Welcome to your next module. My name is Jamie Warren. I am the VP for Care Transformation with MedAxiom. And today we're gonna talk about cardiovascular medicine specific to diagnostics. In this, I'm gonna group the tests together that you would most commonly see. First section we will do is EKG, Holter monitoring and event recorders. So when we're talking about this section, we're talking about looking at the electrical activity in your heart. And the most simplest of all of the tests that your patients will receive is your EKG may also be called an ECG, where it's going to record the electrical signals in your heart. This is a painless non-invasive way to help diagnose many common heart problems. Your patients will have multiple stickers. They're called electrodes and wires that will be placed on their chest. And some may even be placed down by their ankles. And the great thing about this test, it's very quick, just takes a couple of minutes and there is no special prep that the patient needs to do. The next in this category is Holter monitoring. And think of this just like an EKG, but it's a little bit longer. You can wear this for 24 hours, which is the most common up to 48 hours. And with this device, we have some new ones that have hit the market that are just stickers that are placed on the chest that you can see with the bottom pictures. And then the other is like a box that you would wear with wires that come up onto the chest with some electrodes or stickers. And then that box is placed either in a pocket or on the waistband of your pants. This again is a very painless and non-invasive procedure. This can be hidden underneath clothing. It is worn for again, 24 to 48 hours. And the patient will be asked to keep a diary or record their activities that they're doing during that time period that they're wearing it. And if they're having any symptoms. So if you have a patient that's scheduled for a Holter monitor, patient prep that you can discuss with them is that they may wanna take a bath or a shower prior to their appointment time is that they will have to keep this device dry during the time that they're wearing it. And they would also wanna remove any lotion or oils that they have in their chest area immediately prior to the appointment because they will have those stickers or electrodes placed and they would wanna be able to keep them firmly on the chest. And unfortunately the lotion or oil may make the skin where it won't stick with the sticker. The next one in this group is an event monitor. And again, this is still measuring electrical activity in the heart, but this is one that you can wear for a much longer period of time, up to 30 days. And with this one, the patient can take it on and off. They will be instructed on how to do this when they're at their appointment time. And there are two different kinds, one where there is a box and wires and then the second time is where they have the stickers that is just placed directly on the chest. Patient prep, the patient should be advised to again, not wear any lotion or oils from their chest immediately prior to their appointment. So our next section is gonna be stress testing. And this is gonna include exercise and pharmacological. So if a patient is scheduled for what we call a regular treadmill test or stress test or exercise test or exercise stress test, all of this means the same thing. The patient will be hooked up with some electrodes. Again, those stickers placed on the chest and some wires, and then they will either walk on a treadmill or can ride a stationary bike. This is a painless, it's a non-invasive procedure. The treadmill will start out very slowly and it will increase in speed in the incline that you will walk over a period of time until you get to a certain heart rate. Your EKG, your blood pressure and reviewing of your symptoms will be assessed regularly during the test. And you're gonna have several people in the room with you while you're having the test done. You will have an allied health professional that is watching your EKG and you may even have a physician or an APP that's in the room with you. This test typically takes about 20 minutes for the stress portion, but it may also be done in conjunction or with an imaging test like an echo or a nuclear medicine procedure. For a patient prep, what you want to do is check with the ordering provider and if that provider wants medications to be held prior to the test, they will provide them with specific instructions. For this test, patients should remove all lotions and oils from their chest. Again, electrodes being placed on the skin. Be instructed to wear comfortable two-piece clothing and walking shoes. For some patients, they are not able to walk on a treadmill or ride a bike. And so we do have an alternative to this called pharmacological stress testing. And in this, they're going to use a medication that goes through the patient's IV to mimic what would happen if you were to walk on the treadmill or ride a bike. This particular type of stress test is always done in conjunction with an imaging piece to it. It would never be a standalone test. So with this, you may see the doctor order this with regedenosine, it's also called Lexascan, dipertamol, it's also called persantine, adenosine or dobutamine. So from a patient experience perspective, what they can expect are some side effects with the pharmacologic agent that's used. These are very common to the same side effects that they would experience if they were walking on the treadmill. They may have some shortness of breath, they may have a headache or some minor chest pain. Again, the allied health professional will be with them during the entire exam or study. They will also discuss all potential side effects prior to starting the study and then be with them asking questions during. The stress, pharmacological stress piece does take about 20 minutes, but since this is in conjunction with other imaging, the test itself can take a little longer as we will discuss further in this presentation. From a patient prep perspective, patients will also be asked to hold their medications and caffeine for 12 to 24 hours prior to testing. It's important to check in with your ordering provider for specific instructions. And again, due to the electrodes being placed on the skin, they should remove all lotion and oils prior to the appointment and wear comfortable two-piece clothing. Now we're gonna move into echo or epi-clothing. So this is the echo or echocardiogram, and we're gonna talk about a regular echo, a stress echo, and what we call a TEE. The first piece is the most common echo in this category that we're going to see today. And this is also known as a cardiac ultrasound. So just like if you were having an ultrasound if you were expecting a baby, this is very similar in that they're using those ultrasound waves, except they're looking at the heart and the function of the heart or how well the heart is squeezing down as it's moving the blood in and out. The sonographer is going to use a probe. It's a handheld probe that they place on the patient's chest and that's how they can take pictures of the heart's valves and chambers. This study, the patient can plan on being in the room with the sonographer for about 40 to 60 minutes. They will be placed into a gown and they will be asked to lay flat on a stretcher or a bed. The sonographer will place some gel on the skin and then slide the probe over the chest area. During this test, the patient may be given an IV for the administration of an echo enhancement agent to assist with the images. It is important to note that this is not contrast that is commonly used in a CT procedure and does not have an ionizing agent to associate it with it. All side effects that may be associated with the echo enhancement agent will be discussed with the patient prior to starting the IV. And then again, it's important to note that these are not iodine contrast agents. And so patients that express allergies to that will not have allergies to this particular medication. There are three agents that are currently available that you may hear your provider discuss. Those are Lumison, Daffinity and Optison. And there is no special prep for your patient when they're having this test. The next one is a stress echo. And this is adding a stress test to that echo piece. The patient will come in and they'll have some pictures, some echo pictures taken prior. They'll then be hooked up to walk on the treadmill or have a pharmacological stress test with dobutamine. And then once they get their heart rate up to a set heart rate, they will then take some additional pictures. So this allows them to look at what your heart looks like at rest and then immediately after stress. With this, the patient can expect to be changed into a gown. Electrodes and leads, those wires to the treadmill system will be placed on the chest and an IV may be started. Again, the pre-stress echo images will be acquired. They will then move to the stress portion of the test. Allied health professionals will be in the room during the entire procedure. And then once the stress test is complete, they will continue on with the second set of images. With this test, the patient may also receive an echo enhancement agent to assist with the images. So for this particular test, patient prep, they may be asked to hold their medications prior to testing. And it's important to check in with your ordering provider for specific instructions. As we've said before, electrodes are going to be placed so no lotions or oils on the chest and they should wear comfortable two-piece clothing. Our last in this category is with a transesophageal echocardiogram or commonly known as a TEE. And what this is, is being able to take pictures from inside the chest. So in this test, you will have a cardiologist that will guide a very thin flexible tube, which is also the probe down the patient's esophagus to be able to take pictures internally of the heart. So what can the patient expect? The patient will be placed into a gown, an IV will start it, they will take vitals. So they will be looking at their EKG and their blood pressure. And then the patient will be given sedation for testing. And this also includes numbing on the back of their throat. There will be several people that are in the room during the procedure, that is commonly your cardiac sonographer, a nurse and your cardiologist. And they will be monitoring the vitals and signs of any discomfort during the procedure. The entire procedure takes about 90 minutes, but the imaging part or where the probe is placed down the esophagus is approximately 15 minutes. Patient prep is a little bit more involved with this exam. They will want them to have nothing to eat or drink six hours prior to the exam. Medications may need to be held that will be up to the ordering provider and they should wear comfortable clothing when they come in. One special note to tell your patient, because they will be sedated, they will need to have a driver to bring them home. The next piece is with non-invasive vascular testing. So just like we talked about with ultrasound of your heart, we're now gonna talk about ultrasound of the veins and arteries in your body. So with this first one, with a carotid ultrasound, we are taking a look at the blood flow of your carotid arteries. And those are the arteries that are gonna run right parallel on each side of your neck. And this is gonna evaluate if you're getting adequate blood from your heart to your brain. And then this study also is looking for if it's narrowed or if you have any blockages that could increase the risk of stroke. It is a non-invasive study and this patient will have gel placed on their neck and the sonographer will use a probe to obtain the images. The patient might feel some slight pressure from the probe and should plan on being in the exam room for about 30 to 40 minutes. There's no special prep for this test. Patients should wear a comfortable shirt with no collar or an open collar so there's easy access to the neck area. And they may also be asked to change into a gown to access the area. Patients should remove all jewelry around their neck and ears prior to the exam. Abdominal vascular ultrasound. Again, we are looking at the veins and arteries, but now we're moving down to the stomach or belly area. So this is a study performed to assess the main artery or aorta and the main arteries that are including the renal kidney arteries that arise from the aorta. So with this, they're also looking to see if there's any enlargements in those and how the blood supply is being taken down to the legs. So what can the patient expect? Again, this is a painless and non-invasive study. They will have gel placed on their abdominal area and the sonographer will use a probe to obtain the images. They may feel some slight pressure as the sonographer moves the probe around and they plan on being in the exam room for 30 to 40 minutes. The only prep with this study is that the patient should not eat or drink six hours prior to the exam. Venous Doppler ultrasound is now taking a look at the circulation of the large veins that are in your legs and your arms. They are looking to see if there's any blockages, could be from blood clots. So with this, again, is a painless and non-invasive study. They will be asked to change into a gown to be able to access the area that can be scanned, especially the legs. The gel will be placed on the skin and the sonographer will use the probe to obtain the images. The patient might feel slight pressure. This test can approximately take 30 to 45 minutes, but if the patient is having multiple areas scanned, the test may extend in time. There is no special prep for this test, but it is important to note that there can be critical findings from this test if a deep vein thrombus or a DVT has been identified and the patient may have to stay at the imaging facility until they hear back from the ordering provider for next steps. Arterial Doppler ultrasound is very similar to your venous Doppler ultrasound, but now we're gonna look at the arteries versus veins. And again, this can be performed in the arms or the legs, and you may even hear this ordered as an upper arterial or a lower arterial. It is a painless and non-invasive study. Patient will be asked to be changed into a gown and gel will be placed on the skin of the area that is going to be imaged and the sonographer will use that probe to acquire the images. In this study, the patient can also have blood pressure cuffs that will be used. They are placed in three different places on the leg, the thigh, calf, ankle, and on the arms. And this is done to compare the blood pressures in these different areas. They will inflate at different times so the patients may have pressure wherever the blood pressure cup has been placed. And just note that this scan takes 30 to 45 minutes, but if multiple areas are being asked to be scanned, it may extend this time. There's no special prep for the patient. An ankle brachial index or commonly known as an ABI is a very quick and simple way to check for peripheral artery disease or you may see this written as PAD. And this is gonna occur when your arteries narrow and that blood flow is reduced to your arms and your legs. And a good way of looking at this, it's taking the blood pressure in multiple areas in your legs and comparing it to the blood pressure in your arms. And then a low ABI number could indicate a narrowing or blockage of the arteries in the legs. What can a patient expect? This is again, painless, non-invasive study. Really the only discomfort they may have is just with the blood pressure cuffs being placed on their arms and their legs. This test can be performed with or without exercise. And the exercise piece is a very simple exercise piece. They will either be asked to walk very slowly on a treadmill or maybe performing toe ups. And think about that as if you're laying down on a stretcher and you pull your toes up and then you point them out and then pull them up and point them out. This test takes approximately 30 to 45 minutes to complete and there's no special prep for your patients. Now we move on to the nuclear cardiology. We're gonna talk about SPECT and PET. So with a SPECT study, this study has lots of names that you may see that it be ordered underneath. You may hear them say myocardial perfusion SPECT study or NPI. You may hear them say a heart scan or a cardiolite scan or a sensitivity scan. All of these are the same things to explain a study where a patient will go to the nuclear medicine department and they will be injected with a radioactive isotope and then images will be acquired underneath a camera called a gamma camera. And the type of picture that they're taking is a SPECT or a single photon emission computed tomography image. So with this, the hardest part of this test for a patient is having an IV started and they will be administered a radiopharmaceutical that does not contain any iodine contrast and does not have any known side effects. Once this has been administered, they will be asked to wait in a waiting room for about 30 to 45 minutes for this to circulate in the bloodstream. And then they will be placed on the camera for their first set of pictures. Depending on what type of camera the facility has, these images can take anywhere from seven to 25 minutes. Once the first set of images have been completed, the patient will be prepped for their stress test. And this can either be done riding on a bike, on a treadmill or with a pharmacological stress agent where they sit in a chair. During that stress test, they are injected with a second dose of that radiopharmaceutical. Once they complete their stress test, they will be unhooked and wait again for that radiopharmaceutical to circulate in the blood. The patient will return back to the camera for a second set of pictures. And depending on which location you go, the patient may also be asked to do a third set of images where they're asked to lay on their stomachs. What this test is doing is looking at the blood supply to the heart during rest and then after a stress test. This test does have prep with it. The patient will be asked to have no food or drinks four hours prior to the study. No caffeine or decaffeinated products for 12 to 24 hours. It's very important to express to your patients that even some decaffeinated products like decaffeinated Diet Coke or Coke still have traces of caffeine in them. And so a good bet is to say to them water, juice, milk, or lemonade, but to stay away from teas, coffees, or sodas. Patients may also be asked to hold their medications prior to testing, and it's important to ask your ordering provider which medications to hold. Patients should remove all lotions and oils from their chest, wear comfortable two-piece clothing, and have walking shoes. Because this test is using a radial pharmaceutical, it's important to ensure that the patient is not pregnant or breastfeeding, and if they are, please discuss this with the ordering provider as an alternative test may need to be ordered. Our next exam to talk about is amyloid imaging or amyloidosis imaging, or it's also known as PYP scan. So why would we want to do this scan? What is amyloid? So cardiac amyloid occurs when a protein builds up in the heart, and this protein is produced in the bone marrow, but it can be deposited in any tissue or organ. So with this specific test, we are going to take a peek to see if there's anything going on with the heart muscle. This scan is painless, non-invasive. They will have an IV started and administered with a radiopharmaceutical. Again, no side effects with this and does not contain any iodine contrast. Once this is done and being administered, the patient is able to leave the department and then return back. It could either be one hour or three hours or both depending on what the protocol of the department is. The patient will be asked to lay flat on the camera, and the images themselves can take 45 minutes to an hour where the patient is laying flat with their arms either above their head or down by their sides. There is no special prep with this, but a special note, we are injecting them with a radioactive isotope. So if the patient is pregnant or breastfeeding, we'll need to discuss with the ordering provider if an alternative test should be ordered. Our next test is a myocardial perfusion PET study, and you may be asking yourself, didn't we just talk about a myocardial perfusion study with SPECT, and we did. This is a very similar study, but this is done on patients that have a BMI of over 35. There are other reasons to perform a PET study, and that will be dependent on your ordering provider and which study that they would like to perform. So with PET, this stands for positron emission tomography. The camera is a little bit different, and you can see a great picture here on this slide, but the patient will slide through just like they would on the SPECT camera. This is also a painless and non-invasive procedure, and the patient will lie flat on that with their arms above their head. An IV will be started. A radiopharmaceutical will be administered. Again, no side effects with this and does not contain any iodine contrast. Once those first set of pictures are done, with the patient still lying on the table, they will have a pharmacological stress test. During this, they will have several allied health professionals that are checking in with them about symptoms that they may be experiencing. They will be watching their EKG and their blood pressure. Once that stress test has been completed, a second dose of the radiopharmaceutical will be injected, and immediately a second set of images will be taken. This scan takes about 45 to 60 minutes to complete. With this, the prep is very similar to what we discussed on the SPECT, where there is no food or drink for four hours prior to the study, no caffeine or decaffeinated products. It's great to say to your patients the water, juice, milk, or lemonade for 12 to 24 hours, and then the patients may be asked to hold certain medications. Check with your ordering provider on special instructions. Patients should remove all lotion and oils from the chest area immediately prior to their appointment, and plan on wearing comfortable two-piece clothing. Because the patient is being injected with a radioisotope, it is important to check if the patient's pregnant or breastfeeding, and if they are, you would need to discuss with your ordering provider if an alternative test should be ordered. Sarcoid or sarcoidosis PET study is looking at a different aspect in the heart. So with this, we are evaluating for granuloma in the heart, and what a granuloma is, is a small area of inflammation in the tissue specific to the heart. This again, painless and non-invasive, that is our theme for a lot of our studies we'll talk today, but the patient will lay flat on the camera with their arms above their head, and an IV will be started. A radiopharmaceutical will be administered, and the images will be started. Again, please note there are no side effects with this radiopharmaceutical, and it does not have any iodine contrast. The piece with this test is the patient prep. It is the most important part. The dietary prep prior to this exam is very strict, and will depend on the location on where the study is being performed. The particular location should be able to provide a specific checklist of what the patient can have prior to the study. They may be asked to hold their medications. This is up to the ordering provider. Again, they should remove all lotion and oils from the chest area immediately prior to the exam, and wear comfortable clothes and shoes. Due to being injected with the radioisotope, this one again, check with your provider if the patient is pregnant or breastfeeding for alternative testing. A cardiac viability pet study. So this one is taking a look to see if there's any damage to the heart muscle itself. So if a patient has had a heart attack or has significant heart disease, this study is the piece that they will be able to look to see what parts of the heart are functioning appropriately, and if the patient would need to go on to have a cath, or cardiac bypass surgery, or a heart transplant, or other procedures. This again is a painless and non-invasive study. An IV will be started. They will lay down flat on the PET scanner with their arms above their head. A radiopharmaceutical will be administered, and they will have their first set of images taken. Once that's done, they will be taken off the camera and given a second dose of the radiopharmaceutical through their IV, and they will wait 45 minutes and then be placed back underneath the camera for a second set of pictures. Altogether, this test will take approximately three hours. So for this test, no food or drink four hours prior. Also checking with your ordering provider about which medications to behold. Same prep with no lotion or oils on the chest, and to wear comfortable clothing. Because we are injecting with a radioisotope, please ensure that the patient is not pregnant or breastfeeding, and if they are, please discuss with your ordering provider. Now we're going to move on to CT procedures. This is a fairly new technology that we are seeing more and more patients being scheduled for. So a cardiac computed tomography, or cardiac CT, or you may also hear it as a CCTA. So this is a CT that is looking specifically at the heart, the coronary arteries, for blockages. The patient will have an IV started, and they will be placed on a cardiac monitor to evaluate their heart rate. This is usually done in a triage area or a small room that is not in the camera room, but adjacent to it. For this particular study, the heart rate does need to be within a certain range, and an allied health professional will use IV medications to manage the heart rate and get to the appropriate range. Once that patient has reached the heart rate that is needed, they will be moved into the CT camera room, and an iodine-based contrast will be administered so that they are able to see the vessels of the heart during the imaging process. There may be parts in this scan where the patient will be asked to hold their breath and then breathe out. For the patient, they can expect to be in the imaging department for one to three hours, but the imaging piece takes less than 15 minutes. It's very fast once they're on the CT camera. For this, the patient prepped no food or drink for four hours prior to the study. They may be asked to hold their medications, again check with your ordering provider, wear comfortable clothing. With this test, they are using an iodine-related contrast, so asking the patient if they've had any previous known allergies, and if yes, notify your ordering provider. Calcium scoring CT is very similar to the test that we just discussed. With this, they are detecting and measuring calcium-containing plaque that's in the arteries of the heart. They will lay down flat on the scanner, and electrodes will be placed on their chest. Those are the stickers and placed right on the chest area. The patient will be asked to hold their breath and breathe out at certain moments, and to hold very still during the study. This test takes approximately 15 minutes. Again, it's a very quick exam, and no special prep is needed. Please note, the calcium scoring is considered a screening tool and is not covered under most insurance policies. Patients may expect to pay out-of-pocket for this study. With peripheral angiography CT, we're now going to take a look at the blood vessels in the arms and the legs. So just like we previously discussed with ultrasound, we're just now using a CT camera to look at the blood vessels in those particular areas. So for this test, the patient can expect to have an IV placed and lay flat on the CT camera. An iodine-based contrast material is injected, and that allows them to see the vessels in the arms and the legs during the imaging process. The patients may be asked to hold their breath and breathe during certain parts of the exam, and this test time is going to vary depending on what part of the body is being imaged. The prep for this study is no food or drink four hours prior to the study. They may be asked to hold their medications. It is important to check in with your ordering provider for those specific instructions, to wear comfortable clothing, and to ask the patient if they've had any iodine-related allergies, and if yes, please check in with your ordering provider. Now we move on to MRI procedures. This is one of the newest imaging modalities for cardiac and is not commonly seen today. Now over the next few years, we may see this order more and more, but this may be one of the studies that you only see occasionally ordered. So what is it? This is a cardiac MRI or also known as a heart MRI, and this is going to scan the heart in which radio waves and magnets are going to create an image, and this image is going to include the heart's chambers, valves, and muscles, and it can provide information on how well the blood is moving through each part of that anatomy. This is a very painless and non-invasive procedure. They will have an IV started and they will lay flat on the camera. They may be administered with an MRI contrast, which is going to assist in seeing the finer details in the images. This test takes approximately one and a half hours to complete. For the patient prep, there is no special prep. The patient will be asked if they are pregnant or have any metal or devices inside their body. If the patient has a device like a pacemaker, the MRI department will verify if it is safe to scan. It is also important to ask your patient if they're claustrophobic. If they are, they may need to be pre-medicated and will need to plan on having a driver. Cath procedures. So with a cath procedure or a diagnostic cardiac catheterization, this is when we're taking a deeper dive into the patient's heart to evaluate if they have any blockages. So this is a procedure where they take a thin flexible tube called a catheter and they guide that through a blood vessel that's in the groin or arm. And again, this is to diagnose heart disease or blockages in the heart. It's going to take a look at the heart muscle, heart valves, and blood vessels that feed to the heart. So what can a patient expect when they first arrive to the cath lab area? They will be taken into a pre-area or a triage area where the patient will be asked to change into a gown, have an IV started. They may have labs drawn and they will be asked questions about their medical history. From this, the patient is moved to the cath lab itself where the patient will be administered with sedation to help them relax. During this procedure, that cardiologist will insert the catheter through a blood vessel and it could be through the groin or the wrist. And this area is also numbed. Once the procedure is complete, that catheter will be removed and the patient will be required to lie flat for several hours to avoid bleeding. And they will do this in the post or recovery area of that cath department. For the patient prep, the patient should have nothing to eat six hours prior to the exam. Patients may be asked to hold medications prior to the test. Please check with your ordering provider for specific instructions. And because the patient will receive sedation, they will need a driver to return home. The area where the catheter was placed may feel sore for a few days. It is important to instruct the patient that if they experience any bleeding or increase in pain swelling, they will need to contact their cardiologist. If the patient has any iodine related allergies, please notify your ordering provider. When you have your cardiac catheterization, if it's identified that you do have a vessel that is narrowed or blocked, the cardiologist may decide to do a stent or what we also call a PCI or coronary angioplasty. So with this, they're going to open the narrow coronary arteries to improve blood flow to the heart. So the angioplasty uses a tiny balloon catheter that is inserted into the blocked blood vessel to help widen it and improve blood flow to the heart. And this is often combined with the placement of a small wire mesh tube called a stent. And this stent is going to help prop that artery open, decreasing its chances of narrowing again. Most of these stents are coated with medication that helps keep the artery open. And you may see that in the patient notes that they have a drug eluding stent. Patient's medications may be changed post-procedure, including the addition of blood thinners and or anti-plague medications. Our last piece that we will discuss today is lab assessments, and we're just going to hit the most common ones that you will see ordered. Our first one is a cholesterol or lipid panel test, and this is looking exactly what it says. We're taking a peek at the patient's cholesterol levels or measuring the fats in the blood, and the measurements can help determine the risk that the patient has of a heart attack or other related diseases. And many of our cardiology patients will be on medications for their cholesterols, and these tests are required every 3, 6, or 12 months. Our ideal ranges are listed below, and the patient prep for this test is a 12-hour fast. Our next one is a BNP. So a BNP is a protein that the heart and blood vessels make that helps to eliminate fluids, relaxes the blood vessels, and moves the sodium into urine. When the heart is damaged, the body is going to secrete high levels of BNP into the bloodstream to try to ease the strain on the heart. One important use of BNP is determining whether or not the heart is damaged. And determining whether shortness of breath is due to heart failure. No prep is needed for this for our patients, and your normal values are listed below. A troponin, T or I, this is a test that's going to look at certain types of protein troponin in the bloodstream. Those types of troponin only occur in the heart muscle cells and only enter your blood because of heart muscle damage. That makes troponin invaluable in diagnosing heart attacks and other heart-related problems. An elevated level indicates myocardium damage. Ideal levels vary based on the lab and the troponin type. There is no special prep needed, but usually this lab is drawn in the hospital setting when the patient presents with chest pain. A chemistry panel. You may also hear this called metabolic panel. This is going to include labs that assess the electrolyte levels, kidney function, liver enzymes, and blood glucose levels. You will see your panel to the side with your normal values, and patient prep is going to vary between fasting and non-fasting depending on which your physician orders. A complete blood count, or you may also know this as CBC. So what is this? This is going to measure the number of red blood cells, white blood cells, hemoglobin, hemocrit, and platelets. Typically measures prior to or after a procedure or if there is a concern that the patient may have an infection or anemia. There is no special prep that the patient needs to do for this test. So PTINR and PTT. So what is this? The prothrobin time with international normalized ratios, which is why we have the abbreviation of PTINR, measures clotting time for specific clotting factors, and this is used for the management of coumadin or warfarin and in pre-procedure. The PTT is going to measure clotting time for other clotting factors, and it's used for the management of heparin and pre-procedure. There is no prep for the patient when they are scheduled for this lab. And that will conclude today's session. If you have any questions, please send us an email at academy at medaxiom.com. Thank you.

cardiovascular medicine diagnostics

EKG

Holter monitoring

stress testing

echocardiograms

non-invasive vascular testing

nuclear cardiology procedures