The document outlines various non-invasive cardiac diagnostic tests including exercise stress tests, holter monitors, electrocardiograms (EKGs), cardiac MRIs, CT scans, and echocardiograms. Each test is described with its purpose, procedure, risks, and what to expect afterwards, facilitating the diagnosis of cardiac conditions. It emphasizes preparation guidelines and potential follow-up actions based on test results.

1. +
Non- Invasive Diagnostic Cardiac
Testing.
Breonna Schmidt
Hameedat Olaosebikan
Amarachi Okorie

2. +
Exercise Stress Test aka Treadmill
Stress Test

3. +
Why are exercise stress tests
performed?
 Aids in diagnosing different cardiac problems
 Aids in recognizing heart related causes to certain symptoms
 Can help guide treatment measures and determine
effectiveness of previous treatment plans
 May predict risks of heart attacks
 Help determine if it is safe for a patient to have surgery

4. +
What is the procedure and any
special precautions?
 Patient is hooked up to vitals monitor and an EKG monitor
 Must walk on a treadmill that will slowly increase in speed an
incline as the test goes on
 Patient will exercise for 15 minutes or until target heart rate
reached or ECG changes
 While they’re exercising there are quite a few things being
monitored
 Special Precautions: Patients are asked to avoid caffeine 3
hours prior to testing and to avoid smoking

5. +
Risks
 Although the test is noninvasive there are still some rare risks
such as: chest pain, collapsing and or fainting, heart attack and
irregular heart beats.

6. +
Results and what to do next?
 The tests are read by cardiologist by comparing certain factors
 The results may be negative, positive, uninterpreted or
equivocal
 Depending on the results of the test will determine the next
steps: patient may need more testing or set up treatment plans

7. https://youtu.be/NC4hN0mTRsY

8. + Holter Monitor

9. +
Why are holter monitors used?
 May be used if patient has a known arrhythmia or has episodes
of unexplained fainting
 Can be used after an EKG is unsuccessful in showing
changes/abnormalities
 Can also discover heart arrhythmias that are unknown/harmful
 Assess those with heart diseases to assess further risks of
abnormalities

10. +
Any procedure and special
instructions?
 Patient should bathe prior to monitor placement
 Men may need to shave some of their hair
 The technician will place electrodes on chest and connect the wires to a
recording device
 After placement of device the patient can resume all normal activities
 They will be given a template or told to write in a notebook any symptoms
they experience while performing tasks
 Special instructions include: avoid things like swimming, showering,
bathing to prevent monitor from getting wet. Also to prevent interrupted
signals one should avoid electric blankets, razors, toothbrushes, magnets,
metal detectors, and microwaves. Lastly, keep cellphones and music
players 6 inches away.

11. +
This is an example a journal template for
patients to complete while wearing the holter
monitor.
https://professional.heart.org/-
/media/Files/Health-Topics/Cardiac-
Rehab/cardiac-rehab-holter-monitor-
diary.pdf

12. +
Are there any risks?
 Yes, but the only risk is the electrodes may cause skin irritation
in some patients.

13. +
What’s next?
 A doctor will compare the monitor readings and the journal to
help diagnose
 The results may help determine treatment needs or changes
 May also help diagnose conditions
 If this still doesn’t provide enough information for a diagnosis a
patient may need to wear an event monitor

14. +
Event Monitor
 These are very similar to Holter, but they only monitor when
they are pressed for events
 Also, patients are given extra electrodes to replace them as
they perform their hygiene needs
 Worn for weeks to a month at a time and the information can be
electronically submitted to the doctor

16. +
Electrocardiogram also called ECGs or EKGs records the
electrical signals in your heart. An EKG translate the hearts
electrical activity into line tracings on paper. It’s a common
and painless test used to quickly detect heart problems and
monitor your heart’s health.
EKG/ECG

17. +
Why might I need
an EKG?
• To evaluate problems
which may be heart
related such as severe
tiredness, shortness of
breath, dizziness or
fainting
• To identify irregular
heartbeats
• To help determine the
overall health of the
heart before surgical
procedures or after
heart surgery or
cardiac catheterization
• To see how an
implanted pace maker
is working.

18. +
How to prepare for an EKG
 No special preparations are necessary for a standard
echocardiogram. Tell your doctor about any medications and
supplements you take or if you have a pacemaker.
 You may be asked to change into a hospital gown and remove
jewelry. If you have hair on the area where the electrodes will be
placed, it will be shaved off so that the patches stick properly.

19. +
How is the test performed?
 During an EKG, up to 12 sensors will be attached to your chest
and limbs. A computer records the information and displays it
as waves on a monitor or on paper.
 You can breathe normally during the test, but you will need to
lie still and supine. Moving or talking may distort the test
results. A standard EKG takes 5-10 minutes and you can
resume normal activities after the test.

20. +
Risks and Contraindications
 An EKG is a completely safe test. No electricity passes through
your body from the machine and there is no danger of getting
an electrical shock.

21. +
CARDIAC MRI
Cardiac MRI- is a non-invasive
test that uses a powerful
magnetic field, radio waves and a
computer to produce detailed
pictures of the structures within
and around the heart. It is used to
detect or monitor cardiac disease
and evaluate the hearts anatomy
and function. It’s the most
accurate test for circulating the
patients ejection fraction. Some
cardiac MRI require contrast
medium or dye through a vein
before the scan to improve the
ability of the MRI machine to
capture more detailed picture of
the tissues. The entire exam
usually takes 90 min or less once
imagine has started. If sedated,
recovery time ranges from 30min
to 2 hours after the exam.

22. +Cardiac MRI
 What are some uses of the procedure?
 Helps to evaluate the anatomy and function of the heart chambers,
heart valves, size of and blood flow through major vessels, and
surrounding structure such as pericardium.
 Diagnosing a variety of cardiovascular disorders such as tumors,
infections and inflammatory conditions.
 Evaluating the effects of coronary artery disease such as limited
blood flow to the heart muscle and scaring within the heart muscle
after a heart attack.
 Evaluating the effects of surgical changes especially patients with
congenital heart disease.

23. +
How to prepare for the procedure?
 Change into a hospital gown, guidelines about eating drinking vary between
specific exams. Take food and medications as usual unless your doctor tells
you otherwise.
 Some MRI exams use an injection of contrast material called gadolinium. If
there are any allergies, it may be possible to use it after appropriate
medications have been taken.
 Women should always tell the doctor is they are pregnant. MRI has been
used since 1980s with no reports of any ill effects on pregnant women or
their unborn babies. However, the baby will be in a strong magnetic field.
Therefore, pregnant women should not have an MRI in their first trimester
unless the benefit of the exam outweighs the risks.
 If you have claustrophobia or anxiety, your doctor might prescribe a mild
sedative prior to the date of your exam.
 Remove jewelry, watches, credit cards, hearing aids, pins, body piercings,
mobile phones etc.. Tell the technologist or radiologist if you have any metals
implanted in your body because they could heat up during the scan and

24. +How is the Test Performed?
 The technologists will position you on the movable exam table. They maybe use straps
and bolsters to help you stay still and maintain your position.
 The nurse or technologist will likely place ECG leads on your chest. This will help the
MRI machine synchronize the image acquisition with beating of your heart. Men may
require small area to be shaved to ensure the patches stick well.
 A respiratory gait belt around your upper abdomen, this will help the computer know
how you are breathing at any given time. The technologist may ask you to hold your
breath for short periods of time during the exam.
 You will be placed into the Magnet of the MRI unit. The technologist will perform the
exam while working at a computer outside of the room.

25. +
Risks and Contraindications
 Infants and young children may need to be sedated for an MRI,
since they may have a hard time holding still during the scan,
which is required.
 A very irregular heartbeat or Atrial fibrillation may cause
difficulties in acquiring cardiac MRI images.

26. +
MRI SCAN
https://www.youtube.com/watch?v=uPk5tHDLaVo

27. +
CT- SCAN
Computed Tomography- A CT
scan (formerly known as a
computed axial tomography or
cat scan) uses radiology to
obtain detailed images of body
structures. It is done to detect
any abnormalities or obstructions
in body organs and structures. A
Cardiac(CT) scan, also called a
calcium-score screening heart
scan, is used to find calcium
deposits in plaque of people with
heart disease. They’re an
effective way to spot
atherosclerosis before symptoms
develop. An increase in coronary
calcium means there is more
coronary atherosclerosis. Which
gives a higher chance of
cardiovascular problems in the
future.

28. +How is the Test Performed?
 They use a narrow X-ray beam that circles around one part of the body. This provides a series of images
from many different angles. A computer uses this information to create a cross-sectional picture. Like one
piece in a loaf of bread, this two-dimensional (2D) scan shows a “slice” of the inner parts of the body.
 A radiology technologist will perform the CT scan. During the test, the patient lies on a table inside a large,
doughnut-shaped CT machine.
 As the table slowly moves through the scanner, the X-rays rotate around the body. It’s normal to hear a
whirring or buzzing noise.
 Movement can blur the image, so it is important to stay very still. There might be a need to hold your
breath at times.
 A computer program, guided by the cardiovascular radiologist analyzes the images to look for calcification
in the coronary arteries.

29. +What are the uses of a CT-Scan?
 A cardiac CT can be used to assess:
 The heart’s structure and how well the heart pumps blood
 Scarring of the heart muscle caused by a heart attack
 Fluid in the pericardial sac that covers the surface of the heart
 The amount of plaque buildup and narrowing of coronary arteries
 Any abnormalities in the large blood vessels leaving the heart
 Any risk for a heart attack

30. +Limitations and Risks
 Limitations of CT scan
 Compared to other diagnostic tests like a chest x-ray, CT scans deliver a relatively
high dose of radiation to the patient. While this is not usually a problem for a single
scan, patients who need to undergo repeated tests can be subjected to a
significant level of radiation, increasing their cancer risk.
 Because a CT scan is so detailed, it can sometimes alert doctors to minor
abnormalities in the body that don’t have symptoms related to them and that in the
normal course of life would not have caused the patient any problems. However,
doctors may feel the obligation to divulge this information to patients, which can
cause anxiety and possibly unnecessary follow-up tests or treatments.
 Risks and contraindications-
 CT scans use X-rays, which produce ionizing radiation. Research shows that this
kind of radiation may damage your DNA and lead to cancer. But the risk is still
very small and chances of developing a fatal cancer because of a CT
scan are about 1 in 2,000.
 Ionizing radiation may be more harmful in children. That’s because
they’re still growing. They also have more years to get exposed to
radiation. Before the procedure, you may want to ask the doctor or
technician if the CT machine’s settings have been adjusted for a child.

31. +
 Keep taking your medications
as usual after you check with
your doctor.
 Plan for your test to take at
least an hour. Most scans take
from 15 to 60 minutes.
 Ask your doctor any questions
you have before the scan.
 Before a CT scan are to remove
metallic objects and medication
devices from your body such as
Jewelry, watches, glasses,
hearing aids, dentures, hair pins
and nicotine patches.
 CT scan results are considered typical if the radiologist
didn’t see any of the following in the images:
 tumors
 blood clots
 fractures
 Obstructions
 other atypical characteristics
 If any atypical characteristics are detected during the CT
scan, further tests, follow ups or treatments may be
needed depending on the type of a typicality found.
Preparations for the test Interpreting the results

32. +
Echocardiogram
Echocardiogram- An “echo” for
short, also called a transthoracic
echocardiogram, can be expressed
as a non-invasive ultrasound of the
heart that uses high-frequency
sound waves to give a visualization
or image of the movement, strength
and pumping action of the heart.
This procedure is performed when a
heart valve disease, heart rhythm
irregularities and cardiac muscles
disease is suspected.

33. + How is the Test Performed?
 When a heart related disease is suspected, an echo can be ordered and the type that is done
depends on the information the doctor needs. There are several types of echocardiograms but, the
standard one which is the transthoracic echocardiogram is performed by-
 A technician, also called a sonographer, starts by spreading a gel on a device (transducer)
 Then, the transducer is pressed against the skin, aiming an ultrasound beam through the chest to
the heart
 The transducer records the sound waves echo from the heart
 A computer then converts the echoes into moving images on a monitor.

34. +
What are the uses of an
Echocardiogram?
 A cardiac echo allows the doctor to visualize the heart and detect
any specific areas of concern. For example-
 Problems with the heart valves such as mitral valve prolapse can
be detected because the test can visualize the movement of heart
valves.
 A special microphone called a Doppler can be used during the test
to measure the velocity (speed) of blood flow in various areas
within the heart. This is helpful in measuring impaired blood flow in
conditions such as aortic stenosis.
 An echo is also helpful in evaluating congenital heart disease. For
example, tetralogy of Fallot and atrial septal defect are congenital
conditions in which the heart does not develop the proper
anatomic structure.

35. +
Limitation and Risks
 What are the limitations of an echocardiogram?
 While the echocardiogram provides a lot of information about cardiac
anatomy, it does not visualize the coronary arteries or blockages in
coronary arteries. If imaging the coronary arteries is necessary, a cardiac
catheterization is commonly performed.
 Certain physical variations, such as a thick chest wall or emphysema, can
interfere with visualization of your heart during an echocardiogram. If one
of these conditions are suspected and an echo is needed, an invasive
ultrasound of the heart known as a trans esophageal echocardiogram
(TEE) is performed.
 Risks and contraindications?
 Regardless of one’s health, a transthoracic echo can be safely done.
Holding one’s breath might be required for a few seconds during the test,
but there are no expected adverse events related to the test.

36. +
 Preparations for the test-
 There is no need to prepare or do anything special before an echo
such as a screening test or food and activity restrictions. The doctor
may advice that caffeine should not be taken for at least 6 to 10
hours prior to the test, depending on the reason for the test as it can
speed up the heart rate. Other than that, there is no special actions
taken before the test and it takes about an hour to be performed.
 Interpreting the results-
 The results of an echo will be prepared in a report in which the doctor
will describe the heart anatomy, heart movements, and any defects
observed during the test. It may take several days to several weeks
for the report to be received. Often, because the results are so
detailed, and the doctor may schedule an appointment with to
discuss the results and next steps

37. +
YouTube link -
https://www.youtube.com
/watch?v=Kirg2GuESsE

38. +

39. +

40. +
NCLEX REVIEW QUESTIONS
 A patient is ordered to undergo a non-invasive CT scan. The
most important information for the nurse to tell the patient prior
to testing is:
 A. A consent form must be signed.
 B. Encourage fluids when the patient returns from the scan.
 C. Restraint is a must during the procedure.
 D. The patient must stay still during the procedure.

41. +
NCLEX REVIEW QUESTIONS
 A client with possible Parkinson's disease is scheduled to have
an MRI. The daughter asks the nurse how the test is different
from a CT-scan. What is the best response.
 A- They are not different: both use ionizing radiation
 B- The Ct scan does not provide a view of deep brain
structures
 C- A MRI scan provides better contrast between normal tissue
and pathological tissue.
 D- The MRI will not require contrast material and has no
special precautions.