CARDIOVASCULAR

NURSING
ELECTROCARDIOGRAPHY

• is a graphic recording of
electrical activity of the heart

• patches are placed on the chest

wall to obtain the electrical
activity of the heart

• FIRST diagnostic test done when

cardiovascular disorder is
suspected
RESTING ECG

• presents a single recorded

picture of the electrical
activity of the heart
• secure electrodes to
appropriate locations on the
chest and extremities
• instruct the client to remain
still during the test
• reassure client that he or she
will not receive any electrical
shock or impulses
◼ Limb Leads
RA Red Right arm
LA Yellow Left arm
LL Green Left leg
RL Black Right leg
◼ Chest Leads
V1 Red 4th ICS RPSB
V2 Yellow 4th ICS LPSB
V3 Green Midway between V2 and V4
V4 Brown 5th ICS LMCL
V5 Black LAAL Lateral & horizontal toV4
V6 Violet LMAL Lateral & horizontal to V4
HOLTER MONITOR

• A non-invasive test in which

the client wears a Holter
monitor and an ECG tracing
recorded continuously over a
period of 24 hours.

• May be used to detect

dysrhythmias that may not
appear on a routine ECG
STRESS TEST

• A non-invasive test that studies the

heart during activity and detects
and evaluates CAD

• continuous multi-lead ECG

monitoring during controlled and
supervised exercise, usually on
treadmill
Nsg Resp BEFORE Procedure

1. Obtain written consent

2. Explain procedure
3. Instruct client to eat a light
meal 1 to 2 hours before the
exam
4. NO caffeine, alcohol, smoking
5. Wear comfortable clothing and
rubber-soled walking shoes
Nsg Resp DURING Procedure Nsg Resp AFTER Procedure

1. Secure electrodes to appropriate

locations on chest 1. Continue to monitor ECG and
BP until client returns
2. Obtain baseline BP and ECG
tracing completely to baseline and is
3. Instruct client to exercise as
symptom-free.
instructed 2. Once stable, patients may
4. Instruct client to report any pain, resume their usual activity.
weakness, shortness of breath, or
other symptoms immediately
5. Monitor BP and ECG continuously
6. Record at frequent intervals and
with any symptoms or changes in
vital signs, ST segments, or
cardiac rhythm.
ECHOCARDIOGRAM

• Non-invasive test that studies

the structural and functional
changes of the heart with the
use of ultrasound/soundwave
PRE PROCEDURE POST PROCEDURE

• Instruct client to remain still • Cleanse the lubricant from

during the test the client’s chest wall
• Secure electrodes for
simultaneous ECG tracing
• Explain that there will be no
pain or electrical shocks,
however, the lubricant placed
on skin will be cool
 Patient Preparation

• Instruct client to remain

quiet and still during test
• Secure electrodes for
simultaneous ECG tracing
• Explain that there will be
no pain or electrical
PHONOCARDIOGRAPHY shocks

• is a graphic recording of heart

sounds with simultaneous ECG
CARDIAC CATHETERIZATION

❑ is the insertion of a
catheter into the heart and
surrounding vessels to obtain
diagnostic information about
the structure and function of
the heart.
❑ It can be performed on the
right or left side of the heart
PRE PROCEDURE
• Obtain consent
• Assess for allergies, seafood and
iodine
• Client on NPO, usually for 8-12
hours before procedure
• Explain to the client about the
procedure
• Client may be asked to cough or
breathe deeply, especially after
injection of contrast agent.
• Baseline VS- peripheral pulses
POST PROCEDURE
• Observe catheter access site for
bleeding or hematoma
formation, sandbag if required
• Assess the peripheral pulses,
temperature and color in the
affected extremity every 15 min
for 1 hour, and then every 1 to 2
hours until pulses are stable
• Encourage fluids to flush out dye
• Orthostatic hypotension may
occur when getting out of bed
the first time.
CONT. POST PROCEDURE

❑ Maintain strict bed rest for 6-

12 hours
❑ Client may turn from side to
side but bed should not be
elevated more than 30 degrees
and legs always straight
❑ Encourage fluid intake to
flush out the dye
❑ Immobilize the arm if the
antecubital vein is used
❑ Monitor for dye allergy
CENTRAL VENOUS PRESSURE

❑ The CVP is the pressure

within the SVC

❑ Reflects the pressure under

which blood is returned to
the SVC and right atrium

❑ N: 0 – 8 mmHg or 4 – 10 cm
H20
CORONARY ANGIOGRAPHY/
ARTERIOGRAPHY

• is an invasive procedure
during which the physician
injects dye into coronary
arteries and immediately
takes a series of x-ray films to
assess the structure of the
arteries.
RADIONUCLIDE TEST

❑ Are safe methods of

evaluation left ventricular
muscle function and coronary
artery blood distribution

❑ Can procedure some of the

same information as
radiographic angiography
with less risk to client

PRE PROCEDURE
• Obtain written consent if
required
• Explain procedure
• instruct client that fasting may
be required for a short period
before the exam
• Contrast material will be
injected through a venipuncture
• It will be necessary to
alternately change position and
remain still during the exam
• There is an associated pain or
discomfort
DURING PROCEDURE
• Nursing care during procedure –
none; procedure is performed in
nuclear medicine
POST PROCEDURE
• Encourage client to drink fluids to
facilitate the excretion of the
contrast material
• Assess venipuncture site for bleeding
or hematoma
• If stress testing was performed,
assess client’s BP and pulse at
frequent intervals and maintain
continuous ECG monitoring as
indicated
MAGNETIC RESONANCE IMAGING

❑ Uses strong magnetic field

to examine both physiologic
and anatomic properties of
the heart.
BLOOD STUDIES

❑ CBC
❑ Coagulation Studies
❑ Serum Lipid Profile
❑ Serum Enzymes
❑ Serum Electrolytes