1. HEART
Muscular organ located in centre of thorax.
It weights approx 300gram.
Heart pump blood to tissues ,supplying them oxygen and other nutrients by
process of contraction and relaxation.
Heart beats 60 to 80 times per minute in adult ejecting 70ml of blood.
AMRUTHA .K
 RAVEENA .R
PHYSICALASSESSMENT
AND DIAGNOSTIC
EVALUATION OF
CARDIOVASCULAR
SYSTEM

2. INTRODUCTION
 CARDIOVASCULAR DISEASE IS ONE OF MOST
PREVALANT DISEASE NOW IN THE WORLD.
 NURSES, BECAUSE OF THE INCREASE MUST BE
CAPABLE OF ASSESSING CARDIOVASCULAR
SYSTEM AND SHOULD BE ABLE TO PROVIDE
IMMEDIATE CARE.

3. ANATOMY AND PHYSIOLOGIC
OVERVIEW OF HEART
Hollow muscular organ
located in the centre of
thorax.
Weight aprox 300g and
10cm long(size of owner’s
fist)
Heart pump blood to
tissues ,supplying the
oxygen and other nutrients
by process of rhythmic
contraction and relaxation
of heart.

5. POSITION
 It lies in thoracic cavity in
the mediastinum.
 It lies obliquely a little
more left than to right
 It presents a apex (below)
at the 5th intercostal space
and base (above)at the
level of 2nd intercostal
space above.

6. ANATOMY OF HEART
 It is composed of three layers
INNERMOST LAYER- ENDOCARDIUM
MIDDLE LAYER - MYOCARDIUM
OUTERMOST LAYER- PERICARDIUM.
 PERICARDIUM has two layer –Visceral pericardium
- Parietal pericardium
space between this layer is pericardial space which
contain 30ml of fluid which lubricates the surface of
heart and prevents frictional rub.

8. Chambers of heart
 RIGHT ATRIUM – Receives blood from the veins and
pumps into the right ventricle.
 RIGHT VENTRICLE – Receives blood from right atrium
and pump it to lungs oxygenation take place.
 LEFT ARTIUM –Receives oxygenated blood from lungs
and pump it left ventricle.
 LEFT VENTRICLE – Receives blood from left atrium
and pumps oxygenated blood to rest of body.

10. HEART VALVES
 Heart valves ensure a unidirectional flow of blood
through heart and prevent back flow of blood.
 There are two types of valves :
- ATRIOVENTRICULAR VALVE : Seperates the atria
from ventricle i.e
. TRICUSPID VALVE : Seperates the right atria from
right ventricle.
. MITRAL VALVE:Seperates between left atria and left
ventricle.

11. SEMILUNAR VALVES: Composed of three half-moon
leaflets.
Two types :
Pulmonary valve : located between the right
ventricle and pulmonary artery.
Aortic valve: located between left ventricle and the
aorta.

13. BLOOD SUPPLY TO THE HEART
 ARTERIAL SUPPLY: Arterial blood supply through right
and left coronary arteries.
 VENOUS DRAINAGE : Several small vein join to form
coronary sinus which opens to right atrium finally pass to
heart chamber through venous channels i.e superior vena
cava and inferior vena cava.

14. Coronary Arteries

15. PHYSILOGY OF HEART
 Conduction system of heart is controlled intrinsic system
where cardiac muscle is automatically stimulated without
any external stimulation.
 Specialised small group neuromuscular cells in the
myocardium initiate and conduct impulses causing
synchronised contraction of heart.
 SA node (pacemaker of heart) initiates impulses which
reach AV node via atria. Delay in electrical impulses to
reach to AV node takes 0.1 sec to pass through into the
ventricles.

16. •Contd...
 Atrio ventricular bundle(bundle of his ), a mass
specialised fibre which originate from AV node cross
the fibrous ring that separates atria and ventricles.
 At the end of ventricular septum; it divides into right
and left bundle branches and ventricular myocardium
branches break into fine fibre called purkinje fibres.
 AV bundle and purkinje fibre convey electrical
impulses from AV node to apex of the myocardium
causing ventricular contraction pumping blood into
pulmonary artery and aorta

18. BLOOD SUPPLY THROUGH THE HEART

19. NERVE SUPPLY TO THE HEART
 Influenced by autonomic nerve originating in the
cardiovascular centre in medulla oblongata.
 Vagus nerve (parasympathetic ) supply mainly SA and AV
node and atrial muscle.
 Sympathetic nerve supply the SA and AV node and
myocardium of atria and ventricle.

21. CARDIAC CYCLE
Cardiac cycle is series of events in which
the heart act as pump to maintain constant
circulation of blood throughout the body.
 During each cycle (0.8sec);the heart
undergoes a period of contraction
(systole) and period of relaxation
(diastole).

22. STAGES OF CARDIAC CYCLE
The normal number of caridac cycle per
mintute range from 60 to 80.
Taking 74 per min as example , the cycle of
events consists of :
ATRIAL SYSTOLE
VENTRICULAR SYSTOLE
COMPLETE CARDIAC DIASTOLE

23. ATRIAL SYSTOLE
 Superior vena cava and inferior vena cava bring
deoxygenated blood into right atrium, same time 4
pulmonary veins bring oxygenated blood into left
atrium.
 SA nodes triggers which causes a wave contraction
that spreads through both atria , which empty atria
and completes ventricular filling.
Atrial systole last for 0.1 sec.

24. VENTICULAR SYSTOLE
 When the electrical impulses reach AV node, the delay
in AV transmission will lag behind the electrical
impulses for a fraction of a sec allowing atria to finish
emptying into ventricles before ventricular
contraction.
 Now AV node creates its own impulses quickly and
spreads to ventricular muscle through bundle of his
and purkinje fibres creating contraction in the apex of
the heart and across the wall of ventricles pumping
blood into pulmonary artery and aorta.
 Ventricular systole last for 0.3 sec.

25. COMPLETE CARDIAC DIASTOLE
During this time myocardium prepares for the next
heart beat and atria refill in preparation for the next
cycle.
Complete cardiac diastole will last for a period of 0.4
sec.

27. HEART SOUNDS
 During the action of heart due passive closing of the
valves mainly TWO normal heart sounds are heard:
‘DUP’ sound ,which is long and dull sound is due
to the closing of atrioventricular valves and
contraction of ventricles.
‘LUB’ sound ,which is short and sharp is due to the
closing of aortic and pulmonary valves.

29. ELECTRICAL CHANGES IN THE HEART
 Electrical activity is detected by placing the electrodes to
the chest and traced on a paper called as
electrocardiogram and the apparatus used is called as
electrocardiograph
 The normal ECG waves are named as:

30.  P wave: arise when the impulses from SA nodes
sweeps atria.
 QRS complex: represents the rapid spread of
impulses from AV node through the AV bundle and
purkinje fibres and electrical activity of ventricular
muscles.
 T wave: represents the relaxation of ventricular
muscles.
ECG originating from SA node is known as sinus rhythm

31. CARDIAC OUTPUT
 Cardiac output refers to amount of blood pumped by
each ventricle during a given period.
 NORMAL CARDIAC OUTPUT IN ADULT IS 5LITRES
PER MIN.
 CARDIAC OUTPUT =STROKE VOLUME X HEART RATE
 Stroke volume is the amount of blood ejected per heart
beat.
 Average stroke volume = 70 ml
 Heart rate = 60 to 80 beats per minute.

33. DIAGNOSTIC STUDIES IN CVS
 Diagnostic procedures are mainly classified into :
INVASIVE PROCEDURES
NON INVASIVE PROCEDURES
INVASIVE PROCEDURES
NON INVASIVE PROCEDURES

34. RADIOLOGIC TESTS
CHEST
ROENTOGRAMS[CHEST XRAY]
CARDIAC FLUROSCOPY

35. CHEST ROENTOGRAMS
 Determine overall size and configuration of heart.
 It can determine individual chamber size
 Find extra fluids around the heart( pericardial effusion
and pulmonary congestion).
 Visualize calcification in the pericardium, heart
muscles, valves and large blood vessels.

37. Cardiac fluoroscopy
 Observation of heart in varying views while heart is in
motion.
 Detect ventricular aneurysms
 Monitor prosthetic valve movements
 Assess the position of cardiac calcification

38. SCINITIGRAPHIC STUDIES.
MYOCARDIAL
IMAGING
STATIC
MYOCARDIAL
IMAGING

39. Myocardial imaging
 Used to identify myocardial infraction.
 Evaluate myocardial perfusion.
 Asses left ventricular function.
 Patient undergone coronary artery bypass surgery to
identify new infractions.

40. STATIC MYOCARDIAL IMAGING
 Used to produce static picture of myocardium.
 Types of imaging are:

THALLIUM SCAN
 MUTIPLE GATETED RADIOISOTOPE
SCAN/MUTIPLE GATED ACCQUISITION
SCANNING(MUGA).
 TECHNETIUM PYROPHOSPHATE SCANNING
 DYNAMIC MYOCARDIAL IMAGING
 PHARMACOLOGIC NUCLEAR IMAGING
 POSITRON EMISSION TOMOGRAPHY(PET)

41. THALLIUM SCAN
 Radioactive tracer is injected and accumulates in
myocardial tissue that is well profused.
 Tracer has decrease accumulation in myocardial tissue
that is not well profused .these areas are called ‘COLD
SPOT’.
 Test helps to evaluate the perfusion of myocardial
tissue during exercise.

42. NURSES INTERVENTION
• Inform client to be NPO for 3 hour prior to the test.
• Injecting IV for stress testing is given 1 min before the
patient reach maximum heart rate on bicycle or
treadmill.
• Client continue to exercise for 1 min to circulate
radioactive isotopes.
• Actual scanning is done with 5-10 min after exercise.

43. MUGA
 Cardiac blood pool scan
 evaluate function of the left ventricle.
 Small amount of blood removed and mixed with
radioactive isotope and reinjected IV.
 With ECG used for timing images are acquired during
cardiac cycle.
 Indicated for patients with MI,heart failure or valvular
disease and to assess effect of cardiac or cardio toxic
medication on heart.

44. Nurses responsibility
 Explain procedure to patient.
 Establish IV line
 Establish ECG monitor.
 Inform the risk procedure to patient and get consent.

45. TECHNETIUM PYROPHOSPHATE
SCANNING
 Diagnose acute MI in client who experienced
symptoms suggestive of an infract.
 A radioisotope is injected intravenously accumulate in
the damaged tissue and are called ‘HOT SPOT’.
 Test will take 45 to 60 min.
NURSES RESPONSIBILITY
Inform client to avoid smoking ,caffeine and alcohol 3
hours before the test.

46. Dynamic myocardial Imaging
 Helps to assess cardiac wall motion and left and right
ventricular function.
 The earliest method of this imaging is the MUGA.

47. PHARMACOLOGIC NUCLEAR
IMAGING
 TWO most common drugs used in this type of
imaging are:
DIPYRIDAMOLE
- potent coronary vasodilator.
-It block the cellular reuptake of adenosine thereby
increasing blood and tissue concentration of
adenosine.
In normal coronary arteries dipyridamole increases
blood flow 3 to 4 times whereas in stenosed arteries;
blood flow will be significantly reduced(70%).

48. ADENOSINE
It is an alternative proposed for dipyridamole. perfusion
imaging.
It has shorter life compared to dipyridamole.
It elicits more consistent maximal vasodilation .
NURSES RESPONSIBILITY
 Explain the procedure to patient.
 Instruct patient avoid caffeine products 12 hours
before procedure.
 Calcium channel blockers and B adrenergic blockers
should be withheld 24 hours before the procedure.
 Observe for side effects.

49. NURSES RESPONSIBILITY
 Explain the procedure to patient.
Instruct patient avoid caffeine products 12 hours before
procedure.
Calcium channel blockers and B adrenergic blockers
should be withheld 24 hours before the procedure.
Observe for side effects.

50. Positron emission
tomography(PET)
 Highly sensitive in distinguishing viable and non viable
myocardial tissue
 It uses two radionuclieotides
1. NITROGEN 13 AMMONIA which is injected and
scanned first to evaluate myocardial perfusion.

51. 2. FLURO 18 DEOXYGLUCOSE is then injected and
scanned to evaluate myocardial metabolic function.
 In normal heart both the scan matches but in
ischemic or damaged heart it differs.

52. NURSES RESPONSIBILITY
 Explain procedure
• Explain that client scanned by machine and will need to
stay still for long time.
• Patient glucose level should be between 60- 140 mg/dl
for accurate glucose metabolic activity.
• NPO and to avoid tobacco and caffeine 24hr before
procedure if exercise is included as a part of testing.

53. SINGLE PHOTOEMISSION
COMPUTED TOMOGRAPHY(SPECT)
 Determine signs or risk infraction or infraction size.
 Small amount of technetium – tetrofosimin, thallium
201 are injected IV and recording are made of the
radioactivity emitted over a specific area.
 Circulation of isotope can be used to assess coronary
artery blood flow ,intracardiac shunts ,motion of
ventricles . EF(ejection factor) and size of heart
chambers.

54. NURSES RESPONSIBILITY
• Explain procedure to patient.
• Establish IV line for injection.
• Establish ECG monitoring.
• Inform the patient that procedure involves some risk
.consent should be taken.

55. ECHOCARDIOGRAPHY
Echocardiography uses ultrasound to assess cardiac
structure and mobility non invasively .
USES
To diagnose abnormal cardiac conditions like
 abnormal pericardial fluid .
 Valvular disorders including prosthetic valve s
 Ventricular aneurysms
 Cardiac chamber size
 Stroke volume
 Wall motion abnormalities.

57. TYPES OF ECHOCARDIOGRAPHY
Echo cardiogram [ M MODE TWO
Dimension].
Dobutamine echocardiography.
Transesophageal echocardiography
Stress Echocardiography.
Phonography

58. Echocardiogram (M mode two
dimensional)
 Transducer is placed on the patient chest the level of
third and fourth intercostal space near the left lower
sternal border.
 High pitched frequency sound wave passed by
transducer will waves back from the patient as they
are reflected from different structures.
 These ultrasonic beam passes will produce ‘echoes’
that are viewed as lines and spaces on oscilloscope
 Lines represents bone chamber of cardiac and valves,
septum and muscles.

59. Dobutamine echocardiography
 Used in individuals who are unable to walk on
treadmill.
 performed to detect motion abnormalities in each
stage.
NURSES RESPONSIBILITY
Start IV infusion and administer dobutamine
Continous monitioring of vital signs until baseline is
achieved.
Monitor signs and distress of the heart.

60. Transesophageal echocardiography
• It is a high restriction imaging of the cardiac
structures and great vessels through esophagus .
• In this a transducer is fixed into the tip of a modified
,flexible to produce clear posterior images of heart.
endoscope that is advanced into esophagus and
manipulated .

61. Indications for TEE
 Aortic dissection/aneurysm
 Mitral valve prosthetic dysfunction
 Mitral valve regurgitation
 Infective endocarditis
 Congenital heart disease
 Intra cardial thrombi(in LA and LA appendage)
 Cardiac tumor
 Intraoperative assessment ; LV function ,adequacy of
valve repair/replacement.

63.  NURSES RESPONSIBITLITY
o NPO for at least 6 hours before test.
o A tranquilizer will be given and throat locally
anaesthetetized.
o Monitor vital signs and oxygen saturation levels
o Perform continuously suction through out the
procedure.
o Explain proper procedure for easy transducer passage
o Assist patient to relax and provide psychological
support.

64. Phonocardiography
 It involves the use of electrically recorded amplified
sounds .
 Special microphones attached to patient chest pick
cardiac sounds produced by pressure changes in the
heart and great vessels.
 Sounds are graphically recorded on special phonograph
paper.
 It helps in determining the exact timing of cardiac
changes and extra heart sounds.

65. Stress echocardiogram
 Used by a combination of exercise, treadmill test and
echocardiogram.
 Resting images of the heart are taken first with ultrasound
and then the patient exercises.
 Post exercises images are taken within 1 min of stopping
exercises.
 Help to evaluate differences in wall thickening in left
ventricular wall motion and thickening before and after
exercise.

66. NURSES RESPONSIBILITY
 Instruct and inform about the procedure.
 Take precaution if any patient is unable to reach peak
exercise.
 Health educate and make patient aware that
ultrasound is not harmful and importance of speed in
returning to examination table for imaging after
exercise.

67. ELECTROCARDIOGRAM[ECG]

68. Electrocardiogram is the graphical
representation of
electrical forces produced within the
heart.

69. USES
 Tachycardia ,Bradycardia,Dysrthymia.
 Sudden onset of dyspnoea.
 Pain occurring in the upper portion of trunk and in
extremities.
 Syncopial episodes.
 Shock state or coma.
 Preoperative status.
 Postoperative hypertension.
 Hypertension , murmur or cardiomegaly.
 Artificial pacemaker function.

70. ECG helps to detect the rhythm of heart, site of
pacemaker ,conduction abnormalities, position of
heart, size of atria and ventricles and presence of
injury.
NURSES RESPONSIBILITY
 Inform patient about step by step procedure.
 Give assurance of its safe ,painless nature and
comfortability.
 Instruct patient to avoid moving during procedure to
decrease muscle motion artifact.

71. Types of ECG
 CONTINOUS ELECTOCARDIOGRAM
MONITORING.
 SIGNAL AVERAGED ELETROCARDIOGRAM.
 CONTINOUS AMBULATORY MONITORING,
 TRANSTELEPHONIC MONITORING.
 WIRELESS MOBILE CARDIAC MOITORING
SYSTEM.

72. Continuous electrocardiogram
monitoring
 It is used to detect abnormalities in heart rate and rhythm
for patient who are high risk for dysrythmias.
 Two types :
* HARDWARE CARDIAC MONITORING.
* TELEMETRY.

73. HARDWARE CARDIAC MONITORING
 It can be used continuously for observing dysrhymias and
conduction disorders.
 Monitor in oscilloscope at bedside and central monitoring
system station by this device.

75. ADVANTAGES
 It can monitor more than one lead simultaneously.
 Monitor ST Segments abnormalities.
 Provide graded visual and audible alarms.
 Can print rhythm strip.

76. Telemetry
 Telemetry is the transmission of radiowaves from a
battery operated transmitter worn by patient.
 Wireless which allow the patient to ambulate.

78. Single averaged electrocardiogram
 A high resolution ECG .
 Identify life threatening dysrhythmias risks.
 Determine need for invasive diagnostic procedures.
 Done by taking average of 150 -300 QRS wave forms.

79. Continuous ambulatory monitoring
 Used in outpatient patients
 ECG is monitored by a holter monitor, a small tape
recorder which continuously monitor the electrical
activity.
 Used to detect dysrythmias or evidence of myocardial
ischemia during ADL.

80. Transtelephonic monitoring
 Method for evaluating ECG at home
 Used to diagnose dysrhythmias and follow up for
permanent cardiac pacemaker.

81. Wireless mobile cardiac monitoring
system
 Monitor and transmits ECG of patients outside of
hospital or in office continuously .
 Patient wear this small sensing device which monitor
when dysrhythmias is detected and automatically
transmits ECG to monitor either at home or through
wireless communication system.
 Helps in early treatment of dysrhythimias

82. Cardiac stress testing.
 Detect cardiovascular abnormalities during time of
increased demand or ‘stress’.
 INDICATIONS
1. Symptoms suggestive of coronary artery disease.
2. Determine patient physical work capacity and
aerobic activity
3. Functional capacity of patient after post MI
4. Evaluate exercise induced dysrythmias
5. Evaluate pharmacological intervention for
dysrhythmias

83.  CONTRAINDIACTIONS.
1. Severe aortic stenosis.
2. Acute myocarditis and pericarditis
3. Severe hypertension
4. Suspected left main CAD
5. Heart failure
6. Unstable angina

84. Types of cardiac stress test
Mental stress
test
Exercise stress
test
Pharmacologic
stress test

85. Mental stress test
 It uses mental arithmetic test or simulated public
speech to determine whether an ischemic myocardial
response similar to the response evoked by
conventional treadmill exercise test.

86. Exercise stress test

87.  Determine changes in cardiac function through
physical exertion by assessing the symptoms shown.
 Intensity of exercise depends on established protocol
most commonly used is Bruce protocol in which speed
of treadmill increased every 3 min.
 Test is terminated when target heartrate is achieved or
when patient experience abnormal symptoms.
 When ECG abnormalities are detected it is considered
as positive and further diagnostic test are done.

88. NURSES RESPONSISBILITY
1. NPO for 4 hours before procedure,
2. Inform to avoid stimulants .
3. Instruct not take cardiac medication.
4. Provide information about the procedure.
5. Monitor patient for 15 min after procedure.

89. Pharmacologic stress test
 Two vasodilating agents
Dipyridamole and Adenosine[IV] mimic the effects of
exercise by maximum coronary dilatation.
 Another drug Dobutamine increases heart rate and BP
thereby increasing the metabolic demands of heart.

90. Nurses responsibility
1. NPO for 4 hours before test
2. Beverages should be avoided
3. Aminophyline and Theophyline to be stopped 24 to
48 hours before test.
4. Check for sideeffects
5. Test may take to hour if imaging is performed.

91. LABORATORY TESTS

92. CBC ordered in all suspected heart disease
RBC decreased in sub acute endocarditis ,CHD{R-L
shunt},increased in tissue oxygenation.
WBC increased in acute and chronic inflammation,
acute MI.
ESR increased in acute MI and infectious heart
disease.
BUN increases with decreased cardiac output.

93. BLOOD LIPIDS
It is composed of cholestrol,triglycerides,phospholipids
and free fatty acids which are insoluble and hence
need carrier i.e. protein called lipo proteins.
Four type of lipoproteins are:
 CHYLOMICRONS
 VERY LOW DENSITY LIPOPROTEINS
 LOW DENSITY LIPOPROTEINS
 HIGH DENSITY LIPOPROTEINS

94. CHYLOMICRONS
 Triglycerides originating from intestine gut.
 elevated level indicate premature coronary artery
disease.
VERY LOW DENSITY LIPOPROTEINS
Synthesized in liver
Elevated level indicates atherosclerosis
LOW DENSITY LIPOPROTEINS
LDL when it enters arterial intima can cause endothelial
injury. And manifests symptoms of coronary ischemic
heart disease.
HIGH DENSITY LIPOPROTEINS
Made of cholesterol and phospholipids.
Provide protection against CAD

95. NURSES RESPONSIBILITY
Patient must fast for 12 hours before test.
Avoid beverages or lipid influencing drugs.
If patient under stress postpone the test.

96. BLOOD CULTURE
 To Diagnose infective
endocarditis.
 Make sure strict aseptic
technique is followed
obtaining blood for culture.

97. ENZYME STUDIES
 To detect myocardial necrosis.
 Iso enzymes CK and LDH are exclusively found in
myocardial muscle.
 CK molecule has two sub units :
1. M associated with muscle(skeletal muscle)
2. B associated with brain(mostly found in brain and
gastro intestinal gut) .
3. CKMB in serum indicates of myocardial damage.
4. LDH enzyme is also indicator of myocardial damage.

98. URINALYSIS
 Determine effect of cardiovascular disease on renal
function.
 Mild to moderate proteinurea seen in malignant
hypertension.
 Detection myoglobin in urine indicates MI.

99. Serologic tests
 VDRL test to detect on syphilis as it playa important
role in aortic disorders,

100. INVASIVE
HEMODYNAMIC
MONITORING

101. Central venous pressure
 Detects presuure in right atrium and right ventricular
pressure.
 It is utilized in monitoring blood volume and
adequacy of venous return to the heart.
 High CVP indicates left sided pump failure leads to
CCF and pulmonary edema.
 Normal CVP ; 5 to 15 of water.

102. Intra-arterial blood pressure
monitoring
It detects the actual blood pressure when
stroke volume falls which make difficulty in
auscultation blood pressure.
Nurses responsibility
 Continous monitoring of patient especially
site of catheter for loose connection to
prevent bleeding.
 Check pulse colour temperature distal to
catheter for circulatory compromise or
thrombosis.

103. PULMONARY ARTERY WEDGE PRESUURE
AND CAPILLARY WEDGE PRESSURE
 Left ventricular function is assessed by balloon tipped
catheter introduced into pulmonary artery
 TYPES
 Left ventricular end diastolic pressure (12-15mmHg).
 Pulmonary atrery end diastolic pressure(4-12mmHg).
 Pulmonary capillary wedge pressure(4-12mmHg).
 If PCWP is greater than 25 mmHg indicates
pulmonary oedema.

104. Cardiac catheterization
It is valuable diagnostic tool to obtain
information about the structure and
function of heart chambers ,valves and
coronary arteries.

106. Nurses responsibiltiy
BEFORE PROCEDURE
Obtain a written consent
NPO 6-18 hours before procedure.
Inform about use of local anaesthesia insertion of
catheter and feeling of warmth and fluttering
sensation when catheter is inserted.
Instruct the patient to cough or take deep breath
when catheter is inserted.

107. AFTER PROCEDURE
Assess circulation to extremity used for catheter
insertion
Check peripheral pulses and colour and sensation of
insertion.
Observe injestion site for any swelling or bleeding
Monitor vital signs
Apply pressure to arterial site.
Assess for abnormal heart rate ,arythmias and signs of
pulmonary emboli (respiratory difficulty).

108. Other test
 Coronary angiography
 Intracoronary ultrasound.
 Electrophysiology study.