A treadmill exercise stress test evaluates your exercise tolerance, heart rate response to exercise, heart rhythm disturbances and the presence of ischemia (insufficient blood flow to the heart muscle). This exam is supervised by your cardiologist.

Before:

• Take all medications unless instructed otherwise by your provider.
• Don’t eat, drink or smoke for 4 hours before the test.
• Wear comfortable clothes and walking or running shoes.

During:

• Electrodes are placed on your upper body and a blood pressure cuff on your arm.
• You will be shown how to use the treadmill.
• You will then exercise for several minutes.  The treadmill will gradually speed up and increase in incline.  Exercise for as long as long as you can.
• Inform your provider if you feel any of the following: chest, arm, or jaw discomfort; shortness of breath; fatigue; dizziness; leg cramps or soreness

After:

• You can resume your normal activity, unless otherwise instructed. 
• Keep follow-up appointments.

Stress echocardiography captures images of your heart before and after a treadmill exercise stress test and allows your provider to assess whether parts of the heart muscle are receiving a sufficient amount of blood flow.  This exam is supervised by your cardiologist.

Before:

• Take all medications unless instructed otherwise by your provider.
• Don’t eat, drink or smoke for 4 hours before the test.
• Wear comfortable clothes and walking or running shoes.

During:

• A complete transthoracic echocardiogram will be performed by the sonographer using gel and a probe placed on the chest.
• Electrodes are then placed on your upper body and a blood pressure cuff on your arm.
• You will be shown how to use the treadmill.
• You will then exercise for several minutes.  The treadmill will gradually speed up and increase in incline.  Exercise for as long as long as you can.  Once you would like to stop inform your provider.  The treadmill will stop and you will quickly return to the bed where a post-exercise echocardiogram is obtained by the sonographer.
• Inform your provider if you feel any of the following: chest, arm, or jaw discomfort; shortness of breath; fatigue; dizziness; leg cramps or soreness

After:

• You can resume your normal activities, unless otherwise instructed. 
• Keep follow-up appointments.

A transthoracic echocardiogram is an imaging test that uses sound waves (ultrasound) to capture images of the heart by placing a transducer (probe) on the chest wall.  It gives your health care provider information about heart function, chamber size and valve anatomy.

Before:

• Take all medications unless instructed otherwise by your provider.
• Clothing and jewelry may need to be removed from the waist up.  A gown will be provided.

During:

• Electrodes are placed on your chest to monitor your heartbeat.
• A transducer (probe) is moved firmly over your chest. You may be asked to adjust your breathing to allow images to be captured.
• The images of your heart are stored electronically and will be reviewed later by your provider.

After:

• You can resume your normal activities, unless otherwise instructed.
• Your provider will discuss test results at your next visit. 
• Keep follow-up appointments.

A transesophageal echocardiogram is an imaging test that uses sound waves (ultrasound) to capture images of the heart by placing a transducer (probe) into the esophagus.  It gives your health care provider information about infection that affects the heart, valve anatomy, defects in the heart walls and clots in the heart.  This procedure is done in the hospital.

Before:

• Take all medications unless instructed otherwise by your provider.
• Don’t eat or drink anything 8 hours before the test.
• Tell your doctor if you have problems with your esophagus or stomach or if you have difficulty swallowing.
• Arrange for someone to drive you home.

During:

• After changing into a hospital gown, an IV will be started and sedation medications will be administered.
• A nurse will monitor your vital signs.
• A long slender probe will be inserted into your mouth and as you swallow, advanced down the esophagus.  You may feel your doctor manipulating the probe to acquire images, but this shouldn’t hurt.
• The test usually takes 30-40 minutes.

After:

• You will be monitored for a period of time after the procedure. 
• You can resume your normal activities once the sedation wears off, but must be driven home by the person you designate before the procedure.
• Your provider will discuss test results at your next visit. 
• Keep follow-up appointments.

Nuclear stress testing generally relies on SPECT MPI (single photon emission computed tomography myocardial perfusion imaging) to measure blood flow to your heart during rest and during stress.  A small amount of radioactive material (“tracer”) is injected into the bloodstream and a special camera scans the heart to determine where this material is absorbed.  Parts of the heart muscle that do not absorb the tracer may not be getting enough blood flow because of a blocked or narrowed artery or because of a prior heart attack.

Before:

• Take all medications unless instructed otherwise by your provider.
• Make sure you don’t ingest any drinks or foods that contain caffeine for 24 hours prior to the test.
• Don’t eat or drink anything 6 hours before the test.

During:

• You will be attached to an EKG monitor.  An IV will be started and sedation medications will be administered.
• You will be given a medication that simulates exercise and may make you feel flushed or even mildly short of breath for a short time.  The nuclear tracer will then be injected and the nuclear camera will take images of your heart.
• Resting images of the heart will be taken in a similar fashion either before or after.
• Inform someone if you feel any of the following: chest, arm, or jaw discomfort; shortness of breath; fatigue; dizziness; leg cramps or soreness.
• Plan to spend 1-2 hours to complete the exam.

After:

• You will be monitored for a period of time after the procedure. 
• You can resume your normal activities, including driving, unless otherwise instructed. 
• Your provider will discuss test results at your next visit. 
• Keep follow-up appointments.

Duplex ultrasound uses sound waves to image blood vessels and the way blood flow through them.  Your healthcare provider may want to perform this study because of recent symptoms or because you are known to have problems with blood vessels in other parts of the body.

Before:

• Take all medications unless instructed otherwise by your provider.
• Clothing and jewelry may need to be removed depending on which blood vessels are being imaged.  A gown will be provided.

During:

• This test is performed by a vascular sonographer and typically takes 30-60 minutes.
• You may be asked to change into a hospital gown or to remove clothing from the area being examined.
• The sonographer will apply gel to the area being tested and then slide an ultrasound probe (transducer) over the gel.
• A blood pressure cuff may be put on your arm or leg and inflated during the test.
• You may need to stand up or exercise during the test.

After:

• You can resume your normal activities, unless otherwise instructed. 
• Your provider will discuss test results at your next visit. 
• Keep follow-up appointments.

Holter and event monitors are portable devices that record your heart’s activity and help diagnose abnormal heart rhythms.  Your provider may want to use these devices if your heartbeat is too fast, too slow or irregular or if you have symptoms such as palpitations, dizziness or fainting.

Before:

• You will be shown how to use the monitor.  Different types of monitors work in different ways, some have sticky patches (electrodes) that connect to the monitor and some are wireless.
• Follow all instructions, including how the monitor can be removed and when to replace the electrodes.  Skin should be clean and free of oils and creams when applying the electrodes.
• Rarely the electrodes can cause skin irritation.  Call your provider if this occurs.
• The monitor may need to be worn for up to 30 days.

During:

• The monitor may need to be worn up to 30 days depending on the frequency of symptoms.
• Some monitors require than you push a button when symptoms occur.  If you push the button, stop moving so as to ensure a quality recording.
• You will be asked to keep a diary.  When symptoms occur you should note the day and time, a description of symptoms and what activity you were engaged in when symptoms occurred.
• Keep other electronic devices at least 6 inches away from the monitor.

After:

• Follow all instructions for returning the device.
• Follow up with your provider as scheduled to discuss the results.

A pacemaker is a small electronic device that keeps your heart beating at the right pace. You stay awake during the procedure. You may be asked some questions or be asked to take some deep breaths.

Before:

• Don’t eat or drink anything for 8 hours before the procedure.  You may take your usual medications with a few sips of water the morning before the procedure.
• Tell your doctor about any allergies to medicines, shellfish or iodine contrast, tape or adhesives, or antibiotic types of soaps. Alternatives can be provided and precautions can be taken to avoid exposing you to anything that you are allergic to.

• If you are taking a blood thinning medicines, your healthcare provider may give you instructions on stopping it before the procedure to decrease the risk of major bleeding. You may be instructed to stop medicines that interact with the contrast dye that is used to place the pacemaker wires in the vein.
• You may be given an antibiotic through an IV to protect you from infection after the pacemaker implant procedure.
• You will have blood drawn depending on your overall health. If your kidney function is not normal, special precautions may be needed before the procedure.
• If you are a woman of child-bearing age you may be asked to take a pregnancy test before the procedure.

During:

• Your doctor may prescribe a medicine to help you relax and to prevent pain during the procedure.
• A local anesthetic is given by injection to numb the area where the pacemaker will be inserted.
• Hair may be trimmed where the device will be inserted.
• The doctor will make a cut (incision) where the generator is placed.
• The doctor will guide the wire (lead) through a vein into your heart’s chambers using X-ray monitors.
• The doctor will attach the pacemaker generator to the lead or leads.
• The doctor will close the incision site with stitches and may seal the site with a surgical glue to prevent infection.
• A dressing may be applied to your incision to reduce the risk of bleeding and also protect it from infection.
• The pacemaker’s settings are programmed to help your heart beat at a rate that’s right for you.

After:

• • You will have a chest X-ray while you are in the recovery area.
  • Follow the instructions you are given for caring for the implantation site. You will likely be told not to raise the arm on that side for a certain amount of time. You may have a sling or arm immobilizer put on to keep you from moving your arm on the incision side. This is done to prevent the new pacemaker wired from becoming displaced. Your doctor will give you instructions on how long and when you should wear this.
  • Check your incision for signs of infection every day for a week.
  • Return for a follow-up visit as advised.
  • Ask your healthcare provider when it will be safe to shower, bathe, or swim.
  • Avoid all activities that would put pressure on your incision site or cause irritation to the incision.
  • Call 911 if you have chest pain or severe trouble breathing.

Call your healthcare provider for any concerning symptoms, including:

• • You feel any of the symptoms you had before the pacemaker was implanted. These include dizziness, lightheadedness, lack of energy, or fainting spells.
  • Chest or abdominal muscles twitching.
  • Hiccups that won’t stop.
  • Rapid or pounding heartbeat or shortness of breath.
  • Pain in the area around your pacemaker.
  • Fever over 100.4°F (38°C).
  • Redness, severe swelling, drainage, bleeding, or warmth at the incision site.
  • Poor healing of the incision site.
  • If you need an MRI for any reason. In some cases, it is not safe to have an MRI with a pacemaker.

An implantable loop recorder (ILR) is a device that records information about how your heart is working. A small device is placed under the skin on your chest and works as an electrocardiogram (ECG). It constantly picks up electrical signals from your heart. An ILR records for a minimum of 2 years.

Before:

• Before your surgery, you may need an ECG.
• If you request a sedative, you will need to have a family member or friend to take you home.
• Don’t eat or drink after midnight the night before your surgery, unless your doctor says it’s OK.
• If you are taking a blood thinning medicines, your healthcare provider may give you instructions on stopping it before the procedure to decrease the risk of major bleeding.
• Follow all other instructions from your healthcare provider.

During:

• You may be given medicine to help you relax.
• Hair may be trimmed where the device will be inserted.
• A sterile drape will be placed over the incision area.
• A local anesthesia medicine will be used to numb the skin.
• A small cut (incision) will be made, usually done in the left mid-chest, near the breastbone and above the breast.
• The doctor will implant the loop recorder in the incision, just a few millimeters below the skin.
• The doctor will close your incision with stitches (sutures) and/or skin glue or steri-strips (similar to tape).

After:

• You will be shown how to use the activator, if you need one.
• You will likely be able to go home shortly after the procedure. You only need someone to drive you home if sedation medication has been used during the procedure.
• You can go back to your normal activities as soon as you feel able.
• You may keep your loop recorder for over 2 years. When you no longer need it, you will need to have it removed in a similar procedure.
• Follow up with your healthcare provider as scheduled.

Call your healthcare provider for any concerning symptoms, including:

• Bleeding, swelling, redness, pain or warmth at the insertion site.
• Fever of 100.4°F (38°C) or higher.
• Dizziness, chest pain, lack of energy, shortness of breath, fainting spells.

Before:

• Take medication as directed. Your doctor may prescribe anticoagulants (blood thinners), depending on your situation. They help prevent blood clots from forming. Your doctor may order an ultrasound called transesophageal echocardiography. This will help your doctor figure out if you need a blood thinner. 
• Ask your doctor about the risks and benefits of cardioversion.
• Sign your consent form.
• Don’t eat or drink anything for 8 to 12 hours before your procedure.
• Follow any other instructions your doctor gives you. 
• Arrange for an adult to drive you home after the procedure.

During:

• Small pads (electrodes) will be placed on your chest to record your heartbeat.
• An intravenous (IV) line will be inserted in your arm in order to administer sedation medications.
• Pads will be placed on your chest and back.  Once you are sleepy, a very brief electric shock will be given through the pads.

 After:

• You will be monitored you until you are fully awake.
• In most cases, you’ll be able to go home after the sedation wears off.
• For a few days, the skin on your chest may feel a little sore, like a mild sunburn.
• Don’t drive or operate heavy machinery for 24 hours after the procedure.
• Call your doctor if you notice skipped beats, a rapid heartbeat, or chest tightness. These may be signs that an irregular heartbeat has returned.
• Follow up with your healthcare provider as scheduled.

You may have had chest pain (angina), shortness of breath or other symptoms concerning for heart muscle dysfunction. To help diagnose your problem, your healthcare provider may advise a cardiac catheterization. This is a procedure that looks for blockages or narrowing of the arteries that supply the heart muscle with blood. These can cause chest pain or a heart attack if not treated.

This procedure may be done as a planned procedure if you have had recent symptoms and/or an abnormal stress test.  This procedure may also be done right away to treat a suspected heart attack.

Before the procedure

• Tell your healthcare team what medicines you take and about any allergies you have.
• Continue to take all medications, unless instructed otherwise by your doctor.
• Don’t eat or drink anything after midnight the night before the procedure.

During the procedure

• Hair may be trimmed where the catheter will be inserted.
• An IV (intravenous) line will be inserted in your arm in order to administer sedation medications to help you relax.
• A plastic tube called a sheath will be placed in an artery in your wrist or groin.
• Through the sheath, a series of wire and tubes (catheters) will be advanced to the heart through the artery in your wrist or groin.
• An angiogram will then be made by injecting contrast dye into the arteries of the heart (coronary arteries) and using X-ray technology.
• If important blockages are found, balloons (angioplasty) and stents (percutaneous coronary intervention, PCI) may be used to restore adequate blood flow to the heart muscle.

After the procedure

• If the procedure was performed through the groin artery, you may have to lie flat for 3-6 hours after the procedure.
• A nurse will routinely check your vital signs and the access site for bleeding.
• You may be asked to drink fluid to help flush the contrast liquid out of your system.
• You may be able to go home the same day as long as someone drives you home from the hospital.  If stents were placed, someone will need to stay with you overnight.
• There may be a small bruise or lump at the insertion site. This should resolve within a few days.
• Make sure you take all prescribed medications.
• Follow up with you doctor as scheduled.
• Call your healthcare provider if you have any concerning symptoms, including:
  – Return of symptoms that led to cardiac catheterization
  – Bleeding, swelling, pain, redness or warmth at the insertion site
  – Pain weakness, numbness or discoloration of the arm or leg near the procedure  site.
  – Blood in the urine, bright red blood in the stool, dark tarry stools
  – Fever of 100.4°F (38°C) or higher.