TESTING PROCEDURES

Echocardiogram
Transesophageal Echocardiogram
Stress Testing
Pharmacological Stress Testing
Holter monitoring
Signal Average Electrocardiograms
12-Lead Electrocardiograms

Echocardiogram
A non-invasive, pain-free ultrasound procedure using no x-rays. The exam is performed by a registered cardiac sonographer, requires no special clothing or fasting, and takes approximately one hour. By way of video playback, the cardiologist is able to visualize the heart structures, (valves and chambers), heart muscle function and blood flow patterns of the heart.

Transesophageal Echocardiogram
A way to achieve a clearer, more detailed picture of the heart by placing a probe into the esophagus. This testing procedure requires the patient to be fasting for twelve hours prior to the procedure. A family member or friend must accompany the patient, because sedation will be used through an intravenous catheter placed in the arm, and the sedation may hinder the patient's ability to drive safely. The diagnostic testing procedure usually takes approximately three to four hours and requires no special clothing.

Stress Testing
There are several types of cardiac stress tests; each is designed to stress the heart and to monitor the heart's response to stress. A cardiac technologist and a cardiologist administer the cardiac stress test. The different types of stress tests offered at St. Helena Hospital are:

Basic Cardiac Stress Tests take approximately one hour for the total procedure, with nine to twelve minutes being the average exercise time. The patient's fitness level and how fast he or she achieves target heart rate determines the exercise time. Heart rate, heart rhythm, blood pressure and electrical changes on the 12-lead electrocardiogram are monitored throughout the testing procedure. A four-hour fast is required, as well as comfortable clothing and shoes.

Stress Echocardiograms consist of obtaining rest images of the heart, before exercise and immediately after treadmill exercise, using cardiac ultrasound. The use of ultrasound imaging increases the accuracy over the basic cardiac stress test for coronary artery disease. Heart rate, heart rhythm, blood pressure and electrical changes on the 12-lead electrocardiogram are monitored throughout the testing procedure. The procedure is pain free and takes approximately one and a half hours. A four-hour fast is required, as well as comfortable clothing and shoes.

Nuclear Stress Testing Using Cardiolite as the imaging agent increases the accuracy of the basic cardiac stress test to detect coronary artery disease. An intravenous catheter is placed in the arm to allow the administration of Cardiolite during the rest and exercise phase of the test. Rest images using a SPECT camera are obtained in the nuclear medicine department on the second floor by a registered nuclear medicine technologist. After the rest images are obtained, the patient is brought to the cardiology department, where the treadmill stress test is performed. Heart rate, heart rhythm, blood pressure and electrical changes on the 12-lead electrocardiogram are monitored throughout the testing procedure. A cardiologist, cardiac technologist and nuclear medicine technologist are present throughout the exercise testing phase. Post-exercise images are collected in the nuclear medicine department. A staff of experienced radiologists compare the rest and exercise images, the results of which are sent to the referring physician. A four-hour fast is required, as well as comfortable clothing and shoes. The testing procedure lasts approximately four hours.

Pharmacological stress echocardiograms are performed using Dobutamine, which is administered through an intravenous catheter placed in the arm. Dobutamine increases the heart rate while reclining. Ultrasound images of the heart are obtained at rest, low dose, high dose, and post procedure. Heart rate, heart rhythm, blood pressure and electrical changes on the 12-lead electrocardiogram are monitored throughout the testing procedure. This procedure requires a four-hour fast, as well as comfortable clothing. This procedure lasts approximately two hours.

Pharmacological cardiac nuclear stress tests are performed using Persantine, which is administered through an intravenous catheter placed in the arm. Rest images of the heart using a SPECT camera are first obtained in the nuclear medicine department by a registered nuclear medicine technologist. The stress test, using Persantine as the stressing agent, is performed in the cardiology department. Persantine may be administered lying down, sitting or during low-level exercise. Heart rate, heart rhythm, blood pressure and electrical changes on the 12-lead electrocardiogram are monitored throughout the testing procedure. A four-hour fast is required, as well as comfortable clothing and shoes. This procedure lasts approximately four hours.

Cardiopulmonary Exercise Stress Testing is offered in conjunction with the respiratory therapy department for people whose exercise may be limited by breathing problems. During exercise on a treadmill, a registered respiratory therapist collects breathing information using a collection mask placed over the patient's nose and mouth. Several parameters are measured including VO2, O2 saturation, heart rate, heart rhythm and blood pressure. An arterial blood gas, before exercise, is compared with a post-exercise blood gas to see if anaerobic threshold was achieved. The results are interpreted by a pulmonologist, and forwarded to the referring physician. A four-hour fast is required, as well as comfortable clothing and shoes. This procedure lasts approximately one and a half hours.