Diagnostic Testing

What it is:

Using high-frequency sound waves (ultrasound) a transthoracic echocardiogram captures moving pictures of the heart when a trained sonographer places a transducer externally across different locations of the chest and abdominal wall. When the transducer produces sound waves, these bounce off the heart and 'echo' back to the probe, in turn creating pictures viewed on a monitor that one of our cardiologist can then analyze and interpret. An echocardiogram captures pictures of the heart's chambers, valves, walls and blood vessels (the aorta, arteries and veins) attached to the heart and is a helpful tool in determining how well your heart is functioning.

How do I prepare for this test?

There is very little preparation for an echocardiogram. Patients will need to get undressed from the waist up; a johnny is provided to patients to wear during the test. While lying on your left side, images of your heart will be taken with an ultrasound machine. You will be able to hear the sound of your blood as it goes through your heart. An echocardiogram is a painless, non-invasive test that will take approximately one hour to complete. Twenty percent (20%) of the population have difficult acoustic windows (the place between a patient's ribs through which ultrasound waves pass). When this happens, we can perform a contrast echocardiogram to better help the physician reading the study see the walls of your heart. This involves starting an IV and administering the contrast agent.

What it is:

Stress testing in its various forms helps doctors to determine the underlying reason for symptoms you may be experiencing, like chest pain. It is also a useful tool in determining if there is a lack of blood supply through the arteries that go to the heart.

Exercise Stress Test:

During an exercise stress test, a monitor with electrodes that are attached to the skin on the chest area help to record your many aspects of your heart function while you exercise. Among them are your heart rate, breathing, blood pressure, EKG as well as your exercise tolerance. In preparation for a stress test, you may be asked to hold certain medications, usually Beta Blockers. You will be asked to have a light breakfast or lunch depending on the time of your stress test.

How do I prepare for this test?

• Patients should wear rubber soled shoes for this test (sneakers are great).
• Patients will have to get undressed from the waist up; johnnies will be made available.
• A regular exercise stress test takes about a half an hour.

Nuclear Stress Test:

Myocardial Perfusion Imaging (MPI) also known as a Nuclear Stress Test is a non-invasive imaging test that shows how well blood flows through your heart muscle. It can help your physician determine if there are areas of your heart muscle that are not getting enough blood flow due to narrowed arteries. The nuclear stress test can be performed with exercise using a treadmill or pharmacologically with the addition of medication for those patients who are not physically able to exercise.

The difference from a standard exercise stress test is that images are taken of the heart muscle with a special camera. The nuclear imaging agent used in nuclear stress tests is a radioactive tracer; this is not a dye. The contrast provided by this agent reveals to the cardiologist interpreting the test if any part of your heart is not getting enough blood. Rarely do patients have an allergic reaction or adverse effect to this substance.

How do I prepare for this test?

• Patients must fast for three hours prior to the test.
• Patients must also be free of caffeine of any type for 12 hours prior to testing. This includes coffee, tea, chocolate, white chocolate, aspirin compounds that contain caffeine, decaffeinated coffee or tea and other sodas which contain caffeine.
• Patients who are taking medications for lung problems, diabetes or congestive heart failure may need to alter their medications.
• A complete set of written instructions will be given to patients when the test is scheduled.
• The length of the test requires approximately 3-4 hours of your time.

What it is:

A MUGA (multiple-gated acquisition) examination allows our physicians and APP's the opportunity to calculate how well your heart is pumping. The results of this type of nuclear study help determine the overall condition of the heart muscle and its response to medication at rest. Using a radioactive tracer (called a radionuclide) as contrast, a camera takes pictures of your heart during each heartbeat. This test will take approximately 3-4 hours to complete.

What it is:

Stress Echocardiography combines elements of stress testing and echocardiography. As part of a stress echo, patients will have a standard echocardiogram while at rest. A second echo will be performed after the patient exercises and experiences an elevated heart rate. During the exercise portion of the test, the patient's heart rate and rhythm will be closely monitored for changes. The physician interpreting the results of the test will compare both echoes to see how well patient's heart is working when beating at a faster rate and working harder.

Cardiac Holter Monitor and Event Loop Recorder:

A Holter monitor is a battery-operated, portable device that measures and records your heart's electrical activity (ECG) continuously for 24 to 48 hours (holter monitor) or up to 30 days (event monitor), depending on the monitor used. Electrodes (small conducting patches) are placed on your chest and attached to a small recording monitor that you can carry in a pocket or in a small pouch worn around your neck. The recording is then analyzed, a report of the heart's activity is tabulated and irregular heart activity is correlated with a diary that you keep of your activity at the time.

Tests performed in the vascular lab are interpreted by vascular cardiologists or vascular surgeons. Our full spectrum of diagnostic testing for disorders of the arteries and veins in the neck, arms, legs and abdomen includes:

• Ankle Brachial Index (ABI)
  Blood pressure in the arms is compared with measurements at the ankles and big toes. Blood pressure cuffs may also be placed at the thighs and just below the knees. This aids in diagnosis of peripheral arterial disease (PAD), a cause of leg pain.
• Arterial Ultrasound:
  Images of blood flowing through arteries are captured using sound waves. This is used to diagnose blockages in the legs, neck or kidneys.
• Abdominal Ultrasound:
  You will be asked not to eat anything on the day of this test to help us get good pictures. The technician will use sound waves to measure the size of your aorta. This is a screening test for abdominal aortic aneurysm, an enlargement of the main blood vessel running through the center of your body.
• Carotid Intimal Medial Thickness (CIMT):
  Your neck will be scanned with sound waves to measure the thickness of the inner lining of the carotid arteries. Your doctor may order this test to help determine the risk of developing cardiovascular disease.
• Venous Ultrasound:
  Leg veins will be scanned with sound waves. Deep vein thrombosis (DVT), or a blood clot in the leg, can be seen. Gentle compression of the veins allows us to see if they are functioning normally. This test also provides a roadmap of the veins in your legs, which is needed before having leg bypass surgery.

A PET scan of the heart is a noninvasive nuclear imaging test. Is uses radioactive tracers (called radionuclides) to produce a picture of your heart. Health care professionals use cardiac PET scans to diagnose coronary artery disease (CAD) and damage due to heart attack. PET scans can show healthy and damaged heart muscle. PET scans are also used to help find out if you will benefit from a percutaneous coronary intervention (PCI) such as angioplasty and stenting, coronary artery bypass surgery (CABG) or another procedure.

A radioactive tracer is injected into your bloodstream. The tracers used for PET are mostly natural body compounds such as glucose, water or ammonia, which are labeled or “tagged” with a small amount of radioactive material. Inside your body the radioactive tracer produces a type of energy called gamma ray. Gamma rays are detected by a gamma detector and are used to produce a series of clear images of your heart. Images of thin slices made all the way through the heart can be produced from all different directions and angles.

Computer graphics can be used to create a three-dimensional image of your heart from the thin-slice images.