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a. Shows size and shape of heart and mediastinal structures.
b. Standing in a gown or high fowler's (in bed)
a. Records electrial impulses of the heart, determine: heart rate, rhythm, site of pacemaker, and injury at rest.
b. Electrodes (chest/extremities) - show conduction patterns in different directions of electrical flow.
c. Signal-averaged ECG - high risk/serious ventricular arrhythmias.
Holter monitor (ambulatory ECG)
a. Daily activity with electrical function of the heart - determines: activity causes abnormalities.
b. Pt. wears ECG 6, 12, 24 hrs (usual tasks).
c. Diary is kept (time/activities/symptoms).
d. Tape analyzed - correlate dysrhytmia with activity.
e. Record all activites in diary (brushing teeth, sex).
f. Caution: removal of electrodes/wetting.
g. Wear loose shirt.
Exercise ECG stress test (treadmill)
a. Records electrical activity of the heart during exercise.
b. Abnormal waveforms- insufficient blood flow and oxygen.
c. Electrodes on chest - tracing made during exercise.
d. Degree of difficulty of exercise increased as test continues - see how heart reacts to incrasing work demands.
e. Vital signs - cont. recorded.
f. Physician present.
g. Signed consent.
h. Comfortable clothes/shoes.
i. Light meal 2-3 hr prior, then NPO.
j. Reg. meds given.
k. Test will stop if chest pain, severe fatigue, and dyspnea develops.
Chemical stress test
a. Used for those who cannot exercise for an ECG stress test.
b. ECG done and the drug is injected.
c. BP/pulse are taken and recorded q 15min (drug- cardiac ischemia)
d. Scanning images taken with a gamma camera - 40min.
e. May repeat scan (3-4hr), NPO.
f. Mild nausea/headache
Nuclear imaging (thallium perfusion imaging)
a. Evaluates blood flow in the various parts of the heart; determines- infarction
b. Thallium injected IV
c. Radioactivity - few hrs.
d. Camera will be positioned over heart.
e. May be done with an ECG stress test.
f. Electrodes on chest, scanning 10-15min after injection.
(MUGA) multiple-gated acquisition scan
a. Determines- extent of MI, assesses L ventricular function
b. Tc injected IV, taken up by areas of infarction - produces hot spots when scanned.
c. Multiple images.
d. Best results: 1-6 days after suspected MI.
e. IV-radioisotopes/lie still during scan
f. Glucose 60-140.
(V-Q scan) Ventilation-perfusion scan
a. Detects blood clots- pulmonary emboli.
b. Radioisotope- injected, uptake, camera measure amt. of radioactivity present in area in question.
c. Determine allergy to dye.
f. Post test- large fluid intake - flush dye through kidneys.
(Pet scan) Positron emission tomography
a. Evaluates myocardial profusion
b. IV- nitrogen-13-ammonia injected, scan performed to show myocardial metabolic function.
c. Fluoro-18-deoxyglucose injected and a scan performed. Normal heart- scans will match; in ischemic heart, the scans will differ.
d. IV- radioisotopes, lie still.
e. Glucose 60-140.
a. Evaluating: shape, size, position of structures and movement within the heart.
b. Test of choice: for valve problems.
c. Metal wand- emits sonar waves, guided over chest wall, supine/turned on L side.
e. Conduction- jelly cool.
a. Detects differences in L ventricular wall motion before and after exercise.
b. Resting ECG images obtained.
c. Pt. exercises and then within 1min, postexercise images are obtained.
e. No heavy meal beforehand, no smoking or caffeine 6-8hr before test/wear walking shoes.
a. Substitute for an exercise stress test when individual cannot exercise.
b. Detects abnormal heart wall motion.
c. IV dobutamine, a positive inotropic agent, infused.
e. Dosage increased at 5min intervals during ECG.
f. Monitor vital signs; watch for symptoms of distress.
(TEE) Transesophageal echocardiogram
a. Provides images of the hrt, mitral valve, atrial septum, and throacic aorta.
b. Pharynx- anesthetized with topical agent.
c. L side lying position - endoscope and transducer are placed in esophagus behind the hrt.
d. Image recordings are made, takes 20min.
e. NPO 4-6hr. pretest.
f. IV access pretest for sedation.
g. ECG applied for monitoring during test.
h. Monitor pulse oximetry and BP.
i. Observe after test until sedation has worn off.
a. Identifies thrombi within the venous system.
b. A tournique may be placed on the extremity and dye is injected into the affected extremity.
c. Radiographs are taken at timed intervals.
d. Also used to identify venous stenosis.
e. Signed consent.
f. Assess allergies.
g. Hydrate prior procedure.
h. Takes 30-90min; warm flush may be felt when dye is injected.
a. Visualizes arterial anatomy and vascular disease in carotid, vetebral, aorta, renal, coronary, and peripheral arteries.
b. Catheter placed via the femoral artery into desired artery.
c. Radiopaque contrasted injected while x-ray images obtained.
d. CO2 gas - if pt allergic to dye.
e. Ballon used - constricted areas.
f. Stent placement- keep vessel open.
g. Signed consent.
h. NPO 2-8hr pretest.
i. Mark peripheral pulse before procedure.
j. Check renal function, notify abnormal values pretest.
k. Mucomyst- a day before and after test to prevent dye induced nephropathy.
l. Dye can cause- bladder distention during test.
Cardiac catheterization with coronary angiography
a. Assess pumping action of both sides of the hrt.
b. Measures: pressure w/in hrt chambers & cardiac output.
c. Calculates diff. in oxygen of aterial and venous blood.
d. Size and patency of coronary arteries and presence of collateral circulation.
e. Catheter inserted into vein or artery (depending which side of the hrt to be tested) - femoral artery/brachial vein (often used).
f. Anesthetic/sedation - catheter threaded up to hrt, pressure readings and oxygen sat. are taken.
g. Contrast media may be injected to visualize- size/shape of chambers and structures.
h. Fluoroscopy used during procedure.
i. Angiography - dye injection during cardiac catherizations.
j. Computed tomographic angiography- enhance images.
k. Signed consent.
l. NPO 6-8hr pretest.
m. Assess allergy- iodine....
n. Void before preop med.
o. Record baseline vital signs/mark pedal pulses.
p. Strapped to table/table tilts/IV/lie still
q. ECG during test.
r. Dye used- hot flush after injection.
s. Cough during procedure.
t. Video recording made during procedure for later view.
u. Post test: Vitals q 15min x 4... until stable. Assess peripheral pulses, numbness, bleeding (insertion site).
v. Pressure dressing/sandbag wt. in place 1-3hr.
a. Determines patency (open/unblocked) of coronary arteries and presence of collateral (a small side branch, as of a blood vessel or nerve) circulation
b. Lower extremity: Assesses occlusion or thrombosis in an artery or vein.
c. Carotid duplex exam: Studies blood flow in external carotid arteries.
d. During cardiac catheterization.
e. Catheter (with transducer) - into peripheral vessel - avanced into coronary artery.
f. Transducer: emits high-freq. sounds waves - two/three dimensional image.
g. Water-soluble gel applied to skin assessed.
h. Doppler transducer passed over vessel.
i. Grey-scale image of vessel obtained.
j. Computer- two dimensional image/blood flow.
k. Supine with neck extended.
l. Probe- up/down each side of the neck over the external carotid arteries.
n. Abstain smoking 30min pretest.
o. Plaque can be visualized and determine need for endarterectomy surgery.
(MRI) Magnetic resonance imaging/ (MRA-angiography)
a. Evaluates cardiac tissue integrity, detects aneurysms, determines ejection fraction and cardiac output, an determiens patency (open) of proximal coronary arteries.
b. Noninvasive- depict tissues images.
c. IV gadolinium- contrast medium injection.
d. Loud noises.
e. Administer antianxiety medication/music.
a. Measures and records electrical activity from within the heart to determine the area of of origin of the dysrhythmia and the effectiveness of the antidysrhythmic drug for the particular dysrhythmia.
b. 3-6 electrodes placed in the heart through venous system.
c. Attached to oscilloscope- records intracardiac and ECG waveforms simultaneously.
d. After baseline- cardiologist tries to trigger dysrhythmia by programmed electrical stimulation through the electrodes.
e. Once triggered- antidysrhythmic drug is admin. to determine effectiveness.
f. Studies take 1.5 - 4hrs.
g. Psychological support for pt. - scared of induced dysryth.
h. Assure pt.- constant monitoring/emergency equip. on hand.
i. NPO after midnight/IV line/electrodes placed-fluroscopy.
j. Supine/femoral vein most used.
k. Chest electrodes placed before electrodes are threaded into heart.
a. Estimates blood flow in a limb based on electrical resistance before and after inflating a cuff.
b. Detects DVT.
c. Measurements of electrical resistance before and after cuff inflated.
d. Electrodes placed opposite sides of limb.
Hemodynamic monitoring via Swanganz catheter
a. Determines pressure, flow, and oxygenation within the cardiovascular system.
b. Catheter, infusion system, transducer, and a monitor are prepared and the catheter is placed in the hrt. or great vessels by the physician.
c. Readings are taken for right atrial, pulmonary artery, and pulmonary wedge pressures.
d. Other data calculated- stroke vol., cardiac output, and oxygenation.
e. Triglycerides contribute to arterial disease. As triglycerides rise, so do low-density lipoproteins, which are a factor in atherosclerosis.