Beruflich Dokumente
Kultur Dokumente
Invasive Procedure Requires a consent A diagnostic or therapeutic technique that requires entry of a cavity or interruption of normal body activities or functions. Noninvasive Procedure A diagnostic or therapeutic technique that does not require the skin to be broken or a cavity or organ of the body to be entered.
SERUM ANALYSIS
Potassium 3.55.3 meq/L (to detect origin of cardiac dysrhythmias) Sodium 135145 meq/L (to evaluate fluid and elec and acid base balance) Calcium 4.55.5 meq/L or 8.5-10.5mg/dl (to diagnose cardiac dysrhythmias, neuromuscular, skeletal and endocrine disorders)
Aspartate aminotransferase AST Can be found in many cells like liver, pancreas, heart kidneys and skeletal muscle (not a good indicator of MI) Creatinine kinase CK CK-MB = most specific enzyme Elevates in MI within 4 hours, peaks in 18 hours and then declines till 3 days Normal value is 0-7 U/L CK-BB = found in nervous tissues CK-MM = found in muscle TOTAL CK = detects post MI
Lactic Dehydrogenase LDH Elevates in MI in 24 hours, peaks in 48-72 hours Normally LDH1 is greater than LDH2 MI- LDH2 greater than LDH1 (flipped LDH pattern) Normal value is 70-200 IU/L LDH1 and LDH2 = appear primarily in the heart, RBC and kidneys LDH3 = lungs LDH4 and LDH5 = liver and skeletal muscle After 710 days LDH level returns to normal
EKG/ECG NON-INVASIVE
Electrocardiogram--graphic record produced by electrocardiograph Electrocardiograph--a device used for recording the electrical activity of the myocardium by placing leads to certain points in the chest region Electrocardiography--study of records of electric activity generated by the heart muscle
ECG
Placement of the Six (6) Electrodes V1 = 4th right intercostal space right sternal border V2 = 4th left intercostal space left sternal border V3 = halfway between V2 and V4 V4 = left mid clavicular line 5th left intercostal space V5 = left anterior axillary line halfway between V4 and V6 V6 = mid axillary line level with V4
Invasive:
ANGIOGRAPHY
Pretest: informed consent, allergy to dyes, seafood and iodine Intratest: Monitor VS Post-test: maintain pressure dressing over puncture site Immobilize for 6 hours
Introduction of catheter into heart chambers Pretest: informed consent, allergy to dyes, seafood and iodine, NPO 8-12 hours Intra-test: Empty bladder, Monitor VS, explain palpitations Post-test: maintain pressure dressing over puncture site Immobilize for 6-8 hours with extremity straight
SWAN-GANZ
BLOOD PRESSURE
Measure of force exerted by blood against the wall Blood moves through vessels because of blood pressure Measured by listening for Korotkoff sounds produced by turbulent flow in arteries as pressure released from blood pressure cuff
ECHOCARDIOGRAM
Non-invasive
test that studies the structural and functional changes of the heart with the use of ultrasound No special preparation is needed
2 D-echocardiogram
EKG/ECG NON-INVASIVE
Electrocardiogram--graphic record produced by electrocardiograph Electrocardiograph--a device used for recording the electrical activity of the myocardium by placing leads to certain points in the chest region Electrocardiography--study of records of electric activity generated by the heart muscle
ECG
Placement of the Six (6) Electrodes V1 = 4th right intercostal space right sternal border V2 = 4th left intercostal space left sternal border V3 = halfway between V2 and V4 V4 = left mid clavicular line 5th left intercostal space V5 = left anterior axillary line halfway between V4 and V6 V6 = mid axillary line level with V4
ECG
Placement of Four (4) Lead Wires Lead 1 RA right arm Lead 2 LA left arm Lead 3 RL right leg Lead 4 LL left leg
ECG
Travel of an impulse From the right shoulder across the chest to the left lower rib cage.
ECG
How are waveforms produced? Electrical impulses are generated by the: SA to AV to HIS BUNDLE to PURKINJE
ECG
SA node (70-80 bpm) Bachmanns bundle Internodal pathways Anterior Middle (wenckebachs) Posterior (thorels) DEPOLARIZATION OF ATRIA TAKES PLACE
ECG
AV node (30-60 bpm) His bundle Right and Left bundle Purkinje fibers Depolarization of ventricles takes place
ECG
0.04sec/small square 0.20sec/big square 300/150/100/75/60/50 R-R wave 25 small boxes for 1 big box
ECG
NSR (normal sinus rhythm) Sinus Tachycardia and Sinus Bradycardia (considered normal rhythm) Arrhythmias (abnormal rhythm)
ECG
Atrial Arrhythmias: Premature Atrial Contraction (PAC) Atrial Flutter Atrial Fibrillation
ECG
Ventricular Arrhythmias: Premature Ventricular Contraction (PVCs) Ventricular Tachycardia (vtach) Ventricular Fibrillation (vfib)
Atrioventricular or AV Block First Degree AV block (prolonged P wave followed by QRS) Second Degree AV block Type I Wenckebachs PR interval gradually lengthens then drops Type II PR interval is constant and one or more beats are non conduction or dropped Third Degree AV block (complete heart block) atria and ventricles are beating independently or P wave have no relationship to the QRS complex . Pacemaker is necessary
Possible ECG results: Elevation of ST segment = MI Peaked or inverted T wave = MI Pathological Q wave = MI Prolonged P-R interval = 1st degree heart block Widened QRS complex = delayed conduction to purkinje fiber Flattening of T wave = hypo K Depression of ST segment = hypo K Long QT interval = hypocalcemia (torsades de pointes) Prolonged QT interval = hypermagnesemia
P Q
S
P Q
S
P Q
S
P Q
S
Sinus Rhythm
Sinus Rhythm
Sinus Bradycardia
Regularly occurring PQRST Rate < 60 / min Rate = 48/min
Rate = 48/min
56/min
Sinus Bradycardia
Sinus Tachycardia
Regularly occurring PQRST Rate > 100 / min
Rate = 111/min Rate = 111/min Rate = 111/min
105/min
Sinus Tachycardia
Sinus Arrhythmia
Identical but irregularly occurring PQRST longest PP or RR > the shortest by 0.16 sec or more
Rate = 71/min Rate = 94/min Rate = 79/min Rate = 94/min
Sinus Arrhythmia
pathway
pathway
pathway pathway
AV NODE
Atrial Flutter
Atrial Flutter
Atrial rate = 220-300/min ( P as flutter waves ) Variable degree of AV block ( irregular RR interval )
Atrial Fibrillation
No discernible P waves Irregular RR interval
Atrial Fibrillation
Junctional Rhythm
Impulses from the AV node P wave inverted or buried w/in QRS or follows the QRS Rate slow QRS narrow
Atrioventricular Blocks
R P Q S T
R P T
Q
Do you have a normal P wave? Do you have a normal PR segment? Do you have a normal PR interval? Do you have a normal QRS-T?
P waves present QRS complexes present P waves morphology and axis usual for the subject QRS complexes morphology and axis usual for the subject One P wave to each QRS complex P-R interval constant
0.28 sec
0.28 sec
0.28 sec
Longest P-R interval is the one immediately before the dropped beat. Shortest P-R interval is the one associated with the first conducted beat after the dropped beat. P-R interval before the blocked beat increase and do so by progressively decreasing amounts so that the consecutive R-R intervals before the blocked beat actually progressively shorten.
0.20 sec
0.28 sec
0.20 sec
Within period of observation, one P wave is not followed by a QRS complex. No change in P-R interval before the transient failure of atrio-ventricular conduction. n P waves to (n-1) QRS complexes for each example of transient type II block. (n will be 3 or more*)
Trifascicle
0.18 sec
0.18 sec
0.18 sec
2 : 1 AV BLOCK
P waves present QRS complexes present P wave morphology and axis usual for the subject QRS morphology and axis usual for the subject and the lead
Some P waves followed by QRS complexes and some are not Atrio-ventricular conduction ratio is 3:1 or higher P-R interval following a QRS is constant but may be normal or prolonged
Ventricular Tachycardia
At least 3 consecutive PVCs Rapid, bizarre, wide QRS complexes
(> 0.10 sec) No P wave (ventricular impulse origin) Rate > 140 / min
Ventricular Tachycardia
Ventricular Tachycardia
Ventricular Fibrillation
Ventricular Fibrillation
Idioventricular Rhythm
Impulse ventricular in origin Absence of (N), upright P wave
associated with QRS complexes QRS > 0.10 sec T wave opposite in direction to QRS Rate < 40 / min Rate < 40 / min
Agonal Rhythm
Extreme sinus bradycardia with irregular, idioventricular rhythm and occasional atrial activity
Pacemaker Rhythm
No P wave (ventricular impulse origin) Wide QRS complex (>0.10 sec) Pacemaker spike precede the wide
QRS complexes
Thank you