Tests associated with cardiac disorders

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Tests associated with cardiac disorders

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Tests associated with cardiac disorders

  1. 1. Cardiac disorders : primary diagnosis : Auscultation. Detecting abnormal heart sounds. Blood pressure – sphygmomanometer.
  2. 2. SIGNS AND SYMPTOMS:  Chest pain.  Dyspnea with or without orthopnea.  Paroxysmal nocturnal dyspnea.  Cyanosis.  Fatigue.  Palpitations.  Cough.  Edema.  Syncope.  Abnormal heart sounds.
  3. 3. DIAGNOSIS OF CARDIAC DISORDERS:              
  4. 4. HEART SOUNDS:  Stethoscope is the commonest instrument used.  FIRST SOUND: (L-U-B-B)  Occurs at the onset of ventricular systole. o DURATION: 0.1 – 0.17 sec o CAUSES:  Occurs due to sudden closure of the AV valves.  Ejection of blood from the ventricles & the vibration transmitted to the walls of the pulmonary artery & aorta.
  5. 5. o SIGNIFICANCE:  Indicate the condition of myocardium.  Indicates proper closing of AV valves. o CLINICAL IMPLICATIONS:  INCREASED FIRST SOUND:  Hypertrophy.  SHORT & LOW PITCHED FIRST SOUND:  Myocardial weakness.
  6. 6.  SECOND SOUND: (DUP)  Occurs at the onset of the diastole. o DURATION: 0.1 -0.14 sec o CAUSES:  Caused by the sudden closure of the semi lunar valves in the aorta & pulmonary artery. o SIGNIFICANCE:  Indicates the end of systole & beginning of diastole.  Its pitch is directly proportional to the BP.  Indicates proper closing of semilunar valves. o CLINICAL IMPLICATIONS:  DECREASED DIASTOLIC PERIOD: ( PAUSE)  Increased heart rate.
  7. 7.  THIRD SOUND: o DURATION: 0.04 sec o CAUSES:  Sudden rush of atrial blood. o SIGNIFICANCE:  Indicates ventricular filling.  FOURTH SOUND: o DURATION: 0.01 sec o CAUSE:  Contraction of atria o SIGNIFICANCE:  Indicates the ending of ventricular filling.
  8. 8. LABORATORY TESTING : 1. BLOOD TESTS :  SERUM CHOLESTROL : o Total cholesterol : 150 – 200 mgs o TGL : Up to 170 mgs o HDL : 35 – 55 mgs o LDL : Up to 170 mgs o VLDL : 20 – 40 mgs
  9. 9.  CLINICAL IMPLICATION : • Elevated cholesterol level (HYPERCHOLESTEROLEMIA )  Coronary heart disease  Hypothyroidism  Diabetes mellitus  Cholestasis  Hepatocellular disease  Biliary cirrhosis  Glomerulonephritis  Werner’s syndrome  Obesity  Chronic renal failure
  10. 10. • Decreased cholesterol level: ( HYPOCHOLESTEROLEMIA ) Myleoproleferative diseases Hyperthyroidism  Malnutrition Megaloblastic anemia Severe burns Inflammation Infection Chronic obstructive lung disease Mental retardation
  11. 11.  HIGH DENSITY LIPOPROTEIN CHOLESTEROL :  Normal value : 35 -55 mgs  CLINICAL IMPLICATIONS : o ↓ HDL-C Values:  Uremia  Hepatocellular disease  Chronic renal failure  Cholestasis  Diabetes mellitus o ↑ HDL-C Values:  Atherosclerosis  Myocardial occlusion
  12. 12.  LOW DENSITY LIPOPROTEIN (LDL)  Normal value : Up to 170 mgs  CLINICAL IMPLICATIONS : o Increased LDL levels:  Premature CHD  Hyperlipidemia  Nephrotic syndrome  Chronic renal failure  Porphyria  Myocardial infarction  Coronary artery occlusion  Anorexia nervosa
  13. 13. oDecreased LDL levels : Hypoproteinemia Tangier disease Hyperthyroidism Chronic anemias Severe hepatocellular disease Reye’s syndrome Acute stress Inflammatory joint disease Chronic pulmonary disease
  14. 14. 2. ENZYME TESTS : ENZYME NORMAL LEVEL DISEASE CONDITION SGOT Up to 40 U/LT Myocardial Infarction LDH M→82-285 U/LT W→103-227 U/LT Congestive cardiac failure CPK M→<190 U/LT W→>165 U/LT Various heart disease
  15. 15. AST / SGOT :  NORMAL VALUES:  MEN : 14 – 20 U/L  WOMEN : 10-36 U/L  CLINICAL IMPLICATIONS:  Increased AST levels occur in MI:  Increased to 4-10 times the normal value.  AST level reaches a peak in 24 hrs & returns to normal by post MI day 3-7.  Secondary rise in AST levels suggest extension or recurrence of MI.
  16. 16.  Increased AST levels occur in liver diseases:(10-100 times normal)  Acute hepatitis & chronic hepatitis ( ALT > AST)  Active cirrhosis( drug induced ; alcohol induced :( AST >ALT)  Hepatic necrosis & metastasis  Primary or metastatic carcinoma  Alcoholic hepatitis  Reye’s syndrome  Other diseases with elevated AST levels:  Hypothyroidism  Trauma & irradiation of skeletal muscle
  17. 17.  Shock  Hemolytic anemia  Decreased AST levels:  Azotemia  Chronic renal dialysis  Vitamin B6 deficiency
  18. 18. LDH ( LACTATE DEHYDROGENASE)  NORMAL VALUES:  MEN : 82-285 U/L  WOMEN : 103-227 U/L  CLINICAL IMPLICATIONS:  Increased LDH levels:  High levels occur within 36-55 hrs after MI & continue longer than elevations of SGOT or CPK ( 3-10 days)  In pulmonary infarction increased LDH occurs within 24 hrs of pain onset . The pattern of normal SGOT & elevated LDH levels of 1-2 days after an episode of chest pain – pulmonary infarction.
  19. 19.  Congestive heart failure  Liver diseases ( cirrhosis, alcoholism, acute viral hepatitis )  Cancer , leukemia  Hypothyroidism  Lung diseases  Skeletal muscle diseases  Megaloblastic & pernicious anemias , hemolytic anemia, sickle cell disease  Seizures  Shock, hypotension  Renal infarction
  20. 20. LACTATE DEHYDROGENASE ISOENZYMES :      
  21. 21.  CLINICAL IMPLICATIONS: DISEASE LD1 LD2 LD3 LD4 LD5 Myocardial infarction √ √ Pulmonary infarction √ √ Congestive heart failure √ √ Viral hepatitis √ √ Toxic hepatitis √ √
  22. 22. DISEASE LD1 LD2 LD3 LD4 LD5 Leukemia √ √ Pancreatitis √ √ Carcinomato sis (extensive) √ √ Megaloblasti c anemia √ √ Hemolytic anemia √ √ Muscular dystrophy √ √
  23. 23.  First diagnostic test in cardiac work shop.  Provides global information about position & size of the heart & chambers & surrounding anatomy.  The std CXRs for evaluation of lungs & heart are standing posteroanterior & lateral views taken at maximal inspiration.  Portable CXRs – less satisfactory.
  24. 24.  The PA CXR outlines superior vena cava , right atrium on the right & left sides , aortic knob ,main pulmonary artery, left atrial appendage & left ventricle.  In the lateral view CXR visualizes right ventricle , inferior vena cava & left ventricle.  Cardiac enlargement is determined by cardio thoracic ratio.
  25. 25. ELECTROCARDIOGRAM ( ECG ) :    
  26. 26.    
  27. 27.     
  28. 28. NORMAL DURATIONS:    
  29. 29. ECG CONVENTIONS & INTERVALS :       
  30. 30. NORMAL VOLTAGE MEASURMENTS :
  31. 31. 12 lead ECG 6 limb leads & 6 precordial (chest ) leads 6 limb leads 1. Standard bipolar lead 2. Standard unipolar lead Standard bipolar lead
  32. 32. Standard unipolar lead : 6 chest leads :
  33. 33. RECORDING OF ELECTRICAL IMPULSES CLINICAL VALUE OF ECG:
  34. 34. STANDARD BIPOLAR LEADS:
  35. 35. STANDARD UNIPOLAR LEADS:
  36. 36. CHEST LEADS:
  37. 37. CLINICAL IMPLICATIONS : 1) 2) 3) 4) 5) TYPICAL ABNORMALITIES :
  38. 38. CLINICAL IMPLICATION ASSOCIATED WITH WAVES,COMPLEX & INTERVALS OF ELECTROCARDIOGRAPHY : I. P WAVE   NORMAL VALUE :  CLINICAL IMPLICATIONS:  
  39. 39. II. PR INTERVAL :   NORMAL VALUE :  CLINICAL IMPLICATIONS :  III. QRS COMPLEX :   
  40. 40.  NORMAL VALUE :  CLINICAL IMPLICATIONS :   IV. ST WAVE: 
  41. 41.  CLINICAL IMPLICATIONS:   v. Hypertrophy of heart vi. Pulmonary infarction vii. Altered K , Ca, Mg levels viii. Pericarditis ix. Ventricular hypertrophy
  42. 42. DRUGS THAT CHANGES ECG: o o o o o o o o o o o o o o o o o o o o o o o o
  43. 43. AMBULATORY ECG MONITORING :  Also known as Holter monitoring.  During AEM patient wears a portable ECG recorder.  3 types of monitors are available.  Continuous monitor - record an ECG strip over the duration of the test.  Intermittent recorder - continuously monitor the ECG but only record preprogrammed abnormal ECG events.
  44. 44.  Real time analytical recorder -record through out the monitoring period and analysis each beat as it occurs.  Monitors digitize , encode and store the information in a solid state memory or on a magnetic tape  Clinical values of ambulatory ECG includes  Aid to detect ,document ,characterize and evaluate arrhythmias and other ECG abnormalities.  ECG abnormalities include ST segment deviation , QRS complex ,PR intervals.
  45. 45. ECHOCARDIOGRAM Ultrasound imaging of the heart Transducer reflection refraction
  46. 46. DOPPLER ECHOCARDIOGRAPHY Depends on the principle that sound waves reflected from moving objects such as intra cardiac red blood cells undergo frequency shift. The greater the frequency faster the blood is moving. Used for studying the pressure changes on either side of the valve & abnormal directions of blood flow.
  47. 47.  An ultrasound probe in the shape of an endoscope is passed into the oesophagus and positioned immediately behind the left atrium.  Helps in detecting  *patient with valve dysfunction.  *congenital abnormalities .  *patient with systemic embolism.
  48. 48. CARDIAC CATHETERISATION :      
  49. 49. ANGIOGRAPHY :   
  50. 50. COMPUTED TOMOGRAPHY :      
  51. 51.  Very expensive.  Technician places a small sticky electrode patches on your chest and back.  These electrodes are attached to ECG monitor.  Used for detecting  -CHF  -MI
  52. 52. RADIOLOGY : Chest radiograph is useful for determining the size and shape of the heart. Cardiothoracic ratio should be less than 0.5. Transverse cardiac diameter should be less than 15.5cm.
  53. 53. RADIONUCLIDE IMAGING Gamma emitting radionuclide with a short half life. Gamma rays are detected by means of a planar or tomographic camera. Blood pool imaging. Myocardial perfusion imaging.
  54. 54. BLOOD POOL IMAGING : The isotope is injected intravenously and mixes with the circulating blood. The gamma camera detects the amount of isotope emitting blood in the heart at different phases of the cardiac chambers. By linking the gamma camera to the ECG it is possible to collect information over multiple cardiac cycle.
  55. 55. MYOCARDIAL PERFUSION IMAGING : This technique involves obtaining scintiscans of the myocardium at rest & during stress after the administration of an intravenous radioactive isotope such as thallium.
  56. 56. REFERENCES: PHARMACOTHERAPY –A PATHOPHYSIOLOGIC APPROACH- JOSEPH T DIPIRO. DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE- CHRISTOPHER HASLET-19th ed MEDICAL SURGICAL NURSING – SHAFER 5th ed ESSENTIALS OF PHARMACOTHERAPEUTICS-F.S.K BARAR-4th ed. A MANUAL OF LABORATORY & DIAGNOSTIC TESTS –FRANCES FISCHBACH , 8th ed. www.ascp.com/publications

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