12–15 µmol/L: Borderline
o 15 µmol/L: High risk (linked to stroke, CAD, PVD)
Imaging & Monitoring
• Chest X-Ray: Assesses heart size, calcification, pulmonary congestion
• ECG:
o Assesses rate, rhythm, electrical activity (12-lead or telemetry)
• TEE (Transesophageal Echo):
o NPO 6 hrs, sedation, gag reflex must return before food
• Cardiac Stress Test:
o Treadmill or pharmacological (adenosine, dobutamine)
o No ca`eine, alcohol, tobacco pre-test
o Monitor vitals, ECG during/after
Cardiac Procedures
• Coronary Angiogram (Cardiac Cath):
o Pre-op: NPO 8 hrs, check iodine allergy, hold anticoagulants
o Post-op: Bedrest, monitor for bleeding, CMS checks, fluids to flush dye
• Nursing Role:
o Educate on sedation, pressure dressing, need for driver if outpatient
This study source was downloaded by 100000898062787 from CourseHero.com on 09-30-2025 12:03:42 GMT -05:00
https://www.coursehero.com/file/250837674/med-surg-2-test-1-pdf/
, Invasive Cardiac Interventions
• PTCA: Balloon inflates artery, restores flow (door-to-balloon < 60 min)
• Stent: Mesh tube to hold artery open (requires Plavix/ASA)
• Atherectomy: Plaque removal
• CABG: Surgical grafting using saphenous/mammary vein
o Indicated for >70% blockage or left main artery involvement
Hemodynamic Monitoring
• CVP: 2–6 mmHg
• PAWP: 6–15 mmHg
• CO: 3–6 L/min
• SVO2: 60–80%
• High Preload: Crackles, JVD, edema
• Low Preload: Poor turgor, dry membranes
ECG Interpretation Basics
• P wave: Atrial depolarization
• PR interval: 0.12–0.20 sec (AV conduction)
• QRS: < 0.12 sec (ventricular depolarization)
• T wave: Ventricular repolarization
• U wave: Seen with hypokalemia
• QT interval: Full ventricular cycle
• Intervals:
o PP = Atrial rhythm
o RR = Ventricular rhythm
Dysrhythmia Overview
• Named by origin: SA node, atria, ventricles
• Can impact BP, CO
• Diagnosed by ECG
• Common rhythms:
o Sinus bradycardia/tachycardia
o Atrial: PACs, Atrial Flutter, Atrial Fibrillation
o Ventricular: PVCs, V-tach, V-fib
o Conduction Blocks: 1st, 2nd (Wenckebach), 3rd degree
This study source was downloaded by 100000898062787 from CourseHero.com on 09-30-2025 12:03:42 GMT -05:00
https://www.coursehero.com/file/250837674/med-surg-2-test-1-pdf/
Cardiac Enzymes & Lipid Profile
• Cardiac Enzymes (for MI detection):
o Myoglobin: < 90 mcg/L; rises in 2–3 hrs; lasts 24 hrs
o CK (Creatine Kinase): Peaks at 18 hrs; returns in 2–3 days
o Troponin T: < 0.1 ng/mL; lasts 10–14 days
o Troponin I: < 0.03 ng/mL; lasts 7–10 days
• Lipid Panel:
o Total Cholesterol: < 200 mg/dL
o LDL ("bad"): < 130 mg/dL
o HDL ("good"): > 55 mg/dL (females), > 45 mg/dL (males)
o Triglycerides: 40–160 mg/dL (males), 35–135 mg/dL (females)
o Nursing Consideration: 12–14 hr fasting before sample
Diagnostic Labs
• BNP (> 100 pg/mL): Marker for heart failure
• CRP:
o < 1.0: Low risk
o 1.0–3.0: Moderate risk
o 3.0: High risk for CVD
• Homocysteine:
o < 12 µmol/L: Optimal
o 12–15 µmol/L: Borderline
o 15 µmol/L: High risk (linked to stroke, CAD, PVD)
Imaging & Monitoring
• Chest X-Ray: Assesses heart size, calcification, pulmonary congestion
• ECG:
o Assesses rate, rhythm, electrical activity (12-lead or telemetry)
• TEE (Transesophageal Echo):
o NPO 6 hrs, sedation, gag reflex must return before food
• Cardiac Stress Test:
o Treadmill or pharmacological (adenosine, dobutamine)
o No ca`eine, alcohol, tobacco pre-test
o Monitor vitals, ECG during/after
Cardiac Procedures
• Coronary Angiogram (Cardiac Cath):
o Pre-op: NPO 8 hrs, check iodine allergy, hold anticoagulants
o Post-op: Bedrest, monitor for bleeding, CMS checks, fluids to flush dye
• Nursing Role:
o Educate on sedation, pressure dressing, need for driver if outpatient
This study source was downloaded by 100000898062787 from CourseHero.com on 09-30-2025 12:03:42 GMT -05:00
https://www.coursehero.com/file/250837674/med-surg-2-test-1-pdf/
, Invasive Cardiac Interventions
• PTCA: Balloon inflates artery, restores flow (door-to-balloon < 60 min)
• Stent: Mesh tube to hold artery open (requires Plavix/ASA)
• Atherectomy: Plaque removal
• CABG: Surgical grafting using saphenous/mammary vein
o Indicated for >70% blockage or left main artery involvement
Hemodynamic Monitoring
• CVP: 2–6 mmHg
• PAWP: 6–15 mmHg
• CO: 3–6 L/min
• SVO2: 60–80%
• High Preload: Crackles, JVD, edema
• Low Preload: Poor turgor, dry membranes
ECG Interpretation Basics
• P wave: Atrial depolarization
• PR interval: 0.12–0.20 sec (AV conduction)
• QRS: < 0.12 sec (ventricular depolarization)
• T wave: Ventricular repolarization
• U wave: Seen with hypokalemia
• QT interval: Full ventricular cycle
• Intervals:
o PP = Atrial rhythm
o RR = Ventricular rhythm
Dysrhythmia Overview
• Named by origin: SA node, atria, ventricles
• Can impact BP, CO
• Diagnosed by ECG
• Common rhythms:
o Sinus bradycardia/tachycardia
o Atrial: PACs, Atrial Flutter, Atrial Fibrillation
o Ventricular: PVCs, V-tach, V-fib
o Conduction Blocks: 1st, 2nd (Wenckebach), 3rd degree
This study source was downloaded by 100000898062787 from CourseHero.com on 09-30-2025 12:03:42 GMT -05:00
https://www.coursehero.com/file/250837674/med-surg-2-test-1-pdf/
