● 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
puncture site from infection
● Observe patient for few hours to
monitor any symptoms or side
effects
● Instruct patient to tell if they are
bleeding or feeling any numbness or
tingling sensation
● Instruct patient to avoid strenuous
activities for 2-5 days
● Do not submerge puncture site in
water for a week
IF THE CATHETER WAS IN THE ARM:
● Arm must be kept straight for at least
an hour, but the patient can walk
around
IF THE CATHETER WAS IN THE GROIN:
● Supine position and keep leg
straight for 2-6 hrs to prevent
bleeding
● Do not raise the head more than 30
degrees and do not try to sit or stand
until the provider tells you to do so
RECOVERY
● Drink plenty of fluids to clear
contrast material
● They may need to pee more
frequently
● Educate about discharge plans,
treatment meds, diet, future
procedures, wound care, activities,
and follow-up care.
CARDIAC STRESS TEST
● AKA exercise stress test or treadmill
test
● Used to evaluate the functioning of
the heart during physical stress or
exercise
● Evaluate blood flow of heart
● Person walks on the treadmill or
pedals stationary bike while being
monitored
INDICATIONS:
● Assess heart response
● Evaluate symptoms
● Identify the CAD
● Monitor effectiveness of treatment
NURSING RESPONSIBILITIES
BEFORE:
● Review patient’s history
● Assess VS - HR AND BP AND RR
● Evaluate current symptoms
● Informed consent
● Review patient’s meds
● Avoid heavy meals and caffeine
several hours before
● Wear comfy clothing and appropriate
footwear
● Discuss potential risks and side
effects
● Ensure availability of equipment
● Record baseline ECG readings
DURING:
● Place patient on treadmill or
stationary bike
● Continuously monitor VS
● Record and document
● Assess signs of discomfort
● Monitor ECG
● ECG leads are attached should be
ensured
● Inform patient about the progress
● AED is readily available
● Accurately document patient
response
AFTER:
● Evaluate overall condition
● Review ECG tracings
● Ensure patient has a comfy and
quiet place to rest
● Provide clear and specific
instructions
● Accurately document post test VS
● Attentive to emotional well-being
 ELECTROCARDIOGRAPHY
● Used to evaluate cardiac status or
the process of producing an
electrocardiogram
● Provide info about heart’s condition
or performance
LIMB LEAD PLACEMENT
● RIGHT ARM = white
● LA = black
● RL = green
● LL = red
WAVEFORMS
● P wave = atrial depolarization
● QRS complex = ventricular
depolarization
● T wave = ventricular repolarization
INDICATIONS
● Abnormal heart rhythms
● Heart failure
● Heart attacks
● Cardiac meds
● Assess pacemaker performance
NURSING RESPONSIBILITIES
BEFORE:
● Assess patient’s history
● Remain still and relaxed
DURING:
● Position in supine or semi-fowler’s
● Expose chest, ankles, and wrists
● Place and apply electrodes correctly
● Check electrode conductivity
● Monitor ECG tracing
AFTER:
● Remove electrodes and clean skin
● Report abnormal findings or concern
● Document patient response and
follow up.
● Alternative, minimally invasive
ultrasound of the heart that provides
clever images of the heart’s pump
function, assessment of heart
valves, and/or clots or holes in the
heart, wherein ultrasound waves
pass through less tissues
INDICATIONS
● Higher resolution and detailed
imaging
● Better visualization or posterior
structures
● Assessment of blood clots
● Improved assessment of valve
function
● Assessment of intracardiac shunts
● Evaluation of cardiac tumors
NURSING RESPONSIBILITIES
BEFORE:
● Explain procedure
● Informed consent
● NPO
● Assess patient for existing IV line
● Remove dentures, and ready for
anesthetics
DURING:
● Emotional support
● Monitor VS
● Instruct patient on proper positioning
● Monitor after sedation
AFTER:
● NPO until fully alert - 2 hours after
procedure
● Post-procedure diet
● Report presence of any discomfort
for a long period of time

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