Diagnostics

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Abdominal Ultrasound

  • Purpose of Test:

    Non-evasive sonogram evaluating the major organs of the abdomen, including the liver, gallbladder, bile ducts, pancreas, spleen, kidneys, and large vessels.
  • What to Expext During Procedure:

    The patient will lie down during the examination, which will take 30-45 minutes.
  • How to Prepare:

    Eat a fat-free meal the evening before the examination. Nothing to eat or drink after midnight. Do not brush your teeth or smoke the morning of examination if you still have a gallbladder.

Aorta Sonogram

  • Purpose of Test:

    Non-evasive sonogram of the aorta. The aorta is the large artery originating from the heart that extends downward along the left side of the spine. This study demonstrates the presence of plaque, or blockage in the artery. The aorta is also evaluated for aneurysm or enlargement.
  • What to Expext During Procedure:

    This test will take approximately 1 hour. A technician will place placing a transducer on your abdomen with a small amount of ultrasound gel. The transducer sends sound waves through your abdomen to the aorta and back. Then with the aid of computers software and a monitor we are able to image the aorta and display it on a monitor in front of you. In conjunction with this imaging we will assess the blood flow with both pulsed Doppler and Color Flow Doppler, which measure the speed and direction of the blood flow. By assigning color to the direction of blood flow—called Color Flow Mapping—large areas of blood flow may be studied, which allows abnormal blood flow characteristics to be interpreted by the cardiologist.
  • How to Prepare:

    Please do not eat or drink anything 8 hours prior to the test. Also it is best not to eat any gas-producing foods the day before the examination. If you routinely take any medications take them as prescribed with a small amount of water.

Arterial Doppler

  • Purpose of Test:

    The Arterial Doppler study is able to demonstrate blocked or reduced blood flow through the major arteries of the arms and legs. It is used to evaluate:

    • Numbness and tingling sensations in the hands, arms, feet and legs
    • Sensation of fatigue and heaviness in the arms and legs
    • To investigate the possibility of thoracic outlet syndrome.
  • What to Expext During Procedure:

    For the Arterial Doppler exam a blood pressure cuff is applied to each of the arms and legs and a pressure is recorded for each extremity cuff. The pulse is also taken and recorded for each of the extremities. The patient may then be exercised and blood pressure recordings repeated or an ultrasound may be performed to assess the arteries for the location and the amount of narrowing. When evaluating for thoracic outlet syndrome of the upper extremities, the patient will be asked to perform a series of arm movements while recordings are documented.

    The Arterial Doppler studies take approximately 60-90 minutes.
  • How to Prepare:

    None necessary.
  • When Results will be Available:

    Results are available to the physician for interpretation as soon as the examination is completed.

Cardiac Catheterization

  • Purpose of Test:

    Helps doctors diagnose a heart problem accurately and allows them to choose the most effective treatment.
  • What to Expext During Procedure:

    You will be taken to the cath lab in a wheelchair or on a moveable bed. Then you will be helped onto an x-ray table. The table has a large x-ray camera above it and television screens close by. There are are also heart monitors and other instruments.

    The cath lab team generally includes a cardiologist, an assistant, nurses, and technologists.

    Once you are positioned on the x-ray table, you will be connected to several monitors and then covered with sterile sheets. The staff will be wearing sterile gowns, gloves, and possible masks.

    The site where the catheters will be inserted is usually in the groin. Sometimes it is in the wrist or arm. The site is cleansed thoroughly. A local anesthetic is injected into the skin with a tiny needle to numb the area. This may cause a stinging sensation. A small incision is made in the skin, and a needle is used to puncture the blood vessel (usually an artery). A guide wire is threaded into the artery. A short plastic tube, called a sheath, is then slipped over the guide wire and into the artery. The guide wire is then removed.

    Once the sheath is in place, doctors can insert and remove several different catheters without having to use a needle each time. The catheter is inserted into the artery and guided toward the heart, while the staff watches its progress on a TV screen. The catheter may be removed and replaced several times. This is done to reach each of the heart chambers or coronary arteries.

    Once the catheter is inside the heart, the doctors can measure the pressures in the left ventricle and take pictures of the coronary arteries and left ventricle.

    You may be given medication to help you relax and make you drowsy. You may be awake or you may sleep through part or all of the procedure. The staff will be monitoring you at all times.

    You may be asked to take a deep breath and hold it, to keep the pictures from blurring.

    You may also be asked to cough forcefully several times, to help move the dye through the heart. The procedure generally is not painful, although you may feel some pressure as the catheters are inserted. You will not feel the catheters as they move through the blood vessels and into your heart. For many, the most difficult part of the procedure is having to lie still for a long time on a hard table. As x-ray contrast is injected into the heart, you may feel a warm sensation through your body lasting 20 to 30 seconds. You may also feel nausea, chest discomfort, or a mild headache.

    A complete cardiac catheterization procedure usually takes from one to two hours. If you feel pain or discomfort at any time during the procedure, let the staff know.

    After the catheters are removed, the doctor or nurse applies firm pressure to the insertion site for 10 to 20 minutes, to keep the site from bleeding. In some cases, doctors use a compression device to apply pressure to the site. Other times, they may use a vascular closure device to seal off the small hole left in the artery after the procedure.

    You will then be taken to a recovery area or to your room. You will be encouraged to drink liquids to help flush the contrast out of your body.

    If the catheters were inserted in your groin, you will need to lie flat on your back form 2 to 6 hours, so that the site can begin to heal properly. During that time, do not bend or lift your leg. To relieve stiffness, you may move your foot or wiggle your toes.

    The nurse will check your pulse and blood pressure often, and will also check the insertion site for bleeding. If you feel sudden pain at the site or if you notice bleeding, let the nurse know right away.

    The doctor who performed the procedure may give you some preliminary results soon after the test is over. However, a thorough, detailed analysis of all the findings will take more time.

    Most patients go home the same day. Some patients may need to stay for more tests or treatments. When it is time to go home, have a family member or a friend drive you.

    At home, after the procedure limit your activity during the first couple of days at home. You can move about, but do not strain or lift heavy objects.

    Leave the dressing on your groin or arm until the day after the procedure. The nurse will tell you how to take it off and when it is OK to take a shower.

    A bruise or a small lump under the skin at the catheter insertion site is quite common. It should disappear within a few weeks. Call your doctor or nurse if the insertion site becomes painful or warm to the touch, or you develop a temperature over 100 F. Ask you doctor when you can return to your normal activities, and whether there are things you should not do.

    Be sure to check with your doctor or nurse about medications which ones to keep taking and which ones to stop.
  • How to Prepare:

    Generally, you will be asked not to eat or drink anything for 6 to 8 hours before the procedure. This helps prevent nausea. You may have small sips of water to take your medications.

    Check with your doctor several days before the procedure . You may be asked to take medication, such as aspirin, for a few days before the procedure.

    Make arrangements for someone to drive you to and from the procedure. You will not be permitted to drive after the procedure since you may be sedated.

    Pack a small bag incase your doctor decides to keep you in the hospital overnight.

    Bring a list of the names and dosages of all the medications you are taking.

    Tell the doctor or nurse if you have had any allergic reactions to medications or x-ray dye, iodine, or seafood, or if you have a history of bleeding.

    For your comfort, empty your bladder as much as possible before the procedure begins.

Carotid Doppler

  • Purpose of Test:

    Carotid Doppler studies are used to demonstrate blocked or reduced blood flow in the arteries of the neck that could cause stroke. This test is also used to evaluate symptoms of dizziness, vision changes and loss of balance that may be caused by impeded or restricted blood flow through these vessels.
  • What to Expext During Procedure:

    The room is usually darkened for the exam. A gel is applied to the neck area to provide good contact for the handheld transducer. The transducer is placed on the neck and sound is sent into the body and is reflected off arteries and returned to the transducer. The echoes are converted electronically into images of the arteries that can be seen on a monitor. These images are recorded on paper or film. With Doppler and Color Doppler the sound waves reflected from the blood cells are converted to audible sounds that can be heard during the exam. Color is used to represent the blood flow in the artery and the speed and direction of the flow are assessed by the physician. This procedure takes approximately 45 minutes.
  • How to Prepare:

    None necessary.
  • When Results will be Available:

    Results are available for interpretation as soon as the examination is completed.

Contrast Echo with Definity

  • Purpose of Test:

    Echocardiogram examination with the addition of a contrast agent called Definity. Definity is a gas found in the bloodstream, used to increase visibility of the inner heart muscle. There are no side effects of allergies associated with use of Definity.
  • What to Expext During Procedure:

    It is necessary for the patient to have an IV line put in place in the arm or hand during the examination. The study will take approximately 45-60 minutes.
  • How to Prepare:

    None necessary.

Echocardiogram

  • Purpose of Test:

    The echo gives doctors useful information about the heart. For example, the size of the heart chambers and the thickness of the walls, the heart’s pumping strength, the valve function, and other heart conditions.
  • What to Expext During Procedure:

    During an echo test, a small microphone-like device, called a transducer, is held against the chest. The transducer sends ultrasound waves that bounce off the various parts of the heart.

    The transducer picks up the reflected sound waves and sends them to a computer. The computer turns the echos into a moving image of the heart. The image is displayed on a monitor screen, and it can also be recorded on video or printed on paper.
  • How to Prepare:

    None necessary.
  • When Results will be Available:

    If a doctor is performing the test, you may be able to receive results before you leave. Otherwise, your own doctor will discuss the results with you during a future office visit.

Event Monitor

  • Purpose of Test:

    The Cardiac Event Monitor is used to detect abnormal heart rhythms. This small device records the heart's electrical activity (rhythm) at the push of a button. Patients trigger the device when they first begin to feel signs (an "event") such as:

    •Dizziness
    •Weakness
    •Lightheadedness
    •Heart racing and /or fluttering

    The monitor stores the heart rhythm. Later that rhythm is sent via the telephone to the doctor for review. This test allows for on-demand heart monitoring outside the hospital/clinic setting when symptoms are noted and as you go about your normal routine. The test results help guide your doctor to choose treatment options to meet your specific needs.
  • What to Expext During Procedure:

    The monitor, about the size of a deck of cards, is clipped to your waistband. This monitor is connected to a set of wires which attaches to two electrodes worn on your chest (like an EKG). The monitor can be worn for up to 30 days. It is removed during bathing.

    During the test

    After a technician explains the test, your chest will be "prepped" for electrode placement. The electrodes measure the heart's electrical activity. The electrode placement areas may be shaved if needed. Then the area is cleaned with water or rubbing alcohol, or a pumice solution designed for this purpose. Once the electrodes are in place, monitoring wires are attached to each electrode. The other ends of the lead wires are connected to a recording monitor.

    Once monitor is in place the tech will explain in detail how to:

    •Trigger the monitor to record you heart rhythm
    •Use the diary to record symptoms
    •Change the electrodes and the monitor batteries
    •Attach the monitor wires
    •Who to call with questions
  • How to Prepare:

    Before the test:
    Tell your doctor if you are allergic to any tape or other adhesives. There is no other special preparation for the test.

    Day of the test:
    Wear a two-piece outfit, such as a jogging suit or shirt and slacks for easier access to the chest. Avoid wearing lotions or oils on the chest area.

    Be sure to bring:
    •Your doctor's written order for the test •Insurance card •Medicare Card ( Medicare patients)
  • When Results will be Available:

    Your final test report will be sent to your doctor after the monitor is returned and all the recordings have been reviewed by a cardiologist. A full report will be sent/ faxed to your doctor within five days.

Holter Monitor

  • Purpose of Test:

    A Holter monitor is a portable EKG device that records your heart rhythm over time, outside the hospital or doctor's office. Whereas a regular EKG examines your heart's electrical activity for a few minutes, the Holter monitor examines changes over a sustained period of time-usually a 24- to 48-hour period-while you go about your daily activities and even while you sleep. Doctors use it to evaluate symptoms that come and go and that might be related to heart-rhythm changes.
  • What to Expext During Procedure:

    A technician in your doctor's office or a diagnostic lab fits you with a Holter monitor and explains how to use it. Five stickers are attached to your chest. Wires snap onto each of these stickers and connect them to the monitor. The wires detect your heart's electrical pattern throughout the day, while the monitor records and stores the data for doctors to interpret later. You can fit the monitor into a purse or jacket pocket or wear it over your shoulder by its strap.

    You can go about your normal activities with two exceptions. First, you can't take a shower or bath during the period that you're wearing the monitor. Second, you are given a small diary in which to note any worrisome symptoms you feel and record the time when they occur. The doctor will later review both your diary and the data about your heart's activity from the monitor, to see if any symptoms you experienced were caused by some underlying heart problem. There are no side effects from the testing.
  • How to Prepare:

    Men with a lot of hair on their chest will probably have to shave it. Otherwise, there's no special preparation.
  • When Results will be Available:

    It usually takes a few days for your recording to be printed and examined.

LE Arteriogram

  • Purpose of Test:

    A study used to evaluate the arteries of the pelvis and legs.
  • What to Expext During Procedure:

    The exam will last approximately 30 minutes. An IV will be started and several questions pertaining to prior medical history will be asked.

    Once on the table the patient will be monitored by an EKG. The patient’s blood pressure and oxygen saturation will also be monitored. A mild sedation may be given to ease anxiety.

    The patient’s groin area will be prepped with betadine soap. A sterile drape will be applied. The physician will inject a local anesthetic to groin area and a small tube called a sheath will be inserted in the femoral artery. During the injection on contrast, the patient will feel warm or may experience slight burning sensation to area contrast is injected to.

    The patient will go to a holding area where sheath will be removed and pressure will be applied for approximately 20 minutes. The patient will be on bed rest for 2 hours. A small meal will be given approximately 1 hour after procedure.
  • How to Prepare:

    Nothing to eat or drink for 6-12 hours prior to procedure. If patient is allergic to contrast or seafood, iodine premeditation will be required 24 hours prior to procedure.
  • When Results will be Available:

    Physician will inform patient of findings prior to patient leaving facility.

MUGA

  • Purpose of Test:

    The MUlti-Gated Acquisition (MUGA) scan is a non-invasive nuclear test that uses a radioactive isotope called technetium to evaluate the functioning of the heart’s ventricles.

    The MUGA scan is performed to determine if the heart’s left and right ventricles are functioning properly and to diagnose abnormalities in the heart wall. It can be ordered in the following patients:
    •With know or suspected coronary artery disease, to diagnose the disease and predict outcomes •With lesions in their heart valves •With congestive heart failure •Who have undergone percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, or medical therapy, to assess damage to heart tissue and predict the likelihood of future cardiac events •With low cardiac output and open-heart surgery •Who are undergoing chemotherapy
  • What to Expext During Procedure:

    After ECG leads are attached, the technetium is injected, usually into an arm vein. You lie on an examination table under the gamma scintillation camera, and hold still without speaking during the scanning process. Images are viewed on a video screen and recorded on a computer for later viewing and interpretation.
  • How to Prepare:

    None necessary.
  • When Results will be Available:

    A computer is used to process and analyze the data, which is then interpreted by a doctor trained in nuclear cardiology.

Nuclear Stress Test

  • Purpose of Test:

    A nuclear stress test lets doctors see pictures of your heart while you are resting and shortly after you have exercised. The test can give information about the size of the heart's chambers, how well the heart is pumping blood, and whether the heart has any damaged or dead muscle. Nuclear stress tests can also give doctors information about your arteries and whether they might be narrowed or blocked because of coronary artery disease.
  • What to Expext During Procedure:

    You will have small metal disks called electrodes placed on your chest and back. The electrodes are attached to wires called leads, which are attached to an electrocardiogram machine. Doctors will then have you walk on a treadmill.

    After your doctors have the information they need from the exercise part of the test, you will step off of the treadmill and go into another room. You will be given an injection of a radioactive substance, and you will be asked to lie on an examination table, which has a gamma-ray camera above it. The camera is used to take pictures of your heart. The camera can pick up traces of the radioactive substance in your body and then send a picture to a television monitor.

    After this part of the test is over, you can leave the testing area for 3 or 4 hours. Doctors will ask you not to exercise or drink or eat anything with caffeine, such as coffee, tea, sodas, or chocolate. When you return, doctors will give you another injection of the radioactive substance. You will be asked to lie down on the examination table, and the gamma-ray camera will take pictures of your heart while you are resting. This will give your doctor an idea of how your heart works during both exercise and rest.

    After the test is over, you may eat, drink, and go back to your normal activities right away.
  • How to Prepare:

    None necessary.

Peripheral Arteriogram

  • Purpose of Test:

    A Peripheral Arteriogram is performed to test for Peripheral vascular disease. Peripheral vascular disease is caused by arterial blockages or narrowings that restrict the flow of blood to the body excluding the heart. The most common symptom is intermittent claudication. It includes cramping, pain or fatigue in the calves, thighs or buttocks when walking which is relieved when at rest. This condition limits the ability to perform daily and recreational activities.
  • What to Expext During Procedure:

    The procedure requires about an hour. You will be awake, but sedated and comfortable. The cardiologist and lab staff will explain each step of the procedure. If you have questions at any time, please ask.

    The area of the insertion will be scrubbed. You will be covered with sterile sheets and the area will be numbed with a local anesthetic. You will feel pressure during the procedure but you should not feel any pain.

    The cardiologist will place a catheter into a blood vessel from a site in your groin area and maneuver it into place to allow for testing. Tests include x-rays of the leg arteries.

    A contrast solution will be injected through the catheter into your leg arteries. You may feel a warm or hot sensation during the injection but it should last only about 30 seconds. If you experience any pain, please tell the physician or nurse. It's very important to lie very still during the procedure.

    A dressing and five-pound sandbag may be placed over the insertion site and you will be asked to lie flat for about four hours. At that time, you will be allowed to roll to your side and the sandbag can be removed.

    Your IV will remain in place for most of the day and your heart rate, blood pressure and the insertion site will be monitored regularly. You will be allowed to eat and drink as soon as you feel comfortable.

    You will continue to receive intravenous fluids and you will be encouraged to drink fluids to help flush the contrast solution from your kidneys. A nurse will assist you when you feel ready to get out of bed. You may feel dizzy or lightheaded.

    In some cases, you may be allowed to return home and resume restricted activity later the same day. In other cases, you may remain in the hospital or a nearby hotel overnight.

    You may continue to have a bruise, swelling and tenderness at the insertion site. Do not lift anything over 10 pounds for a week after the procedure.
  • How to Prepare:

    After you and your physician have discussed the procedure, you will be asked to sign a consent form. Please read it carefully and ask any questions you have.

    Do not eat or drink anything after midnight the night before the procedure. If you are diabetic, please let your doctor know.

    An intravenous needle will be placed in your arm. Blood may be drawn for use in laboratory tests and you will receive medication to help you relax.
  • When Results will be Available:

    Before you leave, your physician will discuss the results of the test and explain your treatment plan with you.

TEE

  • Purpose of Test:

    A TEE is usually done when doctors want to examine hard to see structures of the heart. Here are a few situations where a TEE may be done:

    •to detect blood clots or masses inside the heart •to assess the severity of some valve defects •to examine prosthetic heart valves •to evaluate holes between the heart chambers •to detect infection of the heart valves •to diagnose a dissection in the lining of the aorta, the body’s main artery •to obtain clearer images than a standard echo would give
  • What to Expext During Procedure:

    The TEE is done at a hospital, clinic, or test center, often as an outpatient procedure. When you arrive for the test, you’ll change into a hospital gown, and then be taken to the procedure room.

    You will be asked to lie on your left side. Your throat will be sprayed with an anesthetic to numb it. You may be given a low dose of a sedative through the IV line in your arm, to help your relax. You may be also be given antibiotics, to help prevent an infection.

    The doctor gently inserts the probe into your mouth. As you swallow, the tube is slowly directed into the esophagus. You may gag when the probe first enters the esophagus, and you may feel the probe moving, but the procedure is generally not painful.

    The transducer is positioned in the esophagus, just behind the heart, where high quality images can be recorded. With the help of control knobs, the doctor can move the tip of the probe up, down, and sideways. This makes it possible to view various parts of the heart from different angles.

    Your heart rate, blood pressure, and oxygen level are carefully monitored throughout the test. Suction may be used to clear secretions from your mouth. You may also be given oxygen.

    The procedure itself usually takes 15 to 20 minutes. However, you should allow about two hours from our arrival to the time you can leave.
  • How to Prepare:

    Do not eat or drink for 6 hours before the procedure, to make sure your stomach is empty. If yo have diabetes and take medication for it, you will need special instructions.

    Have someone drive you to the hospital or clinic. Also, arrange to have someone drive you home afterwards. Do not plan to drive yourself home, as you may be drowsy.

    Tell the doctor if you have any conditions involving your esophagus or stomach, or if you have a problem swallowing.

    Also, tell the doctor or nurse if you have allergies to any medications, especially sedatives.

    If you wear dentures or oral prostheses, you will need to remove them, as they can interfere with the test.

    An intravenous line will be inserted into a vein in your arm, to allow injection of drugs, such as sedatives or antibiotics.
  • When Results will be Available:

    The doctor performing the procedure may be able to give you preliminary results before you leave. Your own doctor will discuss the final results with your during a future office visit.

Thyroid Sonogram

  • Purpose of Test:

    Non-evasive sonogram of the thyroid gland in the neck. This study will evaluate the thyroid tissue for any lumps or masses as well as check the size of the gland.
  • What to Expext During Procedure:

    The patient will lie down for the examination, which will take approximately 30 minutes.
  • How to Prepare:

    None necessary.

Tilt Table

  • Purpose of Test:

    If you’ve been having fainting spells, a tilt table test can help your doctor determine the cause of the problem.

    Syncope is the medical term for a fainting spell. It is a sudden and brief loss of consciousness. Syncope occurs when the brain does not get enough blood flow and oxygen. There are many causes for syncope, such as low blood pressure, abnormal heart rhythms, narrowed heart valves, and seizure disorders, to mention just a few.

    The tilt table test is used to asses a common type of syncope, called neurocardiogenic syncope. In neurocardiogenic syncope, the nerves that control the function of the heart and blood vessels do not work properly. This may cause the heart to slow down and blood pressure to drop, and may result in loss of consciousness. Typical symptoms of neurocardiogenic syncope may also include dizziness, sweating, nausea, and a feeling of almost passing out.

    The tilt table is performed to induce symptoms of syncope while your heart rate, blood pressure, and symptoms are monitored.
  • What to Expext During Procedure:

    Tilt table test is generally performed at a hospital, test center, or clinic.

    Several electrodes (small sticky patches) will be placed on your chest to obtain an electrocardiogram (ECG) and monitor your heartbeat. A blood pressure cuff or similar device will be placed on your arm or around one of your fingers to monitor your blood pressure. An IV will be inserted into a vein in your other arm, so that fluids and medications can be injected. You will then be asked to lie down on a special table, called a tilt table. Safety straps will be fastened across your chest and legs.

    You first lie quietly for several minutes. The table is then moved until your head is nearly upright, a tilt of about 60 to 80 degrees. Even though you lie on a table that is at a steep angle, it feels as if you are standing on a footboard at the bottom of the table.

    You remain in this upright position for a relatively long period of time, up to 45 minutes. Your heart rate and blood pressure are continuously monitored. It’s important that you let the doctor or nurse know if you develop symptoms, such as nausea or dizziness.

    Patients who susceptible to neurocardiogenic syncope often develop a decrease in heart rate and a drop in blood pressure. They may also experience symptoms (such as nausea, dizziness, or faintness). In that case, the table is lowered to the flat position, which restores blood pressure within a few seconds. If you complete the 45-minute period of upright tilt without developing a significant drop in your blood pressure, the table is lowered to the flat position and you may undergo the second part of the test.

    The second part of the test evaluates how your blood pressure responds to a medication that is very much like your own adrenaline.

    The medication is injected very slowly through the IV line in your vein. You may feel your heart beating a little faster and stronger. The table is again moved to an upright position, for up to 45 minutes, while you are being closely monitored.

    The test is called “positive” (abnormal) if you blood pressure drops and you develop symptoms. Such symptoms may include dizziness, nausea, a cold and clammy feeling, or a sensation that you are about to pass out. Few patients actually faint during the test, because the tilt table is returned to the flat position before they lose consciousness.

    A complete tilt table test, including preparation for the test, generally lasts from one to two hours. If your test is positive, you may feel a little unsettled and possible queasy for the first minutes after the test. If this happens, you will be allowed to fully recover before you stand up and get dressed. Most patients feel perfectly normal within 5 to 10 minutes after the test.
  • How to Prepare:

    Generally, you will be asked not to eat of drink for at least 4 hours before the test. If you have diabetes and take medication for it, you will need special instructions.

    If you take heart medications, check with your doctor when you schedule the test. He or she may ask you to stop certain medications a day or two before the test.

    Make arrangements for someone to drive you to and from the procedure.
  • When Results will be Available:

    The doctor conducting the test may be able to give you preliminary test results before you leave. Or, your own doctor will discuss the test results with you during a future office visit.

    The test helps doctors determine whether or not you are susceptible to neurocardiogenic syncope. The information gained for this test helps your doctor make an accurate diagnosis of your condition and develop a treatment plan that’s best for you.

Treadmill

  • Purpose of Test:

    Non-evasive sonogram evaluating the major organs of the abdomen, including the liver, gallbladder, bile ducts, pancreas, spleen, kidneys, and large vessels.
  • What to Expext During Procedure:

    Do not eat or drink for three hours prior to the procedure. This reduces the likelihood of nausea that may accompany strenuous exercise after a heavy meal. Diabetics, particularly those who use insulin, will need special instructions from the physician's office.

    Specific heart medicines may need to be stopped one or two days prior to the test. Such instructions are generally provided when the test is scheduled.

    Wear comfortable clothing and shoes that are suitable for exercise.
  • When Results will be Available:

    The physician conducting the test will be able to give you the preliminary results before you leave the exercise laboratory. However, the official result may take a few days to complete.

Venous Doppler

  • Purpose of Test:

    The most common reason for a venous ultrasound exam is to search for blood clots, especially in the veins of the leg. This condition is often referred to as deep vein thrombosis or DVT. These clots may break off and pass into the lungs, where they can cause a dangerous condition called pulmonary embolism. If found in time, there are treatments that can prevent this from happening.

    A venous ultrasound study is also performed to:

    •determine the cause of long-standing leg swelling. In people with a common condition called varicose veins, the valves that keep blood flowing in the right direction may not work well, and venous ultrasound can help the surgeon decide how best to deal with this condition. •aid in the placement of a needle or catheter in a large interior vein. Sonography can help locate the exact site of the vein and avoid complications, such as bleeding or air in the chest cavity. •map out the veins in the leg or arm so that segments may be removed and used to bypass an area of disease. An example is using pieces of vein from the leg to surgically bypass narrowed coronary arteries. •examine a blood vessel graft used for dialysis if it is not working as expected; an area of narrowing in the graft may be responsible.

    Doppler ultrasound images can help the physician to see and evaluate:

    •blockages to blood flow (such as clots) •narrowing of vessels (which may be caused by plaque) •tumors and congenital malformation
  • What to Expext During Procedure:

    For most ultrasound exams, the patient is positioned lying face-up on an examination table that can be tilted or moved.

    A clear gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. The sonographer (ultrasound technologist) or radiologist then presses the transducer firmly against the skin and sweeps it back and forth over the area of interest.

    Doppler sonography is performed using the same transducer.

    When the examination is complete, the patient may be asked to dress and wait while the ultrasound images are reviewed. However, the sonographer or radiologist is often able to review the ultrasound images in real-time as they are acquired and the patient can be released immediately.

    This ultrasound examination is usually completed within 30 minutes.

    Most ultrasound examinations are painless, fast and easy.

    After you are positioned on the examination table, the radiologist or sonographer will spread some warm gel on your skin and then press the transducer firmly against your body, moving it back and forth over the area of interest until the desired images are captured. There may be varying degrees of discomfort from pressure as the transducer is pressed against the area being examined.

    If scanning is performed over an area of tenderness, you may feel pressure or minor pain from the procedure.

    If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.

    Once the imaging is complete, the gel will be wiped off your skin.

    After an ultrasound exam, you should be able to resume your normal activities.
  • How to Prepare:

    You should wear comfortable, loose-fitting clothing for your ultrasound exam. You will need to remove all clothing and jewelry in the area to be examined.

    You may be asked to wear a gown during the procedure.

    A period of fasting is necessary only if you are to have an examination of veins in your abdomen. In this case, you will probably be asked not to ingest any food or fluids except water for six to eight hours ahead of time. Otherwise, there is no other special preparation for a venous ultrasound.
  • When Results will be Available:

    A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you. In some cases the radiologist may discuss preliminary results with you at the conclusion of your examination.

Exercise Echocardiogram

  • Purpose of Test:

    An exercise echocardiogram (or echo), also called a stress echo, combines an echocardiogram with an exercise test. It allows doctors to learn how well the heart works when made to beat faster and harder.

    The excise echo is particularly useful in diagnosing coronary heart disease, which is caused by blockages in the coronary arteries (the vessels that supply blood to the heart muscle).
  • What to Expext During Procedure:

    Generally, you’ll be told not to eat or drink for at least 3 hours before the test. If you have diabetes and take medication for it, you’ll need special instructions.

    If you take heart medications, check with your doctor when you schedule the test. He or she may ask you to stop certain medications day or two before the test.

    Wear comfortable clothing and shoes that are suitable for exercise. Women usually wear a loose-fitting blouse or hospital gown.

    The procedure will be explained to you and you will be asked to sign a consent form. Feel free to ask any questions you may have.
  • How to Prepare:

    None necessary.
  • When Results will be Available:

    The doctor conducting the test may be able to give you preliminary test results before you leave. Your own doctor will discuss the final test results with you during a future office visit.

Resting Echocardiogram

  • Purpose of Test:

    An echocardiogram examines the heart with the use of ultrasound, an imaging modality that visualizes internal structures by recording the pulsating "echoes" of harmless and painless sound waves that are directed to the heart. These high frequency sound waves are transmitted through a transducer which is a device that converts them into electrical impulses.

    An echocardiograph machine converts the electrical impulses into images that are displayed onto a monitor and recorded so that a cardiologist can view them and interpret the results.
  • What to Expext During Procedure:

    You will be asked to remove clothing from the waist up (women will be given a short gown to wear). Several electrodes will be placed on your chest to obtain an electrocardiogram and monitor your heart. You then lie down on a special bed or exam table. To improve the quality of the pictures, a technologist applies a colorless gel to the area where the transducer will be placed. The technologist places the transducer on your chest and uses a small amount of pressure to obtain the desired images. You may be asked to breathe slowly or hold your breath. The images are displayed on the screen and recorded on video. They will be compared to images taken right after exercise.
  • How to Prepare:

    Generally, you’ll be told not to eat or drink for at least 3 hours before the test. If you have diabetes and take medication for it you’ll need special instructions. If you take medication, check with your doctor when you schedule the test. He or she may ask you to stop certain medications a day or two before the test.
  • When Results will be Available:

    The doctor conducting the test may be able to give you preliminary test results before you leave. Your own doctor will discuss the final test results with you during a future office visit.

Stress Echocardiogram

  • Purpose of Test:

    Possible indications for a dobutamine stress echocardiogram may include, but are not limited to, the following:

    •to assess the heart's function and structures •to determine limits for safe exercise in patients who are entering a cardiac rehabilitation program and/or those who are recovering from a cardiac event, such as a heart attack (myocardial infarction, or MI) or heart surgery •to evaluate blood pressure during stress testing •to assess stress or exercise tolerance in patients with known or suspected coronary artery disease •to evaluate the cardiac status of a patient about to undergo surgery

    There may be other reasons for your physician to recommend a dobutamine stress echocardiogram.
  • What to Expext During Procedure:

    A dobutamine stress echocardiogram may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

    Generally, a dobutamine stress echocardiogram follows this process:

    You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your glasses, dentures, or hearing aids if you use any of these. You will be asked to remove clothing from the waist up and will be given a gown to wear. You will be asked to empty your bladder prior to the procedure. An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed. You will lie on your left side on a table or bed, but may be asked to change position during the procedure. You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure. The ECG tracing that will record the electrical activity of the heart will be compared to the images displayed on the echocardiogram monitor.

    The room will be darkened so that the images on the echo monitor can be viewed by the technologist.

    The technologist will place warmed gel on your chest and then place the transducer probe on the gel. You will feel a slight pressure as the technologist positions the transducer to get the desired image of your heart. The dobutamine infusion will begin at a rate determined by your weight. The rate of the infusion will be increased every few minutes until you have reached your target heart rate (determined by the physician based on your age and physical condition), or until the maximum dose of dobutamine has been reached. After the dobutamine is started and after each increase in the dobutamine rate, your blood pressure will be checked, an ECG tracing will be performed, and echocardiogram images will be obtained. The technologist will move the transducer probe around on your chest so that all areas and structures of your heart can be observed. The different echocardiogram techniques described above (M-mode, 2-D, Doppler, and color Doppler) may be used. You will not be aware of the different techniques except that during the Doppler or color Doppler, you may hear a "whoosh-whoosh" sound, which is the sound of the blood moving through the heart. Once you have reached your target heart rate or the maximum amount of the dobutamine, the medication will be stopped. Your heart rate, blood pressure, ECG, and echo will continue to be monitored for 10 to 15 minutes until they have returned to the baseline state.

    You should notify the technologist if you feel any chest pain, breathing difficulties, sweating, or heart palpitations. Once all the images have been taken, the technologist will wipe the gel from your chest, remove the ECG electrode pads, and remove the IV line.

    You may then put on your clothes.
  • How to Prepare:

    Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.

    Notify the physician if you are allergic to or sensitive to medications or latex. Fasting may be required before the procedure. Your physician will give you instructions as to how long you should withhold food and/or liquids. In some cases, cigarettes and caffeinated beverages, such as coffee, tea, and cola may be restricted several hours before testing. If you are pregnant or suspect that you may be pregnant, you should notify your physician. Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking. Notify your physician if you have a pacemaker. Based upon your medical condition, your physician may request other specific preparation.
  • When Results will be Available:

    The doctor conducting the test may be able to give you preliminary test results before you leave. Your own doctor will discuss the final test results with you during a future office visit.

Cardioversion

  • Purpose of Test:

    Cardioversion is a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm. Most elective or "non-emergency" cardioversions are performed to treat atrial fibrillation or atrial flutter, benign heart rhythm disturbances originating in the upper chambers (atria) of the heart. Cardioversion is used in emergency situations to correct a rapid abnormal rhythm associated with faintness, low blood pressure, chest pain, difficulty breathing, or loss of consciousness.
  • What to Expext During Procedure:

    An electrical cardioversion is performed in a hospital setting such as an emergency room, intensive care unit, recovery room, special procedure room or Electrophysiology Laboratory. A cardiologist, a nurse and/or an anesthesiologist are present to monitor your breathing, blood pressure and heart rhythm. Special cardioversion pads are placed on your chest and back (or alternatively, both pads can be placed on the front of the chest). The pads are connected to an external defibrillator by a cable. The defibrillator allows the medical team to continuously monitor your heart rhythm and to deliver the electrical shock to restore your heart's rhythm back to normal.

    Since the shock can be painful, an anesthesiologist or specially trained nurse administers intravenous sedation. Once you are asleep (but still breathing on your own), the physician charges the defibrillator to a specified energy level and then delivers the shock by pressing a button on the defibrillator. The shock is transmitted along the cable to the pads on the chest where the energy is delivered across the chest wall to the heart muscle. Additional shocks at higher energy levels can be delivered if the first shock does not restore the rhythm back to normal. Rarely, minor skin redness can occur at the site of the cardioversion pads where the electrical energy was delivered. Patients typically awake quickly without any recollection of the shocks, due to the amnesic effects of the sedatives. Because of residual effects of the anesthetic medications used, patients are advised not to drive or make any important decisions for the rest of the day. A responsible adult should be available to provide transportation home. The anesthetic agents typically used for the procedure are short acting; therefore most patients are able to go home an hour or so after the procedure. A normal heart rhythm can be restored more than 90% of the time, although abnormal rhythms may recur in about half the patients within 1 year. The success of electrical cardioversion often depends on the duration of atrial fibrillation and the underlying cause (heart disease). Cardioversion is not appropriate for every patient with atrial fibrillation.
  • How to Prepare:

    You should have nothing to eat or drink for at least eight hours prior to the procedure. Take your regularly scheduled medications the morning of the procedure unless your medical practitioner has told you otherwise. Your medications should only be taken with enough water to get the tablets down. If you are diabetic, you should discuss your insulin or other diabetes medication dosing with your medical practitioner. Bring a list of all your medications with you. Do not apply any lotions or ointments to your chest or back as this may interfere with the adhesiveness of the shocking pads.

    Most medical centers will not let you drive yourself home after receiving sedation/anesthesia; therefore you should arrange a ride home that day. For the remainder of the day, you should not operate a car, heavy machinery, or make any important decisions. You may experience some minor chest discomfort and/or skin irritation following the procedure. An ointment can be applied to the area to reduce the discomfort.