LAB INVESTIGATIONS

IN CARDIOLOGY

Tipsy Antony
Topics
CBC
RFT
 LFT
CARDIAC ENZYMES
BLOOD COAGULATION TESTS
LIPID PROFILE
C Reactive Protein
 BLOOD GLUCOSE
COMPLETE BLOOD CELL COUNT
COMPONENT NORMAL VALUE INCREASED IN DECREASED IN

HB 12-15 GM/DL Congenital heart Anemia

disease Hemorrhage
COPD
Heart failure
Dehydration

RBC 3.8-4.8 million/mic CKD CIRRHOSIS

l CANCER

Haematocrit 40-50% CHD Blood loss

Heart Failure Leukemia
Dehydration Iron and folic acid
Polycythaemia deficiency
Hypovolemic haemolysis (from
shock prosthetic valves)
COMPLETE BLOOD CELL COUNT

COMPONENT NORMAL VALUE INCREASED IN DECREASED IN

WBC 4000-11000 infectious and Aplastic anemia

cells/ml inflammatory Chemotherapy
diseases of the Leukemia
heart and after Rheumatoid
myocardial arthritis
infarction.

PLATELETS 1.5-4.5 Lakh Allergic reaction Aplastic anemia

Cancers DIC
Hemolytic anemia Antiplatelet
medications
MCV,MCH, MCHC ,RDW
• Red Cell Indices
• define the size (MCV) and hemoglobin content (MCH, MCHC) of red
blood cells.
• useful in elucidating the etiology of anemias.
• Red cell indices can be calculated if the values of hemoglobin,
hematocrit (packed cell volume), and red blood cell count are known.
• red cell distribution width (RDW)
Renal function test

COMPONENT NORMAL VALUE INCREASED IN DECREASED IN

urea 17-49 mg/dl Kidney dysfunction -

dehydration
High protein diet
Burns

Creatinine 0.5-0.9mg/dl Kidney dysfunction -

Uric acid 2.4-5.7mg/dl

RFT – electrolytes

COMPONENT NORMAL VALUE INCREASED IN DECREASED IN

Sodium 135-145 mmol/l Kidney dysfunction diuretics

Dehydration Addison disease
SIADH
Potassium 3.5-4.5mmol/l Kidney and Diuretic therapy,
endocrine vomiting, diarrhea
disorders and alkalosis.
RFT – electrolytes
COMPONEN NORMAL INCREASED IN DECREASED IN
T VALUE

Calcium 8.6-10 mg/dl Thiazide diuretic use, Multiple transfusions

acidosis, adrenal of citrated blood,
insufficiency, immobility renal failure, alkalosis,
and vitamin D excess and laxative and
antacid abuse
(phosphate excess)

Phosphorous 2.5-4.5 mg/dl Chronic renal failure Hyperparathyroidism,

Skeletal disease diabetic ketoacidosis,
prolonged use of IV
Those undergoing dextrose infusions, or
chemotherapy renal tubular acidosis.
LFT
BILIRUBUN - NORMAL – 0-1.2MG/DL
• ALT-<33U/L (Acute liver injury )
• AST -32 U/L
• ALP -35-104U/L( related to bile stasis )
• TOTAL PROTEIN -6.4-8.3 GM/DL
• ALBUMIN -4-4.9 GM/DL
• GLOULIN -3-3.7 GM/DL
• AG RATIO – 0.8-2
LOW IN KIDNEY,LIVER DYSFUNCTION, MAL NUTRITION
 CARDIAC ENZYMES- extent of myocardial injury

 Special proteins - catalyze chemical reactions in

living cells.
 Present in high concentration in myocardial tissue.
 Tissue damage causes release from their
intracellular storage areas.
 This leakage - detected by rising plasma levels.
 Level reflects myocardial integrity or infarction
(cellular death).
 MARKERS TIME OF INITIAL Normal value TIME OF PEAK TIME TO
ELEVATION ELEVATION RETURN
TO
NORMAL

CK-MB 6-8 Hrs 0-9U\L 14-36Hrs 48-72Hrs

MYOGLOBIN 30Min-1 hrs <92ng\ml in men and 6-8hrs 24hrs

<72ng\ml in momen

Trop I(renal 3-6 hrs <0.4ng\ml 12hrs 4-7days

failure pts )
Higher specificity <0.1ng\ml
Trop T

80% clients – Elevated LDH within 48 hours after myocardial infarction.

 BLOOD COAGULATION TESTS

• Used to examine the ability of blood to clot.

• Prothrombin Time and Partial Thromboplastin Time.
• Evaluate coagulation tests in people with a greater tendency to form thrombi
(clients with atrial fibrillation, infective endocarditis, or prosthetic valves)
• Increase in coagulation factors during and after a myocardial infarction.
BLOOD COAGULATION TESTS

• Prothrombin Time : 10-14 sec

• INR - <1.1 for warfarin therapy pts 2-3

• Activated Partial Thromboplastin Time: 24-36sec

Prothrombin time/INR increased in
• Liver disease
• vitamin k deficiency
• Factor 7 deficiency
• Disseminated intervascular coagulation(DIC)
• increased warf dose
APTT test
• coagulation factors
• when on heparin therapy
• for heparin therapy – therapeutic value is 1.5-2
times normal value
 SERUM LIPIDS

• Elevated blood cholesterol - major risk factor in the

development of atherosclerosis.

• Low- Density Lipoprotein Cholesterol (LDL-C).

• CHD- Risk increases as blood levels of LDL-C increase.

 SERUM LIPIDS( CONTD...)

• High- Density Lipoprotein Cholesterol (HDL-C).

• Composed of fatty substances - insoluble in water.

• Derived from fats in the diet or synthesized in the
liver.

• Lipid Profile -Serum Cholesterol, Triglyceride, and

Lipoprotein Levels.

• Used to assess - risk for CHD.

 SERUM LIPIDS( CONTD...)

• Cholesterol : 140- 200 mg/dl

• HDL :> 60mg/dl
• LDL :<130mg/dl
• Triglycerides: 40-150mg/dl
 C -REACTIVE PROTEIN

• An acute phase protein

• Measure of the presence and degree of inflammation
• Atherosclerosis - chronic low-grade inflammatory
condition.
• Strong independent predictors of future coronary events.
• A marker for events involving atherosclerotic plaque
rupture and acute thrombosis
 C -REACTIVE PROTEIN
o Normal: <1mg/l

o Moderate risk: 1-3mg/l

o High risk: >3mg/l

BLOOD GLUCOSE
Diabetes mellitus -major risk factor - atherosclerosis.

• Stress of an acute cardiac event - unstable hyperglycemia

(with latent diabetes mellitus).
• American Heart Association –
• Normal FBS- <110mg/dl.
• Diabetic appropriate hypoglycaemic therapy - achieve near
normal FBG- HbA1c< 7% to prevent heart attack and stroke.
 NURSES RESPONSIBILITY IN COLLECTION OF
BLOOD
• Explain the procedure- tests being performed, why they

have been ordered, and when results will be available.

• Check whether the client is taking any blood thinners

• Document the last time of drug taken if it is necessary

• Universal precautions - use of gloves, complete

avoidance of recapping the needles, proper disposal of

sharps, and proper hand washing.

NURSES RESPONSIBILITY IN COLLECTION OF
BLOOD(Contd...)

• Follow institutional policies

• Handle blood samples carefully.

• Avoid vigorous handling of specimens, which

may lead to haemolysis.

• Apply pressure to the puncture site until bleeding

stops.

• Assess the site for hematoma formation.