Presenter

:Parvathy Joshy Msc nsg 1st yr

Diagnostic studies provide important information in

monitoring the patients condition and Planning appropriate interventions.

These studies are considered to be objective data.

Non invasive

Invasive

Chest x ray Electrocardiogram(ECG) Ambulatory ECG monitoring Exercise treadmill test Echocardiogram MUGA Magnetic resonance imaging CT PET PFT

It is a radiographic picture. PURPOSE To depict cardiac contours Heart size Configuration and Anatomical changes in individual chambers.

Postero-anterior Antero-posterior Lateral

Positioning-PA frontal chest radiograph

Positioning-AP chest radiograph

Inquire about frequency of recent x rays and possibility of pregnancy. Provide lead shielding to areas not being viewed. Remove any jewelry or metal objects that may obstruct view of heart and lungs. Inform patient that he/she has to hold breath while taking x ray

ECG records electrical potential changes in the electrical field produced by the heart.

To detect rhythm of heart For diagnosing arrhythmias To detect site of pacemaker To detect position of heart To detect size of atrium and ventricles To detect the presence of any injury. To detect electrolyte abnormalities

Atrial flutter

Atrial pacing

12 lead ECG:each lead has 2 electrodes with opposite polarity(bipolar) or 1 electrode and a reference point(unipolar) 6 limb leads:electrical activity in the frontal plane(up,down &rt ,lt in the heart) 6 precordial leads:in horizontal plane(ant,post & rt/lt)

The ECG records 3 bipolar frontal plane leads Lead I,Lead II,lead III 3 unipolar frontal plane leads aVR,aVL& Avf 6 unipolar precordial leads V1,V2,V3,V4,V5,& V6

ECG waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals . Time and rate are measured on the horizontal axis of the graph, and amplitude or voltage is measured on the vertical axis. When an ECG waveform moves toward the top of the paper, it is called a positive deflection. When it moves toward the bottom of the paper, it is called a negative deflection

Wave forms p wave QRS complex T wave U wave Intervals PR interval ST segment QT interval

The P wave represents the electrical impulse starting in the sinus node and spreading through the atria.

P wave

atrial muscle depolarization.

It is normally 2.5 mm or less in height 0.11 second or less in duration.

The QRS complex ventricular muscle depolarization. Duration:< 0.12 s Q wave: The first negative deflection after the P wave normally less than 0.04s in duration and less than 25% of the R wave amplitude; R wave: the first positive deflection after the P wave

S wave: the first negative deflection after the R wave.

The T wave

ventricular muscle repolarization .

follows the QRS complex usually the same direction as the QRS complex. The U wave repolarization of the Purkinje fibers, but it sometimes is seen in patients with hypokalemia, hypertension, or heart disease.

The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In adults, the PR interval normally ranges from 0.12 to 0.20 seconds in duration.

The ST segment early ventricular repolarization, lasts from the end of the QRS complex to the beginning of the T wave. The QT interval total time for ventricular depolarization and repolarization, is measured from the beginning of the QRS complex to the end of the T wave.

A 1-minute strip contains 300 large boxes and 1500 small boxes. count the number of small boxes within an RR interval and divide 1500 by that number. example, there are 10 small boxes between two R waves, heart rate is 1500 10= 150 if there are 25 small boxes, HR is 1500 25= 60

when the rhythm is irregular, count the number of RR intervals in 6 seconds multiply that number by 10. The top of the ECG paper is usually marked at 3second intervals, which is 15 large boxes horizontally

Hypokalemia : ST segment depression, inverted T waves large U waves, slightly prolonged PR interval. Hyperkalemia : peaked T and prolonged PR and QRS

Inform patient that no discomfort is involved. Instruct patient to hold still

Continuous (Holter monitoring)

Non continuous(Trans telephonic event recorders)

Recording of ECG rhythm for 24-48 hours and then correlating changes with symptoms. Normal patient activity encouraged to stimulate conditions that produce symptoms. Five electrodes placed on chest and recorder is used to store information until it is recalled,printed,and analysed for any rhythm disturbance. It can be performed on an inpatient and outpatient basis.

Preparation of skin and application of electrodes and leads. Explain importance of keeping accurate diary of activities and symptoms. Tell patient that no bath or shower can be taken during monitoring.

Allows more freedom in wearing and recording than regular Holter monitor. Records rhythm disturbances that are not frequent enough to be recorded in one 24 hr period. Some units have electrodes attached to chest and have a loop of memory that captures the onset and end of an event. Other types placed directly on patients wrist,chest ,or fingers and have no loop of memory,but record patients ECG in real time. Recordings are transmitted over the phone to a receiving unit and then printed out for review.

Tracings can then be erased and unit can be reused.

Instruction in use of equipment for recording and transmitting of transient events. Careful instruction of skin preparation for lead placement or steady skin contact for units not requiring electrodes. This will ensure reception of optimal ECG tracings for analysis.

This test is used to evaluate the effect of exercise tolerance on myocardial function. Bruce Protocol: uses 3min stages at set speeds and elevation of treadmill belt. Continuous monitoring of vital signs and ECG rhythms or ischemic changes important in the diagnosis of ventricular function and CAD.

H/O & P E Refrain from ingesting food , alcohol, and caffeine or tobacco products with in 3 hrs. of testing

Clothing Informed written consent Medications

a common treadmill protocol in which the speed and grade of the treadmill are increased every 3 minutes. The goal of the test is to increase the heart rate to the target heart rate. During the test, the following are monitored: two or more ECG leads for heart rate, rhythm, and ischemic changes; BP; skin temperature; physical appearance; perceived exertion; and symptoms including chest pain, dyspnea, dizziness, leg cramping, and fatigue.

The test is terminated when the target heart rate is achieved or when the patient experiences chest pain, extreme fatigue, a decrease in BP or pulse rate, serious dysrhythmias or ST segment changes on ECG, or other complications. When significant ECG abnormalities occur during the stress test (ST segment depressions), the test result is reported as positive and further diagnostic testing is required

Instruct patient to wear comfortable clothes and shoes that can be used for walking and running. Instruct patient about procedure and application of lead placement. Monitor vital signs and obtain 12-lead ECG before ,during each stage of exercise, and after exercise until all vital signs and ECG changes have returned to normal.

Small transducer that emits and receives ultrasound waves placed in four positions on chest above heart. Transducer records sound waves that are bounced off heart.

Also records direction and flow of blood through heart and transforms it to audio and graphic information that measures valvular abnormalities ,congenital cardiac defects, and cardiac function.

Place patient in supine position on left side facing equipment. Instruct family and patient about procedure and sensations (pressure and mechanical movement from head of transducer). No contraindications to procedure exist.

This test obtains information about cardiac tissue integrity ,aneurysms , ejection fractions ,CO , and patency of proximal coronary arteries.

Explain procedure to patient. Inform patient that small diameter of the cylinder ,along with cloud noise of the procedure, may cause panic or anxiety. Antianxiety medications and music may be recommended.

Multiple-gated acquisition (MUGA) scanning:  uses a conventional scintillation camera interfaced with a computer to record images of the heart during several hundred heartbeats.

The computer processes the data and allows for sequential viewing of the functioning heart. The sequential images are analyzed to evaluate left ventricular function, wall motion, and ejection fraction. MUGA scanning can also be used to assess the differences in left ventricular function during rest and exercise. The patient is reassured that there is no known radiation danger and is instructed to remain motionless during the scan

uses x-rays to provide cross-sectional images of the chest, including the heart and great vessels. These techniques are used to evaluate cardiac masses and diseases of the aorta and pericardium.

Patient preparation The nurse should instruct the patient that

he will be positioned on a table during the scan while the scanner rotates around him. The procedure is noninvasive and painless., the patient must lie perfectly still during the scanning process.

An intravenous access line is necessary if contrast enhancement is to be used

Provides more specific information about myocardial perfusion and viability helps evaluate the patency of native and previously grafted vessels and the collateral circulation

Instruct the patient to refrain from using tobacco and ingesting caffeine for 4 hours before the procedure. They should also reassure the patient that radiation exposure is at safe and acceptable levels, similar to those of other diagnostic x-ray studies.

a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body's circulation

PFT results are interpreted on the basis of the degree of deviation from normal, taking into consideration the patients height,weight, age, and gender

Forced vital capacity Forced expiratory volume(qualified by subscript indicating the time intervals in seconds) Ratio of timed forced expiratory volume to forced vital capacity Forced expiratory flow Forced mid expiratory flow Forced end expiratory flow Maximal voluntary ventilation

What are the various non-invasive investigations in cardiology? What is the duration of p wave in a normal ECG? How the target HR is calculated in TMT? What do you understand by holter monitor? What is MUGA?

Non-invasive investigations play an important role in cardiology .As nursing personnel we have to understand the purpose, indications, contraindications, and side-effects if any of the investigations. Many of the patients need further information regarding these procedures , so we have to utilize our knowledge in helping patients physiologically as well as psychologically.

Susan L.Woods,cardiac nursing ,5th edition Brunner and suddarth ,text book of medical surgical nursing