Diagnostic Evaluation of the Heart

Laboratory Tests  A 12-hour fast is necessary before drawing

 Cardiac Biomarker Analysis blood samples from patients for accurate
 Lipid Profile serum measurement.
 Cholesterol levels Results:
 Triglycerides Optimal: less than 12 mcmol/L
 Brain (B-Type) Natriuretic Peptide Borderline: 12 to 15 mcmol/L
 C-Reactive Protein High risk: greater than 15 mcmol/L
 Homocysteine
 Electrocardiography (ECG/EKG)
 Cardiac Biomarker Analysis  It is a graphic representation of the
 Used for the diagnosis of electrical currents of the heart.
Myocardial Infarction.  It is done by placing electrodes in
 Myocardial cells that become standard position on the skin of the
necrotic from prolonged ischemia chest wall and extremities.
or trauma release specific  The standard 12-lead ECG is used
enzymes (Creatine Kinase[CK]), to diagnose dysrhythmias,
CK isoenzymes (CK-MB), and conduction abnormalities, and
proteins (myoglobin, Troponin-T, chamber enlargement, as well as
and Troponin-1) myocardial ischemia, injury, and
infarction.
 Lipid Profile  It can also suggest cardiac effects
 Cholesterol, triglycerides, and of electrolyte imbalance (high
lipoproteins are measured to and low calcium and potassium
evaluate a person’s risk of levels).
developing CAD.
 Although cholesterol levels remain  ECG Components and Intervals
relatively constant over 24 hours,  The P wave is a record of the
the blood specimen for the lipid electrical activity through the upper
profile should be obtained after a heart chambers (atria).
12-hour fast.  The QRS complex is a record of the
 Total Blood Cholesterol movement of electrical impulses
Desirable: less than 200 mg/dL through the lower heart chambers
Borderline high: 200-239 mg/dL (ventricles).
High: over 240 mg/dL  The ST segment shows when the
 Low-density Lipoprotein ventricle is contracting but no
Optimal: less than 100 mg/dL electricity is flowing through it. The ST
Near optimal: 100-129 mg/dL segment usually appears as a
Borderline high: 130-159 mg/dL straight, level line between the QRS
High: 160-189 mg/dL complex and the T wave.
 High-density Lipoprotein  The T wave shows when the lower
Optimum level: 60 or more mg/dL heart chambers are resetting
Risk factor for heart disease: below 40 mg/dL electrically and preparing for their
 Triglycerides next muscle contraction.
Normal: less than 150 mg/dL
Borderline-high: 160-199 mg/dL
High: 200-399 mg/dL
Very high: 500 mg/dL

 Homocysteine
 It is an amino acid linked to the development of
atherosclerosis
because it can damage the endothelial lining of
arteries and promote thrombus formation.
 Elevated blood levels of homocysteine is thought
to indicate a high
risk of CAD, stroke, and peripheral vascular disease.
 ECG Lead Placement
 Nursing Interventions for Inpatient
Cardiac Monitoring
 To minimize false alarms, proper skin preparation
before applying electrodes and changing the
electrodes every 24 hours. Check for allergic
responses to the adhesives and electrode gel.
 Proper positioning of the electrodes to avoid the
occurrence of artifact (which is abnormal ECG
pattern caused by muscular activity, patient
movement, electrical interference or lead cable or
electrode malfunction). Artifact can mimic
dysrhythmias and cause false alarms.
 The nurse’s role is to respond to and correct all
monitor alarms immediately.
 Keep the equipment clean to prevent hospital-
acquired infections.
 Cardiac Stress Testing
 2 types:
Exercise stress test
Pharmacologic stress test
 The stress test helps determine the following:
1. Presence of CAD
2. Cause of chest pain
3. Functional capacity of the heart after MI or heart
surgery
4. Effectiveness of antianginal or antiarrhythmic
medications
5. Occurrence of dysrhythmias
6. Specific goals for a physical fitness program
 Contraindications to Cardiac Stress
Testing
 Acute MI within 48 hours
 Unstable angina pectoris
 Uncontrolled dysrhythmias with
hemodynamic compromise
 Severe aortic stenosis
 Acute myocarditis or pericarditis
 Decompressed HF
 Exercise Stress Test
 Patient walks on a treadmill or
pedals a stationary bicycle.
 During the test, the following are
monitored:
 2 or more ECG leads for heart rate,
rhythm, and ischemic changes.
 BP, skin temperature, physical
appearance, perceived exertion,
and symptoms including chest
pain, dyspnea, dizziness, leg
cramping and fatigue.
 Test is terminated when the target
heart rate is achieved or if the
patient has signs of MI.
 Nursing Interventions
 Instruct patient to fast for at least 3 hours prior
to the test and to avoid stimulants such as
caffeine and tobacco.
 The doctor may instruct the patient not to take
cardiac medications such as beta-blockers
before the test.
 Clothes and sneakers (rubber soled shoes)
suitable for exercise should be worn by the
patient.
 Nurse must explain the procedure to the
patient.
 Monitor the patient for 10-15 minutes after the
procedure.
 Pharmacologic Stress Testing
 Recommended for patients who are cognitively
impaired and unable to follow directions or
physically disabled.
 Vasodilating agents such as dipyridamole
(Persantine), adenosine(Adenocard), or
regadenoson (Lexiscan) given as an IV
infusion are used to mimic the effects of
exercise by maximally dilating normal coronary
arteries.
 The side effects of these agents are: chest
pain, headache, flushing, nausea, heart block,
and apnea.
 If necessary the effects of the drugs can be
reversed with IV aminophylline.
 Dobutamine is another option since it is a
sympathomimetic.
 Nursing Interventions
 Patient is instructed not to eat or drink 3 hours
prior to the test.
 The patient is instructed to refrain from eating
any liquids or foods that contain chocolate or
caffeine for 24 hours.
 If caffeine is taken in by the patient, then the
test is rescheduled.
 Patients taking aminophylline, theophylline, or
dipyridamole are instructed to stop taking the
medication for 24 to 48 hours before the test.
 Transthoracic Echocardiography
 It is a noninvasive ultrasound test that is used
to measure the ejection fraction and examine
the size, shape, and motion of cardiac
structures.
 Useful in diagnosing pericardial effusions,
determining chamber size, and etiology of heart
murmurs; evaluating the functionality of the heart
valves, including prosthetic heart valves; and
evaluating ventricular wall motion.
 Nursing Interventions
 Explain the procedure to the patient, wherein the
test takes place within 30-45 minutes.
 Advise that gel will be used on the chest in order
to move the transducer onto the surface of the
skin.
 Provide privacy to the patient.
 Cardiac Catheterization
It is a common invasive procedure used to

diagnose structural and functional diseases of the
heart and great vessels.
 It involves the percutaneous insertion of
radiopaque catheters into a large vein or artery.
 Fluoroscopy is used to guide the advancement of
the catheters to the right or left side of the heart,
referred to as right and left heart catheterization.
 Right Heart Catheterization
 It usually precedes left heart catheterization.
 Performed to assess the function of the right
ventricle and tricuspid and pulmonary valves.
 The procedure involves the passage of a catheter
from an antecubital or femoral vein into the right
atrium, right ventricle, pulmonary artery, and
pulmonary arterioles.
 Pressures and oxygen saturation from each of the
areas are obtained and recorded to determine
pulmonary hypertension.
 A biopsy of a small piece of myocardial tissue can
also be obtained to detect for the presence of
cardiomyopathy.
 Left Heart Catheterization
 Prior to the procedure, patients who have
previously experienced reaction to a contrast
agent are premedicated with antihistamines
(e.g.diphenhydramine [Benadry]) and
corticosteroids (e.g. prednisone).
 It is performed to evaluate the aortic arch and its
major branches, patency of the coronary arteries,
and the function of the left ventricle and the
mitral and aortic valves.
 The cardiologist inserts the catheter into the
right brachial artery or a femoral artery and
advances it into the aorta and left ventricle.
 Angiography is performed in this procedure as
well as coronary angiography.
 Nursing Interventions before
Cardiac Catheterization
 Instruct the patient to fast 8-12 hours prior to
the procedure.
 Inform patient that the procedure is done at the
OPD.
 Inform the patient about the sensations that will
be expected during catheterization.
 Palpitation
 Flushed feeling throughout the body
during injection of the contrast agent
 Encourage the patient to express fears and
anxieties.
 Assess for allergies in seafood prior to the
procedure.
 Nursing Interventions after Cardiac
Catheterization
 Observe the catheter access site for bleeding
or hematoma formation and assessing
peripheral pulse in the affected extremity, BP,
and HR every 15 minutes for 1 hour, every 30
minutes for 1 hour, and hourly for 4 hours or
until discharge.
 Evaluating the temperature, color, and capillary
refill of the affected extremity during the same
time intervals.
 Screening carefully for dysrhythmias by
observe the cardiac monitor or by assessing
the apical and peripheral pulses for changes in
rate and rhythm.
 Maintaining bed rest for 2 to 6 hours after the
procedure.
 Instruct patient to report chest pain and
bleeding or sudden discomfort from the
insertion site.
 Monitoring the patient for contrast-induced
nephropathy by checking the creatinine levels.