Labs, Tests and Treatments for the Cardiovascular System

Labs
Cardiac Enzymes
Creatine Kinase
Normal Values
Male

25 - 90 U/L

Female

10 - 70 U/L

CK is an enzyme found in striated muscle as well as a number of tissues such as kidney, lung, gastrointestinal tract
and brain, thus limiting its potential as a specific marker of cardiac damage. CK begins to rise in 3-8 hours, peaks at
24 hours and returns to normal after 72-96 hours.
CK-MB
Table Head
Adult

0 - 3 ng/mL

Elevation in the MB isoenzyme form of creatine kinase can be indicative of a myocardial infarction. The enzyme
is released into the blood stream as a result of cardiocyte cell membrane damage.CK-MB begins to rise 4-6 hours
after the onset of symptoms, peaks at 24 hours and returns to normal after 48-72 hours. It is useful for the detection
of re-infarction.
Troponin
Normal Values
Adult

0 - 0.4 ng/mL

Troponin is the most specific marker for cardiac muscle damage. Troponin can be detected 2-4 hours after injury
and will remain elevated for up to 2 weeks.
Homocysteine
Normal Values
Adult

5 - 15 mmol/L

Homocysteine is increased in:

MTHFR deficiency, B12, B6, and folate deficiency

Lipid Profile
Total Cholesterol
Normal Values
Adult

< 200 mg/mL

Total cholesterol is increased in:

Idiopathic hypercholesterolemia, biliary obstruction, pregnancy, nephrosis, hypothyroidism and OCPs

Total Cholesterol is decreased in:

Hepatitis, hyperthyroidism and malnutrition

High-Density Lipoprotein
Normal Values
Adult

30 - 80 mg/dL

HDL levels <40 mg/dL are associated with an increased risk of CAD.
HDL is increased in:

Premenopausal women, exercise and with nicotinic acid and gemfibrozil

HDL is decreased in:

Men, smokers, alcoholics and DM

Low-Density Lipoprotein (LDL)

Normal Values
Adult

50 - 190 mg/dL

LDL is increased with:

DM, hypothyroidism and excess saturated fat intake

LDL is decreased with:

Malabsorption and abetalipoproteinemia

Triglycerides
Normal Values
Adult

< 150 mg/mL

Triglycerides are increased with:

DM, pancreatitis, nephrotic syndrome, alcoholism and medications such as OCPs and Beta Blockers

Triglycerides are decreased with:

Malnutrition and medications such as nicotinic acid and gemfibrozil

Tests
Angiogram
Invasive imaging procedure using contrast dye to visualize blood vessels. In a cardiac
catheterization contrast dye is used to evaluate the coronary arteries to assess for degree of
atherosclerosis.
Arterial (N = 100-140/70-90 mm Hg) and pulmonary (N = 15-30/3-12 mm Hg) pressures can
also be determined.

Non-surgical procedure often performed during cardiac catheterization for the treatment of
coronary artery disease. Occluded coronary arteries are opened using a flexible catheter and balloon.
Stents may be placed at this time.

Figure4.2.2 Angioplasty Echocardiogram

Ultrasound used to evaluate cardiac chamber size, ejection fraction, valvular damage and endocarditis.
Transthoracic Echocardiogram (TTE): Transducer is placed on the chest wall of the patient
Transesophageal Echocardiogram (TEE): Probe is passed into the esophagus of the patient. Once in place it
is closest anteriorly to the left atrium which forms the posterior portion of the heart anatomically.
Stress echocardiogram: Performed during exercise or stress to evaluate cardiac wall motion
MUGA scans are used to evaluate coronary artery disease, congestive heart failure and valvular heart disease.
Electrocardiogram
The EKG is a test used to assess the electrical activity of the heart. See the EKG section in the cardiovascular system
chapter for further details.
Multigated Acquisition Scan (MUGA scan)
A noninvasive, nuclear imaging test used to evaluate the functional capacity of the heart. Radioactive tracer is used
to evaluate the ejection fraction, ventricular wall motion and chamber size. This information is evaluated with a
simultaneous EKG.
Venogram
Venous system is imaged during intravascular injection of contrast agent.

Treatments
Coronary Artery Bypass Grafting (CABG)
Surgical procedure for the treatment of coronary artery disease. Grafted arteries or veins
(commonly left internal thoracic artery or great saphenous vein) bypass the occluded
coronary arteries. CABG is used in the treatment of multi-vessel disease and in patients
with diabetes.
Pacemaker
Pacemakers are electronic devices placed into people hearts in order to help them maintain
a normal heart rate and rhythm.
A biventricular pacemaker can have up to three leads. The leads are placed through the left
subclavian vein and into the superior vena cava. One lead terminates in the right atrium,
one in the right ventricle and the third is placed into the coronary sinus which is in the
atrioventricular groove on the posterior aspect of the heart and advanced in to the lateral
venous tributary to pace the left ventricle.

Pulmonary Artery Catheter (Swan-Ganz)

Figure 4.2.4 Pulmonary Artery Catheter (Swan-Ganz)
The pulmonary artery catheter is used to monitor critically ill patients with
conditions such as congestive heart failure and sepsis. The various ports
allow for the administration of medications, measurements of pressures in the
right atrium, right ventricle, pulmonary artery, and the filling or "wedge"
pressure of the left atrium.