VI.

CARDIAC
A. Normal blood flow through the
heart:
The two major veins that bring
blood to the right side of the heart are
the superior
and inferior vena cava (This blood is
deoxygenated)The blood enters the
right
atrium Then the right ventricle
From the RV the blood is pumped into
the
pulmonary artery (this artery carries
deoxygenated blood) Then the
blood goes to
the lungs where it is oxygenated
Next through the pulmonary veins
(they carry
oxygenated blood) It then goes to
the left atrium to the left ventricle
(the big
bad pump) It is then pumped into
the aorta And finally this
oxygenated blood is
delivered throughout the body through
the arterial system where it eventually
ties
back into the venous system.
B. Cardiac Terms:
1. Preload is the amount of blood
RETURNING to the heart.
2. Afterload is the PRESSURE in the
aorta and peripheral arteries that the
left
ventricle has to pump against to get
the blood out.
That pressure is referred to as
resistance.
The resistance the LV has to
overcome to get the blood out
3. Stroke volume is the AMOUNT of
blood pumped out of the ventricles
with each
beat.
C. Cardiac Output:
CO = HR x SV
Tissue PERFUSION is dependent
on an adequate cardiac output.
Cardiac output changes according
to the bodys NEEDS.
1. Factors that affect cardiac
output:
a. Heart rate and certain arrthymias
b. Blood PRESSURE DECREASE
c. DECREASED contractility
MI, medication, muscle disease
70 Hurst Review Services
2. Pathophysiology of decreased
CO:

If your CO is decreased, will you

perfuse properly? NO
a. Brain: LOC will go DOWN
b. Heart: Client complains of CHEST
pain
c. Lungs: Short of breath? YES
d. Skin: COLD and clammy
e. Kidneys: UO goes DOWN
f. Peripheral pulses: WEAKER
Arrhythmias are no big deal UNTIL
they affect your cardiac output.
(1) PULSELESS
(2) VTACH
(3) VFIB
D. Chronic Stable Angina:
1. Pathophysiology:
a. Decreased blood flow to
myocardium ischemia or necrosis?
temporary
pain/pressure in chest.
b. Usually caused by CAD
c. What brings this pain on? LOW
OXYGEN
d. What relieves the pain? REST
and/or NITROGLYCERINES
2. Tx:
a. Medications:
1) Nitroglycerin (Nitrostat):
Sublingual
Causes venous and arterial
DILATION
This result will cause DECREASE
preload and afterload.
Also causes dilation of
CORONARY arteries which will
increase
blood flow to the actual heart muscle
(myocardium)
Hurst Review Services 71
Take 1 every 5 min x 3 doses.
Okay to swallow? NO
Keep in dark, glass bottle; dry, cool
May or may not burn or fizz
The client will get a HEADACHE.
EXPECT IT TO OCCUR
Renew how often? 3-5 months
Spray? 2 years
After Nitroglycerin (Nitrostat),
what do you expect the BP to do?
DROP
2) Beta Blockers:
Examples: Propranolol (Inderal),
Metoprolol (Lopressor/Toprol
XL),
Atenolol (Tenormin), Carvedilol
(Coreg)
What do beta blockers do to BP, P,
and myocardial contractility?
DECREASE

What does this do to the workload

of the heart? DECREASE
Beta blockers block the beta cells
these are the receptor sites for
catecholamines- the epi and norepi. So
we just decreased the
contractility So what happened to
my CO? Decreased So we have
Decreased the workload on my heart.
This is a good thing to a certain
point because we decreased the
workload on the heart, but could we
decrease the clients cardiac output
(HR and BP) too much with these
drugs? YES
3) Calcium Channel Blockers:
Examples: Nifedipine (Procardia
XL), Verapamil (Calan),
Amlodipine
(Norvasc), Diltiazem(Cardizem)
What do these do to the BP?
DECREASE
They also dilate CORONARY
arteries.
4) Acetylsalicylic Acid (Aspirin):
Dose is determined by the
physician (81 mg-325 mg)
*TESTING STRATEGY*
RULE: NEVER LEAVE AN
UNSTABLE CLIENT.
72 Hurst Review Services
b. Client Education/Teaching:
Avoid isometric exercise (exercises
that make your muscles squeeze/tense
up).
Avoid overeating.
Rest frequently.
Avoid excess caffeine or any drugs
that increase HR.
Wait 2 hours after eating to
exercise.
Dress warmly in cold weather (any
temperature extreme can precipitate an
attack).
Take nitroglycerin prophylactically.
Smoking cessation
Lose weight.
c. Cardiac Catheterization:
1) Pre-procedure:
Ask if they are allergic to
IODINE/SHELLFISH.
Iodine based dye is used during
procedure.
Also we want to check their kidney
function because you excrete the dye
through the KIDNEY.
Hot shot
Palpitations normal
2) Post-procedure:

Monitor VS.
Watch puncture site.
What are you watching for?
BLEEDING
Assess extremity distal to puncture
site (5-Ps).
The 5 Ps
Pulselessness
Pallor
Pain
Paresthesia
Paralysis
*TESTING STRATEGY*
DO EVERYTHING YOU CAN TO
DECREASE
WORKLOAD ON THE HEART.
Hurst Review Services 73
Bed rest, flat, leg straight X 4-6
hours
Report pain ASAP.
Major complication post cath?
HEMORRHAGE
Unstable chronic angina=
Impending MI
E. Acute Coronary Syndrome: MI,
Unstable Angina:
1. Pathophysiology:
a. Decreased blood flow to
myocardium ischemia/necrosis or
both? BOTH
b. Does the client have to be doing
anything to bring this pain ON? NO
c. Will rest or Nitroglycerin
(Nitrostat) relieve this PAIN? NO
2. S/S:
Pain
Cold/clammy/BP drops
Cardiac output is going DOWN.
WBCs
Due to inflammation
temp
ECG changes
Vomiting
You may see the following terms in a
test question:
STEMI: ST-Segment Elevation
Myocardial Infarction-this indicates
that the client is having a
heart attack and the goal is to get them
to the cath lab for PCI in less than 90
minutes.
***WORRY ABOUT THIS
CLIENT***
NSTEMI: Non-Elevation ST Segment
Myocardial Infarction-these clients are
usually less
worrisome.
3. Diagnostic Lab Work:
a. CPK-MB:
Cardiac specific ENZYMES

INCREASE with damage to

cardiac cells
Elevates in 3-12 hours and peaks in
24 hours
b. Troponin:
Cardiac biomarker with specificity
to myocardial damage
Has two specific isomers called
Troponin T and I
Elevates within 3-4 hours and
remains ELEVATED for up to 3 weeks
c. Myoglobin:
Increases within 1 hour and peaks
in 12 hours
NEGATIVE results are a good
thing.
d. Which cardiac biomarker is the
most sensitive indicator for an
MI? TROPONIN
e. Which enzymes or makers are most
helpful when the client delays seeking
care?
TROPONIN
4. Complications:
Major arrhythmias:
What untreated arrhythmias will
put the client at risk for sudden death?
VFIB
If the first shock doesnt work and
client remains in V-Fib, what is the
first
vasopressor we give? EPINEPRINE
Amiodarone (Cordarone) is an
anti-arrhythmic and is used when VFib is
resistant to treatment, and also for fast
arrhythmias. HYPOTENSION
What anti-arrhythmic drugs are
commonly given to prevent a second
episode of
V-Fib? AMIODARONE and
LIDOCANE.
Lidocaine toxicity: ANY NEURO
changes
Amiodarone (Cordarone) is the
first anti-arrhythmic of choice.
Important side effect?
HYPOTENSION
This hypotension can lead to further
arrhythmias.
Troponin
Isomers
T < 0.20
I < 0.03
5. Treatment:
What drugs are used for chest pain
when they get to the ED?
OXYGEN
ASPIRIN (chewable or
tablet?)CHEWABLE

NITROGLYCERINE
MORPHINE
Head up position and why?
DECREASE WORKLOAD ON
HEART
Decreases WORKLOAD on heart and
increases CARDIAC OUTPUT.
a. Fibrinolytics:
Goal: Dissolve the clot that is
blocking blood flow to the heart
muscle
decreases the size of the infarction. 30
MINS.
Medications: Streptokinase
(Streptase), Alteplase (t-PA),
Tenecteplase
(TNKase) (one time push),
Reteplase (Retavase)
How soon after the onset of
myocardial pain should these drugs be
administered? 6-8 HOURS
Brain attack? TIME IS BRAIN.
Major complication: BLEEDING
Obtain a BLEEDING history.
BLEEDING STROKES,
PREGNANCY, POST OP.
QUESTIONS RELATED TO
BLEEDING.
Absolute contraindications:
Intracranial neoplasm, intracranial
bleed, suspected aortic dissection,
internal bleeding
During and after administration we
take BLEEDING precautions.
Draw blood when starting IVs,
decrease the number of PUNCTURE
sites.
Follow-Up Therapy: Antiplatelets
are another important component of
fibrinolytic therapy.
Acetylsalicylic Acid (Aspirin),
Clopidogrel (Plavix), Abciximab
(ReoPro IV) (continuous infusion to
inhibit platelet aggregation)
Bleeding Precautions: Watch for
bleeding gums, hematuria and black
stools.
Use an electric razor, a soft
toothbrush, and No IMs.
b. Medical Interventions:
1) PCI (Percutaneous Coronary
Intervention):
Includes all interventions such as
PTCA (angioplasty) and stents
Major complication of the
angioplasty is a MYOCARDIAL
INFARCTION.
Dont forget client may bleed from
heart cath site.

If any problems occur go to

SURGERY.
Chest pain after procedure: call the
doctor at once re-occluding!
Anti-platelet medications:
Aspirin
Clopidogrel (Plavix)
Abciximab (ReoPro IV) Given to
high risk clients who have
been stented to keep artery open
those waiting to go to cath lab
Eptifibaride (Integrilin IV)
2) Coronary Artery Bypass Graft
(CABG)
Can be scheduled or emergency
procedure
Used with multiple vessel disease
LEFT MAIN artery occlusion
which supplies the entire left ventricle
c. Cardiac Rehabilitation:
Smoking cessation
Stepped-care plan (increase activity
gradually)
Diet changes- LOW fat, LOW salt,
LOW cholesterol
No isometric exercisesINCREASE workload of heart
No valsalva
No straining; no suppository;
Docusate (Colace)
When can sex be resumed? YES
What is the safest time of day for
sex? MORNING
Hurst Review Services 77
Best exercise for MI client?
WALKING.
Teach S/S of heart failure:
Weight GAIN
Ankle edema
Shortness of BREATH
Confusion
d. Pacemaker:
The heart has a natural
pacemaker called the SA node
(sinoatrial node).
This sends out impulses that make the
heart CONTRACT.
What happens to cardiac output if
your natural electrical system
malfunctions
and the heart rate drops below 60?
Cardiac output can
Pacemakers are used to increase
the heart rate with symptomatic
bradycardia.
Pacemakers depolarize the heart
muscle and a contraction will occur
(electricity going through the muscle).

Repolarization (ventricles are

resting and are filling up with blood).
RESTING!!
1) Temporary:
Used in EMERGENCY situations
After heart surgery
Acute MI
Until the client is stable enough for
a permanent pacemaker to be inserted
Can be classified as invasive or
noninvasive:
Noninvasive temporary pacing,
called transcutaneous pacing
Two large electrode pads are applied
to client and turned to the
PACING mode.
This is an EMERGENCY procedure.
Is it going to hurt? YES, the client will
need ANALGESICS.
Invasive temporary pacemaker
has pacing wires that are placed into
the heart CHAMBER (transvenous
pacing).
Wires are connected to power source
OUTSIDE the body.
Epicardial pacing is when the wires
are attached to the epicardium
during surgery.
2) Permanent Pacemakers:
Used when heart condition is
CHRONIC
Electrodes are anchored to the
endocardium and attached to a battery
source implanted into a subcutaneous
pocket.
A demand pacemaker kicks in only
when the client needs it to.
Fixed rate fires at a FIXED rate
constantly.
Its ok for the rate to increase but
never DECREASED.
Always worry if the rate DROPS
below set rate.
Post-Procedure Care:
Monitor the incision.
Most common complication in
early hours? Electrode displacement
Immobilize arm.
PROM to prevent frozen
SHOULDER
Keep the client from raising their
arm too high.
S/S of Malfunction:
Its possible that no mechanical
event or contraction follows the
stimuli.
This is called LOSS OF CAPTURE.
What causes this?
The pacemaker may not be
PROGRAMMED correctly.

Electrodes can DISLODGED.

Battery may be DEPLETED.
Any sign of decreased CO or
decreased RATE
Hurst Review Services 79
Client Education/Teaching:
Check PACEMAKER daily.
ID card
Avoid electromagnetic fields (cell
phones, large motors, arc
welding, electric substations).
Avoid MRIs.
Are they going to set off alarms at
airport? YES
Avoid contact sports.
IMPLANTABLE CARDIAC
DEVICE SPEED UP SLOW
RYTHM, SPEED DOWN FAST
RYTHM
F. Heart Failure (HF):
1. Causes:
HF is a complication that can result
from problems such as
cardiomyopathy,
valvular heart disease, endocarditis,
acute MI, and HYPERTENSION.
2. Types:
a. Left Side Failure: the blood is not
moving forward into the aorta and out
to my
bodyIF it does not move forward,
then it will go backwards into the
LUNGS.
S/S:
Pulmonary congestion
Dyspnea
Cough
Blood tinged frothy sputum
Restlessness
Tachycardia
S-3
Orthopnea
Nocturnal dyspnea
b. Right Side Failure: the blood is
not moving forward into the lungsIF
it does
not move forwards then it goes
backwards into the VENOUS system.
S/S:
Enlarged organs
Edema
Weight gain
Distended neck veins
Ascites
New Terminology: Systolic heart
failure: heart cant contract and eject.
Diastolic heart failure: ventricles
cant relax and fill.
3. Dx:
a. Pulmonary artery catheter (Swan
Ganz catheter):

A type of central line that measures

pressures inside the heart
Helps to determine the cause of
DECREASED cardiac output
Killer complications: AIR embolus,
PULMONARY infarction
b. A-line:
Measures BLOOD PRESSURE
continuously on a monitor
NEVER put medicine in an A-line.
A-lines are placed in what artery?
RADIAL
Allens test- a check for alternative
circulation.
Apply pressure to clients ulnar and
radial arteries at the same time, ask
client to open and close hand, hand
should blanch, release the pressure
from the ulnar artery while continuing
to compress the radial artery and
assess the color in the extremity distal
to the pressure point- pinkness
should return within 6 seconds
(indicating the ulnar artery is
sufficient to
provide hand with adequate
circulation if radial artery is occluded
with Aline).
This is considered a positive Allens
test.
You do have to be careful with an
A-line because if you do not have the
connections secure on your pressure
tubing or if you do not have the
stopcocks in the proper positions your
client could bleed out.
Check ALTERNATE circulation
while in place.
The 5-Ps: Pulselessness, Pallor, Pain,
Paresthesia, Paralysis
c. BNP: B-type natriuretic peptide:
Secreted by ventricular tissues in
the heart when ventricular volumes
and
pressures in the heart are increased
Sensitive indicator
Can be POSITIVE for HF when the
CXR does not indicate a problem
If the client is on Natrecor, turn it
off 2HOURS prior to drawing a BNP.
d. CXR: enlarged HEART, pulmonary
infiltrates
e. Echocardiogram
f. New York Heart Association
Functional Classification of Persons
with HF:
Classes 1-4 (Class 4 being worst)
4. Tx:
a. Medications:
1) Digitalis (Lanoxin)

Actions:
Used with atrial fibrillation and HF
Contraction?
Heart rate? ___________________
When the heart rate is slowed this
gives the ventricles more time to fill
with blood.
Cardiac output will go DOWN.
Kidney perfusion INCREASED.
Nursing Considerations:
Would diuresis be a good thing or
bad thing for this client? GOOD
THING
We always want to DIURESE heart
failure clientsthey cant handle
the fluid.
Digitalizing dose-loading dose .5-2
How do you know the Digoxin is
working? Because the cardiac output
Goes INCREASE
S/S of toxicity?
Early: Anorexia, nausea, and vomiting
Late: Arrhythmias and VISION
changes
Before administering do what?
CHECK APICAL PULSE
Monitor electrolytes
All electrolytes levels must remain
normal, but K+ is the one that
causes the most trouble.
(HYPOKALEMIA + DIGOXIN =
TOXICITY_)
Normal Dig level=
____to____ ng/ml
2) Diuretics: WILL DECREASE
PRELOAD
Examples: Furosemide (Lasix),
Hydrochlorothiazide (HCTZ),
Bumetanide (Bumex),
Hydrochlorothiazide/Triamterene
(Dyazide)
Action: Decrease PRELOAD
Nursing Considerations:
Aldactone may be given to decrease
aldosterone levels.
When do you give diuretics?
MORNING
3) ACE inhibitor/ARBs and/or a
Beta Blocker:
(See next page for examples)
These drugs will decrease the
workload in the heart, prevent
vasoconstriction (decreasing afterload)
which will increase cardiac
outputkeeping
the blood moving forward out of the
heart.
b. Low Na Diet:
Decrease PRELOAD.

Watch salt substitutes.

Salt substitutes can contain excessive
POTASSIUM.
Canned/processed foods & OTCs
can contain a lot of SODIUM.
c. Miscellaneous Information:
Elevate head of bed.
10 blocks under the head of the bed
Weigh daily (report gain of 2 to 3
lbs).
Report S/S of recurring failure.
*TESTING STRATGY*
Fluid retention-think Heart
Problems 1st.
ACE inhibitors
(angiotensin converting enzyme
inhibitor)
Actions: Uses:
Blocks conversion of angiotensin I to
angiotensin II Hypertension and heart
failure
What they do: promote vasodilation
and diuresis, Nursing Observations:
decreases the secretions of aldosterone
(so the If the drug ends in pril it is
most likely an ACE
kidneys will get rid of sodium and
water and retain inhibitor.
potassium). Watch for hyperkalemia,
orthostatic syncope,
Examples: hypotension, and renal
dysfunction.
Enalapril (Vasotec) Angioedemalaryngeal swelling, can be fatal
Fosinopril (Monopril) dry,
nonproductive cough-reversible when
drug
Captopril (Capoten) stopped.
Fall precautions.
ARBs
(angiotensin II receptor blockers)
Action: Uses:
Blocks effects of angiotensin II (a
potent Hypertension and heart failure.
vasoconstrictor) at the receptor site
(used as an Nursing Considerations:
alternative to ACE inhibitors) ACE
inhibitors block If the drug ends in
sartan it is most likely an ARB
the conversion of AI to AII but AII can
also be Watch for hyperkalemia,
hypotension, and renal
formed by other enzymes that are not
blocked by dysfunction..
ACE Inhibitors
What they do: decrease blood
pressure, increase
CO
Examples:
Valsartan (Diovan)

Losartan (Cozaar)
Irbesartan (Avapro)
Beta Adrenergic Blockers
Action: Uses:
Block adverse effects from
sympathetic nervous Angina, chest
pain. Hypertension, ventricular
stimulation. dysrhythmias and thyroid
storm.
What they do: block the receptor
sites for epi and Nursing
Consideration:
norepiso they will decrease
afterload and If the drug ends inlol it
is most likely a Beta
contractility.as a result they
decrease the BP and Blocker.
HR. Dont give to asthmatics (some
beta blockers also
Examples: constrict the smooth
muscle of the bronchioles)
Propranolol (Inderal) Dont give to
diabetics (block the sympathetic
Metoprolol (Lopressor/Toprol XL)
responses seen in hypoglycemia).
Atenolol (Tenormin)
Carvedilol (Coreg)
G. Pulmonary Edema:
1. Pathophysiology:
Heart isnt pumping strong, so
cardiac output goes down, and fluid
backs up into
the LUNGS.
2. S/S:
Severe hypoxia
When does this usually occur?
NIGHT
Sudden onset
Breathless
Restless/anxious
Productive cough (pink frothy
sputum)
3. Tx:
a. Medications:
1) Furosemide (Lasix)
Causes diuresis and vasodilation
which traps more blood out in the
arms
and legs and reduces PRELOAD and
AFTERLOAD
40 mg IV push over 1-2 minutes to
prevent HYPERTENSION and
ototoxicity
2) Bumetanide (Bumex)
Can be given IV push or as
continuous IV to provide rapid fluid
INTAKE.
1-2 mg IV push given over 1-2
minutes
3) Nitroglycerin IV (Nitro-Bid IV)

Vasodilation; DECREASED
afterload
Decreased afterload = increased
CO because the heart is pumping
against
less pressure and more blood can be
moved FORWARD.
4) Digoxin (Lanoxin)
Used to get the blood moving in a
FORWARD direction
5) Morphine (Morphine Sulfate)
2 mg IV push for vasodilation to
decrease preload and afterload
Hurst Review Services 85
6) Nesiritide (Natrecor)
Infusion; short term therapy; not to
be given more than 48 hours
Vasodilates veins and arteries and
has a diuretic effect
7) Milrinone (Primacor)
Continuous infusion
Vasodilates veins and arteries
8) Dobutamine (Dobutrex)
Increases cardiac output
b. Positioning:
UP RIGHT position, legs down
Improves BLOOD FLOW
Promotes POOLING of blood in lower
extremities
c. Prevention:
Prevention when possible:
Check LUNG SOUNDS
Avoid fluid volume
EXCESS/OVERLOAD.
H. Cardiac Tamponade:
1. Pathophysiology:
BLOOD, fluid, or exudates have
leaked into pericardial sac.
This can happen if the client has
had a motor vehicle collision, right
ventricular
biopsy, MI , pericarditis, or
hemorrhage post CABG.
2. S/S:
Decreased cardiac output
CVP will be .
BP will be dropping.
Heart sounds will be muffled or
distant.
Neck veins dilated
Pressures in all 4 chambers are the
same
Shock
Paradoxical pulse (pulsus
paradoxus)
This is when the BP is greater than 10
mm Hg higher on expiration than
on inspiration.

Narrowed pulse pressure (from the

baseline)
What is the pulse pressure? Its the
difference between the SYSTOLIC
and the DIASTOLIC.
3. Tx:
Pericardiocentesis to remove
FLUID from around the heart
Surgery
I. Arterial Disorders:
1. General Information:
a. Pathophysiology:
If you have atherosclerosis in one
place you have it everywhere.
It is a medical emergency if you
have an acute arterial OCCLUSION
(numb,
pain, cold, no pulse).
More symptomatic in LOWER
extremities
Intermittent claudicationhallmark PAIN ARTERIAL
PROBLEMS
Arterial blood isnt getting to the
TISSUE coldness, numbness,
decreased peripheral pulses, atrophy,
bruit, skin/nail changes, and
ulcerations.
Rest pain means SEVERE
obstruction.
b. Tx:
Since arterial blood is having
problems getting to the tissue, if you
elevated
the extremity the pain would increase
or decrease?
Arterial disorders if the lower
extremities are usually treated with
either
angioplasty, endarterectomy.
2. Types of Arterial Disorders:
a. Buergers Disease:
1) S/S:
Inflammation of ARTERIES and
VEINS.
Men
Heavy smoking, cold, emotions
Causes vasoconstriction of vessels
Lower extremities/sometimes
fingers.
2) Tx:
Avoid cause.
Stop smoking.
Avoid cold.
Hydration THINS OUT BLOOD
Bypass surgery

Wear shoes that fit well; avoid any

trauma to feet.
Gangrene amputation
b. Raynauds Disease:
1) S/S:
This occurs in the FEMALE client.
Happens in fingers (bilaterally,
usually in fingers tips)
Turns white, blue, red
Gets cold, upset, smokes
Painful, can cause ulceration
VASOCONSTRICTION
2) Tx:
Avoid the cause.
J. DVT (Deep Venous Thrombosis):
1. Pathophysiology:
Blood stasis, vessel injury, blood
coagulation.
The blood can get to the tissue, it
just cant get away.
2. S/S:

Edema
Tenderness
Warmth
HOMANS SIGN
3. Tx:
Anticoagulant drugs: Heparin,
Fibrinolytics, warfarin (Coumadin),
clopidogrel
(Plavix), Aspirin, enoxaparin
(Lovenox), or dipyridamole
(Persantine).
These drugs either prevent
aggregation or prevent the clot from
getting
bigger.
Limit foods with Vitamin K
/GREEN LEAFY VEGETABLES.
Surgery
Bed rest
Elevate- to increase blood return;
DECREASE pooling.
TED hose- to INCREASE venous
return; decrease pooling

Used with SCDs many times

With a known clot TEDs or SCDs
may not be used
Warm, moist heat- DECREASE
inflammation
Never cold on a vein= excessive
vasoconstriction
Never hot on a vein= excessive
vasodilation
Prevention is the key!
We AMBULATE and HYDRATE the
client.
Also for prevention we put on SCDs
and get the client to do isometric
exercises
*TESTING STRATEGY*
Never delay treatment.
Normal Lab Values:
(may vary with institutions):
aPTT: 30-40 seconds.
PT: 11.0-12.5 seconds
INR: 1.3-2.0