An arterial evaluation evaluates the blood flow in the arteries of the arms or the legs. A Doppler waveform is obtained by bouncing sound waves off blood vessels obtaining tracings of the blood flow. Blood pressures are obtained at various places on the legs or arms. A physician will read the test. There is no preparation for an arterial evaluation.

It is important if the patient has had surgery (bypass or graft on the legs or arms to be tested) to tell the nurse performing the test. Sometimes blood flow is normal at rest but may be abnormal during exercise. When a person exercises the muscles need more blood than they do at rest. Patients may be requested to walk on a treadmill or rise on their toes several times a minute. Blood pressures and Doppler waveforms are obtained immediately after exercise to detect abnormalities of blood flow caused by the exercise. One hour should be allowed for this test. A physician will read the test.

An arterial duplex utilizes sound waves to obtain images of the arteries in the legs or arms. The harmless sound waves leave a transducer that is placed at various points on the legs or arms and the sound waves are bounced back to the transducer and converted to images. This allows the physician to detect blockages in the arteries of the arms or the legs. The nurse may also obtain Doppler sounds by bouncing sound waves off blood vessels and detecting blood flow patterns in the arteries. There is no preparation for the arterial duplex. One hour should be allowed for this test. A physician will read the test.

The carotid arteries are present on each side of the neck. To detect the presence of a narrowing of these arteries or obstruction, a carotid ultrasound (duplex) may be performed. A transducer is placed on each side of the neck. Harmless sound waves leave the transducer and bounce off the carotid arteries and return to the transducer. These sound waves are converted to images that may be recorded. A Doppler will also be obtained by bouncing sound waves off the carotid vessels to obtain blood flow patterns. There is no preparation for this test. One hour should be allowed for this test. A physician will read the test.

There is no preparation for an echocardiogram. An echocardiogram utilizes harmless sound waves that come from a transducer placed on the chest. These sound waves bounce off cardiac structures of the heart and then return to the equipment where the sound beams are converted to images on a screen and can be recorded on paper and on video. An echocardiogram will give the physician information regarding movement of valves and heart walls (muscle) and heart chamber size. A Doppler echocardiogram allows sound waves to bounce off the heart chamber and blood vessels to obtain blood flow patterns in order to detect abnormalities in blood flow.

The patient is requested to remove the clothing on the upper portion of the body and wear a gown. Electrodes are placed on the chest and an EKG will be taken continuously. A transducer will be placed on and moved to various places on the chest. A physician will read the echocardiogram. One hour should be allowed for this test. A physician will read the test.

An event recording is a method of recording an EKG or heart rhythm during an experienced symptom. Electrodes are placed on the chest and connected to wires of a recorder that is worn for up to 30 days. If a symptom is experienced the patient presses a button that allows the recorder to record the EKG several seconds before the button is pressed and after the button is pressed. A physician reads the EKGs. Thirty minutes should be allowed for the preparation for this test.

Holter monitoring is a continuous recording of the EKG for 24 to 48 hours. The patient may continue daily activities during the time the holter is being worn. This test may detect abnormal heart rhythms or arrhythmias. The EKG is recorded on a small recorder. Seven electrodes will be placed on the patient’s chest. These electrodes are attached to wires that are connected to the recorder.

A diary is kept of activities during the time the recorder is worn. It is important to record all symptoms and activities. At the end of the 24 to 48 hours the recorder will be removed, the tape scanned and a reading will be obtained from a physician. Loose fitting blouses or shirts with the buttons in the front should be worn the day of the monitor application. Do not take a bath or shower, swim or do anything that may get the electrodes, wires or recorder wet. Avoid electric blankets, magnets, metal detectors, and high-voltage areas that may cause interference on the tracings. Thirty minutes should be allowed for the preparation for this test. A physician will read the test.

The Cardiovascular Laboratory hosts a pacemaker check clinic each month. A physician’s referral is needed. When making the appointment, it is important to inform the Cardiovascular Laboratory personnel the type or brand of pacemaker that is to be checked.

Several times a month, Nationwide Children’s Hospital holds clinic appointments for both pediatric and adult patients at SOMC. Each clinic is staffed with a team of experts, including board certified cardiologists. Clinical evaluation, electrocardiography, echocardiography, Holter and trans-telephonic event monitoring are available at this clinic as well as Outpatient Adolescent and Adult Congenital services.

Routine Treadmill Stress Test

A stress test may allow your physician to detect heart problems that may not be detected at rest. A continuous exercise EKG will be obtained while the patient walks on a treadmill. The EKG will detect activity of the heart while exercising. The patient will have electrodes (patches) placed on the chest to obtain EKGs prior to exercising. Several EKGs will be taken before exercise. The patient is asked to walk on a treadmill starting slowly and increasing in speed and incline approximately every three minutes. The blood pressure will be checked every minute. The physician will read the EKGs obtained before, during and after the exercise.

It is important to report any symptoms such as chest pain, shortness of breath, leg fatigue, dizziness or general fatigue. The stress test may be helpful to diagnose coronary artery disease or blockages in the coronary arteries. It is important to wear loose and comfortable clothing. Soft soled shoes or sneakers should be worn. Do not eat or drink after midnight before the test. An hour to an hour and a half should be allowed for this test. A physician will read the test.

Myocardial Perfusion

A cardiolite stress test is a test that utilizes a radioactive substance (tracer) to produce images of the heart muscle both before and after exercise. Resting images are obtained before exercise and images are obtained after exercise. This helps to determine if areas of the heart are receiving enough blood or if there are blockages (coronary artery disease).

An IV is started in the arm and a small amount of tracer is injected into the IV. This tracer travels in the blood and is picked up by heart muscle. The pre-exercise and post exercise images are compared. If the heart muscle does not pick up the tracer, it may signify that there is not adequate blood supply to an area. There may be a blockage (coronary artery disease).

The time needed to complete a cardiolite stress test is four to six hours. There should be nothing to eat or drink after mid-night before the test. The ordering physician will determine if the patient should take any of his or her medications prior to the test. The patient should wear loose and comfortable clothing. Soft soled shoes or sneakers should be worn. The patient will receive an IV to allow the injection of the tracer. There will be a wait of approximately an hour to an hour and a half before the first images are taken.

The patient will then have electrodes (patches) placed on the chest and several EKGs will be obtained. The patient will walk on the treadmill, starting slowly and increasing in incline and speed approximately every three minutes. It is important for the patient to tell the nurse or physician of any symptoms he or she may be feeling. At the end of the exercise time another injection of the tracer will be given. The exercise images will be obtained an hour and a half later. The physician will compare the pre-exercise and exercise images. A physician will read the test.

Stress Echocardiogram

A stress echocardiogram is a test in which the echocardiogram images (ultrasound images) are obtained prior to the patient walking on a treadmill and immediately after walking on the treadmill. The blood pressure is taken every minute and an electrocardiogram is obtained continuously. It is important for the patient to inform the nurse or physician of any symptoms he or she may be feeling. The physician compares the echocardiogram images before and after the exercise and reads the electrocardiogram for any abnormalities. This test also takes an hour to an hour and a half. A physician will read the test.

Adenosine Stress Test

The adenosine stress test is a stress test for patients who cannot walk on a treadmill. The tracer (cardiolite) is utilized. Images are obtained before the adenosine is infused and after the adenosine is infused. This helps to determine if areas of the heart are receiving enough blood or if there are blockages (coronary artery disease).

The patient will receive an IV to allow the injection of the tracer. There will be a wait of approximately an hour to an hour and a half before the first images are taken. Patients will then have electrodes (patches) placed on the chest. Several EKGs will be obtained. The patient will receive the medication adenosine through the IV, replacing the exercise portion of the test. After three minutes of the adenosine infusion, the tracer will be injected via the IV. Images will be obtained an hour and a half after the cardiolite injection. The medication adenosine will dilate the heart’s arteries. If the heart’s arteries are healthy they will dilate more than arteries that are not healthy. The patient may feel flushed, chest pressure or pain, shortness of breath, and or headache.

It is important to follow the preparation of the adenosine/cardiolite stress test. For 24 hours before the test the following cannot be taken: coffee, tea, colas, chocolates or candies, frosting, cookies, pies, cocoa, milk that contains chocolate, aspirin products that contain caffeine such as Anacin or Excedrin, persantin (dipyridamole), theophylline or theophylline containing products such as Constant-T, Primatene, Quibron, Slo-phylline, Theo-dur and aggrenox. Drinks cannot be taken if they are labeled “ Caffeine free” or “decaffeinated”. It is important not to have any caffeine 24 hours before the test. The patient may not eat or drink after midnight. 4-6 hours should be allowed for this test. A physician will read the test.

Dobutamine Cardiolite Stress Test

A dobutamine stress test is a test that allows a patient who cannot walk on a treadmill or ride a bicycle to complete a stress test. The tracer (cardiolite) is utilized. Images are obtained before the dobutamine is infused and after the dobutamine is infused. This helps to determine if areas of the heart are receiving enough blood or if there are blockages (coronary artery disease).

The patient will receive an IV to allow the injection of the tracer and the infusion of the dobutamine. There will be a wait of approximately an hour to an hour and a half before the first images are taken. Patients will then have electrodes (patches) placed on the chest. Several EKGs will be obtained. The patient will receive the medication dobutamine through the IV for 12 minutes, replacing the exercise portion of the test.

The medication dobutamine will cause the heart rate to increase as if the patient was exercising. The patient may feel his or her heart rate increase. Cardiolite (tracer) will be injected again at the end of the dobutamine infusion. Images will be obtained an hour and a half after the cardiolite injection.

The patient should not have anything to eat or drink after midnight before the test. The attending physician should determine if the patient should take his or her medications before the test. This test will take 4–6 hours. A physician will read the test.

Dobutamine Echocardiogram Stress Test

A dobutamine stress test is a test that allows a patient who cannot walk on a treadmill or ride a bicycle to complete a stress test. The test combines an echocardiogram (echo) with an infusion of dobutamine, a medication that has an effect on the heart as if the patient was exercising. A dobutamine stress test may help the physician diagnose coronary heart disease. An echocardiogram (ultrasound of the heart) is obtained prior to the infusion of dobutamine and every 3 minutes thereafter. This involves holding a small transducer on the chest to obtain images of the heart structures and walls of the heart. During the stress portion of the test (infusion of dobutamine), the heart will beat faster. An electrocardiogram (EKG) is obtained continuously and the blood pressure is obtained every minute. The physician will compare images obtained before the infusion of dobutamine and during the infusion of dobutamine. It is important for the patient to tell the nurse or physician any symptoms he or she may be feeling. The physician will also review the electrocardiogram for any abnormalities. The patient should not have anything to eat or drink after mid-night before the test. This test will take an hour to an hour and a half. A physician will read the test.

Lexiscan

The lexiscan stress test is a stress test for patients who cannot walk on a treadmill. The tracer (cardiolite) is utilized. Images are obtained before the lexiscan is infused and after the lexiscan is infused. This helps to determine if areas of the heart are receiving enough blood or if there are blockages (coronary artery disease).

The patient will receive an IV to allow the injection of the tracer. There will be a wait of approximately an hour to an hour and a half before the first images are taken. Patients will then have electrodes (patches) placed on the chest. Several EKGs will be obtained. The patient will receive the medication lexiscan through the IV, replacing the exercise portion of the test. The lexiscan is injected into the IV. This is followed by an injection of the tracer via of the IV. Images will be obtained an hour and a half after the cardiolite injection. The medication lexiscan will dilate the heart’s arteries. If the heart’s arteries are healthy they will dilate more than arteries that are not healthy. The patient may feel flushed, chest pressure or pain, shortness of breath, and or headache.

It is important to follow the preparation of the lexiscan/cardiolite stress test. For 24 hours before the test the following cannot be taken: coffee, tea, colas, chocolates or candies, frosting, cookies, pies, cocoa, milk that contains chocolate, aspirin products that contain caffeine such as Anacin or Excedrin, persantin (dipyridamole), theophylline or theophylline containing products such as Constant-T, Primatene, Quibron, Slo-phylline, Theo-dur and aggrenox. Drinks cannot be taken if they are labeled “ Caffeine free” or “decaffeinated”. It is important not to have any caffeine 24 hours before the test. The patient may not eat or drink after midnight. 4-6 hours should be allowed for this test. A physician will read the test.

A tilt table test is used to evaluate the cause of unexplained fainting (syncope). During a tilt table test, you lie on a table that moves from a horizontal to a vertical position. Your heart rate and blood pressure are monitored throughout the tilt table test.

Your doctor may recommend a tilt table test if you’ve had repeated, unexplained episodes of fainting. A tilt table test may also be appropriate to investigate the cause of fainting if you’ve fainted only once, but another episode would put you at high risk of injury due to your work environment, medical history, age or other factors.

Doctors use a tilt table test to help diagnose the cause of fainting. During the test, your blood pressure and heart rate are monitored. You begin by lying flat on a table. Straps are put around your body to hold you in place. Then, the table is tilted to raise your body to a head-up position — simulating a change in position from lying down to standing up. This test allows doctors to evaluate your body’s cardiovascular response to the change in position.

A transesophageal echocardiogram (TEE) is an echocardiogram (using harmless sound waves) obtained from the esophagus (the passage way from the mouth to the stomach). This allows the images of the heart to be obtained through the softer tissue of the esophagus rather than from the outside of the chest and through the ribs. The images obtained are clearer images. Cardiac images that are difficult to obtain may be obtained by utilizing TEE.

The patient is requested not to eat or drink for 6 hours. The patient must tell the physician or nurse if he or she has any difficulty swallowing, has had esophageal surgery or has a condition of the esophagus or stomach, wears dentures or has any allergies to medications. The patient will need someone to drive him or her home after the test.

The patient may be given a spray anesthetic to numb the throat. A sedative will be given through an IV to help the patient relax. The patient will be requested to swallow a probe. The probe will be positioned in the stomach and esophagus to obtain images. The heart rate, EKG, blood pressure and breathing will be monitored continuously. This test will last 10 to 30 minutes. The patient will be allowed to leave the hospital in approximately an hour to an hour and a half after the test. A physician who is especially trained to perform and read transesophageal echocardiograms will read the results.

A venous duplex (venous ultrasound) utilizes harmless sound waves to detect blood clots in the veins of the arms or legs of the patient. The sound waves leave the transducer, bounce back to the transducer, and are converted to images on a screen that may be recorded on paper or on a video. A transducer is placed on the skin and follows the vein, imaging it by sound waves or ultrasound. These images may demonstrate the presence of a thrombus or a clot in the leg or arm. The nurse may also obtain a Doppler image by bouncing sound waves off the blood vessel to obtain blood flow patterns.

There is no preparation for a venous ultrasound or venous duplex. One hour should be allowed for this test. A physician will read the test.