Heart Health

Patient Education from Capital Cardiology Associates

Diagnostic Tests

New tests are constantly being developed to further the understanding of disease, injury, and congenital (present at birth) or acquired abnormalities of the heart. These are just a few of the tests that have been used to diagnose heart and blood vessel disease (cardiovascular). For more information, talk to your cardiologist or other healthcare provider.

Dobutamine Stress Echocardiogram

The procedure may also be called a dobutamine stress echo. If you or a family member have additional questions, please feel free to discuss them with your doctor or nurse at any time.

What is a dobutamine stress echocardiogram?

In order to diagnose certain heart conditions, some heart studies require that the heart be subjected to “stress” or exercise. This allows the cardiologist to evaluate the heart while it is working its hardest.

The dobutamine stress echo was developed for people who are unable to exercise on a treadmill or stationary cycle as required using a more traditional stress echo. In this test, you will be given dobutamine, a special medication that will stimulate your heart and make it think that it is actually exercising.

The dobutamine stress echo is a valuable diagnostic tool that allows the cardiologist to assess a number of different things including:

• The overall function of your heart’s valves and chambers
• The clinical manifestations of many types of heart disease such as valvular problems, myocardial disease, pericardial disease, coronary artery disease and congenital heart disease
• Monitoring, evaluation and follow-up of medical treatments (drugs) or surgical procedures
• Patient preparation

Preparing for the test

Wear comfortable clothing.
• Do not eat for a minimum of 4 hours before the test. If your appointment is in the morning, do not eat after midnight the night before your test.
• Drinking water is allowed before the test.
• If you are diabetic, juice is allowed in the morning with insulin (1/2 dose). If you take pills to control your blood sugar, do not take your medication until after the test is complete.
DO NOT DRINK CAFFEINE (coffee or tea) the day of the test.
• Stop taking all medications including beta blockers, calcium channel blockers, nitrates and digoxin for 24 hours prior to your test unless directed otherwise by your doctor. If you have any questions regarding the medications you are taking, call 292-6030.
• You should plan on being at the Diagnostic Imaging Department for a minimum of 90 minutes.
NOTE: Do not discontinue any medication without first talking with your physician.

What happens during the dobutamine stress echocardiogram?
• You will be given a hospital gown and asked to remove clothing from the waist up.
• An (ultrasound technician) sonographer will place electrodes on your chest to monitor your electrocardiogram (ECG). The electrodes are small, circular pads with a sticky substance to help them adhere to the skin.
• Your blood pressure and ECG will be monitored throughout the test.
• You will be asked to lie on your left side on an exam table. The sonographer will place a wand (the ultrasound transducer that directs the sound waves) on different areas of your chest. To facilitate movement on your skin, a small amount of gel is placed on the end of the wand.
• An intravenous line (IV) will be inserted into a vein in your arm so the dobutamine medication can be delivered directly into your bloodstream.
• Your doctor will begin the infusion of dobutamine into the IV while the ultrasound technician continues to record echo images. The medication will cause your heart to react as if you were exercising.
• The dobutamine may give you a warm, flushing feeling and some patients experience a mild headache.
Throughout the test, your doctor and the ultrasound technician will ask how you are feeling. Be sure to tell them if you feel chest, arm or jaw pain or if you are, short of breath, dizzy or feel lightheaded.
• The IV line will be removed from your arm once all of the medication has entered your bloodstream.

Will I feel any pain or discomfort during the test?
You should not feel any pain or discomfort during the test. The gel on the ultrasound transducer may feel cool on your skin as it is moved across your chest.

How long does the test take?
Usually about 50-60 minutes. After the test, you may get dressed and go about your daily business.

How do I get the results of my echocardiogram?
After your cardiologist reviews the test results, a report will be mailed to your primary care physician. Your doctor will then discuss the test results with you.

Exercise Stress Test

The heart performs differently at rest than it does during exercise. An exercise stress test – also known as a treadmill test – is designed to help your doctor learn how your heart performs during exercise or other activities that would make the heart work harder. The term “stress” is used simply to distinguish the difference between a resting heart and a heart that is more actively pumping.

As activity increases during the test, more oxygen is needed and the heart responds by pumping more blood. This test can show if there is reduced blood flow to the arteries that supply the heart. It also helps doctors learn the limitations of exercise appropriate for each individual patient.

What happens during the exercise stress test?
• Your heart rate, breathing, blood pressure, electrocardiogram (ECG) will be monitored during the test.
• You will begin by walking at a slow pace on the treadmill. The speed of the treadmill will be gradually increased and the incline will be increased to make it feel as though your are going up a small hill.
• You may stop the test at any time you feel uncomfortable.
• There’s very little risk for healthy patients in taking the test – no more than if you were to walk fast or walk up stairs.

Holter Monitoring

Sometimes patients complain of symptoms that require an electrocardiogram (ECG) to help diagnose the problem. Unfortunately, some patients have a normal ECG in spite of having genuine complaints.

Holter monitoring, is a testing method in which the patient wears a portable ECG recorder over an extended period of time while performing normal daily activities – walking, driving, gardening, even sleeping. Because the Holter monitor is used while the patient is moving about, it is sometimes referred to as an ambulatory ECG.

The Holter monitor prints out a graphic chart of changes in the electrical signals generated by the heart. This allows your cardiologist to capture a complete record of the heart’s activity and document shifts in rhythm and the effects of stress or other disturbances over a longer time than would be possible to detect in an office visit.

How long will I need to wear the Holter monitor?
This will be determined by the type of Holter monitor chosen by your doctor. There are two basic types of Holter monitors:
• Continuous monitors that are usually worn for 24-48 hours.
• Intermittent monitors are worn for much longer periods – sometimes over the course of weeks or months. This method provides a wide range of “snap shots” that allow the cardiologist to review your heart’s activity in a wide variety of situations. These monitors are referred to as “loop recorders.”
• Your doctor will determine which method is best for your situation.

How should I prepare for a Holter monitor?
There are no preparations required. Simply go the office where your appointment has been made.

Nuclear Cardiology Stress Test

By producing an image of the heart, radioactive “tracers” such as Thallium and Cardiolyte can increase the accuracy of a traditional stress test. Nuclear scanning of the heart shows how well blood flows to the heart muscle. It’s usually done in conjunction with an exercise stress test on a treadmill, but can also be performed using medicines such as adenosine and dipyridamole that effectively simulate the effects of exercise on the heart. Cardiac Nuclear Stress Imaging helps determine whether coronary artery stenoses (blockages) are so severe as to limit blood flow to heart muscle when it needs it most… during physical activity. In addition, nuclear imaging allows a determination of the heart’s pumping function (ejection fraction).

When a patient reaches his or her maximum level of exercise, or after simulating exercise with medications, a small amount of tracer is injected into a vein. The patient then lies down on a table under a camera that detects the energy emitted from the radioactive tracer and generates pictures (or scans) that reflect the heart’s blood flow both at rest and following stress. If a portion of the heart muscle is under-perfused (doesn’t receive a normal blood supply), a deficiency of tracer activity in that area will appear on the finished images as a “defect”.

Preparations for your test

• Wear comfortable clothing and walking shoes (rubber-soled are best).
• Do not eat for a minimum of 4 hours before the test. If your appointment is in the morning, do not eat after midnight the night before your test.
• Drinking water is allowed before the test.
• If you are diabetic, juice is allowed in the morning with insulin (1/2 dose).
• Do not drink caffeine (coffee or tea) the day of the test.
• If your doctor ordered a nuclear stress test involving the injection of a radioisotope, please let us know if you are pregnant or breast-feeding.
• Because of the high cost of the radioisotope used in the test, please call 24 hours before your appointment if you need to cancel or reschedule.
• Stop taking all medications, including beta-blockers, calcium channel blockers, nitrates and digoxin for 24 hours prior to your test unless directed otherwise by your doctor. If you have any questions regarding the medications you are taking, call 292-6030.

You should plan on being at the Diagnostic Imaging Department for a minimum of 90 minutes.

The nurse will connect you to three monitors:
Electrocardiogram or EKG: Attached to several sticky electrode patches placed onto your chest. Provides a picture on graph paper of the electrical impulses traveling through your heart.

Oximeter monitor: Attached to a small clip on your finger. Checks the oxygen level of your blood.

Blood pressure monitor: Connected to a blood pressure cuff on your arm. Checks your blood pressure intermittently throughout the study.

These monitors allow the doctor to check your heart rhythm and the body’s responses to arrhythmias.

Tilt Table Test

The tilt table test is designed to find out the cause of syncope or fainting spells. During the test, the patient lies on a bed that is tilted at different angles (30-60 degrees) for a period of time to help the cardiologist determine the cause of the fainting spells.

Patient preparation

• Take all medications as prescribed.
• You need to have an empty stomach during the test. Do not eat or drink anything after midnight the evening before your test. If you must take medications, drink only small sips of water to help you swallow your pills.
• Drinking small amounts of water is allowed before the test.
• Wear comfortable clothing. It is best not to wear jewelry or valuables.
• Do not drink caffeine (coffee or tea) the morning of the test.

Tilt table test procedure

Your test will take place in a special room called the EP (electrophysiology) lab at Albany Medical Center or St. Peter’s Hospital.

Before your test begins, a small needle will be inserted into a vein in your arm. This is to allow doctors and nurses to give you medications and fluids during the procedure if necessary.

A physician’s assistant or registered nurse will prepare you for the test. A cardiologist will monitor your test. In order to monitor your vital signs and your reaction to the test, you will be connected to three monitors:

Electrocardiogram: Your chest will be cleaned with an alcohol pad to remove skin oil at the areas where the electrodes will be placed. Men may need to have some chest hair shaved in order to help the electrodes adhere to the skin. Wires will then be attached to each of the electrodes in order to record and monitor your electrocardiogram (ECG) before, during the test.

Oximeter monitor: A small clip will be placed on the tip of your finger to checks the oxygen level of your blood.

Blood pressure monitor: A blood pressure cuff will be placed on your arm to check your blood pressure intermittently throughout the study.

You will be awake throughout the entire test. You will be asked to lie quietly and keep your legs still. The table you are lying on will be tilted at different angles. You may feel nothing at all or you may feel the same symptoms you feel when you experience a fainting spell. The test may even induce you to faint. Remember, you are being monitored and the doctors and nurses are in the room with you.

It is important to tell your doctor or nurse all of symptoms you feel during the test. As part of the test, your doctor may give you a medication. This medication may make you feel nervous, jittery, or you may feel your heart beat faster or stronger. This feeling will go away as the medication wears off.

How long does the test take?
About 1-2 hours.

Can I go home after the test?
Most patients are able to go home after the test. However, you should make arrangements to have someone drive you home.

How do I get the results of my tilt table test?
After your cardiologist reviews the test results, a report will be mailed to your primary care physician. Your doctor will then discuss the test results with you.

Transesophageal Echocardiogram (TEE)

An echocardiogram, or “echo” as it is sometimes called, is a test in which your cardiologist can observe and evaluate the movement of your heart valves and the pumping of blood in the chambers of the heart.

During the echocardiogram, a sonographer or ultrasound technician uses a small wand to direct high frequency sound waves (also called ultrasound) at your heart. The sound waves bounce off the heart and create an “echo” that is translated into a graphic video that your cardiologist can use for diagnostic purposes.

The difference between a standard chest echocardiogram and a transesophageal echocardiogram (TEE), is that the ultrasound wand is part of an endoscope, a long, thin, flexible tube about 1/2 inch in diameter. The endoscope is placed into your mouth and passed into your esophagus or “food pipe.” This test gives the doctor a better look at your heart because your ribs and lungs don’t obstruct the sound waves.

Why do I need a TEE?

Your doctor may ask you to have a TEE to:
• Evaluate the your heart’s valves and chambers
• Determine the presence of different types of heart disease
• Evaluate the effectiveness of valve surgery
• Evaluate abnormalities of the left atrium

Can I eat or drink on the day of the test?
No. DO NOT eat or drink anything for at least 4 hours before the test. If you must take prescribed medication before the test, take it only with a small sip of water.

Should I take my medications the day of the test?
Yes. Take all medications according to your normal schedule as prescribed. Medication taken 4 hours or less before the procedure should be taken with only with a small sip of water.

Special Instructions for Diabetics

If you are diabetic, please contact your doctor for specific instructions about taking your medication before the test.

Should someone come with me the day of the test?
Yes. You will need someone to drive you home. You should not drive until the day after the test. The sedation given to relax you during the procedure causes drowsiness, and may make it unsafe for to drive or operate machinery.

Who will answer my questions before the test?
Before your test, a cardiac sonographer (ultrasound technician), nurse or your cardiologist will explain the procedure in detail, including possible complications and side effects.

The Transesophageal Echocardiogram Procedure

• You will be given a hospital gown and asked to remove clothing from the waist up.
• An (ultrasound technician) sonographer will place electrodes on your chest to monitor your electrocardiogram (ECG). The electrodes are small, circular pads with a sticky substance to help them adhere to the skin.
• An intravenous line (IV) will be inserted into your arm or hand so medications can be delivered when necessary.
• A blood pressure cuff will be placed on your arm to monitor your blood pressure.
• A small clip will be placed on your finger to monitor oxygen levels in your blood.
• You will be asked to gargle liquid solution that will numb your throat.
• The sonographer will spray an anesthetic (pain-relieving medication) at the back of your throat, and medication will be administered through the IV line to help you relax.
• You will be asked to lie on your left side on an exam table, and a dental suction tip will be placed in your mouth to remove secretions. The doctor will then insert the endoscope into your mouth and into your esophagus. The endoscope does not interfere with breathing. You may be asked to swallow at certain times to help pass the endoscope. Throughout the exam, your heart rate, blood pressure and blood oxygen levels will be monitored during and immediately after the exam.

How will I feel during and after the test?
The doctor, sonographer (ultrasound technician) and nurse will keep you as comfortable as possible during the test. Tell them if you feel uncomfortable at any time during the test.

You may feel a temporary soreness or numbness in your throat after the test.

How long does the test take?
The test will take approximately 50-60 minutes. After you have recovered from the sedation and are no longer drowsy, you may go home or go to other scheduled appointments. DO NOT drive yourself home after the test.

Can I eat after the test?
You should wait at least one hour after the test (or until the numbness in your throat is gone) before eating or drinking. Start by drinking a cool liquid. If you have no problems drinking cool liquids, you should be able to resume eating and drinking normally.

How will I be notified about the results of my test?
After a cardiologist reviews the test results, a report will be mailed to your doctor. Your physician will provide the test results to you.

Additional Reading

Read our brochure on Electrocardiography