Exercise Stress Test

In some cases, EKG irregularities can only be identified during exercise or while symptoms are present. An exercise stress test demonstrates the effect that exercise and physical activity has on the heart. In many cases, the exercise stress test is performed to determine the causes of chest pain and/or to identify rhythm abnormalities during exercise.

A standard stress test involves the patient walking on a treadmill or pedaling a stationary bike while being monitored by an electrocardiogram and blood pressure readings to measure the heart’s response to the body’s increased need for oxygen.

The patient continues the test until a target heart rate is reached, unless chest pain or a dramatic rise in blood pressure occurs. The heart will continue to be monitored for several minutes after exercising.

 

Nuclear Stress Testing

A nuclear exercise stress test is a diagnostic test used to evaluate blood flow to the heart. During the test, a small amount of radioactive tracer is injected into a vein. A special camera, call a gamma camera, detects the radiation released by the tracer to produce computer images of the heart.

Can I eat or drink on the day of the test?

  • Yes. However, DO NOT eat or drink anything 4 hours prior to the test. If you must take medications, drink only small sips of water to help you swallow your pills.
  • Avoid all products that contain caffeine for 12 hours prior to the test. In general, caffeine is found in coffee, tea, colas, and other soft drinks, most chocolate products, as well as strawberries (these contain a small amount of caffeine), as caffeine will interfere with the results of the test. Also avoid decaffeinated or caffeine-free products for 12 hours prior to the test, as these products contain trace amounts of caffeine.


Should I take my medications the day of the test?

Please bring a copy of all of your medications, including over-the-counter medications and supplements that you routinely take, to the test appointment.

Please follow theses guidelines about taking your medications the day of the test.

If you have asthma: Your physician will tell you NOT to take theophylline (Theo-Dur) for 48 hours before the test. Please plan to bring your asthma inhaler medication to the test.

If you have diabetes: If you take insulin to control your blood sugar, ask your physician how much insulin you should take the day of the test. Your physician may tell you to take only half of your usual morning dose and to eat a light meal four hours before the test. If you take pills to control your blood sugar, do not take your medication until after the test is complete. Bring your diabetes medications with your so you can take it when the test is complete. Do not take your diabetes medication and skip a meal before the test.

If you own a glucose monitor, bring it with you to check your blood sugar levels before and after your test. If you think your blood sugar is low, tell the nuclear lab personnel immediately. Plan to eat and take your blood sugar medication following your test.

If you take heart medications: Take your heart medications with water on the day of the test unless your physician tells you otherwise.

Your physician may ask you to stop taking heart medications on the day of your test. If you have any questions about your medications, ask your physician. Do not discontinue any medications without first talking with your physician.

What should I wear for the test?

Please wear comfortable clothing and shoes suitable for walking / jogging during the test.

What to expect during the test:

Your test will take place in the Department of Nuclear Medicine.

A nuclear medicine technologist will place an IV into a vein in your arm or hand and inject a small amount of radioactive tracer. The tracer is not a dye or contrast. After the tracer is injected, your will wait about 60 minutes before the first set of “resting” images are taken.

Then you will be asked to lie very still under the gamma camera with both arms above your head for about 12 to 15 minutes. The camera will record images that show blood flow through your heart at rest.

Next, a technician will place electrodes on your chest to monitor your EKG.

You will start walking on a treadmill. At regular intervals, the difficulty of the exercise will increase until you achieve the target heart rate or you develop symptoms. Then, a second dose of radioactive tracer will be injected into the IV. Your heart rate, EKG and blood pressure will be monitored throughout the test. If you are unable to achieve your target heart rate, a medication will be given to stimulate exercise.

About 30 to 40 minutes after exercising, you will be asked to again lie very still under the camera with both arms over your head for about 12 to 15 minutes. The camera will record images that show blood flow through your heart during exercise. These images will be compared to the first set.

How long will the test last?

The appointment will take about 3 to 3 1/2 hours. The actual exercise part of the test lasts about 7 to 12 minutes. If you weigh over 300 pounds, your test will be scheduled as 2 day study.

What happens after the test?

You may resume your normal activities. Your physician will interpret the pictures and either call you with the results or go over them with you at your next appointment.

Our Nuclear Lab is accredited by the Intersocietal Commission for the Accreditation of Nuclear Laboratories (ICANL).

 

Echocardiogram

An echocardiogram (echo) is a type of ultrasound test used to image the heart. During the echo the sonographer will place a small hand held transducer on different areas of your chest and abdomen to provide measurements and video of the chambers and valves.

Why is an echocardiogram performed?

The test is used to:

  • Assess the overall function of your heart
  • Determine the presence of various types of heart disease, such as valve disease, myocardial disease, pericardial disease, infective endocarditis, cardiac massess and congenital heart disease
  • Follow the progress of valve disease over time
  • Evaluate the effectiveness of your medical or surgical treatments

Can I eat or drink on the day of the test?

Yes. Eat and drink as you normally would the day of the test.

Should I take my medications the day of the test?

Take all your medications at the usual times, as prescribed by your doctor.

What should I wear on the day of the test?

A two piece outfit is best. Women will be given a hospital gown to wear.

What happens during the test?

  • Before the test, the sonographer will explain the procedure and you will have the opportunity to ask questions.
  • Your test will take place in the Echo Lab.
  • Women will be given a hospital gown to wear. You'll be asked to remove your clothing from your waist up.
  • A cardiac sonographer will place three electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to the ultrasound machine to help record images.
  • The sonographer will ask you to lie on your left side on an exam table. The sonographer will place the tranducer on several areas of your chest. The wand will have a small amount of gel on the end, which will not harm your skin. This gel helps produce clearer pictures.
  • Sounds are part of the Doppler signal. You may or may not hear the sounds during the test.
  • You may be asked to change positions several times during the exam so the sonographer can take pictures of different areas of the heart. You may also be asked to hold your breath at times.

How will I feel during the test?

You should feel no major discomfort during the test. You may feel a coolness on your skin from the gel on the transducer, and a slight pressure of the transducer on your chest.

How long does the test take?

The appointment will take about 40 minutes. After the test, you may get dressed and leave.

Our Echo Lab is accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL).

 

Holter Monitor

When a patient experiences irregular heart rate, dizziness, shortness of breath, chest pain, abnormal pacemaker function or fainting and/or falling spells, a Holter monitor may be recommended to monitor and record heart rhythms over a 24 hour period.

Worn by the patient, the Holter monitor is a portable EKG device that monitors the electrical activity of a person’s heart during normal activity. Following the 24 hour period, the patient brings the monitor back to his or her physician, and a technician scans through the thousands of beats and generates a report of irregular rhythms or rates.

 

Event Recorder

An event recorder is a type of testing that allows a patient to record periods of electrical activity of the heart over a period of several weeks. The procedure is performed to identify abnormal beats and heart rhythms; evaluate your symptoms in relation to your heart beat; monitor pacemaker or defibrillator activity; and assess if your medications are related to your symptoms over a long period of time.

The event recorder test allows for on-demand heart monitoring during a patient’s normal activities. When the patient experiences an episode of dizziness, weakness or palpitation, he or she will push the button on the device, which stores the data. Following the testing period, the monitor is returned to your physician to record data.

 

Carotid Ultrasound

A carotid ultrasound is a noninvasive, painless screening test. Your doctor uses an ultrasound to look at the carotid arteries in your neck and see the flow of blood through them. Ultrasound, also called sonography, uses sound waves instead of X-rays to make images. A carotid ultrasound is an important test that can detect narrowing, or stenosis of the carotid arteries. Carotid artery stenosis is a major risk factor for stroke. 

You have two carotid arteries, one on each side of your neck. Carotid arteries are major arteries that carry blood from your heart to your brain. A buildup of plaque can narrow or block your carotid arteries. This is called carotid artery disease, which increases your risk of stroke.

Why is a carotid ultrasound performed? 

Your doctor may recommend a carotid ultrasound to diagnose or screen for diseases and conditions of the carotid arteries including:

  • Blood clot in the carotid arteries that can slow or block blood flow to the brain
  • Carotid artery dissection, which is a split in the layers of the carotid artery wall. It can slow blood flow or dangerously weaken the wall of the artery.  This is a risk factor for stroke.
  • Carotid artery stenosis, which is a narrowing of the carotid arteries due to a buildup of plaque inside them. This is a major risk factor for stroke. Your doctor may suspect this condition if you have a carotid bruit (pronounced broo-E). A carotid bruit is an abnormal sound heard through a stethoscope in the carotid arteries. Other risk factors that may indicate the need for a carotid ultrasound include high blood pressure, advanced age, diabetes, high cholesterol, and a personal or family history of stroke or heart attack.
  • Congenital malformations, which are abnormalities that are present at birth
  • Stroke and transient ischemic attack (TIA). A TIA is a group of stroke-like symptoms that generally resolves within 24 hours. It is a warning sign that you are at risk for a stroke.

  

Abdominal Ultrasound

Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys. The blood vessels that lead to some of these organs, such as the inferior vena cava and aorta, can also be examined with ultrasound.