Cardiology

A bubble study is done in conjunction with an echocardiogram. A “contrast” material is used during the test to get better pictures of the heart. One type of contrast is saline (sterile salt water). During a bubble study the nurse will shake the salt water until it forms small bubbles. The bubbles are then injected into the vein through an intravenous line (IV). In a normal heart the bubbles are filtered by the lungs and are seen only on the right side of the heart. If the bubbles are seen on the left side, it shows that there is an opening between the two sides of the heart. This abnormality can be an atrial-septal defect or a ventricular septal defect. The bubble study helps to identify these abnormalities. The study itself is very simple and safe and it usually only adds a few minutes to the test.

Cardioversion is a procedure to restore the heart’s normal rhythm. This is done by administering a therapeutic dose of electric current to the heart at a specific moment in the cardiac cycle. During the procedure, you will be given medication through an IV to keep you free from pain. While your heart and blood pressure are monitored, a special machine is used to send electrical energy to the heart muscle. The procedure restores the normal heart rate and rhythm, allowing the heart to pump more effectively. The procedure is done on an outpatient basis in the hospital. An IV line will be started and medication will be administered by the RN. Electrodes will be placed on your chest to monitor your heartbeat throughout the procedure. Two electrode pads, each comprising a metallic plate which is faced with a saline based conductive gel, are placed on the chest and back and a very brief electric shock will be given through the pads. Your heartbeat will be watched to make sure it is restored to its normal rhythm. You will be monitored until you are fully awake and, in most cases, will be able to go home within a few hours after the sedation wears off. Take it easy the day after your procedure and call your doctor if you notice any chest tightness, skipped beats or rapid heartbeat.

Carotid duplex is a procedure that uses ultrasound to look for plaques, blood clots, or other blood flow problems in the carotid arteries. The carotid arteries, located in the neck, supply blood to the brain.It may be performed if a patient has high blood pressure or a carotid bruit - an abnormal sound in the neck that is heard with the stethoscope. Other risk factors calling for a carotid ultrasound are advanced age, diabetes, elevated blood cholesterol, and a family history of stroke or heart disease. A water-soluble gel is placed on the skin where the transducer (a handheld device that directs the high-frequency sound waves to the arteries being tested) is to be placed. The gel helps transmit the sound to the skin surface where images of the carotid arteries and pulse wave forms are obtained. The test assesses blood flow and is used to detect the conditions involving stenosis (narrowing and hardening), thrombosis (clotting), and other causes of obstruction in the carotid arteries.

A Dobutamine Stress Echo is a test to evaluate coronary artery disease in patients who are unable to exercise on a treadmill. Dobutamine is a medication that increases heart rate and blood pressure similar to the effect of exercise. The rise in heart rate increases the oxygen demand of the heart and helps to determine if the heart muscle is getting enough blood and oxygen.An IV line will be started and Dobutamine will be administered by the RN. The test includes an echocardiogram done at rest and again at peak heart rate. This procedure uses sound waves (ultrasound) to produce an image of internal structures of the heart. In order to produce an image of the heart muscle, gel is applied to your chest area and a transducer (a wand-like apparatus) is moved over the chest. Electrodes are placed on the chest to record an electrocardiogram (EKG) which monitors the heart’s rate and rhythm.The cardiologist will observe for any symptoms, irregular heart rhythms, and inappropriate heart rate of blood pressure responses. This test will help the cardiologist evaluate your cardiac condition related to the following: How well the heart muscle and valves are working and how they function under stressThe size of the heart’s pumping chambers (ventricles).Abnormal heart function: coronary artery disease and/or inadequate coronary blood supply.

An Echocardiogram uses sound waves (ultrasound) to provide an image of your heart’s internal structures, size and movement. This image is produced by moving a transducer (a very sensitive wand-like device) over the chest area. Echocardiography is used to diagnose certain cardiovascular diseases. In fact, it is one of the most widely used diagnostic tests for heart disease. It can provide a wealth of helpful information, including the size and shape of the heart, its pumping capacity and the location and extent of any damage to its tissues. It is especially useful for assessing diseases of the heart valves. It not only allows doctors to evaluate the heart valves, but it can detect abnormalities in the pattern of blood flow, such as the backward flow of blood through partly closed heart valves, known as regurgitation. By assessing the motion of the heart wall, echocardiography can help detect the presence and assess the severity of coronary artery disease, as well as help determine whether any chest pain is related to heart disease. Echocardiography can also help detect hypertrophic cardiomyopathy, in which the walls of the heart thicken in an attempt to compensate for heart muscle weakness. The biggest advantage to echocardiography is that it is noninvasive (doesn't involve breaking the skin or entering body cavities) and has no known risks or side effects.

An electrocardiogram, also called an ECG or EKG, is a simple test that detects and records the electrical activity of the heart. It is used to detect and locate the source of heart problems. An EKG is sometimes called a 12-lead EKG (or 12-lead ECG) because the electrical activity of the heart is most often recorded from 12 different places on the body at the same time. An EKG shows how fast the heart is beating. It shows the heart’s rhythm (steady or irregular) and where in the body the heartbeat is being recorded. It also records the strength and timing of the electrical signals as they pass through each part of the heart. It is the best way to measure and diagnose abnormal rhythms of the heart, particularly abnormal rhythms caused by damage to the conductive tissue that carries electrical signals, or abnormal rhythms caused by levels of salts, such as calcium, that are too high or low.

An event monitor (King of Hearts) is similar to a Holter monitor but can be worn for a longer period of time, up to 30 days. The King of Hearts monitor will measure your EKG only when you push the event button on the monitor. You should push the button only when you feel a symptom. Each pressing of the button causes the device to record for a period of one minute. This information will then be transmitted via a standard phone connection to a center with compatible receiving and rhythm printing equipment. For symptoms that may not happen every day, an event monitor is an effective way to detect an arrhythmia.

A Holter monitor is a portable device for continuously monitoring the electrical activity of the heart for 24 hours or more. Its extended recording period is sometimes useful for observing occasional cardiac arrhythmias that would be difficult to identify in a shorter period of time.The Holter monitor records electrical signals from the heart via a series of electrodes attached to the chest. These electrodes are connected to a small piece of equipment that keeps a log of the heart's electrical activity throughout the recording period. The recording device can be worn on a belt or on a strap worn across the chest. Patients are given a diary and asked to record any heart-related symptoms that they have along with the time displayed on the monitor and what they were doing at the time. They should also record any activity that may change their heart rate (such as going to bed, getting up in the morning and exercising), along with the time and whether they felt any symptoms related to the activity. The data is then uploaded into a computer where it is used by doctors and technicians to rapidly pinpoint problem areas in the vast amount of data recorded during the monitoring period.

To make sure your pacemaker and ICD are working properly, you will need to have it checked a few times each year. During this check-up, the information stored on your device’s computer will be read and analyzed. The battery and other settings are also checked. If adjustments need to be made to your device, it is done using an electronic wand that is placed over the skin where your device is implanted. Once a month, representatives from each of the device manufacturers are in our clinic to assist with pacemaker and ICD checks.

A Stress Echo is a non-invasive test that combines two tests, an echocardiogram (Echo) and a treadmill stress test. The echocardiogram uses sound waves (ultrasound) to provide an image of your heart’s internal structures, size and movement. This image is produced by moving a transducer (a very sensitive wand-like device) over the chest area. Electrodes are placed on the chest to monitor the heart’s rate and rhythm throughout the test. The echocardiogram is done at rest prior to exercise and again at peak heart rate. The cardiologist will have you walk on a treadmill, gradually increasing the speed and incline. Patients will usually exercise from a few minutes up to 15 minutes depending upon his or her level of ability. The test will be stopped if you become too tired or if you are having any symptoms such as chest pain.The cardiologist will be looking for changes in the EKG pattern and any symptoms that you may experience. At the peak of exercise, the treadmill will be stopped, and you will be instructed to lie down immediately on a bed so that a second echocardiogram can be taken to visualize the heart’s motion with exercise. This test will help the cardiologist evaluate your cardiac condition related to: Irregular heart rhythms If there is a decrease supply of blood and oxygen to the heart at rest as well as with exertion. Overall level of cardiovascular conditioning How hard your heart can work before symptoms develop How quickly the heart recovers after exercise.

A Trans-Esophageal Echocardiogram (TEE) is a special test that allows the cardiologist to record ultrasound images of your heart from inside your esophagus (food pipe). Since the esophagus lies just behind your heart, the TEE may produce clearer pictures of the heart’s movement than would standard echocardiography taken on the outside of your chest. During TEE, harmless sound waves bounce (echo) off your heart. These sound waves create images of your heart as it pumps blood through the valves and chambers. These images help your doctor identify and treat problems such as infection, disease or defects in your heart’s walls or valves. During this test, the cardiologist will help you swallow a flexible tube. This tube will pass through your throat and into your esophagus, where it can be used to take pictures of your heart.The procedure is done on an outpatient basis in hospital. An intravenous line (IV) will be placed in your arm to administer fluids and medications to help you relax. Your heart rhythm, blood pressure, breathing, and oxygen level will be monitored throughout the procedure. The cardiologist will numb your throat with an anesthetic spray so you can swallow the tube without gagging. You may feel the doctor moving the probe, but it should not be painful or interfere with your breathing.

A treadmill test or stress EKG is an EKG that is recorded during exercise. The patient walks on a treadmill while an EKG machine records the electrical activity of the heart. The test may uncover problems with heart rhythm or blood supply to the heart which cannot be found on an EKG taken at rest. It can also be used to decide how much exercise is safe for you. This is valuable for planning a cardiac rehabilitation program after a heart attack or heart surgery. A technician will attach electrodes to the skin on your chest. Your blood pressure will be taken and a resting EKG will be recorded. You will begin walking at a low level which gradually increases, as both the speed and slope of the treadmill are increased. The test will continue until you have reached a certain pulse rate, certain EKG changes occur, or you are too tired to continue.