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What is it?

A stress test records the electrical activity of the heart during the stress of exercise. This test may show areas of low blood flow and damaged tissue.

Why do I need a stress test?

If the doctor suspects you have coronary artery disease or if you are experiencing symptoms of chest pain or sudden shortness of breath.

To asses the amount of a possible blockage within the vessels of the heart.

A stress test may be advised to you even if you have already been diagnosed with coronary artery disease to asses the effectiveness of the treatment you are on.

An accurate stress test Decreases the use of unnecessary stenting.

How do I prepare for the test?

Wear sneakers and comfortable clothes (preferably a button down shirt with no metal buttons or zipper).

Avoid wearing long chains and necklaces.

Continue your medications up to the day of the procedure.

Stop this medication on the day of the test-

  • Beta blockers including: Atenolol, Toprol, Metoprolol, Lopressor, Coreg, Zebeta, Betapace, or Corgard

If you have asthma and use an inhaler, bring it with you to your test.

Do Not smoke on the day of the test… or ever!!!

Do not apply body lotion on the day of the test

If you need to cancel your appointment, please do so at least 24 hours prior to your test or you may be charged.

What should I expect during the test?

A trained technician will place electrodes on your chest, arms, and legs. These electrodes connect to wires on an electrocardiogram (EKG) machine. The EKG records the electrical activity of the heart.

Next, you will slowly begin walking on the treadmill. As the test progresses, the speed and incline on the treadmill increases. Your blood pressure and EKG will be monitored throughout the test.

The length of the test depends on your physical fitness and symptoms. The goal is to have your heart working hard for about 5- 15 minutes in order to thoroughly monitor its function. Exercise is continued until you reach your target heart rate.

During the test you may develop symptoms or signs of:

  • Chest pain
  • Shortness of breath
  • High or low blood pressure
  • Abnormal heart rhythm
  • Dizziness

You may stop the test at any time if uncomfortable. Symptoms typically disappear once you rest.

The test lasts about 30 minutes.

What are the risks?

Stress tests are generally safe and complications are very rare. Although with any medical procedure, it does carry a small risk of complication.

These complications include:

  • Hypotension: blood pressure may fall during or after exercise that can cause dizziness. This will usually ease off once you stop exercising
  • Abnormal heart rhythms may occur during exercise. This usually returns to normal once exercise is ceased.
  • Chest pain or flushing feeling may occur

The result:

Once the test is completed, the results of your test will be assessed to determine the condition of your heart.

This is useful in planning for your treatment and also helps in determining whether further testing is needed.

A stress test may reveal:

  • The results may be beneficial in confirming or ruling out the diagnosis of heart disease
  • Confirm whether you are in a stable state
  • Assess the development of new blockage
  • Some patients may be unable to exercise due to joint/muscle pain or limitation. In some of theses cases, a chemical stress test may be appropriate.

What is it?

A nuclear stress test measures the blood flow to your heart both at rest and during stress on the heart during exercise.

This test provides images of the amount of blood flow in all sections of the heart, which can show areas of low blood flow and damaged tissue.

Why do I need it?

  • If the doctor suspects you have coronary artery disease
  • Experiencing symptoms of chest pain or sudden loss of breath
  • To asses the amount of possible blockage within the vessels of the heart
  • To asses the effectiveness of the treatment you are on.
  • To assess the size and shape of your heart. It may be enlarged in patients whose hearts are working harder than normal.
  • To measure the Ejection Fraction this shows how well your heart pumps with each beat.
  • An accurate stress test Decreases the use of unnecessary stenting

How do I prepare for a test?

  • Do not eat or drink 4 hours prior to the test. Small sips of water are permitted.
  • Avoid all caffeinated products for 12 hours before the test. This includes decaffeinated coffee, coffee, tea, soda. Avoid fatty foods as well as dairy products including butter, milk, and cheese. Fatty foods can alter the imaging results.
  • Bring a light breakfast or lunch sandwich and non-caffeinated drink with you.
  • Wear sneakers and comfortable clothes (preferably a button down shirt with no metal buttons or zipper).  Avoid wearing long chains and necklaces.
  • If you are taking heart medications:

Continue your medications up to the day of the procedure. On the day of the test,

Stop these drugs:

Beta blockers (Atenolol, Toprol, Metoprolol, Lopressor, Coreg, Zebeta, Betapace, or Corgard)

Persantine (Dipyridamole)

Theophylline

Primatene/ Theo-dur

  • If you have diabetes and are taking insulin to control your blood sugar:

Ask your doctor how much insulin you should take the day of the test. Your doctor may recommend you to only take half of the usual morning dose and to eat a light meal 4 hours before the test.

Do NOT take your diabetes medication and skip a meal before the test.

  • If you have asthma and use an inhaler, bring it with you to your test
  • Do Not smoke on the day of the test… or ever!!!
  • Do not apply body lotion on the day of the test
  • If you need to cancel your appointment please do so at least 24 hours prior to your test or you may be charged.

What should I expect during the test?

First, a nuclear medicine technologist will place an I.V. into your arm or hand.

You may be injected with an isotope called Cardiolite that allows us to pick up your blood flow on camera.

After this is injected, you will wait about 30 minutes before the first set of “Resting” images are taken.

You will be asked to lie under a gamma camera with both arms above your head for 15-20 minutes. This camera will capture the images of the blood flow through your heart at rest.

Next, the technician will place electrodes on your chest, arms, and legs. These electrodes connect to wires on an electrocardiogram (EKG) machine. The EKG records the electrical activity of the heart.

If a pharmacological stress test has been ordered for you, you will then be injected with a pharmacological medication known as Lexiscan. This medication increases the blood flow to the heart to simulate exercise. This does NOT increase your heart rate, only dilates the vessels as if you were exercising.

Your blood pressure and EKG will be monitored throughout the test.

During the test you may develop symptoms or signs of:

  • Chest pain
  • Shortness of breath
  • High or low blood pressure
  • Abnormal heart rhythm
  • Dizziness

Finally, after a 30-60 minute breakfast or lunch break you will be asked to again lie under the camera with both arms above your head for 15-20 minutes. The camera will capture the “exercise” images of the blood flow through your heart.

This set of images will be compared to the resting images.

The entire test will take about 3-4 hours.

Once your nuclear stress test is complete, you may return to your normal activities, eating habits, and medications.

What are the risks?

Nuclear stress tests are generally safe and complications are very rare. Although with any medical procedure, it does carry a small risk of complication.

These complications include:

  • Infection at the site of intravenous puncture.
  • Allergic reaction although uncommon, may be due to the radioisotope injected.
  • Hypotension: blood pressure may fall during or after exercise that can cause dizziness.
  • Abnormal heart rhythms may occur during exercise. This returns to normal once exercise is ceased.
  • Chest pain or flushing feeling may occur from the medication or if you have coronary artery disease.
  • As with all radiologic procedures, it is important to inform your physician and technologist if you are pregnant. Radiation exposure during pregnancy should be kept to a minimum.

The Result:

Dr. Jamnadas or Dr. Kelly will review the results of your nuclear stress test before your next office visit, not the same day as the test.

The results of the test will compare the images of the heart at rest and during exercise.

 

Interpretations of the results:

  • Normal blood flow both at rest and exercise- it is unlikely you have coronary artery disease. No further work up is needed.
  • Normal blood flow at rest and an abnormal blood flow during exercise- means part of your heart muscle is Not receiving adequate blood when you are exercising or during strenuous activity. You may have coronary artery disease; a blocked artery. Alteration of medication may be needed.
  • Low blood flow at rest and exercise – means a significant amount of your heart is not getting enough blood flow. You may have had a previous heart attack or severe coronary artery disease. Further cardiac evaluation may be needed using a coronary angiography and cardiac catheterization.

In patients with mild to moderate blockage blood flow is not restricted. Usually only coronary blockages of >70% restrict blood flow and will usually show up on a nuclear stress test.

A nuclear stress test showing mild to moderate blockages usually do not show up on a nuclear stress test and do Not need stenting or bypass. This can be cured by lifestyle and preventative changes.

What is it?

An echocardiogram (ECHO) is a simple diagnostic study used to assess the condition and function of the heart using high frequency waves.

This study is performed here in our office.ECHO

When is it used?

An ECHO may show signs of:

  • Congenital heart defects
  • Previous heart attacks
  • Blood clots in the heart
  • Infection of the heart valves
  • May explain chest discomfort or shortness of breath
  • May explain the cause on an irregular heartbeat or heart sound
  • Determines the overall strength of contractions of the heart
  • Pericardial effusion (fluid around the heart)

 

What is the risk?

There is no risk associated with this study.

No radiation exposure is used during this study.

How do I prepare for the study?

No specific preparation is required. You may follow your daily eating habits before and after the study.

Clothing and jewelry need to be removed from the waist up to perform the study.

What happens during the study?

You will lie on a table while a trained ultrasound technician applies a clear jelly over the desired area. A probe is used to glide over this jelly which helps in transmission of sound waves through the skin.

The probe is pressed firmly over the chest to view the heart. Sound waves produced by the heart, create an echo that can be formed into an image. These images are recorded on to a monitor to be interpreted.

You may be asked to momentarily hold your breath or turn into a different position to enhance the images of the heart.

Sound waves given off the blood help to assess the direction of blood flow and blood pressures in the arteries of the heart. This also detects any abnormal sounds that may be produced by the heart.

The study may last up to 30 minutes.

What happens after the study?

After the study is over, the jelly is wiped off and you may return to your daily activities.

The result:

Dr. Jamnadas or Dr. Kelly will review the results of your study to look for healthy heart valves and chambers, as well as normal heart functioning.

This is useful in planning for your treatment and also helps in determining whether further testing is needed.

An ECHO may reveal:

  • The size of the heart and the chambers of the heart
  • The thickness and motion of the ventricular walls
  • The movement and function of the of the heart valves
  • The cardiac output (volume of blood pumped out of the heart per minute)
  • The pressures within various chambers of the heart and major blood vessels in the heart
  • The blood flow within the heart
  • The heart function changes over time
  • The presence of blood clots inside the heart

The results of your ECHO will be discussed with you during your office visit.

What is it?


A transesophageal echocardiogram (TEE) is a diagnostic procedure used to asses the condition and function of the heart using high frequency waves.

This is done in a hospital setting where images of your heart are recorded by introducing an ultrasound transducer into the esophagus.

Why do I need this?

A TEE may have been ordered for you to obtain a more detailed image of your heart compared to a transthoracic echocardiogram done over the chest.

The transmission of beams to the heart may be difficult to reach in patients with over-crowding of the ribs, obesity, or emphysema.

In a transesophageal approach, the esophagus sits directly behind the heart without having to pass through any barriers.

When is it used?

A transesophageal echocardiogram may show signs of:

  • Congenital heart defects
  • Previous heart attacks
  • Blood clots in the heart
  • Infection of the heart valves
  • May explain chest pain discomfort or shortness of breath
  • May explain the cause on an irregular heartbeat or heart sound
  • Determines the overall strength of contractions of the heart
  • Pericardial effusion (fluid around the heart)
  • Presence of a cardiac mass
  • Determines whether cardioversion is required
  • Detects the presence of an ascending aorta dissection or aneurysm

What are the risks?

TEE is a common diagnostic procedure, although with any medical procedure it carries risks.

These include:

  • Allergic reaction: to the medication or latex
  • Infection
  • Dental injury
  • Pharyngeal/ laryngeal trauma
  • Esophageal trauma or bleeding
  • Arrhythmia (irregular heart beat)
  • Respiratory distress (breathing difficulty)

Notify the physician if you have known esophageal problems (i.e. difficulty in swallowing) or have undergone any radiation to the esophagus.

Let your physician know if you have any bleeding disorders.

If you are pregnant or suspect you may be pregnant, let the physician know.

If you are allergic to any medications or to latex notify the physician.

How do I prepare for this procedure?

The possible risks and benefits will be explained to you and any questions you or your family may have will be answered before your procedure.

You will be asked to have blood work done some time before the procedure.

You will be asked to sign a consent form to perform the diagnostic procedure.

Remove nail polish, necklaces, rings, bracelets, and any other jewelry before the procedure.

Do not eat or drink anything from midnight the night before your procedure. You may have small sips of water to take your medicine. The procedure is usually done in the morning. This is done to reduce the risk of vomiting and aspiration during the procedure.

A sedative will be given to you prior to the procedure to help you relax.

Make arrangements to have someone drive you to and from the hospital. You will not be permitted to drive after the procedure.

You will be asked to empty your bladder before the procedure.

The procedure is done on an outpatient basis so you will leave the same day as the procedure.

What happens during the procedure?

The procedure will take place in the hospital in the ECHO lab.

You will be asked to change into a hospital gown before entering the lab.

An I.V. line will be started in your hand or arm for the administration of a sedative.

You will lie on your back on a table and a pillow may be wedged underneath your back.

A local anesthetic spray will be applied to the back of your throat. This will make the back of your throat numb so you will feel more comfortable while the probe is being passed down your throat.

If required, oxygen may be administered through nasal tubes.

Then, you will be asked to lie on your left side.

The physician gently inserts a well lubricated probe into your mouth. You may be asked to swallow to help pass the probe down the esophagus.

Once the probe is in position, images of the heart can be obtained. This does not hurt or interfere with your breathing.

Throughout the procedure your heart rate, blood pressure, and oxygen will be closely monitored.

The procedure usually lasts 30 minutes, but the prep time may take longer.

What happens after the procedure?

Once the procedure is completed, you will be moved into a recovery area where your heart rate, blood pressure, and oxygen levels will be monitored.

Wait at least one hour after the procedure or until your throat is no longer numb to eat and drink again.

You may resume your daily activities after the procedure is completed.

No driving permitted for 24 hours.

Be sure to keep to your follow up appointment.

The result:

The results of your study will be reviewed to look for healthy heart valves and chambers, as well as normal heart functioning.

This is useful in planning for your treatment and also helps in determining whether further testing is needed.

A transesophageal echocardiogram may reveal:

  • The size of the heart and the chambers of the heart
  • The thickness and motion of the ventricular walls
  • The movement and function of the of the heart valves
  • The cardiac output (volume of blood pumped out of the heart per minute)
  • The pressures within various chambers of the heart and major blood vessels in the heart
  • The blood flow within the heart
  • The heart function changes over time
  • The presence of blood clots inside the heart

The results of your ECHO will be discussed with you during your office visit.

What is it?

An arterial Doppler study is a noninvasive, painless study used to assess the blood flow and pressure within the arteries using high frequency sound waves.

Why do I need it?

An arterial Doppler may be used to diagnose a variety of conditions including:

  • Detecting the presence of blood clots
  • Arterial occlusion
  • Decreased blood flow to the arms or legs due to peripheral vascular disease
  • Aneurysm
  • Vascular tumor

What is the risk?

No risks are associated with this study.

No radiation exposure is used during this study.

How do I prepare for the study?

No specific preparation is required. You may follow your daily eating habits before and after the study.

Clothing will need to be removed over the area being examined.

What happens during the study?

You will lie on a table while a trained ultrasound technician applies a clear jelly over the desired area. A probe is used to glide over this jelly which helps in transmission of sound waves through the skin.

Two blood pressure cuffs are applied over the limb being studied. Each cuff is inflated one at a time. Inflation is done to determine the pressure within the artery and to detect the moment blood flow is returned to the vessel.

Blood pressures can be measured at different levels to assess arterial narrowing or occlusion. These readings are used to determine the site and size of arterial narrowing.

The study lasts up to 1 hour.

What happens after the study?

After the study is over, the jelly is wiped off and you may return to your daily activities.

 

The result:

The results of the test will show either a normal or abnormal study.

A normal study shows normal blood flow and pressure.

An abnormal study shows reduced blood flow and high pressure.

This will help diagnose atherosclerotic (narrowing due to plaque) changes.

What is it?

A venous Doppler study is a noninvasive study used to measure the direction of blood flow through a vein using high frequency waves.

This study is useful in detecting any abnormalities which may present within a vein.

Why do I need it?

A venous Doppler study may be used for the following reasons:

  • To search for deep vein thrombosis (DVT)- a blood clot within the vein
  • To determine narrowing within the vein
  • To detect any congenital malformations or presence of any vascular tumor
  • To determine the cause of long standing leg swelling
  • As an guidance tool for the exact placement of a catheter into a vein

What is the risk?

There is no risk associated with this study.

No radiation exposure is used during this study.

How do I prepare for the study?

No specific preparation is required. You may follow your daily eating habits before and after the study.

Clothing will need to be removed over the area being examined. You may consider wearing shorts for the study, if not a gown will be provided.

What happens during the study?

You will lie on a table while a trained ultrasound technician applies a clear jelly over the desired area. A probe is used to glide over this jelly which helps in transmission of sound waves through the skin.

The probe is pressed firmly over the skin in various angles and locations tracing over the area of interest. The limb may be squeezed at various times to check for the flow of blood through the vein. These sound waves show up as images on a monitor to be recorded and interpreted.

The study may last up to 30 minutes.

What happens after the study?

After the study is over, the jelly is wiped off and you may return to your daily activities.

The result:

The results of the study will show as either normal or abnormal.

A normal study shows normal blood flow with no evidence of deep vein thrombosis.

An abnormal study shows reduced blood flow with or without deep vein thrombosis.

This study helps in coming to a conclusion to some of the symptoms you may be having, assess the patency of the vein, as well as detecting any other abnormal findings.