Cardiac Assessment and Diagnostic Procedures

1
Cardiac Assessment and Diagnostic Procedures

• NPN 200
• Medical Surgical 1

2
Assessment

• Subjective Interview
• Why did you seek medical attention?
• What symptoms are you having?
• Weight gain, dyspnea, fatigue, cough,
  palpitations, chest pain (describe), syncope,
  dark urine, edema
• Previous medical history
• Any family history of B/P, heart disease,
  diabetes?
• How has this illness affected your lifestyle?
• Smoking history, diet, physical activity

3
Assessment

• Physical or objective
• Height, weight
• Heart sounds
• Aortic, pulmonic, tricuspid, and mitral
• Listen for extra sounds , S3 and S4
• Murmurs, rubs (best heard over the left sternal
  border)
• Vital signs
• B/P lying, sitting and standing
• apical and radial pulse with the quality
  according to scale of 0-4
• Respirations, effort and skin color, with breath
  sounds

4
Assessment, cont

• Skin
• Color
• Hair distribution
• Capillary refill
• Extremities
• Inspect and palpate for
• Color
• Edema- 1, 2, 3, 4
• Warmth- lowered in heart failure, PVD, and shock
• Pulse quality- strong, weak, thready
• Clubbing

5
Venous and Arterial Pulses

• Check Jugular vein distention
• Must assess all major peripheral pulses
• Will indicate hypovolemia, decreased cardiac
  output
• Must check for symmetry
• Can auscultate the carotid, and the aorta

6
Diagnostic Procedures

• Electrocardiogram (ECG)
• Studies the conduction system
• Electrodes placed on the skin pick up the
  electric impulses
• Placement of pads determines the area of the
  hearts electrical activity
• The cardiac cycle is represented by a wave (
  P,Q,R,S )

7
Normal Sinus Rhythm
8
Diagnostic Procedures, cont.

• Holter monitor
• Echocardiogram
• Transesophageal Echocardiogram
• MRI
• MUGA (multiple-gated acquisition scan)
• Stress Test
• Cardiac Cath
• EPS (electrophysiology study)

9
CARDIAC CATH

• Prep for Cardiac Cath
• May be done as and outpatient
• Chest x-ray, EKG, CBC, coagulation studies
• NPO or light breakfast
• Shave, cleanse
• Check for allergies
• Total assessment
• Teach client
• Mild sedative may be given
• Post care- lie flat, bedrest, may use a closure
  device, vital signs, CMS, cath site

10

11
Diagnostic Procedures, cont

• Laboratory Tests
• ABGs
• Pulse oximetry
• Cardiac enzymes or CPK isoenzymes
• CPK (creatinine phosphokinase) found in high
  concentrations in skeletal, brain and heart
  muscle
• CPK-MB found in heart tissue, rises in 4-6
  hours after damage to heart muscle, and peaks in
  12-24 hours at more than 6 x the normal value,
  then returns to normal in 2-3 days

12
Diagnostic Procedures, cont

• Cardiac enzymes
• LDH (lactate dehydrogenase)
• High concentrations in the heart, skeletal, and
  brain tissue.
• Used as an indicator of damage to heart muscle,
  along with other labs

13
Complete Blood Count (CBC)

• WBC is used to determine if there is inflammation
  or infection (AMI leads to inflammation and
  endocarditis is infection)
• RBCs,HGB HCT indicates the O2 carrying ability
  of the blood
• Platelets are necessary for coagulation and the
  count may be increased in some acute infections
  and heart disease
• Myoglobin released soon after cardiac muscle
  damage
• 1-4 hrs after symptoms
• May also be elevated in skeletal muscle
• Troponin is a protein and is used in muscle
  contraction
• 2 subtypes are found in the blood after an MI
• Levels rise in 3-6 hours after symptoms, peak in
  24 hrs and may be found up to 2 wks
• Results available quickly (15 to 20 min) in the
  ER

14
Lipid Profile

• Composed of Cholesterol, triglycerides, serum
  lipids, and phospholipids
• Considered a risk factor for CVD
• B/P, and MI
• Cholesterol may be non-fasting
• Produced by the liver
• CAD risk 3x if greater than 260
• Must work to keep below 200
• HDL and LDL
• Triglycerides need to be drawn after 12 hrs
  fasting