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Presentation Taniya

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9 views39 pages

Presentation Taniya

Uploaded by

amarythomas758
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ECHOCARDIOGRAM

and ECG
INTRODUCTION
ELECTROCARDIOGRAPH AND ECHOCARDIOGRAPHY
ARE ESSENTIAL DIAGNOSTIC TOOL IN PEDIATRIC
CARDIOLOGY ENABLING HEALTHCARE
PROFESSIONAL TO ASSESS HEART STRUCTURE
AND FUNCTION IN CHILDREN. THIS ASSESSMENT
AIMS TO EVALUATE THE ROLE OF ECG AND ECHO
IN DIAGNOSING AND MONITORING CARDIAC
CONDITION IN CHILDREN, HIGHLIGHTING THEIR
SIGNIFICANCE IN PEDIATRIC CARE.
ELECTROCARDIOGRAPHY

 Ecg change during the first year of life reflect


the switch from fetal to infant circulation
changes in SVR and increasing muscle massof
the left ventricle.
 The size of the ventricle change as the
infant grows into childhood and adulthood.
 The right ventricle is larger and thicker at
birth because of the physiologic stress during
fetal development.
 Heart Rate
 Average heart rate peaks at second
month of life then gradually decrease.
 Resting HR start at 140bpm at birth fall
to 120bpm at 1yr 100bpm at 5 yr and adult
ranges to 10yrs.
INDICATION

 Tachyarrhythmia
 Bradyarrhythmia
 Electrolyte disturbance
 Suncope/seizure
 Congenital heart disease
 Heart failure
 Cyanotic episodes
 Pericarditis
 Myocarditis
Pediatric ECG characteristics

 The heart rate is faster than adult


 All the duration and intervals (PR interval
QRS duration QT interval) are shorter than in
the adult
 Inferior and lateral Q waves
 Marked sinus arrhythmia
 15leads instead of 12leads in adult to better
evaluate Right ventricle.
DEVELOPMENTAL
CHANGES
 Neonates :- Right ventricle larger than left
ventricle
 Right axis deviation (means QRS frontal plane
axis+60to+180degree)
 Upright Twave in the right precordial leads
 By the age of 6years pediatric ECG resemble
those of the adult
STEPS IN ECG INTERPRETATION

 Standardization
 Age of the child
 Rate
 Rhythm
 P wave morphology
 QRS complex abnormalities
 Most important never diagnose only on
ecg
ECG CONVENTION AND INTERVALS

 Depolarisation towards electrode:- +ve deflection


 Depolarisation away from electrodes:- -ve
deflection
 Heart rate=300/no.of large square between each
R-R interval
 Each small square (1mm) =0.04sec
 Each large square (5mm) =0.02sec
ELECTRICAL COMPONENTS

P wave
 PR interval
 QRS complex
 ST segment
 Twave
 QT interval
 U wave
RATE

 Both atrial and ventricular rate should be


measured
 Fast heart rate=1500/no.of small box
 Slow heart rate=300/no.of large box
 For regular heart rate=no.of R wave in a 6sec
strip*10
RHYTHM

 Sinus Rhythm
 Depolarisation originating from SA node

 Two characteristics
 P wave preceding each QRS complex with
constant pRInterval
 P axis between 0to 90 degree
ABNORMALITIES IN THE RHYTHM

 Non ventricular arrhythmia


 Ventricular arrhythmia
 Non ventricular conduction
disturbance
 Ventricular conduction disturbance
NURSES RESPONSIBILITY

 Verify the physician order


 Identify the patient according to policy
 Provide privacy and explain the procedure
 Explain that the test record the heart electrical
activity and that it may be repeated at certain interval
 Perform hand hygiene
 Advice the client to lie supine position in the center of
the bed with arms at his sides
POST PROCEDURE

 Monitor vital signs


 Provide emotional support and reassurance
 Educate the family members on results and
follow up
 Ensure proper documentation of results
and intervention
ECHOCARDIOGRA
M
ECHOCARDIOGRAM

Definition:

› Echocardiogram is a diagnostic test which uses


ultrasound waves to make images of the heart
chambers, valves and surrounding structures. It can
measure cardiac output and is a sensitive test to find
fluid around the heart (pericardial effusion).
COMPONENETS
1. Pulse generator - applies high amplitude voltage to
energize the crystals
2. Transducer - converts electrical energy to mechanical
(ultrasound) energy and vice versa
3. Receiver - detects and amplifies weak signals
4. Display - displays ultrasound signals in a variety of
modes
5. Memory - stores video display
INDICATION

1. Inflammation on various structures.


2. Cardiac chamber size.
3.Ventricular size
4.Ejection fraction
5.Cingenital deformities.
6.Ascending aorta
7. Cardiac mass.
MODALITIES

1. M-Mode
2. 2-D (2 Dimensional)
3. Color Doppler
4. TDI(Tissue Doppler Imaging
Types
1. Trans Thoracic Echocardiogram (TTE)
2. Transesophageal Echocardiogram(TEE)
3. Stress Echo/Dobutamine stress Echo
4. Intravascular Echocardiogram
TRANSTHORACIC ECHO
› A transthoracic echocardiogram (TTE) is the most common
type of echocardiogram. In this case, the probe (or
ultrasonic transducer) is placed on the chest or abdomen of
the subject to get various views of the heart..
▸ It is used as a non-invasive assessment of the overall
health of the heart, including a patient's heart valves and
degree of heart muscle contraction (an indicator of the
ejection fraction).
TRAN ESOPHAGEAL ECHO
CARDIOGRAM

• This test requires that the transducer be inserted


down the throat into the esophagus (the swallowing
tube that connects the mouth to the stomach)..
• The esophagus is located close to the heart, clear
images of the heart structures can be obtained without
the interference of the lungs and chest.
• TEE provides superior image quality, particularly for
posterior cardiac structures which are nearer to the
esophagus and less well visualized on transthoracic
echocardiography
STRESS ECHO CARDIOGRAPHY

• It is performed while the person exercises on a


treadmi.. or stationary bicycle.

• To visualize the motion of the heart's walls and


pumping action when the heart is stressed. It may
reveal a lack of blood flow that isn't always apparent
on other heart tests.

• The echocardiogram is performed just prior and just


after the exercise.
DOBUTAMINE STRESS ECHO
CARDIOGRAM
• A form of stress echocardiogram.

• Instead of exercising to stress the heart, the stress is obtained


by giving a drug that stimulates the heart and makes it "think" it is
exercising.

• The test is used to evaluate heart and valve function when


unable to exercise on a treadmill or stationary bike.

• It is also used to determine how well heart tolerates activity and


likelihood of having coronary artery disease, as well as evaluating
INTRA VASCULAR ULTRASOUND

• Intravascular ultrasound:

• A form of echocardiography performed during cardiac


catheterization.

• During this procedure, the transducer is threaded


into the heart blood vessels via a femoral catheter

• Used to provide detailed information about the


atherosclerosis (blockage) inside the blood vessels.
DOBUTAMINE
STRESS ECHO
CARDIOGRAM
NURSES RESPONSIBILITY

Standard Echo: TTE- no special preparation required

TEE

NPO for 6 hours

Dentures should be removed


No caffeine for 24 hours

No over the counter pills


• Consent obtained.

• Electrodes attached and ECG monitored

BP and Spo2 monitor

•Mild sedation given through IV

• Endoscopic transducer is lubricated and introduced into the


esophagus
• Endoscopic transducer is lubricated and introduced into
the esophagus

Client is advised to swallow.

The pictures and posterior heart is viewed clearly through


TEE

• After the procedure, the client's gag reflex is checked


before starting feed
NPO

No caffeine for 24 hour sand No over the counter pills

Not to take some medications like Beta blockers, isosorbide, NTG


etc. as per order

Do not discontinue any medication without order

Dobutamine stress test-40 to 50 ugm/kg/min, is injected


intravenously before Echo
To increase further the Heart rate bolus of 0.25-1.0mg of atropine is
PEDIATRIC CONSIDERATION

Developmental and age related difference in cardiac

anatomy & Physiology

> sedation and anesthesia consideration for pediatric


Echo procedure

> infection contio, measures in pediatric cardiac


COMPLICATIONS
Respiratory compromise
• Laryngospasm
• Hypoxia.
• Bronchospasm.
Cardiovascular complications:
• Tachyarrhythmias: - Ventricular tachycardia.
• Supraventricular tachycardia.
• Bradyarrhythmias: Third degree atrioventricular block.
• Transient hypotension or hypertension.
• Angina pectoris.
Others:
• Minor pharyngeal bleeding.
• Nausea and vomiting.
• Bacteremia
CONCLUSION

ECG and Echo cardiogram are two indispensable


diagnostic modality in paediatric cardiology
offeringoffering valuable insight into hearts electrical
activity and structural integrity.

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