PATIENT EDUCATION

What is echocardiography?

Essentially the same as the ultrasound procedures used to see unborn babies, this noninvasive test takes about 15 to 20 minutes. A special gel is placed on your chest and a transducer is moved over the gelled areas to produce images your doctor will interpret.

Echocardiography, also known as transthoracic echo, is a painless test that looks at the heart's chambers and valves. Not an x-ray, it uses ultrasound high frequency waves to get a picture of all heart chambers and valves. The sound waves bounce back and produce images and sounds that can be used by the cardiologist to detect damage and disease.

The test shows the size and shape of your heart and how well it’s working, revealing any wall or section of your heart muscle that’s weak and not functioning correctly. This test may be needed if you have a heart murmur, chest pain, a congenital heart defect or if you’ve had rheumatic fever or a heart attack.

What is an exercise stress test?

The exercise stress test, also called an exercise electrocardiogram, treadmill test, graded exercise test, stress test or stress ECG, is used to provide information about how the heart responds to exertion. It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while your electrocardiogram heart rate and blood pressure are monitored.

As your body works harder during the test, it requires more fuel and your heart has to pump more blood. This test can show if there is a lack of blood supply through the arteries that go to the heart. A stress test can help your doctor see if you have heart disease, and if so, how severe it is. The test monitors your heart rate, breathing and blood pressure.  

What is an electrocardiogram?

An electrocardiogram, also referred to as EKG or ECG, is a test that records the electrical activity of your heart through 10 small electrode patches attached to the skin of your chest, arms and legs. An EKG may be part of a physical exam or it may be used to further investigate symptoms related to heart problems.

EKGs are quick, safe, painless and inexpensive tests that are routinely performed if a heart condition is suspected. Your doctor uses the EKG to:

  •  Assess your heart rhythm
  •  Diagnose poor blood flow to the heart muscle (ischemia)
  •  Diagnose a heart attack
  •  Evaluate certain physical abnormalities, such as an enlarged heart

How should I prepare for the test?

- Avoid oily or greasy skin creams and lotions the day of the test. They interfere with the electrode-skin contact.

- Avoid full-length hosiery, because electrodes need to be placed directly on the legs.

- Wear a shirt that can be easily removed to place the leads on the chest.

What happens during the test?

During the procedure, a technician will attach 10 electrodes with adhesive pads to the skin of your chest, arms and legs. Men may have chest hair shaved to allow a better connection. You will lie flat while the computer creates a picture, on graph paper, of the electrical impulses traveling through your heart. This is called a resting EKG. This same test may also be used to monitor your heart during exercise. It takes about 10 minutes to attach the electrodes and complete the test, but the actual recording takes only a few seconds.

Your EKG patterns will be kept on file for later comparison with future EKG recordings. If you have questions, be sure to ask your doctor. In addition to the standard EKG, your doctor may recommend other specialized EKG tests, including a Holter monitor or a signal-averaged electrocardiogram.

What is cardiac rehabilitation?

A cardiac rehabilitation program helps patients recover after heart problems or surgery. It is a supervised program that includes exercise, lifestyle changes, education, and emotional support for people who have had a heart attack or bypass surgery or who have other heart problems. The cardiac rehab program is individually designed and supervised to enhance your quality of life. The goal is to help you return to and maintain your best possible physical and emotional condition.

What is a pacemaker?

A pacemaker is a small, battery-driven unit that produces a small electrical shock to help your heart beat more regularly. The pacemaker is put under the skin of your chest, just under your collarbone and hooked up to your heart with tiny wires.

What is a stress test?

Used to diagnose heart disease, your doctor may want you to have a stress test because you have symptoms or certain risk factors for it. Your test results can help your doctor determine if you have heart disease, rule it out or see if you may be at risk of heart attack.

A stress test has two phases: the rest phase, in which Cardiolite is injected to show the flow of blood through your heart while you’re at rest. This portion of the test may occur before or after the stress phase, and pictures are taken for the doctor to study.

The stress phase determines whether you may safely exercise or not. If you are able, you will exercise on a treadmill during the test. When you reach your peak exercise level you will be injected with Cardiolite which will be photographed as it travels through your heart. If you are unable to exercise, the medicine will be introduced through an IV, which will mimic the effects of the treadmill.

The stress test is normally completed in one four-hour session or in two-hour sessions on separate days. The tests are performed by a doctor and/or trained technician. Taking a stress test also helps your doctor know the kind and level of exercise that's right for you. The most commonly performed stress test is the exercise stress test.

What is a Holter monitor?

A Holter monitor is a portable EKG that monitors the electrical activity of a freely moving person's heart, generally for one to two days, 24 hours a day. It is most often used when the doctor suspects an abnormal heart rhythm or ischemia, which means not enough blood flowing to the heart muscle.

It is a painless test – electrodes from the monitor are taped to the skin. Once the monitor is in place, you can go home and perform all of your normal activities, except showering. You will be asked to keep a diary of your activities, any symptoms you experience and when they occur.

What is an event monitor?

If your symptoms are infrequent, your doctor may suggest an event monitor. This is a device that, when you push a button, will record and store the heart's electrical activity for a few minutes. Each time you develop symptoms you should try to get a reading on the monitor. They are used for weeks to months, typically one month. This information can later be transmitted by telephone to the doctor for interpretation.

What is a Holter scan?

After the patient wears the Holter monitor for a 24-hour period, he or she brings the monitor back and a technician scans through more than a hundred thousand beats looking for any irregular rhythms or rates. The technician interprets the findings, creates a written report and has it reviewed by an electrophysiologist. Finally, the report is sent to the referring physician.

What is an arterial doppler?

It is a sonogram of the leg which checks for blockages, thrombosis or narrowing of arteries.

What are carotids?

One of the carotid tests is a duplex ultrasound, an imaging procedure that uses high-frequency sound waves to view the blood vessels in the neck and to determine the presence of narrowing in the carotid arteries. This study is recommended in anyone with heart disease and anyone over the age of 60.

Carotid angiography (also known as carotid angiogram, carotid arteriogram or carotid angio), is a test your doctor may schedule prior to treatment if he or she suspects carotid artery disease. This is an invasive imaging procedure that involves inserting a catheter into a blood vessel in the arm or leg, and guiding it to the carotid arteries with the aid of a special x-ray machine. Contrast dye is injected through the catheter so that x-ray movies of your carotid arteries can be taken.

What are the symptoms of carotid artery disease?

There may not be any symptoms of carotid artery disease. However, there are warning signs of an impending stroke. A transient ischemic attack, also called TIA or mini-stroke, is one of the most important warning signs of a stroke. A TIA is a temporary episode of:

  •  Blurred or loss of vision in one or both eyes

  •  Weakness and/or numbness of your arm, leg or face on one side of your body

  •  Slurring of speech, difficulty talking or understanding what others are saying

  •  Loss of coordination, dizziness or confusion

  •  Trouble swallowing

What is a venous doppler?

A venous doppler exam is an ultrasound test for the veins which takes approximately one hour. This exam is performed to evaluate varicose veins or look for a blood clot in the veins. You will rest flat on your back with your head elevated and ultrasound gel is spread on the extremity being examined.

As the ultrasound wand, or transducer, is slid across your arm or leg, it takes pictures of the blood vessels for the physician to interpret. Transducer pressure will be used to see if your veins are compressible. You will also hear doppler noise during the exam. A final report of the test findings are sent to your doctor.

What is PVR?

PVR is a test to check for venous and arterial disease. The patient is hooked up to a series of cuffs, similar to blood pressure cuffs, which are connected to a machine. The machine’s readings will determine if any disease is present.

What is MUGA scan?

There are two types of cardiac blood pool scans to measure how well your heart is pumping blood to the rest of your body. During this test, a small amount of a radioactive substance called a tracer is injected into a vein. A gamma camera detects the radioactive material as it flows through the heart and lungs. The percentage of blood pumped out of the heart with each heartbeat is called the ejection fraction. It provides an estimate of how well the heart is working.

First-pass scan. This scan makes pictures of the blood as it goes through the heart and lungs the first time. A first-pass scan can be used in children to look for heart problems that have been present since birth (congenital heart disease).

Gated scan or multigated acquisition (MUGA) scan. This scan uses the electrical signals of the heart to trigger a camera, which takes a series of pictures that can be viewed like a motion picture. The pictures record the heart's motion and determine if it is contracting properly. MUGA scanning may take two to three hours and can be done both before and after you exercise. You may be given nitroglycerin to see how your heart responds to this medicine.

A cardiac blood pool scan is done to:

  •  Check the size of the heart chambers (ventricles).

  •  Check the pumping action of the lower ventricles.

  •  Look for an abnormality in the wall of the ventricles, such as an aneurysm.

  •  Look for abnormal movement of blood between the heart chambers.

What is a T-Wave Alternans?

In this test, the patient walks on a treadmill for an allotted amount of time to maintain the heart rate at a certain level. The test shows if the patient is at risk for sudden death. There is a very vigorous prep required to hook the EKG. Doctors must keep patients off their beta-blocking medication for at least 24 hours, preferably 48 hours, before the test.

What is a pacemaker check?

The patient needs to have a special machine that they put bracelets on, and they have to take a 30-second cardiogram of the normal rhythm, a 30-second cardiogram of the pace rhythm making sure that it is set at the correct rhythm and rate. Then schedule next appointment.

What is transtelephonic monitoring?

A transtelephonic test is an ECG that is recorded outside the hospital and then sent to the hospital over the phone. This is done using a special device called a transtelephonic monitor. The receipt of the recorded ECG is the most important part of this diagnostic test.

Even though technologies in monitoring devices have improved, it is still the skill and patience of the nurses and technicians receiving the test results by phone who make the difference in useful diagnostic information. Many hospitals and doctors offices that provide this diagnostic test allow the recorded ECG's to be transmitted into a recording machine.

Sometimes a nurse or technician is available only during office hours, and night and weekend ECG transmissions are taken by a recording machine. Recording machines tend to be unreliable, and are not practical for a patient who has had a serious arrhythmia event or for patients who are nervous and frightened.

Instead, our nurse talks to the patient both before and after the transmission, asking the patient to describe the symptoms in his or her own words. The nurse can reassure an anxious patient if the ECG is normal. And if a serious arrhythmia is detected, the nurse can contact the patient's doctor for further instruction.

In the presence of a life-threatening arrhythmia, or in the case of very severe symptoms, the nurse will contact emergency services in the patient's area and notify the doctor immediately. In cases like this, our nurse stays on the phone with the patient until emergency services arrive.

What is venipuncture?

Venipuncture is the collection of blood specimen from a vein, usually for laboratory testing.

How is the test performed?

Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and an elastic band or blood pressure cuff is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the elastic band to fill with blood. A sterile needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe.

During the procedure, the band is removed to restore circulation. Once the blood has been collected, the needle is removed and the puncture site is covered to stop any bleeding.

How will the test feel?

When the needle is inserted to draw blood, you may feel moderate pain, or only a prick or stinging sensation. Afterward, there may be some throbbing.

Why is the test performed?

Blood is the mode of transportation for oxygen, food, waste products, and other materials within the body. It is also used for regulation of body temperature, regulation of fluids, and acid-base equilibrium. Because blood is used for multiple functions within the body, tests on the blood or its components may give valuable clues in the diagnosis of a multitude of medical conditions.

How do I prepare for a test?

Preparation may vary depending on the specific test, and many tests do not require any special preparation. The health care provider may limit certain medications shortly before the test or require an overnight fast to assure an accurate sample.

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