Heart tests in the Emergency Department. What do they do?

If you find yourself in the Emergency Department for suspected heart problems, be prepared for a barrage of tests. Most involve needles. 

Here is a description of the tests I had in the Emergency Department and their purpose.

Blood tests & Infusions

Electrolytes

It is important to know the level of electrolytes (sodium, potassium, magnesium and calcium) in the blood because imbalances might affect the heart in a bad way. Low levels are fixed by being hooked up to a drip infusion.

I had several bags’ worth of electrolyte infusion.

Heart enzymes

An enzyme is a protein involved in biochemical reactions. Some of them linger around after the reaction has happened.

In the case of heart attacks, troponin enzymes slowly leak out. I imagine them as tears seeping from a sad, injured heart.

Troponin levels take a while to reach a maximum level so blood samples are taken at intervals up to 24 hours. A positive troponin result means a heart attack happened.

I had a negative result after 6 hours. No heart attack!

Iron

Iron is in haemoglobin which is in red blood cells. As a team, they carry oxygen around your body.

A diseased heart already has trouble pumping enough oxygen around the body, so optimising iron levels is a good idea and can avoid anaemia.

I needed an iron infusion.

IV Infusion bags on a stand

Don’t be a drip

Electrocardiogram (ECG)

Most people recognise ECGs as screens of mysterious lines and numbers in medical dramas. When things go bad, everyone is whipped into a frenzy. As a witness, I attest there is truth in that.

I was hooked up to some form of ECG monitor for 17 days. They come in different shapes and sizes. Actually, they are pretty cool.

My first one was the size and shape of a ghetto blaster. Yep, that big! Probably because it included a defibrillator.

An ECG measures the electrical activity of your heart.

Different stages of the heart beat cycle have different electrical patterns. The ECG shows where, when and how these are occurring.

103px-Tnorm_(ECG).svg

A normal T-wave. By Bron766 [CC BY-SA 3.0], via Wikimedia Commons

For example, the T-wave (shown in the shaded zone) shows ventricular repolarisation

Translation:

  • The chambers of the heart that pump blood to the body (ventricles)
  • are charging up (repolarisation)
  • so that they can contract again

Doctors study the ECG trace to find abnormalities and diagnose heart problems. Any ECG abnormality needs further investigation.

Tbiphasic_(ECG).svg

Biphasic T-wave. By Bron766 [CC BY-SA 3.0], via Wikimedia Commons

Unfortunately, sometimes abnormalities are transient and can be missed.

My T-waves were abnormal (biphasic) and weren’t happening consistently.

Blood Pressure

Is it too obvious to say that my blood pressure (BP) was monitored continuously?

I’ve never had hypertension (high BP) in my life. Except like everyone does during something scary or exciting. Or being in a hospital emergency department.

I thought that if I was having a heart attack, my BP would be high. So I kept asking if my BP was normal. It was. I suppose I just wanted something to be normal and reassuring.

But you can have normal BP and still have heart problems

Pulse

Your pulse is your heart beating and it’s measured in beats per minute (bpm). When you’re chilled, it has a slow rate. The bpm goes up when you’re active or excited. Or in a hospital emergency department.

I am guessing mine was as fast as a Les Mills track-list.

Heart rate

Do you have any comments or similar experience to share?

References

  1. Relation of Electrolyte Disturbances to Cardiac Arrhythmias

Importance of electrolytes in heart function (an oldie from 1973 but still a goodie)

http://circ.ahajournals.org/content/47/2/408.full.pdf+html

  1. Electrolyte Disturbances in Chronic Heart Failure: Metabolic and Clinical Aspects

http://onlinelibrary.wiley.com/doi/10.1002/clc.4960180704/pdf

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