Diagnostic Tests and Procedures | 마이메르시 MyMerci

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Diagnostic Tests and Procedures

NCLEX Review Guide: Cardiovascular Diagnostic Tests and Procedures

Non-Invasive Cardiac Diagnostics

Electrocardiogram (ECG/EKG)

ECG records electrical activity of the heart through skin electrodes, providing information about heart rhythm, rate, and conduction abnormalities. Normal sinus rhythm shows P waves before each QRS complex with regular intervals.
12-lead ECG placement requires specific electrode positioning: V1-V6 across chest, limb leads on extremities for comprehensive cardiac assessment.

Key Points

Always assess patient for chest pain, shortness of breath, or palpitations before ECG
Remove hair, clean skin, and ensure good electrode contact for accurate readings

Echocardiogram

Echocardiogram uses ultrasound waves to visualize heart structures, assess valve function, and measure ejection fraction. Normal ejection fraction is 55-70%.
Transesophageal echocardiogram (TEE) provides clearer images through esophageal approach, requiring conscious sedation and NPO status.

Clinical Scenario

Patient scheduled for TEE: Ensure NPO 6-8 hours prior, remove dentures, establish IV access, and monitor for gag reflex return post-procedure.

Stress Testing

Exercise Stress Test

Patient exercises on treadmill while continuous ECG monitoring detects ischemic changes during increased cardiac demand. Target heart rate is typically 85% of maximum predicted heart rate.
Stop test immediately if patient experiences chest pain, severe dyspnea, dizziness, or significant ECG changes indicating ischemia.

Memory Aid: STOP Criteria

Systolic BP >250 or drop >10mmHg
Tachycardia or dangerous arrhythmias
Oxygen saturation <90%
Pain (chest) or severe symptoms

Pharmacologic Stress Test

Used when patients cannot exercise adequately; dobutamine or adenosine simulate exercise effects on heart rate and contractility.
Monitor for side effects: dobutamine may cause palpitations and hypertension, while adenosine can cause temporary heart block and dyspnea.

Invasive Cardiac Procedures

Cardiac Catheterization

Cardiac catheterization involves threading catheter through blood vessels to heart for diagnostic imaging or therapeutic interventions. Pre-procedure assessment includes allergies to iodine/shellfish due to contrast dye use.
Post-procedure care focuses on monitoring insertion site for bleeding, maintaining bed rest with affected extremity straight, and assessing distal pulses.

Pre-procedure: NPO 6-8 hours, baseline vitals, mark distal pulses
During: Monitor for chest pain, arrhythmias, allergic reactions
Post-procedure: Flat bed rest 4-6 hours, pressure dressing, frequent vital signs
Discharge: Avoid heavy lifting, watch for bleeding/swelling at site

Clinical Alert

Immediately report: sudden groin/back pain (possible retroperitoneal bleeding), loss of distal pulse, or signs of contrast-induced nephropathy (decreased urine output).

Laboratory Tests

Cardiac Enzymes

Enzyme	Peak Time	Duration	Significance
Troponin I/T	12-24 hours	7-14 days	Most specific for MI
CK-MB	12-24 hours	2-3 days	Cardiac muscle damage
Myoglobin	2-6 hours	24 hours	Early marker, less specific

Lipid Panel

Requires 12-hour fasting for accurate triglyceride and LDL measurements. Total cholesterol <200 mg/dL, LDL <100 mg/dL, HDL >40 mg/dL (men) or >50 mg/dL (women) are target values.
Elevated triglycerides (>150 mg/dL) increase cardiovascular risk, especially when combined with low HDL cholesterol.

Commonly Confused Concepts

Concept	Key Difference	NCLEX Focus
ECG vs Echo	ECG = electrical activity; Echo = structural/functional	ECG for rhythm, Echo for ejection fraction
Exercise vs Pharmacologic Stress	Exercise uses treadmill; Pharmacologic uses drugs	Contraindications differ
Troponin vs CK-MB	Troponin more specific and lasts longer	Troponin preferred for MI diagnosis

Study Tip: Cardiac Cath Remember

PULSE check post-procedure:
Pulses distal to insertion site
Urine output (contrast nephropathy)
Lie flat with leg straight
Site assessment for bleeding
Emergent signs (chest pain, SOB)

Quick Self-Assessment

☐ I can identify normal ECG components and placement
☐ I understand pre/post cardiac catheterization care
☐ I know when to stop a stress test
☐ I can differentiate cardiac enzymes and their timing
☐ I understand fasting requirements for lipid panels

Common NCLEX Pitfalls

Forgetting to assess for iodine allergies before contrast procedures
Not maintaining bed rest position after cardiac catheterization
Confusing peak times of cardiac enzymes
Missing signs of retroperitoneal bleeding post-catheterization

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