| Testing Procedures |
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| Written by Administrator |
| Thursday, 14 May 2009 23:45 |
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Diagnostic services offered by the the Kingston Heart Clinic include: Cardiology consultations, Electrocardiography, Holter monitoring, Event monitoring,Treadmill exercise testing, Treadmill exercise echocardiography, Supine bicycle exercise echocardiography, Dobutamine stress echocardiography, Transthoracic echocardiography, 24hr Ambulatory 24hr blood pressure monitoring, exercise myocardial perfusion scanning, persantine myocardial perfusion scanning, dobutmamine myocardial perfusion scanning and MUGA scanning. Click on the links below for more details: ProceduresTreadmill Exercise Testing (TET) Event Monitoring Treadmill Exercise Testing (TET)
The Treadmill Exercise Test (TET) is usually ordered for Patients who are experiencing symptoms of chest discomfort, shortness of breath or palpitations (irregular heart beat). Often these symptoms are related to physical activity. The TET is used as a screening test for the detection of coronary artery disease (a build up of plaque in the blood vessels to the heart causing a partial or complete obstruction). Your Electrocardiogram (ECG) and blood pressure are monitored while you are walking on a treadmill. Prior to the test, an Allied Health Care Professional will take a brief history including medication history and symptoms, ask you about your risk factors (High blood pressure, Cholesterol level, Smoking, Diabetes, etc…) and then explain the test to you. You will then be examined to make sure there is no reason to cancel the test. Once this is completed you will be asked to read and sign a consent form. The staff will answer any questions relating to the consent form. The nurse or technician will then prepare the skin so the Electrocardiogram (ECG) can monitor your heart rhythm continuously throughout the test without interference from motion and sweat. For Men this involves shaving the skin, rubbing it vigorously with alcohol and then gently roughening the skin with special abrasive paper. For Women the skin still has to be rubbed with alcohol and also gently roughed. Ten electrodes are then applied to the chest. During your TET there are always 2 experienced Physicians immediately available. All the necessary resuscitation equipment and emergency medications are readily available. The staff takes yearly Basic Cardiac Life Support (BCLS) certification. Before the TET your blood pressure and an Electrocardiogram (ECG) will be recorded in the sitting and standing position. You will then be instructed to begin walking. Initially the treadmill will be flat and moving very slowly. The Allied Health Care Professional will help you coordinate your walking. During the TET you will be asked how you are feeling and your blood pressure will be recorded every 3 minutes. Your heart rhythm is monitored continuously and an ECG is taken every 3 minutes as a permanent record for the Physician to review. During the TET the speed and incline of the treadmill will progressively increase. If you are experiencing any difficulties please notify your atttending staff member immedately. The TET is a heart rate limited and symptom limited test. The target heart rate is 85% of your maximum predicted heart rate (220-Age in years). The test will stop if you develop symptoms or if you achieve the target heart rate, whichever occurs first. The test will also be stopped if you ask to stop the test. The test may also be stopped because of changes in the ECG or blood pressure. At the completion of the test your clinical condition, blood pressure and ECG will be monitored until everything returns to baseline. At the Kingston Heart Clinic all Treadmill Exercise Tests are interpreted by the supervising Physician and a formal written report will then be mailed and received by your Doctor within 10 days. Tests which are significantly abnormal are interpreted immediately and FAXed to the referring Physician. If necessary, the patient will be interviewed and advice and/or drug therapy initiated. Treadmill Exercise Echocardiography (ExECHO)
The Treadmilll Exercise Echocardiograph (ExEcho) is usually ordered for Patients who are experiencing symptoms of chest discomfort, shortness of breath or palpitations (irregular heart beat). Often these symptoms are related to physical activity. The ExECHO is used as a test for the detection of coronary artery disease (a build up of plaque in the blood vessels to the heart causing a partial or complete obstruction). It is more accurate than a regular Treadmill Exercise Test (TET). It combines the usual TET with ultrasound imaging of the heart. Prior to the ExECHO an Allied Health Care Professional will take a brief history including medication history and symptoms, ask you about your risk factors (High blood pressure, Cholesterol level, Smoking, Diabetes, etc…) and then explain the test to you. You will then be examined to make sure there is no reason to cancel the ExECHO. Once this is completed you will be asked to read and sign a consent form. The staff will answer any questions relating to the consent form. The Allied Health Care Professional will then prepare the skin so the Electrocardiogram (ECG) can monitor your heart rhythm continuously throughout the ExECHO without interference. For Men this involves shaving the skin, rubbing it vigorously with alcohol and then gently roughening the skin with special abrasive paper. For Women the skin still has to be rubbed with alcohol and gently roughed. Ten electrodes are then applied to the chest. The electrodes are placed in a different position than the regular TET so that the Echocardiographer can obtain good Ultrasound images of the heart. During your ExECHO there are always 2 experienced Physicians immediately available. One of these Physicians is experienced in the interpretation of Echocardiography. All the necessary resuscitation equipment and emergency medications are readily available. The staff takes yearly Basic Cardiac Life Support (BCLS) certification. There are 2 Allied Health Professionals present throughout the test. The Kingston Heart Clinic has performed over 12,000 ExECHO studies. Before the ExECHO your blood pressure and ECG will be recorded in the sitting and standing position. The Echocardiographer will then take the resting ultrasound images of the heart. The Chest will be marked with marker pen to accurately localize where the best images were obtained. You will be instructed to remember the position you were laying when these images were obtained. This position will need to be duplicated as closely as possible after exercise. You will be instructed on how to breath after exercise and the importance of getting into position quickly after the completion of exercise. We are now ready to begin walking. Initially the treadmill will be flat and moving very slowly, the technician will help you coordinate your walking. During the ExECHO you will be asked, how you are feeling and your blood pressure will be recorded every 3 minutes. Your heart rhythm is monitored continuously and an ECG is taken every 3 minutes as a permanent record for the Physician to review. If you are experiencing any difficulties this must be related to your attending staff memeber immediately. During the ExECHO the speed and incline of the treadmill will progressively increase. The ExECHO is a heart rate limited and symptom limited test. The target heart rate is 85% of your maximum predicted heart rate (220-Age in years) plus an extra 10 beats per minute. The test will stop if you develop symptoms or if you achieve this target heart rate, whichever occurs first. You may ask to discontinue the test at any time. The test may also be stopped because of changes in the ECG or blood pressure. At the end of exercise the treadmill will be stopped abruptly and you must resume your pre exercise position immediately so the Echocardiographer can re-record the ultrasound images as quickly as possible. The Echocardiographer has only 90 seconds to record the ultrasound images so speed is essential. The sooner the images are obtained the better the information. At the completion of the ExECHO your clinical condition, blood pressure, and ECG will be monitored until everything returns to baseline. Once this has occurred a final set of ultrasound images are obtained. At the Kingston Heart Clinic all ExECHOs are interpreted by the supervising Physician and a formal written report will then be mailed and received by your Doctor within 10 days. Tests which are significantly abnormal are interpreted immediately and FAXed to the referring Physician. If necessary, the patient will be interviewed and advice and/or drug therapy initiated. Holter MonitoringThis special monitor records your hearts electrical activity for a period of 24, 48 or 72 hours depending on the request of a Physician. The test is usually performed because your Physician suspects an abnormal heart rhythm as the cause of your symptoms. Common reasons include dizziness, fainting, fluttering or palpitations. Often these tests are performed to monitor the efficacy of drugs to control heart rhythm. Male patients may have to have small areas of the chest shaved. The skin is prepared by rubbing firmly with alcohol and then rubbing with special abrasive paper. 5 electrodes are placed on the skin. The wires are connected to the monitor, which is about the size of a “Walkman”. This records the rhythm electrocardiogram. You will be provided with a diary to record symptoms, this diary will then be able to be correlated with your heart rhythm. You must record the type of symptom and the time. Do not take a bath, shower or swim while wearing the monitor. Avoid dropping or knocking the monitor. You must return the monitor the following day along with your diary. The diary must be returned whether or not you have made an entry. Once the monitor has been removed you must have a good wash as the electrode sites may cause skin irritation. If irritation continues for more than 4 days contact your Physician. Your Doctor will receive a report by mail within 2 weeks. Event MonitoringThis test is performed on patients who have infrequent symptoms ( at least once every two weeks) that may be related to some sort of heart beat irregularity. The device is worn like a Holter monitor except it is worn for 2 weeks (OHIP rules not ours). The device is continually recording and deleting information about your heart rhythm. If an event occurs the patient must activate the device by pressing a button. The device will then record the heart rhythm for the 30 seconds before ativation and the 15 seconds after activation. This information is then stored. The device will stor 5-6 episodes and then will alert the patient tha it is full. The information is then downloaded to the Kingston Heart Clinic by telephone. You will be supplied with batteries and electrodes. The electrodes are changed daily. The batteries are changed when the device instructs you to do so.
Dobutamine Stress Echocardiography (DobECHO)The Dobutamine Stress Echocardiograph (DobECHO) is usually ordered for Patients who are experiencing symptoms of chest discomfort, shortness of breath or palpitations (irregular heart beat). Often these symptoms are related to physical activity. The DobECHO is used as a test for the detection of coronary artery disease (a build up of plaque in the blood vessels to the heart causing a partial or complete obstruction). It is a test performed in Patients who are unable to exercise for various reasons such as arthritis, poor circulation in the legs or lung disease. It is also used in some Patients to determine whether damaged heart muscle is dead or not. Dobutamine is a drug, which essentially simulates the changes that occur during exercise. The Dobutamine is given by a constant intravenous infusion. The heart rate will increase and the force of contraction of the heart will become stronger as increasing doses of Dobutamine are administered. The blood pressure response is variable. Usually the blood pressure either does not change much or may even drop a little during the infusion. Prior to the DobECHO an Allied Heath Professional will take a brief history including medication history and symptoms, ask you about your risk factors (High blood pressure, Cholesterol level, Smoking, Diabetes, etc…) and then explain the test to you. You will then be examined to make sure there is no reason to cancel the DobECHO. Once this is completed you will be asked to sign a consent form. It is important you bring all of your medications or an up to date list. The Allied Health Professional will then prepare the skin so the Electrocardiogram (ECG) can monitor your heart rhythm continuously throughout the DobECHO without interference. For Men this involves shaving the skin, rubbing it vigorously with alcohol and then gently roughening the skin with special abrasive paper. For Women the skin still has to be rubbed with alcohol and then gently roughed. Ten electrodes are then applied to the chest. The electrodes are placed in a position so that the Echocardiographer can obtain good images of the heart. Following this, an intravenous line will be established for the delivery of Dobutamine using a special IMED infusion pump and a specific protocol whereby the drug dose is gradually increased. If during the Dobutamine infusion it becomes obvious to the Allied Health Professional that the heart rate response is inadequate a drug called Atropine will be give to increase the heart rate. During your DobECHO there are always 2 experienced Physicians immediately available. One of these Physicians is experienced in the interpretation of Echocardiography. All the necessary resuscitation equipment and emergency medications are readily available. There are 2 Allied Health Professionals present throughout the test. At the Kingston Heart Clinic we have performed over 7,000 DobECHOs. Before the DobECHO your blood pressure and ECG will be recorded. The Echocardiographer will then take the resting ultrasound images of the heart. Ultrasound images will be viewed continuously throughout the test and images aquired at low dose Dobutamine, pre-peak Dobutamine and peak Dobutamine. During the DobECHO you will be asked, how you are feeling and your blood pressure will be recorded every 3 minutes. Your heart rhythm is monitored continuously and an ECG is taken every 3 minutes as a permanent record for the Physician to review. If you are experiencing any difficulties this must be related to your Allied Health Professional. The DobECHO is a heart rate limited, symptom limited and protocol limited test. The target heart rate is 85% of your maximum predicted heart rate (220-Age in years) plus an extra 10 beats per minute. The test will stop if you complete the protocol, develop symptoms, achieve your target heart rate, or develop multiple wall motion abnormalities by ultrasound imaging, whichever occurs first. The test will also be stopped if you tell the Allied Health Professional to stop. The Allied Health Professional because of changes in the ECG, Ultrasound images or blood pressure may also stop the DobECHO test. At the completion of the DobECHO your clinical condition, blood pressure, and ECG will be monitored until everything returns to baseline. Once this has occurred a final set of ultrasound images are obtained. At our facility, all DobECHOs are interpreted at a later time by a Physician and a formal written report will then be mailed to your Doctor, which will be received within 10 days. Tests which are significantly abnormal are interpreted immediately and FAXed to the referring Physician. If necessary, the patient will be interviewed and advice and/or drug therapy initiated Supine Bicycle Exercise Echocardiography
The Physicians at the Kingston Heart Clinic usually order this test. The test is an alternative to Treadmill Exercise Echocardiography. It has the advantage that the Echocardiographer is able to record ultrasound images during exercise rather than after the completion of exercise. It is used for Patients who are experiencing symptoms of chest discomfort, shortness of breath or palpitations (irregular heart beat). Often these symptoms are related to physical activity. At the Kingston Heart Clinic most of these tests are actually perfomed in patients with valvular heart disease. The test is most useful in Patients with heart valve disease where blood flow across the heart valves can be recorded during exercise. Prior to the Supine Bicycle Exercise Echocardiography an Allied Heath Professional will take a brief history including medication history and symptoms, ask you about your risk factors (High blood pressure, Cholesterol level, Smoking, Diabetes, etc…) and then explain the test to you. You will then be examined to make sure there is no reason to cancel the test. Once this is completed you will be asked to read and sign a consent form. The staff will answer any questions relating to the consent form. The Allied Health Professional will then prepare the skin so the Electrocardiogram (ECG) can monitor your heart rhythm continuously throughout the test without interference. For Men this involves both shaving the skin and then gently roughening the skin with special sandpaper. For Women the skin still has to be gently roughed. Ten electrodes are then applied to the chest. The electrodes are placed in a position so the Echocardiographer can take good quality images of the heart. During your Supine Bicycle Exercise Echocardiography test there are always 2 experienced Physicians immediately available. One of these Physicians is experienced in the interpretation of Echocardiography. All resuscitation equipment and emergency medications are readily available. There are 2 Allied Health Professionals present throughout the test. The staff takes yearly Basic Cardiac Life Support (BCLS) certification. The Kingston Heart Clinic has performed just over 2,000 bicycle tests. Before the test your blood pressure and ECG will be recorded. The Echocardiographer will then acquire the resting ultrasound images of the heart. The bicycle bed is a special bed to which you will be snuggly strapped. Your feet are firmly attached by special shoes, which also form the bicycle pedals. The Bed is able to rotate 45 degrees to your left. The pedal distance can be adjusted for individual comfort before cycling commences. During cycling you will be instructed to look at a light, which will be green, if you are cycling at the correct speed. A white light means you have to speed up and a red light means you have to slow down. You will be instructed to either speed up or slow down by the Allied Health Professional. The workload of the bicycle will progressively increase during the test. Cycling at a 45-degree angle can be difficult. The Allied Health Professionals supervising the test will give you all the encouragement you will need. During the test you will be asked, how you are feeling and your blood pressure will be recorded every 3 minutes. Your heart rhythm is monitored continuously and an ECG is taken every 3 minutes as a permanent record for the Physician to review. If you are experiencing any difficulties this must be related this to your Allied Health Professionals. The Supine Bicycle Exercise Echocardiogram test is a heart rate limited and symptom limited test. The target heart rate is 85% of your maximum predicted heart rate (220-Age in years) plus an extra 10 beats per minute. The test will stop if you develop symptoms or if you achieve this target heart rate, whichever occurs first. The test will also be stopped if you tell the Allied Health Professional to stop. The Allied Health Professional because of changes in the ECG or blood pressure may also stop the test. Once you reach your target heart rate or if you are near the end of your ability to exercise the Echocardiographer will record ultrasound images while you are still cycling. If need be the workload on the bicycle can be reduced so you can still cycle while the ultrasound images are being acquired. At the completion of the test your clinical condition, blood pressure, heart rhythm and ECG will be monitored until everything returns to baseline. Once this has occurred a final set of ultrasound images are obtained. At the Kingston Heart Clinic all Supine Bicycle Stress ECOs are interpreted by the supervising Physician and a formal written report will then be mailed and received by your Doctor within 10 days. Tests which are significantly abnormal are interpreted immediately and FAXed to the referring Physician. If necessary, the patient will be interviewed and advice and/or drug therapy initiated. 24 hour Ambulatory Blood Pressure MonitoringThis is a device which measures your blood pressure automatically. The device is activated every half hour from 7am to 10pm and every hour from 10pm to 7am. When the device is first activated it will inflate to a high level and may cause some discomfort. Once the machine has learned the average blood pressure measurements it will not inflate as high. Sometime the cuff may inflate several times over a short period. This is usually because the device is having difficulty recording an accurate measurement. Sometimes this is corrected by repositioning the cuff. The following day when the monitor is removed it will be processed immediately by computer and the verbal report will be given to you immediately. A formal written report will be sent to your Physician by mail. Your Physician will receive the report within 10 days. If necessary the reports can be FAXed to the referring Physician. This is decided by the reporting Physician based on the blood pressure results.
An echocardiogram is ordered to look at the structure and function of your heart including the heart muscle and the heart valves. The echocardiogram uses ultrasound waves to build up a picture of the heart. The ultrasound waves are transmitted from a device on your chest (a transducer). This same transducer also acts as a receiver to record the sound waves as they are reflected back off the heart. The strength of the reflected signal depends upon the tissue density of the various cardiac structures. The test takes about 1 hour. Exercise Myocardial Perfusion Scan Exercise myocardial perfusion scanning 2 day protocol.Day 1. The Rest Scan.
Day 2 The Stress Scan.
Exercise myocardial perfusion scanning 1 day protocol.
Note: Special instructions for diabetics Normal diet and normal medications on the day of the test. Beta-blockers: Calcium blockers: Persantine Myocardial Perfusion ScanPersantine myocardial perfusion scanning 2 day protocol.Day 1. The Rest Scan.
Day 2 The Stress Scan.
Persantine myocardial perfusion scanning 1 day protocol.
Dobutamine myocardial perfusion scanning.Dobutamine myocardial perfusion scanning 2 day protocol.Day 1. The Rest Scan.
Day 2 The Stress Scan.
Dobutamine myocardial perfusion scanning 1 day protocol.
MUGA scanning.MUGA (MUltiple Gated Acquisition) scan.
Carotid Duplex Imaging.For the most part this test is performed in patients who are suspected of having carotid disease. Patients with symptoms suggestive of either a stroke, or TIA (mini-stroke), or a carotid bruit in either a symptomatic or an asymptomatic patient. We also believe that measurement of cIMT in the common carotid artery is a useful screening test for vascular disease in patients with Intermediate Framingham Risk Scores (FRS, 10-19). Our own data suggests that even patients with a low FRS have a high prevalence of abnormal cIMT in patients referred to a cardiac facility. Patients with abnormal cIMT can be targetted for other vascular preventative therapies such as Aspirin, Statins and even ACE inhibitor therapy. There are no specific pre-test recommendations. The procedure is performed using ultrasound. There are no recognized specific complications. The test is preformed for the following indications.
Peripheral arterial testing.PAD testing is performed in patients with suspected claudication or other symptoms and signs suggestive of PAD. There are no specific pre-test recommendations. The test is performed for the following indications.
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| Last Updated on Saturday, 05 June 2010 00:53 |
