NON INVASIVE DIAGNOSTIC TESTING

• Stress Test
• Echocardiogram
• Stress Echocardiogram
• Transesophageal Echocardiogram
• Electrocardiogram (EKG)
• Holter Monitor
• Event Monitor
• Cardiolite® Nuclear Stress Test

Stress Test

This diagnostic procedure will be used to measure how your heart responds to physical activity. In addition, it can be useful in detecting if the blood flow in your coronary arteries is restricted due to blockages.

During the exam, you will be asked to walk on a treadmill. Starting slowly, you will be asked to gradually increase your speed and grade. As you exercise longer and harder, your blood pressure and heart rate will rise. The exercise portion of your exam will take 10-12 minutes to complete.

During the procedure, the attending medical professional and cardiac technician will monitor your heart rate, blood pressure and ECG. If you experience any unusual symptoms during the exam such as dizziness, shortness of breath or chest discomfort, please notify the person in attendance. He/she will then make any necessary adjustments to the stress test to alleviate your symptoms. If you have any physical disabilities or limitations which might impede your ability to work on a treadmill, please inform the medical professional in attendance. With this information they may alter the protocol by performing a non exercise or pharmacological stress test.

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ECHOCARDIOGRAM

A. What is an Echocardiogram?

An echocardiogram is a procedure that evaluates the heart by using ultrasound waves. By performing an echocardiogram, doctors can accurately diagnose various heart problems and measure the blood flow through the heart. An echocardiogram is a painless and noninvasive procedure with no adverse side effects.

B. How Does an Echocardiogram Work?

During the examination, a transducer (similar to a microphone) is held to the chest. The transducer transmits ultrasound waves that bounce or echo off of different components of the heart. A computer then translates the information it receives from the transducer, and creates a picture of the heart. This picture is then transmitted onto a television screen where it can be captured on videotape or printed on paper.

C. What Will Happen During the Echocardiogram?

An echocardiogram will be conducted at one of our medical offices. Prior to the exam, you will be requested to remove your clothing above the waist. A hospital gown or sheet will be given to provide comfort and warmth during the test. While lying on an examination table, small patches (or electrodes) will be placed on your chest and shoulders to record an electrocardiogram (or EKG). An electrocardiogram displays the electrical activity of the heart during the echocardiogram.

To ensure quality images, a colorless gel will be applied to the area where the transducer will be placed. The patient will then be asked to lie on either their back or their left side. The transducer is moved to different areas of the chest to capture multiple images of the heart. To obtain a better picture, the technician may ask the patient to change positions, breathe more slowly, or even hold their breath. A complete examination will take anywhere from 20-45 minutes to complete.

D. What Does an Echocardiogram Show?

The value of diagnostic ultrasound lies in the wealth of accurate information it can deliver about the heart without risk to the patient. It provides a window into the human body, through which we can see certain manifestations of disease that might otherwise go undetected.

Cardiac ultrasound, or echocardiography, helps diagnose heart disease by allowing cardiologists to evaluate blood flow in the heart, measure the size and function of the contracting heart, and study the motion of heart valves. It provides accurate information that shows diseased areas that might otherwise go undetected. Echocardiography also gives cardiac surgeons the opportunity to see the heart before, during and after surgery, making cardiac care safer and more effective.

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Stress Echo

Coronary artery disease (CAD) represents a large percentage of the cardiology workload today. Stress echocardiography has become a useful and widely applied clinical tool in the assessment of the heart’s function and the severity of coronary artery disease. The technique is based on the assumption that induced myocardial ischemia can be detected and localized with 2-D echocardiography. (Myocardial ischemia is a deficiency of blood supply to the heart muscle, caused by an obstruction or constriction of the blood supply in the coronary arteries.)

By utilizing stress echo, the hearts wall motion at rest is compared to the hearts wall motion with exercise or with the administration of a special drug. Abnormalities that occur with exercise that were not present at rest are indicators of myocardial ischemia.

The relatively low cost and noninvasive nature of the procedure when compared with traditional radionuclide examinations, as well as the convenience of performing the test on an outpatient basis, have helped contribute to the popularity of stress echo.

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Transesophageal Echocardiography (TEE)

In some cases, ultrasound imaging through the patient’s chest wall is not possible (e.g. during heart surgery) or does not produce the desired images - as can be the case with patients who are difficult to image due to obesity, barrel chest, chronic obstructive lung disease, or chest trauma. In these cases, cardiologists, anesthesiologists and cardiac surgeons rely on transesophagael echocardiography (TEE) to obtain the images they need.

In this application after sedation has been administrated, a special ultrasound transducer is inserted down a patient’s esophagus to image the heart from a different orientation not seen through the conventional chest-wall approach. Unlike transthoracic imaging, where the transducer is placed on the patient’s chest, TEE positions the transducer behind the heart.

TEE is often used to asses the severity of valvular abnormalities, heart valve infections, and cardiac masses. During cardiac surgery, TEE is helpful in determining whether or not a heart valve needs to be repaired or replaced following bypass surgery. It is also valuable in assessing the function of a heart valve immediately following repair or replacement of that valve.

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Electrocardiogram (ECG or EKG)

An electrocardiogram is a simple diagnostic procedure that records the electrical impulses of the heart as it contracts and rests.

An EKG is obtained by placing electrodes on the patient’s chest, arms and legs. The electrodes record the electrical activity of the heart and record it to a tracing which will be interpreted by your physician. The procedure is painless and will take 5-10 minutes to complete.

The results of the electrocardiogram can be useful in detecting abnormal heartbeats, inadequate blood flow and heart muscle damage.

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HOLTER MONITOR

What is a Holter monitor?

A Holter monitor, refers to a portable device that monitors heart abnormalities. The device continuously records an electrocardiogram (ECG) for a period of time. The monitor records the ECG while you perform your daily activities. Holter monitoring is a painless monitoring procedure.

Holter monitors are used to detect arrhythmias (irregular heart beats and palpitations) and to detect ischemia (a local, temporary deficiency of blood supply to the heart)

How is the Holter Monitor used?

The Holter Monitor is a portable device that is worn by the patient under the clothing. Several adhesive-backed monitoring electrodes are attached to the skin (chest hair is shaved for the placement of electrodes). These electrodes, or "leads" capture your heart's electrical signals. The electrodes are typically attached to a small tape recorder that record these electrical signals. You will be asked to keep a record of your daily activities in a journal or diary. When the monitoring period is done, you will return to the medical facility, and the electrodes will be removed. A cardialogist will review the recordings and your journal for any abnormalities.

Your doctor will discuss the results of the monitoring procedure with you. Occasionally, the monitoring procedure may need to be repeated.

What are the risks?

The procedure is painless. Some patients experience minor skin irritation due to the adhesive used to attach the electrodes, or the gel used. If you experience any burning in the area where the electrodes are attached, contact your doctor. Let your doctor or the doctor's staff know if you have had any previous problems with irritation associated with the placement of electrodes.

© Copyright 1999 Dialog Medical, Inc. All rights reserved.

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Event Monitor

An Event Monitor is similar to a Holter Monitor in that it is used to detect heart rhythms. However, the Event Monitor is worn for several days to several weeks while the Holter Monitor is usually worn for 24 hours.

The Event Monitor is most useful in detecting abnormal heart rhythms that occur infrequently. When the patient experiences symptoms, he/she activates the event monitor by pressing a button and holding it to their chest. The device will then record the patient’s heart rhythm for one minute.

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Cardiac Nuclear Imaging

Why Have a Cardiac Nuclear Imaging Exam?

The heart receives blood from vessels called coronary arteries. When these vessels become partially blocked or restricted by the accumulation of fatty deposits, the heart may not receive the proper amount of blood it needs to function properly. The narrowing of coronary arteries is often referred to as Coronary Artery Disease or CAD.

Cardiac Nuclear Imaging Exams are used to diagnose the presence of CAD and to assess cardiac function. Your exam will be in two (2) parts:

Part 1 - STRESS IMAGING

Injection of a radioisotope during an Exercise Stress Test lasting about 15 minutes followed by a cardiac imaging exam lasting about 30 minutes.

Patients that are unable to walk on a treadmill during an Exercise Stress Test may be given a Pharmacologic Stress Test using Persantine, Adenosine or Dobutamine.

Part 2 - REST IMAGING

Generally this part of the procedure will require a second injection of a radioisotope while at rest, followed by a second imaging exam lasting about 30 minutes.

The Nuclear Imaging Medicine Physician will then compare the blood flow images of the coronary arteries and the heart muscle during REST and after STRESS.

The results of the Cardiac Nuclear Imaging Exam can be helpful in:

• Detecting the Presence & Significance of CAD
• Detecting Heart Attacks
• Measuring the Heart’s Pumping Action
• Studying Wall Motion of the Heart

What Happens During the Stress Test?

Upon your arrival, the nuclear medicine technologist will explain the procedure and answer your questions. You will then be required to sign a consent for the procedure. Several electrodes will then be placed on your chest so that your heart rhythm can be closely evaluated during the test.

An IV will then be inserted into your arm to enable the isotope to be injected into your blood stream approximately one (1) minute before completing the exercise portion of the exam.

During the exam, you will be asked to walk on a treadmill. Starting slowly, you will gradually increase your speed and grade. As you exercise longer and harder, your blood pressure and heart rate will rise. The exercise portion of the cardiac imaging exam will take approximately 10-15 minutes.

The attending medical professional will monitor your heart rate and blood pressure during the exam. If you experience any unusual symptoms during the exam such as dizziness, shortness of breath or chest discomfort, please inform the attending medical professional. He/She will then make any necessary adjustments to the stress test to alleviate your symptoms.

What Happens During the Nuclear Imaging Portion of the Exam?

You will receive two (2) cardiac imaging scans, one after the exercise stress test and one at rest. Each cardiac scan will take approximately 30 minutes to complete.

Generally the procedure involves 5 basic steps:

1. The patient receives an IV injection of a radioactive isotope in their hand or arm.
2. The isotope travels to targeted tissues i.e. coronary arteries and heart muscle.
3. The isotope gives off Gamma Rays which are a form of radiation that can only be seen with a Gamma Camera.
4. In the imaging room, you will be asked to lie on a padded table that is adjacent to the gamma camera. The camera will then be positioned to take images of the heart and surrounding tissues.
5. The images will be interpreted by the Nuclear Medicine Physician and a summary report will be generated for review by your doctor.

What About Radiation Exposure?

Cardiac nuclear exams are safe. Only a small amount of radioactive isotope is used in this procedure. The isotope will only remain in your body for a few hours after the procedure. Your radiation exposure will be comparable to that from an X-ray or CAT (CT) Scan.

Please discuss with your physician prior to undergoing a nuclear medicine procedure if you are pregnant or are a nursing mother.

Preparing for the Cardiac Nuclear Imaging Exam

• It is highly recommended that you wear loose fitting clothing such as slacks, shorts or sweat pants as well as sneakers for walking on a treadmill.
• Do NOT eat or drink anything four (4) hours prior to the exam.
• Do not eat or drink any foods containing caffeine (i.e. coffee, tea, chocolate, soda, etc.) for 24 hours prior to the exam.
• Please bring a list of your current medications and related dosage information. Please continue to take all prescribed medications unless specified otherwise by your doctor.

Who Will Interpret My Cardiac Nuclear Imaging Exam?

Syed Sajid Husain, M.D., M.S.
Diplomate American Board of Nuclear Medicine
Associate Professor of Clinical Nuclear Medicine

Appointments:

• Available at the Bailey Avenue facility only.
  
• Monday - Friday 8:00 a.m. - 5:00 p.m.
  
• Early morning and evening appointments are available upon request
  
• Please call 835-2966 for additional scheduling information
  
• Located at the intersection of Bailey and Winspear Avenues. (Buffalo, NY)
  
• Close proximity to the University of Buffalo Main Street Campus and the Veteran’s Administration Hospital.
  
• Easy access via Main Street, the 33 Expressway and the NYS Thruway.

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