4Cardiovascular – Part II_2

4Cardiovascular – Part II_2 - Cardiovascular Part II Amy...

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Cardiovascular – Part II Amy L. Huff, MSN, RN Martin Methodist College Spring 2015
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Chest Pain Differential diagnoses – very long list! Consider ischemia until proven otherwise Women and diabetics often have atypical presentations Common descriptors: pressure, aching, squeezing, discomfort Use PQRST or OLDCART to evaluate
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Chest Pain - Assessment Obtain critical information quickly Look for clues to indicate heart disease: cachexia, pallor, cyanosis, edema, etc…….
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Diagnostic Tests Troponin - released into blood with cardiac muscle damage - any elevation should be treated - Isotypes T & I – cardiac necrosis or AMI (not present in healthy patients) - Troponin T: <0.2 ng/mL - Troponin I: <0.03 ng/mL
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Diagnostic Tests (cont) Creatinine Kinase (CK) Isoenzymes: CK-MM – skeletal muscle CK-MB – myocardial muscle CK-BB - brain Myoglobin – earliest detected marker (2 hours) Rapid decline after 7 hours Not cardiac specific More limited than troponin
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Cardiac Enzymes Enzyme Rise Peak Return Total CPK 4-6 hours 24 hours 3-4 days CK-MB 4 hours 18 hours 2 days LDH 24 hours 72 hours 8-9 days Troponin 4-6 hours 10-24 hours 4 days
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  • Spring '14
  • Ferguson
  • Nursing, cardiac tamponade, cardiac cath, heart cath

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