| A | B |
|---|
| Total cholesterol | Less than 200 mg/dL |
| Triglycerides | Less than 190 mg/dL |
| High-density | 29-77 mg/dL |
| Low-density (desirable) lipoproteins (LDL) | Less than 100 mg/dL |
| Very low-density lipoproteins (VLDL) | 25%–50% of total |
| Lipid Profile EXPLANATION | Performed to evaluate risk for atherosclerosis and coronary heart disease. Lower levels of total cholesterol and triglycerides are better. Higher levels of HDL help remove excess cholesterol from the blood and are desirable. LDL and VLDL promote cholesterol buildup in arteries; lower levels are better. |
| LIPID Profile NURSING | These tests should be performed fasting. Instruct the client to refrain from eating or drinking(sips of water are allowed) for 12 hours before testing and to avoid alcohol intake for 24 hours before testing. |
| C-reactive protein | 0, A sensitive measure of inflammation; may help predict coronary heart disease. No special precautions or preparation required |
| Creatine phosphokinase (CK or CPK) | Male: 30–180 IU/L, Female: 25–150 IU/L |
| CK-MB | is a subset of CK found in heart muscle. |
| cTnT, cTn1-Troponin T and I | Troponin T Less than 0.2 mcg/L, Troponin I Less than 0.5 mcg/L |
| Cardiac muscle troponins,cTnT and cTn1 | sensitive indicators of heart muscle damage |
| Cardiac Markers | are proteins released from |
| CK | is a protein in heart and skeletal muscle |
| CK-MB | is a subset of CK found in heart muscle. |
| Brain natriuretic peptide | These hormones are released by the heart muscle in response to changes in blood volume. Increased blood levels indicate heart failure. |
| 12-Lead ECG (resting ECG) | Used to evaluate the heart rhythm, conduction through the electrical pathways of the heart, andthe size and position of the heart in the chest cavity. Can reveal areas of ischemia, injury, or infarction (tissue necrosis). Noninvasive. Very tense muscles (for example,a highly anxious client) and movement can |
| Stress electrocardiography | Monitors the ECG during exercise on a treadmill or stationary bicycle to detect asymptomatic coronary heart disease (CHD). During exercise, the workload of the heart increases; this increase workload may cause myocardial ischemia and angina in clients with CHD.Requires informed consent. Smoking and food, alcohol, and caffeine intake should be avoided for 2 to 3 hours before the test. The client’s ECG, heart rate, and blood pressure are monitored continuously during testing. Stress testing may cause a cardiac emergency. A physician is present or immediately available during stress testing and emergency resuscitation supplies are kept in the immediate area. |
| Pharmacologic stress | Used when physical exercise is not possible (e.g., for clients with orthopedic problems). A vasodilator drug is administered which may cause ischemia in areas of the heart affected by CHD, much like exercise does. |
| Continuous or event cardiac monitoring (telemetry, Holter monitoring, ambulatory or event | Electrodes placed on the client’s chest are connected to a monitoring system for continuous monitoring of the heart rate and rhythm to detect and diagnose abnormal heart rhythms. ECG signals may be displayed on a bedside monitor or central monitoring station, or recorded in a portable unit for later evaluation (Holter monitoring).Ambulatory monitors may record continuously for a 24- to 72- hour period or allow the client to record cardiac activity intermittently when symptoms are experienced (such as chest pain or palpitations).The latter is known as event monitoring. When the client’s symptoms occur only rarely, a device such as an implantable loop recorder (ILR) may be used. The ILR is implanted under the skin of the chest. It records when activated by the client or if the pulse rate is above or below preset limits. |
| Sonography (Doppler Studies, | Echoes from high-frequency sound waves are used to study the structure and movement of organs (e.g., the heart) and the flow of blood within a vessel. |
| Transthoracic echocardiogram (TEE) | A transducer lubricated with conductive gel held against the chest wall transmits and receives the ultrasonic impulses. A computer converts the impulses to an image of the heart walls, chambers, and their movements. Noninvasive; performed at the client’s bedside or in an ambulatory care setting. No food or fluid restriction is necessary. Conductive gel may be cold. Provide a washcloth or wash the chest wall after the exam for comfort. |
| Transesophageal echocardiogram (TEE) | A flexible transducer mounted on an endoscope provides a more direct view of the heart by avoiding the interference of chest wall structures. |
| Stress echocardiogram | This test combines a resting TTE, exercise on a treadmill or stationary bicycle with continuous ECG monitoring, and a repeat TTE immediately after exercise to evaluate the effect of exercise on cardiac function. Although noninvasive, requires informed consent and food and fluid restrictions before testing, and monitoring as for a stress ECG |
| Vascular ultrasound Doppler imaging, duplex | These are noninvasive procedures that provide information about the structure of and blood flow through major blood vessels. Conductive gel is applied over the vessel to be studied, and a handheld transducer is maneuvered over the vessel. Blood pressures at various locations of the extremity are taken when used to evaluate peripheral circulation. Explain the test and its purpose. Monitor blood pressures as indicated.Wash the extremity after the exam for comfort. |
| Radiography (X-Ray Studies) | Used to identify the size and location of structures, and, when combined with use of an injected contrast medium, used to study blood flow through vessels and organs. If contrast is injected, ask about allergies (specifically including iodine or seafood) before the exam; ensure good hydration before and after the exam to reduce the risk of kidney damage. |
| Chest and abdominal x-rays | Used to evaluate the size and position of the heart and to identify abnormalities of major blood vessels such as the aorta (e.g., an abdominal aortic aneurysm). Although these studies are noninvasive, they expose the client to potentially damaging radiation. Ask women of childbearing age about possible pregnancy before the exam. Inform the physician and x-ray technician if pregnancy is known or possible |
| Angiography | This is an invasive procedure that combines x-rays and fluoroscopy (a radiographic image dis- played on a screen) with injection of a contrast agent into the vessel to illuminate blood flow through the vessel,and evaluation of its patency and structure.May also be used to treat cardio- vascular disease (e.g.,insertion of a stent into a partially blocked vessel to restore blood flow). |
| Cardiac catheterization | Used to detect abnormalities in the chambers and valves of the heart; often done together with coronary angiography. A catheter inserted into the chambers of the heart (via a large vein to access the right side of the heart, or the femoral or brachial artery to access the left side of the heart) is used to measure pressures within the chambers of the heart, cardiac out- put, and the oxygen content and saturation of the blood. Contrast agents injected into the heart outline structures of the heart. |
| Computed tomography | Specialized radiographic procedures that produce computer-generated images with significantly more detail than standard x-rays allow. May be done with or without contrast media, although contrast is used when a CT scan is done to identify vessel abnormalities such as an aneurysm. |
| Electron beam computedtomography (EBCT) | A noninvasive imaging study that can detect calcium deposits in coronary arteries. Calcium deposits indicate atherosclerosis and can pre- dict coronary heart disease in people with no symptoms. May be used as an alternative to stress testing for diagnosing coronary heart disease. Ask women of childbearing age about possible pregnancy. |
| Magnetic Resonance Imaging (MRI) | MRI uses a supermagnet and radiofrequency signals to elicit a response from hydrogen nuclei. As a result, blood flow can be studied, and diseased tissue can be differentiated from healthy tissue. a Cardiac MRI shows thickness of the heart walls, size of the chambers, valve function, and coro- nary vessel flow. a MRI angiography is noninvasive and is used to evaluate vessel structure and blood flow. |
| Radionuclear Scans | Used to evaluate blood flow to the heart muscle. A radioactive substance is injected intra- venously, and the heart is scanned with a radia- tion detector. Ischemic or infarcted heart mus- cle cells do not take up the substance normally, creating an image on the scan. |
| Multigated Acquisition (MUGA) Scan | Used to evaluate heart size,ventricular wall motion, and ejection fraction.The client’s blood is tagged with a radioactive isotope.Imaging procedures allow visualization of the heart and its function. Requires informed consent; no food or fluid restriction required. Note client’s current med- ications as these may interfere with results. Isotope is injected intravenously.The ECG is monitored during scanning. |
| Exercise perfusion imaging or stress tests (Thalliumstress test; technetium stress test | Used to evaluate myocardial perfusion during exercise. A radioisotope such as thallium-201 or technetium-99m is given during exercise stress testing; the heart muscle is scanned for accu- mulation of the isotope to evaluate perfusion. |
| Continuous or event cardiac monitoring (telemetry, Holter monitoring, ambulatory or event: Nursing implentation | Provide teaching about the purpose of monitoring. Apply electrodes to clean, dry skin, removing hair as appropriate. Instruct the client how to replace the electrodes (if appropriate) and about care of the skin and recording or telemetry unit. Caution the client to avoid getting the telemetry or recording unit wet. Instruct the client to record activity when symptoms such as chest pain or palpitations are experienced. Instruct when it is appropriate to contact the nurse or physician. |
| Transesophageal echocardiogram (TEE) | Requires informed consent. Food and fluid withheld for at least 4 hours before testing.The client is sedated and the throat anesthetized to allow passage of the endoscope into the esophagus. Monitor breathing, cough, and gag reflexes after the exam. Keep NPO until the gag reflex returns and the client is fully awake. |
| Angiography | Risks associated with insertion of the catheter into a high-pressure artery include (1) bleeding from the insertion site and (2) clot formation at the insertion site and impaired blood flow to the extremity |
| Angiography Risk | Risks associated with insertion of the catheter into a high-pressure artery include |
| clinical alert angiography | Closely monitor the client, the insertion site, and the extremity after the procedure. Immediately report evidence of bleeding, pain, or a pale, pulseless extremity to the charge nurse and physician. |
| Nursing Implications CT Scan | Informed consent is required. If contrast is used, inquire about allergies (to iodine and seafood in particular),and ensure that the client is well hydrated to reduce the risk of kidney damage. |
| Magnetic Resonance Imaging (MRI) implementation | The client is not exposed to radiation during an MRI. Ask about implanted metal (e.g., a joint prosthesis) or electronic devices such as pacemakers or automatic defibrillators. Provide teaching because the experience can be frightening. |
| Exercise perfusion imaging or stress tests (Thalliumstress test; technetium stress test implentation | Informed consent is required.The client should withhold medications that may affect heart rate or BP for 24 hours before the test and be NPO for 2 to 3 hours before the test. An IV line is inserted.The isotope is injected before and/or during the test.The client may need to return for follow-up scanning 3 or more hours after the stress test. |
