Types of Tests
Modern Cardiology involves a wide variety of medical tests. From complex blood tests to echocardiography, treadmills to catheterization, the list is extensive. We have started with a small sample including some of the most common tests. We will be adding to our list regularly. Check back with us soon.

Curious about the test you are scheduled to have? Can you eat/drink before the test? How long will it take? We will try to answer these questions and more.

Click on the links below to access information about the test you are curious about. Click here for definitions of medical terms.

Treadmill Heart Catheterization Thallium/Sestamibi Stress Test Lexiscan Stress Test Endovascular Laser Therapy

Treadmill Testing
A Treadmill Test is a useful procedure, which has been utilized by physicians for the past 40 years or so. This procedure can be safely performed in an office or hospital setting.

What is a Treadmill Test?
The object of the test is to raise the heart rate. This stresses the heart so that any potential ischemia (lack of blood flow to a particular area of the heart) can be brought on by the exercise itself. The heart at rest requires considerably less blood than the heart with exercise. The exercise done during the test can show any reduction in blood flow caused by a narrowed artery. The procedure itself usually takes about 45 minutes to complete.

What will I have to do?
The test is accomplished by walking on a moving belt at a gradually increasing speed and slope for a pre-determined period of time. The object is to walk until a target (desired) heart rate is reached. As a general rule, the patient's EKG is monitored continuously before, during and for six or eight minutes after the exercise stops.Practically, the treadmill study takes into account the patient's age, the patient's lifestyle and activity level.

How can walking tell you my arteries are narrow?
The EKG taken before, during and after exercise will usually show changes with the increasing heart rate if narrowed arteries are present. This test is around 70% accurate in men and probably 50% accurate in women for rather complicated reasons.

Is the test safe?
The study is quite safe and carries with it a very low risk of complications (less than 0.1%). The complication rate is less than one would encounter if he/she were walking fairly briskly up a small hill. A physician and a technician are present for the duration of the procedure.

What should I wear? Can I eat?
We ask that you wear loose clothing and comfortable shoes. We prefer that you not have any food and minimal fluids prior to the procedure. You will be able to take your medicines the morning of the test unless otherwise instructed.

When will I get the results?
Your cardiologist will either discuss your results after the test or an appointment will be made to discuss your results soon thereafter. Our staff will give you more detailed instructions at the time of scheduling.

Heart Catheterization
Since the 1960s, it has become increasingly more frequent for a patient to undergo heart catheterization in the diagnosis of their potential or known heart disease. Today, hundreds of thousands of heart catheterizations are done yearly to define whether or not a patient's heart condition is related to congenital, muscle, valve, artery, or rhythm problems, or a combination of all of these.

How long does it take?
What happens during a heart catheterization?
Is it safe?
What is the recovery time?
How should I prepare?

How Long Does it Take?

In order to have the procedure done, a patient needs to be in a suitable hospital or outpatient facility for at least six or eight hours, and sometimes overnight. The catheterization (cath) itself generally lasts 15-20 minutes and is not associated with discomfort in most cases. Following the cath the patient is moved to the recovery area for 15-20 minutes. The patient then goes back to his/her room for 3-6 hours of bed rest. Then, ambulation (walking) occurs for 1 or 2 hours so that the insertion site can be evaluated for any bleeding. After this observation period, you will either be dismissed, or admitted, whichever your cardiologist suggests is appropriate.

What happens during a heart catheterization?
Preparation: To do the test, the right or left groin is shaved in preparation for the study. The patient is then brought to the catheterization laboratory and placed on a special x-ray table, which is fairly well padded and reasonably comfortable. A special soap is applied to sterilize the right and/or left groin area. The groin area is covered with a large sterile drape that extends from around the chin area down below the feet. A cutout in the drape has been made so that there is access to the femoral artery, which is just below the skin in the groin area.

Procedure: Lidocaine or a similar anesthetic is injected around the femoral artery through the skin. This stings or burns a little. Once the area has been anesthetized, a hollow needle is inserted through the skin into the femoral artery. A very slender and soft guide-wire is inserted through the needle and is advanced up toward the heart. You will not be aware of this movement, as there is no physical sensation or discomfort during this phase.

The needle is removed and the guide-wire remains in place in the artery. Next a catheter (thin plastic tube) is threaded over the guide wire and advanced up into the heart area. The guide wire is removed, leaving the catheter in place. An x-ray dye material is injected into the heart pumping chamber and rapid sequence x-ray pictures are taken of the dye as it is pumped from the heart out to the body. This determines whether or not the pumping chamber of the heart (left ventricle) has any weakness. It also evaluates the function of the various heart valves on the left side of the heart.

The first catheter is removed and a second catheter is inserted into the artery and advanced up into the heart. This second catheter, by its shape, is able to identify and enter one of the main arteries of the heart, the left main coronary artery. Dye is injected through the catheter into the left coronary artery system (revealing three of the four heart arteries). Rapid sequence x-ray pictures of the injection of dye through the heart artery system are taken in multiple angle views of the arteries so that all parts of the arteries can be clearly seen.

The second catheter is then removed and a third catheter is inserted. Third catheter is able to identify the arteries of the heart that supply the underside of the heart. Additional x-ray pictures are taken with this third catheter.

That catheter is then removed. If the patient has had prior bypass surgery, some additional views of the bypass arteries are obtained in a similar manner.

Post Procedure: The patient is then moved to a recovery area where the sheath is removed and a pressure device is placed on the involved groin area for 15-20 minutes. After 20 minutes, the pressure device is removed and a pressure dressing is applied. The patient goes back to his/her room for 3-6 hours of bed rest. Then, ambulation (walking) occurs for an hour or two so that insertion site can be evaluated for any signs of bleeding.

Is this safe?
Today, many hundreds of thousands of heart catheterizations are done yearly. The procedure itself is very safe and carries with it a very small risk of significant complications of probably 1 in 1,000 or less.

What is the recovery time?
What is the recovery time? You should not anticipate any complications relating to the test once you have gone home. You may notice a temporary increase in urination since the dye leaves your body through the kidneys. Some patients have some minimal soreness in the groin area for a couple of days. You may also notice some bruising in the groin area which is just some blood that went underneath the skin. It will gradually fade. If you should notice an increase in the bruising or should a hardened area appear, please let us know.

How should I prepare?
In general, you are not allowed to eat anything after midnight just prior to your cath. If it is scheduled for later in the day, you will be given different instructions on your food/fluid intake. You will be able to take your medications with sips of water unless instructed otherwise. You should also arrange to have someone drive you home following the procedure.

When our staff schedules your heart catheterization, you will be given specific instructions. The procedure will be explained again and/or questions answered so that you can sign an informed consent form.

Thallium/Sestamibi Stress Test
Stress TestHow does it work?
It has been found that if a patient exercises on a treadmill machine and is given a dose of a specific radioactive material intravenously which specifically travels to the heart muscle, it will tell us if the heart muscle is receiving adequate blood supply. If the specific radioactive material doesn't get to the heart muscle because of blocked arteries, it means there is a limited blood supply. This alerts your doctor that perhaps further tests are warranted. The agents employed are generally Sestamibi and Thallium.

What happens during a Stress Test?
In general, the patient comes to the exercise location, either in a physician's office or at the hospital and is given a dose of radioactive material at rest. Pictures of the heart are taken with a large and bulky, but totally non-invasive, radioactive camera showing the heart rather clearly. An hour or so later, the patient is exercised on a treadmill or is "exercised"** using an intravenous medication instead of true exercise. At the appropriate time, a second dose of radioactive material is given intravenously. Then, some minutes later, additional pictures of the heart are taken with the radioactive camera.

The initial resting pictures obtained are compared to the exercise pictures. The data is manipulated in a computer, and additional diagrams are obtained showing whether or not there is evidence of reduced blood supply to a particular area of the heart muscle. If no changes from the resting to the exercise pictures are noted, then it is assumed that no blockages are present. If there is a difference with exercise, then it is assumed that a blockage may indeed be present. Further study or adjusted medications would be required in that circumstance.

**Occasionally a person is unable to do exercise such as walking because they are ill or have physical limitations. In this case, a medication such as adenosine/lexiscan is given to the patient instead of performing an exercise test. This medication increases blood flow to the heart and thus "mimics" an exercise test. The Thallium portion of the test is then performed as usual.

Why do I need a Thallium/Sestamibi Stress Test instead of a Standard Treadmill Stress Test?
The radioactive stress test is more accurate than the standard treadmill and is probably around 85% accurate across the board.

Is this safe?
The radioactive stress test also is extremely safe and carries with it a small potential risk of complications, probably 1 in 1,500 to 1 in 2,000 cases. These complications mainly involve rare skin rashes and generally nothing other than that.

What should I wear? Can I eat?
You will be asked to wear comfortable clothes and shoes. In general, you will be asked not to eat or drink anything after midnight. You may take your medicines with sips of water unless otherwise instructed.

You may not have any intake of caffeine 24 hours prior to the test. Caffeine is in food and beverages such as all regular and decaffeinated coffees or teas, all chocolate products, Cokes, Pepsi, Mountain Dew, and certain pain relievers. These are just a few examples. Please read your labels carefully. The test will have to be canceled if you have consumed any caffeine.

How long does it take?
The entire procedure takes approximately five hours. You will not have any type of sedation; therefore, you will be able to drive yourself to and from the facility.If your cardiologist orders this procedure for you, our scheduling staff will make all the appropriate arrangements and give you specific instructions.

Lexiscan Stress Test
How does it work?
Lexiscan is a stress agent that works by increasing blood flow in the arteries of the heart. Lexiscan is given in preparation for a radiologic (x-ray) examination of blood flow through the heart to test for coronary artery disease.

What happens during a Lexiscan Stress Test?
Lexiscan is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. After Lexiscan is injected, you will be given other intravenous (IV) medications that allow blood vessels to be seen more clearly on the radiologic examination.
Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely during your stress test.

Important information about a Lexiscan Stress Test
You should not use Lexiscan if you are allergic to regadenoson, or if you have a serious heart condition such as AV block or "sick sinus syndrome" (unless you have a pacemaker). Before you receive Lexiscan, tell your doctor if you have asthma or COPD, a history of heart disease, or if you have had an illness causing vomiting or diarrhea. Tell your caregivers if you have a serious side effect such as chest pain or heavy feeling, pain spreading to the arm or shoulder, sweating, general ill feeling, wheezing or trouble breathing, slow heart rate, weak pulse, slow breathing, or fainting.

If you have certain conditions, you may need a dose adjustment or special tests to safely receive Lexiscan. Before you receive Lexiscan, tell your doctor if you have:

• asthma or COPD (chronic obstructive pulmonary disease);
• a history of heart disease; or
• if you have had a prolonged illness that caused vomiting or diarrhea

It is not known whether Lexiscan is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Lexiscan passes into breast milk or if it could harm a nursing baby. Do not use Lexiscan without telling your doctor if you are breast-feeding a baby.

Is this safe?
Since Lexiscan is given by a healthcare professional in preparation for medical testing, you are not likely to be on a dosing schedule and run the risk of an underdose or overdose.

What should I wear? Can I eat?
You will be asked to wear comfortable clothes and shoes. Avoid drinking coffee or other beverages with caffeine for at least 12 hours before your stress test.

Are there side effects?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have a serious side effect such as:

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling
• slow heart rate, weak pulse, fainting, slow breathing (breathing may stop)
• wheezing, trouble breathing
• feeling like you might pass out

Less serious Lexiscan side effects may include:

• headache
• dizziness
• nausea, stomach discomfort, decreased sense of taste
• mild chest discomfort
• warmth, redness, or tingly feeling under your skin

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

Endovascular Laser Therapy
Endovenous Laser Therapy: We use a form of treatment called endovenous laser therapy. With this type of treatment, no surgery is required, and the entire procedure can be performed here in our office.

To diagnose your venous reflux we will use ultrasound. If you have venous reflux, we will schedule an endovenous laser therapy procedure. It is possible that your insurance company may require you to wear compression stockings for a period of time before your procedure. The procedure itself takes less than one hour. You will be awake during the procedure, and your leg will be numbed with local anesthetic.  

On the day of your procedure, your physician will re-examine your leg with ultrasound and map the veins to be treated. Then your leg will be prepared for the procedure. The first step is to puncture the diseased vein with a small needle, insert a wire through the needle, remove the needle and pass a catheter into the vein through the puncture site. Next, a laser fiber is passed through the catheter and connected to a laser console. Lastly, laser energy is delivered as your physician slowly pulls the fiber and sheath out of the vein. The laser energy heats the blood in the vein and causes the vein to seal shut. Other healthy veins remaining in your leg take over from there, redirecting the blood flow to your heart. 

After treatment, a gauze pad is placed over the puncture site and a compression stocking is placed on the treated leg. Walking immediately after the procedure is encouraged, and you can return to normal daily activity right away. During the next two weeks, you should avoid swimming, intense gym workouts, hot baths, and excessive sun.

You can expect to recovery rapidly with little pain after the procedure. You may notice some bruising along the treatment site, which is normal and should disappear within a month. You may also feel some tenderness, tingling, itching, or tightness in your treated let for two weeks after the procedure. Walking or taking over-the-counter pain relievers helps relieve any discomfort.

Your physician will provide customized instructions for you to observe after your procedure, including how long to wear a compression stocking.  Should you have any further questions about endovenous laser therapy, please contact our office.

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