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  2. 2. 2/7/2023 By Zewude M 2 Cardiovascular lab studies By Zewude M Turn around time :30 minutes
  3. 3.  Objectives of the presentation  Cardiovascular lab-studies  Reference 2/7/2023 By Zewude M 3
  4. 4. At the end of this session ,the learner will be able to:  List Cardiovascular lab-studies.  Interpret CBC results  Describe cardiac markers  Define cardaic stress test 2/7/2023 By Zewude M 4
  5. 5. BRAINSTORMING What are the Cardiovascular lab that nurses should be familiar with? 2/7/2023 By Zewude M 5
  6. 6.  Cardiovascular lab that nurses should be familiar with include: Cardiac biomarkers  CBC  Cardiac Stress testing Angiography  cardiac catheterization Electrocardiography(ECG 2/7/2023 By Zewude M 6
  7. 7.  Data obtained by history and physical assessments and confirmed by diagnostic tests and procedures  All tests should be explained to the patients.  Some may need special preparation before they are performed and need special monitoring after the procedure. 2/7/2023 By Zewude M 7
  8. 8.  Reason To assists in diagnostic acute MI To identify abnormalities in the blood. To assess the degree of inflammation To screen for risk factors associated with atherosclerotic coronary artery disease To determine baseline values before performing therapeutic intervention 2/7/2023 By Zewude M 8
  9. 9.  In cardiac function Blood cells have crucial role  Blood used as transport medium for oxygen, glucose, electrolytes, plasma proteins, hormones, and medications. And also a vesicle for removal of waste products  Changes in blood cell integrity and total cell count may reflect specific disorders of the cardiac system. 2/7/2023 By Zewude M 9
  10. 10.  Is a commonly used laboratory test to support the diagnosis of several diseases.  The values of hematological parameters are varies by a number of factors even in apparently healthy individuals. These include age, sex, nutritional, environmental and social factors with cultural backgrounds.  Some hematological parameters show extensive variation in different period of life. 2/7/2023 By Zewude M 10
  11. 11.  Used to evaluate your overall health  Detect a wide range of disorders, including anemia, infection and leukemia.  Blood consists of three types of cells suspended in fluid called plasma:  white blood cells (WBCs)  Red blood cells (RBCs), and  platelets (PLTs). 2/7/2023 By Zewude M 11
  12. 12.  They are produced and mature primarily in the bone marrow and, under normal circumstances, are released into the bloodstream. 2/7/2023 By Zewude M 12
  13. 13. Constituents of Red cell count 1) Red blood cell count (RBC)  It's also known as an erythrocyte count.  Is used to find out how many red blood cells (RBCs) present in a patient's sample blood.  Reference range: Men: 4.5-5.9 x 106/microliter, Women: 4.1-5.1 x 106/microliter 2/7/2023 By Zewude M 13
  14. 14. Causes of low result in red blood cell count  Anemia.  Acute or chronic bleeding  RBC destruction (e.g., hemolytic anemia,etc.)  Nutritional deficiency (e.g., iron deficiency,vitamin Bl2 or folate deficiency)  Chronic inflammatory disease  Bone marrow disorders or damage 2/7/2023 By Zewude M 14
  15. 15. Examples of causes of high result  Living at high altitude  Smoking  Polycythemia vera  Dehydration 2/7/2023 By Zewude M 15
  16. 16. 2. HAEMOGLOBIN  Hb is the protein which carries oxygen in the blood. REFERENCE RANGE: Men: 14-17.5 g/dL Women: 12.3-15.3 g/dL 3. HEMATOCRIT (HCT).  Also known as Packed Cell Volume (PCV); Volume percentage of red blood cells in the blood. REFERENCE RANGE: 2/7/2023 By Zewude M 16 Men:41.5 %-50.4% Women: 35.9-44.6%
  17. 17. 4. RBC INDICES.  Are blood tests that provide information about the hemoglobin content and size of red blood cells  They are used to help diagnose the cause of anemia, a condition in which there are too few red blood cells and other disorders of RBC. These are: i. Mean corpuscular/cell volume (MCV), ii .Mean corpuscular hemoglobin (MCH), Iii.Mean corpuscular hemoglobin concentration (MCHC), 2/7/2023 By Zewude M 17
  18. 18.  Also called leukocytes, that the body uses to maintain a healthy state and to fight infections or other causes of injury  There are five different types of WBCs,  These are :  Neutrophils  Lymphocytes  Basophils,  Eosinophils and  monocytes 2/7/2023 By Zewude M 18
  19. 19.  They are present in the blood at relatively stable numbers.  These numbers may temporarily shift higher or lower depending on what is going on in the body. WHITE BLOOD CELL DIFFERENTIALS 1.NEUTROPHIL COUNT  Neutrophils are a type of white blood cell (WBC or granulocyte) that protect a body against infections,  Are the first cells to arrive on the scene when we experience a bacterial infection. 2/7/2023 By Zewude M 19
  20. 20.  If neutrophils are below and above normal values it is Known as leukopenia and leukocytosis respectively. Example if the pt has sign and syptom of cardiac problem and neutrophils is raised we suspect endocarditis . 2.LYMPHOCYTE COUNT  Lymphocytes are type of white blood cell (leukocyte) that is of fundamental importance in the immune system,  They are made in the bone marrow and found in the blood and lymph tissue. 2/7/2023 By Zewude M 20
  21. 21.  They are the main type of cell found in lymph, which prompted the name "lymphocyte".  Lymphocytes help your immune system remember every antigen it comes in contact with.  Are the first cells to arrive on the scene when we experience a viral infection  If lymphocyte are below and above normal values it is Known as lymphocytopenia and lymphocytosis respectively.  Example if the pt has myocarditis there may be lymphocytosis 2/7/2023 By Zewude M 21
  22. 22. 3.MONOCYTE COUNT  Monocytes are the largest type of leukocyte and can differentiate into macrophages and myeloid lineage dendritic cells.  monocytes are important in the immune system's ability to destroy invaders, but also in facilitating healing and repair.  Examples of Causes of high count chronic infections like:a  fungal infections  tuberclosis Infection within the heart (bacterial endocarditis) 2/7/2023 By Zewude M 22
  23. 23. 4.EOSINOPHIL COUNT Most often indicates a parasitic infection, an allergic reaction or cancer 5.BASOPHIL COUNT  are involved in immediate hypersensitivity reactions as well as chronic inflammatory or immunologic responses. 2/7/2023 By Zewude M 23
  24. 24.  Platelets, also called thrombocytes, are special cell fragments that play an important role in normal blood clotting.  A person who does not have enough platelets may be at an increased risk of excessive bleeding and bruising  REFERENCE RANGE: SI Units :150-450 x 109/L 2/7/2023 By Zewude M 24
  25. 25. 2/7/2023 By Zewude M 25
  26. 26. 2/7/2023 By Zewude M 26
  27. 27.  Cardiac enzymes also know as cardiac biomarker.  Are those found in cardiac tissue release into the bloodstream when the heart is damaged or stressed.  These tests are most useful in diagnosing myocardial infarction (heart attacks)  The markers are normally present at all time, however, they are significantly elevated during a damage of the heart muscle. 2/7/2023 By Zewude M 27
  28. 28. 2/7/2023 By Zewude M 28
  29. 29. 2/7/2023 By Zewude M 29
  30. 30.  Used for diagnosing cardiac disease along other tests.  Use this four enzyme diagnosis:- Cardiac Troponin I& T Creatine Kinase Myoglobin Lactate dehydrogenase(LDH) 2/7/2023 By Zewude M 30
  31. 31.  Also known as creatine phosphokinase (CPK) or phosphocreatine kinase.  A test to know the concentration of CPK in the serum.  The level of total CK in plasma usually becomes abnormal 6 to 8 hours after onset of MI and peaks in 24 - 28 hours.  But because levels of CK can go up in many other conditions besides a heart attack, it is not very specific. 2/7/2023 By Zewude M 31
  32. 32.  Found in cells of heart , skeletal muscles and brain.  Three creatine kinase (CK) isoenzymes CK-MM: skeletal muscle-specific isoenzyme CK-MB: heart muscle-specific isoenzyme CK-BB: brain tissue-specific isoenzyme  Normal range 55-170units /L for men 30-135 units/L for women 2/7/2023 By Zewude M 32
  33. 33.  CK-MB rises 4 to 6 hours after a heart attack, but generally back to normal within a day or two.  Increases only when there has been damage to cardiac cells: acute MI, Myocarditis, CHF,  Recurrent elevation suggests re-infarction or extension of ischemic damage  Elevation diminishes as the disease progresses and muscle mass decreases 2/7/2023 By Zewude M 33
  34. 34.  There is LDH1 and LDH2, normally LDH2 is greater than LDH1  Found in: heart, liver, skeletal muscle, kidney, lung, fat and red blood cells. Due to that no longer considered a specific test for MI.  LDH is used to help diagnose: Myocarditis, Liver and renal dysfunction, Skeletal muscle disorders or trauma 2/7/2023 By Zewude M 34
  35. 35.  May be abnormally elevated in various conditions, including: Hemolytic anemia; Pulmonary infarction; Renal infarction; Hepatic disorders (hepatitis and hepatic congestion); Skeletal muscle disorders.  Normal ratios are:-LDH-1:- 17%-27% :-LDH-2:- 27%-37% 2/7/2023 By Zewude M 35
  36. 36. Is muscle protein with high sensitivity but low specificity(also elevated during other muscle injury) detection of ischemic muscle damage. Appears in the serum earlier than CK (in 1 to 3 hours) after onset of symptoms, usually peaks in 2 to 4 hours. Normal value:-(17.4-105.7ng/ml) 2/7/2023 By Zewude M 36
  37. 37.  Regulates the myocardial contractile process  Highly specific for cardiac muscle  Detectable as cardiac troponin I & troponin T . Troponin I found only in cardiac muscle Rising in the blood 4-6 hours post infraction Peaks in 12-24 hours Come to baseline within 10-14 days Range Norman individual: <0.001ng/ml. Therefore it has good utility for retrospectively diagnsing AMI 2/7/2023 By Zewude M 37
  38. 38. Troponin T  Found in cardiac and skeletal muscle,  Also elevated during kidney and skeletal damage  Highly sensitive to detect minor myocardial injury 2/7/2023 By Zewude M 38
  39. 39. 2/7/2023 By Zewude M 39
  40. 40.  It demonstrates the ability of the myocardium to respond to increased oxygen demand by increasing blood flow to the coronary arteries.  We get information about the pumping function of the heart and specifically about the vessels which supply the blood flow to the heart, whether or not there are significant blockages  Stress testing can be life-threatening with potential occurrence of MI, cardiac arrest, HF, and severe dysrhythmias thus, testing facilities must have staff and equipment ready to provide treatment, including advanced cardiac life support. 2/7/2023 By Zewude M 40
  41. 41.  Cause of chest pain,  Functional capacity of the heart after MI or heart surgery,  Effectiveness of anti angina or antiarrhythmic medications,  Dysrhythmias that occur during physical exercise, 2/7/2023 By Zewude M 41
  42. 42.  Severe aortic stenosis,  Acute myocarditis or pericarditis,  Severe hypertension,  HF, and  Unstable angina 2/7/2023 By Zewude M 42
  43. 43. Can be: 1. Mental or emotional stress test 2. Pharmacologic stress test 3. Exercise stress test Mental or emotional stress test  Patient exposed to an emotional stressor (The death of a loved one, dismissal from work) using a standardized mental stress test,  Then, heart pictures examined whether reduced blood flow (ischemia) occurred during mental stress. 2/7/2023 By Zewude M 43
  44. 44.  Vasodilation agents (dipyridamole and adenosine) administered IV  used to mimic the effects of exercise by maximally dilating the coronary arteries  Is used in combination with imaging modalities such as echocardiography.  General indication  Elderly patients with decreased functional capacity and possible CAD  Younger patients with functional impairment 2/7/2023 By Zewude M 44
  45. 45. 2/7/2023 By Zewude M 45
  46. 46.  Advise the patients to be fast for 4 hours before the test  Avoid stimulants: like tobacco and caffeine  Medications may be taken with sips of water  Certain cardiac medications may not be taken, such as beta blocking agents, before the test  Wear clothes and sneakers or rubber-soled shoes suitable for exercising 2/7/2023 By Zewude M 46
  47. 47.  During the test, the following are monitored  ECG changes for heart rate, rhythm, and ischemic changes; • BP; • Skin temperature; • Physical appearance; • Symptoms: chest pain, dyspnea, dizziness, leg cramping, and fatigue. 2/7/2023 By Zewude M 47
  48. 48.  Patient experiences:  Chest pain,  Extreme fatigue,  Decrease in BP or pulse rate,  Serious dysrhythmias or st-segment changes  ECG changes 2/7/2023 By Zewude M 48
  49. 49.  When significant ECG abnormalities occur during the stress test  ST-segment depressions or elevations 2/7/2023 By Zewude M 49
  50. 50. 1. Michael swash, hutchison’s clinical methods, 9th edition,2003 2. Janice L.Hinkle and Kerry H.Cheever (2018) Medical-Surgical, nursing.14th edition, 2018 3. www.google. com 2/7/2023 By Zewude M 50
  51. 51. 2/7/2023 By Zewude M 51

Notes de l'éditeur

  • red blood cell count that's higher than normal (erythrocytosis), or high hemoglobin or hematocrit levels, could point to an underlying medical condition,
    such as polycythemia Vera or heart disease
  • Mean corpuscular volume (MCV), which measures the average size of your red blood cells
    Mean corpuscular hemoglobin (MCH), which measures the average amount of hemoglobin in a single red blood cell. Hemoglobin is a protein in red blood cells that carries oxygen.
    Mean corpuscular hemoglobin concentration (MCHC), which also measures hemoglobin in red blood cells. In addition, it includes a calculation of the size and volume of your red blood cells.
    Red cell distribution width (RDW), which measures differences in the volume and size of your red blood cells.
  • Therfore CK estimation is very useful to detect early cases.
    Ck level is not raised in hemolysis or in congestive heart faliure; and therefore CK has an advantage over LDH.
    CK levels are changed in disorder of cardiac and skeletal muscle.
    Mainly useful in detecting damage to myocardial and skeletal muscle tissue.

  • Is used in combination with imaging modalities such as echocardiography.
    General indication
    Elderly patients with decreased functional capacity and possible CAD
    patient with chronic debilatation and possible CAD
    Younger patients with functional impairment due to injury, arthritis, orthopedic problems, peripheral neuropathy, myopathies, or peripheral vascular disease, in which a maximal heart rate is not easily achieved with routine exercise stress testing, usually because of an early onset of fatigue due to musculoskeletal, neurologic, or vascular problems rather than cardiac ischemia.
  • Beta blockers slow the heart rate, which can prevent the increase in heart rate that typically occurs with exercise.
    One side effect of the treadmill test for some individuals is nausea, a problem that would only be exacerbated by having food in your stomach
    If you smoke, you get less oxygen in your heart, lungs and muscles. This reduces your physical fitness
  • Any feels discomfort