Download Cardiovascular Testing Guide

Cardiovascular Testing Guide
EKG (ECG )
This test records the electrical activity of the heart from twelve different “views” for a few
seconds. It is a basic part of a patient’s cardiovascular exam and is repeated at least yearly for
comparison to previous ECG’s. This test screens for suggestion of many potential heart
abnormalities (ie: old heart attacks, evidence of new heart attacks, evaluating chest pain,
looking for abnormal heart rhythms, and some possible structural problems). One of its
greatest limitations is that it is only a few seconds “view” of the heart’s electrical activity.
Stress Tests:
a. Primarily a test to screen for severe coronary artery disease (CAD).
b. All of the types of stress tests have about the same risk for a patient.
c. The test may also be indicated for evaluating exercise induced dysrhythmias (abnormal heart
rhythms), or patency (assuring the vessels are open) following revascularization procedures (ie: PCI
or CABG).
d. Nuclear Stress Tests (Cardiolite) add nuclear imaging to better assess blood flow to the heart
muscle. The heart’s pump function can also be assessed with these tests. The heart can be stressed
either with exercise or a chemical (we use Adenosine or Persantine (dipyridamide). A nuclear
imaging substance is injected into a vein at peak stress and again for a second set of resting pictures
(the two are compared by the doctor). The nuclear substance most often used in our office is
sestamibi (Cardiolite). Thallium may also be used. The substance adds no more risk to the stress test.
(i) Persantine or Adenosine Cardiolite stress testing is a resting stress test for individuals who
may have a problem with exercise, or have certain heart rhythms (ie: certain paced rhythms). These
medications simulates the way blood flows through the coronary arteries with exercise (they are
vasodilators). If patients have severe symptoms from the persantine its effects can be reversed with
an injection of another medication (theophylline). Adenosine is ultra-short acting and the side effects
begin to rapidly disappear within a minute of completion of the infusion.
(ii) Exercise Cardiolite stress testing uses exercise to stress the heart with nuclear imaging to image
the stressed heart.
e. Stress Echocardiogram is an exercise stress test with the added benefit of ultrasound imaging of
the heart. The heart’s pump function is also assessed with this test. Images are taken at rest and
compared to images taken at the peak of exercise to look for changes in the motion of the walls of the
heart which might suggest severe CAD. This test is NOT the same as a full echocardiogram. The
images are solely of the heart’s wall motion. Heart valves and other structural and functional aspects
are not assessed by this test.
Echocardiogram:
Ultrasound images of the heart are taken from different angles to assess the structure and
function of the heart’s valves and four chambers. This test is often used to assess murmurs,
congenital or acquired heart and heart valve abnormalities, the heart’s pumping function,
chamber sizes and thickness, and blood pressures in the lungs.
24 Hour Holter Monitor:
This test looks for abnormal heart electrical activity (heart rhythm, dysrhythmias, or
arrhythmias). It is often ordered to evaluate symptoms such as fainting (syncope), nearfainting, dizziness, heart racing, skipping, or palpitations. The patient wears a small heart
monitor with monitoring patches and wires (electrodes) on the chest for 24 hours. A “diary”
of symptoms and activities is kept while the monitor is worn to look for correlation between
the symptoms and the patient’s heart rhythm.
30 Day Event Monitor:
This test expands the monitoring period for suspected heart rhythm problems to 30 days. If
no symptoms occur during a 24 hour holter monitor and the patient continues to have
intermittent symptoms, or has only rare episodes of a symptom this device may be used to try
to “catch” the heart rhythm during a symptomatic episode. The patient wears the monitor and
electrodes every day (changing the electrodes daily). The device digitally records the rhythm
for a short period of time and then continuously records over itself. If a symptom occurs the
patient presses a button which will “freeze” that rhythm. Certain event monitors have the
ability to record and “freeze” some abnormal rhythms that may be undetected by the patient
(asymptomatic). It is then downloaded over the telephone to the monitoring company. That
company will mail normal rhythms and fax
abnormal rhythms to us.
Pacemaker Clinic:
Patients with pacemakers and/or AICD’s need a full evaluation of their device by a
pacemaker expert about two months after implant and at least every six months thereafter
(every three months for AICD’s). A full pacemaker evaluation involves not only evaluating
stored data within the device, but other testing (such as thresholds of energy required and
testing how sensitive the monitoring system of the device is). In pacemaker clinic these
devices are “fine tuned” for optimal functioning and monitored for any abnormalities as well
as battery life. A Pacemaker Clinic Visit is scheduled with the pacemaker expert who visits
our office; it is NOT a visit with the doctor or one of our other providers. HOWEVER, the
information gathered and any changes made during the visit are always reviewed by the doctor
within the next day or so following clinic.
ABI’s (Ankle-Brachial Index):
This test is a screening for peripheral arterial disease (PAD). PAD is limitation of blood flow
to an extremity (usually the hips and legs) because of arteriosclerosis, or narrowing of blood
vessels from cholesterol deposits. The most common symptom is pain or discomfort in the
buttocks, thighs or calves when using those muscles (ie: walking). The discomfort usually
resolves with resting those muscles. The test involves measuring blood pressure in all four
extremities with an amplifying device called a Doppler. The blood pressure is normally the
same in all four extremities. If the pressure is lower in the leg(s) than the arms it suggests a
limitation in blood flow to that extremity.
Wathch-PAT 100:
The WP100 device is a non-invasive home monitoring device, intended for use as a
diagnostic aid in the detection of sleep related breathing disorders. It is used to evaluate cases
of suspected sleep disorders.