Diagnostic Tests

Minimally invasive diagnostic tests: What to expect...

 Color Doppler Echocardiogram | Dobutamine Stress Echocardiogram | Electrocardiogram | Exercise Testing | Holter Monitor | IV Persantine Stress Test with Nuclear Imaging | Single-averaged Electrocardiogram (SAECG) | Stress Echocardiogram | Transesophageal Echocardiogram (TEE)   

Color Doppler Echocardiogram

 What is an Echocardiogram? 

An Echocardiogram is a non-invasive procedure that uses sound waves (ultrasound) to evaluate how well the heart is working. Gel is applied to the chest and a transducer (wand-like apparatus) is moved over the chest area to produce an image of the internal structures of the heart. The test will take from 20 to 30 minutes depending on the patient's condition and the type of echo needed. This test must be ordered by a doctor.

Why is an Echocardiogram Done?  

This test will help the doctor to evaluate:

  • How well the heart is moving
  • How well the valves are working
  • The size of the heart and its pumping chambers (ventricles)

What Preparation is Needed?  

This test is for adults (17 years and older). There are no restrictions on food, liquids or medications prior to the test.

Dobutamine Stress Echocardiogram

What is a Dobutamine Stress Echocardiogram (Echo)?  

A Dobutamine Stress Echo is a non-invasive test used to evaluate coronary artery disease in patients who are unable to exercise on a treadmill. Dobutamine is a medication that increases heart rate and blood pressure similar to the effect of exercise. The rise in heart rate increases the oxygen demand of the heart and helps to determine if the heart muscle is getting enough blood and oxygen. The test includes an echocardiogram done at rest and again at peak heart rate. This procedure uses sound waves (ultrasound) to produce an image of the internal structures of the heart. Gel is applied to the patient's chest area and a transducer (a wand-like apparatus) is moved over the chest. Electrodes are placed on the chest to record an electrocardiogram (EKG) which monitors the heart's rate and rhythm. An IV line will be started and Dobutamine will be administered by a nurse. The cardiologist will observe for any symptoms, irregular heart rhythms, an inappropriate heart rate or blood pressure responses. The test takes about 90 minutes. This test must be ordered by a doctor.

Why is a Dobutamine Stress Echo Done?  

This test will help the doctor evaluate the patient's cardiac condition related to the following:

  • How well the heart muscle and valves are working and how they function under stress
  • The size of the heart's pumping chambers (ventricles)
  • Abnormal heart function: coronary artery disease and/or inadequate coronary blood supply

What Preparation is Needed?  

  • No solid food for four hours prior to testing
  • Clear liquids ( juices, clear broth, Jell-O)  up to 1 hour prior to study
  • Water at any time
  • Do not apply lotions, oils or powders to the chest area
  • Wear comfortable clothing (shorts or pants with shirt or blouse) and walking or jogging shoes

Ask Your Doctor:   

  • How to adjust your insulin and food intake prior to the test if you have diabetes
  • If you should take your regular medications the morning of the test
  • If you are on a Beta Blocker, can you safely STOP taking this medication before the test, as this is recommended for best results

Electrocardiogram

What is an Electrocardiogram or EKG?  

An electrocardiogram is a non-invasive test that records the electrical activity of the heart. The electrical activity is related to the impulses that travel through the heart that determine the heart's rate and rhythm. Electrodes are placed on the chest, arms and legs. The test takes about five to 10 minutes. This test must be ordered by a doctor.

Why is an Electrocardiogram Done?  

This test will help the doctor to determine:

  • If a heart attack has occurred
  • What part of the heart was damaged
  • If there are any irregular heart beats or rhythm
  • If there is a decreased supply of blood and oxygen to the heart

What Preparation is Needed?  

  • No restrictions on food, liquid or medications prior to the test
  • Do not apply lotions, oils, or powder to the chest

Exercise Testing

What is a Treadmill Stress Test?   

A treadmill stress test records the heart's electrical activity (rate and rhythm) during exercise. During the test, the cardiologist, a nurse or a technician is present. Electrodes will be placed on the chest the same way as for an electrocardiogram (EKG). The patient will be asked to walk on a motorized treadmill. The speed and incline of the treadmill will gradually be increased. The doctor will be looking for changes in the EKG pattern and any symptoms that the patient may experience. The patient may be on the treadmill for up to 15 minutes, depending upon the level of recovery and cardiovascular conditioning. The test will be stopped if the patient becomes too tired, or has any symptoms such as chest pain. The test will last about 30 minutes. This test must be ordered by a doctor.

Why is a Treadmill Stress Test done?  

This test will help the doctor evaluate the patient's cardiac condition related to:

  • Irregular heart rhythms
  • If there is a decreased supply of blood and oxygen to the heart with exercise
  • How hard the heart can work before symptoms develop
  • How quickly the heart recovers after exercise
  • The patient's overall level of cardiovascular conditioning
  • What the exercise target heart rate (THR) should be

What Preparation is Needed?  

  • No solid food for four hours prior to testing
  • Clear liquids (juices, clear broth, Jell-O) up to 1 hour prior to study
  • You can have water at any time
  • Do not apply lotions, oils or powders to the chest area
  • Wear comfortable clothing (shorts or pants with shirt or blouse) and walking or jogging shoes

Ask Your Doctor:   

  • How to adjust insulin and food intake prior to the test if you have diabetes
  • If you should take your regular medications the morning of the test

Holter Monitor

What is Holter Monitoring?  

Holter monitoring is a continuous, 24-hour electrocardiographic (EKG) recording of the heart's rhythm. Electrodes are placed on the chest area with the leads attached to a small recorder. The patient will keep a 24-hour diary to record daily activities and any symptoms experienced. It will take 15 minutes to have the monitor put on. The patient will return the next day to have the monitor removed. This test must be ordered by a doctor.  

Why is Holter Monitoring Done?  

This test will help the doctor evaluate the type and amount of irregular heart beats during regular activities, exercise and sleep.

What Can be Expected After the Monitor is Put on?  

Once the monitor is in place, do not touch or adjust the electrodes or the monitor. Do not get the electrodes or the monitor wet. Do not have X-rays taken while wearing the holter monitor. Avoid using an electric blanket, heating pad or water bed while wearing the monitor. The patient must record daily activities and any symptoms experienced in the daily diary provided. This will help the doctor make a more accurate evaluation.

What Preparation is Needed?  

  • Do not apply creams, oils, or powder to your chest before the test
  • Wear loose, comfortable clothing

IV Persantine Stress Test with Nuclear Imaging

What is an IV Persantine Test with Nuclear Imaging?   

This test is an alternative procedure for patients with coronary artery disease who cannot exercise on a treadmill. An IV line is started to administer Persantine and an isotope. Persantine helps to expand the coronary arteries, increasing the blood flow to the area. This is similar to what happens during exercise. The radioisotope shows which parts of the heart muscle are receiving enough oxygen. Read more about radioisotopes... Possible temporary side effects of Persantine may include: headache, dizziness, nausea/vomiting, and/or chest discomfort. Electrodes will be placed on the chest so that the heart rate and rhythm will be monitored by an electrocardiogram (EKG). A special camera takes pictures of the heart. This test is usually administered in two phases, with each phase lasting 20 to 30 minutes. The patient may be required to return the following day to complete the second phase or both phases may be completed on the same day. This test must be ordered by a doctor.

Why is a Persantine Stress Done?  

This test will help the doctor to evaluate the patient's cardiac condition related to:

  • Irregular heart rhythms
  • Which areas of the heart are not getting enough blood and oxygen

What Preparation is Needed?  

  • No coffee, soda or tea (including decaf ) for at least 24 hours
  • No solid food for four hours prior to testing
  • Clear liquids (juices, clear broth, Jell-O) up to one hour prior to study
  • Water at anytime
  • Do not apply lotions, oils or powders to the chest area
  • Women should not wear bras with under wire

Ask Your Doctor:   

  • How to adjust your insulin and food intake prior to the test if you have diabetes
  • If you should take your regular medications on the morning of the test

You also must notify your physician if:

  • You are taking Aminophylline, Theodur or Theodur-type medication. This medication should be discontinued 48 to 72 hours prior to the test, under supervision of your physician.
  • You are allergic to Theophylline or Persantine.
  • You have asthma or chronic lung disease .

Single-averaged Electrocardiogram (SAECG)

What is a Single-Averaged Electrocardiogram (SAECG)?  

A SAECG is a non-invasive test that records the electrical activity of the heart. It is similar to a regular electrocardiogram (EKG) but uses computer processing to record lower-level signals that do not normally appear on a standard EKG. Electrodes are placed on the chest. The test takes approximately 10 to 30 minutes. This test must be ordered by a doctor.

Why is a SAECG Done?  

This test helps to predict the likelihood of a high-risk patient developing life-threatening heart rhythms.

What Preparation is Needed?  

  • No restrictions on food, liquid or medications prior to the test
  • Do not apply lotions, oils, or powder to the chest area

Stress Echocardiogram

What is a Stress Echo Test?  

A Stress Echo is a non-invasive test that combines two tests, a treadmill stress test and an echocardiogram (ECHO). An echocardiogram is done at rest prior to exercise and again at peak heart rate. The echocardiogram uses sound waves (ultrasound) to provide an image of the heart's internal structures, size and movement. This image is produced by moving a transducer (a very sensitive wand-like device) over the chest area. Electrodes are placed on the chest to monitor the heart's rate and rhythm throughout the test. The cardiologist will have the patient walk on a treadmill, gradually increasing the speed and incline. The patient will exercise from a few minutes up to 15 minutes, depending upon the level of ability. The test will be stopped if the patient becomes too tired, or has any symptoms such as chest pain. The cardiologist will be looking for changes in the EKG pattern and any symptoms that the patient may experience. At the peak of exercise, the treadmill will be stopped, and the patient will be instructed to lie down immediately on a bed so that a second echocardiogram can be taken to visualize the heart's motion with exercise. The test takes from 60-75 minutes. This test must be ordered by a doctor.

Why is a Stress Echocardiogram Done?  

This test will help the doctor to evaluate the patient's cardiac condition related to:

  • Irregular heart rhythms
  • If there is a decreased supply of blood and oxygen to the heart at rest as well as with exertion
  • Overall level of cardiovascular conditioning
  • How hard his heart can work before symptoms develop
  • How quickly the heart recovers after exercise

What Preparation is Needed?  

  • No solid food for four hours prior to testing
  • Clear liquids (juices, clear broth, Jell-O) up to 1 hour prior to study
  • Water at any time
  • Do not apply lotions, oils or powders to the chest area
  • Wear comfortable clothing (shorts or pants with shirt or blouse) and walking or jogging shoes

Ask Your Doctor:  

  • How to adjust your insulin and food intake prior to the test if you have diabetes
  • If you should take your regular medications on the morning of the test

Transesophageal Echocardeogram (TEE)

What Is a Transesophageal Echocardiogram?  

This test allows the cardiologist to view the internal structures of the heart and the heart's major vessels by inserting a probe (a thin flexible tube with a special tip) down the throat. Sedation allows the patient to be relaxed and unaware of any discomfort during the procedure. An IV line will be started so a sedative can be given by the nurse. A monitor will be placed on the patient's finger so that the amount of oxygen in the blood can be monitored continuously throughout the procedure. The patient will be positioned on the left side so that the probe can be inserted through the mouth into the esophagus. A liquid anesthetic is given to the patient to gargle. This numbs the throat and tongue and makes the probe easier to swallow. The patient will be instructed to take several deep breaths to help relax the muscles in the back of the throat so the probe can be swallowed more easily. Suctioning to decrease the secretions in the mouth and throat may be needed. The tip of the probe sends out sound waves (ultrasound) that echo within the chest wall cavity. These echoes are picked up and create a picture of the heart that is displayed on the video monitor. The procedure takes 10 to 15 minutes. The patient will be occupied for 60-90 minutes.

 Why Is A Transesophageal Echocardiogram Done?  

This test will help the doctor to evaluate the patient's cardiac condition related to the following:

  • If there are any congenital defects, heart valve disease, or heart muscle disease
  • If an artificial valve is functioning properly
  • If there are blood clots within the heart

What Preparation is Needed?  

  • Do not eat or drink after midnight before the procedure.

Ask your Doctor:  

  • How to adjust insulin and food intake if you have diabetes
  • If you should take your regular medications on the morning of the test; If yes, take the medications with water 3 hours before the test

Inform your Doctor:  

  • About allergies to medications
  • If there is a history of difficulty in swallowing, and /or gastric bleeding
  • If antibiotics must be taken with any dental work

What Happens After The Test?  

  • You will not be allowed to eat or drink for at least two hours
  • You may be required to stay after the test is completed
  • You must have someone drive you home after this test
  • You must not be left alone for the rest of the day