Baylor Scott & White Cardiology Consultants of Texas

Cardiac catheterization

Cardiac catheterization provides more accurate and detailed information about how well your heart is working than other diagnostic tests. It helps doctors diagnose your problem accurately, and it lets them choose the best treatment for you.

What is cardiac catheterization?

During cardiac catheterization, doctors insert a long, thin, flexible tube, called a catheter, into the body. The catheter is inserted into a blood vessel and is guided toward the heart.  The procedure allows doctors to study how well your heart pumps blood and to examine the coronary arteries (the vessels that supply blood to the heart muscle) and the heart valves.  Other terms used to describe cardiac catheterization include coronary angiography, angiogram, cardiac cath, and heart cath. 

Why perform a cardiac catheterization

This test provides the most accurate and detailed information about how your heart is working.

In general, cardiac catheterization is done for one or more of the following reasons:

• Evaluate or confirm coronary heart disease (for example, in patients with chest pain and/or an abnormal stress test
• Determine whether treatment (with balloon angioplasty or bypass surgery) can help a patient diagnosed with coronary heart disease
• See how well blood flows through the coronary arteries after angioplasty or bypass surgery
• Determine if there is significant heart valve disease that might require surgery
• Determine whether there is a congenital heart defect and evaluate how severe it is

Preparing for catheterization

Unless you are already in the hospital, you will most likely be asked to arrive in the morning on the day of your catheterization.  You may have several routine tests, such as an ECG, X-rays, and blood tests. (These tests may be done a few days before the procedure.)  The doctor will review your medical history and examine you. (You may see the doctor at the office several days before the procedure.)  The doctor or nurse will talk with you about the procedure and its purpose, benefits, and risks.  This is a good time to ask questions and, most important, to share any concerns you may have.  You will then be asked to sign a consent form.  A nurse will shave and cleanse the area where the catheters will be inserted.  This is usually at the groin (the fold between the thigh and abdomen).  In some cases, it may be at the wrist or arm.  Shaving and cleansing make it easier to insert the catheters and help to prevent infection.  An intravenous (IV) line will be inserted into a vein in your arm.  This line allows drugs to be injected directly into the vein, if they are needed.  To help you relax, you will be given a sedative.  If you wear dentures, hearing aids, or glasses, you will most likely be allowed to keep them on.

Before your catheterization

Generally, you will be asked not to eat or drink anything for 6 to 8 hours before the procedure.  This helps prevent nausea.  You may have small sips of water to take your medications.  Check with your doctor several days before the procedure.  You may be asked to stop some medications (such as aspirin or anticoagulants) for a few days before your catheterization.  Make arrangements with a friend or family member to drive you to and from the hospital.  You will not be permitted to drive home after the procedure, since you may be sedated.  Pack a small bag in case your doctor decides to keep you in the hospital overnight.  You may want to include a robe, slippers, pajamas or nightgown, and toiletries.  Bring a list of the names and dosages of all the medications you are taking. Tell the doctor or nurse if you have had any allergic reactions to medications or X-ray dye (contrast), iodine or seafood, or if you have a history of bleeding problems.  For your comfort, empty your bladder as much as possible before the procedure begins.  There will also be a bedpan or a urinal, should you need it during the procedure. 

During cardiac catheterization

Cardiac catheterization is performed in a specially equipped X-ray room called a cardiac catheterization laboratory, or simply, cath lab.  You will be taken to the cath lab in a wheelchair or on a movable bed.  Then you will be helped onto an X-ray table.  The table has a large X-ray camera above it and television screens close by.  There also are heart monitors and other instruments.  The cath lab team generally includes a cardiologist, an assistant, nurses, and technologists.  Once you are positioned on the X-ray table, you will be connected to several monitors and then covered with sterile sheets.  The staff will be wearing sterile gowns, gloves, and possibly masks. 

What happens during the procedure

The site where the catheters will be inserted is usually in the groin. Sometimes it is in the wrist or arm. The site is cleansed thoroughly. A local anesthetic is injected into the skin with a tiny needle to numb the area. This may cause a stinging sensation.  A small incision is made in the skin, and a needle is used to puncture the blood vessel (usually an artery).  A guidewire (a soft and flexible wire) is threaded into the artery.  A short plastic tube, called a sheath, is then slipped over the guidewire and into the artery.  The guidewire is then removed.  Once the sheath is in place, doctors can insert and remove several different catheters without having to use a needle each time.  The catheter is inserted into the artery and guided toward the heart, while the staff watches its progress on a television screen.  The catheter may be removed and replaced several times.  This is done to reach each of the heart chambers or coronary arteries.  Once the catheter is inside the heart, the doctors can measure the pressures in the left ventricle (the main pumping chamber) and take pictures of the coronary arteries and left ventricle.  If you are also having a right-heart catheterization, a special catheter is inserted into a vein and is guided to the right side of the heart.  This is usually done to measure the pressures inside the right heart chambers and in the lungs, especially in people who have a weakened heart. 

What you can expect

You will be given medication to help you relax and make you drowsy. You may be awake, or you may sleep through part or all of the procedure.  The staff will be monitoring you at all times.  You may be asked to take a deep breath and hold it, to keep the pictures from blurring.  You may also be asked to cough forcefully several times, to help move the dye through the heart.  The procedure generally is not painful, although you may feel some pressure as the catheters are inserted.  You will not feel the catheters as they move through the blood vessels and into your heart.  For many, the most difficult part of the procedure is having to lie still for a long time on a hard table.  As X-ray contrast is injected into the heart, you may feel a warm sensation ("hot flash") through your body, lasting for 20 to 30 seconds.  You may also feel nausea, chest discomfort, or a mild headache.  A complete cardiac catheterization procedure usually takes from one to two hours. If you feel pain or discomfort at any time during the procedure, let the staff know.

What does catheterization show? 

Cardiac catheterization allows doctors to measure the pressures inside the heart, study how well the heart is pumping blood, and take pictures of the coronary arteries and the heart chambers.

Cardiac rehabilitation

Cardiac rehabilitation is a series of educational classes for you and your family on diet and nutrition, heart risk factors, stress management, exercise, and heart disease. Support group sessions may also be offered for patients and family members to help cope with heart disease. Cardiac rehabilitation includes exercise sessions for heart patients and is monitored by doctors, nurses, and/or exercise specialists. 

Before starting the cardiac rehabilitation program

• Most programs require a written order from your physician before you can join.
• Many insurance companies cover all or part of cardiac rehabilitation. It is the patient's responsibility to contact his or her insurance company to get pre-approval before actually starting cardiac rehabilitation. Your physician's office staff can help you with questions about this approval process.
• If you or your insurance company needs additional information about a specific cardiac rehabilitation program, call that program's main number and ask for information to be sent to your insurance company. Many programs have a standard packet that helps the insurance companies and patients better understand the components of their program.
• Try to get a friend, family member, or significant other to attend the program with you. By joining a cardiac rehabilitation program, you have the opportunity to learn more about your heart condition as well as learn ways to help you make educated decisions about food choices, exercise, and stress. Having a partner to share the experience may give you additional support and companionship. We have learned in cardiac rehabilitation that often times loved ones have their own fears and concerns about your heart condition. Our program may help them as well.
• Try to start cardiac rehabilitation as soon as your doctor says it is okay. This way you will have faster access to education and support about your condition. Also, many insurance companies have time limits on their coverage for cardiac rehabilitation after a heart event. 

During the exercise program

The Baylor cardiac rehabilitation programs offer exercise classes on Monday, Wednesday and Friday. Education programs are offered at different times during the day to accommodate your schedule. Education and exercise sessions may vary from program to program. Contact the cardiac rehabilitation department of your choice for information. 

• The staff will need information about your heart condition. You may be asked a number of questions about your health and lifestyle.
• cardiac rehabilitation programs individualize the exercise prescriptions for the patient. Because each patient has different needs and types of illness or disease, you may be exercising on various pieces of equipment at individual intensities.
• The staff will help you set goals for your exercise and educational classes. Your vital signs will be monitored at various times during the exercise sessions. Any symptoms you have may be noted.
• Your doctor may receive reports throughout the program on your progress and your attendance in educational sessions. Many insurance companies require these progress reports. Many programs will take care of this paperwork for you. 

After the cardiac rehabilitation program

• You may graduate from the program when you meet your goals, need to return to work, or feel you have obtained maximum benefit from the program. This graduation time differs from patient to patient. Many insurance companies cover up to 12 weeks of cardiac rehabilitation; however, your doctor may request a shorter program for you.
• Because cardiac rehabilitation is a program that educates you to possible changes in lifestyle and physical fitness, many programs and physicians recommend continuing your exercise program either at home or in a fitness center. Some fitness centers may offer discounts for people who have just graduated from cardiac rehabilitation programs.
• If you are participating in cardiac rehabilitation in a Baylor Scott & White Health program, your doctor will receive a summary report of your activities and educational sessions after your graduation.
• If you would like more information on cardiac rehabilitation in the Baylor Scott & White Health, please call 1.844.BSW.DOCS (1.844.279.3627).

Cardioversion

Cardioversion is a procedure designed to restore normal heart rhythm.  Elective non-emergent cardioversion is performed by your physician and nursing staff in your room.  Heart irregularities, such as atrial fibrillation or atrial flutter, may be converted to a normal heart rhythm (normal sinus rhythm). 

Before the procedure

• You will be asked to sign a consent form after your doctor has explained the procedure and the risks to you.
• Please do not eat or drink after midnight before the procedure.
• Staff will enter your room with an equipment cart and monitor.
• You will be connected to the monitor with pads placed on your chest and back.
• An intravenous catheter (IV catheter) will be placed in your hand or arm. The medicine given during the procedure will be given through this catheter. 

During the procedure

• Oxygen will be given to you by facemask.
• After connecting you to a heart monitor, some medication will be given through your IV catheter. You may feel some burning in your arm and may briefly fall asleep. You may not remember the procedure.
• An electrical impulse is administered through the two pads placed on your chest and back. This impulse may restore your heart to a normal sinus rhythm. 

After the procedure

• Some short-term drowsiness may occur and you may notice some redness on your chest.
• The nursing staff monitors your vital signs until you are fully awake.
• You will be instructed when to take your medicines, eat, and get out of bed.
• Depending upon your overall condition you may go home later the same day.

Carotid scan

A sonogram is a test that sends high-pitched sound waves through your skin, and the echoes form a picture on a TV monitor.  This test measures blood flow through your arteries. It is useful for locating blockages. This test is non-invasive (there is no penetration of the skin by needles, etc.).

Before the procedure

There are no special preparations for this test.  You will be taken to the Vascular Lab in a wheelchair or by stretcher.

During the procedure

If you go by wheelchair, you will then lie on a bed in an exam room for the test. There will be a short wait while the Vascular lab technician reviews your chart.  A water-based gel is used to keep contact with the skin. The sound waves then produce a visual and sound image on a monitor.

While the technician does the test, he/she may be making a video tape for your physician to watch. The technician will be talking into the machine telling your physician what the test shows about your vascular system. You may hear your heartbeat and/or a whooshing sound as your blood flows.

After the procedure

After a brief wait, you will be taken back to your room by wheelchair or stretcher.  Your physician will explain the results of the tests after he/she views the video.

Coronary angiogram

The arteries around your heart that supply blood to the heart muscle are called coronary arteries. Sometimes these arteries are narrowed or blocked. A cardiac catheterization is a test that is done to look at these arteries and to look inside your heart. You will be taken to the Cardiac Cath Lab. A small catheter will be inserted into your heart through an artery or a vein. Dye will be injected to allow the doctor to see the blood flow in your heart and coronary arteries, and X-rays pictures will be taken.

Before the procedure

A few basic ideas of what to expect before, during and after the procedure may decrease some anxiety over your hospitalization.

• You will be asked to sign consent forms after your doctor has explained the procedure, and its risks.
• Most patients are told not to eat or drink anything after midnight. Please ask your nurse.
• One or both of your groins will be shaved.
• You will need to empty your bladder and wear only a hospital gown.
• Tell the doctor or nurse if you are allergic to shellfish, iodine, X-ray dye or any medications.
• You may be given some medications to help you relax; you will not be put to sleep, but you may become very drowsy.
• You will be taken to the Cardiac Cath Lab.

During the procedure

• You will be lying on a hard table, surrounded by X-ray equipment.  There will be patches on your chest that will have wires connected, which go to a machine that monitors your heart.
• The equipment is sensitive to heat the room is kept cool - around 68 degrees Fahrenheit.
• A local anesthetic (numbing medication) will be applied to the groin area.
• The doctor will insert a small tube under the skin and into the vessel, much like an IV is started.
• An X-ray dye is injected which may cause a "hot feeling." You may be asked to follow simple commands to help your doctor with the procedure such as "cough", or "take a deep breath and hold it."
• Inform your doctor how you are feeling, or if you have chest discomfort, nausea, shortness of breath.
• The length of the procedure depends on a number of factors. An hour is typical. If it takes longer, that does not necessarily mean there is a problem.
• Your heart rate and blood pressure will be watched closely.

After the procedure

• You may have one or two IV lines left in your groin for several hours or overnight.  You must stay in bed and not bend the leg to prevent bleeding.
• When the IV's are removed, a C-clamp (a mechanical device) will be used to apply pressure to your groin for at least one hour.
• It will be several hours before you can get out of bed to prevent any bleeding at the insertion site.
• Please feel free to ask questions about this procedure, we want you to feel as comfortable as possible about your cardiac catheterization.

Dobutamine echocardiogram

Dobutamine echocardiogram measures your heart's tolerance to work and the heart wall movement when it is working very hard. This is a stress test of the heart using the medicine dobutamine to make it beat faster and harder. An echocardiogram is performed during the test. Your heart rate is measured by an electrocardiogram (ECG), and your blood pressure is taken while you are being given the medicine.

Before the test

• You will be asked to sign a consent form after your doctor has explained the procedure and its risks to you.
• You may be asked to refrain from eating or drinking (except water) for three hours before the test. Some foods may affect the test results. You should refrain from tobacco usage (cigarettes, chewing tobacco) for three hours before this test.
• If you are being tested as an outpatient, please bring a list of your medications or the prescription bottles with you. If you are unsure whether to take your medications, please consult your doctor.
• Please avoid using body lotion or body powder on your chest the day of the test. Lotions and powders interrupt the signals the monitor is picking up from your heart.

During the test

• You will need to undress from the waist up; women will be given a hospital gown or a blanket with which to cover.
• A staff member will place electrodes on your chest to monitor your heart rate. The skin may need to be lightly scraped and chest hair shaved on men to obtain clear test results.
• Blood pressure cuffs will be used during this test. If your doctor has asked you to avoid using a blood pressure cuff on one or both arms, please inform the staff about this when you are getting prepared for the test.
• A small intravenous catheter (IV catheter) will be placed in your hand or arm.
  The medicine given during the test will be given through this catheter. If you are an Inpatient and already have a catheter in your hand or arm, the staff nurse may first try to use this IV site.
• You will first receive a resting echocardiogram. A trained technician will place a small instrument called a probe on the outside of your chest to obtain an image of your heart and its blood flow.
• You will be asked to lie on your left side for the echo portion of the test. The technologist may ask you to change positions periodically.
• You may hear a loud "whooshing" sound during the test. This sound occurs when the technologist is recording your blood flow.
• Once this information is collected, the nurse or staff member will give you dobutamine, a medicine that quickens your heartbeat and increases your blood pressure. Lie quietly while this medicine is being given; however, if you have any discomfort or pain or shortness of breath, please let the staff know immediately. Sometimes this medicine can cause nausea. If you begin to feel bad, please tell the staff. Other medicines may be given to help you with symptoms or to assist doctors in obtaining additional information.
• Once the medicine is given, the technologist will perform another echo ultrasound procedure with you lying on your side. This study usually takes only 15 - 20 minutes; once the medicine is stopped, your heart rate and blood pressure should gradually slow down. Your heart rate and blood pressure will be monitored during this time.

Immediately after the test

• When the technologist has collected all the necessary data, the electrodes will be removed and you may get dressed.
• Depending on your doctor's request, the catheter may be removed by a nurse or technologist from the arm or hand. Light pressure will be applied to the site to decrease any bleeding. If you are on medications that keep your blood from clotting, please tell the nurse so that pressure can be held a little longer.
• You will probably feel tired after the test. You should avoid heavy exercise or physical work for the reminder of the day. If you have any symptoms or discomfort after you have left the Heart Center, you should contact your doctor immediately.
• Your test results will be sent to your doctor, who will explain them to you.

Echocardiogram

Similar to the sonograms used during pregnancy, an echocardiogram uses a transducer that is gently moved across the chest. The transducer emits sound waves that are converted into moving images of the heart. These images are displayed on a screen and can be recorded. This test allows our doctors to learn how the heart functions at rest. It provides valuable information about the structure, size, and how well your heart is pumping.

Before the test

• You should allow one hour, which includes preparation and the imaging portion.
• Wear comfortable attire, as you will be lying on an exam table, while the sonographer obtains your images.
• There are no dietary restrictions for this test.
• Bring your medications in their original containers with you to the test, so we may obtain an accurate list.

During the test

• You will be asked to lie on an examination table. To improve the quality of the pictures, a colorless gel is applied to the area of the chest where the transducer will be placed.
• We will apply electrodes (small sticky patches) to your chest, so we can record the electrical activity of your heart. This is called an EKG.
• The sonographer moves the transducer to various places over the left side of your chest. Pictures of your heart at rest are recorded.

Immediately after the test

• A written report will be sent to your referring physician.
• Information gained from this test helps your doctor make an accurate diagnosis and develop a treatment plan that is best for you.

Electrocardiogram

An electrocardiogram or ECG is a graphic record of the electrical impulses of the heart. These impulses are conducted to the external surface of the body where they are detected by electrodes. It is important to realize that the ECG does not depict the actual physical state of the heart, or its function, but rather the electrical activity. These impulses (or your heart rate) are normally discharged 60 to 100 times per minute.

Before the test

• There are no dietary restrictions prior to this test.
• Please bring all of your current medications with you, or provide us with an accurate list. Include dosage and number of times you take medication in a day. Certain cardiac medications can slow the heart rate, and it will be helpful to know if you are on any of this medication. In contrast, certain cold and sinus medicine can increase your heart rate, and this information will be valuable to your physician.
• Do not wear a one-piece jumpsuit, as you will be asked to undress from the waist up. Women will be provided a half gown, or cape to wear.

During the test

• A trained medical assistant (or nurse) will place several electrodes (small sticky patches) on your chest. Men may need to have areas of their chest shaved, to ensure that the electrodes stay in place.
• The electrodes are connected by wires to an ECG machine.

After the test

• Immediately after the test, the physician can give you a complete interpretation.
• If the test is abnormal or inconclusive, you doctor may order additional tests.

Electrophysiology study

The purpose of an Electrophysiology Study is to review the electrical system of the heart so the physician will know best how to treat you. The heart has an electrical system that controls how your heart beats. When this electrical system is working properly, the heart usually beats between 60 and 100 times per minute. The electrical impulse travels a pathway from the top of the heart to the bottom of the heart. Sometimes, the electrical system is not following a normal pathway, and the heart may beat too rapidly or too slowly. When this happens, the heart may not be able to pump adequate amounts of blood to your body.

Before the test

• You may be asked to stop taking any medicines that affect your heart.
• Your heart will be monitored prior to the procedure.
• You will be asked to sign consent forms after your doctor has answered all of your questions.
• Most patients are not allowed to eat or drink after midnight prior to the procedure. Ask your nurse.
• You will be asked to empty your bladder prior to the procedure and to wear only a hospital gown.
• You may be given some medicine to help you relax before the procedure.
• You will be taken to the cardiac cath lab by wheelchair or stretcher.

During the test

• You will be lying on a padded flat table. Your heart will be monitored, and X-ray equipment will be around you. The equipment is sensitive to heat so therefore, the room is kept cold.
• A numbing medicine (local anesthetic) will be injected into your groin area and a small catheter (tube) will be inserted into the vein in your groin.
• Small wires will be guided into your heart through the catheters in the groin. X-ray equipment will be used to tell if the wires are in the correct position in your heart.
• The doctor will use the wires to attempt to determine what is wrong with the electrical system in your heart.
• Inform your doctor how you are feeling during the procedure.

Immediately after the test

• The catheter in your groin may be removed before you return to your room, or it may remain in place for a short time. When this catheter is removed, a bandage will be applied and the site will be checked. You will be ordered to stay on bed rest for several hours after the procedure.
• The doctor will talk to you about the results of the study and any necessary treatment plan.

Exercise echocardiogram (stress echo)

An exercise echocardiogram (also known as a stress echo) is a test that combines an ultrasound study of the heart with an exercise test.  The test allows the doctor to learn how the heart functions when it has to work harder. This test is useful in diagnosing heart problems, such as coronary artery disease (blockages in the coronary arteries).

Before the test

• You should allow an hour to an hour and a half for this test.
• Wear or bring comfortable attire and walking/running shoes.
• Refrain from eating at least two hours before the test. This will prevent the possibility of nausea, which may accompany vigorous exercise after eating.
• Make your last meal light and without tea, coffee or alcohol.
• If you are currently taking any heart medication, check with your CCT doctor. He or she may ask you to stop certain medications a day or two before the test. This may help obtain more accurate tests results.
• Before the test, you will be given an explanation of the test and you will be asked to sign a consent form. Feel free to ask any questions about the procedure.
• Several areas on your chest and shoulders will be cleansed with alcohol and an abrasive pad will be used to prepare the skin for the electrodes (small sticky patches). Men may need to have areas of their chest shaved, to ensure that the electrodes stay in place.

During the test

• The test is divided into three parts. First, a resting echocardiogram is performed. Next, you will walk on a treadmill, and then another echocardiogram is performed while your heart is still beating rapidly after exercise.
• Resting echocardiogram - You will be asked to lie on an exam table. To improve the quality of the pictures, a colorless gel is applied to the area of the chest where the transducer will be placed. Pictures of your heart are recorded on videotape.
• Exercise test - You will walk slowly in place on a treadmill, on which the speed is increased to a faster pace and is then tilted to produce the effect of going up a small hill. The doctor will stop the test when you reach your peak heart rate, when you get too tired, or have significant symptoms.
• After exercise echocardiogram - You will be asked to very rapidly return to the examining table, and lie once again on your left side. The sonographer will then record a second set of images while your heart is still beating rapidly. The CCT doctor can then compare the two sets of images. This will be before and after exercise side by side to see how your heart responds to the stress of exercise.

After the test

• The doctor conducting the test can give you results before you leave. A complete interpretation will be sent to your referring physician.
• If the test is abnormal or inconclusive, then additional tests may be ordered.
• The information gained from the stress echo helps your doctor make an accurate diagnosis and develop a treatment plan that is best for you.

Exercise stress test

This test, typically involving the patient walking on a treadmill while attached to an electrocardiogram, measures a patient's ability to exercise and the electrical waves of the heart during exercise. This test can help detect heart problems that may not be apparent at rest.

Before the test

• You should allow one hour, which includes preparation for the test, the exercise portion, and the recovery period.
• Wear or bring comfortable attire and walking/running shoes.
• Refrain from eating at least two hours before the test. This will prevent the possibility of nausea, which may accompany vigorous exercise after eating.
• Make your last meal light and without tea, coffee or alcohol.
• If you are currently taking any heart meditation, check with you Baylor Scott & White Cardiology Consultants of Texas doctor. He or she may ask you to stop certain medications a day or two before the test. This can help-get more accurate test results.
• Before the test, you will be given an explanation of the test and you will be asked to sign a consent form. Feel free to ask any questions about the procedure.
• Several areas on your chest and shoulders will be cleansed with alcohol and an abrasive pad will be used to prepare the skin for the electrodes (small sticky patch). Men may need to have areas of their chest shaved, to ensure that the electrodes stay in place.

After the test

• After the exercise portion of the test is over, you will still be monitored for another 5 to 10 minutes while you recover. The medical assistant or nurse will remove the electrodes and cleanse the electrode sites.
• The doctor conducting the test can give you results before you leave. A complete interpretation will be sent to your referring physician.
• If the test is abnormal or inconclusive, then additional tests may be ordered.
• The information gained from the exercise test helps your doctor make an accurate diagnosis and develop a treatment plan that is best for you.

Exercise thallium

A thallium scan is a test that uses a radioactive substance (known as a tracer) to produce images of the heart muscle. When combined with an exercise test, the thallium scan helps determine if areas of the heart do not receive enough blood.

Purpose

The exercise thallium test is especially useful in diagnosing coronary artery disease, the presence of blockages in the coronary arteries. These arteries supply oxygen to the heart muscle. Tracers, other than thallium, can be used for this type of scan. Your Baylor Scott & White Cardiology Consultants of Texas doctor will decide if your situation warrants a different type of tracer.

Before the test

If you are nursing or if you think you may be pregnant, inform the BSW Cardiology Consultants of Texas doctor or nuclear tech before the examination.

• You will receive an instruction sheet that pertains to the specific type of tracer your physician plans to use. If you have any questions, please ask your doctor or the nuclear technician.
• You may be asked to fast (not eat or drink anything) for three to four hours or longer prior to your exam. If you cannot fast, or are diabetic, ask your BSW Cardiology Consultants of Texas doctor or nurse for special instructions.
• You will be instructed not to have food or drink prior to the test that contains caffeine. For example, coffee, tea, colas (even "caffeine-free"), and chocolate foods all contain different amounts of caffeine.
• Be sure to notify our office nurse or nuclear tech of all the medicines you are taking. Some medicines may affect the test results.
• Wear loose, comfortable clothing that is suitable for exercise. You should also wear comfortable walking shoes or tennis shoes.
• Before the test, you will be given an explanation of the test and you will be asked to sign a consent form. Feel free to ask any questions about the procedure.

During the test

• The test has two parts: the exercise imaging portion and the rest imaging portion.
• Several electrodes (small sticky patches) will be placed on your chest to obtain an electrocardiogram (ECG). This will record your heart's electrical activity.
• An intravenous (IV) line will be started in a vein in your arm. This will allow injection of the radioactive tracer during exercise.
• Depending on the type of exam that is ordered, you will be exercising several minutes on a treadmill. If you cannot walk on a treadmill, then a prescribed medication will be injected over several minute periods. In either case, the purpose is to increase the workload being placed on your heart.
• You will be instructed to report any symptoms, such as chest pain, shortness of breath, or dizziness. Try to exercise for as long as you are able to, as this will increase the accuracy of the test.
• Tell the nuclear technician when you are almost to the point when you can no longer exercise. At this point, the tracer will be injected into the intravenous line. You will be asked to continue to exercise for another minute or so after the injection.
• Imaging portion: You will then lie flat on a special table under a scanning camera. Several pictures of the heart will be taken at various angles. You should remain still while the pictures are being taken. This part can take up to 20 minutes.
• After this initial set of pictures, you will be asked to return in 2 to 4 hours to have additional pictures taken without repeating the exercise. These images are compared to the images obtained during the first part of the test. The technician will give you specific instructions regarding when to return, and what food you can eat.

After the test

• No sedation is given during this test; therefore, you will be able to drive home directly after the test.
• The BSW Cardiology Consultants of Texas doctor conducting the test may be able to give you preliminary results before you leave. However, a complete interpretation usually takes several days.
• In addition to being called, a copy of your test results is sent to your referring physician.
• This test generally provides more information than an exercise stress test. This will help your doctor make an accurate diagnosis and develop a treatment plan that is best for you.

Holter monitoring

Holter monitoring is a continuous recording of your ECG, usually for 24 hours, while you go about your usual daily activities. It is especially useful in diagnosing abnormal heart rhythms. The Holter monitor itself is a small, portable cassette recorder, worn on a strap over the shoulder. Several electrodes (small sticky patches) are placed on your chest and connected by wires to the recorder.

Purpose

• To detect abnormal heart rhythms that may now occur during a standard ECG test.
• To assess recurring symptoms such as dizziness, fainting, and palpitations.
• To evaluate the effectiveness of treatments, such as medications and pacemakers, that help control abnormal heart rhythms.

Before the test

• Wear a loose fitting blouse or shirt, with the buttons in the front.
• Do not use lotions or bath oil on your skin. This will prevent the electrodes from sticking on your skin for 24 hours.
• There are no dietary restrictions.
• Ask your physician if you are to take your medication as ordered.

During the test

• Several areas on your chest will be cleansed with alcohol and an abrasive pad, to ensure good electrode contact. Men may need to have areas of their chest shaved.
• Please inform the medical assistant or nurse if you are allergic to cloth or paper tape. This will be used to help secure the electrodes on your skin.
• The electrodes are connected by wires to the recorder. The nurse or medical assistant will check the system to make sure it is working properly.
• You can do anything you would normally do, except take a bath or shower while the monitor is on. Do not get the electrodes, wires, or recorder wet.
• The nurse will show you a button on the recorder to press if you have a symptom that you want the physician to especially note. When you press this button, it marks the tracing for the doctor. This will help the doctor correlate your symptoms with your ECG tracing.
• Try to sleep on your back, with the recorder positioned at your side so that the electrodes are not pulled off.
• You will keep a diary (or log) in which you enter your activities, any symptoms you experience, and the time at which the symptoms occurred. The diary is very important, because it enables the doctor to correlate your activities and symptoms with the ECG tracing. Do not forget to bring the diary back when you return the recorder.

After the test

• Once you return the monitor, the cassette is analyzed by a computer, and scanned by a technician. The report is printed for the CCT doctor to review.
• The information gained will help your Baylor Scott & White Cardiology Consultants of Texas doctor make an accurate diagnosis and develop a treatment plan for you. A full report will be sent to your referring physician.

Nuclear stress test

Consult your physician for specific instructions concerning this test. Your instructions may differ slightly to fit your specific needs. The information below is a general guideline.

When to arrive

• Please arrive at least 15 minutes ahead of your scheduled appointment time. If you are not on time, we may need to reschedule you to another day or time.
• We ask that you please notify us at least 24 hours prior to your appointment if you need to cancel your appointment.
• If you have asthma or any respiratory condition, please notify us of this condition when we make your appointment. We may need to change the type of test that we scheduled if you have a respiratory condition.

What to wear

• Wear comfortable two-piece loose clothing and walking shoes (i.e. tennis shoes).

How long will the test last?

• If you are scheduled for a one-day study, plan to be in our office for 4 hours.
• If you are scheduled for a two-day study, plan to be in our office 2 hours each day.

Medications

• Please bring all of your medications or a complete list with you the day of the study.
• Please notify us if you are diabetic, hypoglycemic, or asthmatic. If you are diabetic, please adjust your insulin or oral medication to your dietary intake.
• If you use an inhaler, please bring this with you.

Dietary

• Absolutely no caffeine the day of your study. No coffee, tea, chocolate, or soft drinks. This includes decaffeinated beverages. Caffeine will alter your scan results. If you are scheduled prior to 12 noon, you may eat a light breakfast. If you are scheduled after 12 noon, you may have a light breakfast and light lunch. We want you to arrive "hungry".

No smoking or vigorous exercise 8 hours prior to your study.

Notice Concerning Testing Regulations: In order to comply with the Risk Management policies of Baylor Scott & White Cardiology Consultants of Texas , family members may not be present in the test area during patient testing, unless medically necessary. Otherwise, family members must wait in the main lobby.

Percutaneous transluminal coronary angioplasty

The arteries of your heart that supply blood to the heart muscle are called coronary arteries. PTCA sometimes called "angioplasty" or "the balloon procedure" is used to restore adequate blood flow to coronary arteries that are narrowed or blocked. The narrowing may be due to plaque build-up or thrombus (blood clot).

Before the procedure

• You will be asked to sign a consent form after your doctor has explained the procedure and its risk to you.
• One or both groins will be shaved which is the site of entry for the procedure.
• Tell your doctor or nurse if you are allergic to iodine, X-ray dye or other medications or shellfish.
• Most patients are told not to eat or drink anything after midnight. Please ask your nurse.
• You will need to empty your bladder and wear only a hospital gown.
• You may be given some medication to help you relax. You will not be put to sleep; you will be awake, but drowsy.

During the procedure

• You will be lying on a hard table, surrounded by X-ray equipment.
• A local anesthetic (numbing medicine) will be applied to the groin area.
• The doctor will insert a small tube (catheter) under the skin and into an artery in your groin. This tube will remain in your groin until the doctor removes it at a later time. A smaller catheter with a tiny balloon will be guided through this existing catheter in the artery and advanced into the affected coronary artery.
• An X-ray dye is injected to allow the doctor to view the affected arteries. It may cause a "hot" feeling.
• To help the doctor with the procedure, you may be asked to follow simple directions such as "take a deep breath and hold it".
• To attempt to widen the inside of the affected artery, the balloon will be inflated and deflated several times.
• You may feel chest discomfort or your original symptoms when the balloon is inflated. Be sure to tell your doctor.

After the procedure

• You may spend the night in an Intensive Care Unit (CCU) or in the Interventional Cardiology Care Unit (ICCU). Your nurse will be checking your heart rate, your blood pressure, groin, and the pulses in your feet.
• You will have one or two IV lines left in your groin for several hours or overnight. You must stay in bed and not bend the affected leg.
• A device may be placed on your finger to indirectly measure your oxygen level.
• When the IV's are removed from the groin, a "c-clamp" (a device used to hold pressure to prevent bleeding) will be used to apply pressure.
• It will be several hours before you can get out of bed. Ask your nurse.
• Later, you will be transferred to a regular room.

Permanent pacemaker insertion

A permanent pacemaker is a battery-operated device that is placed under the skin, usually in the left upper chest. Small wires connect the pacemaker to the heart. The device is approximately the size of a half-dollar and about 1/2 inch in thickness. The pacemaker is able to sense your heart's rate and the time between beats. If your heartbeat is not regular or is too slow, the pacemaker sends a small amount of electricity to the heart to speed up the heart or make it beat more regularly. The insertion, which usually takes about 2 hours, is performed in a special room in the Heart Center.

Before the test

• You will be asked to sign a consent form after your doctor has explained the procedure and the risks to you.
• Most patients are not allowed to eat or drink anything after midnight prior to the surgery. Please ask your nurse.
• You may be asked to remove dentures, glasses, and jewelry, and to wear a hospital gown.
• You will need to empty your bladder before you go for the procedure.
• Tell your doctor or nurse if you are allergic to iodine, X-ray dye, or other medications.
• You may be given some medicine to help you relax. You will not be put to sleep; you will be awake, but drowsy.

During the test

• You will be lying on a hard table surrounded by X-ray equipment and will be connected to a heart monitor.
• A numbing medicine will be given.
• The permanent pacemaker will be inserted just under the skin through a small incision.
• Your heart rate, blood pressure, and breathing will be monitored.

Immediately After the test

• You will probably be returned to your same room.
• Your heart rate and blood pressure will be monitored.
• You will be able to eat and/or drink as soon as you are awake.
• Before you go home, you will be given information regarding your device and follow-up care from the nurses in the pacemaker lab.

Resting ankle pressures

Systolic pressures measured at the ankle should be equal to or greater than the pressures measured at the arm. The ankle-arm pressure index (API) is normally 1.0 or greater. The API declines as levels of disease increase.

Before the procedure

• There are no special preparations for this test.
• You will be taken to the Vascular lab in a wheelchair or stretcher.
  • If a family member would like to go with you, they must be prepared to walk a great distance quickly.

During the procedure

• If you go by wheelchair, you will be asked to lie on a bed in an exam room for the test.
  • There will be a short wait while the technician reviews your chart.
• Blood pressures will be taken on your arms and ankles.
  • The changes in pressures will help your physician locate any suspected blockages.
• The technician will chart out the pressures on a map of the vascular system, and place it in your chart for your physician to review.

After the procedure

• After a brief wait, you will be taken back to your room by wheelchair or stretcher.
• Your physician will explain the results of the test after he/she reviews the charted pressures.

Segmental limb pressures

Systolic pressures are measured in sequence at different points along the legs, and compared to the pressure in the arms. By comparing the pressures, the physician can detect suspected blockages.

Before the procedure

• There are no special preparations for this test.
• You will be taken to the Vascular lab in a wheelchair or by stretcher.
  • If a family member would like to go with you, they must be prepared to walk a great distance quickly.

During the procedure

• If you go by wheelchair, you will be asked to lie on a bed in an exam room for the test.
  • There will be a short wait while the technician reviews your chart.
• Pressures will be taken on your arms.
• Pressures will also be taken up and down your legs.
• The technician will chart out these pressures on a map of the vascular system, and put it in your chart for your physician to review.

After the procedure

• After a brief wait, you will be taken back to your room by wheelchair or stretcher.
• Your physician will explain the results of the test after he reviews the charted pressures.

Signal average electrocardiogram

A signal average ECG, or "late potential detector" is a microprocessor based electrocardiogram (ECG). This type of ECG provides the cardiologist with knowledge about the potential to have a life threatening heart rhythm. It gives the Baylor Scott & White Cardiology Consultants of Texas doctor different information than a 12 lead ECG.

Purpose

This is a good screening test for detecting patients prone to sustained ventricular tachycardia (a potential life threatening heartbeat). If the test does show the potential to have this rhythm, then a more aggressive cardiac evaluation is warranted. the test itself only takes about 5 minutes.

Before the test

• There are no dietary restrictions.
• Wear a loose fitting blouse or shirt, with the buttons in the front. Do not wear a one-piece jumpsuit.
• Do not use lotions or bath oil on your skin. This will prevent the electrodes (sticky patches) from sticking to your skin.

During the test

• A trained medical assistant (or nurse) will place six electrodes (small sticky patches) on your chest and one electrode on your back. The areas on your chest and back will be cleansed with alcohol and an abrasive pad will be used to ensure good electrode contact. Men may need to have areas of their chest shaved.
• The electrodes are connected by wires to the signal average ECG machine.
• You will be lying on your back on an exam table. Once the test has started, you will be asked to lie very still on the table, while the machine is collecting data for the 3 channel ECG.
• The machine will then produce a 3 channel ECG for the BSW Cardiology Consultants of Texas doctor to interpret.

After the test

• Immediately after the test, the physician can give you a complete interpretation. The presence of a "late potential" has been associated with the potential to have an abnormal heart rhythm.
• If the test is abnormal, your doctor may order additional tests.

Tilt table

Tilt table test is for people who have unexplained fainting spells, called syncope.  The test enables the doctor to identify how changes in your position from lying to standing affect your blood pressure and heart rhythm.  During the test, there will be constant monitoring of your blood pressure and heart rate.  Your heart rate will be measured by an electrocardiogram (EKG). 

Before the procedure

• You will be asked to sign a consent form after your doctor has explained the procedure and its risks to you.
• Please do not eat or drink after midnight before the procedure.
• You will be taken to the Electrophysiology lab by wheelchair or stretcher.
• You will be awake when you are brought into the lab and during the procedure.
• Electrodes will be placed on your chest to monitor your heart during the procedure.  The skin may need to be lightly scraped and chest hair shaved on men to obtain clear test results.
• Safety belts will be placed across your chest and legs to secure your position on the table during the procedure.
• A small intravenous catheter (IV catheter) will be placed in your hand or arm.  The medicine given during the test will be given through this catheter.
• You will need to undress from the waist up; hospital gowns will be available to wear.

During the procedure

• The table on which you are lying will be tilted upward so that your head is higher than your body to stimulate normal gravity effects on the body.
• Throughout the test, your blood pressure and heart are carefully monitored.
• You are encouraged to let your doctor know how you are feeling during the test.
• During the test you may receive Isuprel.  This medicine stimulates your normal stress response, which may bring on the symptoms you have had in the past.  Isuprel may cause nausea.  If you begin to feel bad, please tell the staff.
• The procedure will take approximately 90 minutes.

After the procedure

• You will return to your room and may go home after the procedure.
• The doctor will discuss the results of the test with you and your referring physician.

Transesophageal echocardiogram

An echocardiogram is an ultrasound of the heart. It uses sound waves that are bounced off the heart, reflected back and converted to images on the screen. A trained cardiologist will pass a flexible tube through the mouth and into the esophagus to obtain more information about your heart. This gives clearer pictures of the values, structures and size of the heart as opposed to an echocardiogram done from outside the chest wall.

Purpose

The images reflect the structure of the heart and the function and movement of the valves and heart chambers.

Before the test

• If done as an outpatient we advise you to have someone drive you to the hospital and take you home. You may receive sedation.
• Do not eat for several hours before the test (your Baylor Scott & White Cardiology Consultants of Texas doctor will instruct you as to the exact amount of time).
• If you accidentally do eat, please notify the lab, as your test may need to be rescheduled.

Day of the test

• You will be asked to sign a special permit after the test has been explained to you.
• Electrodes will be attached to your chest to monitor your heart.
• The oxygen in your blood will be monitored using a monitoring device attached to a finger.
• An intravenous (IV) line will be started so that medications can be given to you.
• You will be asked to lie on your left side.
• A "numbing medicine" will be sprayed into the back of your throat.
• Medications to induce drowsiness will be given through an IV line.
• Once sedated, a tube will be passed down the patient's throat into the esophagus.
• Images are then taken of the heart.
• The test lasts approximately 15 minutes.

Immediately after the test

• Patient begins to wake up shortly after scope is removed.
• Liquids are given once throat is no longer numb (your BSW Cardiology Consultants of Texas doctor will instruct you as to the exact amount of time).
• Patient is observed until the doctor okays your return to hospital room or leaving the hospital.

Reactions

• Most patients notice a mild sore throat after the procedure.
• A cardiologist will review the study and inform you or your doctor of the results.