● Evaluate pumping ability of the

cardiac chambers
CARDIOVASCULAR DIAGNOSTIC TESTS
● Performing percutaneous coronary
intervention
CARDIAC CATHETERIZATION
● Also known as cardiac cath or NURSING RESPONSIBILITIES
coronary angiogram BEFORE:
● Invasive imaging procedure that ● Assess allergies and be aware of the
allows the heart function to be medications
evaluated. ● Instruct the patient about what to eat
● A catheter (tiny tube) is inserted into and drink 24 hrs prior to the test
a blood vessel then into the coronary ● Instruct patient for NPO 6-8 hrs
arteries before test
● A contrast material will be injected ● Educate patient on what to expect
through the catheter during and after the test and also the
● Creates an x-ray image risks
● Generally takes 30 mins - Skin reaction / allergic
● Preparation and recovery period reactions
takes several hours - Irregular rhythm
● Client stays awake but will be - Blood clots
administered sedative - Infection
● Local anesthesia will be used to - Low bp
numb the injection site - Chest pain
- Sunburn
TYPES: - Cardiac tamponade
● ANGIOGRAPHY - When a catheter - Coronary artery damage
is used to inject a dye that can be - Heart attack
seen in x-rays - Stroke
● ANGIOPLASTY / PERCUTANEOUS DURING:
CORONARY INTERVENTION - ● Advise the patient to tell provider if
when a catheter is used to clear a they feel:
narrowed or blocked artery. - Nausea
● VALVULOPLASTY - when a - Chest discomfort
catheter is used to widen a narrowed - Allergic reactions
heart valve opening ● STEP BY STEP
- Sedative and anesthesia (IV)
INDICATIONS: - Plastic introducer sheath (IV)
● Biopsy - Catheterization
● Measuring oxygen content in 4 - Contrast dye
cardiac chamber - X-Ray photographs
● Narrowed or blocked coronary artery - Sheath and catheter removal
● Cardiac valve or chamber defects
● Check pressure in the 4 cardiac AFTER:
chambers ● Monitor VS
 ● Place sterile dressing to protect INDICATIONS:
puncture site from infection ● Assess heart response
● Observe patient for few hours to ● Evaluate symptoms
monitor any symptoms or side ● Identify the CAD
effects ● Monitor effectiveness of treatment
● Instruct patient to tell if they are
bleeding or feeling any numbness or NURSING RESPONSIBILITIES
tingling sensation BEFORE:
● Instruct patient to avoid strenuous ● Review patient’s history
activities for 2-5 days ● Assess VS - HR AND BP AND RR
● Do not submerge puncture site in ● Evaluate current symptoms
water for a week ● Informed consent
IF THE CATHETER WAS IN THE ARM: ● Review patient’s meds
● Arm must be kept straight for at least ● Avoid heavy meals and caffeine
an hour, but the patient can walk several hours before
around ● Wear comfy clothing and appropriate
IF THE CATHETER WAS IN THE GROIN: footwear
● Supine position and keep leg ● Discuss potential risks and side
straight for 2-6 hrs to prevent effects
bleeding ● Ensure availability of equipment
● Do not raise the head more than 30 ● Record baseline ECG readings
degrees and do not try to sit or stand DURING:
until the provider tells you to do so ● Place patient on treadmill or
stationary bike
RECOVERY ● Continuously monitor VS
● Drink plenty of fluids to clear ● Record and document
contrast material ● Assess signs of discomfort
● They may need to pee more ● Monitor ECG
frequently ● ECG leads are attached should be
● Educate about discharge plans, ensured
treatment meds, diet, future ● Inform patient about the progress
procedures, wound care, activities, ● AED is readily available
and follow-up care. ● Accurately document patient
response
CARDIAC STRESS TEST AFTER:
● AKA exercise stress test or treadmill ● Evaluate overall condition
test ● Review ECG tracings
● Used to evaluate the functioning of ● Ensure patient has a comfy and
the heart during physical stress or quiet place to rest
exercise ● Provide clear and specific
● Evaluate blood flow of heart instructions
● Person walks on the treadmill or ● Accurately document post test VS
pedals stationary bike while being ● Attentive to emotional well-being
monitored
 ELECTROCARDIOGRAPHY ● Alternative, minimally invasive
● Used to evaluate cardiac status or ultrasound of the heart that provides
the process of producing an clever images of the heart’s pump
electrocardiogram function, assessment of heart
● Provide info about heart’s condition valves, and/or clots or holes in the
or performance heart, wherein ultrasound waves
LIMB LEAD PLACEMENT pass through less tissues
● RIGHT ARM = white
● LA = black INDICATIONS
● RL = green ● Higher resolution and detailed
● LL = red imaging
WAVEFORMS ● Better visualization or posterior
● P wave = atrial depolarization structures
● QRS complex = ventricular ● Assessment of blood clots
depolarization ● Improved assessment of valve
● T wave = ventricular repolarization function
● Assessment of intracardiac shunts
INDICATIONS ● Evaluation of cardiac tumors
● Abnormal heart rhythms
● Heart failure NURSING RESPONSIBILITIES
● Heart attacks BEFORE:
● Cardiac meds ● Explain procedure
● Assess pacemaker performance ● Informed consent
● NPO
NURSING RESPONSIBILITIES ● Assess patient for existing IV line
BEFORE: ● Remove dentures, and ready for
● Assess patient’s history anesthetics
● Remain still and relaxed DURING:
DURING: ● Emotional support
● Position in supine or semi-fowler’s ● Monitor VS
● Expose chest, ankles, and wrists ● Instruct patient on proper positioning
● Place and apply electrodes correctly ● Monitor after sedation
● Check electrode conductivity AFTER:
● Monitor ECG tracing ● NPO until fully alert - 2 hours after
AFTER: procedure
● Remove electrodes and clean skin ● Post-procedure diet
● Report abnormal findings or concern ● Report presence of any discomfort
● Document patient response and for a long period of time
follow up.

TRANSESOPHAGEAL
ECHOCARDIOGRAM ECHOCARDIOGRAPHY
 ● Uses soundwaves to create images ● Translate
of heart in motion ● stab/pressure
● It shows how blood moves through
the heart and heart valves Parasternal long axis
● Not painful - no needles or blood ● Start between 3rd-4th intercostal
loss space or nipple line
● Not dangerous ● Probe marker - facing right shoulder
Transthoracic echocardiogram ● Useful for estimating ejection
● Most common fraction, systolic function
● Non-invasive ultrasound test
● Used to measure ejection fraction Parasternal short
and examine size, shape, and ● Rotate probe 90 degrees, same
motion of cardiac structures sonographic window
● NORMAL EJECTION FRACTION: ● Probe marker - Left shoulder
55-70% (amount of blood that your
heart pumps each time it beats) Apical
- Less than 55% is susceptible ● Slide down the apex or when you
for heart attack see the chamber size getting smaller
Stress echocardiogram ● Probe marker - left axilla
● Measure function of heart both at ● Pulmonary hypertension / pericardial
rest and while exercising effusion
Dobutamine echocardiogram
● Dobutamine is given instead through Subxiphoid
a vein ● Sunxiphoid position drag slightly to
the patient’s right
INDICATIONS: ● Probe marker - left shoulder / elbow
● Diagnosis for:
- Atherosclerosis NURSING RESPONSIBILITIES
- Cardiomyopathy BEFORE:
- Congenital heart disease ● Explain procedure
- Heart failure ● Procedure is safe and painless
- Aneurysm ● No fasting
- Heart valve disease ● Void prior and change into a gown
- Cardiac tumor ● Advise patient to remain still
- Pericarditis ● Explain the need to darken
- Pericardial effusion or examination field
tamponade ● Provide privacy
- Atrial or septal wall defects DURING:
- Shunts ● Place in supine position
● Inform that a conductive gel is
SCANNING TIPS applied to chest area
● Fan ● Position patient on his left side, bring
● Angle heart forward
● Rotate ● Takes about 30-45 minutes
AFTER:
● Remove gel from skin
● Instruct to resume diet

INTERFERING FACTORS:
● Patient doing unnecessary
movement
● Incorrect placement of transducer
over the desired test area
● Metallic objects within examination
field
● Patients who are dehydrated,
resulting in failure to demonstrate
the boundaries between organs and
tissue structures
● Patients with severe COPD have
significant air and space between
heart and chest cavity
● In obese patients, the space
between the heart and the
transducers is greatly enlarged,
therefore the accuracy of the test is
decreased.