Cardiovascular Disorders

Diagnostic Examination

Mark Job Bascos, PhD, RN

LORMA College of Nursing
 Learning Objectives
At the end of the presentation, the learners will
be able to:
1. Identify the different diagnostic examinations
in cardiovascular disorders.
2. Analyze and integrate the diagnostic
examinations in the plan of care of patients
with cardiovascular disorders.
 Topic contents
1. Cardiac proteins and enzymes
ü CK-MB
ü Lactate dehydrogenase
ü Troponin
ü Myoglobin
ü Serum lipid profile
ü High-sensitivity C-reactive protein (hsCRP)
 Topic contents
2. Blood Studies
ü Complete Blood Count (CBC)
ü Coagulation factor
ü Erythrocyte Sedimentation Rate (ESR)
ü Serum Potassium Test
ü Serum Sodium Test
ü Serum Calcium Test
ü Blood Urea Nitrogen (BUN)
ü Blood Glucose
ü B-type Natriuretic Peptide (BNP)
 Topic contents
3. Chest x-ray
4. Electrocardiogram
5. Holter monitor
6. Echocardiogram
7. Phonocardiogram
8. Stress test
9. Cardiac catheterization
CARDIAC PROTEINS AND ENZYMES
 CK-MB
Creatine kinase-MB (CK-MB) is a form of
an enzyme found primarily in heart muscle
cells.

CK-MB is one of three forms (isoenzymes) of

the enzyme creatine kinase (CK). These
include:
• CK-MM (skeletal muscles and the heart)
• CK-MB (mostly in the heart, but small
amounts in skeletal muscles)
• CK-BB (mostly in the brain and smooth
muscle, such as the intestines and uterus)
 CK-MB
Increased CK-MB can usually be detected in someone with a heart
attack about 3-6 hours after the onset of chest pain.

Peaks in 12-24 hours

Returns to normal within about 48-72 hours.

 CK-MB
Normal value is 0(3)% to 5% of total CK

Total CK is 26 to 174 units/L.

CK-MB Normal Range:

5-25 IU/L

Women: Less than 4.4 ng/mL.

Men: Less than 7.8 ng/mL.

Note!
An elevation in value indicates myocardial damage.
 LACTATE DEHYDROGENASE (LDH)
LDH is a type of protein, known as an enzyme.

It is found in almost all the body's tissues, including those in the blood,
heart, kidneys, brain, and lungs.

An LDH test is most often used to:

• Find out if you have tissue damage
• Monitor disorders that cause tissue damage. These include anemia,
liver disease, lung disease, and some types of infections.
• Monitor chemotherapy for certain types cancer.
 LACTATE DEHYDROGENASE (LDH)

Normal value: 140 to 280 international units/L.

Elevations in LDH levels occur 24 hours following myocardial

infarction and peak in 48 to 72 hours.

LDH-1 is found primarily in heart muscle and red blood cells.

LDH-2 is concentrated in white blood cells.

Adult/older adults: LDH-1: 17% to 27% LDH-2: 29% to 39%

 TROPONIN
Troponin is a type of protein found in cardiac muscles.

As heart damage increases, greater amounts of troponin are

released in the blood.
 TROPONIN
Troponin is composed of three proteins:
1. Troponin C
2. Troponin I
3. Troponin T.

Normal values:
lower than 0.6 ng/mL
0 to 0.2 ng/mL

Troponin I especially has a high affinity for myocardial injury; it rises

within 3 hours and persists for up to 7 to 10 days.

Other reasons for higher than normal troponin levels include:

• Congestive heart failure
• Kidney disease
• Blood clot in your lungs
 MYOGLOBIN
It is a protein found in your skeletal and heart muscles.
 MYOGLOBIN
Normal values: 5 to 70 mcg/L

The level rises within 2 hours after cell death, with a rapid decline in
the level after 7 hours.
 SERUM LIPID PROFILE
The test includes four basic parameters:
1. Total cholesterol
2. HDL cholesterol
3. LDL cholesterol
4. Triglycerides.
 SERUM LIPID PROFILE
Normal values:
ü Serum cholesterol: <200 mg/dL
ü LDL: < 130 mg/dL
ü HDL: 30 to 70 mg/dL
ü Triglycerides: <150 mg/dL

Lipoprotein-a or Lp(a), a modified form of LDL, increases

atherosclerotic plaques and increases clots; value should be less than
30 mg/dL
 HIGH-SENSITIVITY C-REACTIVE
PROTEIN (hsCRP)
ü a marker of inflammation
ü C-reactive protein (CRP) is a protein made by the liver.
BLOOD STUDIES
 COMPLETE BLOOD COUNT (CBC)
A complete blood count (also known as CBC) is a test that
provides information about several features and
components of your blood, including:

• Red blood cells

• White blood cells
• Hb or Hbg (hemoglobin)
• Hct (hematocrit)
• Platelets
 COMPLETE BLOOD COUNT (CBC)
The results of the test can show a variety of health conditions. Some
common examples are:

• Anemia
• Polycythemia
• Leukocytosis
• Leukopenia
• Thrombocytosis
• Thrombocytopenia
 COMPLETE BLOOD COUNT (CBC)
RBC count – women – 4.2-5.4M/mm3; men – 4.7-6.1M/mm3
HEMOGLOBIN – women -12-16g/dl; men – 13-18 g/dl
HEMATOCRIT – women 36-42 %; men – 42-48%
RBC INDICES – MCV (mean corpuscular volume); MCH (mean
corpuscular hemoglobin); MCHC (mean corpuscular hemoglobin
concentration)
COMPLETE BLOOD COUNT (CBC)
 COAGULATION FACTOR

BLEEDING TIME – measures the ability to stop bleeding after small

puncture wound.
NORMAL VALUE – 2.75-8 mins

PARTIAL THROMBOPLASTIN TIME - used to identify deficiency

of coagulation factors, prothrombin and fibrinogen; monitors heparin
therapy.
NORMAL VALUE – 60-70 Seconds

PROTHROMBIN TIME – determines activity and interaction of the

PT group clotting factors; used to determine dosages of oral anti-
coagulant
NORMAL VALUE – 12-14 seconds
 ERYTHROCYTE SEDIMENTATION RATE
(ESR)
• it is a measurement of the rate at which RBCs settle out of
anticoagulated blood in an hour
• It is elevated in infectious heart disorders or myocardial infarction
• Non specific inflammatory test
• NORMAL VALUES: men: 15-20 mm/hr; women: 20-30
mm/hr
 POTASSIUM BLOOD TEST

Electrolytes are electrically charged minerals that help control fluid

levels and the balance of acids and bases (pH balance) in your body.
They also help control muscle and nerve activity and perform other
important functions.

Cells, nerves, heart, and muscles need potassium to work properly

Normal results are about: 3.5 to 5.2 mEq/L for adults.

 POTASSIUM BLOOD TEST

Hypokalemia causes increased cardiac electrical instability, ventricular

dysrhythmias, and increased risk of digoxin toxicity.

Flattening and inversion of the T wave, the appearance of a U wave,

and ST depression
 POTASSIUM BLOOD TEST

Hyperkalemia causes asystole and ventricular dysrhythmias.

tall peaked T waves, widened QRS complexes, prolonged PR intervals,

or flat P waves
 POTASSIUM BLOOD TEST

If potassium levels are too high (hyperkalemia), symptoms may include:

• Arrhythmia
• Fatigue
• Muscle weakness
• Nausea
• Numbness or tingling

If potassium levels are too low (hypokalemia), symptoms may include:

• Irregular heartbeat
• Muscle cramps
• Weak or twitching muscles
• Fatigue
• Nausea
• Constipation
 SODIUM BLOOD TEST

They help control the amount of fluid and the balance of acids and
bases (pH balance) in your body. Sodium also helps your nerves and
muscles work properly.

Normal sodium levels:135 and 145 millimoles per liter (mmol/L).

 SODIUM BLOOD TEST

Symptoms of high sodium levels (hypernatremia) include:

• Thirst
• Urinating (peeing) very little
• Vomiting
• Diarrhea
• Confusion
• Muscle twitching
• Seizures

Symptoms of low sodium levels (hyponatremia) include:

• Weakness
• Fatigue
• Confusion
• Muscle twitching
• Seizures
 CALCIUM BLOOD TEST

Serum calcium is usually measured to screen for or monitor bone

diseases or calcium-regulation disorders (diseases of the parathyroid
gland or kidneys).

Normal: 8.5 to 10.2 milligrams/deciliter (2.15 to 2.55 millimoles/liter).

 CALCIUM BLOOD TEST
Hypocalcemia:
• ventricular dysrhythmias
• prolonged ST and QT intervals
• cardiac arrest

Hypercalcemia:
• shortened ST segment and widened T wave
• atrioventricular block
• tachycardia or bradycardia
• digitalis hypersensitivity
• cardiac arrest
 BLOOD UREA NITROGEN (BUN)
A blood urea nitrogen (BUN) test measures the amount of urea
nitrogen in your blood.

Urea nitrogen is a waste product.

BUN: elevated in heart disorders that adversely affect renal circulation,

such as heart failure and cardiogenic shock
 BLOOD UREA NITROGEN (BUN)

Age and Sex Normal BUN Level

(mg/dL)
Children between 1 and 17 years. Between 7 and 20 mg/dL.
Adult women Between 6 and 21 mg/dL.
Adult men Between 8 and 24 mg/dL.

Persistent high BUN levels in hospital are associated with an increased

risk of cardiovascular death and HF readmission.
 BLOOD UREA NITROGEN (BUN)

Generally, a high BUN level means your kidneys aren't working well.
But elevated BUN can also be due to:
• Dehydration, resulting from not drinking enough fluids or for other
reasons
• Urinary tract obstruction
• Congestive heart failure or recent heart attack
• Gastrointestinal bleeding
• Shock
• Severe burns
• Certain medications, such as some antibiotics
• A high-protein diet
 BLOOD GLUCOSE

Blood glucose: An acute cardiac episode can elevate the blood glucose
level.

Normal fasting blood glucose: 70 mg/dL (3.9 mmol/L) and 100 mg/dL
(5.6 mmol/L).
 B-TYPE NATRIURETIC PEPTIDE (BNP)
• This blood test measures the levels of a protein called BNP in your
bloodstream. When your heart has to work harder to pump blood, it
makes more BNP. Higher levels of BNP can be a sign of heart
failure.

• Normal BNP levels: <100 picograms per milliliter (pg/mL).

• BNP levels over 100 pg/mL may be a sign of heart failure.
 CHEST X-RAY
Chest X-rays produce images of the heart, lungs, blood vessels, airways,
and the bones of your chest and spine. Chest X-rays can also reveal fluid
in or around your lungs or air surrounding a lung.
 CHEST X-RAY

A chest X-ray can reveal many things inside your body, including:

The condition of your lungs. Chest X-rays can detect cancer, infection or air
collecting in the space around a lung, which can cause the lung to collapse. They can
also show chronic lung conditions, such as emphysema or cystic fibrosis, as well as
complications related to these conditions.
 CHEST X-RAY

A chest X-ray can reveal many things inside your body, including:
Heart-related lung problems. Chest X-rays can show changes or problems in your
lungs that stem from heart problems. For instance, fluid in your lungs can be a result of
congestive heart failure.
 CHEST X-RAY

A chest X-ray can reveal many things inside your body, including:

The size and outline of your heart. Changes in the size and shape of your heart may
indicate heart failure, fluid around the heart or heart valve problems.
 CHEST X-RAY

A chest X-ray can reveal many things inside your body, including:

Blood vessels. Because the outlines of the large vessels near your heart — the aorta
and pulmonary arteries and veins — are visible on X-rays, they may reveal aortic
aneurysms, other blood vessel problems or congenital heart disease.
 CHEST X-RAY
A chest X-ray can reveal many things inside your body, including:

Fractures. Rib or spine fractures or other problems with bone may be seen on a chest
X-ray.
 CHEST X-RAY
A chest X-ray can reveal many things inside your body, including:

Calcium deposits. Chest X-rays can detect the presence of calcium in the heart or
blood vessels. Its presence may indicate fats and other substances in your vessels,
damage to your heart valves, coronary arteries, heart muscle or the protective sac that
surrounds the heart.
 CHEST X-RAY
A chest X-ray can reveal many things inside your body, including:

Postoperative changes. Chest X-rays are useful for monitoring the recovery after
you've had surgery in your chest, such as on your heart, lungs or esophagus.

A pacemaker, defibrillator or catheter. Pacemakers and defibrillators have wires

attached to the heart to help control heart rate and rhythm. Catheters are small tubes
used to deliver medications or for dialysis. A chest X-ray usually is taken after
placement of such medical devices to make sure everything is positioned correctly.
 CHEST X-RAY
Nursing Responsibilities for Chest X-ray
The following are the nursing interventions before chest x-ray:

• Remove all metallic objects. Items such as jewelry, pins, buttons etc can hinder the
visualization of the chest.

• No preparation is required. Fasting or medication restriction is not needed unless

directed by the health care provider.

• Ensure the patient is not pregnant or suspected to be pregnant. X-rays are

usually not recommended for pregnant women unless the benefit outweighs the risk
of damage to the mother and fetus.

• Assess the patient’s ability to hold his or her breath. Holding one’s breath after
inhaling enables the lungs and heart to be seen more clearly in the x-ray.

• Provide appropriate clothing. Patients are instructed to remove clothing from the
waist up and put on an X-ray gown to wear during the procedure.

• Instruct patient to cooperate during the procedure. The patient is asked to

remain still because any movement will affect the clarity of the image.
 ELECTROCARDIOGRAM (ECG)
An electrocardiogram (ECG) is a simple test that can be used to
check your heart's rhythm and electrical activity.

An ECG can help detect:

•arrhythmias
•coronary heart disease
•heart attacks
•cardiomyopathy
 ELECTROCARDIOGRAM (ECG)
There are 3 main types of ECG:
a resting ECG – carried out while you're lying down in a comfortable
position
a stress or exercise ECG – carried out while you're using an exercise
bike or treadmill
an ambulatory ECG (sometimes called a Holter monitor) – the
electrodes are connected to a small portable machine worn at your waist
so your heart can be monitored at home for 1 or more days
 ELECTROCARDIOGRAM (ECG)
Nursing Responsibilities
Before the procedure
• Explain the procedure to the patient. Inform the patient that echocardiography is
used to evaluate the size, shape, and motion of various cardiac structures. Tell who
will perform the test, where it will take place, and that it’s safe, painless, and
noninvasive.
• No special preparation is needed. Advise the patient that he doesn’t need to restrict
food and fluids for the test.
• Ensure to empty the bladder. Instruct patient to void prior and to change into a
gown.
• Encourage the patient to cooperate. Advise the patient to remain still during the
test because movement may distort results. He may also be asked to breathe in or out
or to briefly hold his breath during the exam.
• Explain the need to darken the examination field. The room may be darkened
slightly to aid visualization on the monitor screen, and other procedures (ECG and
phonocardiography) may be performed simultaneously to time events in the cardiac
cycles.
• Explain that a vasodilator (amyl nitrate) may be given. The patient may be asked
to inhale a gas with a slightly sweet odor while changes in heart functions are
recorded.
 ELECTROCARDIOGRAM (ECG)
Nursing Responsibilities
During the procedure
The following are the nursing considerations during an echocardiogram:
• Inform that a conductive gel is applied to the chest area. A conductive gel will be
applied to his chest and a quarter-sized transducer will be placed over it. Warn him
that he may feel minor discomfort because pressure is exerted to keep the transducer
in contact with the skin.
• Position the patient on his left side. Explain that transducer is angled to observe
different areas of the heart and that he may be repositioned on his left side during the
procedure.
 ELECTROCARDIOGRAM (ECG)
Nursing Responsibilities
After the procedure
The nurse should be aware of these post-procedure nursing interventions after an
echocardiogram, they are as follows:
• Remove the conductive gel from the patient’s skin. When the procedure is
completed, remove the gel from the patient’s chest wall.
• Inform the patient that the study will be interpreted by the physician. An
official report will be sent to the requesting physician, who will discuss the findings
with the patient.
• Instruct patient to resume regular diet and activities. There is no special type of
care given following the test.
ELECTROCARDIOGRAM (ECG)
 ELECTROCARDIOGRAM (ECG)
Basic PQRST:
P-wave: The first little “hump” or “bump” you see is known as the P-wave. Remember
from the electrical conduction lecture, that the SA node is responsible for this.
Study tip: The P-wave represents ATRIAL DEPOLARIZATION (depolarization is a
big, fancy word for CONTRACTION).
 ELECTROCARDIOGRAM (ECG)
QRS Complex: The next area you see is a big spike. This spike is called the QRS
complex. The bundle of His, bundle branches, and Purkinje fibers are responsible for
this.
Study tip: The QRS complex represent VENTRICLE DEPOLARIZATION
(contractions of the ventricles)
 ELECTROCARDIOGRAM (ECG)
U-wave: This is not very common, but I wanted to show it to you and mention it. The
u-wave sometimes is seen after the t-wave. This is thought to be caused by the
relaxation of the Purkinje fibers.
 ELECTROCARDIOGRAM (ECG)
PR -interval: As noted on the diagram above, the PR-interval starts at atrial contraction
(remember atrial contraction is represented by the P-wave) and ends at the beginning of
ventricle depolarization. So in other words, it starts at the P-wave and ends at
the beginning of the QRS complex.
 ELECTROCARDIOGRAM (ECG)
ST segment: This segment starts at the J-point. The J-point is where you start to see an
upward stroke after the S wave. The segment ends at the beginning of the T-wave. The
ST-segment represents when the ventricles are relaxing, also called repolarizing.
 ELECTROCARDIOGRAM (ECG)
Nursing Responsibilities
After the procedure
The nurse should be aware of these post-procedure nursing interventions after an
echocardiogram, they are as follows:
• Remove the conductive gel from the patient’s skin. When the procedure is
completed, remove the gel from the patient’s chest wall.
• Inform the patient that the study will be interpreted by the physician. An
official report will be sent to the requesting physician, who will discuss the findings
with the patient.
• Instruct patient to resume regular diet and activities. There is no special type of
care given following the test.
 HOLTER MONITOR

is a small, wearable device that records the heart's rhythm. It's used to detect or
determine the risk of irregular heartbeats (arrhythmias).

A health care provider may recommend a Holter monitor if you have:

• Signs and symptoms of an irregular heart rhythm (arrhythmia)
• Unexplained fainting
• A heart condition that increases the risk of arrhythmias
 HOLTER MONITOR

Nursing Responsibilities of Holter Monitoring

The following are the nursing interventions and nursing care considerations for a
patient indicated for Holter monitoring
Before the procedure
The following are the nursing interventions before wearing a Holter monitor
Advise the patient to wear loose-fitting clothing. This will allow the Holter monitor to
stay in place and to avoid lead dislodgment.
Provide precautionary measures. Advise patient to avoid contact with magnetic or
electrical devices such as magnets, metal detectors, high-voltage areas, and electric
blankets where it can interfere with the function of the monitor; Refrain from taking
showers and tub bathing.
Apply electropaste or conductive paste to the skin sites. This will provide conduction
between the skin and electrodes.
Explain the importance of maintaining a diary to record activities. The patient may
perform his or her normal routine such as walking, eating, sleeping, sexual activity,
emotional upsets, exercise, and ingestion of medications and to log them in a diary.
Explain how to check the recorder to make sure it’s working properly. A light signal
on the monitor will signify that an equipment malfunction or that an electrode has
accidentally come off.
 HOLTER MONITOR

Nursing Responsibilities of Holter Monitoring

The following are the nursing interventions and nursing care considerations for a
patient indicated for Holter monitoring
After the procedure
The nurse should note of the following nursing interventions after Holter monitoring
Remove all chest electrodes. After the patient has worn the monitor, gently remove
the tape and other paraphernalia securing the electrodes.
Schedule appointment with the health care provider (HCP). The ECG recording will be
interpreted by a computer and a copy of a report is printed. This will be forwarded to
the HCP who will discuss the results with the patient.
 ECHOCARDIOGRAM
An echocardiogram uses sound waves to create pictures of the heart. This common
test can show blood flow through the heart and heart valves.

An echocardiogram can help detect:

• damage from a heart attack – where the supply of blood to the heart was suddenly
blocked
• heart failure – where the heart fails to pump enough blood around the body at the
right pressure
• congenital heart disease – birth defects that affect the normal workings of the
heart
• problems with the heart valves – problems affecting the valves that control the
flow of blood within the heart
• cardiomyopathy – where the heart walls become thickened or enlarged
• endocarditis – an infection in the lining of the heart which damages the heart
valves
 ECHOCARDIOGRAM
Nursing Responsibilities
The following interventions are done prior to and during the study:
• Explain the procedure to the patient. Inform the patient that echocardiography is
used to evaluate the size, shape, and motion of various cardiac structures. Tell who
will perform the test, where it will take place, and that it’s safe, painless, and
noninvasive.
• No special preparation is needed. Advise the patient that he doesn’t need to
restrict food and fluids for the test.
• Ensure to empty the bladder. Instruct patient to void prior and to change into a
gown.
• Encourage the patient to cooperate. Advise the patient to remain still during the
test because movement may distort results. He may also be asked to breathe in or
out or to briefly hold his breath during the exam.
• Explain the need to darken the examination field. The room may be darkened
slightly to aid visualization on the monitor screen, and other procedures (ECG and
phonocardiography) may be performed simultaneously to time events in the
cardiac cycles.
• Explain that a vasodilator (amyl nitrate) may be given. The patient may be asked
to inhale a gas with a slightly sweet odor while changes in heart functions are
recorded.
 ECHOCARDIOGRAM
Nursing Responsibilities
During the procedure
The following are the nursing considerations during an echocardiogram:
• Inform that a conductive gel is applied to the chest area. A conductive gel will be
applied to his chest and a quarter-sized transducer will be placed over it. Warn him
that he may feel minor discomfort because pressure is exerted to keep the
transducer in contact with the skin.
• Position the patient on his left side. Explain that transducer is angled to observe
different areas of the heart and that he may be repositioned on his left side during
the procedure.
 ECHOCARDIOGRAM
Nursing Responsibilities
After the procedure
The nurse should be aware of these post-procedure nursing interventions after an
echocardiogram, they are as follows:
• Remove the conductive gel from the patient’s skin. When the procedure is
completed, remove the gel from the patient’s chest wall.
• Inform the patient that the study will be interpreted by the physician. An official
report will be sent to the requesting physician, who will discuss the findings with
the patient.
• Instruct patient to resume regular diet and activities. There is no special type of
care given following the test.
 PHONOCARDIOGRAM
• A graphic recording of heart sound with simultaneous ECG
• A plot of high fidelity recording of the sounds and murmurs made by
the heart
• Provides a recording of all the sounds made by the heart during a
cardiac cycle.
 STRESS TEST
A stress test shows how the heart works during physical activity. It also may be called a
stress exercise test. Exercise makes the heart pump harder and faster. A stress test can
show problems with blood flow within the heart.

You may need this test to detect heart problems like:

• Congenital heart disease.

• Congestive heart failure.
• Coronary artery disease.
• Heart valve disease.
• Hypertrophic cardiomyopathy.

noninvasive test, studies the heart during activity and detects and evaluates CAD

may be used with myocardial radionuclide testing (perfusion imaging), at which point
the procedure becomes invasive because a radionuclide must be injected
 STRESS TEST
Exercise stress test
This is the most common and basic heart stress test. It involves walking
on a treadmill or riding a stationary bicycle. A well-trained exercise
physiologist usually tailors the speed and elevation of the treadmill to
your ability to walk and your overall fitness.
 STRESS TEST
Exercise stress echocardiogram
An exercise stress echocardiogram is similar to the basic stress test but
provides more detail. Healthcare providers perform an echocardiogram
(ultrasound of your heart) before and at peak exercise. This cardiac
imaging test uses sound waves to evaluate blood flow through your
heart as well as the pumping chambers of your heart (muscle) and valve
functions.
 STRESS TEST
Nuclear stress test
This advanced heart stress test uses safe levels of a radioactive substance
and a cardiac imaging scan to assess heart function. A healthcare
provider takes pictures of your heart before (at rest) and after you
exercise. A cardiologist compares the amount of blood flow to the
muscle of your heart at rest and after stress. A decrease in blood flow
signal usually indicates a blockage in one or multiple arteries in your
heart.

Nuclear cardiac stress tests can:

• Determine the severity of blockage of coronary artery disease.
• Assess whether previous treatments, such as stents or bypass surgery
are working as they should.
• Help you avoid more invasive heart tests, such as cardiac
catheterization.
• Show whether your heart is healthy enough for non-cardiac surgery or
exercise.
 CARDIAC CATHETERIZATION
(coronary angiography/arteriography)

-is a procedure in which a thin, flexible tube (catheter) is guided through

a blood vessel to the heart to diagnose or treat certain heart conditions,
such as clogged arteries or irregular heartbeats. Cardiac catheterization
gives doctors important information about the heart muscle, heart valves
and blood vessels in the heart.
• Insertion of a catheter into the heart and surrounding vessels
• Is an invasive procedure during which physician INJECTS a dye into
the coronary arteries and immediately takes a series of x-ray films to
assess the structures of the arteries.
• Determines the structure and performance of the heart valves and
surrounding vessels.
• Used to diagnose CAD, assess coronary artery patency and determines
extent of atherosclerosis
 CARDIAC CATHETERIZATION
Doctor may use cardiac cath to help diagnosis these heart conditions:
• Atherosclerosis. This is a gradual clogging of the arteries by fatty
materials and other substances in the blood stream.
• Cardiomyopathy. This is an enlargement of the heart due to
thickening or weakening of the heart muscle
• Congenital heart disease. Defects in one or more heart structures
that occur during fetal development, such as a ventricular septal
defect (hole in the wall between the two lower chambers of the
heart) are called congenital heart defects. This may lead to abnormal
blood flow within the heart.
• Heart failure. This condition, in which the heart muscle has become
too weak to pump blood well, causes fluid buildup (congestion) in the
blood vessels and lungs, and edema (swelling) in the feet, ankles, and
other parts of the body.
• Heart valve disease. Malfunction of one or more of the heart valves
that can affect blood flow within the heart.
 NUCLEAR CARDIOLOGY
Nuclear cardiology studies use noninvasive techniques to assess
myocardial blood flow, evaluate the pumping function of the heart as
well as visualize the size and location of a heart attack. Among the
techniques of nuclear cardiology, myocardial perfusion imaging is the
most widely used.

Myocardial Perfusion Imaging

Myocardial perfusion images are combined with exercise to assess the
blood flow to the heart muscle.
 NUCLEAR CARDIOLOGY
TYPES OF NUCLEAR CARDIOLOGY

Ø MULTIGATED ACQUISITION (MUGA) or Cardiac Blood Pool

Scan
Ø Provides information on wall motion during systole and diastole,
cardiac valves, and ejection fraction
 CENTRAL VENOUS PRESSURE
Central venous pressure is considered a direct measurement of the
blood pressure in the right atrium and vena cava.
 CENTRAL VENOUS PRESSURE
The CVP catheter is an important tool used to assess right ventricular
function and systemic fluid status.

•Normal CVP is 2-6 mm Hg. Or 2-8 cm H20

•CVP is elevated by :
• overhydration which increases venous return
• heart failure or PA stenosis which limit venous outflow and lead to
venous congestion
• positive pressure breathing, straining,
•CVP decreases with:
• hypovolemic shock from hemorrhage, fluid shift, dehydration
• negative pressure breathing which occurs when the patient
demonstrates retractions or mechanical negative pressure which is
sometimes used for high spinal cord injuries.
 CENTRAL VENOUS PRESSURE
• Reflects the pressure of the blood in the right atrium
• Engorgement is estimated by the venous column that can
be observed as it rises from an imagined angle at the
point of manubrium (angle of Louis)
• With normal physiologic condition, the jugular venous
column rises no higher than 2-3 cm above the clavicle
with the client in a sitting position at 45 degree angle.
Questions?
Thank you!