Electrocardiography for Healthcare Professionals Learning Outcomes Learning Outcomes (Cont d) 11.1 What Is Exercise Electrocardiography?

Transcription

1 1 2 Electrocardiography for Healthcare Professionals Chapter 11: Exercise Electrocardiography Learning Outcomes 11.1 Describe exercise electrocardiography, and identify it s other names Identify uses of exercise 11.3 Describe variations of exercise 11.4 Prepare a patient for exercise 11.5 Summarize safety measures that are used before, during, and after exercise 11.6 Explain the responsibilities of a healthcare professional during exercise Learning Outcomes (Cont d) 11.7 Compare common protocols followed in exercise 11.8 Explain the responsibilities of a healthcare professional after exercise 11.1 What Is Exercise Electrocardiography? Known as: Exercise tolerance test Treadmill stress test Cardiac stress test Stress ECG Exercise treadmill test 11.1 What Is Exercise Electrocardiography? (Cont d) Non-invasive procedure performed in presence of cardiologist or physician Usually involves an exercise treadmill Apply Your Knowledge Why is exercise electrocardiography considered noninvasive? 11.1 Apply Your Knowledge Why is exercise electrocardiography considered noninvasive? Answer: It does not require entrance into a body cavity, tissue, or blood vessel Why is Exercise Electrocardiography Used? Diagnose causes of chest pain After surgery or MI to determine function Screens for heart disease Sets limitations for exercise programs Identifies dysrhythmias that occur during exercise Evaluate effectiveness of cardiac drugs 11.2 Why Is Exercise Electrocardiography Used? (Cont d) Evaluates how the heart and blood vessels respond to physical activity Typically performed when physician suspects coronary vascular disease 1

2 10 Narrowed/obstructed arteries may change the ECG tracing, specifically the ST segment 11.2 Apply Your Knowledge A treadmill stress test is typically performed for which disease? Apply Your Knowledge A treadmill stress test is typically performed for which disease? ANSWER: Coronary vascular disease 11.3 Variations of Exercise Electrocardiography Thallium stress test Similar to treadmill stress test except: Thallium is injected during test The heart is scanned and a cardiologist studies the pictures Determines decrease in blood flow to the heart 11.3 Variations of Exercise Electrocardiography (Cont d) Pharmacologic stress test Similar to thallium stress test, except performed on patients not able to exercise Cardioactive medications are given, which causes the heart to exercise artificially 11.3 Apply Your Knowledge Which stress test variation can be used in a patient who is unable to exercise? Apply Your Knowledge Which stress test variation can be used in a patient who is unable to exercise? ANSWER: Pharmacologic stress test 11.4 Prior to the Procedure: What the Patient Should Know No smoking, drinking alcohol or caffeine three hours prior to test Do not eat two hours prior to test Wear comfortable clothes and shoes Certain medications should not be taken check physician s order 11.4 Verification No alcohol, caffeine, or tobacco for previous three hours Medications stopped, if required Patient s medical history is complete Consent form is signed 11.4 Preparing the Patient Inform the patient that the test is not timed, but will take approximately 45 minutes to 1 hour 2

3 Explain safety precautions to alleviate patient s fears 11.4 Preparing the Patient (Cont d) Physician should explain why procedure is being done Ensure that patient understands what will occur during the test and what he or she should report to the physician during the test 11.4 Required Forms Patient history medical history current medications cardiovascular risk factors reason for test Informed consent 11.4 Preparing the Patient (Cont d) Informed consent is required before exercise electrocardiography patient understands test patient understands risks involved patient understands risks if test is refused 11.4 Apply Your Knowledge True or False: Informed consent is not necessary when performing exercise Apply Your Knowledge True or False: Informed consent is not necessary when performing exercise ANSWER: False; informed consent is always necessary when performing this procedure Apply Your Knowledge Which substances should the patient avoid 3 hours prior to the procedure? Apply Your Knowledge Which substances should the patient avoid 3 hours prior to the procedure? ANSWER: Alcohol, caffeine, and tobacco 11.5 Patient Safety Inform patient of expected symptoms A physician must be present during test Emergency equipment is nearby Patient must be monitored at all times Patient must report any abnormal symptoms 11.5 Patient Safety (Cont d) An exercise electrocardiography should not be done if: 3

4 a change occurs in the resting ECG patient has dysrhythmia patient has pericarditis or myocarditis 11.5 Patient Safety (Cont d) An exercise electrocardiography should not be done if: patient has uncontrolled hypertension patient has severe aortic stenosis patient has an aneurysm or embolism patient has congestive heart failure 11.5 Troubleshooting If you suspect a problem, ask the patient, then report to supervising physician Be prepared to respond to patient complaints/problems since physician may not be aware 11.5 Apply Your Knowledge What two medical emergencies is a patient at risk for while undergoing an exercise electrocardiography? 11.5 Apply Your Knowledge What two medical emergencies is a patient at risk for while undergoing an exercise electrocardiography? Answer: Heart attack or stroke 11.6 Your Responsibilities During Exercise Electrocardiography Provide for safety Educate and prepare the patient prior to the procedure Instruct the patient to report symptoms 11.6 Your Responsibilities During Exercise Electrocardiography (Cont d) Instruct the patient to report symptoms Monitor the patient, including blood pressure Your confidence can reduce patient fears 11.6 Preparation Blood pressure equipment Shaving equipment, abrasive skin cleaner, skin rasp (used to abrade skin) 11.6 Preparation (Cont d) Skin prep solution 2x2 or 4x4 guaze Chest electrodes Electrode paste or gel, unless electrodes are pre-jelled 11.6 Preparation (Cont d) ECG machine with monitor Lead wires Treadmill or stationary bicycle Adhesive tape belt 4

5 Prepare Electrode Sites for Placement Shave skin, if necessary Rub site with skin prep, let dry Abrade skin 11.6 Performing Exercise Electrocardiography Attach blood pressure cuff and electrodes according to manufacturer s instructions Perform resting ECG and blood pressure to obtain baseline sitting, supine, standing 11.6 Performing Exercise Electrocardiography Have patient hyperventilate for 30 seconds, then perform additional ECG and blood pressure ECG changes that result from changes in breathing are identified here 11.6 What Is Monitored During Exercise Electrocardiography? ECG Blood pressure Heart rate Skin temperature Oxygen level Physical appearance 11.6 Apply Your Knowledge What should be monitored during exercise electrocardiography? Apply Your Knowledge What should be monitored during exercise electrocardiography? ANSWER: ECG, blood pressure, heart rate, skin temperature, oxygen level, and physical appearance 11.7 Common Protocols Test is divided into two stages of three minutes each At end of each stage, blood pressure is checked and ECG is repeated Level of exercise is then increased 11.7 Common Stress Testing Protocols Bruce protocol most common protocol utilizes 3-minute stages where treadmill speed/grade is increased with each stage Modified Bruce protocol used for patients whose exercise capacity is limited 11.7 Common Stress Testing Protocols (Cont d) Naughton protocol ideal for sicker patients gradual increase in intensity speed stays at 2 mph uses 2-minute stages 5

6 Common Protocols (Cont d) Exercise period may last up to 15 minutes, depending on patient s cardiac risk factor and ability Physician may terminate test if conditions that lead to complications are identified 11.7 Common Protocols (Cont d) Goal of test is target heart rate (THR) without symptoms or complications THR = 220 patient s age x (60-85%) Percentage used depends on the testing protocol Patient should not exceed THR during test 11.7 During the Procedure Monitor the following: Blood pressure Pulse Signs of cardiac distress You may also monitor: Patient s oxygen level in the blood 11.7 During the Procedure (Cont d) Watch patient closely, including: Skin color Breathing pattern Amount of perspiration Facial expressions 11.7 Communication Failure to report abnormal blood pressure or other complications can result in severe patient problems and inaccurate test results 11.7 Apply Your Knowledge What is measured during each stage of the exercise electrocardiography procedure? Apply Your Knowledge What is measured during each stage of the exercise electrocardiography procedure? ANSWER: Blood pressure and ECG 11.8 Following Exercise Electrocardiography Monitor patient for 10 to 15 minutes after test (cooling-off period) 11.8 Factors Used to Interpret Results of Exercise ECG ECG changes and symptoms (most important) Heart rate and rhythm Blood pressure Changes in oxygen consumption 11.8 Inconclusive Tests Do not verify or exclude abnormality 6

7 May require additional testing Echocardiogram (ultrasound) Coronary angiogram 11.8 Instructions for Patient After Exercise ECG Rest for several hours Avoid extreme temperature changes Avoid stimulants (caffeine, tobacco, alcohol) for three hours No bath or shower for two hours When to expect test results 11.8 False Positive Results Occurs in approximately 5% of adults (more common in females) Can cause unnecessary fears and additional testing Physician is responsible for providing information 11.8 Patient Education and Communication Patient questions about exercise electrocardiography results should be referred to the physician 11.8 Apply Your Knowledge How many minutes should the patient be monitored following an exercise ECG? 11.8 Apply Your Knowledge How many minutes should the patient be monitored following an exercise ECG? ANSWER: 10 to 15 minutes Chapter Summary Exercise ECG monitors the patient during exercise to diagnose problems that do not occur during rest Known by many names, including treadmill stress test, cardiac stress test and stress ECG Chapter Summary (Cont d) Used to diagnose cause of chest pain and screen for heart abnormalities Determine the capacity of the heart Evaluate effectiveness of cardiac medications Chapter Summary (Cont d) Thallium and Pharmacologic-thallium stress tests are variations of the exercise ECG Preparing the patient for the procedure involves education, obtaining a consent form and documentation Educate the patient about how to prepare for the procedure, its complications, and what to report during the procedure itself 64 Chapter Summary (Cont d) Responsibilities may include education and preparation, electrode attachment, and monitoring of patient Important to ensure safety before, during, and after an exercise ECG 7

8 Testing protocols are commonly used for exercise ECGs 8