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S3

( early in diastole during the period of rapid ventricular filling, normal finding in children and adults up to 35 or 40, in adults it is usually a sign of volume overload in one or both ventricles)

S4

(occurs just before S1, due to ventricular hypertrophy caused by HTN, CAD, cardiomyopathies, aortic stenosis, and others)

clicks

(systolic click is result of opening of a rigid an calcified aortic or pulmonic valve during ventricular contraction)

rubs

(harsh grating sound heard in both diastole and systole caused by abrasion of the inflamed pericardial surfaces from pericarditis)

murmurs

(created by turbulent flow of blood, graded 1-6, 1 being very faint, 6 being extremely loud

CK-MB

(heart muscle, cardiac specific isoenzyme, found mainly in cardiac cells and therefore increases only when there has been damage to these cells. Elevated CK-MB assess by mass assay is an indicator of acute MI; the level begins to increase within a few hours and peaks within 24 hours of an MI)

troponins

(protein found in the myocardium, regulates the myocardial contractile process, increase in the level of serum troponin can be detected within a few hours during acute MI, it remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage)

lipid profile

(measured to evaluate a person's risk of developing atherosclerotic disease, blood specimen should be taken after a 12 hour fast)

cholesterol

(elevated LDL levels are associated with a greater incidence of CAD, normal level is less than 200 mg/dL)

triglycerides

(elevated after meals and affected by stress, have a direct correlation with LDL and an inverse one with HDL, normal range is 100-200 mg/dL)

BNP

(neurohormone that helps regulate BP and fluid volume, levels of BNP increase as the ventricular walls expand from increased pressure, greater than 100 pg/mL is suggestive of HF)

C-reactive protein

(venous blood test that measures CRP, a protein produced by the liver in response to systemic inflammation. Inflammation is thought to play a role in the development and progression of atherosclerosis, high risk is 3.0 mg/dL or greater)

Homocystine

( an amino acid linked to the development of atherosclerosis because it can damage the endothelial lining of the arteries and promote thrombus formation, diets low in folic acid, B6, and B12 are associated with elevated homocystine levels. A 12 hour fast is necessary, high risk is greater than 15 umol/L)

Chest X-ray

(used to determine the size, contour and position of heart, reveals calcifications and demonstrates physiologic alterations in the pulmonary circulation, does not help diagnose acute MI but can help diagnose some complications e.g. HF)

ECG

(graphical representation of the electrical currents of the heart, usually 12 leads but can be 15 or 18, used to diagnose dysrhythmias, conduction abnormalities, chamber enlargement, and myocardial ischemia, it can also suggest cardiac effects of electrolyte disturbances, high or low CA++ and K+ levels),

Stress test

(helps determine presence of CAD, cause of chest pain, functional capacity of heart after MI or heart surgery, effectiveness of meds, dysrhythmias that occur during exercise and specific goals for a physical fitness program, contraindications include severe aortic stenosis, acute myocarditis or pericarditis, severe HTN, suspected left main CAD, HF and unstable angina, NPO for 4 hours, no caffeine, no smoking, hold beta blockers, after test patient monitored for 10-15 minutes, pharmacologic stress test uses two vasodilating agents dipyridamole (Persantine ) and adenosine (Adenocard), admin IV to mimic effects of exercise, Dobutamine is also used)

ECHO

(ultrasound test used to measure the ejection fraction and examine the size, shape and motion of cardiac structures, useful in diagnosing pericardial effusions, determining chamber size and the etiology of heart murmurs, evaluating function of heart valves, and evaluating ventricular wall motion, periodically patient may be asked to hold their breath or lay on their left side)

TEE

(ultrasound through esophagus, provides clearer images because ultrasound waves pass through less tissue, patient asked to swallow several times during positioning, diagnostic tool for CVD, HF, valvular heart disease, dysrhythmias, education, NPO, consent, IV line, monitoring vitals, NPO until sedation resolved and gag reflex returns, sore throat)

Myocardial perfusion

(isotope into the arteries to assess uptake, it is slower in damaged tissue, used with stress testing, indicates cardiac ischemia, Thallium isotope not taken up by infarcted tissue, when used with SPECT patient arms will need to be positioned over the head for 20-30 minutes, if impossible, planar imaging used rather than SPECT)

CT (structure)/PET (metabolic uptake)

(called CT, CAT or EBCT, uses x-rays to scan, used to evaluate cardiac masses and diseases of the aorta and pericardium, contrast may be used with CT, isotopes are used with PET, patient must lie perfectly still, PET usually used with neuro, more recently being used to diagnose cardiac dysfunction, helps evaluate patency of native and previously grafted vessels and the collateral circulation, blood glucose should be within normal range because PET evaluates glucose metabolism, patient should refrain from using tobacco and ingesting caffeine for 4 hours prior to procedure.
MRA (noninvasive

MRA

(noninvasive, valuable in diagnosing diseases of the aorta, heat muscle, pericardium and congenital heart lesions, no pacemakers, wires or metal of any kind, looks at blood vessels, patient supine , given mild sedative, offered headset and told to remain still.

EPS

(diagnose dysrhythmias, looks at the electrical path through the heart, NPO at midnight, sedation, and catheter in groin)

Heart Catheterization

(used to diagnose CAD, pulmonary hypertension, can place stents and balloons during, labs done prior to test for clotting, renal and electrolytes, looks at aorta, coronary arteries and right and left heart, catheterized through femoral or brachial, contrast used, assess for shellfish/iodine allergies, NPO, shave, mark pedal pulses, IV, monitor BP and ECG during procedure, assess site for coagulation after, monitor temperature, color, pulses, bleeding internal and external, sensation, ECG, bed rest for 2- 6 hours, orthostats (BP and O2) before initial ambulation

Nitroglycerine (Nitrostate, Nitro-Bid)

Short term and long term reduction of myocardial oxygen consumption through selective vasodilation.

Beta adrenergic blocking agents (beta blockers): Metoprolol (Lopressor, Toprol) Atenolol (Tenormin)

Reduction of myocardial oxygen consumption by blocking beta adrenergic stimulation of the heart

Calcium Ion Antagonist (Calcium Channel Blockers)
Amlodipine (Norvasc)
Diltiazem (Cardizem, Tiazac)
Felodipine (Plendil )

Negative inotropic effects; indicated in patients not responsive to beta-blockers; used as primary treatment for vasospasm

Antiplatelet medications:
Aspirin,Clopidogrel (Plavix), Glycoprotein IIb/IIa agents:
Abciximab (ReoPro), Tirofiban (Aggrastat), Eptifibatide (Integrilin)

Prevention of platelet aggregation

Anticoagulant:
Heparin (unfractionated)
Low-molecular-weight heparins (LMWHs)
Enoxaparin (Lovenox), Dalteparin (Fragmin)

Prevention of thrombus formation

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