Echocardiography
Jaelyn Green
April 14, 2019
Patty Hanks Shelton School of Nursing
What is Echocardiography?
Echocardiography, also called an echo test or heart ultrasound, is a test that takes “moving pictures” of the heart with sound waves. You don’t have to stay in the hospital. It’s not surgery and doesn’t hurt.
How is the test done?
Echo tests are done by trained sonographers.
You’ll lie on a bed on your left side or back.
Special jelly is administered on a probe and is moved over your chest area.
Ultra-high-frequency sound waves will pick up images of your heart and valves. No X-rays will be used.
Your heart’s movements can be seen on a video screen. A videotape or a photograph can be made of the pictures.
Time: Approximately 1 hour
It’s painless and has no side effects.
The Importance of Diagnostic Testing in Echocardiography
Uses a non-invasive, acoustic imaging procedure using ultrasound to produce high frequency waves.
The test helps determines size, shape, position, thickness, and movements of the heart valves, walls, and chambers during each cardiac cycle.
The test can detect defects, heart failure, tumors, infections, and bleeding.
The test is used to diagnose cardiovascular disorders.
Normal & Abnormal Findings
Normal:
Normal appearance of the heart with the correct size, shape, position, structures that properly function, and efficient heart valves.
Proper size of the muscles, and walls of the ventricles to allow for sufficient filling of blood.
Abnormal:
Pulmonary valve abnormalities, septal defects, aortic valve abnormalities, cardiac neoplasm, cardiomyopathy, congenital heart defects, endocarditis, heart failure, mitral valve abnormalities, pericardial effusion, ventricular/atrial mural thrombi, pericarditis, pulmonary hypertension, aneurysms, ventricular hypertrophy, and tamponade.
What can affect the outcome of test results?
The patient moving during the procedure can cause artifacts and the results to be inaccurate.
If there isn’t enough of the special gel, it can cause the transducer not to produce an image and the sound waves would not be able to penetrate accurately.
Thick chest walls, COPD, obesity, chest wall abnormalities or scar tissue, or dressings may alter the display of ultrasonic waves on the recorder.
Children have more of an accurate reading than adults due to their thinner and less dense chest wall. It helps produce higher frequency and a shorter wavelength sound.
The sonographer needs to be able to place the transducer in the appropriate area of the chest.
Pulmonary hypertension reduces the accuracy of Doppler measurements of pulmonary artery systolic pressure.
COPD patients or patients on mechanical ventilation increases the air between the heart and chest wall, reducing the penetration on the sound waves.
Those experiencing dysrhythmias will produce an unclear image.
Dehydration results in failure to demonstrate clear boundaries between organs and tissue structures.
Metallic objects (jewelry) may inhibit organ visualization and cause unclear images.
Patient Care/Teaching
Before the procedure:
Explain the process of the procedure and what to expect.
Inform the patient that an IV line may be inserted to allow IV infusion of NS fluids, anesthetics, sedatives, dye, or emergent medications.
Inform the patient that the procedure is painless and their are no risk factors associated with it. The only pain the patient might feel is if an IV needs to be placed.
Explain how long the procedure may last. It should last from 30-45 minutes. No longer than an hour.
The nurse must ask for informed consent and make sure it has been given before the procedure starts.
During the procedure:
Position the patient in the correct position: supine or left lateral lying.
Monitor vitals (blood pressure, heart rate, respirations, spO2, temperature)
Apply and monitor an EKG.
Monitor any discomfort.
The nurse may need to ask the patient to breath in deeply, breath slowly, or hold their breath at certain times during the procedure.
Place the gel and transducer on the chest in the appropriate areas to obtain views and tracings of the portions of the heart.
Continued..
After the procedure:
Discuss the results of the procedure. Talk about the normal/abnormal results.
The nurse must be able to provide patient teaching and information regarding the test results and provide any contact information related to the American Heart Association.
Schedule any follow up tests that are needed.
Recognize anxiety related to the test results.
Remain supportive of impaired activity related to cardiac insufficiency.
Potential Follow Up Test
Electrolyte Levels
Electrocardiogram
MI infarct scan
PET scan
Exercise Stress Test
Blood pool imaging
Transesophageal echocardiogram
Doppler Echocardiogram
Blood pool imaging
Electrocardiogram
MRI of the chest
MI infarct scan
Myocardial perfusion heart scan
Pulse oximetry
Triglyceride study
Troponin levels
Nursing Diagnosis
Anxiety
Deficient Knowledge
Risk for Decreased Cardiac Output
Risk for Ineffective Tissue Perfusion
Activity Intolerance
Excess Fluid Volume
Risk for Impaired Gas Exchange
Acute Pain
Ineffective Breathing Pattern
Ineffective Airway Clearance
Impaired Gas Exchange
Fatigue
Increased fluid retention
Ineffective coping
Ethical Issues
The goal of the code of ethics is to promote excellence in patient care by fostering responsibility and accountability and, thereby, help to ensure the integrity of professionals involved in all aspects of diagnostic medical ultrasound.
An ethical dilemma example:
A patient arriving at an ER presented with chest pains that were consistent with serious heart disease. She was in a hurry because she had a plane to catch and was unwilling to let health care personnel assess her heart activity by means of an electrocardiogram (ECG). The healthcare personnel had to decide, there and then, whether the patient’s refusal to submit to an ECG should be respected, or whether they should set the patient’s expressed wishes aside by exercising verbal power and persuasive communication techniques.
References
Van Leeuwen, A.M. & Bladh, M. L. (2016). Textbook of Laboratory and Diagnostic Testing: Practical Application at the Bedside. F. A. Davis Company.
Chernecky, C. C., & Berger, B. J. (2013). Laboratory tests and diagnostic procedures. St. Louis, MO: Elsevier.
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