CARDIAC PRESENTATION - NON INVASIVE PROCEDURES

Non invasive

1. Non- Invasive Diagnostic Cardiac Testing. Breonna Schmidt Hameedat Olaosebikan Amarachi Okorie

2. Exercise Stress Test aka Treadmill Stress Test

3. Why are exercise stress tests performed? Aids in diagnosing different cardiac problems Aids in recognizing heart related causes to certain symptoms Can help guide treatment measures and determine effectiveness of previous treatment plans May predict risks of heart attacks Help determine if it is safe for a patient to have surgery

4. What is the procedure and any special precautions? Patient is hooked up to vitals monitor and an EKG monitor Must walk on a treadmill that will slowly increase in speed an incline as the test goes on Patient will exercise for 15 minutes or until target heart rate reached or ECG changes While they’re exercising there are quite a few things being monitored Special Precautions: Patients are asked to avoid caffeine 3 hours prior to testing and to avoid smoking

5. Risks Although the test is noninvasive there are still some rare risks such as: chest pain, collapsing and or fainting, heart attack and irregular heart beats.

6. Results and what to do next? The tests are read by cardiologist by comparing certain factors The results may be negative, positive, uninterpreted or equivocal Depending on the results of the test will determine the next steps: patient may need more testing or set up treatment plans

7. https://youtu.be/NC4hN0mTRsY

8. Holter Monitor

9. Why are holter monitors used? May be used if patient has a known arrhythmia or has episodes of unexplained fainting Can be used after an EKG is unsuccessful in showing changes/abnormalities Can also discover heart arrhythmias that are unknown/harmful Assess those with heart diseases to assess further risks of abnormalities

10. Any procedure and special instructions? Patient should bathe prior to monitor placement Men may need to shave some of their hair The technician will place electrodes on chest and connect the wires to a recording device After placement of device the patient can resume all normal activities They will be given a template or told to write in a notebook any symptoms they experience while performing tasks Special instructions include: avoid things like swimming, showering, bathing to prevent monitor from getting wet. Also to prevent interrupted signals one should avoid electric blankets, razors, toothbrushes, magnets, metal detectors, and microwaves. Lastly, keep cellphones and music players 6 inches away.

11. This is an example a journal template for patients to complete while wearing the holter monitor. https:// professional.heart.org /-/media/Files/Health-Topics/Cardiac-Rehab/cardiac-rehab-holter-monitor- diary.pdf

12. Are there any risks? Yes, but the only risk is the electrodes may cause skin irritation in some patients.

13. What’s next? A doctor will compare the monitor readings and the journal to help diagnose The results may help determine treatment needs or changes May also help diagnose conditions If this still doesn’t provide enough information for a diagnosis a patient may need to wear an event monitor

14. Event Monitor These are very similar to Holter, but they only monitor when they are pressed for events Also, patients are given extra electrodes to replace them as they perform their hygiene needs Worn for weeks to a month at a time and the information can be electronically submitted to the doctor

15. Electrocardiogram also called ECGs or EKGs records the electrical signals in your heart. An EKG translate the hearts electrical activity into line tracings on paper. It ’ s a common and painless test used to quickly detect heart problems and monitor your heart’s health. EKG/ECG

16. Why might I need an EKG? To evaluate problems which may be heart related such as severe tiredness, shortness of breath, dizziness or fainting To identify irregular heartbeats To help determine the overall health of the heart before surgical procedures or after heart surgery or cardiac catheterization To see how an implanted pace maker is working.

17. How to prepare for an EKG No special preparations are necessary for a standard echocardiogram. Tell your doctor about any medications and supplements you take or if you have a pacemaker. You may be asked to change into a hospital gown and remove jewelry. If you have hair on the area where the electrodes will be placed, it will be shaved off so that the patches stick properly.

18. How is the test performed? During an EKG, up to 12 sensors will be attached to your chest and limbs. A computer records the information and displays it as waves on a monitor or on paper. You can breathe normally during the test, but you will need to lie still and supine. Moving or talking may distort the test results. A standard EKG takes 5-10 minutes and you can resume normal activities after the test.

19. Risks and Contraindications An EKG is a completely safe test. No electricity passes through your body from the machine and there is no danger of getting an electrical shock.

20. CARDIAC MRI Cardiac MRI- is a non-invasive test that uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the structures within and around the heart. It is used to detect or monitor cardiac disease and evaluate the hearts anatomy and function. It ’ s the most accurate test for circulating the patients ejection fraction. Some cardiac MRI require contrast medium or dye through a vein before the scan to improve the ability of the MRI machine to capture more detailed picture of the tissues. The entire exam usually takes 90 min or less once imagine has started. If sedated, recovery time ranges from 30min to 2 hours after the exam.

21. Cardiac MRI What are some uses of the procedure? Helps to evaluate the anatomy and function of the heart chambers, heart valves, size of and blood flow through major vessels, and surrounding structure such as pericardium. Diagnosing a variety of cardiovascular disorders such as tumors, infections and inflammatory conditions. Evaluating the effects of coronary artery disease such as limited blood flow to the heart muscle and scaring within the heart muscle after a heart attack. Evaluating the effects of surgical changes especially patients with congenital heart disease.

22. How to prepare for the procedure? Change into a hospital gown, guidelines about eating drinking vary between specific exams. Take food and medications as usual unless your doctor tells you otherwise. Some MRI exams use an injection of contrast material called gadolinium. If there are any allergies, it may be possible to use it after appropriate medications have been taken. Women should always tell the doctor is they are pregnant. MRI has been used since 1980s with no reports of any ill effects on pregnant women or their unborn babies. However, the baby will be in a strong magnetic field. Therefore, pregnant women should not have an MRI in their first trimester unless the benefit of the exam outweighs the risks. If you have claustrophobia or anxiety, your doctor might prescribe a mild sedative prior to the date of your exam. Remove jewelry, watches, credit cards, hearing aids, pins, body piercings, mobile phones etc.. Tell the technologist or radiologist if you have any metals implanted in your body because they could heat up during the scan and cause damages. Anyone accompanying a patient into the exam room must also undergo screening for metal objects and implanted devices.

23. How is the Test Performed? The technologists will position you on the movable exam table. They maybe use straps and bolsters to help you stay still and maintain your position. The nurse or technologist will likely place ECG leads on your chest. This will help the MRI machine synchronize the image acquisition with beating of your heart. Men may require small area to be shaved to ensure the patches stick well. A respiratory gait belt around your upper abdomen, this will help the computer know how you are breathing at any given time. The technologist may ask you to hold your breath for short periods of time during the exam. You will be placed into the Magnet of the MRI unit. The technologist will perform the exam while working at a computer outside of the room.

24. Risks and Contraindications Infants and young children may need to be sedated for an MRI, since they may have a hard time holding still during the scan, which is required. A very irregular heartbeat or Atrial fibrillation may cause difficulties in acquiring cardiac MRI images.

25. MRI SCAN https://www.youtube.com/watch?v=uPk5tHDLaVo

26. CT- SCAN Computed Tomography - A CT scan (formerly known as a computed axial tomography or cat scan) uses radiology to obtain detailed images of body structures. It is done to detect any abnormalities or obstructions in body organs and structures. A Cardiac(CT) scan, also called a calcium-score screening heart scan, is used to find calcium deposits in plaque of people with heart disease. They’re an effective way to spot atherosclerosis before symptoms develop. An increase in coronary calcium means there is more coronary atherosclerosis. Which gives a higher chance of cardiovascular problems in the future.

27. How is the Test Performed? They use a narrow X-ray beam that circles around one part of the body. This provides a series of images from many different angles. A computer uses this information to create a cross-sectional picture. Like one piece in a loaf of bread, this two-dimensional (2D) scan shows a “slice” of the inner parts of the body. A radiology technologist will perform the CT scan. During the test, the patient lies on a table inside a large, doughnut-shaped CT machine. As the table slowly moves through the scanner, the X-rays rotate around the body. It’s normal to hear a whirring or buzzing noise. Movement can blur the image, so it is important to stay very still. There might be a need to hold your breath at times. A computer program, guided by the cardiovascular radiologist analyzes the images to look for calcification in the coronary arteries.

28. What are the uses of a CT-Scan? A cardiac CT can be used to assess: The heart’s structure and how well the heart pumps blood Scarring of the heart muscle caused by a heart attack Fluid in the pericardial sac that covers the surface of the heart The amount of plaque buildup and narrowing of coronary arteries  Any abnormalities in the large blood vessels leaving the heart Any risk for a heart attack

29. Limitations and Risks Limitations of CT scan Compared to other diagnostic tests like a chest x-ray, CT scans deliver a relatively high dose of radiation to the patient. While this is not usually a problem for a single scan, patients who need to undergo repeated tests can be subjected to a significant level of radiation, increasing their cancer risk. Because a CT scan is so detailed, it can sometimes alert doctors to minor abnormalities in the body that don’t have symptoms related to them and that in the normal course of life would not have caused the patient any problems. However, doctors may feel the obligation to divulge this information to patients, which can cause anxiety and possibly unnecessary follow-up tests or treatments. Risks and contraindications- CT scans use X-rays, which produce ionizing radiation. Research shows that this kind of radiation may damage your DNA and lead to cancer. But the risk is still very small and chances of developing a fatal cancer because of a CT scan are about 1 in 2,000. Ionizing radiation may be more harmful in children. That’s because they’re still growing. They also have more years to get exposed to radiation. Before the procedure, you may want to ask the doctor or technician if the CT machine’s settings have been adjusted for a child.

30. Keep taking your medications as usual after you check with your doctor. Plan for your test to take at least an hour. Most scans take from 15 to 60 minutes. Ask your doctor any questions you have before the scan. Before a CT scan are to remove metallic objects and medication devices from your body such as Jewelry, watches, glasses, hearing aids, dentures, hair pins and nicotine patches. CT scan results are considered typical if the radiologist didn’t see any of the following in the images: tumors blood clots fractures Obstructions other atypical characteristics If any atypical characteristics are detected during the CT scan, further tests, follow ups or treatments may be needed depending on the type of a typicality found. Preparations for the test Interpreting the results

31. Echocardiogram Echocardiogram - An “echo” for short, also called a transthoracic echocardiogram, can be expressed as a non-invasive ultrasound of the heart that uses high-frequency sound waves to give a visualization or image of the movement, strength and pumping action of the heart. This procedure is performed when a heart valve disease, heart rhythm irregularities and cardiac muscles disease is suspected.

32. How is the Test Performed? When a heart related disease is suspected, an echo can be ordered and the type that is done depends on the information the doctor needs. There are several types of echocardiograms but, the standard one which is the transthoracic echocardiogram is performed by- A technician, also called a sonographer, starts by spreading a gel on a device (transducer) Then, the transducer is pressed against the skin, aiming an ultrasound beam through the chest to the heart The transducer records the sound waves echo from the heart A computer then converts the echoes into moving images on a monitor.

33. What are the uses of an Echocardiogram? A cardiac echo allows the doctor to visualize the heart and detect any specific areas of concern. For example- Problems with the heart valves such as mitral valve prolapse can be detected because the test can visualize the movement of heart valves. A special microphone called a Doppler can be used during the test to measure the velocity (speed) of blood flow in various areas within the heart. This is helpful in measuring impaired blood flow in conditions such as aortic stenosis. An echo is also helpful in evaluating congenital heart disease. For example, tetralogy of Fallot and atrial septal defect are congenital conditions in which the heart does not develop the proper anatomic structure.

34. Limitation and Risks What are the limitations of an echocardiogram? While the echocardiogram provides a lot of information about cardiac anatomy, it does not visualize the coronary arteries or blockages in coronary arteries. If imaging the coronary arteries is necessary, a cardiac catheterization is commonly performed. Certain physical variations, such as a thick chest wall or emphysema, can interfere with visualization of your heart during an echocardiogram. If one of these conditions are suspected and an echo is needed, an invasive ultrasound of the heart known as a trans esophageal echocardiogram (TEE) is performed. Risks and contraindications? Regardless of one’s health, a transthoracic echo can be safely done. Holding one’s breath might be required for a few seconds during the test, but there are no expected adverse events related to the test.

35. Preparations for the test- There is no need to prepare or do anything special before an echo such as a screening test or food and activity restrictions. The doctor may advice that caffeine should not be taken for at least 6 to 10 hours prior to the test, depending on the reason for the test as it can speed up the heart rate. Other than that, there is no special actions taken before the test and it takes about an hour to be performed. Interpreting the results- The results of an echo will be prepared in a report in which the doctor will describe the heart anatomy, heart movements, and any defects observed during the test. It may take several days to several weeks for the report to be received. Often, because the results are so detailed, and the doctor may schedule an appointment with to discuss the results and next steps

36. YouTube link - https://www.youtube.com/watch?v=Kirg2GuESsE

37. NCLEX REVIEW QUESTIONS A patient is ordered to undergo a non-invasive CT scan. The most important information for the nurse to tell the patient prior to testing is: A. A consent form must be signed. B. Encourage fluids when the patient returns from the scan. C. Restraint is a must during the procedure. D. The patient must stay still during the procedure.

38. NCLEX REVIEW QUESTIONS A client with possible Parkinson's disease is scheduled to have an MRI. The daughter asks the nurse how the test is different from a CT-scan. What is the best response. A- They are not different: both use ionizing radiation B- The Ct scan does not provide a view of deep brain structures C- A MRI scan provides better contrast between normal tissue and pathological tissue. D- The MRI will not require contrast material and has no special precautions.