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cardiac-rehab-therapistsThe Non-Invasive Cardiology Department at DRMC offers a complete range of diagnostic cardiology procedures with interpretations provided by our staff of board certified cardiologists. Testing is provided by a qualified staff of registered nurses and registered cardiac sonographers supervised by our team of certified nurse practitioners. Procedures performed are:

• Complete line of stress testing (Regular, Nuclear, Pharmacologic)
• Echocardiography (Adult, Pediatric, Neonatal)
• Contrast Enhanced Echocardiography
• Transesophageal Echocardiography
• Stress Echocardiography
• Dobutamine Stress Echocardiography
• Enhanced External Counter Pulsation (EECP)
• 24-hour Cardiac Monitor (Holter Monitor)
• Cardiac Event Monitor
• 24-hour Ambulatory Blood Pressure Monitor
• Tilt Table Testing (Non Cardiac Syncope)


 

Stress Testing

Exercise Stress Test

An exercise stress test shows your heart's response to exercise. The test records your heartbeat while you walk on a treadmill.

Before the test

• Review your medications and ask if it is appropriate to take them before the test.
• Avoid food and drinks containing caffeine.
• Do not eat, drink, smoke or have any caffeine for eight hours before the test.
Getting ready

• Wear flat, comfortable walking shoes.
• Wear a shirt or blouse that can be removed easily.
• You may be asked to remove your clothing from the waist up or to wear a gown.
During the test

• Electrodes (small pads) are placed on the upper body and a blood pressure cuff is placed on the arm. The electrodes are used to monitor the heartbeat and blood pressure during and after testing.
• You will be given instruction on the proper use of the treadmill.
• You will then be asked to exercise for several minutes. Exercise will be easy at first and slowly get harder.
• Exercise as long as you can or until you are asked to stop.

Report symptoms during the test or if you feel any of the following:

• Chest, arm or jaw discomfort
• Severe shortness of breath
• Fatigue
• Dizziness
• Leg cramps or soreness

After the test

• Resume normal activity
• Keep follow-up appointments
Nuclear Stress Test (Cardiac Nuclear Imaging)

Cardiac nuclear imaging is also called a "perfusion scan." A tracer (small amount of radioactive matter) is delivered into the bloodstream. A camera scans the tracer in the blood as it flows through the heart muscle. The tracer leaves your body within hours.

Before the test

• The entire test will take a few hours. For best results, prepare for your test as instructed.
• When you schedule the test, be sure to mention the medications you take. Ask if you should stop taking them the day of the test. *Theophylline products should be held for 48 hours.
• Stop smoking and avoid caffeine for as long as directed.
• Don't eat or drink for eight hours before the test. Sips of water are okay.
• Dress for comfort. Wear a two-piece outfit, top and bottoms. Be sure to wear walking shoes.
• Let the technologist know if you have diabetes, knee or hip problems, arthritis, asthma or chronic lung disease.
• Let the technologist know if you have had a stroke or have vascular disease of the leg.
• Let the technologist know if you are pregnant or think you may be pregnant or are nursing.

During the test

• Scanning pictures will be taken while you rest.
• You will be connected to EKG and blood pressure monitors. An IV (intravenous) line will be started in your arm.
• You will exercise on a treadmill for a few minutes. This increases the rate of blood flow to your heart muscle.
• Speak up when you feel that you cannot exercise for even one more minute. At this point, the tracer is given to you through the IV.
• If you cannot exercise, special medications can be used to open up blood vessels or increase heart rate according to the nuclear schedule time.
• After you have received the tracer, you will be positioned on the scanning bed.
• You must lie very still for up to 30 minutes. During this time, a scanning camera will be taking pictures and the images will show where blood flows through the heart muscle.

Report symptoms during the test or if you feel any of the following:

• Chest, arm or jaw discomfort
• Severe shortness of breath
• Dizziness or lightheadedness
• Leg cramps or pain

After the test

• Before going home, ask when you may eat.
• Most people can go back to their daily routine as soon as the test is complete.


 

Echocardiography

An echocardiogram (echo) is an imaging test that helps doctors evaluate the heart. It is a safe and painless and can be done in the hospital. It helps show the size of the heart and helps show the health of the heart's chambers and valves.

Before the test

• Discuss any questions or concerns with your physician
• Allow extra time for registration
• You will be given a hospital gown

During the test

• Most echo tests take 10-20 minutes.
• Small pads (electrodes) are placed on the chest to monitor the heartbeat.
• A transducer coated with cool gel is moved firmly over the chest. This device creates the sounds waves that make images of the heart.
• At times, you may be asked to exhale or hold your breath for a few seconds. Air in the lungs can affect the images.
• The transducer may also be used to do a Doppler study. This test measures the direction and speed of blood flowing through the heart. During the test, you may hear a ìwhooshingî sound. This is the sound of blood flowing through the heart.
• The images of the heart are stored on a computer or recorded on video. This is to allow the doctor to view the images.

After the test

• Resume normal activity unless otherwise instructed
• Be sure to keep follow-up appointments


 

Transesophageal Echocardiography (TEE)

A transesophageal echocardiogram (TEE) is a test that allows the doctor to record images of the heart from inside the esophagus, or food pipe. These images will help the doctor identify and treat problems such as infectious disease, or defects in the heart's wall or valves.

Before the test

• Discuss all medications and if it is okay to take them before the test.
• Do not eat or drink for 6-8 hours before the test. This includes water.
• Tell your doctor if you have ulcers, a hiatal hernia, problems swallowing or any allergies to medications or sedatives.
• Arrange to have someone drive you home after the test.

During the test

• When you arrive, you will change into a hospital gown.
• Your throat is sprayed with an anesthetic to numb it. You may be given a mild sedative through an IV (intravenous) line in your arm to help you relax. You may also be given oxygen. You will then be asked to lie on your left side.
• The doctor gently inserts the probe into the mouth. As you swallow, the tube is slowly guided into the esophagus. The tube is lubricated to make it slide easily.
• You may feel the doctor moving the probe, but it should not hurt or interfere with breathing. A nurse will monitor your heart rate, blood pressure, and breathing. The test usually takes 20-40 minutes.

After the test

• You may eat and drink when your throat is no longer numb.
• Be sure to keep follow-up appointments.


 

Stress Echocardiography

Stress echocardiography, or stress echo, is a test that records images of the heart before and after exercise. By comparing images, the doctor can tell whether the heart is getting enough blood to meet its increased demand for oxygen.

Before the test

• Discuss all medications and if it is okay to take them before the test.
• Do not eat, drink, smoke or have caffeine for three hours before the test.
• Wear flat, comfortable walking shoes.
• Wear a shirt or blouse that can be removed easily.

During the test

• A transducer and gel are placed on the chest to record images on videotape of the heart at rest
• Blood pressure is monitored and electrodes are attached to the chest to record an electrocardiogram (EKG), a test that records the heartbeat pattern.
• You will then walk on a treadmill until your heart is beating rapidly. Note: If you are not able to exercise, you will be given a drug to get your heart working harder.
• The technician records a second set of video images of the heart immediately after exercise.

After the test

• Resume normal activity.
• Be sure to keep follow-up appointments.


 

Dobutamine Stress Echocardiography

This type of echocardiogram uses the drug Dobutamine and sound waves to help see if any blood vessels in the heart are blocked.

Before the test

• Discuss all medications and if it is okay to take them before the test.
• Do not eat, drink, smoke or have caffeine for four hours before the test. Sips of water are okay.
• Wear flat, comfortable walking shoes.
• Wear a shirt or blouse that can be removed easily or a two piece outfit.

During the test

• Small pads (electrodes) are placed on the chest to record heartbeat.
• An intravenous (IV) line is started in the arm.
• A transducer coated with cool gel is moved firmly over the chest. This device creates sound waves that make images of the heart.
• Dobutamine is then slowly given through the IV. It is normal to feel your heart pound for a few minutes.
• Echo images are taken while you feel the effects of the drug and after your pulse returns to normal. You may be given a second drug to return the heartbeat to a normal level.

Report symptoms during the test or if you feel any of the following:

• Chest, arm or jaw discomfort
• Irregular heart beat
• Feeling flushed
• Shortness of breath
• Nausea
• Headache

After the test

• Resume normal activity.
• Be sure to keep follow-up appointments.


 

Enhanced External Counter Pulsation (EECP)

EECP is a non-invasive, outpatient treatment to relieve or eliminate angina. Inflatable cuffs are placed on the calves, thighs and buttocks. Inflation and deflation of the cuffs is synchronized with every heartbeat. This treatment stimulates the opening or formation of blood vessels to create a natural bypass around narrowed or blocked arteries.


 

Holter Monitor (24-hour cardiac monitor)

Holter monitoring is a painless way to record your heartbeat away from the doctor's office. It is a small electrocardiogram (EKG) that you carry with you. Holter monitoring records your heartbeat for your doctor to review at a later time.
When you receive a Holter monitor, small, painless pads (electrodes) are put on your chest. These connect to a lightweight unit which attaches to a belt or shoulder strap. You need to keep the device on for at least 24-hours and complete a diary. While wearing the monitor follow these tips:

• Try to sleep on your back.
• Don't take a shower. A sponge bath is okay.
• Follow your normal routine. Don't avoid stress, work or exercise.
• If an electrode falls off or the unit makes noise, call to see what you should do.

Holter monitor diary

• Write in the time of day for each entry you make.
• Note any symptoms you feel.


 

Cardiac Event Monitoring

The event monitor lets you record your irregular heartbeats as you feel them. You may carry this monitor for days or weeks.


 

Ambulatory Blood Pressure Monitor

An ambulatory blood pressure monitor is a small machine that is the size of a portable radio. The blood pressure cuff on the monitor can be worn under clothes. The machine allows your doctor to monitor blood pressure every 15-30 minutes over a 24 hour period.


 

Tilt Table Testing

Tilt table testing is a simple test that helps the doctor pinpoint the cause of fainting. It evaluates how changes in body position can affect blood pressure. Patients are placed on a table that is tilted upward. The test tries to recreate fainting symptoms while blood pressure and heart rate are monitored.

Before the test

• Arrive to the hospital 15 minutes before your appointment.
• Discuss all medications and if it is okay to take them before the test. Hold medications as directed.
• Do not eat or drink after midnight the night before the test.
• Wear a shirt or blouse that can be removed easily or a two piece outfit.

During the test

• The test takes approximately 60 minutes.
• Small pads (electrodes) are placed on the chest to record heartbeat.
• A blood pressure cuff is placed on the arm.
• An IV (intravenous) line may be placed in the other arm.
• You will be asked to lie flat on the table. Your upper body and thighs will be held in place with straps.
• The table tilts until you are almost standing upright.
• Occasionally, medications are administered and the patient is retested. These medications may induce a headache.

Report symptoms during the test or if you feel any of the following:

• Overall weakness
• Nausea
• Dimmed vision
• Sweating or lightheadedness
• Rapid heartbeat
• Any other symptoms

After the test

• The medications administered during the test should leave your system within 15 minutes.
• Ask if you should start taking your regular medications.
• Arrange to have someone drive you home after the test.

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