Preventative and Diagnostic Testing Instructions

The Cardiovascular Centers, LLC provides various non-invasive test procedures for accurate and timely diagnosis of various cardiovascular conditions. We are proud to offer these services to our patients in the convenience of our office. More invasive procedures are performed at the hospital.

We request that you please read and follow the specific pre-test instructions applicable to your appointment. This will enable us to obtain the highest quality results.

Description and instructions for the common cardiac and Vascular procedures are listed below. Please don't hesitate to contact our office, if you have any unanswered questions regarding these instructions.

1. Echocardiogram
2. Nuclear Stress Test
3. Stress Echocardiogram
4. Exercise Stress Test
5. Event Monitor
6. Holter Monitor
7. Cardiac Catheterization.
8. Vascular Studies (Carotid Duplex, Lower Extremity Ultrasound, Aorta Ultrasound, Ankle Brachial Index & Pulse Volume Recording)

Test description:
Echocardiogram is one of the most popular test to evaluate the heart. It allows the doctor to visualize the heart and its components. It is a noninvasive procedure that uses sound waves (ultrasound) to evaluate how well the heart and its components are working. Gel is applied to the chest and a transducer (wand-like apparatus) is moved over the chest area to produce an image of the internal structures of the heart.  The test will take from 30 to 90 minutes depending on the patient's condition and the type of echo needed. This test must be ordered by a doctor.

Echocardiogram will allow the doctor to access the heart function. It may also be able to provide information about any part of the heart (Ventricle) that may not be pumping as well as the other segments. It also allows for evaluation of the heart valves and access if there are any structural problems with the heart.

Testing instructions:

1. If you are unable to make your scheduled appointment, please call the office a day prior to your test.
2. Please ARRIVE 15 minutes before scheduled time and bring your INSURANCE CARD and PICTURE ID to the front desk upon check in.
3. No special preparation is required.
4. Please do not apply powder, lotions or oil on chest.
5. Wear comfortable walking shoes and two-piece clothing (without metal snaps). Do not wear jewelry.
6. Bring all medications, or a list of medications, for review.
7. Friends/family are welcome to accompany you to the office but are not allowed in the testing area due to our privacy policy.
8. Allow approximately 1 hour for the test.
9. Test results will be communicated to you by your ordering physician.

Test description:
The stress test shows if your heart receives enough blood from its own arteries to work harder, safely.

The stress test shows if your heart receives enough blood from its own arteries to work harder, safely. Taking the stress test helps your doctor know what type of exercise and how much is right for you.

A nuclear stress test combines the treadmill portion with images recorded on computerized gamma cameras. In some cases medicines may be used to increase your heart rate to simulate exercise. For the images, the patient receives a small dose of radioactive substance (isotope), which the cameras can see.

The basic stress test requires leads on the chest to provide the Electrocardiogram (EKG) signal. The EKG is the electrical signal the doctor monitors during the test. The doctor monitors your heart rate, heart rhythm, blood pressure and looks for changes which suggest that the heart is not receiving enough blood for its needs. The doctor records an EKG at rest, at peak exercise and afterwards. The doctor asks about symptoms and how tired you feel.

At peak exercise the doctor or technologist injects the isotope. The patient has the images recorded. The images may take 30-minutes and you must wait for about four hours. During this time the heart rests from the exercise. After resting, the patient has a second set of images. For the second set, the patient may require a second injection of the isotope. The doctor compares the two sets of images to determine if the study is normal or abnormal.

Testing instructions:

1. If you are unable to make your scheduled appointment, please call the office by 3:00 pm the day prior to your test. Missing a scheduled Nuclear Stress Test may result in a $150 charge.
2. Please ARRIVE 15 minutes before scheduled time and bring your INSURANCE CARD & PICTURE ID to the front desk upon check in.
3. If you are severely claustrophobic, cannot lie flat, or cannot raise your left arm over your head, please call the office.
4. Some patients will have their portions of the nuclear stress test performed on two separate days. This is done to improve the quality of the pictures of the patient's heart. Women over 250lbs and men over 275lbs will be scheduled in this way. The second part of the testing procedure will be scheduled for the patient by the nuclear staff.
5. Do not eat or drink anything, including water, for 4 hours prior to your test. Do not use any caffeine, de-caf, or nicotine for 12 hours prior to the test (including some medications).
6. Medications should be taken as directed by your physician. Diabetic patients with early morning appointments may take 1/2 of your insulin dose with juice and dry toast. If you use an inhaler, please bring it with you to your test.
7. Wear comfortable walking shoes and two-piece clothing (without metal snaps). Do not wear jewelry.
8. Bring all medications, or a list of medications, for review.
9. Friends/family are welcome to accompany you to the office but are not allowed in the testing area due to our privacy policy.
10. In the testing room, a nurse or technician will start an intravenous line, or IV, in your arm and will administer a small amount of radioactive tracer. A short time later, you will be asked to lie still on a table underneath a camera that rotates around the chest and senses the radiation being emitted by the tracer. The camera will record images for 13-15 minutes.
11. The nurse or technologist will then place on you approximately 10 small, sticky ECG electrodes with wires attached to them. Recordings of the heart's resting activity are made before the stress test begins. You begin the stress test by either walking on a treadmill or by receiving medication. If you are scheduled to walk on a treadmill, the speed and incline of the treadmill typically increase every 3 minutes to raise your exertion level and increase the work the heart must do. Exercise typically lasts from 5 to 15 minutes. For medication stress tests, you may be asked to do a slow and easy walk on the treadmill during their test. A second radioactive tracer is injected through the IV during the stress test. You are then asked to lie still on a table underneath a camera for another image of the heart.
12. The entire nuclear stress test may take between 2 and 4 hours and you can resume normal activities immediately following the test.
13. Test results will be communicated to you by your ordering physician.

Test description:
An Exercise Stress Echocardiogram, sometimes called a stress echo, is a tool used to evaluate heart function by combining an exercise (stress) test with a transthoracic echocardiogram. A stress echocardiogram uses ultrasound waves to produce images of the heart both before (sometimes during) and immediately following exercise. Images of the heart at rest are compared with images of the heart during and/or after exercise to evaluate how the heart responds to exercise. A stress echocardiogram is most often requested to check for good blood flow to the heart. An ECG may help to provide an early detection of coronary artery blockage.

Testing instructions:

1. If you are unable to make your scheduled appointment, please call the office a day prior to your test.
2. Please ARRIVE 15 minutes before scheduled time and bring your INSURANCE CARD and PICTURE ID to the front desk upon check in.
3. Do not eat or drink anything, including water, for 3 hours prior to the test.
4. Wear comfortable walking shoes and two-piece clothing (without metal snaps). Do not wear jewelry.
5. Bring all medications, or a list of medications, for review.
6. Friends/family are welcome to accompany you to the office but are not allowed in the testing area due to our privacy policy.
7. Allow approximately 90 minutes for the test.
8. Test results will be communicated to you by your physician.

Test description:
An ETT records the electrical activity of the heart on an electrocardiogram and takes blood pressure readings while you walk on the exercise treadmill.

The ETT is used to:

• Check for heart disease
• Determine if treatment for heart disease is effective
• Access heart rhythm

An ETT is performed when your healthcare provider thinks you might have heart disease. The most common heart disease is caused by narrowing of the coronary arteries. The coronary arteries are the blood vessels that supply blood, oxygen and nutrients to the heart. The arteries can become narrowed when substances such as cholesterol build up inside the artery. ETT is one of the safest and most widely used tests for heart disease in the United States. It is a quick way to check your heart's arteries for narrowing or blockage. Your healthcare provider uses it to help decide whether you need more tests.

Testing instructions:

1. If you are unable to make your scheduled appointment, please call the office a day prior to your test.
2. Please ARRIVE 15 minutes before scheduled time and bring your INSURANCE CARD and PICTURE ID to the front desk upon check in.
3. Do not eat or drink anything, including water, for 3 hours prior to the test.
4. Wear comfortable walking shoes and two-piece clothing (without metal snaps). Do not wear jewelry.
5. Bring all medications, or a list of medications, for review.
6. Friends/family are welcome to accompany you to the office but are not allowed in the testing area due to our privacy policy.
7. Allow approximately 1 hour for the test.
8. Test results will be communicated to you by your ordering physician.

Test description:
Cardiac event monitoring is used to record a patient’s heart rhythm when he or she is experiencing symptoms. It is activated by the patient when he or she is experiencing symptoms such as dizziness, palpitations, shortness of breath, fainting spells or chest pain to help diagnosis what is causing the symptoms. For instance, heartbeats that are too fast or too slow may cause light-headedness or fainting. Since an irregular heart beat might not last long enough to show up on an electrocardiogram, cardiac event monitoring can help pinpoint the cause when the heartbeat irregularity occurs.

Event monitoring involves wearing a very small, portable, EKG recorder over a period of time that can vary from weeks to a month. Two small adhesive electrodes are attached to a patient’s chest and attached to a small device which can be kept in a pocket or on a belt. These electrodes may be removed for showering.

When a patient is having an event, he or she just pushes a button to record what is happening with the heart. The recorded data can be sent over the phone to your doctors for analysis.

During the time the monitor is worn, patients are encouraged to go about their usual activities, but will be asked to record the dates and times for activities such as walking, resting, and eating, when medication is taken, and when symptoms occur.

A cardiologist will review the recordings and inform the patient about the results at the next visit or sooner, if needed.

Test description:
Holter monitoring is used to record your heartbeat away from our office and allows your doctor to evaluate how it responds to normal activity. When you receive a Holter Monitor, small, painless electrodes (conducting patches) are placed on your chest and attached to a small recording monitor. The monitor can be placed in a pocket or small pouch worn around your neck. The monitor is battery operated.

While you wear the monitor, it records your heart's electrical activity. You need to keep the device on at least 24 hours and complete a diary of your activities while wearing the monitor. After 24 hours, you return the monitor to our office. Your records will be studied to determine if there have been any irregular heart rhythms.

Test description: (Please refer to the following websites)

http://www.nhlbi.nih.gov/health/health-topics/topics/cath/
https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_317626.pdf

Testing instructions:

1. Please do not eat or drink after midnight for morning procedures. A clear liquid breakfast only is allowed for procedures scheduled after 12 noon.
2. You cannot drive yourself home after the procedure. Please make certain that a responsible person is available to drive you home.
3. If your cath is being done in one of our Outpatient Cardiovascular Centers, please bring only one person with you on the day of your procedure as our waiting areas are small. Arrange for a responsible adult to help you at home for at least 24 hours following your procedure.
4. Bring all your medications with you on the day of your procedure. The doctor or nurse will verify the medications you are taking, and you might be asked to take your medications while at the cath lab.
5. You may take all of your medications at the regular time EXCEPT for blood thinners (coumadin) and diabetic medication (metformin). If you are a diabetic, you will be asked to take a reduced dose, usually half, of what you normally take in the morning. Please check with your physician. If you are on metformin, please hold the dose the morning of the procedure.
6. Please wear comfortable clothing and leave all jewelry and money at home. You may wear eyeglasses, hearing aids and dentures.

On the day of your procedure:
Go directly to the location where your cardiac cath is scheduled. At the designated time, you will be asked to change into a gown. The typical prep includes a complete nursing assessment with questions about your medical history and allergies. Cath lab staff will start an IV infusion and shave and prep both groin areas. After your prep is complete, the cath lab staff will transport you to the lab for the procedure. You will be transferred to an x-ray table. The room will feel cool since the temperature is kept low for the equipment. Once you are on the table, you will be covered with warm blankets. You may be given medication to help you relax. You will be awake but may feel sleepy during the procedure. A cardiac cath takes about one hour.

During the cardiac cath:
Once you are on the x-ray table, electrodes will be applied to your chest to monitor your heart during the procedure. The insertion site (groin area) will be cleansed with an antiseptic to help prevent infection. You will then be covered with sterile sheets and asked to keep your arms at your sides. The physician will numb the area in your groin, insert a plastic tube (catheter) in a blood vessel in your groin, inject a dye, and take picture of your coronary arteries. You will feel pressure when the tube is inserted, but not pain. If you experience any pain, let your physician know. When the dye is injected, you will feel a warm sensation for a few seconds.

After the procedure:
When the procedure is finished, you will be taken to the recovery room to have the tube removed from your groin. Pressure will be held at the puncture site for 10-20 minutes to stop any bleeding. A bandage, ice bag and/or sandbag will then be applied to the groin area until you are ready to get out of bed. You will be in bed for two to four hours. For the first hour, your will remain relatively flat. You will be offered liquid to drink and will receive food before you go home. The staff will frequently monitor your blood pressure, heart rate, pulse on the affected leg, and insertion site. It is important not to move around in bed to prevent the puncture site from re-bleeding. Once the recovery period is completed and you are stable, the staff will begin helping you get up to walk around. You and your family member/guest will be given discharge instructions regarding care and medications.

Cardiac cath results:
Your physician will give you preliminary findings while you are still in the cath lab and will speak to your family member/guest about findings, recommendations and plans when the procedure is over.

Follow-up visit:
A follow-up visit should have been scheduled for 1 to 3 weeks following your cath procedure. Please contact the office if you do not know the date and time for this appointment.

Test descriptions:

Lower extremity arterial ultrasound:

Lower extremity arterial ultrasound is a safe and painless way of visualizing the arteries of the legs. It can detect the presence and location of peripheral arterial disease (PAD), narrowing of the arteries supplying the legs. It uses a small hand-held device called a transducer to transmit and receive sound waves. Special equipment changes the sound waves into images that are seen on a monitor. This is the same technology used to image babies in utero (sonogram).

Lower extremity venous ultrasound:

Lower extremity venous ultrasound is a safe and painless way of visualizing the veins of the legs. It can detect the presence of deep vein thrombosis (DVT) and/or venous insufficiency (venous reflux disease). It uses a small hand-held device called a transducer to transmit and receive sound waves. Special equipment changes the sound waves into images that are seen on a monitor. This is the same technology used to image babies in utero (sonogram). During the study, the technologist may ask you to tighten your abdominal muscles while certain images are recorded. This is to assess for leakage in the valves that typically prevent backflow of blood into the legs.

Carotid Doppler

Carotid ultrasound is a safe, painless procedure that uses sound waves to examine the structure and function of the carotid arteries in the neck.

You have two carotid arteries, one on each side of the neck, which deliver blood from the heart to the brain. Carotid ultrasound can reveal whether an artery has any blockage and how well blood flows through the artery.

Carotid ultrasound is usually used to screen for blockages that indicate an increased risk of stroke. Results from a carotid ultrasound can help your doctor determine what kind of treatment you may need to lower your risk.

The primary purpose of a carotid ultrasound is to screen for a narrowing of the carotid arteries that indicates an increased risk of stroke. Narrowing is usually caused by plaques — a buildup of fats, cholesterol, calcium and other substances that circulate in the bloodstream. Early detection of narrowing of the carotid arteries enables your doctor to begin treatments that improve blood flow to the brain and decrease your risk of stroke.

Aorta Ultrasound

This test helps your physician determine if there are blockages, narrowing or aneurysm (an enlargement or a “bulge”) in your aorta, which is a large artery in your abdomen. Ultrasound is used to obtain images of the aorta and the blood flow within. The test is noninvasive and should cause no significant discomfort.

You should not eat or drink anything except non-carbonated water for 8 to 12 hours prior to the test. You may take your usual medications on the day of the test, unless your doctor instructs you otherwise.

For this test you will be asked to lie quietly on an examination table while the technologist moves an instrument called a transducer over your abdomen. To obtain clear images of your blood vessels the technologist may apply moderate pressure to your abdomen. During the Doppler portion of the exam you will be able to hear your blood flow and your heartbeat. The resulting images are recorded and stored in your record. The test takes approximately 20 to 30 minutes.

For this test you will be asked to lie quietly on an examination table while the technologist moves an instrument called a transducer over your abdomen. To obtain clear images of your blood vessels the technologist may apply moderate pressure to your abdomen. During the Doppler portion of the exam you will be able to hear your blood flow and your heartbeat. The test takes approximately 20 to 30 minutes. Your cardiologist will review your test for any abnormalities.

Ankle Brachial Index (ABI) & Pulse Volume Recordings (PVR)

Ankle Brachial Index (ABI) test is done by measuring blood pressure at the ankle and in the arm while a person is at rest. Measurements may be repeated at both sites after 5 minutes of walking on a treadmill.

The ankle-brachial index (ABI) result is used to predict the severity of peripheral arterial disease (PAD). A slight drop in your ABI with exercise means that you probably have PAD. This drop may be important, because PAD can be linked to a higher risk of heart attack or stroke. This test may also be done to screen for peripheral arterial disease of the legs. Sometimes, it may also used to see how well a treatment is working (such as medical treatment, an exercise program, angioplasty, or surgery).

 Pulse volume recordings (PVR), or arterial waveforms, are obtained with a cuff system that incorporates a pneumoplethysmograph to detect volume changes in the limb throughout the cardiac cycle. Changes in pulse contour and amplitude can be analyzed, providing additional information on the status of the underlying blood vessels.

Vascular Studies Testing instructions:

1. If you are unable to make your scheduled appointment, please call the office a day prior to your test.
2. Please ARRIVE 15 minutes before scheduled time and bring your INSURANCE CARD and PICTURE ID to the front desk upon check in.
3. No special preparation is required for most studies.
4. Renal/Abdominal Vessel Studies require the following preparation: No food after midnight the night before the test. For late afternoon testing, have dry toast and clear liquids for an early breakfast. Take your normal medications with small sips of water. Take Gas-X the night before and the morning of the test.
5. Wear comfortable walking shoes and two-piece clothing (without metal snaps). Do not wear jewelry.
6. Bring all medications, or a list of medications, for review.
7. Friends/family are welcome to accompany you to the office but are not allowed in the testing area due to our privacy policy.
8. Allow approximately 1 hour for the test.
9. Test results will be communicated to you by your physician.