Electrocardiogram, or ECG/EKG
An electrocardiogram is a few-minute test where electrodes are placed on the chest and an electrical tracing of the heart electrical activity is obtained. The test provides information regarding the heart rhythm, rate, conduction system, and at times prior heart attack.
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Information Provided by Cardiac Stress Testing
Cardiac stress testing helps determine whether or not coronary artery disease, or blockage in the heart blood vessels, is present. Additionally, information regarding a patient’s exercise tolerance is also obtained. The cardiologist interpreting the stress test will analyze several types of information from the test in order to determine whether the results are normal or abnormal. This information includes the duration of exercise, symptoms brought on by the exercise, the response of the ECG, blood pressure, and HR to exercise, and, if performed, the results of cardiac imaging during the stress test.
What to Expect During the Test
An exercise stress test involves having electrodes placed on a patient’s chest, and then walking on a treadmill, with the speed and elevation increasing every 3 minutes. Most patients walk for 6 – 10 minutes, though some walk less and some walk more. The exercise portion of the test ends at the discretion of the patient and supervising personnel, usually when the patient is fatigued or when a specific heart rate goal is achieved. Following exercise the patient is monitored for several more minutes. During the test the patient’s ECG, heart rhythm, and blood pressure are monitored and recorded.
Preparation for Stress Testing
- Take your usual medications at the usual times prior to the test, unless told to do otherwise.
- Do not eat for 2 hours prior to the test.
- It is okay to consume water or juice prior to the test.
- Please avoid caffeine-containing beverages 12 hours prior to pharmacologic nuclear medicine stress testing.
- Wear sneakers or comfortable walking shoes and clothing.
Stress Testing with Imaging
The addition of heart imaging to stress testing increases the information available from the test as well as the tests accuracy. Stress testing with imaging can be formed with either treadmill exercise or with pharmacologic (medication) stress. Stress testing with imaging includes stress echocardiography and nuclear medicine stress testing.
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A stress echocardiogram is a stress test which involves walking on a treadmill, as described above, with ultrasound images of the heart obtained prior to and immediately after exercise. By assessing the effect of exercise on ultrasound-defined heart movement, the cardiologist can have a better idea of whether or not a patient has significant heart blood vessel blockage.
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Nuclear Medicine Stress Testing
A nuclear medicine stress test involves injection of a radioactive tracer through an IV, and two 20 minute sets of images of the heart, one taken prior to treadmill exercise, and one taken following exercise. The heart images define blood flow to the heart muscle, assessing for prior heart damage, and for significant or severe heart blood vessel blockage.
A pharmacologic nuclear medicine stress test, or medication stress test, involves injection of a radioactive tracer through an IV, and two 20 minute sets of images of the heart, one taken prior to medication stress, and one taken following medication stress. The heart images define blood flow to the heart muscle, assessing for prior heart damage, and for significant or severe heart blood vessel blockage.
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An echocardiogram is a 45 minute test which requires no specific patient preparation. An ultrasound probe is placed in various positions on the chest, and images are recorded, allowing the cardiologist to assess heart structure, including heart size, strength, thickness, and valvular function, as well as the large blood vessels near the heart.
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Transesophageal Echocardiogram (TEE)
A transesophageal echocardiogram (TEE) is a more precise test than a regular echocardiogram, and is utilized when additional clarity of heart structural information is required. The test is performed on a fasting patient who has received intravenous sedation anesthesia, and involves placing a thin tube down the patient’s throat (much like an upper endoscopy), with the tube having a small ultrasound at its end. The test takes approximately 30 minutes, and the patient will require a ride home, and should not work that day, as he/she will have received sedation anesthesia.
Preparation for Transesophageal Echocardiography
- Take your usual medications at the usual time prior to the procedure, unless told to do otherwise
- Do not eat for 6 hours prior to the test
- You will require a ride home following the procedure, and should remain at home for the rest of the day
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A carotid duplex is a one hour test which requires no specific patient preparation. An ultrasound is placed against both sides of the neck in order to visualize blood flow and blockage within the carotid arteries.
A holter monitor is placed in order to record every heart beat that a patient has over a 24 hour period, assessing heart rate and heart rhythm, looking for slow, fast, and abnormal heart beats. Several electrodes are placed and taped on the chest, and normal activities may proceed during the 24 hours, with the exception of bathing and showering.
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An event recorder is provided to patients for 30 days, in order to attempt to detect abnormal heart rates or heart rhythms. Patients are taught how to place and remove the monitor themselves, to allow for bathing/showering, and how to activate the monitor should a symptom occur.
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