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    • Cardiac DiagnosticsElectrocardiogram (ECG)Exercise Stress TestHolter MonitorEchocardiogram (cardiac ultrasound)Transesophageal Echocardiogram (TEE)Stress EchocardiogramDobutamine Stress EchocardiogramNuclear Stress TestElectrocardiogram (ECG)What is it?An electrocardiogram (ECG) is a routine test that is used to record the electrical activityof your heart. A healthy heart should show a specific pattern, so when there are changesin this pattern, it is an indication that there is a problem.Why is it done?This test can help your doctor identify any abnormalities in your heart’s rhythm. Once theproblem is identified, your doctor can prescribe a treatment plan that best meets yourhealth care needs.How is the test done?You will be given a gown and asked to remove any clothing above your waist.You will lie on an examination table and a technician will place small disks, calledelectrodes, on your chest. The electrodes are attached to wires (or leads) that connect tothe electrocardiogram machine. The electrocardiogram machine will trace the path ofelectrical energy through your heart and will provide a print-out for your doctor toreview.How should I prepare?No special preparation is needed before an electrocardiogram. On the day of your test,please ensure that you bring your Ontario Health Card to your appointment.Is there any pain or risk associated?An electrocardiogram is a pain-free test that presents no risk of injury to the patient.How long will the test take?This test will take approximately 10 minutes.Exercise Stress TestWhat is it?An exercise stress test records the electrical activity of your heart at rest, during exercise,and after exercise. Southlake Regional Health Centre © 2005
    • Why is it done?This test will help your doctor see how your heart performs during physical activity andidentify possible heart complications during exercise.How is the test done?A technician will apply small disks, called electrodes, to your chest and a blood pressurecuff around your arm. The electrodes are attached to wires (or leads) that are connected tothe electrocardiogram machine. While hooked up to the machine, you will be asked towalk on a treadmill. Every two to three minutes, your doctor or technician will increasethe speed and incline which will cause you to work harder. This test will allow yourdoctor to see changes in your heart’s electrical pattern or in your blood pressure levels,which may indicate that your heart isn’t getting enough oxygen. You will also bemonitored for chest pain or unusual shortness of breath.How should I prepare?Be sure to ask your doctor about any medication you are taking and whether or not youshould stop taking it before the test. Do not eat or drink anything for two hours beforeyour test, especially items that contain caffeine, such as coffee, tea, soda, or chocolate.Do not use body creams or powder on your chest prior to the test. Wear loose-fitting,comfortable clothes and flat, soft-soled shoes, such as running shoes. Be sure to alsobring your Ontario Health Card to your appointment.Is there any pain or risk associated?There are some risks associated, but your doctor will explain these to you before youhave the test. Be assured that a doctor will be present at all times during the test.How long will the test take?This test will take approximately 30 minutes.Holter MonitorWhat is it?Holter Monitoring is a test that records your heart beat for 24, 48, or 72 hours andprovides your doctor with a constant reading of your heart rhythm.Why is it done?The Holter Monitor is a battery-powered device with highly sensitive electrodes that canpick up electrical impulses in your heart. It records what your heart is doing when youfeel chest pains or irregular heart beats. The printout can then help your doctor diagnoseany problems you may be experiencing and prescribe a treatment plan that best meetsyour health care needs.How is the test done?You must visit the hospital for approximately 20 minutes to be fitted for your monitorand receive instructions on how to use it. A technician will place small disks, calledelectrodes, on your chest. The electrodes will be attached to wires (or leads) that will Southlake Regional Health Centre © 2005
    • connect to a small device that looks like a cassette recorder, which you will wear on abelt around your waist. You must continue with your normal routine and keep a log ofyour daily activities including what you do and at what times. You MUST NOT showeror bathe for the duration of the test because it is important to keep the monitor andelectrodes dry.NOTE: If one of the leads come off, feel free to tape it back to the same spot by usingscotch or masking tape.How should I prepare?You should bathe before you visit the hospital to be fitted for your Holter Monitorbecause you will be unable to shower or bathe for the duration of the test. Please ensurethat you bring your Ontario Health Card to your appointment.Is there any pain or risk associated with the test?There is no pain or risk associated with this test.How long will the test take?Holter Monitoring can be a 24, 48, or 72-hour test.Echocardiogram (cardiac ultrasound)What is it?An echocardiogram is a test that uses sound waves (also called ultrasound) to produce amoving picture of your heart. These sound waves are sent through a wand-like device,called a transducer, and into your body. They bounce off your heart and return to thetransducer as echoes. These echoes are then turned into moving images of your heart thatcan be viewed on a television monitor.Why is it done?Depending on the type of echocardiogram that is performed, this test allows your doctorto learn about the size and shape of your heart muscle and evaluate its function, valves,and the flow of blood through your heart. This test allows your doctor to diagnose anyproblems you may be experiencing and prescribe a treatment plan that best meets yourhealth care needs.How is the test done?You will be given a gown and asked to remove any clothing above your waist and lie onan examination table. A technician will apply a thick gel and place the transducer to theleft side of your chest. He or she will press firmly and move the transducer across yourchest. You may be asked to change your position, breathe in or out, or hold your breathduring the test, but most of the time you will be asked to lie still.How should I prepare?There is no special preparation needed before an echocardiogram. On the day of yourtest, please ensure that you bring your Ontario Health Card to your appointment. Southlake Regional Health Centre © 2005
    • Is there any pain or risk associated?An echocardiogram is a pain-free test that presents no risk of injury to the patient.How long will the test take?This test will take approximately 30-45 minutes.Transesophageal Echocardiogram (TEE)What is it?A transesophageal echocardiogram is a test that uses sound waves to produce a movingimage of your heart. Unlike a standard echocardiogram where the image is producedfrom the outside of the chest, this test produces an image from the inside. It involves theinsertion of a soft, tube-like device, approximately the diameter of your little finger, intoyour mouth and down your food pipe (esophagus) until it is positioned directly behindyour heart. The tube has a transducer on the end that bounces sound waves off of yourheart to create moving images on a television monitor.Why is it done?This test can show your doctor the size, shape and movement of your heart muscle andthe aorta, the main blood vessel supplying blood to your body. This test will also showhow blood is flowing through your heart and how your heart valves are working. A TEEwill give your doctor exceptionally clear images of your heart, and it is usually donewhen your doctor cannot get a clear picture using standard echocardiography.How is the test done?The doctor will begin by spraying your throat with an anaesthetic that will make it feelnumb. While lying on the examination table, an intravenous line (or IV) will be put inyour arm and you will be given a mild sedative to relax you. Small disks, calledelectrodes, will be placed on your chest to monitor your heart rhythm during the test.A small tube, called a probe, will be put down your throat. Once in place, the transduceron the end of the probe will take pictures of your heart at different angles.After the test, a nurse will stay with you until most of your sedative has worn off.How should I prepare?You must not eat or drink anything after midnight the night before your test. On the dayof your test, please ensure that you bring your Ontario Health Card to your appointment.Is there any pain or risk associated?You may experience a sore throat for one day following your test.How long will the test take?This test will take approximately 30-45 minutes.Discharge InstructionsYou CANNOT drive a motor vehicle for 24 hours; therefore, you must arrange for aresponsible adult to drive you home following your test. Southlake Regional Health Centre © 2005
    • You may begin drinking clear fluids two hours after your test. If you experience nodifficulty swallowing, you may continue with your regular diet.Stress EchocardiogramWhat is it?A stress echocardiogram combines a standard exercise stress test and an echocardiogram.Why is it done?By comparing ultrasound images of your heart before and after you exercise, your doctorcan tell how well your heart is pumping. This test can detect the presence and/or thesignificance of CAD (blocked arteries). It allows your doctor to diagnose any problemsyou may be experiencing and prescribe a treatment plan that best meets your health careneeds.How is it done?A technician will apply small disks, called electrodes, to your chest and a blood pressurecuff around your arm. You will be asked to exercise on a treadmill, and, once your heartrate reaches a certain rate, you will be asked to lie down on an examination table.A technician will apply a thick gel to your chest and will use sound waves through awand-like device, called a transducer, to look at moving images of your heart.How should I prepare?Be sure to ask your doctor about any medication you are taking and whether or not youshould stop taking it before the test. If possible, Beta Blockers should not be taken oneday before or the morning of this test.• Do not discontinue any medication without first talking to your doctor.• Do not eat or drink anything for two hours before your test, especially coffee, tea, soda or chocolate.• Do not use body creams or powder on your chest prior to the test.• Wear loose-fitting, comfortable clothes and flat, soft-soled shoes, like running shoes• Please ensure that you bring your Ontario Health Card to your appointment.Is there any pain or risk associated?There are some risks associated, but your doctor will explain these to you before youhave the test. Be assured that a doctor will be present at all times during the test.How long will the test take?This test will take approximately 60 minutes.Dobutamine Stress EchocardiogramWhat is it?During this test, you will be given a medication called dobutamine through anintravenous (IV) line in your hand. It will cause your heart to work as though you were Southlake Regional Health Centre © 2005
    • doing exercise. You will also have ultrasound images of your heart recorded before themedication is given to you and again while the medication is being given to you.Why is it done?This test is used to determine how well your heart is pumping. This test can detect thepresence and/or the significance of blocked arteries (CAD). This will help your doctorprescribe a treatment plan that best meets your health care needs.How is the test done?A technician will place small disks, called electrodes, on your chest. These are attachedto wires (or leads) and connected to an electrocardiogram machine. An intravenous (IV)line will be inserted into your arm. A technician will apply a thick gel to your chest andwill use sound waves through a wand-like device called a transducer to look at movingimages of your heart while it’s in a resting state. Your doctor or nurse will thenadminister the dobutamine medication through your IV, which will cause your heart toreact as though you were exercising. Ultrasound images will be taken again while thedobutamine is being administered. You will be closely monitored at all times.NOTE: The dobutamine may cause a warm, flushing feeling and, in some cases, a mildheadache. If you begin to experience any of these symptoms, chest discomfort, excessiveshortness of breath, or irregular heartbeats, tell the doctor immediately.How should I prepare?Be sure to ask your doctor about any medication you are taking and whether or not youshould stop taking it before the test. If possible, Beta Blockers should not be taken oneday before or the morning of this test. Do not discontinue any medication without firsttalking to your doctor.• Do not eat or drink anything for two hours before your test, especially items that contain caffeine, such as coffee, tea, soda, or chocolate.• Do not use body creams or powder on your chest prior to the test.• Wear loose-fitting, comfortable clothes and flat, soft-soled shoes, like running shoes.• Please ensure that you bring your Ontario Health Card to your appointment.Is there any pain or risk associated?There are some risks associated, but your doctor will explain these to you before youhave the test. Be assured that a doctor will be present at all times during the test.How long will the test take?This test will take approximately 90 minutes.Nuclear Stress TestWhat is it?A nuclear stress test is an assessment of blood flow to your heart during rest and exercise. Southlake Regional Health Centre © 2005
    • Why is it done?Your doctor needs to know how efficiently your heart is being supplied with the adequateamount of blood. When your heart is forced to work hard, the arteries will open up anddeliver more blood, and therefore, more oxygen. If the arteries are plugged with plaque, itis harder for the blood to get through and less oxygen is delivered to that part of the heart.By injecting you with a substance and tracing its presence through your heart, yourdoctor can tell if and where your arteries are plugged.How is the test done?When you arrive, the technologist will give you a small injection of a substance calledTetrofosmin. One hour after your injection, you will be asked to lie on an examinationtable so a gamma-ray camera can move around your chest and take pictures of your heart.During this time (approximately 15 minutes), it will be necessary for you to hold yourarms above your head.One hour after the pictures are taken, the stress test can begin. A technician will placesmall disks, called electrodes, on your chest. These are attached to wires (or leads) andconnect to an electrocardiogram (ECG) machine.The doctor supervising your stress test will either ask you to walk on a treadmill, whichwill cause your arteries to open up and deliver more blood, or give you a medicine calledPersantine, which will also cause your arteries to open, but without exercise.Once your heart rate has reached a certain level, the technologist will give you a secondinjection of Tetrofosmin. You will be asked to wait one hour before the final set ofpictures can be taken. If you completed the stress test on a treadmill, you will bepermitted to leave the department to get something to eat during this time. However, ifyou were given Persantine, we strongly recommend that a friend or family memberaccompany you and bring food to you, as we prefer you not leave the department.Once the final set of pictures have been taken, you may go home.How should I prepare?Be sure to ask your doctor about any medication you are taking and whether or not youshould stop taking it before the test. If possible, Beta Blockers should not be taken one totwo days prior to this procedure. Do not discontinue any medication without first talkingto your doctor.• Avoid items that contain caffeine, such as coffee, tea, soda, and chocolate for two days before the test.• Do not eat anything the morning of the test. If you are diabetic, check first with your doctor.• Do not use body creams or powder on your chest prior to the test.• Wear loose-fitting, comfortable clothes and flat, soft-soled shoes, like running shoes.• Please ensure that you bring your Ontario Health Card to your appointment.How long will the test take?This test will take approximately four to five hours. Southlake Regional Health Centre © 2005
    • Is there any pain or risk associated?There are some risks associated, but your doctor will explain these to you before youhave the test. Be assured that a doctor will be present at all times during the test.NOTE: Any woman who is pregnant or thinks she may be pregnant should inform herdoctor before proceeding with this test. Southlake Regional Health Centre © 2005