Welcome to General Patient Education

Table of Contents .... please click on the links below which will take you to the indicated non-invasive test. The test summaries are designed for basic patient education. More in-depth explanations may be obtained from your physician.

1. The Electrocardiogram ECG

2. Treadmill testing Tm

3. Echocardiogram Echo

4. Nuclear Scanning NS

5. Holter Ambulatory Monitoring Holter

6. Tilt Testing Tilt

7. Pacemaker Follow-Up PPM

The more invasive tests (Cadiac Angiogram etc..) are indicated on the scrolling menu on the left of this page.

What is an ECG? Your heart produces its own electricity but the amount is very small. An ECG machine can detect it, amplify it and print it out on a piece of paper. It is simply a painless recording of your heart's electrical activity. This is probably the first test you will have. It is considered the most basic, baseline test that all cardiac patients receive. It provides your doctor with some general information about any abnormalities of the heart rhythm, enlargement of the hear chambes and evidence of heart damage from heart attacks?

How is an ECG done? Up to 10 small electrodes will be placed in specific locations on your arms, legs and around your chest. An ECG machine then records the electrical current that your heart generates while you are laying quietly on the bed. A typical ECG appears below:

What is a stress test? The treadmill exercise or stress test is designed to see how well your heart works when you are actually doing something stressful like exercising. It is used to test whether yu have any evidence of coronary artery narrowings and their severity. It can also give information regarding your level of physical fitness and can be used to try and bring out any heart rhythm disturbances. The physician orders it when he/she wants to know what's your heart's response to exercise will be. Does your heart get better with exercise? Does your heart get worse with exercise? Do you get short of breath? Do you get chest pain? These are a few of the questions that a treadmill test can answer

How is it done?The technician starts by hooking you up to an electrocardiogram machine by attaching electrodes and wires to your body. Tape may be used to help hold the electrodes on your chest so that sweating during the exercise does not cause them to fall off. If you are allergic to adhwsive tape, please let the technician know in advance. Next, a blood pressure cuff is attached to one arm. After a short rest period, you step onto the treadmill and the walk begins. The speed and/or steepness of the treadmill are gradually increased. During the test, the electrocardiogram, heart rate and blood pressure are periodically re-checked. The test continues until you have reached the target set by the physician, you reach the limit of your ability to exercies, develop concerning symptoms or if the physician is concerned about any findings. At the end of the test, you come off the treadmill and quickly lie down in bed while you electrocardiogram, heart rate and blood pressure continue to be checked. Finally, when you have returned to normal, the equipment is removed and you are discharged from the room.

The above example is typical of what an ECG looks like when you are walking/running on a treadmill. Keep in mind that a treadmill test should not be feared. We will only exercise you as far as YOU can go; NOT what we think you should be able to do. This is why we call this test "Symptom Limited". When you get your symptoms, we will stop.

What is an echocardiogram? The echocardiogram is like sonar or radar. We bounce sound waves off your heart and take pictures of those sound waves as they bounce back to the machine. It sounds rather "high-tech" and it is! In the Navy, it takes a lot of training for the technician to be able to distinguish between a submarine and a whale. Similarily, our physicians and technicians undergo a lot of training so they can get great pictures of your heart and its movements. These pictures show us how well the muscle and valves are working and can even assess how blood is flowing through the heart. The sound waves will NOT cause any damage to the heart. A typical picture of an echocardiogram is seen below.

When you enter the room, you will be asked to take off your shirt or top and put on a hospital gown and then lie down on a bed. The technician may sit on the edge of the bed next to you as shown in the picture. He/she places some jelly and a transducer (a hand-held plastic wand) on the chest. The technician will then move the wand over the chest to take the best pictures of the heart from different directions. Sometimes, the technician may have to press rather firmly to improve the quality of the pictures. Please feel free to let the technician know if you feel any discomfort. At the end of the test, the technician will wipe of the jelly and you can get dressed. The technician will not be able to give you much information about the test results. A doctor must look at the entire test first and a report will then be sent to the doctor ordering the test.

The first test MIBI is a test where the technologist will inject you with a small amount of a radioactive tracer and then take pictures of it when it has flowed into your heart. How the tracer is distributed within your heart muscle tell us whether one area of your heart is not getting as much blood supply as another area. This lack of uniform distribution of the tracer is helpful in telling the physician whether you have narrowings in your coronary arteries.

The Wall Motion study involves injecting you with a tracer that grabs onto your red blood cells and circulates throughout your entire blood stream. As the blood is being pumped in and out of your heart, we can take pictures of it and with some fancy computer programs calculate how efficiently your heart is working. The exercise part is done to see how efficiently your heart works when you are doing something stressful.

Both of these tests may be done during exercise. Exercise is the best way the physician can tell how your heart responds to an increase in heart rate. Normally your heart get more efficient when your heart rate goes up. If it doesn't, something may be wrong.

This is basically a tape recorder of the heart rhythm. Many patient come to the hospital complaining of 'palpitations" which is a word used by people to describe the fact that feel there heart beating funny or abnormally. Blackouts are another common reason for doing this test. Unfortunately, like a watched pot that never boils, when you arrive at the hospital, many times the symptoms are not present. Your doctor may suspect that an abnormal heart rhythm is responsible and this test is intended to find out what kind of heart rhythm you are having when you feel your typical symptoms. To find out, you will be asked to wear a special tape recorder for 24 or 48 hours. Hopefully in that time, you will experience the same symptoms and the tape recorder will save them. When you return, the technician will play back the tape in a special machine that reads it and print out the findings. One typical recording is shown below:

The technician will escort you into a private room and ask you to remove your shirt or top. He/she will then prepares the skin by wiping small areas clean with some gauze. He/she will then put some adhesive electrodes onto four or five areas (shoulder, chest) and then snap wires to connect to these electrodes. These wires then hook to a small tape recorder box that is within a cloth carrying bag so that you can wear it around your neck for the duration of the test. If you are asked to wear the tape recorder for more than 2 days, the technician will teach you how to change batteries or tapes for the recorder. You will then get dressed and leave the room. During the time that you wear the recorder, you will also carry a diary. Please write down your activities, any symptoms and the time of day that you feel them in the diary. Please be careful not to get the recorder wet. You will not be able to shower while you wear this recorder. The test is usually quite painless. However, wearing a tape recorder for a couple of days may be slightly annoying to some and those with sensitive skin may develop a slight rash to the tape adhesive. Please let the technician know if you have an allergy or skin sensititvity to tape adhesive.

Tilt testing is one test that we can perform to try to find out why you have fainted. One reason for fainting may be that your nervous system does not react quickly enough to changes in posture. When this happens, your blood pressure may drop rather quickly causing you to faint. This is usually only a temporary situation but rather upsetting when you wake up with a cut on your forehead.