Chest Radiograph Applications –

     For the registered nurse who is working in the emergency department or on an acute surgical unit (CCU’s ICU’s, or MICU’s), she and/or he may be the first to review the radiography or fluoroscopy preliminary findings.  Also, it is becoming more prevalent among teaching hospitals today to have a few key nurses round with the treating physicians and /or team specialists. 

     Therefore, it is important for the lead nurses to have a basic and working understanding in the anatomy and physiology of the ‘target organ’ within the event horizon. One may not rely just on the routine chest radiograph to diagnose LVH alone.  Subtle dilation of the ascending aortic shadow can be found in many patients with HTN and have no apparent evidence of cardiac disease.   Sometimes in older adults and in pediatric patients (e.g., usually congenial heart disease is present), the presence of aortic coarctation as a cause of HTN can be suspected on the chest radiograph. 

 
Heart Dimension: Does Size Matter –

     An enlarged heart is always abnormal and identifiable within a chest x-ray or on a fluoroscopy exam.  However, mild cardiomegaly (i.e., enlargement of the heart muscle), may reflect a higher-than-average cardiac output from a normal heart, as seen in athletes.  The cardiothoracic ratio remains the simplest yardstick for assessment of the cardiac size; the mean ratio in upright postero-anterior (PA) view is 44 percent. ¹⁸ 

     The nature of cardiomegaly can indeed usually be determined by the specific roentgen or chest x-ray (i.e., Wilhelm K. physicist, discovered x-ray in 1895), appearance.  As a rule, when the pulmonary blood flow (PBF) pattern remains normal, volume overload tends to present a greater degree of cardiomegaly than lesions (i.e., a pathologic change in the tissues or types of primary, secondary, and vascular lesions), with pressure overload alone. ¹⁹  For example, patients with aortic stenosis (AS) typically show features of LVH without dilatation.  On the other hand, the LV both dilates and hypertrophies in the case of aortic regurgitation (AG), which may produce a lager heart even before the development of heart failure appears.  

Assessment of Cardiovascular Dynamics –

     The chest x-ray that is taken at random largely records the diastolic image of the heart.  Fluoroscopy, on the other hand, provides a continuous vision of the pulsating organ throughout the entire cardiac cycle.  Once familiar with the normal cardiovascular movements, the fluoroscopist will find any deviation from the norm to be obvious. ²⁰ 

     Note:  On an x-ray, signs of cardiac lesions may manifest themselves usually in the ventricular systole.  Therefore, what may be missed on the x-ray film is often readily seen and diagnosed under the fluoroscope. For instance, left ventricul enlargement may be the only radiographic abnormality of severe aortic regurgitation (AR) in children or young adults.  On the fluoroscopy, the aorta will usually appear vigorously expanding in systole and rapidly collapsing in diastole.²¹  This dynamic alternation is characteristic of aortic regurgitation. 

Clinical Assessments – 

     As a nurse clinician, you should have a strong association between B/P elevation and other coronary risk as seen before the development of established HTN.  Compared with normotensive individuals, patients with permanent or even with “white-coat-syndrome” borderline HTN tend to be overweight; and have high cholesterol, triglycerides, plasma insulin, and hematocrit levels; and show significantly decreased HDL cholesterol levels.   Therefore, you may want to take charge, and mandate to incorporate these parameters in your evaluation of borderline HTN testing for cardiovascular risk factors. 

Note:  As part of your total assessment practice, have a plasma lipid panel ran to be determined routinely in everyone, and fasting plasma insulin values will be useful to gauge the effectiveness of non-pharmacological intervention.  Also, you should have a copy of the PDR Nurse’s Drug Handbook for quick referencing guidelines. Consider this part of your assessment gear just as your stethoscope is used for B/P and heart sound investigations.

     Also, regardless of which method or technique you choose to measure your patient’s B/P, “notations”, “notations”, and “notations” should be made of the conditions so that others can compare the findings or interpret them properly.  This is particularly critical in scientific reports, and patient nursing assessment annals.  Ultimately, the treating physician or a patient’s perception of cardiovascular risk and consequently, the quality plus the duration of life of many patients rely on the correct assessment skills of B/P and lipid panels, not only in the medical environment but also at home and/or under ambulatory care conditions.

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