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Cardiac Diagnostic Screenings and Tests

Calcium Scoring

Calcium Scoring is used to help determine the amount of calcium in the arteries of your heart. Used with other tests to help evaluate your heart, It is usually performed using a CT scan of your heart. Your calcium score gives doctors an idea of how much plaque there is in your heart arteries that hasn’t caused problems yet. Your calcium score may help predict your risk of a heart attack, and tell you and your doctor how much more aggressive you should be to reduce your risk factors. This is particularly helpful if you are at “intermediate” risk.

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Cardiac & Neuro Testing

The Cardiac & Neuro Testing Department performs many different types of tests including:

  • EKG (heart)
  • EEG (nerve conduction)
  • EMG (muscle)
  • CARDIAC ECHO (heart)
  • STRESS TESTS (heart)
  • PACEMAKER CHECKS (heart)
  • HOLTER MONITORING (heart)
  • CARDIAC EVENT RECORDING (heart)
  • TILT TABLE TESTING (heart)

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Coronary Angiography

Coronary Angiography is a procedure used to visualize blood vessels of the heart. A catheter is used to inject a dye into the vessels; the vessels can then be seen by x-ray.

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Echocardiogram or Cardiac Stress Test with Echocardiogram

echocardiogram patient

An Echocardiogram (or cardiac ultrasound) is an ultrasound of the heart. It measures blood flow through the heart and also enables physicians to view the heart valve structure and heart wall function. It is helpful in determining heart size and ventricular function. Echocardiography can also detect heart clots and damage after a heart attack. It is often used in conjunction with Doppler ultrasounds.

A Stress Echocardiogram consists of an Echocardiogram, which produces images of the heart including the heart valves before and after exercise. You will have an Echocardiogram and exercise, immediately followed by another Echocardiogram. This will evaluate your heart’s response to exercise and will demonstrate abnormalities in heart wall motion.

For pediatric patients, please bring your child tired and hungry. When you are called back to the echo lab, we will ask you to feed your baby For toddlers and up, a light snack might be helpful if you deem appropriate. Please bring a pacifier, if used, and favorite blanket and /or toy of the child’s. Familiar things in an unfamiliar environment can make the baby more at ease.

Why have an Echocardiogram?

  • Size of the chambers
  • Dimension of each cavity
  • Thickness of the walls
  • Pumping power

Echocardiography is used to study the heart and surrounding structures and to detect life-threatening cardiovascular disorders. This information helps provide an accurate assessment of the heart's true functionality.

About the Procedure:

The patient lies on an exam table while a technologist moves a transducer over the chest and heart region. A small amount of gel is applied during this procedure. The patient will be asked to lay still, change positions or hold your breath.

Patients Can Expect:

  • The exam should take approximately 30 to 45 minutes to complete.
  • These tests are painless and non-invasive.
  • Some prior preparation may be needed. Your doctor will inform you beforehand.

What to Bring:

  • Physician referral form
  • Current medical insurance card
  • Driver’s license or other government-issued identification
  • Wear comfortable clothing. (Avoid metal straps, buttons, zippers)

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EKG

An electrocardiogram (EKG or ECG) is a test that checks for changes in the heart while the patient exercises. Sometimes ECG abnormalities can be seen only during exercise or while symptoms are present.

During the test, specialists monitor the heart while the patient exercises on a treadmill or a stationary bicycle. Small disks, called electrodes, are applied to the patient’s chest and are connected to wires called leads. The leads are connected to a monitor that records the electrical activity of the heart. The level of exercise is gradually increased to see how the patient’s heart responds to exercise.  

An ECG is done to help find the cause of chest pain or other symptoms, and to determine treatment plans for people with heart problems. Sometimes cardiologists perform the test without exercise. This may involve medication that has the same effect on the heart as exercise.

Patients can expect:

  • Some prior preparation, including no food or fluid for a minimum of 4 hours before the test.
  • No food or drink items containing caffeine (coffee, tea, chocolate, cola) for at least 12 hours before the test.
  • The patient may be advised to stop taking certain medications before the test.

What to Bring:

  • Physician referral form
  • Current medical insurance card
  • Driver’s license or other government-issued identification
  • Wear comfortable clothing. (Avoid metal straps, buttons, zippers)

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Electrophysiology Study (EP)

An Electrophysiology (EP) Study of the heart is a nonsurgical analysis of the electrical conduction system (normal or abnormal) of the heart. The test employs cardiac catheters and sophisticated computers to generate electrocardiogram (EKG) tracings and electrical measurements with exquisite precision from within the heart chambers.The EP study can be performed solely for diagnostic purposes. It also is performed to pinpoint the exact location of electrical signals (cardiac mapping) in conjunction with a therapeutic procedure called catheter ablation.

Electrophysiology is the branch of cardiology that deals with the electrical impulses, or the rhythms of your heart. If you have an abnormal heart rhythm (an arrhythmia), your heart rate is abnormally fast, slow or even irregular. “Normal” heart rates differ dependent upon your age, activity level, medications you may be taking, as well as any preexisting heart conditions that you may have.

There are a variety of symptoms that may be caused by arrhythmia ranging from a simple awareness of your heart beating, to lightheadedness, blurred vision, or cardiac arrest. Other symptoms include chest pain, shortness of breath, dizziness and fainting. The symptoms that occur depend on your heart rate during the arrhythmia, your activity at the time of the arrhythmia, and the possibility of structural heart problems. Your physician will discuss your symptoms with you extensively. Testing and treatment will be determined based on your doctor’s assessment of your symptoms.

There are many types of arrhythmia and their significance and treatment depends on the exact type. To better understand the different types of arrhythmias, it would be helpful to first understand how the heart works and the heart's normal electrical system.

What is electrophysiology?

Electrophysiology is the study and management of the electrical system of the heart. An electrophysiologist is a cardiologist who has received additional training in the diagnosis and treatment of heart rhythm disorders (cardiac arrhythmia).

What is an arrhythmia?

It is an abnormal heart rhythm; your heart may be fast, slow, or irregular.  A “normal” heart rate varies between individuals.  It is important to discuss concerns about your heart rate with your doctor.

Symptoms of Arrhythmia

There are a variety of symptoms that may occur with arrhythmia. This can include awareness in changes of heart rate, lightheadness, blurred vision and cardiac arrest.  Other symptoms may be present such as chest pain, shortness of breath, dizziness and fainting.

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Holter Monitor

Holter Monitoring is a continuous monitoring of the electrical activity of a patient's heart muscle (electrocardiography) for 24 hours, using a special portable device called a Holter monitor. Patients wear the Holter monitor while carrying out their usual daily activities. Holter monitoring is used to help determine whether someone has an otherwise undetected abnormal rhythm (cardiac arrhythmia), or inadequate blood flow through the heart.

Event/MCT Monitoring - Event monitors (or mobile cardiac telemetry) are similar to Holter monitors in that they monitor and record a patient's heart rhythm. Event/MCT monitors are worn for up to 30 days, however, because your physician wants a longer monitoring period. You can perform all your normal daily activities with an Event/MCT monitor, but they must be taken off for showers, bath, pool, hot tub, etc. Staff will instruct you how to remove and re-attach the electrodes and leadwires, and other basic maintenance. Event/MCT monitors transmit heart rhythm data to a monitoring center throughout each day, so if an arrhythmia is detected, your physician will be alerted usually within a few hours.

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MUGA Scan

A MUGA Scan (Multiple Gated Acquisition scan) is a noninvasive tool for assessing the function of the heart. The MUGA scan produces a moving image of the beating heart, and from this image several important features can be determined about the health of the cardiac ventricles (the heart’s major pumping chambers).

During a A MUGA scan a small amount of a radioactive substance or tracer (called a radionuclide) is put into the patient's blood.and a special camera is used to take pictures of your heart as it pumps blood. The test measures how well your heart pumps with every heartbeat. The test is called “multi-gated” because a gamma camera takes pictures at specific times during each heartbeat. The test may be done while you stay still (resting scan), exercise or both. The test measures your ejection fraction, which is the amount of blood pumped out of the heart during each heartbeat (contraction). It’s usually expressed as a percentage. For example, an ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle when it is full is pumped out with each heartbeat. A normal ejection fraction is between 50 and 75 percent.

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Myocardial Viability Testing with PET/CT and CT

PET/CT Scanning- McLaren Bay Region offers Myocardial Viability testing to determine heart muscle health. The test combines two sophisticated imaging techniques, positron emission tomography (PET) and computed tomography (CT), to help doctors identify blood flow and viable muscle within areas of the heart. Cardiac PET/CT scans are painless and noninvasive, performed by a doctor on an outpatient basis.

The highly sensitive scans help cardiologists and surgeons evaluate high-risk cardiac patients with a great degree of accuracy, prior to potentially serious cardiac procedures and surgeries. Physicians who are considering these procedures can refer patients and get results often within 72 hours.

Scan results are interpreted by a board-certified specialist with extensive experience in cardiac PET imaging.

About the procedure: Patients having the Myocardial Viability test lie on an exam table, while a technologist injects a safe, radioactive substance called a tracer into a vein. The tracer travels through the body to the heart and releases energy. The PET/CT scanner detects this energy and, with the help of a computer, produces extremely detailed pictures of the heart and how it's working.

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Peripheral Vascular Disease (PVD) Screenings

Anyone with leg pain symptoms, or leg pain after a brief walk, is encouraged to call for a free PVD screening. The screening takes just a few minutes. It's painless, simple and non-invasive.

During the screening, a cardiac professional measures blood pressure in the arms and compares that to the blood pressure taken at the ankle. The difference between them is calculated and used to determine if there is a reason to suspect a blockage in the peripheral arteries leading to the legs. This is called an ankle-brachial index (ABI). Test results will be sent to your primary care physician.

Depending on the results of the Ankle-Brachial Index (ABI), more extensive vascular testing may be recommended including

  • Aortic Scan: The Doppler Test detects the presence of aneurysms that could rupture and be fatal.
  • Carotid Scan:  A painless ultrasound test to detect blockages in your carotid arteries, that could lead to stroke..
  • Consider this screening annually if:

    • Any individual 55 and older
    • Have diabetes, hypertension, or uncontrolled high cholesterol (starting no later than age 40)
    • Have a family history of heart disease

    If potential blockages are found, further testing may be recommended to confirm the presence and degree of blockage detected. A copy of test results is given to the patient or their family physician.

    Please contact the locations below for screening dates, screening costs or for more information.

    Supervised exercise programs through our Cardiac Rehab program, designed for people with Peripheral Vascular Disease, are also available. The specialized program helps patients with PVD get on the right course toward treating and controlling symptoms, while lowering the risk for future complications.

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    Stress Testing - Cardiac Exercise or Treadmill

    Exercise Stress Test-- During this test, specialists monitor the heart while the patient exercises on a treadmill. Small disks, called electrodes, are applied to the patient's chest and are connected to wires called leads. The leads are connected to a monitor that records the electrical activity of the patient's heart (EKG). The level of exercise is gradually increased to see how the patient's heart responds to exercise.

    Preparation for testing: Once your physician has ordered the test and received authorization from your insurance carrier, you will be notified of some additional preparation.

    Please note: For all these types of stress tests, it is required that patients should have nothing by mouth (food or fluid) for a minimum of 4 hours before the test.

    It is also very important that you do not eat or drink items containing caffeine (coffee, tea, chocolate, cola) for at least 12 hours before the test. Caffeine can interfere with test results. This includes decaffeinated coffee or tea, since they do contain small amounts of caffeine. You may also need to stop taking some medications before the test, so be sure to let your doctor know in advance about any medications you are taking.

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    Stress Testing - Cardiac Pharmacologic

    Pharmacologic Stress Tests-- If a patient is physically unable to exercise, the staff can give the patient a medication that has the same effect on the heart as exercise. The patient wears the same electrodes for the EKG as described above so that doctors can monitor the way the heart performs under the conditions of the drug.   Pharmacologic stress testing is always done with either Nuclear or Echocardiogram imaging (see below) and simply substitutes medicine stress for treadmill stress.

    Preparation for testing: Once your physician has ordered the test and received authorization from your insurance carrier, you will be notified of some additional preparation.

    Please note: For all these types of stress tests, it is required that patients should have nothing by mouth (food or fluid) for a minimum of 4 hours before the test.

    It is also very important that you do not eat or drink items containing caffeine (coffee, tea, chocolate, cola) for at least 12 hours before the test. Caffeine can interfere with test results. This includes decaffeinated coffee or tea, since they do contain small amounts of caffeine. You may also need to stop taking some medications before the test, so be sure to let your doctor know in advance about any medications you are taking.

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    Stress Testing - Nuclear Medicine

    A Nuclear Cardiac Stress Test measures blood flow to your heart muscle at rest and during stress. It is performed similar to a routine exercise stress test but provides images in addition to those of an electrocardiogram. During a nuclear stress test, a radioactive substance is injected into your bloodstream. This substance mixes with your blood and travels to your heart. A special scanner — which detects the radioactive material in your heart — creates images of your heart muscle. Inadequate blood flow to any part of your heart will show up as a light spot on the images — because not as much of the radioactive substance is getting there.

    Preparation for testing: Once your physician has ordered the test and received authorization from your insurance carrier, you will be notified of some additional preparation.

    Please note: For all these types of stress tests, it is required that patients should have nothing by mouth (food or fluid) for a minimum of 4 hours before the test.

    It is also very important that you do not eat or drink items containing caffeine (coffee, tea, chocolate, cola) for at least 12 hours before the test. Caffeine can interfere with test results. This includes decaffeinated coffee or tea, since they do contain small amounts of caffeine. You may also need to stop taking some medications before the test, so be sure to let your doctor know in advance about any medications you are taking.

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    Stress Testing - Tilt Table

    Tilt table testing is used by doctors to find out why people feel faint or lightheaded or actually completely pass out. Tilt-table tests can be used to see if fainting is due to abnormal control of heart rate or blood pressure. A very slow heart rate (bradycardia) can cause fainting.

    During the test, you lie on a special table that can have your head raised so that it is elevated to 60 to 80 degrees above the rest of your body while a nurse or doctor monitors your blood pressure and heart rate. You may have an IV inserted to give medicine or draw blood.

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    Transesophageal Echocardiogram (TEE)

    Transesophageal Echocardiogram (TEE) is a test like a standard echocardiography where high-frequency sound waves are used to produce an image of the heart. The difference with this test is that the sound waves travel through a tube-like device put into the mouth and passed down the throat into the esophagus. The TEE provides greater detail about the size and movement of the heart muscle, the condition of the aorta and how the heart valves are working. The TEE is used when physicians cannot get a clear picture of the heart using standard echocardiography.

    About the procedure:

    The patient should not eat at least 4 hours before the test. Talk to your doctor about any medications you are taking because they may also need to be stopped before the test.

    Before the procedure, the staff will spray the patient's throat with an anesthetic to numb it and the patient will typically get an IV line to administer a mild sedative. The staff will place metal disks, called electrodes, on the patient's chest, which connect to an electrocardiogram machine to monitor the heart rhythm during the test. Then a small, flexible tube will be placed in the throat and the cardiologist will ask the patient to swallow as he or she moves the tube gently down the throat. The tube has a transducer on the end of it, which takes pictures of the heart.

    After the test, the tube and IV line are removed. The patient may feel a little sleepy until the sedative wears off. The patient may also experience a sore throat that typically goes away in a day or so.

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