Page 314 - Cardiac Nursing

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290 P A R T III / Assessment of Heart Disease
usually present and responsible for supervising the test (i.e., tak- hold promise include (but are not limited too) improved assess-
ing blood pressures, examining the ECG). A sonographer is ment of ventricular volumes, improved assessment of the valvular
present for image acquisition; an ECG technician may also be apparatus, and improved detection of thrombus within the left
present. atrial appendage. It is important to remember though that the
For those patients who cannot exercise, dobutamine is the same artifacts and limitations that apply to 2-D echo also apply to
most common stress agent used; however, it should be understood 3-D echo.
that dobutamine does not completely simulate the physiological
state of exercise. A nurse should be present during dobutamine in-
fusion since medications need to be given intravenously. Starting R EFERENCES
doses are between 5 and 10 mcg/kg/min, increasing by 10 mcg/ 1. Feigenbaum, H., Armstrong, W. F., & Ryan, T. (Eds.). (2005). Feigen-
kg/min increments every 3 minutes to a peak of 40 mcg/kg/min. baum’s echocardiography (6th ed.). Philadelphia: Lippincott Williams &
Doses of atropine can be given and physical maneuvers can be Wilkins.
performed in addition to dobutamine infusion to achieve 85% of 2. Otto, C. M. (2004). Textbook of clinical echocardiography (3rd ed.).
Philadelphia: W.B. Saunders.
the maximally predicted heart rate. 3. Weyman, A. E. (1994). Principles and practice of echocardiography (2nd ed.).
Philadelphia: Lea & Febiger.
3-D 4. Definity® (2007). Perflutren Lipid Microsphere [Package Insert]. Billerica,
MA: Bristol-Myers Squibb Medical Imaging.
5. Optison™ (2003). Perflutren Protein-Type A Microspheres [Package In-
3-dimensional echo displays a volume of data within 3 spatial ori- sert]. Princeton, NJ: Amersham Health.
2
entations. This field is in much flux and clinical applications of 6. Ellestad, M. H. (1996). Stress testing: Principles and practice (4th ed.). New
this technique are being investigated. Some applications that may York: Oxford University Press.