Please enable JavaScript.

Coggle requires JavaScript to display documents.

Cardiac Markers Tests (Enzymes & Protein) - Coggle Diagram

- - - - Triglycerides, total cholesterol, lipoprotein
    - - RBC, Hb, Haematocrit, Platelets
    - - Determine risk of heart disease
    - - IM injection, recent angina or cardioversion can cause elevated myoglobin
  - - - Bleeding Time (BT)
        
        Measures the ability to stop bleeding & after small puncture wound
        
        Normal Values: 2.75 - 8 min
      - Partial Thromboplastin Time (PTT)
        
        Normal Values: 60-70 sec
        
        To identify deficiencies of coagulation factors, prothrombin, & fibrinogen; monitors heparin therapy
      - Prothrombin Time (PT)
        
        Normal Values: 10 - 14 sec
        
        Determines activity & interaction of the Prothrombin group: factors V, VII, X, prothrombin & fibrinogen; used to determine dosages of oral anti-coagulant
      - International Normalized Ratio (INR)
        
        Patient on warfarin therapy, recommended INR 2.0 - 3.0; Patients with mechanical prosthetic heart valves, INR 2.5 - 3.5 is recommended
        
        ↑ INR: disseminated intravascular coagulation, cirrhosis, hepatitis, vitamin K deficiency, salicylate intoxication, uncontrolled anticoagulation therapy or massive blood transfusion
  - - - Elevated in infectious heart disorder or myocardial infarction
      - Male: 15-20 mm/hr, Female: 20-30 mm/hr
      - Measurement of the rate at which RBC's settle out of anticoagulated blood in an hour
- - - - Provide information about the heart's position and size, movements of the valves & chambers & velocity of blood flow
      - Ultrasound waves reflect interfaces in the heart, e.g. ventricle & atrial walls, heart, valves, major vessels
      - Purpose
        
        Evaluate a pericardial effusion
        
        Evaluate the velocity & direction of blood flow
        
        Determine biologic & prosthetic valve dysfunction
        
        Furnish direction for further diagnostic study on cardiac status/function
        
        Monitor cardiac patient over an extended period
      - Visualises structures and function of the heart
      - Advantages
        
        Can be performed at the bedside with mobile equipment
        
        Can be done in laboratory
      - Procedure
        
        Specific diagnosis should accompany the request for the test, eg: 'rule out pericardial effusion', 'determine severity of mitral stenosis'. If a stress echocardiogram is ordered, the patient's ability to perform exercise must be indicated. (Consent is required from patient)
        
        Patient lies on the examining table in a slight side (left lying position)
        
        Skin surface over chest is lubricated with acoustic gel to permit maximum penetration of the ultrasound beam. The transducer is held over various regions of the chest and upper abdomen to obtain the appropriate view of the heart
        
        Examination time is 30-45 mins
  - - - Diagnose a possible heart-related cause of symptom such as chest pain, shortness of breath or lightheadedness
      - Determine a safe level of exercise
      - Determine drug effects
      - Diagnose coronary artery disease
      - Check the effectiveness of procedures done to improve coronary artery circulation in patients with coronary artery disease
      - Predict risk of dangerous heart-related conditions such as heart attack
    - - Consent is required, adequate rest, eat a light meal or fast for 4 hrs & avoid smoking, alcohol & caffeine
      - Void prior test & wear suitable clothing & shoes
    - - Instruct patient to exercise as instructed & report any pain, weakness and SOB
      - Monitor BP every 3 mins & ECG continuously, record every minute
      - Secure electrodes to appropriate location on chest, obtain baseline BP & ECG tracing
      - Resuscitation equipment must be available
    - - Instruct patient to notify the physician if any chest pain, dizziness, or shortness of breath
      - Instruct patient to avoid taking a hot shower for 10-12 hrs after the test
    - - Severe ECG changes
      - Ventricular arrhythmias
      - Marked cardiovascular related symptoms
      - Fall in blood pressure
- - - - Ensure consent, assess for allergy to seafood & iodine
      - NPO
      - Document weight & height, baseline VS, blood tests & document the peripheral pulses
      - Fasting for 8-12 hrs, teachings, medications to allay anxiety
    - - Inform patient of a fluttery feeling as the catheter passes through the heart; inform the patient that a feeling of warmth & metallic taste may occur when dye is administered
    - - Monitor peripheral pulses, color & warmth and sensation of the extremity distal to insertion site
      - Maintain pressure bandage at insertion site & monitor for bleeding & haematoma formation
      - Monitor VS & cardiac rhythm
    - - Check VS frequently according to institution protocols
      - Check catheter insertion site for haematoma, swelling, bleeding, or bruits (an indication of narrowed/partially blocked haematoma)
      - Nurse in supine position with head elevated NOT > 30 degrees because > angles put strain on the insertion site
      - Assess color, motion, sensation, capillary refill times, temperature, & pulse quality of the extremity involved & conduct a bilateral extremities comparison (eg: palpation of brachial artery, dorsalis pedis)
      - Bed rest is maintained 6-12 hours
      - All VS are properly documented & signed. The presence of any of this signs has to be promptly reported to the physician
      - Encourage fluid intake - flush out injected dye. Food intake to be maintained as normal diet
      - Keep the affected extremity extended, not elevated or flexed. Immobilised legs with sandbags if necessary (prevention of bleeding). Limbs not affected (advise ROM)
      - Assist with the rest of ADLs as per patient's requirement
      - Daycare (discharge home upon reviewed)