Nursing Protocols for Cardiovascular Conditions PDF - Procedures, Assessment

**STANDARD PROTOCOLS FOR ALL NURSING PROCEDURES** **[Before the Procedure]** 1. Verify physician's orders if procedure is a dependent or collaborative nursing intervention. 2. Gather equipments and supplies and complete necessary charges according to the agency's policy. 3. Perform ha...

**STANDARD PROTOCOLS FOR ALL NURSING PROCEDURES** **[Before the Procedure]** 1. Verify physician's orders if procedure is a dependent or collaborative nursing intervention. 2. Gather equipments and supplies and complete necessary charges according to the agency's policy. 3. Perform hand washing for at least 10-15secs before each client's contact. 4. Identify client by checking client's folder or identification bracelet or having client state his or her name if able to do so. 5. Introduce yourself to client and or family including your name, title or role. 6. Explain to client, exactly what you plan to do. 7. Identify teaching needed and describe what the client can expect in simple terms. 8. Assess client to determine if intervention is still appropriate before implementing. 9. Adjust the bed to appropriate height and lower side rail on the side near to you. 10. Provide adequate lighting for the procedure. 11. Provide privacy for client, position and drape client as needed. 12. Obtain written consent from client 13. Perform all necessary physical preparations needed e.g. shaving **[During the Procedure]** 1. Promote client's independence and involvement if possible. 2. Assess client's tolerance and be alert for signs of discomfort and fatigue. **[After the Procedure]** 1. Assist client to a position of comfort and organize needed toiletry or personal items within reach 2. Ensure that client has a means to call for help and knows how to use it 3. Raise side rails and lower the bed to the lowest position. 4. Dispose off/decontaminate used supplies and equipments. 5. Remove and dispose of gloves, if used. Perform hand hygiene for at least 2-3mins. 6. Document and report client's response to expected or unexpected out **[NURSING MANAGEMENT OF PATIENTS WITH CARDIOVASCULAR CONDITIONS]** The care of people with cardiovascular disorders utilizes a significant amount of nursing skill and resources. This is because, cardiovascular diseases remain one of the highest causes of morbidity and mortality in the world (WHO 2005). **[Assessment]** Assessment of the individual's cardiovascular function provides data needed to identify actual and potential health problems, guide nursing intervention and evaluate care. This includes; 1. Health history 2. Physical examination 3. Diagnostic procedures 4. Knowledge of manifestations of cardiovascular disorders 1\. [Health history] This will assist the nurse in defining the patient's health problems. The depth and manner in which this information is collected will depend on the patient's clinical status and availability of family or significant others. The health history includes data on: - Primary health problem - History of present illness - Past health history - Family history - Social and personal history **[Primary health problem:]** The main concern or reason for patient contacting the healthcare system e.g. chest pain, dyspnea, palpitation, etc. **[History of present illness:]** This is a detailed investigation of the patient's presenting problem and primary health problems. Obtain a detailed picture, beginning with the time the patient was last well and ending with a description of the patient's current condition. How long has the patient been ill? What has the course of the illness been? Investigate the chief complaint by eliciting information through the use of the pneumonic **["OLD CARTS":]** - **Onset** -- setting, circumstances, rapidity, or manner in which it began - **Location** -- exact place where the symptom is felt, radiation pattern - **Duration** -- if intermittent, how long and the frequency - **Character/Course** -- nature or quality of the symptom, how it has changed or evolved over time - **Aggravating/Associated factors** -- medications, rest, activity, diet, associated nausea, fever, etc - **Relieving factors** -- lying down, sitting up in bed, lying over affected side, etc - **Treatments tried** -- pharmacologic and non pharmacologic methods attempted and their outcome - **Severity** -- the quantity of the symptoms, e.g. how severe on a scale of 1-10 Alternatively, use the pneumonic **PQRST** - Provocative/Palliative factors - Quality/Quantity - Region/Radiation - Severity - Timing **[Past health history:]** Assess patient's childhood and adult illness, hospitalizations, accidents and injuries. - Does the patient have hypertension, diabetes mellitus, hyperlipidaemia, chronic obstructive pulmonary disease (COPD), or other chronic illnesses (bleeding disorders or acquired immune deficiency syndrome)? These may increase the risk of cardiac disease or aggravate disease. - Review the patient's past illnesses and hospitalizations: trauma to chest (possible myocardial contusion); sore throat and dental extractions (possible endocarditis); rheumatic fever (valvular dysfunction, endocarditis); thromboembolism (myocardial infarction, pulmonary embolism). - Ask if the patient is allergic to any drugs, foods, environmental agents, or animals. **[Family history:]** Note the ages and health status of patient's family members (parents, grandparents, siblings and other blood relatives). A family history of sudden death, hypertension, or diabetes could place the patient at an increased risk for heart disease. **[Social and personal history:]** assess the patient's health habits, such as alcohol or drug use, tobacco use, nutrition obesity, pattern of recurrent weight gain after dieting, stress, sleeping patterns, and physical activity (sedentary lifestyle). 2\. [ **Physical examination**] A complete or partial examination is conducted following a careful comprehensive or problem-related history. Basic physical examination is a cornerstone of the nurse's methods of data collection. Performing a physical examination facilitates gathering the objective data on the person's cardiovascular system, which is necessary to establish a baseline of the person's condition and to assess ongoing changes in health status. It is conducted in a quiet, well-lit room with consideration for patient privacy and comfort. **[General appearance]:** Is the patient awake and alert or lethargic, stuporous, or comatose? Does the patient appear to be in acute distress? Focus the physical examination on what is essential when examining a patient in acute distress. Observe the patient's general build (e.g. thin, emaciated, or obese) and skin colour (e.g. pink, pale, flushed or cyanotic). Assess the patient for shortness of breath and distention of jugular veins. **[Inspection:]** It begins with the first encounter with the patient and it is the most important of all the physical examination techniques. It is an organized scrutiny of the patient's behaviour and body. With knowledge and experience, the examiner can become highly sensitive to visual clues. The examiner begins each phase of the examination by inspecting the particular part with the eyes. 1. Examination of the head includes assessment of facial characteristics and facial expressions, colour of skin and eyes, any of which can reveal underlying cardiac disease. - Earlobe creases in a patient younger than age 45 may indicate a genetic tendency toward coronary artery disease (CAD) - Facial colour: look for a flush, cyanotic lips or slightly jaundiced skin (rheumatic heart disease) - Facial oedema may be noted with constrictive pericarditis and associated tricuspid valve disease 2. Examine the neck for jugular venous pulse. Jugular vein distention is characteristic of heart failure and other cardiovascular disorders. 3. Examine the skin for temperature, diaphoresis, cyanosis, pallor, or jaundice. - Warm, dry skin indicates adequate cardiac output (CO) whereas cool, clammy skin indicates compensatory vasoconstriction due to low cardiac output - Cyanosis may be central (noted on tongue, buccal mucosa and lips) due to lung cancer, heart failure, pulmonary oedema, etc or may be peripheral (noted on distal aspects of extremities, tip of nose and earlobes) due to chronic arteriosclerosis, heart failure, cold exposure, etc - Jaundice may be a sign of right-sided heart failure or chronic haemolysis from prosthetic heart valve 4. [Extremities:] a. Ins pect the nailbeds for colour, splinter haemorrhages, clubbing and capillary refill. - Colour -- pale nailbeds may be indicative of anaemia, whereas cyanotic may be indicative of decreased oxygenation - Splinter haemorrhages are thin brown lines in nailbed and are associated with endocarditis - Clubbing (swollen nail base and loss of normal angle) is associated with pulmonary or cardiovascular disease - Capillary refill indicates an estimate of the rate of peripheral blood flow b. Inspect and palpate for oedema -- if pitting oedema, describe the degree of oedema in terms of depth of pitting that occurs with slight pressure ( 1+ or mild, 2+ or moderate, 3-4+ or severe) **[Palpation:]** This involves touching the region or body parts involved and observing or noting whether these are tender to touch and what the various structures feel like. With experience, the examiner is able to distinguish normal from abnormal. This should be performed in an organized manner from region to region. **[Percussion:]** It helps in determining the density of underlying tissues and whether it is air-filled, fluid-filled or solid. Audible sounds and palpable vibrations are produced, which can be distinguished by the examiner. The techniques for percussion may be described as follows: - Hyperextend the middle finger of your left hand, pressing the distal portion and joint firmly against the surface to be percussed. - Cock the right hand at the wrist, flex the middle finger upward, and place the forearm close to the surface to be percussed. The right hand and forearm should be as relaxed as possible. - With a quick, sharp, relaxed motion, strike the extended left middle finger with the flexed right middle finger, using the tip of the finger not the pad. Aim at the end of the extended left middle finger (just behind the nailbed) where the greatest pressure is exerted on the surface to be percussed. - Lift the right middle finger rapidly to avoid damping the vibrations. - The movement is at the wrist, not at the finger, elbow, or shoulder; the examiner should use the lightest touch possible to produce a clear sound. **[Auscultation:]** This method uses the stethoscope to augment the sense of hearing. The stethoscope must be constructed well and must fit the user. Earpieces should be comfortable, the length of the tubing should be 10-15 inches (25-28cm) and the head should have a diaphragm and a bell. - The bell is used for low-pitched sounds such as certain heart murmurs - The diaphragm screens out low-pitched sounds and is good for hearing high frequency sounds such as breathe sounds. - Extraneous sounds can be produced by clothing, hair, and movement of the head of the stethoscope. **[CARDIAC CATHETERIZATION]** This complex procedure involves the insertion of a catheter into the heart and surrounding vessels to obtain detailed information about the structure and functions of the heart. It is a specialized form of angiography in which a catheter is inserted into either the right or left side of the heart to study pressures within the heart, cardiac volumes, valvular function and patency of coronary arteries. Cardiac catheterizations are performed in specially equipped laboratories. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart. Using this catheter, doctors can then do diagnostic tests as part of a cardiac catheterization. Some heart disease treatments, such as coronary angioplasty and coronary stenting, also are done using cardiac catheterization. Usually, you\'ll be awake during cardiac catheterization but be given medications to help you relax. Recovery time for a cardiac catheterization is quick, and there\'s a low risk of complications. A contrast medium is injected, and the structures and functions of the heart are assessed. In right sided heart catheterization, usually the **subclavian** or **femoral** vein is used for vascular access. In left sided heart catheterization, the **femoral** or **brachial** arteries are used. **[Right Heart Catheterization]** Right heart catheterization usually precedes left heart catheterization. It involves the passage of a catheter from an antecubital or femoral vein into the right atrium, right ventricle, pulmonary artery, and pulmonary arterioles. Pressures and oxygen saturation levels from each of these areas are obtained and recorded. Although right heart catheterization is considered relatively safe, potential complications include cardiac dysrhythmias venous spasm, infection of the insertion site, cardiac perforation, and, rarely, cardiac arrest. **[Left Heart Catheterization]** Left heart catheterization is performed to evaluate the patency of the coronary arteries and the function of the left ventricle and the mitral and aortic valves. Potential complications include dysrhythmias, MI, perforation of the heart or great vessels, and systemic embolization. Left heart catheterization is performed by retrograde catheterization of the left ventricle. In this approach, the physician usually inserts the catheter into the right brachial artery or a femoral artery and advances it into the aorta and left ventricle. After the procedure, the catheter is carefully withdrawn and arterial homeostasis is achieved using manual pressure or other techniques previously described. If the physician performed an arterial or venous cutdown, the site is sutured and a sterile dressing is applied. **[Purpose]** 1. To obtain a clear picture of the cardiac structure and function prior to heart surgery. ======================================================================================= To obtain a pressure within the heart chambers and the great vessels. ===================================================================== To inject contrast medium directly into the heart chambers and the great vessels in order to obtain x-rays of the heart and blood vessels (angiocardiography). ============================================================================================================================================================== To diagnose the existence of congenital abnormalities e.g. atrial septal defect (ASD) and ventricular septal defect (VSD). ========================================================================================================================== Locate narrowing or blockages in your blood vessels that could cause chest pain (angiogram) =========================================================================================== Measure pressure and oxygen levels in different parts of your heart (hemodynamic assessment) ============================================================================================ Check the pumping function of your heart (right or left ventriculogram) ======================================================================= Take a sample of tissue from your heart (biopsy) ================================================ To obtain the measurement of the cardiac output. ================================================ To confirm the diagnosis of the heart and determine the extent to the disease has affected the structure and the function of the heart. ======================================================================================================================================= To detect the pulmonary and mediastinal abnormalities, the displacement of vessels from their normal positions or reduced blood flow to an area caused by emboli, congenital defects, etc. ========================================================================================================================================================================================== - Closing holes in the heart and fixing other congenital defects - Widening a narrowed artery (angioplasty) with or without stent placement - Repairing or replacing heart valves - Opening narrow heart valves (balloon valvuloplasty) - Treating irregular heart rhythms with ablation - Closing off part of your heart to prevent blood clots - Coronary angiogram. If you\'re having this test to check for blockages in the arteries leading to your heart, a dye will be injected through the catheter, and X-ray images of your heart arteries will be taken. In a coronary angiogram, the catheter is usually first placed in the artery in your groin or wrist. - Right heart catheterization. This procedure checks the pressure and blood flow in the right side of your heart. A catheter is inserted in the vein in your neck or groin. The catheter has special sensors in it to measure the pressure and blood flow in your heart. - Heart biopsy. If your doctor is taking a sample of heart tissue (biopsy), the catheter will usually be placed in the vein in your neck. Less often, it may be placed in your groin. A catheter with a small, jaw-like tip is used to obtain a small sample of tissue from your heart. - Balloon angioplasty, with or without stenting. This procedure is used to open a narrowed artery in or near your heart. The catheter can be inserted in either your wrist or groin for this procedure. - Repair of heart defects. If your doctor is closing a hole in your heart, such as an atrial septal defect or patent foramen ovale, you will probably have catheters inserted in both the arteries and veins of the groin and neck. A device is then inserted into your heart to close the hole. In cases of heart valve leak repair, a clip or plug may be used to stop the leak. - Balloon valvuloplasty. This procedure is done to open up narrowed heart valves. The placement of your catheters will depend on which valve problem you have. - Valve replacement. This procedure is similar to balloon valvuloplasty, except that an artificial valve will be implanted in your heart to replace a narrowed heart valve. - Heart ablation. In this procedure, you\'ll usually have multiple catheters placed in the arteries and veins of your groin or neck so that radiofrequency energy can be directed to the part of your heart causing abnormal heartbeats. **[Contraindications]** **Nursing responsibilities before cardiac catheterization include the following:** - The patient is instructed to fast, usually for 8 to 12 hours, before the procedure. If catheterization is to be performed as an outpatient procedure, a friend, family member, or other responsible person must transport the patient home. - The patient is informed of the expected duration of the procedure and advised that it will involve lying on a hard table for less than 2 hours. - The patient is reassured that IV medications are given to maintain comfort. - The patient is informed about sensations that will be experienced during the catheterization. Knowing what to expect can help the patient cope with the experience. The nurse explains that an occasional pounding sensation (palpitation) may be felt in the chest because of extra heartbeats that almost always occur, particularly when the catheter tip touches the endocardium. The patient may be asked to cough and to breathe deeply, especially after the injection of contrast agent. Coughing may help disrupt a dysrhythmia and clear the contrast agent from the arteries. Breathing deeply and holding the breath help lower the diaphragm for better visualization of heart structures. The injection of a contrast agent into either side of the heart may produce a flushed feeling throughout the body and a sensation similar to the need to void, which subsides in 1 minute or less. - The patient is encouraged to express fears and anxieties. The nurse provides teaching and reassurance to reduce apprehension. - If you have diabetes, ask for instructions about diabetes medications and insulin. You will usually be able to have something to eat and drink soon after your test. - Your doctor may recommend you stop medications that may thin your blood,such as warfarin, aspirin, apixaban, dabigatran and rivaroxaban. - Take all your medications and supplements with you to the test. It\'s best if you take the original bottles so that your doctor will know the exact dose you take. - Blood pressure and pulse are checked. Ask patient to use the toilet to empty the bladder. - Remove dentures and also jewelry, especially necklaces that could interfere with pictures of your heart. Patient will wait in a pre-op room until it\'s time for the procedure --- someone may wait there with the patient. **[Requirements]** \#Protective supplies: mask, goggles, sterile gown and gloves \#Special packs containing various sizes and types of procedure catheter \#Intravenous equipment for establishing vascular access. \#Medications: diazepam, midazolam, or other sedative \#Emergency supplies: oxygen, defibrillator, cardiac monitor, pulse oximeter **[Steps]** \*Perform hand hygiene and apply appropriate protective equipment \*Have patient empty bladder \*Prepare monitoring equipment, including cardiac monitor, pulse oximeter, blood pressure cuff \*Provide IV access using a large bore cannula, and remove gloves \*Monitor vital signs, obtain weight and palpate peripheral pulses \*Assist patient in assuming a comfortable supine position on examination table or in a slight trendelenburg's position. Immobilize the extremity that will be injected with contrast dye \*Take time out to verify patient's name, type of procedure scheduled and procedure site with the patient \*Tell patient that during the injection of the dye, he may experience chest pain and a severe hot flash that is quite uncomfortable but last only few seconds. \*Physician cleanse site for catheter insertion with antiseptic. \*All team members must apply mask, goggles, sterile gown, cap and gloves. Drape patient with sterile drape leaving puncture site exposed. \*Anesthetize the skin overlying the arterial puncture site. \*The physician performs needle puncture of artery; inserts needle guide wire through needle and angiographic catheter threaded over the wire. Advance catheter to desired artery or cardiac chamber, and inject contrast medium. During dye injection, specialized machinery takes rapid sequence of X- ray films \*Observe patient for signs of anaphylaxis including respiratory distress, palpitation, itching and diaphoresis \*Assist with measuring the cardiac volumes and pressure. \*Monitor level of sedation and level of consciousness \*Physician withdraws catheter and applies pressure to puncture site for 5 to 15 minutes. \*Remove and discard gloves \*After the procedure, keep affected extremity immobilized for 6 to 8 hours after removal of sheath, according to agency protocol. Use orthopaedic bedpan for female patients while on bed rest. \*Emphasize the need to lay flat for 6 to 12 hours \*Encourage patient to drink 1 to 2 litres of fluid after procedure NB; \*Be prepared to end the cardiac catheterization procedure early in the event of severe unrelieved chest pain, neurological symptoms of a cardiovascular accident, cardiac dysrhythmias, or haemodynamic changes. \*Manual pressure applied to the groin can stimulate the baroreceptors and cause a vaso vagal reaction in which the patient becomes bradycardic and hypotensive. They are usually brief and self limiting. \*Treat by lowering the head of the bed to the flat position and giving a bolus of intravenous fluids. **Nursing responsibilities after cardiac catheterization may include the following:** - The catheter access site is observed for bleeding or hematoma formation. Peripheral pulses are assessed in the affected extremity every 15 minutes for 1 hour, and then every 1 to 2 hours until the pulses are stable. - Temperature, color, and capillary refill of the affected extremities are frequently evaluated, per local nursing standards. The patient is assessed for affected extremity pain, numbness, or tingling sensations that may indicate arterial insufficiency. Any changes are reported promptly. - Assess the patient for nausea or pain (including back pain from lying still) and provide medication as indicated. - Dysrhythmias are carefully screened by observing the cardiac monitor or by assessing the apical and peripheral pulses for changes in rate and rhythm. A vasovagal reaction, consisting of bradycardia, hypotension, and nausea, can be precipitated by a distended bladder or by discomfort from manual pressure that is applied during removal of an arterial or venous catheter. The vasovagal response is reversed by promptly elevating the lower extremities above the level of the heart, infusing a bolus of IV fluid, and administering IV atropine to treat the bradycardia. - Bed rest is maintained for 2-6 hours after the procedure. If manual or mechanical pressure is used, the patient must remain on bed rest for up to 6 hours with the affected leg straight and the head of the bed elevated no greater than 30 degrees. For comfort, the patient may be turned from side to side with the affected extremity straight. If the cardiologist deployed a percutaneous vascular closure device or patch, the nurse checks local nursing care standards and anticipates that the patient will have fewer activity restrictions. The patient may be permitted to ambulate within 2 hours. Analgesic medication is administered as prescribed for discomfort. - The patient is instructed to report chest pain and bleeding or sudden discomfort from the catheter insertion sites promptly. - Review the discharge orders with the patient and family, including activity restrictions, and educate them about signs and symptoms of complications, including MI, stroke, and insertion-site bleeding or infection. - If indicated, inform the patient that he may need blood urea nitrogen and creatinine monitoring after discharge. - The patient is monitored for contrast agent--induced nephropathy by observing for elevations in serum creatinin levels. Oral and IV hydration is used to increase urinary output and flush the contrast agent from the blood. - Finally, instruct patient to follow up with his primary care provider. **[Complications of Cardiac Catheterization]** - Irregular heart rhythms (Cardiac arrhythmias) - Venous spasm - Damage to the artery, heart or the area where the catheter was inserted - Thrombophlebitis - Myocardial infarction - Heart failure - Bruising - Bleeding - Stroke - Allergic reactions to the dye or medication - Kidney damage - Infection - Blood clots NB: If you are pregnant or planning to become pregnant, tell your doctor before having the procedure. **[ECHOCARDIOGRAPHY]** It is a diagnostic tool that utilizes ultrasound to visualize the structures of the heart. It is a recording of high frequency sound vibrations that have been sent into the heart through the chest wall. The cardiac structures return the echoes derived from the ultrasound. The movement of the echoes are traced on an **oscilloscope** and can be recorded on a film. An echocardiogram uses sound waves to produce images of your heart. This common test allows your clinician or doctor to see your heart beating and pumping blood. Your doctor can use the images from an echocardiogram to identify heart disease. Depending on what information your doctor needs, you may have one of several types of echocardiograms. Each type of echocardiogram involves few risks, if any. **Purpose** Your doctor may suggest an echocardiogram to: 1. 2. 3. The type of echocardiogram you have depends on the information your doctor needs. **[Advantages ]** \*Echocardiography is a non-invasive, comfortable and convenient diagnostic tool \*Time required for the test is only 20-40minutes \*There are no contraindications for the test \*There is no need for any special preparation of the client \*It is highly reliable test ### Transthoracic echocardiogram In this standard type of echocardiogram: - - - - If your lungs or ribs block the view, you may need a small amount of an enhancing agent injected through an intravenous (IV) line. The enhancing agent, which is generally safe and well tolerated, will make your heart\'s structures show up more clearly on a monitor. ### Transesophageal echocardiogram If your doctor wants more-detailed images or it\'s difficult to get a clear picture of your heart with a standard echocardiogram, your doctor may recommend a transesophageal echocardiogram. In this procedure: 1. 3. ### Doppler echocardiogram Sound waves change pitch when they bounce off blood cells moving through your heart and blood vessels. These changes (Doppler signals) can help your doctor measure the speed and direction of the blood flow in your heart. Doppler techniques are generally used in transthoracic and transesophageal echocardiograms. Doppler techniques can also be used to check blood flow problems and blood pressure in the arteries of your heart --- which traditional ultrasound might not detect. The blood flow shown on the monitor is colorized to help your doctor pinpoint any problems. ### Stress echocardiogram Some heart problems --- particularly those involving the arteries that supply blood to your heart muscle (coronary arteries) --- occur only during physical activity. Your doctor might recommend a stress echocardiogram to check for coronary artery problems. However, an echocardiogram can\'t provide information about any blockages in the heart\'s arteries. In a stress echocardiogram: - Ultrasound images of your heart are taken before and immediately after you walk on a treadmill or ride a stationary bike - If you\'re unable to exercise, you may get an injection of a medication to make your heart pump as hard as if you were exercising 5. ### Risks No risks are involved in a standard transthoracic echocardiogram. You may feel some discomfort from the transducer being held very firmly against your chest. The firmness is necessary to produce the best images of your heart. If you have a transesophageal echocardiogram, your throat may be sore for a few hours afterward. Rarely, the tube may scrape the inside of your throat. Your oxygen level will be monitored during the exam to check for any breathing problems caused by sedation medication. During a stress echocardiogram, exercise or medication --- not the echocardiogram itself --- may temporarily cause an irregular heartbeat. Serious complications, such as a heart attack, are rare. 6. ### [Preparation] ### Food and medications No special preparations are necessary for a standard transthoracic echocardiogram. You can eat, drink and take medications as you normally would. If you\'re having a transesophageal echocardiogram, your doctor will ask you not to eat for several hours beforehand. ### Other precautions If you\'re having a transesophageal echocardiogram, you won\'t be able to drive immediately after the procedure because of the medication you\'ll likely receive. Be sure to arrange for a ride home. ### During the procedure An echocardiogram can be done in the doctor\'s office or a hospital. For a standard transthoracic echocardiogram: - You\'ll undress from the waist up and lie on an examination table or bed. - The technician will attach sticky patches (electrodes) to your body to help detect and conduct your heart\'s electrical currents. - The technician will also apply a gel to the transducer that improves the conduction of sound waves. - The technician will move the transducer back and forth over your chest to record images of sound-wave echoes from your heart. You may hear a pulsing \"whoosh,\" which is the ultrasound recording the blood flowing through your heart. - You may be asked to breathe in a certain way or to roll onto your left side. If you have a transesophageal echocardiogram: - Your throat will be numbed with a spray or gel - You\'ll be given a sedative to help you relax - The tube containing the transducer will be guided down your throat and into your esophagus, and positioned to obtain images of your heart Most echocardiograms take less than an hour. If you have a transesophageal echocardiogram, you may be watched for a few hours at the doctor\'s office or hospital after the test. ### After the procedure Most people can resume their normal daily activities after an echocardiogram. If your echocardiogram is normal, no further testing may be needed. If the results are concerning, you may be referred to a cardiologist for more tests. Results/Findings ---------------- Information from the echocardiogram may show: - Changes in your heart size. Weakened or damaged heart valves, high blood pressure or other diseases can cause the chambers of your heart to enlarge or the walls of your heart to be abnormally thickened. - Pumping strength. The measurements obtained from an echocardiogram include the percentage of blood that\'s pumped out of a filled ventricle with each heartbeat (ejection fraction) and the volume of blood pumped by the heart in one minute (cardiac output). A heart that isn\'t pumping enough blood to meet your body\'s needs can lead to symptoms of heart failure. - Damage to the heart muscle. An echocardiogram helps your doctor determine whether all parts of the heart wall are contributing normally to your heart\'s pumping activity. Areas of heart wall that move weakly may have been damaged during a heart attack, or be receiving too little oxygen. - Valve problems. An echocardiogram can help your doctor determine if your heart valves open wide enough for adequate blood flow or close fully to prevent blood leakage. - Heart defects. An echocardiogram can show problems with the heart chambers, abnormal connections between the heart and major blood vessels, and complex heart defects that are present at birth. **[ELECTROCARDIOGRAPHY (ECG)]** An electrocardiogram is a simple, painless test that measures your heart's electrical activity. It's also known as an ECG or EKG. Every heartbeat is triggered by an electrical signal that starts at the top of your heart and travels to the bottom. Heart problems often affect the electrical activity of your heart. An electrocardiogram is a graphic record of the electrical impulses that are generated by depolarization and repolarization of the myocardium. These impulses are conducted to the external surface of the body where they are detected by electrodes and measured by galvanometer (ECG machine). The SA node (pacemaker of the heart) initiates each heart beat by discharging an electrical impulse. As this electrical impulse spreads over the atria and ventricles, the atria contracts first which is followed by contraction of the ventricles (depolarization). As the wave of contraction passes off, the atria and the ventricles relax (repolarization). This process normally takes place with each heartbeat (60-100 times per minute). Cardiac monitoring provides continuous tracing of the patient's heart rate and rhythm through leads that are attached to electrodes placed on the patient's chest. It allows the health care worker to observe for changes in the rate, rhythm and pattern of the electrocardiogram and to initiate treatment as appropriate. **Indications** Your doctor may recommend an EKG if you're experiencing symptoms or signs that may suggest a heart problem, including: - pain in your chest - trouble breathing - feeling tired or weak - pounding, racing, or fluttering of your heart - a feeling that your heart is beating unevenly - detection of unusual sounds when your doctor listens to your heart 2. Purpose ------- An ECG gives two major kinds of information. First, by measuring time intervals on the ECG, a doctor can determine how long the electrical wave takes to pass through the heart. Finding out how long a wave takes to travel from one part of the heart to the next shows if the electrical activity is normal or slow, fast or irregular. Second, by measuring the amount of electrical activity passing through the heart muscle, a cardiologist may be able to find out if parts of the heart are too large or are overworked. Getting ready for your EKG -------------------------- Avoid drinking cold water or exercising before your EKG. Drinking cold water can cause changes in the electrical patterns that the test records. Exercise can increase your heart rate and affect the test results. What happens during an electrocardiogram? ----------------------------------------- An EKG is quick, painless, and harmless. After you change into a gown, a technician attaches 12 to 15 soft electrodes with a gel to your chest, arms, and legs. The technician may have to shave small areas to ensure the electrodes stick properly to your skin. Each electrode is about the size of a quarter. These electrodes are attached to electrical leads (wires), which are then attached to the EKG machine. During the test, you'll need to lie still on a table while the machine records your heart's electrical activity and places the information on a graph. Make sure to lie as still as possible and breathe normally. You shouldn't talk during the test. After the procedure, the electrodes are removed and discarded. The entire procedure takes about 10 minutes. Types of electrocardiograms --------------------------- An EKG records a picture of your heart's electrical activity for the time that you're being monitored. However, some heart problems come and go. In these cases, you may need longer or more specialized monitoring. ### Stress test Some heart problems only appear during exercise. During [[stress testing]](https://www.healthline.com/health/exercise-stress-test), you'll have an EKG while you're exercising. Typically, this test is done while you're on a treadmill or stationary bicycle. ### Holter monitor Also known as an ambulatory ECG or EKG monitor, a [[Holter monitor]](https://www.healthline.com/health/holter-monitor-24h) records your heart's activity over 24 to 48 hours while you maintain a diary of your activity to help your doctor identify the cause of your symptoms. Electrodes attached to your chest record information on a portable, battery-operated monitor that you can carry in your pocket, on your belt, or on a shoulder strap.