Cardio Vascular System assessment- Nursing PPT

HEALTH AND DIAGNOSTIC ASSESSMENT OF
CARDIO VASCULAR SYSYTEM
MATHEW VARGHESE V
MSN(RAK),FHNP (CMC Vellore),CPEPC
Nursing officer
AIIMS Delhi1mathewvmaths@yahoo.co.in

Introduction
• The application of complex technology to the assessment
and management of cardiovascular and cardiopulmonary
conditions has increased greatly in the past several
decades.
• Use of advanced and complex technologies is an integral
part of the care of critically ill patients. Nevertheless, the
value of a comprehensive cardiovascular history and
physical examination should never be underestimated.
2mathewvmaths@yahoo.co.in

Cardiac Conduction System
• The cardiac conduction system is a group of
specialized cardiac muscle cells in the walls of the
heart that send signals to the heart muscle causing it
to contract.
• The main components of the cardiac conduction
system are the SA node, AV node, bundle of His,
bundle branches, and Purkinje fibers.

Cardiac Conduction System
• The SA node (anatomical pacemaker) starts the sequence
by causing the atrial muscles to contract. From there, the
signal travels to the AV node, through the bundle of His,
down the bundle branches, and through the Purkinje
fibers, causing the ventricles to contract.
• This signal creates an electrical current that can be seen
on a graph called an Electrocardiogram (EKG or ECG).
Doctors use an EKG to monitor the cardiac conduction
system's electrical activity in the heart.

CARDIAC HISTORY AND PHYSICAL
EXAMINATION
• The cardiovascular history provides
physiological and psychosocial information
that guides the physical assessment, the
selection of diagnostic tests, and the choice of
treatment options.
• During the history, the nurse asks about the
presenting symptoms, past health history,
current health status, risk factors, family
history, and social and personal history.

CARDIAC HISTORY AND PHYSICAL
EXAMINATION
• The nurse also inquires about behaviors
that promote or jeopardize cardiovascular
health and uses this information in guiding
health teaching.
• During the process of taking a thorough
history and performing a physical
examination, the nurse has an opportunity
to establish rapport with the patient and
to evaluate the patient’s general
emotional status.

CARDIAC HISTORY
Chief Complaint and History of Present Illness
• The nurse begins the history by investigating
the patient’s chief complaint.
• The patient is asked to describe in his or her
own words the problem or reason for seeking
care.
• The nurse then asks for more information
about the present illness, using the following
questions (NOPQRST Format)

NOPQRST Format
N-Normal
• Describe your normal baseline?
• What was it like before this symptom developed?
O-Onset
• When did the symptom start?
• What day?
• What time?
• Did it start suddenly or gradually?

NOPQRST Format
P- Precipitating and palliative factors
• What brought on the symptom?
• What seems to trigger it—factors such as stress,
position change, or exertion?
• What were you doing when you first noticed the
symptom?
• What makes the symptom worse?
• What measures have helped relieve the symptom?
• What have you tried so far?
• What measures did not relieve the symptom?

NOPQRST Format
• Q- Quality and quantity
• How does it feel?
• How would you describe it?
• How much are you experiencing now?
• Is it more or less than you experienced at any other time?
• R-Region and radiation
• Where does the symptom occur?
• Can you show me?
• In the case of pain, does it travel anywhere such as down
your arm or in your back?

NOPQRST Format
• S-Severity
• On a scale of 1 to 10, with 10 being the worst ever experienced, rate your
symptom.
• How bad is the symptom at its worst?
• Does it force you to stop your activity and sit down, lie down, or slow
down?
• Is the symptom getting better or worse, or staying about the same?
• T- Time
• How long does the symptom last?
• How often do you get the symptom?
• Does it occur in association with anything, such as before, during, or after
meals?

Common S/S Related to CVS
• Chest Pain
• Dyspnea
• Edema Of Feet/Ankles
• Palpitations And Syncope
• Cough And Hemoptysis
• Nocturia
• Cyanosis
• Intermittent claudication

Chest Pain
• Most common
• Chest pain is often a disturbing or even
frightening experience for a patient
• Chest pain caused by coronary artery
disease is often precipitated by physical or
emotional exertion, a meal, or being out in
the cold
• The quality of cardiac chest pain is often
described as heaviness, tightness,
squeezing, or choking sensation

Chest Pain
• If the pain is reported as superficial,
knifelike, or throbbing, it is not likely to
be anginal.
• Cardiac chest pain is usually located in
the substernal region and often
radiates to the neck, left arm, the back,
or jaw.

Chest Pain
• When the patient is asked to point to the
painful area, the painful area is about the
size of a hand or clenched fist.
• It is unusual for true anginal pain to be
localized to an area smaller than a
fingertip.
• When asked about time, the patient with
cardiac chest pain reports the pain lasting
anywhere from 30 seconds to hours.

Dyspnea
• Dyspnea occurs in patients with both pulmonary and
cardiac abnormalities.
• Dyspnea is a subjective complaint of true difficulty in
breathing, not just shortness of breath
• If dyspnea is present when the patient lies flat but is
relieved by sitting or standing, it is orthopnea.
• If it is characterized by breathing difficulties starting
after approximately 1 to 2 hours of sleep and relieved
by sitting upright or getting out of bed, it is paroxysmal
nocturnal dyspnea

Edema of the Feet and Ankles
• Many other problems can leave a patient
with swollen feet or ankles
• In CVS – main reason is Heart Failure-The
heart is unable to mobilize fluid
appropriately
• Because gravity promotes the movement
of fluids from intravascular to extra
vascular spaces, the edema becomes
worse as the day progresses and usually
improves at night after lying down to sleep

Edema of the Feet and Ankles
• Patients or families may report that shoes do not
fit anymore, socks that used to be loose are now
too tight, and the indentations from sock bands
take more time than usual to disappear.
• The nurse should inquire about the timing of
edema development (e.g., immediately after
lowering the extremities, only at the end of the
day, only after a significant salt intake) and
duration (e.g., relieved with temporary elevation
of the legs or with constant elevation).

Palpitations and Syncope
• Palpitations refer to the awareness of
irregular or rapid heartbeats. Patients may
report the “skipping” of beats, a rushing of
the heart, or a loud “thudding.”
• The nurse asks about onset and duration
of the palpitations, associated symptoms,
and any precipitating events that the
patient or family can remember.

Palpitations and Syncope
• Because a cardiac arrhythmia may
compromise blood flow to the brain,
the nurse asks about symptoms of
dizziness, fainting, or syncope that
accompany the palpitations.

Cough and Hemoptysis
• Abnormalities such as heart failure,
pulmonary embolus, or mitral stenosis
may cause a cough or hemoptysis.
• The nurse asks the patient about the
presence of a cough and inquires about
the quality (wet or dry) and frequency of
the cough (chronic or occasional, only
when lying down or after exercise).

Cough and Hemoptysis
• If the cough produces expectorant, the
nurse records its color, consistency, and
amount perceived by the patient.
• If the patient reports spitting up blood
(hemoptysis), the nurse asks if the
substance spit up was streaked with
blood, frothy bloody sputum, or frank
blood (bright or dark)

Nocturia
• Kidneys that are inadequately perfused by
an unhealthy heart during the day may
finally receive sufficient flow during rest at
night to increase their output.
• The nurse asks about the number of times
the patient urinates during the night. If
the patient takes a diuretic, the nurse also
evaluates frequency of urination in
relation to the time of day the diuretic is
taken.

Cyanosis
• Cyanosis reflects the oxygenation and
circulatory status of the patient.
• Central cyanosis is generally distributed and
best found by examining the mucous
membranes for discoloration and duskiness,
and reflects reduced oxygen concentration.
• Peripheral cyanosis is localized in the
extremities and protrusions (hands, feet,
nose, ears, and lips) and reflects impaired
circulation.

Intermittent Claudication
• Claudication results when the blood
supply to exercising muscles is
inadequate.
• Usually the cause of claudication is
significant atherosclerotic obstruction
to the lower extremities.
• The limb is asymptomatic at rest unless
the obstruction is severe.

Intermittent Claudication
• Blood supply to the legs is inadequate to
meet metabolic demands during exercise,
and ischemic pain results.
• The patient describes a cramping, ache, or
weakness in the foot, calf, thigh, or
buttocks that improves with rest. The
patient should be asked to describe the
severity of the pain and how much
exertion is required to produce the pain.

Past Health History
• Childhood illnesses:
• Rheumatic fever,
• Murmurs,
• Congenital anomalies
• Past medical problems:
• Heart failure
• Hypertension
• Coronary artery disease

Past Health History
• Myocardial infarction
• Hyperlipidemia
• Valve disease
• Cardiac arrhythmias
• Peripheral vascular disease
• Diabetes

Past Health History
• Past surgeries:
• Cardiovascular surgeries such as
coronary artery bypass grafting, valve
replacement, peripheral vascular
procedure
• Surgeries for other health problems

Past diagnostic tests and
interventions:
• Electrocardiogram
• Echocardiogram,
• Cardiac catheterization
• Stress test
• Electrophysiological studies
• Stent placement
• Atherectomy

Past diagnostic tests and
interventions:
• Percutaneous transluminal coronary
angioplasty
• Pacemaker implantation
• Implantable cardioverter–defibrillator
placement
• Valvuloplasty

Current Health Status and Risk
Factors
• Medications:
• Prescription drugs, over-the-counter
drugs, vitamins, herbs and
supplements
• Allergies and reactions:
• Medications, food, contrast agents

Current Health Status and Risk
Factors
• Tobacco, alcohol, and substance use
• Diet
• Sleep patterns
• Exercise
• Leisure activities

Risk Factors for Cardiovascular
Disease
• Major Uncontrollable Risk Factors
• Age
• Heredity
• Gender
• Race

Major Risk Factors That Can Be Modified,
Treated, or Controlled
• Tobacco smoking
• High blood cholesterol
• Hypertension
• Physical inactivity
• Obesity
• Diabetes mellitus

Other Contributing Factors
• Stress
• Sex hormones:
• Birth control pills:
• Excessive alcohol intake
• Homocysteine levels

Family History
• The nurse asks about the age and health,
or age and cause of death, of immediate
family members, including parents,
grandparents, siblings, children, and
grandchildren.
• The nurse inquires about cardiovascular
problems such as hypertension, elevated
cholesterol, coronary artery disease, MI,
stroke, and peripheral vascular disease

Social and Personal History
• ■ Family composition
• ■ Living environment
• ■ Daily routine
• ■ Sexual activity
• ■ Occupation
• ■ Coping patterns
• ■ Cultural beliefs
• ■ Spiritual/religious beliefs

CARDIAC PHYSICAL EXAMINATION
• Cardiac assessment requires
examination of all aspects of the
individual, using the standard steps of
inspection, palpation, percussion, and
auscultation.
• A thorough and careful examination
helps the nurse detect subtle
abnormalities as well as obvious ones.

Rating Scale Used for Assessing
Strength of Pulses
• 0 - Absent
• 1- Palpable but thready, weak, easily
obliterated
• 2- Normal, not easily obliterated
• 3 - Full, bounding, easily palpable,
cannot obliterate

Pulse
• Pulses can also be described according to
their characteristics.
• Pulsus alternans is pulse that alternates in
strength with every other beat; it is often
found in patients with left ventricular
failure.
• Pulsus paradoxus is a pulse that
disappears during inspiration but returns
during expiration.

Areas of Auscultation.
Name of the Area Description of area Name of Heart sound
Aortic area Second intercostal space
to the right of the sternum
S2 Heart Sound
Pulmonic area Second intercostal space
to the left of the sternum
S2 Heart Sound
Tricuspid area Fifth intercostal space to
the left of the sternum
S1 Heart Sound
Mitral area Fifth intercostal space
midclavicular line
S1 Heart Sound

Areas of Auscultation

Gradation of Heart Murmurs
• Grade 1: Barely audible in a quiet room; very
faint; may not be heard in all positions
• Grade 2: Quiet, but clearly audible
• Grade 3: Moderately loud
• Grade 4: Loud with a palpable thrill
• Grade 5: Very loud with an easily palpable
thrill
• Grade 6: Very loud; may be heard with
stethoscope entirely off of the chest; thrill
palpable and visible

CARDIAC LABORATORY STUDIES
• 1. Routine Laboratory Studies
• Hematological Studies
– Red blood cell count
– Hematocrit
– Hemoglobin
– Corpuscle indices
– White blood cell count (Total)
– Differential Count
– Sedimentation rate (ESR)

Coagulation Studies
• Platelet count
• Prothrombin time
• Partial thromboplastin time
• Activated partial thromboplastin time
• Activated clotting time
• Fibrinogen level
• Thrombin time

Blood Chemistries
• Serum electrolytes
• Blood gases
• Bilirubin
• Calcium
• Creatinine
• Glucose (fasting)
• Magnesium
• Phosphorus

Blood Chemistries
• Phosphatase, alkaline
• Protein (total)
• Urea nitrogen
• Uric acid
• Total blood cholesterol
• LDL cholesterol
• HDL cholesterol

Factors That Influence Low-Density Lipoprotein
(LDL) and High-Density
Lipoprotein (HDL) Level
• LDL Levels
Increased with
• Diets high in cholesterol
• Diets high in saturated fat
• Alcohol
• Strict vegetarian diet
• Hypothyroidism
• Obesity
• Obstructive liver disease
• Nephrosis

• Thiazide diuretics
• Beta-adrenergic blocking agents
• Progestin and anabolic steroids
Decreased with
• Low-cholesterol diet
• Low-fat diet
• Alcohol restriction
• Regular strenuous exercise

HDL Levels
Increased with
• Not smoking
• Lean body mass
• Estrogen
• Vigorous exercise
• Diet low in sucrose and starch
• Increased clearance of very–low-density
lipoprotein(triglyceride)
• Alcohol

Decreased with
• Cigarette smoking
• Obesity
• Progesterone
• Male sex
• Sedentary lifestyle
• Hypertriglyceridemia
• Type 2 diabetes mellitus
• Strict vegetarian diet

Decreased with
• Hypertriglyceridemia
• Anabolic steroids
• Starvation
• Beta-adrenergic blocking agents
• Infectious illness

Enzyme Studies
• Creatine Kinase
• The level of total CK in plasma usually
becomes abnormal 6 to 8 hours after
onset of MI and peaks in 24 and 28 hours.
• Within 2 to 4 days after MI,the serum
concentration of total CK usually has
returned to normal.
• The normal level of total CK typically is
higher in men than in women

Creatine Kinase Isoenzymes
• The three CK isoenzymes routinely
reported are CK-MM, CK-BB, and CK-MB,
which are found to the greatest extent in
skeletal muscle, brain, and heart muscle,
respectively
• Within 6 to 12 hours after the onset of
infarction, CKMB usually begins to appear
in serum, and it peaks at approximately 24
hours.

Lactate Dehydrogenase (LDH)
• LDH can be found in many organs
besides the heart, including the liver,
skeletal muscle, kidney, lung, fat, and
red blood cells.

Lactate Dehydrogenase in Cardiac
Disease
• Total LDH is less specific than CK for
cardiac disease.It usually begins to
appear in the serum within 24 hours
after the onset of acute MI and does
not peak until 2 to 3 days; it may
remain elevated for 7 to 10 days before
returning to normal levels.

Biochemical Markers: Myocardial
Proteins
• Myoglobin
• Troponin
• It is highly specific for cardiac muscle
damage and is detectable in two
subforms, cardiac troponin I (cTnI) and
troponin T (cTnT). An advantage of
troponin assays is that, unlike myoglobin,
troponin is unaffected by skeletal injury.

: Myocardial Proteins
• Troponin I can be detected within 4
hours after an acute MI and can remain
elevated for 7 to 10 days.
• Troponin T has been shown to be
highly sensitive in detecting minor
myocardial injury and may provide
valuable prognostic information in
patients experiencing angina pectoris.

Normal Range
• Troponin-I 0–2 ng/mL
• Troponin-T 0–3.1 ng/mL
• Myoglobin
– Men 20–90 ng/mL
– Women 10–75 ng/mL

Neurohumoral Hormones: Brain-
type Natriuretic Peptide
• BNP is released in response to
ventricular dilation and increased
intraventricular pressures. BNP levels
are helpful in the diagnosis of
ventricular dysfunction caused by heart
failure.
• Normal Value- 0.5-30 pg/mL

Newer Diagnostic Markers
• C-reactive protein and D dimer are newer
markers of inflammation and necrosis.
• C-reactive protein, an acutephase protein
and marker of systemic inflammation, has
been shown to be elevated in patients
with acute coronary syndromes
• Normal values are 0 to 2 mg/dL

D dimer
• It is another newer physiological
marker that may be useful in predicting
the risk of cardiac events.
• Universal normal serum values for D
dimer are not yet established, although
a threshold of 500 μg/L indicates
increased sensitivity for acute MI.
•

Standard 12-Lead
Electrocardiogram
• A recording of the electrical activity of the heart
over time
• Gold standard for diagnosis of cardiac
arrhythmias
• Helps detect electrolyte disturbances (hyper- &
hypokalemia)
• Allows for detection of conduction abnormalities
• Screening tool for ischemic heart disease during
stress tests

ECG Graph Paper
• Runs at a paper speed of 25 mm/sec
• Each small block of ECG paper is 1 mm2
• At a paper speed of 25 mm/s, one small block
equals 0.04 s
• Five small blocks make up 1 large block which
translates into 0.20 s (200 msec)
• Hence, there are 5 large blocks per second
• Voltage: 1 mm = 0.1 mV between each
individual block vertically

ECG

Recording of the ECG:
• Leads used:
Limb leads are I, II, II. So called because at
one time subjects had to literally place
arms and legs in buckets of salt water.
Each of the leads are bipolar; i.e., it requires
two sensors on the skin to make a lead..
There will be a positive end at one electrode
and negative at the other.

Einthoven’s triangle
• The positioning for leads I, II, and III
were first given by Einthoven. Form
the basis of Einthoven’s triangle.

ECG
• Bipolar leads record voltage between
electrodes placed on wrists & legs (right leg is
ground)
• Lead I records between right arm & left arm
• Lead II: right arm & left leg
• Lead III: left arm & left leg

EKG Augmented Limb Leads
• The same three leads that form the standard
leads also form the three unipolar leads known
as the augmented leads.
• These three leads are referred to as aVR (right
arm), aVL (left arm) and aVF (left leg) and also
record a change in electric potential in the frontal
plane.
• These leads are unipolar in that they measure the
electric potential at one point with respect to a
null point (one which doesn't register any
significant variation in electric potential during
contraction of the heart).

• This null point is obtained for each lead
by adding the potential from the other
two leads. For example, in lead aVR,
the electric potential of the right arm is
compared to a null point which is
obtained by adding together the
potential of lead aVL and lead aVF.

Augmented Leads

Precordial leads
• The standard left precordial leads are
– V1 (fourth Intercostal space, right sternal border);
– V2 (fourth intercostal space, left sternal border);
– V3 (diagonally between V2 and V4);
– V4 (fifth intercostal space, left midclavicular line)
– V5 (same horizontal line as V4 in left anterior
axillary line);
– V6 (same horizontal line as V4 and V5, in
midaxillary line).

Chest leads

• 3 distinct waves are produced during
cardiac cycle
• P wave caused by atrial depolarization
• QRS complex caused by ventricular
depolarization
• T wave results from ventricular
repolarization

ECG

Elements of the ECG:
• P wave: Depolarization of both atria;
• Relationship between P and QRS helps distinguish
various cardiac arrhythmias
• Shape and duration of P may indicate atrial
enlargement

• QRS complex: Ventricular depolarization
• Larger than P wave because of greater muscle
mass of ventricles
• Normal duration = 0.08-0.12 seconds
• Its duration, amplitude, and morphology are useful
in diagnosing cardiac arrhythmias, ventricular
hypertrophy, MI, electrolyte derangement, etc.
• Q wave greater than 1/3 the height of the R wave,
greater than 0.04 sec are abnormal and may
represent MI

• PR interval: from onset of P wave to onset of QRS
• Normal duration = 0.12-2.0 sec (120-200 ms) (3-4
horizontal boxes)
• Represents atria to ventricular conduction time
(through His bundle)
• Prolonged PR interval may indicate a 1st degree
heart block

• ST segment:
• Connects the QRS complex and T wave
• Duration of 0.08-0.12 sec (80-120 msec
• T wave:
• Represents repolarization or recovery of
ventricles
• Interval from beginning of QRS to apex of
T is referred to as the absolute refractory
period

• QT Interval
• Measured from beginning of QRS to
the end of the T wave
• Normal QT is usually about 0.40 sec
• QT interval varies based on heart
rate

Holter Monitoring
• The Holter monitor is a battery-powered tape-
recording device that may be worn on a belt
around the patient’s waist or carried on a
shoulder strap.
• Commonly, two leads are recorded
continuously on tape through four or five
electrodes placed on the patient’s anterior
chest; the electrodes are arranged so that one
lead reflects the inferior wall of the heart, and
the other lead reflects the anterior wall.

• Continuous recording of ECG leads usually
is performed for 24 to 48 hours.
• The Holter monitor contains a clock so
that time also is recorded on the tape.
After completion of the test, the tape is
removed and played back for
identification and quantification of ST
segment changes or arrhythmias.
•

Nursing Assessment and
Management
• Patients who are scheduled to undergo Holter
monitoring should be instructed to bathe before
the test because the electrodes cannot be
removed during the 24- to 48-hour recording.
• Skin preparation and electrode placement are
crucial to obtaining high-quality ECG recordings.
• Often, the skin under and around the electrodes
becomes irritated, and the patient must be
cautioned to avoid pulling at the electrodes
because loss of electrical contact can mimic sinus
pauses or heart block, making the diagnostic
interpretation of the test difficult.

Loop recorder (IMPLANTABLE LOOP
MONITOR)
• Here we do a minor surgery to implant
this device about the size of a zip drive
under the skin to monitor and record
the heartbeats for up to 2 year.
• The insertable loop recorder (ILR) is a
newer, implantable device designed to
capture and record the patient’s ECG
during a syncopal episode.

Tilt table test.
• Doctor will connect patient to an ECG and
blood pressure monitor.
• Client will be strapped to a table that tilts
him from a lying to standing position.
• This test is used to determine if patient is
prone to sudden drops in blood pressure
(orthostatic hypotension), or slow pulse
rates with position changes.

Chest Radiography
• Chest radiography is a routine diagnostic test
used to assess critically ill patients with
cardiac disease.
• The test can be performed easily at the
bedside in patients too ill to be transported to
the radiology department.
• The image obtained on a radiograph that
allows visualization of vascular and cardiac
shapes is based on the premise that thoracic
structures vary in density and permit different
amounts of radiation to reach the film.

Chest radiography
• Chest radiography may be used for the
evaluation of cardiac size, pulmonary
congestion, pleural or pericardial
effusions, and position of intracardiac
lines, such as transvenous pacemaker
electrodes or pulmonary artery (PA)
catheters.

Stress Test
A test that is given while a patient walks on a
treadmill or pedals a stationary bike to
monitor the heart during exercise.
Breathing and blood pressure rates are also
monitored. A stress test may be used to
detect coronary artery disease, and/or to
determine safe levels of exercise following
a heart attack or heart surgery.

Echocardiogram (also known as
echo)
•
A noninvasive test that uses sound
waves to produce a study of the
motion of the heart’s chambers and
valves. The echo sound waves create an
image on the monitor as an ultrasound
transducer is passed over the heart.

Transesophageal Echocardiogram
(TEE)
•
A test in which a small transducer is
passed down the esophagus to provide
a clearer image of heart structures.

• Nursing Considerations for the Patient
Undergoing Transesophageal
Echocardiography (TEE)

Coronary Arteriogram (or
Angiogram)
• Coronary Arteriogram (or Angiogram)
With this procedure, x-rays are taken
after a contrast agent is injected into an
artery – to locate the narrowing,
occlusions, and other abnormalities of
specific arteries.

NURSING CARE OF THE CLIENT
HAVING CORONARY ANGIOGRAPHY
• BEFORE THE PROCEDURE
Assess the client’s and family’s knowledge
and understanding of the procedure.
Provide additional information as
needed.
Provide routine preoperative care as
ordered-Signed consent is required,
and pre procedure fasting needed

• Administer ordered cardiac
medications with a small sip of water
unless contraindicated.
• Regularly ordered medications are
continued to prevent cardiac
compromise or dysrhythmias during
the procedure.

• Assess for hypersensitivity to iodine,
radiologic contrast media, or seafood.
• Record baseline assessment data,
including vital signs, height, and weight.
• Mark the locations of peripheral pulses;
document their equality and amplitude.
• instruct to void prior to going to the
cardiac catheterization laboratory,to
promote comfort.

AFTER THE PROCEDURE
• Assess vital signs, catheterization site for
bleeding or hematoma, peripheral pulses,
and neurovascular status every 15 minutes
for first hour, every 30 minutes for the
next hour, then hourly for 4 hours or until
discharge.
• The data provide vital information about
the client’s status and potential
complications such as bleeding,
hematoma, or thrombus formation.

• Maintain bed rest as ordered, usually for 6
hours if the femoral artery is used, or 2 to
3 hours if the brachial site is used.
• The head of the bed may be raised to 30
degrees. Bed rest reduces movement of
and pressure in the affected artery,
reducing the risk of bleeding or hematoma

• Keep a pressure dressing, sandbag, or ice pack
in place over the arterial access site. Check
frequently for bleeding
• Instruct to avoid flexing or hyper extending
the affected extremity for 12 to 24 hours.
• Minimizing movement of the affected joint
allows the artery to effectively seal and
promotes blood flow, reducing the risk of
bleeding, hematoma, or thrombus formation.

• Unless contraindicated, encourage liberal
fluid intake. An increased fluid intake
promotes excretion of the contrast
medium, reducing the risk of toxicity
(particularly to the kidneys)
• Promptly report diminished peripheral
pulses, formation of a new hematoma or
enlargement of an existing one, severe
pain at the insertion site or in the affected
extremity, chest pain, or dyspnea.

• Provide instructions about dressing
changes, follow-up appointments, and
potential complications prior to
discharge

PET
• Positron Emission Tomography (PET) Scan
A nuclear scan that gives information
about the flow of blood through the
coronary arteries to the heart muscle.
• PET F-18 FDG (Fluorodeoxyglucose) Scan
A glucose scan sometimes done
immediately after the PET scan to
determine if heart muscle has permanent
damage.

Thallium Scans or Myocardial
Perfusion Scans
• Resting SPECT Thallium Scan or Myocardial
Perfusion Scan
A nuclear scan given while the patient is at
rest that may reveal areas of the heart muscle
that are not getting enough blood.
• Exercise Thallium Scan or Myocardial
Perfusion Scan
A nuclear scan given while the patient is
exercising that may reveal areas of the heart
muscle that are not getting enough blood.

• Persantine Thallium Scan or
Myocardial Perfusion Scan
A nuclear scan given to a patient who is
unable to exercise to reveal areas of
the heart muscle that are not getting
enough blood.

What is a MUGA scan?
• A multigated acquisition scan (also called
equilibrium radionuclide angiogram or blood pool
scan) is a noninvasive diagnostic test used to
evaluate the pumping function of the ventricles
(lower chambers of the heart).
• During the test, a small amount of radioactive
tracer is injected into a vein.
• A special camera, called a gamma camera, detects
the radiation released by the tracer to produce
computer-generated movie images of the beating
heart. The MUGA scan is a highly accurate test
used to determine the heart’s pumping function.

How should prepare for the test?
• There is no special preparation
required for this test; there are no
medication or food restrictions.
• Wear comfortable clothes that can be
easily removed, as you may be asked to
wear a hospital gown during the test.

MUGA Scans/Radionuclide Angiography (RNA) Scans
• Resting Gated Blood Pool Scan (RGBPS),
Resting MUGA, or Resting Radionuclide
Angiography
A nuclear scan to see how the heart wall
moves and how much blood is expelled with
each heartbeat, while the patient is at rest.

• Exercise Gated Blood Pool Scan,
Exercise MUGA, or Exercise
Radionuclide Angiography
A nuclear scan to see how the heart
wall moves and how much blood is
expelled with each heartbeat, just after
the patient has walked on a treadmill
or ridden on a stationary bike

• Electrophysiology Study
A test in which insulated electric
catheters are placed inside the heart to
study the heart’s electrical system.

Cardiac Catheterization
•
A test in which a small catheter (hollow tube) is
guided through a vein or artery into the heart. Dye
is given through the catheter, and moving x-ray
pictures are made as the dye travels through the
heart. This comprehensive test shows: narrowing
in the arteries, outside heart size, inside chamber
size, pumping ability of the heart, ability of the
valves to open and close, as well as a
measurement of the pressures within the heart
chambers and arteries.

References
• https://www.bmj.com/content/354/bmj.i3309
• https://www.bapen.org.uk
• www.gwheartandvascular.org
• ccn.aacnjournals.org/content/34/3/16
• https://www.urmc.rochester.edu/encyclopedia/content
• https://web2.aabu.edu.jo/tool/course_file/1001326_morton
_ch17_Part1
• https://accessmedicine.mhmedical.com/content.aspx
• https://www.ncbi.nlm.nih.gov/books/NBK393
• https://www.hopkinsmedicine.org/healthlibrary/.../cardiovas
cular_diseases/cardiac_di
• https://www.mayoclinic.org/diseases-conditions/heart-
disease/diagnosis.../drc-2035

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