Nuclear Stress Test (Stress Cardiolite / Thallium) Read the Nuclear Stress Test Instructions Here.
Purpose:
To screen for severe cholesterol blockages of the heart. The use of
nuclear imaging increases the sensitivity of the test over the regular
stress test.
Procedure: (See stress testing.) In
addition to the electrical tracings (EKG), nuclear images of the heart are
obtained before and after exercise. In a normal heart, all the walls
should receive an adequate amount of blood with exercise. Therefore, if a
radioactive tracer (Cardiolite or Thallium) is injected during exercise it
should be seen in all parts of the heart when imaged under a nuclear
camera. Occasionally when a patient is unable to adequately walk to
provide an adequate test, a medication stress test can be done. Commonly a
drug called Adenosine is administered for 6 minutes to simulate the
effects of exercise so that the nuclear tracer can be administered. An
abnormal test may indicate the need for further testing.
Preparation prior to test: See stress testing.
Additionally, do not drink any beverages with caffeine (like coffee) for
12 hours prior to the test.
* Echocardiogram
Purpose: To study the structure and function of the
heart. This test painlessly bounces sound waves off the heart to make
images of the pumping chambers and valves.
Procedure: This test is done in the
office. The patient lies on a bed and a handheld probe images the heart by
placing it on the chest.
Preparation prior to test: None.
* Stress Echocardiography
Purpose: To screen for severe
cholesterol blockages of the heart. The use of ultrasound imaging
increases the sensitivity of the test over the regular stress test.
Procedure: This test is done in our
office. See stress testing. In addition to the electrical tracings (EKG),
ultrasound images of the heart are obtained before and after exercise. In
a normal heart, all the walls should move with exercise. An abnormal test
may indicate the need for further testing.
Preparation prior to test: See stress
testing.
* Stress Testing
Purpose: A simple test to screen for severe
cholesterol blockages of the heart.
Procedure:
This test is done in our office. The patient is attached to electrodes
(sticky patches on skin) that monitor the electrical activity of the
heart. A treadmill is used to exercise by walking on an incline. The
initial speed is slow, but the speed and incline are increased every three
minutes until the target heart rate is achieved. A normal test is
suggested if the electrical tracings remain normal with exercise, whereas
poor blood flow (from blockages) may change the tracings and cause chest
pain. An abnormal test may indicate the need for further testing.
Preparation prior to test: Do not eat or
drink for 4 hours prior to the test. If you have diabetes and take
medicines, get special instructions so we can avoid low blood sugars while
you are fasting. Wear comfortable clothes and walking shoes. If you take a
blood pressure medicine called a Beta- blocker, you may be asked to hold
the medicine prior to the test as the medicine may prevent us from
adequately speeding up the heart rate. Examples of Beta-blockers include:
acebutalol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), bisoprolol
(Zebeta), carteolol (Cartrol), carvedilol (Coreg), labetalol ( Trandate,
Normodyne), metoprolol (Lopressor, Toprol), nadolol (Corgard), penbutolol
(Levatol), pindolol (Visken), propanolol (Inderal), sotalol (Betapace),
timolol (Blocadren). There are also combination drugs with beta blockers:
Corzide, Inderide, Lopressor HCT, Tenoretic, Timolide, Ziac.
* Carotid Artery Duplex
Purpose: To image the arteries in the
neck that supply blood to the brain. Cholesterol blockages can be seen and
quantified.
Procedure: This test is done in the
office. The patient lies on a bed and a handheld probe is placed on the
neck.
Preparation prior to test: None.
* Arterial Segmental Doppler
Purpose: To screen for
blockages in the arteries of the arms or legs.
Procedure:
This test is done in the hospital as outpatient testing. Blood pressure
cuffs are placed on the limbs and blood flow is estimated. Sometimes the
patient is exercised for a short time to increase the sensitivity of the
test. An abnormal test may suggest the need for further testing.
Preparation prior to test: None.
* Arterial Duplex
Purpose: To screen for cholesterol blockages
in the arteries of the arms or legs.
Procedure:
This test is done in the office. The patient lies on a bed and a handheld
probe is placed on the limb to visualize the arteries and estimate the
severity of a blockage. We often combine the test with blood pressure
checks in the limb to increase the accuracy of the test.
Preparation prior to test: None.
* Venous Duplex
Purpose: To image clots in the veins of the
legs.
Procedure: This test is done in
the hospital as outpatient testing. An ultrasound probe is placed on the
legs and the veins are imaged. A normal test is suggested if the vein has
normal blood flow and is easily collapsible when compressed.
Preparation prior to test: None.
* Event Monitor
Purpose: To study the electrical
activity of the heart when the cardiac symptoms occur infrequently. This
monitor is carried by the patient for up to a month. It will only record
when the patient activates it.
Procedure:
The recorder is activated when the button is pressed. After the recording
is taken it is transmitted by telephone to a monitoring company and
electrical strips are sent to our office. Preparation prior to test:
None.
* 24 Hour (Holter) Monitor
Purpose: To study the electrical
activity of the heart over a 24 hour period. It records the heart rhythm
continuously to capture electrical abnormalities of the heart
(arrhythmia).
Procedure: This test is done in our
office. After the nurse places the electrodes to the skin, the patient
takes home a small digital recorder for 24 hours and engages in his usual
activities (except anything that endangers the monitor such as jumping in
water). The patient keeps a diary of any symptoms that occur. The Holter
should be returned to our office the next working day so the data can be
analyzed.
Preparation prior to test: None.
* Transesophageal Echocardiogram (TEE)
Purpose: To study the
structure and function of the heart. This test bounces sound waves off the
heart to make images of the pumping chambers and valves. As the imaging
probe is swallowed, this test provides very high quality images of the
heart.
Procedure: This test is scheduled in the
hospital as an outpatient. The mouth is sprayed with a local anesthetic
and a mild sedative is given. The patient swallows the probe which looks
like a long tube. Pictures are taken of the heart then the probe is
removed. The test usually takes around 10 to 15 minutes.
Preparation prior to test:
Do not eat or drink anything for at least 8
hours before the test. You must have a ride home, so bring a family
member. If you have medicines to take, take them with a sip of water. If
you are diabetic, check with the doctor. You might be asked to wait on
taking your diabetes medicines until after the test so that your blood
sugar does not get too low while fasting.
* Angiography (Cardiac or Vascular Catheterization / Intervention)
Purpose: To visualize the arteries of the body. Cardiac angiography
visualizes the arteries of the heart only. Angiography may also be
performed of the arteries of the extremities, kidneys, or carotid
arteries. When blockages are found, they can sometimes be opened by an
interventional procedure. Frequently a balloon is used in a procedure
called an angioplasty. The balloon is inflated to expand the blockage.
Other devices are also available such as stents, which are metal cages
that act as scaffolding to help keep the artery open.
Procedure: This test is performed in the
hospital. The patient receives a mild sedative to maintain comfort. After
being placed on the x-ray table, a local anesthetic is injected into the
skin of the leg (or arm) using a small needle. Another needle is used to
puncture the artery on the leg and a guide-wire (flexible wire) is
threaded into the artery. A short, hollow plastic tube (sheath) is
threaded over the wire and left in the artery to allow access of a
smaller, long hollow plastic tube called the catheter. The catheter is
introduced through the sheath and placed near the artery to be imaged.
X-ray dye (contrast) is injected into the artery and images are obtained
in several different views. Pressure measurements within the body may also
be obtained. After the procedure is over the catheter and sheath are
removed and firm pressure is held over the puncture site over the groin to
seal the puncture site. The patient must then lie flat on his back for 4
to 6 hours. Most people are sent home the same day, but are kept overnight
if an intervention is performed.
Preparation prior to test: Some routine blood
tests are done before the test. These tests may be done a few days before
the procedure. You will be contacted by the hospital. Pack a small bag in
case you are kept in the hospital overnight. Make arrangements for someone
to drive you, as you will not be permitted to drive after the procedure.
Bring a list of your medicines. Do not eat or drink anything 6 hours prior
to the test. You may have sips of water to swallow your medicines. Notify
us if you are allergic to x-ray contrast, drugs, or local anesthetic. If
you have diabetes and take medicines, get special instructions so we can
avoid low blood sugars while you are fasting. The diabetes drug metformin
(Glucophage) is held for 48 hours before the test as it may interact with
the x-ray contrast. If you take the blood thinner warfarin (Coumadin) get
special instructions as it is usually held 4 to 5 days before the
procedure. Aspirin is usually not a problem.
* Inferior Vena Cava (IVC) Filter
Purpose: To place an umbrella
like device in the large vein prior to the heart, to prevent clots from
going to the lungs. This filter catches clots that are travelling towards
the heart and lungs.
Procedure: This procedure is done in the
hospital. The patient receives a mild sedative to maintain comfort. After
being placed on the x-ray table, a local anesthetic is injected into the
skin of the leg using a small needle. Another needle is used to puncture
the vein of the leg and a guide-wire (flexible wire) is threaded into the
vein. A short, hollow plastic tube (catheter) is threaded over the wire
and x-ray dye (contrast) is injected into the large vein that carries
blood from the legs to the heart (inferior vena cava). After the
appropriate location is found, the filter device (which looks like an
umbrella) is deployed and permanently sits in the vein. The catheter and
wire are removed and the procedure is complete.
Preparation prior to test: Do not eat or
drink for 6 hours prior to the test. If you have diabetes and take
medicines, get special instructions so we can avoid low blood sugars while
you are fasting. Notify us if you are allergic to x-ray contrast or local
anesthetic.
* Pacemakers
Purpose: A small permanent device placed under the skin
that is used to treat a slow heart rate. The pacemaker monitors the
heart's electrical activity and stimulates the heart if it is beating too
slowly.
Procedure: Most
often the pacemaker is implanted in the upper chest near the left
shoulder. The patient receives a mild sedative to maintain comfort. A
local anesthetic is used to numb the skin where a small incision is made.
An electrical lead is placed in the vein under the skin and collarbone. A
x-ray camera is used to place the lead into the appropriate position in
the heart. The lead is attached to the pulse generator (a metal case
comprised of the battery and circuitry that is the size of a silver
dollar. The incision is closed with suture and or staples.
Preparation prior to test: Some routine blood
tests are done before the test. These tests may be done a few days before
the procedure. You will be contacted by the hospital. Pack a small bag as
you are kept in the hospital overnight. Make arrangements for someone to
drive you, as you will not be permitted to drive after the procedure.
Bring a list of your medicines. Do not eat or drink anything 6 to 8 hours
prior to the test. You may have sips of water to swallow your medicines.
Notify us if you are allergic to x-ray contrast, drugs, or local
anesthetic. If you have diabetes and take medicines, get special
instructions so we can avoid low blood sugars while you are fasting. If
you take the blood thinner warfarin (Coumadin) get special instructions as
it is usually held 4 to 5 days before the procedure.
* Electrocardiogram (EKG)
Purpose:
To study the electrical activity of the heart.
It provides basic information on heart rhythm.
Procedure: This test is done in our
office, usually at the time of an office visit. Electrical wires
(electrodes) are attached to the skin and a recording is painlessly made.
Preparation prior to test: None.
|
