Download CARDIAC TESTING GUIDE STRESS TESTS: Screen for severe

CARDIAC TESTING GUIDE
STRESS TESTS:
Screen for severe coronary artery disease (CAD). All of the types of stress tests have about the
same risk for a patient. The test may also be indicated for evaluating exercise induced
dysrhythmias (abnormal heart rhythms), or patency (assuring the vessels are open) following
revascularization procedures such as coronary intervention or CABG.
•
Nuclear Stress Tests (Cardiolite) uses 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
Persnatine). A nuclear imaging substance is injected into a vein for resting pictures and
at peak stress. The two sets of images are compared by the doctor. The nuclear
substance most often used in our office is Cardiolite. This substance adds no more risk
to the stress test.
• Adenosine Cardiolite stress testing is a resting stress test for individuals who may
have a problem with exercise or have certain heart rhythms, i.e. certain paced
rhythms. The medication simulates the way blood flows through the coronary
arteries with exercise. It is a vasodilator. If the patient has severe symptoms
from the medication, its effects can be reversed with an injection of another
medication, theophylline.
• Exercise Cardiolite stress testing uses exercise, usually a treadmill, to stress the
heart and nuclear imaging to image the stressed heart.
There is a form for patient instructions for Cardiolite testing that should be given to
each patient scheduled for these tests. Emphasis should be placed on the importance of
following these instructions and being well hydrated the day before. The patient should
be aware that they may be in the office for several hours.
•
Stress Echocardiogram is an exercise stress test with the added benefit of ultrasound
imaging of the heart. Ultrasound 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 coronary artery disease. This test is NOT as complete as an
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 and would require a
complete echocardiogram.
Patients should be instructed not to eat 2 hours prior to the test. No tobacco, caffeine
or beta blocker medications should be used the day of the test. There is an instruction
sheet for this test. The test takes approximately 30 minutes.
ECHOCARDIOGRAM:
An echocardiogram is an ultrasound exam of the heart and its great vessels. The resting
function of the heart is ascertained by imaging the muscle of the heart and the heart valves and
their connective tissues. It also images the blood flow leading into the heart, within the heart
and leaving the heart via the great vessels. A medication called Definity may be utilized through
an IV site to give better visualization of the heart chambers and valves.
Definity is an imaging agent used in connection with either an echocardiogram or a stress echo
to enhance the visibility of the wall definition within the heart. It is administered through an
intravenous site. There are usually no noticeable effects to the patient.
Patients should be instructed not to use any tobacco products the day of the test. The exam
typically lasts 30 -45 minutes.
EKG (ECG) ELECTROCARDIOGRAM:
An EKG records the electrical activity of the heart from 12 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 EKG’s. An EKG will be performed on every new patient. The EKG screens for many
possible heart abnormalities such as old heart attacks, evidence of new heart attacks,
evaluation of chest pain, possible structural problems and abnormal heart rhythms.
No patient preparation is necessary for the test. It takes only a few minutes.
24 HOUR HOLTER MONITOR:
This test looks for abnormal heart electrical activity or arrhythmias. It is often ordered to
evaluate symptoms such as fainting or near fainting, palpitations, dizziness, and heart racing or
skipping. The patient wears a small heart monitor with electrodes and wires on the chest for 24
hours. A patient “diary” of symptoms and activities is kept while the monitor is worn.
No patient preparation is necessary before the monitor is placed. Attaching the monitor takes
15-30 minutes.
30 DAY EVENT MONITOR:
This test allows an extended monitoring period in order to be able to capture intermittent
suspected heart rhythm problems. The patient wears the monitor and electrodes every day.
The device digitally records continuously over itself in a loop. If the symptoms occur the patient
presses a button that will then freeze and record the rhythm at that time. The data is then
downloaded over a land based telephone line to the monitoring company. Abnormal readings
are faxed to the ordering physician to evaluate.
No patient preparation is necessary before the monitor is placed. Attaching the monitor takes
15-30 minutes.
VASCULAR TESTING GUIDE
ABDOMINAL AORTA OR ILIAC DUPLEX:
An ultrasound of the abdominal aorta and its main branches to evaluate their patency.
The patient must fast 8-10 hours prior to the exam. The patient should be well hydrated the
day prior to the test if possible. The exam should be scheduled early in the day. Patient should
bring their medications with them to take immediately following the exam. No tobacco or gum
chewing the day of the test. This test takes approximately 30 minutes.
RENAL ARTERY DUPLEX:
An ultrasound examination of the renal arteries and the kidneys to evaluate patency of the
arteries leading to the kidneys.
The patient must fast 8-10 hours prior to the exam. The patient should be well hydrated the
day prior to the test if possible. The exam should be scheduled early in the day. Patient should
bring their medications with them to take immediately following the exam. No tobacco or gum
chewing the day of the test. This test takes approximately 30 minutes.
CAROTID DUPLEX:
An ultrasound examination performed at rest and lying flat. Bilateral (both sides of the neck)
carotid arteries, subclavian arteries and vertebral arteries are imaged to determine the patency
of these vessels.
No tobacco the day of the test. This test takes approximately 45 minutes.
UPPER OR LOWER EXTREMITY ARTERIAL DUPLEX:
An ultrasound of the upper or lower extremities (arms or legs) to examine patency of the blood
flow to those areas. This may be ordered as a unilateral exam (one side, right or left) or as a
bilateral exam (both sides). An ABI (ankle brachial index) is usually done prior to the exam.
No tobacco the day of the test. The times for this test vary according to the amount of area to
be studied. A unilateral lower extremity takes approximately 45 minutes. A bilateral lower
extremity may take 1 and ½ hours (90 minutes).
LOWER EXTREMITY VENOUS DUPLEX:
An ultrasound examination of the veins in the leg performed to evaluate the venous anatomy
and to identify the presence of a clot or thrombus.
No tobacco the day of the test. This test takes approximately 60 minutes.
SEGMENTAL EXAM:
A test of arterial waveforms of the lower extremities by using pressure cuffs and a specialized
machine to evaluate the arterial flow in the legs. An ABI is part of this exam.
No tobacco or gum chewing the day of the test. This test takes approximately 30 minutes.
ABI (ankle brachial index):
A test to measure a comparison of blood pressure indexes or ratios of the upper and lower
extremities (arms and legs). It is done as a screening test for peripheral arterial disease (PAD).
No tobacco the day of the test. This test takes approximately 15 minutes.
STRESS ABI:
This is an ABI exam done before and after a five minute walk on the treadmill with a mild
incline. This is done to evaluate borderline, known or suspected PAD.
No tobacco on the day of the test. Also patient should not have a large meal prior to the test.
This test takes approximately 30 minutes.
ADDITIONAL TESTS AND THERAPIES:
Cardiac Rehab and Cardiac Therapy: We offer both cardiac rehabilitation and therapy in
partnership with DeRosa Therapy. All questions and scheduling is handled by the cardiac
rehabilitation staff.
Sleep Studies: We offer overnight diagnostic and titration sleep studies as well as home sleep
studies using the Watch-Pat 100. These are methods to aid in the detection and treatment of
sleep related breathing disorders. All questions and scheduling is handled by the sleep staff.
EECP(Enhanced External Counter Pulsation): A schedule of treatments using timed pressure
cuffs to the legs to aid in promoting circulation to the heart muscle. A series of 35 treatments
are scheduled over 7 weeks. All questions and scheduling is handled by the EECP treatment
coordinator.