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  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, B 12 , B 6 , 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.

SOAL EAP

Jul 23, 2017
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