Cardiovascular labs and diagnostic testing

Question 1

What does a CBC consist of

Answer 1

• Hemoglobin
• hematocrit
• WBCs
• Platelts
• RBCs

Question 2

Hemoglobin

Answer 2

• Normal: 12-18
• Decreased levels = decreased oxygen carry capacity
• <7-8 essential activities only/No exercise
• > 8 symptoms based approach
• low critical values can lead to heart failure
• High critical values can lead to clogging of capillaries due to concentration of hemoglobin

Question 3

Hematocrit

Answer 3

• 36-45.2%
  (37-47 females 42-52 males)
• Low values are critical and can lead to heart failure
• High values lead to clogging of arteries
• > 25 - symptom based approach
• <60 symptoms based approach

Question 4

White blood cells- acute care section guidelines

Answer 4

• 5-10.8 K/uL
• <4,000 with fever = no exercise
• > 4,000 light exercise, symptoms based approached

Question 5

Platelets

Answer 5

• 140-400 K/uL
• <50,000 - risk of spontaneous hemorrhage
• greater than 1 million = risk of clotting

Question 6

RBCs - normal range

Answer 6

3.85-5.15

Question 7

Prothrombin time (PT)

Answer 7

• Warfarin use
• Normal 11-13 seconds
• Increase risk of bleeding with increase PT
• Increase risk of clotting with decrease PT

Question 8

INR

Answer 8

• Normal: 0.9-1.1
• DVT/clot prevention 2-3
• Post MI/valve replacement 2.5-3.5
• Increase risk of bleeding (>3.6 hold therapy)

Question 9

aPTT`

Answer 9

• Normal 21-35 seconds
• 2-2.5 upper normal limit with heparin use
• Increase risk of bleeding with increased PTT
• > 100 second - patient should not be mobilized)
• Increase risk of clot formation with decreased

Question 10

what measures coagulation

Answer 10

• PT
• INR
• aPTT
• D-dimers
• platelts count

Question 11

Basic metabolic panel

Answer 11

• A lab panel where multiple tests are grouped together in a single profile for ease of ordering
• Monitors:
  Electrolyte and fluid states
  Kidney function tests
  Blood sugar levels/Glucose
  Calcium
  Sodium
  Chloride
  Potassium
  CO2
  BUN
  Creatinine

Question 12

Comprehensive metabolic panel

Answer 12

• BMP + protein albumin and liver function
• ALP- liver
• AST - liver
• ALT- liver
• Bilirubin: liver
• Total protein
• Albumin
• Globulin
• BUN/creatinine ratio: kidney function

Question 13

Diabetes mellitus type 1

Answer 13

• Occurs when the pancreas is unable to produce enough insulin
• Tends to develop at a young age
• Cannot be prevented
• Requires insulin therapy

Question 14

Diabetes mellitus type 2

Answer 14

• Occurs due to insulin resistance
• Tends to develop older age
• Can be prevented with lifestyle changes
• Can be managed with lifestyle modifications alone if diagnosed early

Question 15

Common symptoms of both types of diabetes

Answer 15

Both share symptoms of

• frequent urination,
• increase thirst,
• extreme hunger,
• unintentional weight loss,
• fatigue,
• blurry vision,
• sores or wounds that heal slowly,
• numbness and tingling sensation in hands and feet

Question 16

What could both types of diabetes benefit from

Answer 16

Both can benefit from lifestyle modifications such as

• a healthy diet,
• physical activity,
• blood sugar level monitoring,
• management of stress and other existing health conditions

Question 17

Fasting blood glucose

Answer 17

• 99 mg/dL or lower = normal
• 100-125 mg/dL = prediatbetic
• 126 or above is diabetes
• Use caution if < 70mg/dL (supplement with carbs) or > 200mg/dL (use of insulin); and no exercise of >300mg/dL

Question 18

A1C

Answer 18

<5.7% = normal
5.7-6.5 = prediabetic
>6.5 = diabetic

Question 19

Blood glucose of diabetes diagnosis goal levels of A1C and preprandial and postprandial

Answer 19

• A1C targets different based on age and health
• More or less stringent glycemic goals may be appropriate for each individual
• A1C less than 6.5-7 typically for people with diabetes
• Before a meal (preprandial): 80-130 mg/dL
• 1-2 hours after beginning of the meal: less than 180 mg/dL

Question 20

Hyperglycemia causes

Answer 20

too much food, too little insulin or diabetes pills, illness or stress

Question 21

hyperglycemia onset

Answer 21

often starts slowly; may lead to medical emergency if not treated

Question 22

hyperglycemia symptoms

Answer 22

Extreme thirst
Need to urinate
Dry skin
Hungry
Blurry vision
Drowsy
Slow healing wounds

Question 23

Hyperglycemia: type 1 and type 2

Answer 23

• Type 1: insulin needed
• Type 2: antihyperglycemic medication/insulin if prescribed
  *If signs of diabetic ketoacidosis call 911- Fruity smelling breath , Confusion
  Fatigue

Question 24

Hypoglycemia causes

Answer 24

• too little food or skipped a meal
• too much insulin or diabetes pills
• more active than usual

Question 25

hypoglycemia onset

Answer 25

often sudden, may pass out if untreated

Question 26

hypoglyecmia symptoms

Answer 26

Shaky Fast heartbeat Sweating Dizzy Anxious Hungry Burred vision Weakness or fatigue Headache Irritable

Question 27

what to do if hypoglycemic

Answer 27

- Provide snack or juice - Monitor - Do not exercise until stable

Question 28

Total cholesterol level

Answer 28

Desirable = <200 moderate/borderline high = 200 - 240 High > 240

Question 29

LDL cholesterol level

Answer 29

Desirable <100 Near desirable 100-130 Border line high 130-160 High = 160-190 Very high <190

Question 30

HDL cholesterol level

Answer 30

Major risk: <40 Less risk >60

Question 31

triglycerides

Answer 31

Standard range <150 mg/dL 150-199 = borderline high 200-400 = high >499 very high

Question 32

cardiac enzymes

Answer 32

Troponin: spikes during a heart attack Troponin T and troponin I AST LDH CKMB: muscle breakdown associated with MI

Question 33

Natriuretic peptides

Answer 33

ANP - a type natriuretic peptide BNP - b-type natriuretic peptide

Question 34

Cardiac testing tools

Answer 34

- EKG/ECG/Holter monior - stress testing - echocardiography - X-ray, Pet, MRI, CT, Angiograms - Cardiac catheterization

Question 35

EKG/ECG/Holter monitoring:

Answer 35

monitors the electrical activity of the heart and heart rate - check to see what is happening over a period of time

Question 36

Stress testing/exercise testing

Answer 36

- Max or sub max - Activity: treadmill, bicycle, other - Pharmacological: an injection that elicits a similar response to the activity for those who cannot do the activity - All involve monitoring response of patient to increased stress on the cardiac, vascular and/or pulmonary systems - Exercise testing with imaging: use of non-invasive image pre and post exercise for greater diagnostic accuracy - Usually used to look at cardiac perfusion - Radioactive isotope

Question 37

Echocardiography

Answer 37

another way of getting an image of the heart that uses US

Question 38

Cardiac catherterization

Answer 38

- A procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms - Dye visible by X-ray is injected into blood vessels using a thin hallow tub called a catheter - Can go into the brachial artery, radial artery, femoral artery or vein

Question 39

interventions for blockages of coronary arteries

Answer 39

1. CABG: by pass - Take a smaller vein such as saphenous and use it to reperfuse parts of the heart 2. Stenting (PTCA ro PCI) - Use a balloon to squish or scrape plaque and open the artery

Question 40

types of peripheral vascular testing

Answer 40

Arterial and venous angiography (not done by PT) Ankle brachial index Doppler ultrasound Rubor dependency Venous filling time Homans sign