01.07 Echocardiogram (Cardiac Echo)

An echocardiogram uses sound waves to create a picture that is used to view the heart, valves, and blood flow in heart like in this picture. The doctor might order an echo if the patient has heart disease, problems with their valves, any congenital defects, or a cerebral vascular accident. Let’s explore the different types.

The transthoracic echo is the standard test used where a transducer is placed on the skin above the heart. The transesophageal echo uses a transducer that goes down the patient’s throat to get a closer look at the heart. This one’s good for obese patients or patients with something in the way of their chest like a pacemaker. Doppler echos view the blood flow speed and direction by measuring the pitch of sound waves as they bounce off of the blood cells like in this picture. The stress echo is done immediately before and after physical activity to view the effect of stress on the heart. Let’s explore what the nurse should expect before the procedure. 

So when the doctor orders an echo, you will let the patient know and explain the procedure and why they’re having the test done. Have them empty their bladder before to avoid interruptions to the test. 

During the transthoracic echo, gel is placed on the skin where the transducer goes on the skin over the chest. During the transesophageal echo, the radiology tech will numb the throat and the nurse or tech will give IV medicine to relax the patient before placing the transducer in the esophagus like in this picture. A bubble study may be indicated during the echo if the patient has had a suspected CVA to determine if there’s a hole in the heart causing the blood backflow that can cause clotting. During the bubble study, the nurse or tech will shake saline with a small amount of air to make tiny bubbles in the syringe. The nurse will inject it into the IV while the tech is controlling the echo machine and bubbles will be visible on the picture in the right side of the heart. When the bubbles move from the right side to the lungs, they are absorbed. If bubbles appear in the left side of the heart, that means there is a hole allowing them to flow through. Guys, I floated to neuro recently and go to do this for the first time. It’s actually really cool to watch!

So after the echo is over, wipe off any gel on the skin. The radiologist will interpret the test. If a transesophageal echo was done, the patient should be NPO until the numbness is gone to avoid aspiration or choking. Let’s touch on patient education. 

Prior to the test, the doctor may order the patient to be NPO or nothing by mouth for a few hours before the test. Let the patient know that they shouldn’t eat or drink anything until the numbness is gone if they had a TEE. 

Alright, our priority nursing concepts for the patient with an echocardiogram are perfusion, oxygenation, and patient-centered care.