This is blog 2 of 3 that explains the ins and outs of pre-admissions cardiac testing from my perspective. As an anesthesiologist, with over 30 years of experience, I’ve done everything from open heart and liver transplant to fast-paced ASCs and pain management. My goal is to provide a common-sense explanation that helps ASC preop nurses to better understand cardiac testing in the context of a preop evaluation for ambulatory surgery.
So here’s what I can tell you: If stranded on a deserted island (or is it a desert island!?) doing anesthesia on old folks and I could have only one cardiac test, the cardiac echo would be it. Hands down. Stop the show.
Why’s that? Because an echo gives you the best information about the pump function of the heart. As an anesthesiologist, the drugs I give each patient have the potential to change blood pressure, heart rate, and heart contractility. Knowing how well a patient’s heart contracts (systolic function) and fills (diastolic function) and the status of the heart valves preop will guide how much of which drugs I give and what heart rate and blood pressure I am going to shoot for.
An echocardiogram or ECHO for short is just an ultrasound of the heart, but it gives you a wealth of information about “pump function”.
- What it is – it’s an ultrasound movie of the heart’s valves and chambers. You can see individual valve leaflets and you can turn on color doppler to assess blood flow
- What it can tell you for sure – pump function, valve function, diastolic dysfunction, presence of pulmonary hypertension, whether the patient has had a large mi in the past
- What it can maybe tell you – presence of ischemia
- What it can’t tell you – The quality and quantity of blood flow to the heart
- What to look for – normal ejection fraction and normal valves
If the patient has had a prior MI that is large enough to cause a wall motion defect, that part of the heart will be noted as being “akinetic”, i.e., not moving. If an area of the heart is ischemic or near an old MI, it will be noted as being “hypokinetic”, i.e., showing less movement than normal. Valvular defects, either regurg or stenosis, are assessed by color doppler flow (like the image above). An ECHO is so precise that all kinds of things can be measured precisely down to the level of a millimeter including aortic valve area, left ventricle size and wall thickness, left atrial size, etc.
That’s it! If the ejection fraction is above 50% and there is only “minimal” regurgitation or stenois of any of the valves you’re “good to go”!
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Check out the last part of the series soon: A PreOp Nurse’s Guide to the “Big 3” of Cardiac Testing – Part 3 The Nuclear Medicine Stress Test