Tests and Procedures

 
Angiography
Is a form of imaging that allows the doctor to view the blood flow through the arteries as it happens. Some contrast material (dye) is injected into the patient’s blood vessels, which allow the doctor to trace the flow of the contrast material using imaging machines such as an X-ray.
Balloon Angioplasty is used in place of surgery to open or widen narrowed arteries. It relieves symptoms of angina by improving the flow of blood to the heart muscle.
Once you are positioned to the operating table you will be connected to several monitors. The site where the catheter will be inserted (usually the groin, sometimes the arm or wrist) is cleansed and a local anesthetic is then injected into the skin where the tiny needle to numb the area. A small incision is made in the skin and a needle is used to puncture the artery. A guide-wire (a flexible wire) is threaded into the artery once the sheath is in place, the cardiologist can insert and remove several different catheters without using a needle. The doctor then inserts a guiding catheter (a long flexible tube) through the sheath. The catheter is directed toward the opening of the diseased artery with the help of an x-ray camera. X-ray dye (contrast) may then be injected into the artery to show exactly where the blockage is. Next the doctor inserts a balloon catheter through the guiding catheter. It has a small balloon at the tip that is used to open or widen the narrowed artery. The balloon catheter is threaded into the artery and the balloon is placed across the narrowed area. Once the catheter is in position, the doctor slowly inflated the balloon. This stretches the artery and flattens the plaque. The balloon is now deflated and removed. The larger opening allows more blood to flow through the artery. Sometimes, the balloon has to be inflated several times to widen the artery. To help prevent the artery from closing off again doctors often insert a coronary stent.

Before the Procedure:

  • Get specific instructions about the food you can have. Generally, you will be asked not to eat or drink anything for 6 to 8 hours before the procedure. You may have sips of water to take your medications.
  • You may be asked to take certain medications, so check with your doctor a few days before the procedure.
  • Make arrangements with someone to drive you to and from the hospital.
  • Pack a small bag for your hospital stay. You may want to include a robe, pajamas or nightgown, slippers, and toiletries.
  • Bring a list of all the medications you are currently taking.
  • Be sure to let your doctor know if you have any allergies to drugs, or if you have a history of bleeding problems.
  • For your comfort, empty your bladder as completely as possible before the procedure starts.

After You Go Home

  • Limit your activity during the first few days after returning home. You can move about, but do not strain or lift heavy objects.
  • A bruise or a small lump under the skin at the insertion site are common. They generally disappear within 3 to 4 weeks.
  • Call your doctor if the insertion site begins to bleed, the bruising or swelling increases, or the leg (or arm) in which the catheters were inserted feels cold or numb.
  • Call your doctor or nurse if the insertion site becomes painful or warm to the touch, or you develop a fever over 100°F.
  • Ask your when you can return to your normal activities, and whether there are any specific restrictions.
  • Do not stop taking any medication unless your doctor tells you to. If you experience any side effects, let the doctor know.
  • Call your doctor if you notice worsening chest pain or discomfort, marked shortness of breath, or excessive fatigue with exertion, all of which may signal a restenosis.
  • Do not have an MRI scan within 8 weeks of stent implantation without first discussing it with your cardiologist.
Blood Test doctors may ask patients to have a blood test in order to measure cholesterol and check the level of C-reactive protein, which is responsible for heart disease.
Bone Densitometry This test is used to check for osteoporosis, which is a gradual loss of calcium, causing the bones to become thinner and more likely to break. Bone densitometry is an enhanced form of x-ray technology that is used to measure bone loss. A part of the body, usually the lower spine or hips, is exposed to a small dose of ionizing radiation to produce pictures of the inside of the body.
Cardiac Catherization is a procedure during which doctors insert a long, thin, flexible tube, called a catheter, into the body. The procedure allows doctors to assess how well your heart is pumping and to examine the coronary arteries (the vessels that supply oxygen-rich blood to the heart muscle) and the heart valves.
The site where the catheters will be inserted, usually the groin, and a local anesthetic is injected into the skin with a tiny needle to numb the area. A small injection is made in the skin, and a needle is used to puncture the artery. A guide- wire (a flexible wire) is threaded into the artery. A short plastic tube, called a sheath, is then slipped over the guide-wire and into the artery. Once the sheath is in place, the cardiologist can insert and remove several different catheters without using a needle. A complete catheterization study usually takes from one to two hours.

Before Your Catherization:
  • Generally, you will be asked not to eat or drink anything after midnight. You may have sips of water to swallow your medications.
  • Be sure to check with your doctor several days before the procedure. You may be asked to take certain medications (such as aspirin) prior to your catheterization.
  • Make arrangements for someone to drive you to and from the hospital, since you may not be permitted to drive after the procedure.
  • Pack a small bag in case your doctor decides to keep you over night. You may want to include a robe, slippers, pajamas or nightgown, and toiletries.
  • Bring a list of all the medications you are currently taking. It is important for the doctor to know the exact names and dosages of any medications that you take.
  • Tell the doctor or nurse if you have had any allergic reactions to drugs or x-ray dye (contrast), iodine or seafood, or if you have a history of bleeding problems.
  • For you comfort, empty your bladder as much as possible before the procedure begins. (A bedpan or urinal will be available during the procedure.)

At Home After the Procedure

  • Have a family member or friend drive you home from the hospital.
  • Limit your activity during the first 24 hours after returning home. You can move about, but do not strain or lift heavy objects.
  • Leave the dressing on your groin (or arm) until the day after the procedure. The nurse will tell you how to take it off and when it’s okay to take a shower.
  • A bruise or lump under the skin at the insertion site is quite common. It should disappear within 3 to 4 weeks.
  • Call your doctor if the insertion site begins to bleed, the bruising or swelling increases, or the leg (or arm) in which the catheters were inserted feels cold or numb.
  • Call your doctor or nurse if the insertion site becomes painful or warm to the touch, or you develop a fever over 100°F.
  • Ask your doctor when you can return to your normal activities and whether there are things you should not do.
  • Be sure to check with your doctor or nurse about medications ---which ones to continue and which ones to stop.

 

Corodid Ultrasound

depicts plaque that narrows the carotid arteries, the large blood vessels in the neck that deliver blood to the brain, and may limit the free flow of blood to the brain. This imaging uses high-frequency sound waves, which means there is no exposure to ionizing radiation. A picture of blood flow is created as it is at the very moment of the imaging.
Coronary Stenting
A stent is usually implanted when there is a concern that the artery may close off after an angioplasty. Other times, a stent may be implanted to help reduce the chance of restenosis (the recurrence of a blockage). A stent may look like a small metal coil, a slotted tube, or a mesh and usually less than an inch long. It acts like a tiny metal scaffold that provides support to the artery’s walls and is permanent. The procedure is generally not painful, although there might be some pressure sensation as the catheters are inserted. The angioplasty and stent procedure usually take from one to two hours.

Before the Procedure:

  • Get specific instructions about the food you can have. Generally, you will be asked not to eat or drink anything for 6 to 8 hours before the procedure. You may have sips of water to take your medications.
  • You may be asked to take certain medications, so check with your doctor a few days before the procedure.
  • Make arrangements with someone to drive you to and from the hospital.
  • Pack a small bag for your hospital stay. You may want to include a robe, pajamas or nightgown, slippers, and toiletries.
  • Bring a list of all the medications you are currently taking.
  • Be sure to let your doctor know if you have any allergies to drugs, or if you have a history of bleeding problems.
    For your comfort, empty your bladder as completely as possible before the procedure starts.

After You Go Home

  • Limit your activity during the first few days after returning home. You can move about, but do not strain or lift heavy objects.
  • A bruise or a small lump under the skin at the insertion site are common. They generally disappear within 3 to 4 weeks.
  • Call your doctor if the insertion site begins to bleed, the bruising or swelling increases, or the leg (or arm) in which the catheters were inserted feels cold or numb.
  • Call your doctor or nurse if the insertion site becomes painful or warm to the touch, or you develop a fever over 100°F.
  • Ask your when you can return to your normal activities, and whether there are any specific restrictions.
  • Do not stop taking any medication unless your doctor tells you to. If you experience any side effects, let the doctor know.
  • Call your doctor if you notice worsening chest pain or discomfort, marked shortness of breath, or excessive fatigue with exertion, all of which may signal a restenosis.
  • Do not have an MRI scan within 8 weeks of stent implantation without first discussing it with your cardiologist.
Echocardiogram a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer, which picks up echoes of the sound waves as they bounce off the different parts of the heart. These echoes are turned into moving pictures of the heart that can be seen on a video screen.
EKG Exercise Stress Test is used to test the effect of exercise on your heart and determines how healthy the heart is.  While walking on a treadmill the patient is hooked up to an electrocardiogram that records heart activity and blood pressure. The test continues until a target heart rate is reached and monitoring is continued after exercise for ten to fifteen minutes, or until the heart rate returns to baseline.
Electrocardiogram (EKG or ECG) is a recording of the heart’s electrical activity as a graph or series of wave lines on a moving strip of paper. It can show the heart’s rate and rhythm and detect decreased blood flow (cardiac ischemia), enlargement (hypertrophy) of the heart, or the presence of either current or past heart attacks. This is a noninvasive test that is quick, safe, painless, and inexpensive. The test can be performed almost anywhere, such as, a hospital, clinic, or doctor’s office.
Holter Monitor is a twenty-four hour recording of the electrical activity of the heart. Holter monitors are cassette tape or digital recordings that record three electrical leads of the heart. This monitor allows the doctor to see how the heart reacts to activities such as, walking driving, eating, and sleeping. To comfortably carry the monitor patients use either a belt or shoulder harness. While wearing the monitor patients are also expected to keep proper entries in a diary of any activities performed through out the day.
Nuclear Stress Test also referred to, as Cardiac Perfusion imaging, is a test that uses a radioactive substance, known as a tracer, to assess the flow of blood to the heart muscle. Images are produced of the heart muscle during periods of exercise. A patient will walk on the treadmill and then later a technologist will inject the tracer into the patient’s arm through the intravenous line. After injection, there will be another minute or two on the treadmill. Patients are advised to report to the doctor any discomforts, such as chest pain, dizziness, or severe shortness of breathe. The patient is then directed to lie down and hold still under a large scanning camera that produces an image of the heart.
Pace Maker Check For patients with a pacemaker, which is a small, battery-powered electronic device that is implanted in the patient’s chest. The patient needs checkups several times a year to verify for proper heart rhythm. The doctor uses a computerized programmer device that can communicate with the pacemaker and adjust its settings as necessary.
Peripheral Arterial Disease

is a common circulatory problem in which narrowed arteries reduce the blood flow to your limbs or pelvis. The doctor may find signs of PAD during a physical examination. Some signs are:

  • A weak or absent pulse below a narrowed area of your artery.
  •  Bruits or whooshing sounds over the arteries that can be heard with a stethoscope.
  • Evidence of poor wound healing in the area where the blood flow is restricted.
  • Decreased blood pressure in an affected limb.

To diagnose Peripheral Arterial Disease the doctor may use the following tests:

  • Ankle-brachial index (ABI): A diagnostic test that compares the blood pressure in the patient’s ankle with the blood pressure in the arm. To get a blood pressure reading, the doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow.
Pulmonary Function Test Are used to measure how well the lungs take in and exhale air and how efficiently they transfer oxygen into the blood. There are broad ranges of tests that are usually performed in a health care provider’s office or specialized facility