Exercise Stress Test

Why is an exercise test sometimes needed for assessing a valve problem?

Also called a stress test or treadmill test, exercise testing can provide valuable information in patients with valvular heart disease, especially in those whose symptoms may be difficult to assess. It has a proven track record of safety, even among symptomatic patients with severe aortic stenosis. Your healthcare provider may use an exercise test in combination with echocardiography, an angiogram and cardiac catheterization.

Exercise testing helps evaluate changes in blood pressure, changes in symptoms, and the heart’s response to a more challenging workload. If you have a heart murmur, your healthcare provider will take note of any changes in the murmur that happen during exercise. Read more about exercise testing.

What the test does:

• Helps find the cause of unexplained chest pain or shortness of breath
• Checks for signs of diseases that affect the walls and chambers of the heart
• Finds out how well your heart is pumping blood
• Regularly checks to see how your heart valves are working if you have a valve disease or you have an artificial valve

How to prepare:

• Please do not eat for at least 2 hours before the test
• Wear loose-fitting, comfortable, two-piece clothing, such as a jogging or warm-up suit. Wear comfortable shoes. Tennis, walking, or running shoes are best.
• You may need to alter or stop some of your medications, especially beta blockers, before the test. Please discuss this with your physician at least 48 hours in advance of the test.
• Please refrain from taking medicines for erectile dysfunction, such as Viagra, Levitra, and Cialis, within 48 hours before the test. If you take one of these medicines for other reasons, such as pulmonary hypertension, please discuss with your physician.
• You should plan for the test to take about an hour. This should include enough time for the test to be done and for undressing and redressing.
• If you cannot keep your appointment, please give us 24 hours notice.

What is an exercise stress test?

Stress testing is a test that exerts the heart to determine how strong it is and whether it has any irregular heartbeats or blockages in the coronary arteries. Stress testing can be done using different methods depending on your physical capacity and medical history.

An exercise stress test, also known as a treadmill test, helps your doctor assess how well your heart responds to stress. It involves walking on a treadmill while your electrocardiogram, blood pressure and heart rate are being monitored. Depending on your medical indication, an ultrasound of the heart may also be done immediately following the completion of the exercise stress test in order to obtain images of your heart immediately after stress.

How do I prepare?

• Tell your doctor about any medicines (including over-the-counter, herbs and vitamins) you take. He or she may ask you not to take them before the test. May continue all other medications, unless instructed otherwise.
• Do not eat, drink or smoke for two hours before the test.
• Wear comfortable, loose-fitting clothing and walking shoes with rubber soles. Shorts or sweatpants and jogging or tennis shoes are good choices.
• You may need to alter or stop some of your medications, especially beta blockers, before the test. Please discuss this with your physician at least 48 hours in advance of the test.
• Please refrain from taking medicines for erectile dysfunction, such as Viagra, Levitra, and Cialis, within 48 hours before the test. If you take one of these medicines for other reasons, such as pulmonary hypertension, please discuss with your physician.

• You should plan for the test to take about an hour. This should include enough time for the test to be done and for undressing and redressing.

• We will provide you with instructions once your test is scheduled.
• If you cannot keep your appointment, please give us 24 hours notice.

Holter Monitoring

Arrhythmia is a condition where the heart beats too slow, too fast or irregularly. We offer various tests to look for heart rhythm disorder.

What is a Holter Monitor test?

A Holter monitor is a test that will record the electrical activities of your heart for 24 hours or more. During the duration of the test, you are allowed to continue with your usual activities including walking, eating, sleeping, etc.

How do I prepare?

Please shower before the test and wear loose clothing, preferably two pieces, the day of your test. This test is simple and noninvasive. It generally will not include any complications or require any recovery time.

Event monitors are small, portable electrocardiogram devices that record your heart’s electrical activity for long periods of time while you do your normal activities. These monitors can record how fast your heart is beating, whether the rhythm of your heartbeats is steady or irregular, and the strength and timing of the electrical impulses passing through each part of your heart. Information from these recordings helps doctors diagnose an arrhythmia, or irregular heartbeat, and check whether treatments for the irregular heartbeat are working.

There are many types of monitors, such as episodic monitors, autodetect recorders, 30-day event recorders, and transtelephonic event monitors. Your doctor will decide which monitor is best for you. Most monitors have electrodes with sticky adhesive patches that attach to the skin on your chest. Some monitors and electrodes used for long-term recording may be implanted under your skin to make it easier for you to bathe and perform your daily activities. Your doctor will explain how to wear and use the monitor and tell you whether you need to adjust your activity during the testing period. You should avoid magnets, metal detectors, microwave ovens, electric blankets, electric toothbrushes, and electric razors while using your monitor. Usually, you will be instructed to keep electronic devices such as cell phones, MP3 players, and tablets away from the monitor. After you are finished using the monitor, you will return it to your doctor’s office or the place where you picked it up. If you were using an implantable recorder, your doctor will remove it from your chest.

Also known as ambulatory EKG; continuous EKG; EKG event monitors.

What the test does?

An electrocardiogram (ECG or EKG) is one of the simplest and fastest procedures used to evaluate the heart. Electrodes (small, plastic patches) are placed at certain locations on the chest, arms, and legs. When the electrodes are connected to an ECG machine by lead wires, the electrical activity of the heart is measured, interpreted, and printed out for the doctor's information and further interpretation.

A signal-averaged electrocardiogram is a more detailed type of ECG. During this procedure, multiple ECG tracings are obtained over a period of approximately 20 minutes evaluating several hundred cardiac cycles to detect subtle abnormalities that increase risk for cardiac arrhythmias. These subtle abnormalities are usually not detected on a plain ECG. A computer captures all the electrical signals from the heart and averages them to provide the doctor more detail regarding how the heart’s electrical conduction system is working.

Signal-averaged ECG is one of several procedures used to assess the potential for dysrhythmias or arrhythmias (irregular heart rhythms) in certain medical situations.

Why have the procedure?

Reasons your doctor may request a signal-averaged ECG may include, but are not limited to, the following:

• To assess risk for potentially fatal heart arrhythmias in patients with known heart disease including coronary artery disease, heart failure, or after a heart attack
• To evaluate other signs and symptoms which may be heart-related, such as fatigue, shortness of breath, dizziness, or fainting
• To help identify irregularities in heartbeats that can lead to sudden cardiac death in patients at risk, such as those with hypertrophic cardiomyopathy (an abnormal thickening of heart muscle)
• For further evaluation of dysrhythmias or arrhythmias noted on resting ECG

There may be other reasons for your doctor to recommend a signal-averaged ECG.

How do I prepare?

• Office personal will explain the procedure to you and you can ask any questions that you might have about the procedure.
• You will not usually have to fast before the procedure.
• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor if you have a pacemaker.
• Based on your specific medical condition, your doctor may request additional preparations.

What is a pacemaker?

A pacemaker is a small-battery operated device that helps your heart beat regularly. Some pacemakers are surgically implanted and permanent. Other pacemakers are external and temporary.

What is an Implantable Cardioverter Defibrillator (ICD)?

An implantable cardioverter defibrillator (ICD) is a small-battery operated device that provides an electric shock to your heart to stop any life-threatening arrhythmia.

How do I prepare?

• We will provide you with instructions once your test is scheduled.
• If you cannot keep your appointment, please give us 24 hours notice.

Your doctor will work with you to understand your risk and then recommend the most suitable approach, including the advantages and disadvantages of treatment with statins. Factors to consider with your doctor include a family history of premature heart attack or stroke and an LDL cholesterol level of 160 mg/dL or higher. Your doctor may also suggest a high sensitivity C reactive protein inflammation test or a coronary artery calcium score, which can help determine your risk.

DAY-TO-DAY CHOICES MATTER

A healthy diet and exercise are vital to fend off high cholesterol and heart disease. Risk reduction begins with knowing your lifestyle habits.

Get active, eat better, lose weight, stop smoking, control cholesterol, manage blood pressure and reduce blood sugar.

Know your numbers, but treat your risk

A constellation of "numbers" is used to determine one’s personal risk of heart attack and stroke. The American Heart Association recommends that everyone know where they stand with the following four measurements. Ideal numbers for most adults are:

•     Total cholesterol of less than 180 mg/dL
•     Body mass index (BMI) of less than 25 kg/m2
•     Blood pressure of less than 120/80 mm/Hg
•     Fasting blood sugar of less than 100 mg/dL

High cholesterol may cause serious heart disease to develop. It’s important to have your cholesterol levels monitored because, in most cases, high cholesterol doesn’t have any symptoms.

What is this test?

A cardiac perfusion scan measures the amount of blood in your heart muscle at rest and during exercise. It is often done to find out what may be causing chest pain. It may be done after a heart attack to see if areas of the heart are not getting enough blood or to find out how much heart muscle has been damaged from the heart attack.

What is the procedure?

During the scan, a camera takes pictures of the heart after a special test medicine (radioactive tracer) is given through an IV. The tracer travels through the blood and into the heart muscle. As the tracer moves through the heart muscle, areas that have good blood flow absorb the tracer. Areas that do not absorb tracer may not be getting enough blood or may have been damaged by a heart attack.

Two sets of pictures may be made during a cardiac perfusion scan. One set is taken while you are resting. Another set is taken after your heart has been stressed, either by exercise or after you have been given a medicine. The resting pictures are then compared with the stress images.

This test is also known by other names including myocardial perfusion scan, myocardial perfusion imaging, thallium scan, sestamibi cardiac scan, and nuclear stress test.