The electrocardiogram is a non-invasive, painless, simplest procedure used to evaluate the heart. This test is primarily used to screen for and diagnose a variety of cardiac conditions as well as to monitor the heart’s response to therapy. It generates graphical representation of the electrical activity of the heart.

PREPARATION/WHAT TO EXPECT:

• Patient is instructed to lie down in supine position.
• Chest surface area will be cleaned with cotton balls soaked lightly with alcohol. Those with heavy chest hair may need to be clipped to assure adequate electrode-to-skin-contact.
• Clip rods are affixed to each arm and leg and electrodes to the chest. The electrical activity is recorded from the patient’s body surface (limbs and chest) by the electrodes and clip rods, held snugly against the skin.
• Patient will be required to remain still for 2-3 minutes.

There are no restrictions for food or fluids However, ingestion of cold water immediately before an ECG may produce changes in one of the waveforms recorded (the T wave). Exercise (such as climbing stairs or heavy walking) immediately before an ECG may significantly increase your heart rate.

The test takes 5 - 10 minutes to complete and yields information about the heart rhythm and rate, hypertrophy (thickness of the heart muscle) and chamber enlargement, presence of an old or ongoing heart attack (myocardial infarction), or evidence of impaired blood supply (ischemia). There are no special preparations or instructions prior to the study.

Treadmill Test is a diagnostic EKG procedure designed to test the heart during physical exercise. The treadmill test more accurately diagnoses the presence or severity of blockages in arteries leading to the heart. Not only is it a screening procedure, it can gauge the effectiveness of treatment programs. It is performed to determine if your heart can pump blood safely and effectively throughout your body during the stress of exercise. It is performed under a physician’s supervision.

PREPARATION/WHAT TO EXPECT:

• Patient is instructed to not eat, drink anything containing caffeine or alcohol (for at least two hours) or smoke before taking the test. Continue all medications unless instructed otherwise.
• Patients are encouraged to wear comfortable clothing and shoes that will permit walking. A towel and extra clothing will be used after exercise.
• A nurse or exercise technologist will place electrodes on the chest to record’s heart activity. For the clearest test results, the skin needs to be secured or clipped.
• To monitor patient’s blood pressure, a cuff will be placed on the arm. This will be inflated every few minutes, producing a squeezing sensation that may feel tight.
• Baseline measurements of heart rate and blood pressure will be taken before exercise starts.
• After a resting electrocardiogram is recorded, patient will walk on the treadmill. The speed and elevation of the treadmill will be increased at periodic intervals, in order to raise your heart rate safely. While patient is walking, the doctor together with the nurse technologist will monitor and record the heart rate, electrocardiogram (EKG), and blood pressure (BP).
• The test will be stopped when the pre-determined heart rate is reached, or at patient’s request (cannot walk any farther or feels chest pain/shortness of breath) or with exaggerated rise in blood pressure develops with activity.
• Upon termination of exercise, patient will be requested to sit and relax. Recovery period will take about 5 to 10 minutes.

A medication called nitroglycerin is sometimes given during a stress test if chest pain suddenly occurs. Depending on the results of the exercise EKG, additional tests or procedures may be scheduled to gather further diagnostic information.

Echocardiography uses sound waves to produce an image of the heart and to see how it is functioning. Stress echocardiography (or stress echo) compares the heart’s function during exercise to its function at rest, and is used to more accurately determine the presence or absence of blockages within the heart arteries. The test can show if certain areas of the heart muscle are not getting enough oxygen-rich blood. If the doctor want to have a stress echocardiogram, the patient will have the same test as Treadmill Exercise Test, except that when the heart rate reaches a certain number patient will be asked to step off of the treadmill and lie down. At the same time, this diagnostic test records both the resting and post exercise echocardiogram.

Patient who is unable to walk or too sick to exercise will be subjected to a chemical stress test ( Dobutamine Stress Echocardiography) using a drug called Dobutamine Hcl instead of plain Stress Echocardiography.

PREPARATION/WHAT TO EXPECT:

Patient is instructed to not eat, drink anything containing caffeine or alcohol (for at least two hours) or smoke before taking the test.

Continue all medications unless instructed otherwise.

The stress echo is similar in many ways to the Stress Test and 2D Echocardiography

• Prior to the test, the Cardiologist will explain the procedure in detail, including possible complications and side effects. The Nurse Technologist in turn will request patient to sign the Written Consent.
• Initially a Resting 2D Echocardiography will be obtained and recorded. Electrodes are placed on the chest to record an electrocardiogram (EKG) which monitors the heart's rate and rhythm. The sonographer positions patient on the left side and a sound-wave transducer will be placed on several areas of his your chest. To facilitate movement on the skin, a small amount of gel is placed on the transducer, to help get clearer pictures. The gel may feel cold, but this will not harm the skin.
• Afterwhich, patient is prepared for Treadmill Exercise Test.
• Immediately after the exercise, the sonographer/technician will take the post exercise echocardiogram. Patient is requested to breathe in and out (or not to hold his breath) during the test.

Most stress echo tests take about 60 minutes, but a dobutamine stress echo takes longer.

This is an echocardiographic test that helps determine the presence or absence of coronary artery disease in the heart. An intravenous medication (Dobutamine) is infused while echocardiographic images are taken. The medicine increases the heart rate which allows your doctor to assess heart This non-invasive test was developed for people who are unable to exercise on a treadmill as required using a more traditional Stress Echo and is used to evaluate coronary artery disease in patients . This procedure uses sound waves (ultrasound) to produce an image of the internal structures of the heart. The test includes an echocardiogram done at rest and again at peak heart rate.

PREPARATION/WHAT TO EXPECT:

Patient is instructed to not eat, drink anything containing caffeine or alcohol (for at least two hours) or smoke before taking the test.

Continue all medications unless instructed otherwise.

• Prior to the test, the Cardiologist will explain the procedure in detail, including possible complications and side effects. The Nurse Technologist in turn will request patient to sign the Written Consent.
• Initially a Resting 2D Echocardiography will be obtained and recorded. Electrodes are placed on the chest to record an electrocardiogram (EKG) which monitors the heart's rate and rhythm. The sonographer position patient on his left side and a sound-wave transducer will be placed on several areas of the chest. To facilitate movement on the skin, a small amount of gel is placed on the transducer, this will also help get clearer pictures.
• An IV line will be started and Dobutamine will be administered. The cardiologist will observe for any symptoms, irregular heart rhythms, an inappropriate heart rate or blood pressure responses and continues to obtain echo images.
• The medication will cause the heart to react as if were exercising: the heart rate will rise and the patient may feel it beating more strongly. It may cause a warm, flushing feeling and, in some cases, a mild headache.
• As soon as the heart rate is adequately high, echo pictures are taken.
• The test will be stopped when it has reached a pre-determined heart rate, or at patient’s request or if there’s an exaggerated rise in blood pressure develop with activity
• Upon termination of procedure, blood pressure, heart rate and electrocardiogram will be monitored carefully till it returns to baseline. Then the IV line will be removed by the Nurse.

The test takes 60 to 90 minutes to complete. Preparation prior to this test is the same with Stress Echocardiography.

Holter monitoring is a painless test which provides a continuous recording of heart rhythm during normal activity. This electrophysiologic test is used to assess and document cardiac rhythm disturbances, and to monitor the effect of antidysrhythmic and pacemaker therapy. The monitor is usually worn for 24 hours (or longer) to obtain a recording.

The Holter monitor can record heart rate and rhythm when you feel chest pain or symptoms of an irregular heartbeat (called arrhythmia). The doctor can then look at the time when patient noticed these symptoms. Reading this printout will give the doctor an idea about the nature of the heart problem.

PREPARATION/WHAT TO EXPECT:

• Electrodes are placed on the chest and attached to a small recording monitor that patient can carry in a pocket or in a small pouch worn around the neck. The monitor is battery operated.
• The heart electrical activity is recorded (much like the recording of an ECG), usually for a 24-hour period while patient keeps a diary of activities.
• The recording is then analyzed, a report of the heart's activity is tabulated, and irregular heart activity is correlated with the activity at the time.

It is a good idea to bathe before monitor is attached, because once fitted, patient cannot get wet in the shower or bathtub.

It takes 10-15 minutes to complete the preparation and instructions.
The nurse/technician gives intructions on the following:

• how to keep the electrodes attached to patient’s skin.
• how to check the monitor for problems.
• when to call the physician's office for help.
• keeping the electrodes and monitor dry
• avoiding situations where patient may perspire excessively, causing the leads to detach.
• how to keep a diary during the procedure, noting the date and time of day of any changes in activity and symptoms patient experiences.
• avoiding using electrical appliances such as electric razors, hair dryers, or electric toothbrushes near the patient so that the EKG signal will not receive electrical interference on the recording tape. If these appliances must be used , patient should note it in the diary.
• avoiding magnets, metal detectors, areas with high-voltage electrical wires, and electric blankets during the procedure, since they can also create electrical interference on the recording tape.

After 24 hours, patient returns to the hospital and the electrodes will be removed and the monitor discontinued.

Depending on the results of the Holter monitor, additional tests or procedures may be scheduled to gather further diagnostic information.