ERGONOVINE PROVOCATION TEST – Purpose, Finding, Interfering Factors, Client Preparation, Procedure, After Care and Complications (NURSING PROCEDURE)
Ergonovine provocation testing is used to diagnose coronary artery spasm and vasospastic angina accurate diagnosis of coronary artery spasm is necessary, because of its risk, ergonovine provocation testing is limited to carefully selected clients
PURPOSE
Ergonovine provocation testing is indicated in clients with atypical angina in whom coronary artery spasm is suspected
FINDING
A positive response to ergonovine includes chest pain with ST segment abnormalities, spasm visible on the arteriogram, serious dysrhythmia or a combination of those responses
INTERFERING FACTORS
Ergonovine provocation testing should not be performed if severe obstruction of a coronary artery or multivessel obstructive cardiac disease exits or in the presence of severe congestive heart failure, uncontrolled hypertension, pregnancy, acute myocardial infarction or possible cerebral hemorrhage. It is contraindicated in anyone with a history of hypersensitivity to ergonovine
CLIENT PREPARATION
- Warn the client that chest pain is expected but will be treated immediately
- Discontinue vasoactive medications: nitrates for 4 hours before the test, calcium channel blockers for 24 hours before rest and beta blockers for 48 hours before the test
- Continue cardiac and hemodynamic monitoring is performed
PROCEDURE
- The ergonovine provocation test is usually performed as part of a cardiac catheterization
- First, the cardiac catheterization must rule out severe coronary artery obstruction
- A pacing wire is then inserted
- Intravenous ergonovine maleate (ergotrate maleate) is given, which will stimulate a spasm within 3 to 6 minutes
- Its effect lasts 10 to 15 minutes. If a positive response occurs, the spasm is reversed by administering nitroglycerin intravenously
- Bedside ergonovine provocation testing can be performed in the coronary care unit in clients who have had a cardiac catheterization to verify that the coronary arteries are not severely obstructed
- Ergonovine is given intravenously every 5 minutes up to seven times
- The ergonovine is stopped when ST segment changes are seen on the monitor, whether the client has pain or not. Nitroglycerin is given to reverse the spasm
- Continuous cardiac and hemodynamic monitoring is performed. If major adverse effects are noted, the ergonovine is stopped
AFTER CARE
- Assess the client for chest pain with or without ST segment changes, as spasm may recur after the nitroglycerin is stopped
- Maintain monitoring and bed rest for 1-2 hours if the procedure is performed in the coronary care unit
COMPLICATION
- Atypical chest pain
- Bronchospasm
- Dysrhythmia
- Hypotension or hypertension
- Myocardial infarctions
