List of Procedures

Nuclear Imaging / MIBI Stress Test (Nuclear Stress Test) / MIBI Stress Test (Nuclear) with Pharmaceutical Stress / Cartoid Duplex / Venous Duplex / Arterial Duplex / Treadmill Stress Testing / Stress Echocardiogram Treadmill / Echocardiogram / Echocardiogram with Bubble Study / Pacemaker Telephonic Marketing / Pacemaker Interrogation / Automatic Implantable Cardiac Defibrillator (AICD) Assessment / Holter/Event Monitoring


Nuclear Imaging

This is a diagnostic nuclear test used to determine if the heart muscle is getting the blood supply it requires. This exam consists of two parts. During the first part you are administered a contrast material while you are resting and a picture of your heart is taken. A second injection is given later during the exercise portion of your exam and additional pictures of your heart will be taken.

Patient Instructions

  • DO NOT OR DRINK ANY OF THESE FOR 24 HOURS BEFORE THE SCHEDULED TEST DATE.
    • Coffee, Tea, Soda (not even decaffeinated)
    • Chocolate (Dark, White, Cocoa… none)
    • Hot Chocolate
  • If you are diabetic, please eat a small meal.
  • No food for 4 hours before the test.
  • Please call the office if you are taking asthma/COPD medication or if you are taking theo-dur or theophylline.
  • Bring a bagel or hard roll with butter, cream cheese, or peanut butter, when you come for the test. No fat free spreads, please!  Eating this is part of the test.
  • Wear comfortable clothes and either sneakers or rubber-soled shoes.  No lotion or oil on your body the day of the test.
  • Please be aware that this test will take a minimum of 3 hours.
  • TAKE ALL MEDICATIONS unless directed differently by your doctor.  If your doctor asks you to withhold meds, please bring them with you so you can take them as soon as the test is over.

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MIBI Stress Test (Nuclear Stress Test)

This test is a sensitive means of detecting abnormalities in blood flow to the heart muscle. You will receive an intravenous dose of a radiopharmaceutical. Images of your heart will be taken under a camera for 7 to 20 minutes. We will then perform a treadmill stress test and at a specific heart rate, you will receive a second dose of the radiopharmaceutical. You will then eat the snack you brought from home. Forty minutes later, a second set of images will be taken under the camera, again for 7 to 20 minutes. The entire test takes roughly 3 hours.

Patient Instructions

  • Bring a bagel or a hard roll with butter, cream cheese or peanut butter when you come for the test. These spreads cannot be fat free.
  • Wear comfortable clothes including rubber soled shoes or sneakers as you will be walking on a treadmill

Restrictions

  • Take all of your prescribed medications unless your physician tells you otherwise
  • Do not apply body lotion; this interferes with EKG tracings
  • Avoid caffeine starting 24 hours before the test; this includes caffeinated and decaffeinated products (coffee, tea, chocolate, soda, etc.)
  • You may eat a small meal up to 2 hours prior to your test. (Note: do not eat within 8-12 hours of the arterial ultrasound.) These tests should not be performed on a full stomach. Diabetic patients may eat a small meal as necessary to ensure proper maintenance of blood sugar.
  • Please make sure to arrive 15 minutes prior to your test time to complete paperwork that is needed for your testing. Also please bring your insurance card(s) and a photo ID.

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MIBI Stress Test (Nuclear) with Pharmaceutical Stress

This test is a sensitive means of detecting abnormalities in blood flow to the heart muscle and is designed for patients who may not be able to increase their heart rate through exercise or who have a certain abnormal rhythm on their EKG. You will receive an intravenous dose of a radiopharmaceutical. Images of your heart will be taken under a camera for 7 to 20 minutes. A drug will be given to you through the IV line to increase flow to the heart. This is the exertion part of the test. An additional dose of the radiopharmaceutical will be given to you. You will then eat the snack you brought from home. Forty minutes later, a second set of images will be taken under the camera, again for 7 to 20 minutes. The entire test takes roughly 3 hours.

Patient Instructions

  • Bring a bagel or a hard roll with butter, cream cheese or peanut butter when you come for the test. These spreads cannot be fat free.

Restrictions

  • Take all of your prescribed medications unless your physician tells you otherwise
  • Do not apply body lotion; this interferes with EKG tracings
  • Avoid caffeine starting 24 hours before the test; this includes caffeinated and decaffeinated products (coffee, tea, chocolate, soda, etc.)
  • You may eat a small meal up to 2 hours prior to your test. (Note: do not eat within 8-12 hours of the arterial ultrasound.) These tests should not be performed on a full stomach. Diabetic patients may eat a small meal as necessary to ensure proper maintenance of blood sugar.
  • Please make sure to arrive 15 minutes prior to your test time to complete paperwork that is needed for your testing. Also please bring your insurance card(s) and a photo ID.

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Cartoid Duplex

A Carotid Duplex Scan uses sound waves to evaluate the main arteries in the neck which supply blood to the brain. The test is non invasive, which means no needles, catheters, or dyes are used. Ultrasound is used to create a picture of the shape of tissues and organs inside your body. The walls of blood vessels, including any deposits or narrowing, can also be seen.

Gel is placed on the skin over the area to be studied. An instrument, called a transducer, is placed on your skin. Sound waves are transmitted from the transducer. The sound waves reflect off the tissues and organs to create a picture that can be seen on a screen. Blood flow through the blood vessels can be heard as the test is being completed.

Patient Instructions

  • No special preparation is required
  • Allow 45 minutes
  • Please do not wear a turtleneck shirt to allow access to the neck area for the scan.

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Venous Duplex

A Venous Duplex Study uses sound waves to check the venous flow in the legs and arms for blood clots which may cause pain or swelling. The test is noninvasive, which means no needles, catheters, or dyes are used. Ultrasound is used to create a picture of the shape of tissues and organs inside your body. The walls of blood vessels, including any deposits or narrowing, can also be seen.

Gel is placed on the skin over the area to be studied. A instrument, called a transducer, is placed on your skin. Sound waves are transmitted from the transducer. The sound waves reflect off the tissues and organs to create a picture that can be seen on a screen. Blood flow through the blood vessels can be heard as the test is being completed.

Patient Instructions

  1. Allow 45 minutes for one arm or leg and 1 hour for both extremities.
  2. Wear two-piece clothing.

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Arterial Duplex

An Arterial Duplex Scan uses sound waves to evaluate the main arteries in the neck which supply blood to the brain. The test is non invasive, which means no needles, catheters, or dyes are used. Ultrasound is used to create a picture of the shape of tissues and organs inside your body. The walls of blood vessels, including any deposits or narrowing, can also be seen.

Gel is placed on the skin over the area to be studied. An instrument, called a transducer, is placed on your skin. Sound waves are transmitted from the transducer. The sound waves reflect off the tissues and organs to create a picture that can be seen on a screen. Blood flow through the blood vessels can be heard as the test is being completed.

Patient Instructions

  1. Allow 45 minutes for each arm or leg and one hour for both extremities.
  2. Wear two-piece clothing.
  3. Take all your regular medications, unless otherwise instructed by your physician.
  4. Do not eat within 8 hours of the arterial duplex scan.

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Treadmill Stress Testing

The heart electric activity is observed and recorded while you walk on treadmill. The speed and incline of the treadmill increases slightly every three minutes until you tire or the pulse rate reaches a target value determined by your age. The ECG recording will then be reviewed. If considered normal, it is unlikely that you have significant coronary artery narrowings. If abnormal, other tests may be suggested (Nuclear Stress Test).

A Treadmill Stress Test is a diagnostic exam during which you will walk at an increasing rate on the treadmill while being continuously monitored electrocardiographically. This exercise protocol allows our staff to observe the electrocardiogram for changes that may warn of current or future heart problems. This test will take approximately 1 hour.

Patient Instructions

  • Wear comfortable clothes including rubber soled shoes or sneakers as you will be walking on a treadmill

Restrictions

  • Take all of your prescribed medications unless your physician tells you otherwise
  • Do not apply body lotion; this interferes with EKG tracings
  • Avoid caffeine starting 24 hours before the test; this includes caffeinated and decaffeinated products (coffee, tea, chocolate, soda, etc.)
  • You may eat a small meal up to 2 hours prior to your test. (Note: do not eat within 8-12 hours of the arterial ultrasound.) These tests should not be performed on a full stomach. Diabetic patients may eat a small meal as necessary to ensure proper maintenance of blood sugar.
  • Please make sure to arrive 15 minutes prior to your test time to complete paperwork that is needed for your testing. Also please bring your insurance card(s) and a photo ID.

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Stress Echocardiogram Treadmill

A Treadmill Stress Echocardiogram is given to help evaluate the condition of your heart and arteries.  An echocardiogram is a sound wave picture of your heart. These images will be obtained before, during and after exercise on the treadmill. While you exercise on the treadmill, your EKG and blood pressure will be closely monitored. The exercise protocol gradually increases the work of your heart, allowing the physician to look for changes that may warn of heart problems. This entire test will take 1 hour.

  • Wear comfortable clothes including rubber soled shoes or sneakers as you will be walking on a treadmill

Restrictions

  • Take all of your prescribed medications unless your physician tells you otherwise
  • Do not apply body lotion; this interferes with EKG tracings
  • Avoid caffeine starting 24 hours before the test; this includes caffeinated and decaffeinated products (coffee, tea, chocolate, soda, etc.)
  • You may eat a small meal up to 2 hours prior to your test. (Note: do not eat within 8-12 hours of the arterial ultrasound.) These tests should not be performed on a full stomach. Diabetic patients may eat a small meal as necessary to ensure proper maintenance of blood sugar.
  • Please make sure to arrive 15 minutes prior to your test time to complete paperwork that is needed for your testing. Also please bring your insurance card(s) and a photo ID.

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Echocardiogram

For our referring providers, as we all share the same goal of using testing as necessary, here is a link to the ASE Appropriate Use Criteria website: http://www.asecho.org/files/AUCEcho.pdf

Sound waves are used to create an image of the heart. The sound waves are painlessly transmitted to the heart by placing a metal cylinder (a transducer) on the chest wall. The echoes returning to the transducer are converted by complex computer into a picture of the heart. This test allows us to evaluate the muscle and valves of the heart.

An echocardiogram is an ultrasound or sound wave test of the heart. It is used to evaluate the size, thickness and pumping action of the heart. It can also help evaluate murmurs, valve problems, or fluid around the heart.

The test is noninvasive, which means no needles, catheters, or dyes are used. Ultrasound is used to create a picture of the heart, including the blood vessels, valves, atria and ventricles. Gel is placed on the skin over the area to be studied. An instrument, called a transducer, is placed on your skin. Sound waves are transmitted from the transducer. The sound waves reflect off the tissues and organs to create a picture that can be seen on a screen. Blood flow through the blood vessels can be heard as the test is being completed.

Patient Instructions

  • No special preparation is needed for this test.
  • Wear two-piece clothing.
  • Allow approximately 1 hour
  • Your physician will be notified of the results.

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Echocardiogram with Bubble Study

Echocardiogram an echocardiogram shows the structure and function of your heart. The standard form of this test is called a transthoracic echocardiogram.

With this test, a Sonographer will apply gel to a device called a transducer against the skin over the heart. The transducer emits high-pitched sound waves and records the sound wave echoes as they reflect off internal structures in the heart. A computer converts the echoes into moving images on a monitor. Variations of this procedure may be used to identify patent foramen ovale:

Saline contrast study (bubble study) with this approach, a sterile salt solution is shaken until tiny bubbles form and then is injected into a vein. The bubbles travel to the right side of your heart and appear on the echocardiogram. If there’s no hole between the left atrium and right atrium, the bubbles will simply be filtered out in the lungs. If you have a patent foramen ovale, some bubbles will appear on the left side of the heart.

Patient Instructions:

  • No special preparation is needed for this test.
  • Wear two-piece clothing.
  • Allow approximately 1 hour
  • You physician will be notified of the results.

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Pacemaker Telephonic Marketing

The pacemaker’s activity and battery life is monitored by telephone. Established protocols, age of the unit and whether it works in one or two chambers of the heart determines the frequency of follow-up

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Pacemaker Interrogation

Interrogation is a complete analysis of pacemaker function. It is done in the office with a device that “talks” to the pacemaker by telemetry. It allows adjustment of pacemaker rate, electrical output, and evaluation and adjustment of many other parameters.

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Automatic Implantable Cardiac Defibrillator (AICD) Assessment

By talking to the AICD unit with a telemetry device, the settings, discharges and functions of the AICD can be assessed and reprogrammed, if needed.

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Holter/Event Monitoring

A Holter Monitor records the electrical activity of the heart beats for 24 hours on a solid state device. A diary is provided for entry of daily activity and a button to signal a symptom on the actual recording allows correlation of symptoms and activities with the heart’s electrical function. The Event Recorder captures only 2-3 minutes of the hearts electrical activity but can be carried in purse of pocket and use when symptom occurs. It is best for infrequent and intermittent problems that may not occur on a daily basis.

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