Transcript Heart Notes
Heart Notes Common Cardiac Diagnostics • Blood enzymes: – CPK-MB (Creatine Phosphokinase) – found in brain and muscle tissue. Elevated in MI 2-3 hours after infarction; peaks in 12-24 hours. – LDH (Lactic Dehydrogenase) – produced during Krebs cycle. Elevated in MI 12-48 hours after infarction. – SGOT (Serum Glutamic-oxaloacetic Transamine) – produced during Krebs cycle. Elevated up to 72 hours after infarction. Wave Form Measurements • ECG/EKG – record of electrical activity produced by heart with each heartbeat. Shows damage to heart muscle and/or conduction. • Holter Monitor – ECG recorded over extended time (24-48 hours). Correlated to activity via patient diary. • Stress ECG – ECG recorded during exercise; purposely stress heart. Imaging Techniques • CXR – Image of heart, lungs and great vessels using gamma rays. Shows size and shape of heart. • ECHO – Image of myocardium, chambers, valves, and blood flow using sound waves. Shows these structures in action. • MRI – Image of myocardium, chambers and valves using magnetism. Shows soft tissue best. More Imaging Techniques • PET – Image of metabolic heart activity. Shows areas of necrotic tissue. • Cardiac Catheterization (Heart Cath) – Image of coronary arteries using contrast medium and fluoroscopy. Shows patency and/or occlusion of heart arteries. May lead to angioplasty or CABG. Common Cardiac Diseases • CAD: – Arteriosclerosis – hardening of coronary arteries – Atherosclerosis - hardening of coronary arteries with deposits of plaque (fat and cholesterol) More Cardiac Diseases • Angina – heart pain due to ischemia. Usually not present when patient is resting. • Myocardial Infarction (MI) – Interruption in blood supply to a part of the heart leading to necrosis of the area. Valve Disorders • Rheumatic Heart Disease – inflammation and damage to the mitral valve caused by toxins from streptococci. • Stenosis – narrowing of the opening of a valve due to inflammation and calcium deposits. • Insufficiency/prolapse – blood leaks backwards thru valve due to inflammation, trauma, or congenital defect. More Cardiac Disease • Cardiomyopathy – inability of the heart muscle to contract fully. The cause is usually idiopathic, but may be due to toxins, viruses, malnutrition or endocrine disorders. • CHF – inability of the heart chamber(s) to empty completely due to kidney disease (chronic) or MI (acute). Common Treatments • Medications: – Cardiotonics – strengthen and slow heart beat. Lanoxin – Vasodilators – dilate coronary arteries to relieve ischemia. Nitroglycerin – Antiarrhythmics – interfere with extra conduction sites. Lidocaine – Diuretics – decrease volume of blood by removing extra fluid via the kidneys. Lasix More Medications – Anticoagulants – increase clotting time. Heparin (parantal) or Coumadin (PO) – Clot Dissolvers – dissolve clots within 8 hours of formation. Streptokinase, TPA. – Antibiotics – kill microorganisms (not viruses). PCN, Tetracycline, Bactrin, Septra, Cipro, Gentamycin – ASA – increase clotting time. Given as prophylactic daily or 1st Aid for MI. More Treatments • Surgery: – Angioplasty – decrease size of coronary obstruction by inflating balloon at site during Heart Cath. Keep open with a stint. – CABG – use veins or artery from other sites to bypass blocked coronary areas. More Surgery – Heart Transplant – replace all or part of heart from donor. Must be on immunosuppressive drugs for life. Cyclosporin – Valve Replacement – replace damaged heart valve with manmade device or one from pig, or cadaver. Cardiac Specialists • Cardiologist – MD who dx and tx cardiac/coronary disease/disorders medically. Does stress test, heart cath and angioplasty procedures. • Cardiac Surgeon – MD who does heart and coronary surgery. CABG and transplant. More Specialists • CCU RN – nurse who cares for critically ill heart patients. • Cath Lab RN – nurse who assists Cardiologist during heart caths. • Cardiac Biomedical Technician – specialist with 2-4 years of formal training who maintains and repairs equipment used to diagnose/treat heart problems. More Specialists • ECG Technician – on-the-job trained person who operates ECG machine. • ECHO Technician – ECG tech who has specialized training in ultrasonography of the heart.