List at least 5 Diagnostic and Laboratory procedures

done on pediatric clients with congenital heart

Disease.

1. Electrocardiogram.
Indications
An electrocardiogram, also known as an EKG or ECG, is a
test that measures the electrical activity of the
heartbeat. An electrical impulse (or "wave") travels
through the heart with each beat. This electrical wave
causes the muscle to contract and the heart to pump
blood. An ECG showing a normal heartbeat will show the
rate and rhythm of contractions in the upper and lower
chambers.

Purpose
An electrocardiogram (ECG) can be used to check your
heart's rhythm and electrical activity to see if you have a
congenital heart Disease.

Procedure

After changing into a gown, a technician applies about

ten soft electrodes (the size of a quarter) to your
chest, arms, and legs with gel. These electrodes are
connected to wires that connect to the EKG machine.
.If you haven't shaved the areas where the electrodes are
attached, the technician may shave them for you.
Lie still on the table and breathe normally during the test.

Do not speak during the examination.

The machine will record the electrical activity of your heart

and display the results on a graph.

After the test, the electrodes are removed and discarded. The
entire process should take no more than 10 minutes.

Normal and abnormal findings

Normal findings
P wave:
upright in leads I, aVF and V3 - V6
normal duration of less than or equal to 0.11 seconds
polarity is positive in leads I, II, aVF and V4 - V6; diphasic
in leads V1 and V3; negative in aVR
shape is generally smooth, not notched or peaked

PR interval:
Normally between 0.12 and 0.20 seconds
QRS complex:
Duration less than or equal to 0.12 seconds, amplitude
greater than 0.5 mV in at least one standard lead, and
greater than 1.0 mV in at least one precordial lead. Upper
limit of normal amplitude is 2.5 - 3.0 mV.
small septal Q waves in I, aVL, V5 and V6 (duration less
than or equal to 0.04 seconds; amplitude less than 1/3 of
the amplitude of the R wave in the same lead).
represented by a positive deflection with a large, upright
R in leads I, II, V4 - V6 and a negative deflection with a
large, deep S in aVR, V1 and V2
in general, proceeding from V1 to V6, the R waves get taller
while the S waves get smaller. At V3 or V4, these waves are
usually equal. This is called the transitional zone.

ST segment:
isoelectric, slanting upwards to the T wave in the normal
ECG
can be slightly elevated (up to 2.0 mm in some precordial
leads)
never normally depressed greater than 0.5 mm in any
lead
T wave:
T wave deflection should be in the same direction as the
QRS complex in at least 5 of the 6 limb leads
normally rounded and asymmetrical, with a more gradual
ascent than descent
should be upright in leads V2 - V6, inverted in aVR
amplitude of at least 0.2 mV in leads V3 and V4 and at
least 0.1 mV in leads V5 and V6
isolated T wave inversion in an asymptomatic adult is
generally a normal variant.

QT interval:
Durations normally less than or equal to 0.40 seconds for
males and 0.44 seconds for females.

2. Echocardiogram.
Indications
Echocardiography is a test that uses sound waves to produce
live images of your heart. The image is called an
echocardiogram. This test allows your doctor to monitor how
your heart and its valves are functioning.
 Purpose
An echocardiogram is key in determining the health of the
heart muscle, especially after a heart attack. It can also reveal
heart defects, or irregularities, in unborn babies.

Procedure
You will need to remove your clothes from the waist up and
put on a gown.

If the doctor is using a contrast dye or saline solution, the

solution will be injected or infused.

You will be placed on a table or stretcher on your back or

side.

To collect images, the technician will apply gel to the chest

and move a wand across it.

At specific intervals, they may ask you to change positions or

hold your breath for a short period of time.
 Normal and abnormal findings

The results of an echo show real heart images that indicate its
functionality. Whether or not it is working normally or if the
things are on an abnormal end etc. One of the things you can
see via these pictures are the walls.

They are abnormal if they measure more than 1.5 cm in

thickness from the echocardiogram. This much change from
the normal range clearly indicates high BP – blood pressure,
weak and damaged heart valves.

Moreover, if the cardio wants to know the pumping function

of your heart, an echo can be used to determine if there is
adequate flow or not.

Left ventricular ejection fraction is the level of blood released

from the heart per beat. Cardiac output is the amount of
blood pumped out each minute. The total of which is 4.8 to
6.5 liters.
3. Chest X-ray
Indications
Chest X-ray and other organs of the thoracic cavity may be
prescribed when a number of symptoms indicate developing
diseases. As a rule, the study is assigned to patients who
complain of severe shortness of breath, chest pain or cough.

Purpose
An X-ray is a type of imaging test that uses small amounts of
radiation to create images of the body's organs, tissues, and
bones. It can detect abnormalities or diseases of the airways,
blood vessels, bones, heart, and lungs when focused on the
chest. Chest X-rays can also reveal whether you have fluid in
your lungs or if there is fluid or air surrounding your lungs.

Procedure
The patient will be asked to remove any clothing or jewelry
which might interfere with the exposure of the body area to
be examined. The patient will be given a gown to wear if
clothing must be removed.

The patient is positioned on an X-ray table that carefully

positions the part of the body that is to be x-rayed - between
the X-ray machine and a cassette containing the X-ray film.
Some examinations may be performed with the patient in a
sitting or standing position.
Body parts not being imaged may be covered with a lead
apron (shield) to avoid exposure to the X-rays.

The X-ray beam is then focused on the area to be

photographed.

The patient must be very still or the image will be blurred.

The technician steps behind a protective window and the

image is taken.

Sometimes, various X-rays may have to be taken at different

angles, such as the front and side view during a chest X-ray.

Normal and abnormal findings

If the CTR is <50% on either a Posterior - Anterior (PA) or an

Anterior - Posterior (AP) view, then the heart size is within
normal limits.

If the heart contours are not clearly seen, this may indicate
increase in density of the adjacent lung.

The lingula - part of the upper lobe of the left lung - wraps
over the left ventricle. Loss of definition of the left heart
border may be related to lung disease involving the lingula,
such as a lobar pneumonia.
The right middle lobe is located adjacent to the right atrium.
Loss of definition of the right heart border may be due to
increased density caused by disease in this lobe, such as a
right middle lobe pneumonia.

4. Heart magnetic resonance imaging

Indications
Magnetic resonance imaging (MRI) uses magnets and radio
waves to capture images inside your body without making a
surgical incision. It allows your doctor to see the soft tissues
in your body, along with your bones.

Purpose
It can be used to examine your heart and blood vessels, and
to identify areas of the brain affected by stroke. Magnetic
resonance imaging is also sometimes called nuclear magnetic
resonance (NMR) imaging.

Procedure
If indicated, an IV line is started to administer a contrast
medium before the procedure begins.

The patient is placed in a supine position on a narrow,

padded, nonmetallic bed that slides to the desired position
inside the scanner.
The patient is asked to remain still.

Radiofrequency energy is directed at the area being tested.

The radiologist may vary the waves and use the computer to
manipulate and enhance the images.

The resulting images are displayed on a monitor and recorded

on film or magnetic tape for permanent storage.

The patient is advised to keep his eyes closed to promote

relaxation and prevent a closed-in-feeling.

If nausea occurs because of claustrophobia, the patient is

encouraged to take deep breaths.

If the test is prolonged with the patient lying flat, monitor him
for orthostatic hypotension.

5. Blood test

Indications
Cardiac catheterization is a test that can check your heart
and many people fear this medical procedure but it is rather
normal procedure. This test uses a thin, flexible tube called a
catheter that is inserted into the heart through blood vessels.
This test can include a coronary angiogram, which checks the
coronary arteries.
 Purpose
Providers can use a heart catheterization to detect problems and
then use other procedures to correct them, all within the same
appointment. For example, your provider could correct a
congenital heart defect or replace a heart valve without requiring a
large incision and traditional surgery.

Procedure

1. Your provider will inject a numbing medicine underneath your

skin with a small needle. They’ll insert a plastic introducer
sheath (a short, hollow tube through which they place the
catheter) in a blood vessel in your arm, neck or groin. Then
they’ll insert a catheter through the sheath and thread it to
your heart’s arteries. You may feel pressure when your provider
puts in the introducer sheath or catheter, but you shouldn’t
feel pain. Tell your provider if you do.
2. To help position the catheter, your provider may ask you to
turn your head or take a deep breath and hold it for a few
seconds.
3. When the catheter is in place, your provider will dim the lights
and inject a small amount of contrast material through the
catheters into your arteries and heart chambers. The contrast
material outlines the vessels, valves and chambers.
4. When the contrast material goes into your heart, you may feel
hot or flushed for several seconds. This is normal and will go
away in a few seconds.
5.Your provider will use an X-ray camera to take photographs of
your arteries and heart chambers while the contrast is flowing
through them. You may need to hold your breath while your
provider takes the X-rays. When all the photos are done, your
provider will remove the catheter and turn the lights on.

6. The sheath has to be removed very carefully because pulling it

out incorrectly can cause you to bleed. Your provider will ask you
to keep as still as you can while they remove the sheath.

Normal and abnormal findings

The pulmonary artery and right ventricle: 0.5 mL/dL (0.5 vol%)
The right ventricle and right atrium: 0.9 mL/dL (0.9 vol%)
The right atrium and superior vena cava: 1.9 mL/dL (1.9 vol%)
If the blood oxygen content in a chamber exceeds that of the
more proximal chamber by more than these values, a left-to-right
shunt at that level is probable. Right-to-left shunts are strongly
suspected when LA, LV, or arterial oxygen saturation is low (≤
92%) and does not improve when pure oxygen (fractional
inspirational O2 = 1.0) is given. Left heart or arterial desaturation
plus increased oxygen content in blood samples drawn beyond
the shunt site on the right side of circulation suggests a
bidirectional shunt.
References:

https://nurseslabs.com/magnetic-resonance-imaging-mri-
diagnostic-test/?fbclid=IwAR0I4LQezcOdgWFY3waxaZH3TjCF6h-
v8qp_seFtjajv6Z5fypRwlp_TfIg

https://stanfordhealthcare.org/medical-
tests/x/xray/procedures.html?
fbclid=IwAR1OM4RBAUFmZTjp9XBZ4CXtmRKXadd_o8E58NHjmBw
xfTqAjoYed738-Fc

https://www.healthline.com/health/echocardiogram?
fbclid=IwAR177WpIU4txdQ4zH3bC4E3v4S4BRwAmDgtwxQnbh9nR
-nAR5rthV1dQBdg#results

https://www.nwcardiovascularclinic.com/normal-vs-abnormal-
echocardiogram-a-guide/?
fbclid=IwAR3LSJ0ga283UZGqXHZxG0e936bqTeS25S-
lSLhZs9qokvZiM4c_BnC0VVM

https://elentra.healthsci.queensu.ca/assets/modules/ECG/normal_
ecg.html?
fbclid=IwAR3VnkDYA2UFJSfFd0L6lG3qKf51raR1gOSAyKI8Q5wcNq
2Av46eHvThx9E

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-
heart-attack/electrocardiogram-ecg-or-ekg?
fbclid=IwAR1oJ7TlBLsqdU4QyuWgm47Uh7xbEIGjnlxLWCsSUCfX25
wOopXrAKWurq0

https://www.msdmanuals.com/professional/cardiovascular-
disorders/cardiovascular-tests-and-procedures/cardiac-
catheterization