Stress Echocardiogram

Stress Echocardiograms are screening tools to help detect heart disease. First, a resting echocardiogram is performed, and then EKG monitoring is performed while you walk on a treadmill. The speed and incline of the treadmill increase every three minutes until you reach a maximum heart rate, become fatigued, develop symptoms, or have specific EKG changes. Immediately following the treadmill, the patient will then undergo an echocardiogram showing the heart under stress.

Patient Preparation:

Wear loose, comfortable clothing and walking shoes.

No heavy meals 2 hours prior to test. You may have a light snack and you may take your morning medicines with a sip of water.

This appointment generally takes 90 minutes.

Nuclear stress tests

commonly performed as dual isotope stress tests, using radioactive tracers including Technetium-99m to image the heart at rest and following treadmill exercise. You will sit in an imaging camera for roughly 15 minutes before and after the treadmill test. Nuclear stress tests increase the sensitivity of routine treadmill testing, and allow specific assessment of different areas of the heart muscle.

If you are unable to walk on the treadmill or have specific conduction defects on your EKG, an Lexiscan stress test may be ordered. Intravenous Lexiscan dilates the heart arteries and mimics the effect of walking on the treadmill. Lexiscan infusion is followed by nuclear imaging.

Patient Preparation:

No food or drink four hours before the test.

No caffeine 12 hours before the test.

Take your medications with a sip of water unless otherwise instructed.

Wear loose, comfortable clothing and shoes suitable for walking.

Bring a list of current medications.

Plan on spending three hours for a nuclear stress test.

Echocardiogram

An echocardiogram is a non-invasive, painless, test that uses ultrasound (high frequency sound waves) to produce a two dimensional image of the heart. As we view the beating heart on a computer monitor, we can measure heart chamber sizes and wall thickness, assess the function of the heart and examine its structure, including the heart valves. Color flow and Doppler techniques use ultrasound frequencies to measure the degree of valvular obstruction (stenosis) or leakage (regurgitation or insufficiency).

Echocardiograms are commonly ordered to evaluate heart murmurs, palpitations, chest pain and valvular abnormalities.

Patient Preparation:

No special preparations are necessary for routine echocardiograms.

Allow up to one hour

Carotid ultrasound and doppler

examination is a non-invasive, painless, scanning of the neck arteries using high frequency sound waves to detect plaque buildup. Your physician may order this test if examination of the neck arteries reveals sounds called "bruits" or if you have had a stroke or T.I.A or have experienced dizziness or syncope. The amount and location of blocked arteries helps guide therapy and is an important part of stroke prevention.

Patient Preparation:

No special preparation is required for vascular studies.

Please allow 1 hour to complete the test

Impedance Cardiography (ICG)

Impedance Cardiography is performed in our office as a part of your regular exam. An ICG is the latest in new technology that checks your cardiac function through bioimpedance. Electrodes will be placed on 6 points on your neck and chest and allow the physician to check your vascular status, and whether you are vasoconstricted or dehydrated. This allows the physician another method of determining whether you are on the right cardiac medication and to make a proper diagnosis.

Patient Preperation:

None

Holter Monitoring

Holter monitors record your heartbeat during daily activities. The Holter monitor records all your heartbeats, usually over a 24-hour period. The Holter monitor is roughly the size of an iPod. The monitors are often ordered for complaints of palpitations, dizziness, or syncope.

Patient Preparation:

No special preparations are necessary. Because of its electrical circuitry, it is recommended that you shower before a Holter monitor is applied.

Cardiac catheterization

Cardiac catheterization, also known as a coronary angiogram, is an invasive diagnostic procedure that assesses the heart's arteries, valves, and contractility (squeezing strength of the heart muscle) as well as the pressures generated within the heart and lungs. Tiny tubes called catheters are inserted through the groin or arm vessels under X-ray (fluoroscopic) guidance while you lie flat. Dye is injected into the heart arteries to determine if there is blockage and into the main pumping chamber of the heart to determine its strength, known as the "ejection fraction". Local anesthesia is given at the insertion site and oftentimes a light conscious sedation is used. If the groin approach is used, you may need to lie flat for several hours to allow the puncture site to heal. Catheterizations are performed both on inpatients and outpatients.

Following cardiac catheterization, the Doctor may advise medication, balloon angioplasty and stenting, or surgery.

Percutaneous Transluminal Coronary Angioplasty and stenting

Percutaneous Transluminal Coronary Angioplasty, also known as PTCA, is the procedure that uses a balloon to open a blocked artery. After a thin wire is passed across a blockage, a balloon-tipped catheter is inflated, flattening the plaque against the artery. Blood thinners are given during the procedure, and the tiny tubes inserted in the groins, called sheaths, may not be removed for several hours until the blood thinners lose their effect. Because there is a small risk of needing emergency surgery for failed angioplasty, the procedure is performed at the hospital on an inpatient basis. Coronary stents or metal implants, sometimes coated with special medications, are also placed to optimize the results.

Intravascular Ultrasound, or IVUS

Intravascular Ultrasound, or IVUS is essentially an ultrasound performed on a catheter placed within the artery. It gives information on vessel size, plaque composition and percent stenosis. Intravascular ultrasound is used to ensure the proper seating of stents against the arterial wall.

Peripheral angioplasty and stenting

Peripheral angioplasty also known as PTA, is the balloon technique applied to the peripheral arteries. Peripheral stents are placed in selective locations. Renal artery angioplasty and stenting are used for treating blockages of the kidney arteries. This may help preserve kidney function or decrease the high blood pressure caused by these blockages. Peripheral stents are placed to help decrease leg pain with walking and to improve wound healing.

Patient Preparation:

No food or drink at least four (4) hours before the procedure.

Take your medications with a sip of water unless otherwise instructed.