Non-Invasive Cardiac Tests

Topics on this page:
> Holter Monitor
> Event Monitor
> Electrocardiogram (EKG)
> Echocardiogram (Cardiac Ultrasound)
> Stress Test (Stress EKG) 


24 or 48 Hour Holter Monitor (Ambulatory Monitor)

Holter Monitoring is a continuous recording of your heart rhythm for 24 or 48 hours while you perform normal daily activities.

The purpose of this monitoring is to detect the presence of abnormal heart rhythms, to evaluate the effectiveness of heart medications, to rule out the heart as the cause of your symptoms (dizziness, palpitations, fainting spells), to evaluate pacemaker function, and to determine if the heart is receiving an adequate blood supply.

Procedure:

  • Areas of your chest will be cleansed with an abrasive alcohol pad
  • Several electrodes (adhesive patches) are placed on your chest, attached to wires, and connected to a small, portable recorder

Special Instructions while Wearing Holter Monitor:

  • All wires and electrodes must remain in place for the entire 24 or 48 hour period

  • Do not allow electrodes, wires, or recorder to become wet. Do not take a bath, shower, or swim while wearing monitor

  • Avoid coming into contact with electric blankets, magnets, or metal detectors during monitoring period

  • A diary will be provided for you to record all activities and symptoms. Please include the time of your activities and/or symptoms.

  • Please report to the Cardiology Clinic to have the recorder removed at the time provided by the Holter Technician along with the completed diary.

Your monitor recordings will be scanned by a computer and interpreted by a Cardiologist. A complete report of the Holter Monitor test results will be sent to your physician who ordered the Holter Monitor.

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Event Monitor

Event Monitoring records your heart rhythm for a period of time up to 2 weeks. Recordings are not continuous and are initiated when you press an Event button when you experience symptoms such as dizziness, light–headedness, and/or palpitations.

These recordings are transmitted to a scanning service that provides a summary of events and heart rhythm tracings to the cardiologist for interpretation.

Procedure:

  • Areas of your chest will be cleansed with an abrasive alcohol pad

  • Two electrodes (adhesive patches) are placed on your chest, attached to wires and connected to a small, portable recorder (size of a beeper/pager)

  • Recorder is attached to belt or waistband or can be placed in shirt pocket

Special Instructions while wearing Event Monitor:

  • All wires and electrodes must remain in place when recording symptoms. May be removed for bathing; however, follow instructions provided by EKG Technician when re–attaching electrodes and wires. Do Not allow electrodes, wires, or recorder to become wet.

  • Please return the event monitor, promptly, to the Cardiology Clinic, when notified by the EKG Technician

Your monitor recordings will be interpreted by a Cardiologist, and a complete report of the test results will be sent to your physician who ordered the Event Monitor.

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Electrocardiogram (EKG)

This is the most common cardiac test and measures electrical activity of the heart. Performed to evaluate:

  • heart rate and rhythm

  • patients experiencing chest pain, irregular heart rhythms

  • inadequate blood flow to the heart muscle

  • detects prior heart attacks

  • effectiveness of cardiac medications

  • pacemaker function

Procedure

  • 10 electrodes (adhesive patches) will be applied to your chest, arms, and legs

  • Electrodes are connected to wires attached to an EKG machine

  • Recording is obtained

  • Wires and electrodes are removed

Preparation for Test

None

Time for Testing

15 Minutes

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Echocardiogram (Cardiac Ultrasound)

An Echocardiogram is a non–invasive test that transmits pulses of sound (ultrasound waves) from a transducer (microphone) that produces pictures of your heart on a television type screen. The evaluates:

  • heart murmurs (abnormal heart sounds)

  • size of the heart chambers

  • motion and function of heart chambers

  • heart valve function

  • blood clots or masses in the heart

  • presence of fluid around the heart

  • presence of openings/holes between the chambers of the heart

  • prior injury, damage to heart muscle caused by heart attack

  • presence of congestive heart failure and other cardiac conditions


Types of Echocardiograms:

Transthoracic and Stress

  • M–Mode measures heart chamber size

  • Two Dimensional evaluates shape and motion of heart structures

  • Doppler /Color Flow Doppler assesses blood flow through the heart

  • Contrast uses sonicated albumen or saline to detect for structural heart problems

  • Stress Echocardiography is performed before and after exercise to evaluate tolerance to exercise, heart problems caused by exercise, and detects reduced blood flow to heart muscle during exercise/stress

Procedure:

Transthoracic:

  • Three Electrodes (adhesive patches) are placed on chest by Echo Tech
  • You will be instructed to lie on your back and left side during the test. A water soluble gel is applied to the transducer to transmit pictures over various areas of your chest.

  • Slight pressure may be applied by the transducer to your chest in order to obtain quality pictures, and you may be asked to hold your breath for brief periods of time.

  • Exam room will be darkened to allow Echo Tech better visibility during testing

  • Upon completion of Echo, electrodes are removed, and chest is cleaned of gel

Preparation for Test

None

Time for Test

30 - 45 Minutes

Stress Echocardiography

  • You will be asked to review and sign a consent form for the test

  • Areas of your chest will be cleansed with an abrasive alcohol pad

  • Six Electrodes (adhesive patches) are placed on chest

  • During preparation by CV Technician, a demonstration of walking on the treadmill will be provided for you

  • An echo technician performs a resting Echocardiogram, obtaining pictures of your heart while moving the transducer over various areas of your chest

  • You will be assisted to the treadmill for the stress portion of the test

  • Stress test continues until you need to stop, you reach the target heart rate predicted for you, or until the test is stopped by the Cardiologist

  • You will be assisted back to the exam table for a repeat Echocardiogram

Preparation for Test

  • Nothing to eat or drink 2 ½ hours prior to test

  • Take your current medications, unless otherwise instructed by your Physician

  • Wear comfortable, flat shoes/sneakers and loose–fitting clothing appropriate for exercise

  • Please bring a list of medications you are currently taking

  • No smoking on the day of the test

Time for Test

1 Hour

Test Results

Test will be interpreted by the Cardiologist and report sent to your physician who ordered test.

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Stress Test (Stress EKG)

This is a cardiac diagnostic test to evaluate:

  • Heart function and functional capacity of heart

  • Abnormalities of the heart or heart rhythm during exercise

  • The presence or absence of heart disease

  • The supply of blood to the heart during exercise

  • Symptoms such as chest pain or shortness of breath

Types of Stress Tests:

  • Standard Stress Test (Treadmill)

  • Nuclear Stress Test—Myoview (Treadmill)

  • Nuclear Stress Test—Persantine (Pharmacologic/Medication) 

Procedure:

  • Consent form for Stress test is reviewed and signed

  • You will be instructed by the EKG Tech to remove clothing from waist up and will be provided with a gown

  • Areas of your chest will be cleansed with an abrasive alcohol pad

  • Six electrodes (adhesive patches) are placed on chest, connected to wires, and attached to stress machine

  • EKGs will be performed at rest, sitting, and during hyperventilation

  • Demonstration of walking on the treadmill will be provided by EKG Tech

  • Cardiologist or Physician Assistant will review indication for stress test, your symptoms, and answer any questions you may have regarding the test

  • Baseline Blood Pressure is obtained, and BP cuff remains in place on arm throughout test

  • You will be assisted to the treadmill and exercise begins

  • Treadmill speed and height will increase every three minutes (EKG Tech will inform you prior to treadmill change)

  • The Cardiologist monitors your blood pressure and EKG, continuously.

  • Stress test continues until either you need to stop, you reach the target heart rate predicted for you, or until the test is stopped by the Cardiologist

  • After the test, you will be monitored for several minutes until heart rate, blood pressure, and EKG return to pre–test levels

Preparation for Test:

  • Nothing to eat or drink 2 ½ hours prior to test

  • No smoking on day of test

  • Take your current medications unless instructed by your Physician

  • Wear comfortable, flat shoes/sneakers and loose–fitting clothing appropriate for exercise

  • Please bring a list of medications you are currently taking

Time for Test:

It varies—one hour for standard stress test to half–day for Nuclear stress test.

Test Results:

Test will be interpreted by the Cardiologist and report sent to your physician who ordered test

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Diagrams:
Click images to enlarge
 

Holter Monitor 

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