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Cardiac Consultation

A cardiology consultation is usually requested by your primary care physician or another specialist or surgeon seeking more information and input from a provider specialized in cardiovascular medicine. This may be for many different reasons such as concern over a known diagnosis, treating an unknown diagnosis but new symptoms, managing a chronic condition, or for a pre-operative cardiac evaluation.

Pre-Op Clearance

Our physicians are often asked to perform a cardiac evaluation on a patient prior to surgery. They may be asked to see the patient at the request of the surgeon or the primary care physician assessing the patient for possible surgery. The evaluation is used to determine the cardiac risk to the patient of the proposed surgery and to minimize known cardiac risks.

ECG

An Electrocardiogram (EKG or ECG) is a test that records the heart’s electrical activity. It shows how fast your heart is beating, the rhythm of your heartbeat, and the strength and timing of electrical signals as they pass through each part of your heart. It is used to detect and evaluate problems such as heart attack, arrhythmia, and heart failure.

What to expect during an Electrocardiogram?

A nurse attaches soft sticky patches called electrodes to the skin of your chest. These are hooked to a machine that traces your heart activity to paper. The test usually takes 5 to 10 minutes.

Blood Pressure Monitors

An Ambulatory Blood Pressure Monitor consists of a small machine connected to a blood pressure cuff that is generally worn for 24 hours that automatically checks and records your blood pressure throughout the day and night, even while you sleep. It is a valuable tool in the assessment and management of your blood pressure. The monitor is applied in our office. You will be given instructions and asked to keep a diary of your day’s activities, so the doctor knows when you were active and when you were resting. After 24 hours of monitoring, you will return the machine, cuff, and your diary to the office. The information is transferred from the monitor to a computer. Your doctor will review the information with you and decide if a treatment plan is needed or a current treatment plan needs changed.

Holter and Event Monitors

A Holter Monitor is a device that is worn for 24 to 48 hours and records a patient’s heart rate and rhythm. It will take approximately 30 minutes to hook up the monitor and give you instructions.

Patient Instructions for Holter Monitoring:

  • Do not get EKG leads or Monitor wet.
  • Please press Purple Button on Monitor when experiencing any symptoms.
  • Please keep a Diary of all symptoms, what you were doing at the time, and the time they occurred below.
  • Please return the MONITOR and LEAD WIRES to our office no later than one day after you are finished wearing the monitor.

Nuclear Stress Testing

NUCLEAR STRESS TEST PREPARATION

What to expect from a Stress Nuclear test:

This test will take approximately 2-3 hours to complete in the morning and may have to return for a 30 minute image in the afternoon (the time to be determined by the Nuclear Technologist).

– The test will help your doctor determine if there are areas of your heart which do not receive enough blood supply due to coronary artery disease.

– An IV will be started for injection of the radioactive isotope.

– During the stress portion of the test, you will be asked to walk on a treadmill or be infused with medicine to simulate exercise.

– A dual-head emission camera will take images of your heart.

Do not eat anything after midnight. Drink lots of water up until time of test unless otherwise instructed.

No smoking after 6:00 P.M. the day prior to testing.

Avoid caffeine 24 hours prior to the test – Avoid aspirin products that contain caffeine: Anacin, Excedrin

Avoid Asthma medication, Theo-Dur and Theophylline, 24 hours prior to testing.

Do not take Beta blockers (24 hrs prior to test) such as:

Betapace (sotalol) Normadyne (labetelol)      Coreg (carvedilol)            Sectral (acebutelol)

Corgard (nadolol)            Tenormin (Atenolol)        Inderal (propanolol)          Toprol XL (metoprolol)         Lopressor (metoprolol) Trandate (labetelol)

Medications held prior to testing, please bring with you to take after your morning testing is completed.

Diabetics:

– If you use insulin, check your sugar. You may eat a light breakfast and take half of your morning insulin. Once the stress portion of the test is finished, we will give you crackers and juice.  Bring your insulin with you to take after the test.

Please do not allow anyone who is pregnant or children 12 years and younger to accompany you when having a nuclear stress test.

 What to bring for your stress test:

– Insurance card

– Current list of all medications you are taking

– Comfortable, loose fitting clothing and tennis shoes.

If you are unable to keep this appointment, please notify us 24 hours prior to your appointment.

Treadmill ECG

Treadmill Test (ETT)

The purpose of this test is to determine how your heart responds to stress and evaluate your cardiovascular status. You will be asked to walk on a treadmill until you reach a “target” heart rate based on your age. During the treadmill, you will be continuously monitored for blood pressure, heart rate, rhythm, and ECG changes. The exercise portion of the test usually lasts for 5 to 15 minutes. You should allow about an hour for the entire test.

Patient Instructions:

-Do not eat or drink anything two hours prior to the test.

-Diabetics should eat a light breakfast and take their insulin prior to the test.

-wear two-piece clothing and comfortable shoes. No “flip flop” type shoes.

-Take all your regular medications, unless otherwise instructed by your physician.

Echocardiogram

2-D Echocardiogram with Doppler and Color flow

An echocardiogram is an ultrasound of the heart. It is used to evaluate the size, thickness, and pumping action of the heart. It can also help evaluate murmurs, valve problems, or fluid around the heart.

The test is noninvasive, which means no needles, catheters, or dyes are used. Ultrasound is used to create a picture of the heart, including the blood vessels, valves, atria, and ventricles. Gel is placed on the skin over the area to be studied. An instrument, called a transducer, is placed on your skin. Sound waves are transmitted from the transducer. The sound waves reflect off the tissues and organs to create a picture that can be seen on a screen. Blood flow through the blood vessels and valves can be heard as the test is being completed.

 Patient Instructions

  1. No special preparation is required.
  2. Allow 30 minutes.
  3. Wear two-piece clothing.
  4. Your physician will be notified of the results.

If you are unable to keep this appointment, please notify us 24 hours prior to your appointment.

Stress Echocardiogram

Stress Echocardiogram

An echocardiogram is an ultrasound of the heart. It is used to evaluate the size, thickness, and pumping action of the heart. It can also help evaluate murmurs, valve problems, or fluid around the heart.

A stress echocardiogram incorporates a treadmill test along with imaging of the heart utilizing ultrasound. The test will help your doctor determine if there are areas of your heart which do not receive enough blood supply due to coronary artery disease. Areas of your heart which may have been damaged from a previous heart attack may also be seen. Ultrasound images will be obtained before and immediately after exercise on a treadmill. During the treadmill, you will be continuously monitored for blood pressure, heart rate, rhythm, and ECG changes.

 Patient Instructions

  1. Do not eat or drink anything 4 hours prior to the test.
  2. Diabetics should eat a light meal and take their insulin
  3. Take all regular medications EXCEPT Beta Blockers, unless otherwise instructed by your physician.
  4. Wear two-piece clothing and comfortable shoes. No “flip flop” type shoes.
  5. The test takes approximately 1 hour.
  6. Your physician will be notified of the results.

If you are unable to keep this appointment, please notify us 24 hours prior to your appointment.

Carotid Doppler

Carotid Duplex

A carotid duplex scan uses sound waves to evaluate the main arteries in the neck which supply blood to the brain. The test is noninvasive, which means no needles, catheters, or dyes are used. Ultrasound is used to create a picture of the shape of tissues and organs inside your body. The walls of blood vessels, including any deposits or narrowing, can also be seen.

Gel is placed on the skin over the area to be studied. An instrument, called a transducer, is placed on your skin. Sound waves are transmitted from the transducer. The sound waves reflect off the tissues and organs to create a picture that can be seen on a screen. Blood flow through the blood vessels can be heard as the test is being completed.

 Patient Instructions

  1. No special preparation is required.
  2. Allow 30 minutes.
  3. Please do not wear a turtleneck shirt to allow access to the neck area for the scan.
  4. Your physician will be notified of the results.

If you are unable to keep this appointment, please notify us 24 hours prior to your appointment.

Peripheral Arterial Study

ABIs with segmental Arterial Waveforms and Pressures

This is an arterial study to check the circulation in your legs. Blood pressures are taken in the legs at several different sites. These results are then compared and studied for differences. You may be asked to exercise by walking on a treadmill, after which blood pressures will be repeated in your legs and compared to the resting pressures. This can help determine if there are any blockages that may be causing pain with exercise, numbness, skin discoloration, or coldness in the legs. The test is noninvasive, which means no needles, catheters, or dyes are used.

 Patient Instructions:

-Allow 45 minutes for both legs.

-Wear two-piece clothing

-Take all of your regular medications, unless otherwise instructed by your physician.

Lower Extremity Venous Duplex

Venous Duplex

A venous duplex study uses sound waves to check the venous flow in the legs for blood clots and/or insufficiency or reflux which may cause pain or swelling. The test is noninvasive, which means no needles, catheters, or dyes are used. Ultrasound is used to create a picture of the shape of tissues and organs inside your body. The walls of blood vessels, including any deposits or narrowing, can also be seen.

Gel is placed on the skin over the area to be studied. An instrument, called a transducer, is placed on your skin. Sound waves are transmitted from the transducer. The sound waves reflect off the tissues and organs to create a picture that can be seen on a screen. Blood flow through the blood vessels can be heard as the test is being completed.

 Patient Instructions

  1. No special preparation is required.
  2. Allow 30 minutes for the test.
  3. Wear two-piece clothing.
  4. Your leg will be examined from the groin to the ankle.
  5. Your physician will be notified of the results.

If you are unable to keep this appointment, please notify us 24 hours prior to your appointment.

Abdominal Aortic Ultrasound

An abdominal Aorta Duplex uses sound waves to check for an aortic aneurysm (Dilation of the abdominal aorta). The test is noninvasive, which means no needles, catheters, or dyes are used. Ultrasound is used to create a picture of the shape of tissues and organs inside your body. The walls of the blood vessels, including any deposits or narrowing, can also be seen.

Gel is placed on the skin over the area to be studied. An instrument, called a transducer, is placed on your skin. Sound waves are transmitted from the transducer. The sound waves reflect off the tissues and organs to create a picture that can be seen on a screen. Blood flow through the blood vessels can be heard as the test is being completed.

Patient Instructions

  1. Do not eat or drink anything 4 hours prior to the test.
  2. Allow 15 minutes for the test.
  3. Wear two-piece clothing.
  4. Take all of your regular medications, unless otherwise instructed by your physician.
  5. Your physician will be notified of the results.

If you are unable to keep this appointment, please notify us 24 hours prior to your appointment.

MUGA

MUGA TEST PREPARATION

What to expect from a MUGA test:

-This test will take approximately 1 hour to complete.

– The test will help give an accurate and reproducible means of measuring and monitoring the ejection fraction (EF) and left ventricle of your heart.

– An IV will be started for injection of a radioactive isotope.

– A dual-head emission camera will take images of your heart.

 Patient Instructions:

-There is no preparation for this test.

-Take all of your regular medications, unless otherwise instructed by your physician.

If you are unable to keep this appointment, please notify us at least 24 hours prior to your appointment

Pacemaker checks

For our patients with a pacemaker or implantable cardioverter-defibrillator (ICD), ongoing monitoring is an important part of care. Our physicians are able to monitor your device through a combination of office visits and telephonic transmissions done from the comfort of your own home. Via your home telephone, your device can transmit data to our office that will allow our physician to ensure proper overall functioning of your device.

Cardiac catheterization

Cardiac Catheterization

Cardiac Catheterization (angiogram) is a nonsurgical procedure that assists your cardiologist in gaining information about your heart. This procedure enables your cardiologist to determine the best options in your care. The test is done by passing a small flexible plastic catheter into the artery of the arm or leg and is gently passed toward your heart. Fluid, called dye, is injected through the catheter and X-rays are obtained. You will be awake during the procedure, allowing you to watch the test on a television monitor.

Why is Cardiac Catheterization Necessary?

It is performed when other tests such as a nuclear scan, stress test or echocardiogram are non-diagnostic or do not reveal the complete picture associated with your symptoms. The “cath” can reveal: clogged vessels, heart valve problems and congenital heart problems.

Preparation for the Cardiac Catheterization

Your cardiologist and the staff will discuss the possible risks and benefits of the procedure and give you specific instructions to follow. Risks are low but do exist including: infection, bleeding or clotting, stroke, heart attack, allergic reaction to the dye and arrhythmia. Feel free to discuss the risks and benefits with your physician or the staff of nurses and technicians. An EKG and blood work are necessary before the “cath”. This allows your cardiologist to evaluate different systems of the body in preparation for the test. These are usually done one to two days before the catheterization. The night before your test, you will be asked not to eat or drink anything after midnight. You should take your medications as regularly scheduled including aspirin the morning of the test with a sip of water. You may prefer not to take any diuretics until after the catheterization. If you are diabetic, inform your physician’s nurse so special medication instructions can be given to you. It is a good idea to take all of your medicines to the hospital with you.

The catheterization is usually an outpatient procedure. Discharge time is usually mid to late afternoon. Arrange for someone to drive you home.

Having the Cardiac Catheterization

Shortly before the procedure, you will be given a mild sedative to help you relax. Once in the cath lab, an IV will be started to supply fluids and if needed, give emergency access for medication during the procedure. A local numbing medication will be given to numb the area. Once in place, the dye will be injected.  At this point, you may experience mild nausea or a feeling of warmth. It is important that you communicate any “unusual” discomfort.   At the close of the procedure, the catheter will be removed and pressure will be applied to the insertion site.  Usually the procedure takes one hour.  You will be transported back to your room and asked to lay flat for approximately four hours.

Going Home

Have someone drive you home from the hospital. Activities should be light for the first 24-48 hours. No heavy lifting should be done. It is not unusual to notice some bruising or develop a small hematoma (lump) at the insertion site. Reasons to call your cardiologist include: bleeding at the insertion site, bruising or hematoma increases, and if the arm or leg of the insertion site becomes cold, numb or changes color.

 Special Instructions:  

  • Nothing to eat or drink after midnight before the test.
  • Take medications the morning of the test with sips of water.
  • Go to the laboratory on __________________ to have your blood work.

Coronary Angioplasty and Stent Placement

Coronary Angioplasty/Stent

A coronary angioplasty (PTCA) is a procedure in which a physician utilizes a small balloon catheter to open up a blockage in an artery that supplies blood to the heart muscle. Frequently a stent is also implanted into the coronary artery to reduce the chance that the blockage will recur. Coronary angioplasty/stent can relieve blockages to allow a person to be active without chest discomfort and prevent a heart attack. Patients are usually given a mild sedative prior to the procedure. You will be taken to the cardiac catheterization lab for this procedure. Most PTCAs are done through a large artery in the groin, however sometimes they are done from the wrist or elbow area. The nurse or technician will cleanse and shave the groin area and cover with sterile drapes. The doctor will then numb the area and insert a small hollow tube into the artery in your groin. The doctor can then thread catheters up to the heart. Through these catheters, the doctor can thread a wire across the blockage in the artery and then place and inflate a balloon to open the blockage.

During the stent procedure, the stent, which is mounted on the balloon, is placed across the blockage and the balloon is inflated opening the stent. Some people may notice mild chest discomfort while the balloon is inflated.

After the procedure, most patients are transferred to a post-procedure care area where your sheaths are removed. You will be asked to lie flat for several hours to allow the hole in the artery to seal. Some doctors use a vascular closure device to seal the artery. Most patients will stay overnight. After the procedure, it is normal for the puncture site to be tender and bruised, and a small knot may develop. If you notice redness, drainage, sever pain, or swelling, talk to your doctor to see if further evaluation is indicated.

Prior to the procedure, you will be told not to eat or drink anything after a certain time. Your doctor will inform you which medications you should take prior to the procedure, and which medications to avoid. Please inform your doctor if you have had previous allergic reaction to x-ray contract dye or shellfish. He will prescribe medication to reduce the risk of the allergic reaction.

Peripheral Angiography, Stent Placement, and Atherectomy

Peripheral angioplasty is a procedure that helps open blockages in peripheral arteries. These vessels carry blood to your lower body and legs.
Before the Procedure

  • Don’t eat or drink after midnight the night before the procedure.
  • Arrange for a family member or friend to drive you home.

During the Procedure

  • You may get medication through an IV (intravenous) line to relax you. After an injection numbs the site, a tiny skin incision is made near an artery in your groin.
  • Your doctor inserts a catheter (thin tube) through the incision (insertion site), then threads it into an artery while viewing a video monitor.
  • Contrast “dye” is injected into the catheter. X-rays are taken (angiography).
  • If you require a stent or angioplasty, a tiny balloon is pushed through the catheter to the blockage. Your doctor inflates and deflates the balloon a few times to compress the plaque. A stent (small metal or mesh tube) may be placed to help keep your artery open. The balloon and catheter are then removed.

After the Procedure
You’ll be taken to a recovery area. Pressure is applied to the insertion site for about 15 minutes. You will need to keep your leg still and straight for a few hours. You will go home that day or spend the night in the facility. You will be instructed what to do when you go home.
Call Your Doctor If:

  • You notice a lump or bleeding at the site where the catheter was inserted.
  • You feel pain at the insertion site.
  • You become lightheaded or dizzy.
  • You have leg pain or numbness.

Special Instructions: 

  • Nothing to eat or drink after midnight before the test.
  • Take medications the morning of the test with sips of water.
  • Go to the laboratory on __________________ to have your blood work.

Tilt Table

What is a Tilt Table Test?

A tilt table test evaluates for neurocardiogenic syncope. Syncope is a condition when a person passes out, faints, or is unconscious for a short time. Neurocardiogenic means that the nervous system “neuro” and the heart system “cardio” are involved. The person’s blood pressure and heart rate drop suddenly and the brain does not receive enough blood. This results in the loss of consciousness.

When is a Tilt Table Test needed?

The most common reason for a tilt table test is when a person has passed out for reasons that are unclear. These spells can be dangerous if the person is injured when falling or crashes while driving a car.

Is the Tilt Table Test safe?

You may be given a medication during the test. Some possible side effects from the medication include fast heart rate, nausea, or slight nervousness.

If you are pregnant, suspect you may be, or are a nursing mother; discuss this with your doctor before the test.

How should I prepare for the test?

Do not eat, drink, or smoke for 4 hours before the test. You may have hard candy to suck or gum to chew. Check with your doctor about continuing to take any heart medications. Your doctor may want you to stop taking some medicines a day or two before the test. Wear loose, comfortable clothing. Family may come with you, but they will need to wait in the waiting room.

How is the test performed?

Several small sticky patches, called electrodes, will be placed on your chest. Wires to an electrocardiograph, or EKG, machine will connect these electrodes. A blood pressure cuff will be placed on your arm. A recording of your heart rhythm, heart rate, and blood pressure will be obtained throughout the test. An intravenous line (IV) will be placed into a vein in your arm. You will lie on a table; straps will be placed around your chest, waist, and above your knees to prevent you from falling.

The table will be placed in a standing position. If you notice any symptoms similar to when you passed out (such as yawning, nausea, warmth, or dizziness) please tell the staff.

If none of your symptoms reoccur, you will be placed flat and medication will be given through your IV to increase your heart rate. After a short time, you will stand up again. If you notice any symptoms similar to when you passed out or chest pain, dizziness, or shortness of breath tell the staff. After the medication is done, you will be placed flat. Your heart rate and blood pressure will continue to be checked for about 10 minutes.

The test will take about 2 hours.

How will I find out the test results?

Your cardiologist will read the test and report the results to your family physician. You will receive your results from your cardiologist.

TEE

What is a Transesophageal Echocardiogram?  

A transesophageal echocardiogram is a special ultrasound test that uses sound waves to take pictures of the heart. This type of echo can take clearer pictures of the heart than regular ultrasound especially in older children and adults. It is also used during heart operations to help guide the surgeon. There is no known risk from ultrasound exposure and no radiation exposure is involved.

How is it done? 

The study is done by passing a special tube down the throat into the esophagus or food pipe. The end of this tube is placed near the heart which allows very clear, detailed pictures to be taken.   A local anesthetic is sprayed on the throat to prevent gagging. An IV is also started and IV sedation is given before the tube is passed.

How do I prepare for it? 

  • Nothing to eat or drink after midnight, the night before the test
  • Do not take medications prior to the test

A transesophageal echo is performed by a doctor specializing in the care of patients with heart disease. During the test, the patient’s heart rate, heart rhythm, breathing, and blood pressure are carefully monitored. The study takes about 30 minutes and the pictures taken of the heart are recorded for later review.

What happens after the test?  

  • Do not drive for the rest of the day. Be prepared to have someone drive you home.
  • Do not eat or drink for 2 hours after the procedure.
  • You may notice a sore throat afterwards. Throat lozenges or sore throat sprays are available over the counter for discomfort.

NOTIFY OUR OFFICE IF ANY OF THE FOLLOWING OCCUR:

  • Trouble swallowing
  • Vomiting or coughing up blood
  • Loss of voice
  • Pain in abdomen, chest or back
  • Fever

Cardioversion

What is an electrical cardioversion?  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 cardioversions are performed to treat atrial fibrillation or atrial flutter.  While some patients have no symptoms, others may experience shortness of breath, lightheadedness and fatigue. Depending on your specific medical history and symptoms, your physician may recommend a cardioversion to return your heart to a normal rhythm.

What will happen during my Cardioversion?  The goal of the cardioversion is to convert your heart from atrial fibrillation to a normal rhythm.  Your procedure will be performed in the catheterization lab.   The nurse will start an IV when you arrive.  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.   You are asleep during the procedure.  Patients typically awake quickly without any recollection of the shocks, due to the amnesic effects of the sedatives.   Most patients are able to go home an hour or so after the procedure.
Preparing for a Cardioversion

  • Nothing to eat or drink after midnight.
  • Do not take your medications the morning of the test.
  • Do not apply any lotions or ointments to your chest or back as this may interfere with the adhesiveness of the shocking pads.
  • You will not be able to drive yourself home after receiving sedation/anesthesia; therefore you should arrange a ride home that day.
  • You may experience some minor chest discomfort and/or skin irritation following the procedure. An antibiotic ointment can be applied to the area to reduce the discomfort.

What happens after the test?  

  • Do not drive after the procedure. Be prepared to have someone drive you home.
  • Do not eat or drink for 2 hours after the procedure.