Echocardiogram: TTE and TEE

• Echocardiograms are noninvasive ultrasound tests used to evaluate heart structure and function.

Transthoracic Echocardiogram (TTE)

• TTEs are non-invasive "ultrasounds for the heart" performed externally.
• TTEs diagnose valve disorders and cardiomyopathy, and evaluate the size, shape, and motion of heart structures.
• TTEs look for wall motion abnormalities, valve problems, ejection fraction, and fluid around the heart
• They measure the ejection fraction to assess heart health, with a normal range of 50-70%.
• Ejection fraction indicates how much the left ventricle pumps out with each heartbeat.
• Ejection fraction is non-reversible, but progression can be slowed.
• TTE image quality is generally good but can be limited by body type.
• No sedation or special preparation is needed for a TTE.
• The procedure uses sound waves and has no radiation.
• The procedure uses sound waves, applying gel to help waves pass through the skin as a probe is moved over the chest.
• TTE Tests take 30-60 minutes, are painless, require no sedation, and have no recovery time.
• At the end of the procedure the gel is wiped off.
• The purpose of the test should be explained before the procedure starts

Transesophageal Echocardiogram (TEE)

• TEEs are invasive procedures involving a scope passed into the esophagus.
• TEE image quality is superior due to the closer proximity to the heart providing clearer ultrasonic images, with waves passing through less tissue.
• TEEs detect clots, valve issues, endocarditis, and congenital defects.
• TEEs are more convenient for obese patients or those with large breasts by bypassing the extra tissue to get a closer look at the heart..
• The procedure involves passing a small transducer through the mouth into the esophagus to provide images of the heart.
• Sedation is used to prevent gag reflex during a TEE.
• Patients must be NPO for at least 6 hours before a TEE, and consent is required.
• Dentures/glasses are removed, and the patient is sedated but awake, with throat numbed with spray.
• TEEs take 20-30 minutes
• TEE post-op care includes constant monitoring of LOC and vitals.
• Patients remain NPO until gag reflex returns (1-2 hours) to prevent aspiration pneumonia.
• Sore throat, difficulty swallowing, or bleeding should be monitored post-TEE.
• Driving is prohibited for 24 hours post-TEE due to sedation.
• Provider should be contacted if trouble breathing, chest pain, severe sore throat, or coughing up blood arise.
• The purpose of the test and procedure should be explained before the procedure starts.

Cardiac Catheterization

• Cardiac catheterization is used for coronary angiography, stent placement, and more, performed in a cath lab or OR.
• This invasive procedure evaluates the presence and degree of coronary artery blockage.
• The procedure involves inserting a catheter into the femoral, brachial, or radial vessel and threading it into the heart.
• Cardiac catheterization looks for a blockage and fixes it by opening it up and moves that blockage out of the way

Percutaneous Coronary Intervention (PCI)

• PCIs are performed when the cardiologist accesses the blockage via catheter.

Percutaneous Transluminal Coronary Angioplasty (PTCA)

• During PTCA, a balloon is inflated to expand the artery, and a stent is placed to keep it open.
• Arthrectomy: cleans out blockage

Stents

• Stents: expandable tubes inserted into narrowed or blocked artery.
• Rheolytic thrombectomy: aspirating clots out of the vessel.

Post-Cath Care

• Post-cath care includes frequent vital sign checks for hemodynamic status.
• Bedrest is required per protocol due to blood thinners and fall risk.
• For groin catheter placement, keep patient on bedrest with HOB no more than 15 degrees for 1-2 hours to prevent bending and bleeding.
• Bending of the hip can cause stress on the hip and cause bleeding
• Assess for bleeding, hematoma formation, thrombosis, cardiac dysrhythmias, and kidney damage.
• For bleeding in perforation, heart, insertion site: insertion is why position is important
• In recovery, pressure will be help on the cath site for around 15 minutes to stop any bleeding.
• If bleeding occurs on the wrist a balloon is placed and little by little you draw air out of the balloon to slowly release pressure.
• If bleeding occurs on the groin, assess the site and look for bleeding beneath them.
• Hematoma formation: bleeding inside; bleeding in tissues; assess the site for color, swollen, hard, or soft.
• If the site is darker and hard, it might be a sign of hematoma so call provider
• Thrombosis: assess circulation, capillary refill, pedal pulse, and look at foot for skin tone, it should be nice & warm.
• IV fluids are used to help the kidneys eliminate radioactive dye used during the procedure.
• Discharge instructions include no heavy activity for 24-48 hours (over 5-10 punds) until they check up with their cardiologist, keeping the site clean, and watching for infection.
• Clean the site with soap and water and pat dry.
• Report any abnormalities, hematomas, bleeding, or numbness in limbs.
• Medication teaching should be included for discharge instructions

Post-Cath Complications

• Post-Cath complications include bleeding/hematoma, infection, dysrhythmias, contrast-induced nephropathy, thrombosis, and allergic reaction to contrast dye.
• Arterial dissection
• If bleeding occurs, hold pressure and call the provider.