In Office Tests

An abdominal aortic ultrasound is a test utilized to image the aorta which is the main blood vessel carrying blood from the heart to the body. It is non-invasive and painless and uses high-frequency sound waves or ultrasound to image the aorta.

When the walls of the abdominal aorta become weak, they may balloon outward putting a patient at risk for an abdominal aortic aneurysm. As the aneurysm grows there is an increased risk of rupture. Through this ultrasound procedure, we are able to measure the size of the aneurysm and also to screen for these aneurysms in patients. Screening is particularly recommended for men over the age of 60 who have smoked at some point in their life and anyone with a family history of abdominal aortic aneurysm. In addition to screening, ultrasound is also a useful tool after the diagnosis of AAA to monitor its size on a regular basis to see if it needs to be repaired.

• No food and drink 8 hours before the procedure
• Take your medications as usual

The North Texas Heart Center pacemaker clinic is a full-service follow-up clinic established to serve patients who have either a pacemaker or a defibrillator. Our state-of-the-art center and our multiple programmers provide a complete analysis for patients with implanted cardiac devices.

Routine detailed pacemaker and/or defibrillator checks are performed using an external programmer that assesses many aspects of the pacemaker, including appropriate function, test generator and lead integrity, and battery life. Our programmers are also able to extract diagnostic information and determine elective replacement time. These checks are performed by our highly trained staff and reviewed by your cardiologist.

This is an ultrasound test of the arms and/or legs to look at the blood flow in the large arteries and veins in the arms and legs. This test is used in analyzing and determining peripheral artery disease in patients.

The test procedure:

• A water-soluble gel is placed on a handheld device called a transducer which uses ultrasound to image the artery or veins being tested.
• Blood pressure cuffs may be put around different parts of the body, including the thigh, calf, ankle, and different points along the arm to take readings during the various steps of the test.
• A paste is applied to the skin over the arteries being examined allowing for images to be created as the transducer is moved over each area.
• This test is done in office or in a special lab
• You will be asked to remove clothing from the area on which the test is being performed

Ankle Brachial Indices

This test is done by measuring blood pressure at the ankle and in the arm while a person is at rest. Some people also do an exercise test. In this case, the blood pressure measurements are repeated at both sites after a few minutes of walking on a treadmill. The ankle-brachial index (ABI) result is used to predict the severity of peripheral arterial disease in the legs. A slight drop in your ABI with exercise means that you probably have PAD, which can be linked to a higher risk of heart attack or stroke.

Carotid ultrasound is a painless imaging test that uses high-frequency sound waves to create pictures of the inside of your carotid arteries. This test uses an ultrasound machine, which includes a computer, a screen, and a transducer. The transducer is a handheld device that sends and receives sound waves, creating images of the carotid artery.

This test is done to look for narrowing of the carotid arteries, which cause an increased risk of stroke. This narrowing occurs due to a build up of plaque in the arteries from cholesterol, fat, calcium and other substances in the bloodstream. Your doctor may recommend this test if you have experienced certain types of strokes or transient ischemic attacks. Conditions that increase your risk of stroke include:

• Diabetes
• High blood pressure
• Family history of heart disease
• Recent stroke or TIA

The test may also be used to evaluate the location for a stent, to look for clots and / or to evaluate the blood flow through the carotid arteries.

Preparation

• Wear an open collar shirt or shirt with no collar
• Do not wear necklaces or earrings

At North Texas Health Center we work with many different devices used for control of heart rhythm conditions and disease and also for monitoring. Device management is crucial in maintaining your device, working with any issues that occur with an implantable device, including scarring and other issues that require attention.

With monitoring devices, we are constantly using that data to monitor control of your heart condition or disease, or to use in analysis and evaluation of your heart rhythm disease in order to prescribe appropriate treatment and procedures.

An echocardiogram is a test used to assess the heart’s function and structures. A stress echocardiogram is a test done to assess how well the heart works under stress. The “stress” can be triggered by either exercise on a treadmill or medication called dobutamine.

A dobutamine stress echocardiogram (DSE) may be used if you are unable to exercise. Dobutamine is put in a vein and causes the heart to beat faster, mimicking your heart under exercise. This allows your doctor to see the structures of the heart and the heart walls and valves.

Reasons for this test:

• To assess the heart’s function and structures
• To assess stress or exercise tolerance in people with known or suspected coronary artery disease (CAD)
• To further assess the degree of known heart valve disease
• To determine limits for safe exercise before you start a cardiac rehabilitation program
• To evaluation level of safe exercise for someone after a cardiac event, such as a heart attack or heart surgery
• To evaluate the cardiac status before heart surgery

What are the risks of a dobutamine stress echocardiogram?

• Severely high blood pressure
• Irregular heartbeats
• Dizziness
• Nausea
• Chest pain
• Extreme tiredness
• In very rare cases, heart attack

There may be other risks depending on your specific medical condition and you will want to fully discuss these with your physician before the procedure.

Certain factors that may interfere with a this test are:

• Smoking or using any other form of tobacco 3 hours before the procedure
• Ingesting caffeine within 3 hours of the procedure
• Taking beta-blocking medications

Preparation

• Tell the doctor or nurses if you are allergic to or sensitive to any medications or latex.
• Fasting may be required before the test. Your doctor will give you instructions on how long you should withhold food and/or liquids.
• Tobacco use and caffeinated beverages, such as coffee, tea, and soda, may be restricted several hours before testing.
• Tell your doctor of all medications (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
• You may be instructed to hold certain medications before the procedure, such as beta blockers. Your doctor will give you specific instructions
• If you are pregnant or think you may be pregnant, you should notify your doctor.
• Tell your doctor if you have a pacemaker.

The procedure

• Remove any jewelry or other objects that may interfere with the procedure.
• You may wear your glasses, dentures, or hearing aids
• Remove clothing from the waist up and you will put on a hospital gown
• An intravenous (IV) line will be started in your hand or arm prior to the procedure
• You will lie on your left side on a table or bed, but may be asked to change position during the test.
• You will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of your heart and monitors your heart during the procedure using small electrodes that stick to your skin
• The technician will place warmed gel on your chest and then place the transducer on the gel.
• During the test, notify the technician of any pain or pressure
• The images will be taken for your doctor and the radiologist to review

An Echocardiogram, also called an echo test, is a non invasive test that uses ultrasound to produce a two dimensional image of the heart. Echocardiograms are commonly ordered to evaluate heart murmurs, palpitations, chest pain and valvular abnormalities. This procedure allows the physician to view the beating heart to measure heart chamber size and wall thickness, assess the strength of the heart and examine its structure. Color flow and Doppler techniques use ultrasound frequencies to measure the degree of valvular obstruction (stenosis) or leakage (regurgitation or insufficiency).

Preparation

• No special preparations are necessary for a standard You can eat, drink and take medications as you normally would.
• If you are having a transesophageal or stress echocardiogram, your doctor will ask you not to eat for a few hours beforeh the test. With a transesophageal echocardiogram, if you have trouble swallowing, let your doctor know as this may affect his or her decision to order the test.
• For a stress echocardiogram, wear comfortable shoes.

Procedure

• You will be asked to remove clothing from the waist up
• You will lie back on a table and the technician will place electrodes (sticky pads) to your chest to monitor your heart electrical impulses
• They will apply a gel and then run the transducer device back and forth across your chest to retrieve images of your heart and heart activity
• You may also hear a whoosh which is the ultrasound recording the sound of blood pumping through your heart

After the procedure

• You may resume your normal activities
• If the test is normal, additional testing may not be necessary according to your doctor’s instructions

An electrocardiogram (EKG or ECG) is a test that checks for problems with the electrical activity of your heart. An EKG shows the heart’s electrical activity as line tracings on paper. The spikes and dips in the tracings are called waves.

The heart is a muscular pump made up of four chambers . The two upper chambers are called atria. The two lower chambers are called ventricles. A natural electrical system causes the heart muscle to contract. This pumps blood through the heart to the lungs and the rest of the body.

An EKG is done to:

• Check the heart’s electrical activity.
• Find the cause of unexplained chest pain or pressure. This could be caused by a heart attack, inflammation of the sac surrounding the heart (pericarditis), or angina.
• Find the cause of symptoms of heart disease. Symptoms include shortness of breath, dizziness, fainting, and heartbeats that are rapid and irregular (palpitations).
• Find out if the walls of the heart chambers are too thick.
• Check how well medicines are working and see if they are causing side effects that affect the heart.
• Check how well mechanical devices that are implanted in the heart, such as pacemakers, are working. These devices help to control the heartbeat.
• Check the health of the heart when other diseases or conditions are present. These include high blood pressure, high cholesterol, cigarette smoking, diabetes, and a family history of early heart disease.

Preparation

• Be sure to tell your doctor about all the medicines you take, even over-the-counter ones. Many medicines can change the results of this test.
• Remove all jewelry from your neck, arms, and wrists. Men are usually bare-chested during the test. Women may often wear a bra, T-shirt, or gown. You will be given a cloth or paper covering to use during the test.
• Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean.

During an EKG:

• You will lie on a bed or table. Certain areas of your arms, legs, and chest will be cleaned and may be shaved. This provides a clean, smooth surface to attach the electrodes.
• Several electrodes are attached to the skin on each arm and leg and on your chest. These are hooked to a machine that traces your heart activity onto a paper. If an older machine is used, the electrodes may be moved at different times during the test. This measures your heart’s electrical activity from different places on your chest.
• You will be asked to lie very still and breathe normally during the test. Sometimes you may be asked to hold your breath. You should not talk during the test.
• After the test, the electrode paste is wiped off. The test usually takes 5 to 10 minutes.

An electrophysiology study (EP study) is a specialized cardiac catheterization that looks at the heart’s electrical and conduction system instead of its blood flow. The heart’s electrical system controls the beginning of each heartbeat regulates the heart rate. Cardiac arrhythmias are disturbances in the rate or rhythm of the heart’s electrical system.

EP studies may lead to the discovery of abnormal or diseased electrical systems. In these cases, an ablation may be needed to fix an abnormally fast rhythm problem. During an ablation, energy can be applied to destroy abnormal tissue. This may be done by freezing (cryoablation) or heating (radiofrequency ablation) tissue.

Our electrophysiologists also manage and implant various devices ranging from pacemakers, implantable defibrillators, and biventricular defibrillators and pacemakers. Pacemakers may be indicated in patients with bradycardia (slowing of the heart rate) and defibrillators may be indicated in patients with weak hearts (cardiomyopathies, heart failure) or in patients with sudden cardiac arrest. Once these devices are implanted, they are exclusively managed by our dedicated arrhythmia center and electrophysiologists.

Lead extractions are procedures where broken, infected, or redundant pacemaker / defibrillator leads are removed from the body. Often, specialized equipment such as an excimer laser may be needed to remove the leads. We are currently one of only a handful of practices in Dallas / Fort Worth that offer and have the capability to provide this service.

This section covers:

Holter Monitoring
Event Monitoring
Loop Monitoring
Mobile Cardiac Outpatient Telemetry

Holter Monitoring

Holter monitors and event monitors record your heartbeat during daily activities. The Holder monitor records your heartbeats over a 24 hour period. Event monitors record selected rhythms that correlate with your symptoms over a 3-4 week period. These monitors are often ordered for complaints of palpitations, dizziness or passing out.

A Holter monitor is a battery-operated portable device that measures and records your heart’s activity ECG continuously for 24 to 48 hours or longer depending on the type of monitoring used. The device is the size of a small camera. It has wires with silver dollar-sized electrodes that attach to your skin. The Holter monitor and other devices that record your ECG as you go about your daily activities are called ambulatory electrocardiograms.

Quick facts:

• You may be asked to wear a Holter monitor to see if you have a slow, fast or irregular (uneven) heartbeat. Or, your doctor may use it to see how well your medicines are working to treat these problems. If you have a pacemaker and feel dizzy, your doctor may use a Holter monitor to find out if your pacemaker is working properly.
• This monitor has no risks and wearing it isn’t painful.
• The results of wearing a Holter monitor will help you and your doctor decide if you need more tests or medicines for your heart, or if you need a pacemaker or cardioversion procedure to restore a regular heart rhythm.
  “I thought wearing the monitor at night would be very uncomfortable, but the cord was long so I could put it on the nightstand. I made sure the electrodes were on tight before I went to bed.” Sarah, age 62.

Why do people wear Holter monitors?>

Regular electrocardiograms (ECGs or EKGs) let your doctor look at your heart’s activity at one point in time during your ECG test. But abnormal heart rhythms and cardiac symptoms may come and go. That’s why your doctor may want to evaluate your heartbeat over time while you go about your normal activities. You may be asked to wear a Holter monitor if you have fast, slow or irregular heartbeats called arrhythmias.

Wearing the monitor may tell your doctor:

• If your medicines are working.
• Why you have symptoms such as dizziness, faintness or the feeling that your heart is racing or skipping a beat.
• If your heart is getting enough oxygen to meet its needs.

What are the risks of Holter monitors?

Wearing a Holter monitor has no risks and causes no pain. Holter monitors have wires that connect to small discs (electrodes) attached to your chest to record the electrocardiogram. Because the electrodes are attached with tape or adhesives, they may cause mild skin irritation. Tell the technician if you are allergic to any tapes or adhesives.

What should I expect with the Holter monitor?

A specially trained technician will attach the Holter monitor and instruct you how to record your symptoms while wearing it.

• The technician first attaches the electrodes to your chest. If you have a hairy chest, he or she may shave some hair off to attach the electrodes firmly.
• Once the electrodes are in place, the technician helps you put the Holter monitor on and explains how to take care of it.
• You can carry the monitor in a pocket or pouch, slung across your shoulders and neck like a purse or camera, or attach it to your waist.
• Do your usual activities while you wear the monitor with these exceptions:
• Don’t bathe, shower or swim while wearing the monitor.
• Don’t have X-rays while wearing the monitor.
• Stay away from high-voltage areas, metal detectors or large magnets.
• The technician will show you how to keep a diary of your activities and symptoms during the test. It’s important to keep an accurate diary. If you feel symptoms such as chest pain, shortness of breath, uneven heartbeats or dizziness, note in your diary the time of day they began and what you were doing. Your diary will be compared to the changes in your ECG recorded by the Holter monitor.

What happens after wearing a Holter monitor?

After the test period, return the monitor to the technician. He or she will process the record of your heart activity and prepare a report for your doctor. This will include the notes in your diary. You should get the results of the test in one or two weeks.

Event Monitoring

What is a cardiac event recorder?

A cardiac event recorder is a battery-powered portable device that you control to tape-record your heart’s electrical activity when you have symptoms. There are two types of event recorders: a loop memory monitor and a symptom event monitor.

Cardiac event recorders and other devices that record your ECG as you go about your daily activities are also called ambulatory electrocardiographic monitors.

Quick facts:

• A cardiac event recorder makes a record of your electrocardiogram (ECG or EKG) when you have fast or slow heartbeats, or feel dizzy or like you want to faint. It can also be used to see how you respond to medicines.
• Some cardiac event recorders store your ECG in memory in the monitor. Your ECG can be sent by telephone to a receiving center or to your doctor.
• There are no risks when using a cardiac event recorder.

Why do people need to use a cardiac event recorder?

Tests such as electrocardiograms let your doctor look at your heart’s activity at rest and at one point in time. But abnormal heart rhythms and cardiac symptoms may come and go. The main purpose of an event monitor is to record your heart rate and rhythm during a symptom (“event”). They work only when a person turns on the device. Your doctor may recommend an event monitor when symptoms are infrequent – less than daily.

You may be asked to wear a cardiac event recorder if you have fast, slow or irregular heartbeats called arrhythmias.

Wearing the monitor may tell your doctor:

• If your medicines are working.
• If a pacemaker or an implantable cardioverter defibrillator (ICD) is working properly.
• Why you have symptoms such as chest pain, dizziness, faintness or the feeling that your heart is racing or skipping a beat.
• If your heart is getting enough oxygen to meet its needs.

What are the risks of cardiac event recorders?

Wearing a cardiac event recorder has no risks and causes no pain. However, if you wear electrode patches, the adhesive might irritate your skin. Any skin irritation disappears when the patches are removed.

What are the two types of event recorders?

The two types are:

• A looping memory monitor is a small device about the size of a pager that can be programmed to record your ECG for a period of time, such as 5 minutes. You must push a button to activate it, and it stores your ECG for the period before and during your symptoms. If you faint and push the button after you recover, it will record your ECG during the time you felt faint and passed out, and right after you pushed it.
• A symptom event monitor can be either a hand-held device or worn on your wrist. When you feel a symptom or irregular heartbeat, you place the monitor on your chest and activate a recording button. The back of this device has small metal discs that function as the electrodes. If the monitor is worn on a wrist, you press the button to record. This stores your ECG in memory. Unlike the looping memory monitor, these won’t store your ECG before you activate it.
  Both devices can send your ECG by telephone to a transmission or receiving center in the hospital, doctor’s office or clinic. A staff person receives your ECG “tracing” and gives it to your doctor. If the tracing indicates an emergency, you will be asked to go to the emergency room.

How do I attach a cardiac event recorder?

Cardiac loop memory monitors have small disks (electrodes) that attach to your chest. Wires are attached from the electrodes to the device. To get a good ECG recording:

• Your skin should be free of oils and creams.
• You should clean your skin with alcohol or a gauze square and rub until the skin is slightly pink.
  A technician at the receiving center will tell you exactly where to place the electrodes and how often to change them. You can wear the electrodes in the bath or shower.
  Cardiac event recorders that you hold or wear on your wrist don’t require electrodes on your chest. Instead, you place the device against your chest and press a recording button, or press the recording button on the wrist monitor when you have symptoms.

How do I send my ECG recordings by telephone?

The staff of the receiving center will teach you how to send your ECG over the telephone. This normally involves placing the telephone mouthpiece over the microphone on the front of the monitor. If you have irregular heartbeats on an ECG you send by phone, you will probably get a call from a staff person at the receiving center. This person will ask you about your symptoms, and may have you come in for an ECG or to see your doctor.

What happens after wearing a cardiac event recorder?

You may need to wear an event recorder for several days or up to a month. With several recordings, your doctor will be able to decide if your irregular heartbeats require more tests or treatment.

Mobile Cardiac Outpatient Telemetry

A Cardiac Outpatient Telemetry monitor, also referred to as Mobile Cardiovascular Telemetry, is a device that continuously records the electrical activity of the heart for up to 30 days. The Cardiac Outpatient Telemetry monitor is attached to the patient’s chest by 3 leads and records every beat for the entire study.

The patient can trigger a recording at any time by pushing the Record event button on the Cardiac Outpatient Telemetry monitor. The event will then be sent over cellular networks to a lab where the recording is edited and sent to the patient’s physician. Recordings may also be automatically triggered by cardiac arrhythmia.

When using Cardiac Outpatient Telemetry physicians have access to a recording of every heart beat throughout the extended study. The physician utilizes the collected data to diagnose and recommend further treatment for the patient.

Some physicians and insurance companies may refer to this monitor as a Mobile Cardiovascular Telemetry monitor.

A Nuclear Perfusion Study is a very sensitive tool that is able to access noninvasively the blood supply to your heart, both at rest and with exercise. In this way we can diagnosis, without invasive procedures, whether your heart is at risk of any significant blockages. This study involves injecting a small amount of radioactive substance through a vein in the arm. The stress portion of the study can be performed on a treadmill or chemically.

A MUGA scan is the gold standard for the most accurate assessment of the function of the heart muscle. This is a safe and well established radioisotope technique.

If you have symptoms of peripheral arterial disease (PAD), you may be a candidate for a peripheral vascular ultrasound examination. There are several types of peripheral ultrasound exam, but each uses high-frequency sound waves as the means of detection.

Lower-extremity arterial evaluation

The purpose of a lower extremity arterial evaluation is to detect the presence, severity and location of atherosclerosis (narrowing of the arteries caused by plaque) in your legs. Some of the indications for a lower extremity arterial evaluation include leg pain while walking (claudication), leg pain at rest, leg numbness and tingling, or non-healing ulcers or sores of the legs or feet. A lower-extremity arterial evaluation includes the following components:

Pulse volume recordings and segmental pressures

Blood-pressure cuffs are placed on your thighs, calves and ankles (both legs). The blood cuffs are inflated slightly, and waveforms as well as blood pressures are obtained. Blood pressures are obtained by using a special microphone, a Doppler transducer, to listen to the pulses at your ankles. This procedure is painless and takes approximately 30 minutes.

If the blood pressures and the waveforms are normal, it may be necessary for you to walk on a treadmill to determine the effects of exercise on lower-extremity blood flow and blood pressure. If the blood pressures remain normal, no further testing is required. If the blood pressures drop, an ultrasound evaluation of the arteries will be performed.

Sometimes an exercise treadmill test is not required or cannot be tolerated by the patient. In these cases, an ultrasound scan of the lower extremity arteries is performed without exercise.

Exercise treadmill test

If a treadmill test is required, you will walk on a treadmill at a slow speed for five minutes or less. You will be asked to report any symptoms such as leg pain or numbness, hip pain, chest pain or dizziness as soon as they begin. When you have completed the exercise, blood pressures in both legs are obtained.

If the post-exercise blood pressures in you legs are normal, no further testing is required. If the post-exercise blood pressures in your legs differ significantly from those at rest, an ultrasound scan of your legs will be performed.

Ultrasound scan

An ultrasound scan is a painless procedure that uses high-frequency sound waves, which are bounced off structures and moving blood inside the body. The images and signals produced are used to evaluate arterial blood flow.

A water-based gel will be applied to your legs, and an ultrasound probe, or transducer, will be used to scan the arteries in you legs. Images of your arteries and the sound of your blood flow will be recorded. This portion of the examination takes approximately one hour.

If all three portions of the arterial evaluation are performed, the evaluation could take up to 2.5 hours. There is no special preparation for a lower extremity arterial evaluation.

Lower-extremity venous duplex scan

The purpose of a venous duplex scan is to detect the presence of thrombus (blood clot) in your veins. Some indications for a lower-extremity venous scan include warmth, pain and swelling of one or both legs, or ulcers of legs.

A water-based gel will be applied to your legs, and images of your veins and the sound of blood flow within them will be recorded using ultrasound. You will be asked to perform various breathing maneuvers and will feel compressions of your leg in several places throughout the test. This examination is usually painless, although you may feel some discomfort if your leg is tender. This procedure takes approximately 1 hour to perform, and no special preparation is required.

Abdominal aorta duplex scan

An ultrasound scan of your abdominal aorta is performed to detect aneurysms (weakening and stretching of the walls of the aorta). A water-based gel will be applied to your abdomen, and images of your abdominal aorta and the sound of blood flow will be recorded using and ultrasound transducer. This procedure is painless and will take approximately 45 minutes. It is necessary to refrain from eating and drinking for six hours prior to this procedure.

Carotid-artery duplex scan

The purpose of a carotid-artery duplex scan is to detect the presence of atherosclerosis (narrowing caused by plaque) in your carotid arteries, which are the arteries in your neck that supply blood flow to your brain. Some indications for a carotid artery duplex scan include weakness, paralysis or dysfunction of limbs, change in speech, visual disturbances, numbness or tingling in limbs, and balance disturbances. Your doctor may also order a carotid duplex scan if he detects a bruit (sound or murmur) when he listens to the blood flow in your neck with his stethoscope.

A water-based gel will be applied to your neck, and an ultrasound transducer will be used to obtain the images and sound of your blood flow. This scan is painless and takes approximately 45 minutes to an hour. No special preparation is required for this examination.

Stress echocardiograms combine stress testing, either on a treadmill or with intraveneous Dobutamine and an echocardiogram. This test can shed further information on specific regions of the heart muscle and heart valves when the body demands increased blood flow.

An echocardiogram is a test used to assess the heart’s function and structures. A stress echocardiogram is a test done to assess how well the heart works under stress. The “stress” can be triggered by either exercise on a treadmill or medication called dobutamine.

A dobutamine stress echocardiogram (DSE) may be used if you are unable to exercise. Dobutamine is put in a vein and causes the heart to beat faster, mimicking your heart under exercise. This allows your doctor to see the structures of the heart and the heart walls and valves.

Reasons for this test:

• To assess the heart’s function and structures
• To assess stress or exercise tolerance in people with known or suspected coronary artery disease (CAD)
• To further assess the degree of known heart valve disease
• To determine limits for safe exercise before you start a cardiac rehabilitation program
• To evaluation level of safe exercise for someone after a cardiac event, such as a heart attack or heart surgery
• To evaluate the cardiac status before heart surgery

What are the risks of a dobutamine stress echocardiogram?

• Severely high blood pressure
• Irregular heartbeat
• Dizziness
• Nausea
• Chest pain
• Extreme tiredness
• In very rare cases, heart attack
  There may be other risks depending on your specific medical condition and you will want to fully discuss these with your physician before the procedure.

Certain factors that may interfere with a this test are:

• Smoking or using any other form of tobacco 3 hours before the procedure
• Ingesting caffeine within 3 hours of the procedure
• Taking beta-blocking medications

Preparation

• Tell the doctor or nurses if you are allergic to or sensitive to any medications or latex.
• Fasting may be required before the test. Your doctor will give you instructions on how long you should withhold food and/or liquids.
• Tobacco use and caffeinated beverages, such as coffee, tea, and soda, may be restricted several hours before testing.
• Tell your doctor of all medications (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
• You may be instructed to hold certain medications before the procedure, such as beta blockers. Your doctor will give you specific instructions
• If you are pregnant or think you may be pregnant, you should notify your doctor.
• Tell your doctor if you have a pacemaker

The procedure

• Remove any jewelry or other objects that may interfere with the procedure.
• You may wear your glasses, dentures, or hearing aids
• Remove clothing from the waist up and you will put on a hospital gown
• An intravenous (IV) line will be started in your hand or arm prior to the procedure
• You will lie on your left side on a table or bed, but may be asked to change position during the test.
• You will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of your heart and monitors your heart during the procedure using small electrodes that stick to your skin
• The technician will place warmed gel on your chest and then place the transducer on the gel.
• During the test, notify the technician of any pain or pressure
• The images will be taken for your doctor and the radiologist to review

Exercise Stress Tests are screening tools used to help detect heart disease. This test provides your cardiologist with information about the effect exercise has on your blood pressure, heart rate and rhythm. EKG monitoring is performed while you walk on a treadmill. The speed and incline of the treadmill is increased until you reach your maximum heart rate.

Carotid Ultrasound and Doppler examination is a non invasive scan of the neck arteries using high frequency sound waves to detect plaque buildup. Knowing the amount and location of blocked arteries helps determine therapy and is an important part of stroke prevention.

Peripheral Artery Doppler examination is preformed by measuring blood pressures and waveforms at multiple levels of the arms or legs. Occasionally exercise testing is added to help differentiate the pain caused by blocked leg arteries (claudication) verses leg pain caused by nerve irritation.

Peripheral Venous Doppler detects blood clots in the arm or leg veins. This test is usually ordered for painful or swollen extremities.

A Doppler ultrasound is a test that uses high-frequency sound waves to measure the amount of blood flow through your arteries and veins, usually those that supply blood to your arms and legs.

Vascular flow studies, also known as blood flow studies, can detect abnormal flow within an artery or blood vessel. This can help to diagnose and treat a variety of conditions, including blood clots and poor circulation. A Doppler ultrasound can be used as part of a blood flow study.

A Doppler ultrasound is a risk-free and pain-free procedure that requires little preparation. The test provides your doctor with important information about the flow of blood through your major arteries and veins. It can also reveal blocked or reduced blood flow through narrowed areas in the arteries, which could eventually lead to a stroke.