Stress Test
A stress test is a test in which a non-invasive study of the heart performed
while at exercise. The patient should prepare for this test by wearing loose
comfortable clothing, and sneakers or rubber soled shoes. The patient should also
avoid drinking caffeine or smoking the day of the test. The test will take
approximately one hour and fifteen minutes.
Electrodes are placed on the patient's chest in
order to monitor the heart during the test. Once the doctor has examined the
patient, they will then be asked to begin walking on a treadmill. Blood pressure,
heart rate, and heart rhythm will be monitored throughout the test. The patient will
not be asked to exercise longer than they feel able, and will be asked frequently by the
technician and the doctor how they are feeling during the test.
When the patient can no longer exercise, or the
doctor determines that the test is complete, the treadmill will come to complete stop.
When the test is complete, the doctor and patient will discuss the results.
Echocardiogram
An echocardiogram is a safe, noninvasive test that uses ultrasound (sound waves) to
evaluate the structures, function, and blood flow of the heart. There is no special
pre-test preparation. The test is done in our office. The patient lies on the left
side to enhance viewing of the heart. Electrodes are placed on the patient’s
chest, and an instrument called a transducer is placed on the left side of your chest and
tilted at different places to view the heart.
The echocardiogram usually takes one-half hour to
one hour, depending on the study your doctor has ordered. When the test is complete, the
doctor and patient will discuss the results.
Stress
Echocardiogram
A stress echocardiogram is a non-invasive study of the
heart performed while at rest and again at exercise. An echocardiogram (sonogram) is
performed of the patient's heart while lying down, at rest. This portion of the test
is performed by an echo technician. Then, electrodes are placed on the chest in
order to monitor the heart during the exercise portion of the test. Once the doctor
has briefly examined the patient, the patient will be asked to begin walking on a treadmill. Blood pressure, heart rate and heart rhythm will
be monitored throughout the test. The patient will not be asked to exercise longer
he or she feel they are able. The technician and doctor will ask frequently how the
patient is feeling during the test.
When the patient can no longer continue
to exercise, or the doctor feels the test is complete, the treadmill
will come to a complete stop. The patient will then be asked to quickly walk over to
the table to lay down. At that time, the echocardiogram (sonogram) will be repeated
in order to look at the heart at peak exercise. This allows the doctor to compare
the heart muscle at rest and at exercise. The patient should prepare for this test
by wearing comfortable walking shoes and clothes. Sneakers or flat shoes are
required for walking on a treadmill. When the test is complete, the doctor and
patient will discuss the results.
Dobutamine Stress Echocardiogram
A Dobutamine stress echocardiogram is an invasive study of the heart while at rest.
A medication known as Dobutamine which makes the heart beat stronger and faster is
utilized to imitate exercise in patients that are unable to walk on a treadmill.
An echocardiogram (sonogram) is
performed of the heart while the patient is at rest. This portion of the test will
be performed by an echo technician. The patient will be lying down for the entire
test. Then, electrodes will be placed on the patient's chest in order to monitor the
heart during the test. The nurse will start an intravenous line (IV) in order to
infuse the medication. Once the doctor has briefly examined the patient, the
medication infusion will begin. The dosage of the medication will increase slowly
over time in order to monitor the heart rate, rhythm, and pumping function of the
heart. The echocardiogram (sonogram) will be repeated at intervals throughout the
test in order to evaluate the effect of the medication on the patient's heart. The
doctor and technicians will ask the patient frequently how they are feeling. The
test will be stopped when the required information has been obtained. Before the
test, the patient should avoid coffee, tea and alcohol for at least 4 hours, as they may
cause changes in heart rate and rhythm. The test will take approximately one hour
and fifteen minutes. The doctor will discuss the results at the end of the test with
the patient.
Upright Tilt Table Testing
An Upright tilt table test is an exam used to determine the cause for syncope (passing
out). The entire test lasts about one hour and thirty minutes. During this
time, baseline vital signs including EKG will be taken, and the patient will be prepped
for the test. The patient will be asked to lay down on a procedure table which will
be tilted to various degrees (80° head upright tilt), during which time simultaneous
vital signs, heart rhythm, and oxygen saturation will be monitored. Results of this
test will be discussed with the patient upon completion.
Transesophageal Echocardiogram
The Transesophageal Echocardiogram (TEE) is used to evaluate the internal anatomy
(structure) of the heart and motion of the heart muscle. This test may follow a
regular echocardiogram for further of a documented abnormality or to better assess the
valvular anatomy of the heart.
The patient should not eat or drink for
4 hours prior to the exam. Upon arrival, the patient will be greeted by a nurse or
technician who will review the test procedure and ask the patient to sign a consent form
giving permission to perform the test.
This procedure will involve vital signs
including blood pressure, heart rate, and respiratory rate to be taken and recorded. An IV
(intravenous line) will be started and the doctor will spray the back of the patient's
throat with a local topical anesthetic to numb the throat for the procedure.
The patient will then be asked to swallow a small flexible tube. The tube will be
positioned in the passageway between the mouth and the stomach (the esophagus). This
will cause gagging but will not be painful. A small probe at the end of the tube
will then generate harmless sound waves. The sound waves are bounced off the heart
and then back to a screen to be recorded. The images on the screen will then be
viewed by the physician and used to diagnose abnormalities in the structure of the heart
or the motion of the heart muscle.
The entire test will take approximately
1-1.5 hours. Once the test is over, the patient will be asked to stay for 15-30
minutes for observation. The results of the test will be discussed with the patient
after the test.
Carotid
Ultrasound
A carotid ultrasound is a non-invasive ultrasound evaluation of the arteries
in the patient's neck, known as the carotid arteries. The function of these
arteries is to carry blood from the heart to the brain.
The patient will be asked to lie on a
table for this test. A technician specifically trained to perform this test will
place a probe with ultrasound gel for transmission on each side of the neck over the
carotid arteries. One side of the neck will be evaluated at a time. Ultrasound
pictures will be generated from the probe and transmitted across a television
screen. The probe also has acoustic ability and will allow us to listen to blood as
it travels through the arteries. The test is recorded on a video cassette which will
be evaluated by a physician for final interpretation.
Cardiac
Catheterization
Cardiac catheterization is a minor surgical procedure in which the doctor inserts a small
tube called a catheter into the patient's heart. This is done to measure blood
pressure and blood flow in the chambers and blood vessels of the heart. Blood can be
withdrawn from the heart chambers and analyzed. If necessary, a special dye can be
injected through the catheter, which allows x-ray pictures outlining the heart chambers to
be taken. This is called angiography. If the coronary arteries are to be
outlined, the x-ray dye is directly injected into the arteries. This is called
coronary angiography. Hospitalization is not required for most catheterizations.
The patient will be given medications
that will make them feel relaxed, however, they will remain awake. The patient will
lie on a table that will allow a fluoroscopic x-ray of the heart. The patient will
be given a shot in the groin area to make the insertion of the catheter pain free.
The catheter is inserted through a small incision, and pushed towards the heart
through the blood vessels. Fluoroscopic x-ray is used to follow the position of the
catheter as it passes through the blood vessels.
By twisting the hub of the catheter,
the doctor will direct the tip of the catheter to precise positions in the heart and its
blood vessels. The catheter hub is attached to a pressure measuring device, and
accurate measurements of blood flow and blood pressure are taken from various location in
the heart and blood vessels.
If a picture of the heart chambers,
valves, or heart blood vessels is necessary, a special dye is injected through the
catheter. During this injection, moving x-ray pictures are recorded. The
catheter is then withdrawn.
The doctor will study the x-ray moving
pictures for abnormalities of the valves, check how well the heart is pumping, and look
for possible blockages in the coronary arteries. The direction and the amount of
blood flow through the heart is also measured. After review, the doctor will discuss
the results with the patient.
Percutaneous
Transluminal Coronary Angioplasty (PTCA)
Percutaneous Transluminal Coronary Angioplasty (PTCA) is a procedure that was developed
about 20 years ago that has become one of the most widely used treatments for blocked or
narrowed arteries.
Arteries can become blocked or narrowed
when certain substances build up in the artery wall. These substances--cholesterol,
minerals, blood and muscle cells--are called plaque. The increased blood flow
through the arteries after PTCA reduces the likelihood of a heart attack. It stops
angina pectoris (chest pain), a sign that not enough blood is getting to the
heart muscle.
PTCA has also been used for the
treatment of people with acute heart attacks. Successful PTCA seems to reduce the
heart muscle damage done by the heart attack. It is not yet clear whether PTCA will
become the recommended treatment for these people.
In this procedure, a tube (catheter)
with a deflated balloon at its tip is inserted into an artery in the patient's groin.
The patient will receive a shot first to make the insertion of the catheter pain
free. The patient will remain awake during this procedure. The doctor will
then push the catheter toward the heart watching on fluoroscopic x-ray. When the tip
of the catheter is in the right place in the coronary artery, fluid is pumped into the
balloon.
The balloon expands the narrowed artery
until the plaque cracks slightly. The artery can then return to its normal size.
The balloon remains dilated for about a minute before it is deflated. Some
patients may feel mild chest discomfort while the balloon is inflated, however, this
discomfort usually disappears quickly when the balloon is deflated. Several dilation
may be necessary to properly open the artery. After the doctor is satisfied with the
artery opening, they will remove the catheter. The patient will then return to the
hospital room, and rest for 12 to 24 hours. The patient will most likely be
sent home the next day. Normal activity can usually resume within a day or two.
Shortly after discharge, the patient is scheduled for a follow-up office visit.
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