Baylor Scott & White Denton Heart Group

Abdominal scans

An abdominal scan is a test (sonogram) done using a handheld device (transducer), covered with a warm gel, applied to the abdomen. Sound waves are used to produce a visual image of and to measure the blood flow in the aorta. The scan can detect the location and severity of blockages in the aorta. It can also detect the presence of an aneurysm (ballooned area) in the aorta.

Preparation

No special preparation is needed.

During the test

The technician will apply the transducer and warm gel to the area to be scanned. The test is painless and takes about 30 minutes to complete.

After the test

• You may resume your normal activities
• If you are seeing your provider the same day, they will tell you about the test results at that time
• If the test is done on a day that you don’t see your provider, the nurse will contact you with information about the results after the provider reviews it, usually 7-10 days.

Angioplasty

Angioplasty is a procedure that is used to open blocked or narrowed arteries to the heart, bypass grafts, brain, kidneys or extremities to restore normal blood flow to those areas. A hospital stay of 1-2 days may be required for any of these procedures. The hospital and your provider’s nurse will inform you of any specific instructions.

Cardiac angioplasty is commonly known as PCI (percutaneous coronary intervention). A small catheter with a balloon on it is placed in the narrowed area of the artery and is inflated to compress the plaque against the side of the artery wall.

Bypass graft angioplasty is similar to cardiac angioplasty, but instead of improving blood flow in the hearts natural arteries, it is used to open narrowing or blockages of bypass grafts from previous coronary bypass surgery.

Renal angioplasty is a procedure that is used to open blocked or narrowed arteries to the kidneys. It is used when high blood pressure or abnormal kidney function is related to a blockage in a renal artery.

Carotid angioplasty is a procedure used to improve the blood flow to the brain when a blockage is found in the carotid artery.

Peripheral angioplasty is commonly known as PTA (peripheral thrombosis angioplasty). It is a procedure used to improve blood flow, and to open narrowed blockages in the arteries that supply blood to the arms or legs.

Stenting is a procedure that can be used along with angioplasty to keep a narrowed area of an artery open. In some cases, if angioplasty is not enough to keep the narrowed area opened, the cardiologist may insert a stent. A stent is a small, expandable device that is put in place over the angioplasty catheter.

Arterial and venous doppler scans

Arterial and Venous Doppler scans of the upper and lower extremities are done using a handheld device (transducer) applied to areas of the arms or legs where the arteries and veins are located. Sound waves are used to produce a visual image of the actual artery or vein, and to measure the blood flow in them. The scans can detect blood clots and problems with valves in the veins. The scan can also detect the severity and location of any blockages in the arteries that supply your legs or arms with blood flow. Your provider uses this information to determine the best course of treatment for you if needed.

Preparation

No special preparation is needed.

During the test

The technician will apply the transducer and warm gel to the area to be scanned. The test is painless and takes 30 – 60 minutes to complete.

After the test

• You may resume your normal activities.
• If you are seeing your provider the same day, you will receive the test results during your visit. tell you about the test results at that time.
• If the test is done on a day that you don’t see your provider, the nurse will contact you with the results after the provider reviews it, usually 7-10 days. 

Cardiac catheterization

Cardiac catheterization is a test done by inserting a catheter (thin, flexible tube) into the heart, through an artery in the arm or leg, and injecting a dye into the heart arteries. The purpose of this test is to evaluate the heart valves and heart function, and to define any blockage in the coronary arteries that can restrict blood flow to the heart. Frequently this procedure is done as an outpatient procedure. The hospital and your provider’s nurse will inform you of specific test instructions.

Cardiovascular consultation

Baylor Scott & White Denton Heart Group realizes that the most important step in your cardiac health is the introduction and consultation with your cardiologist. During your consultation, the physician will obtain important information about your heart problem. Other information will be obtained about your current symptoms or heart problems, the history of those problems, your history of other diseases, the medical history of your close relatives, and information about pertinent risk factors for heart disease including smoking, high blood pressure, high cholesterol, and diabetes.

It is important to prepare in advance and bring with you a list of all of your medications, doses and the frequencies taken. A list of any medication allergies or intolerances is also important. If it is possible, obtaining copies of recent tests from other doctors, such as ECGs, Stress tests, X-rays, and lab work is helpful.

After obtaining your history and reviewing your healthcare information, the cardiologist will perform an examination and assessment of the cardiovascular system. Following this examination, the cardiologist will discuss his impression about your symptoms and talk with you about his recommendations. This may include additional testing or medications. Some of these tests may be performed in the office, but some would be scheduled at the hospital.

Preparation

• Contact your family physician about any records that you may need to bring with you
• Bring current insurance cards with you, including Medicare and Medicaid information
• Be prepared to pay any co-pay or deductible payment as required by your insurance plan
• Be prepared to complete a patient information sheet, sign a privacy notice acknowledgment and complete a personal and family health history before you are seen.
• Bring an updated list of your medications, dosage, and the frequency taken and a list of any medication or other allergies that may affect your medical care

During your visit

• An Electrocardiogram (ECG) may be done before your appointment if you have not had one within the last few weeks.
• A nurse or medical assistant will call you from the waiting area, weigh you, and record your blood pressure and heart rate (pulse). They will then escort you to the examination room
• In the examination room, the nurse will ask you for a few brief questions about the reason for your visit or about any symptoms that you have listed on the patient history form and they will ask you about any drug or other allergies or intolerances and ask for your list of current medications, dosages and the frequency taken
• In some instances, you will be asked to remove clothing from the waist up and to put on an examination gown. The nurse will step out of the room at this time.
• After a period of time, the provider will enter the examination room. They will ask you for a verbal history of many of the things that you have already written down. They do this because many patients describe symptoms differently when talking than they do in writing, and this can provide them with a clearer idea of what you are experiencing.
• After listening to your history, the provider will begin an examination of the cardiac and vascular system, as well as some other body systems.
• At the end of the examination, the provider will generally tell you his opinion of what medical issues need to be further investigated, or his opinion of what is wrong. If he wants to order further testing, that will usually be done on another date. If he wants to begin you on a medication, he will give you directions, samples (if available) and any instructions about any tests or lab work that need to be done in relationship with taking the medication.
• After he leaves the examination room, he may give the nurse additional instructions about your care. If so, she will speak with you about them. It may be necessary for her to call you on the following day to complete the instructions.

After Your Visit

• A follow-up appointment, if needed, will usually be scheduled for you when you check out at the cashier window, although it may not be scheduled until after some other testing is completed.
• Any tests ordered by the physician will also be scheduled at check out. Special instructions for testing will either be given to you by the nurse, or at the cashier window.
• You will be asked to pay your co-payment or deductible amount as required by your insurance company, or you may need to make payment arrangements with one of our financial counselors.

Carotid duplex scans

Carotid Duplex Scans are tests done using a handheld device (transducer) applied to the neck area, where the carotid arteries (the arteries that supply blood to the brain) are located. Sound waves are used to produce a visual image of the artery and to measure the blood flow through the artery. This may be done on one side of the neck, or on both sides. The scan can detect the severity and location of any blockages in these arteries. Your provider uses this information to determine the best course of treatment for you, if any is needed.

Preparation

No special preparation is needed.

During the test

The technician will apply the transducer and warm gel to the area to be scanned. The test is painless and takes about 30 minutes to complete

After the test

• You may resume your normal activities
• If you are seeing your provider the same day, they will tell you about the test results at that time
• If the test is done on a day that you don’t see your provider, the nurse will contact you with information about the results after the provider reviews it, usually 7-10 days.

Coumadin clinic

Our Coumadin clinic is designed to assist providers and their patients who take the anticoagulant drug known as Coumadin (Warfarin).

In our clinic, we educate patients about:

• the medication and its interactions with other medications and foods;
• the uses of the drug and the reason they are taking it;
• the expected effects of the medication;
• the importance of monitoring the medication level by regularly scheduled fingerstick testing; and
• other important aspects of being on Coumadin.

Your cardiologist will enroll you in the clinic if you are being prescribed Coumadin as part of your treatment.

At your first visit, the nurses will ask you for some specific information about your health history as it relates to bleeding disorders, and about any medications you are taking, both prescription and over the counter.

Preparation

• No special preparation is needed. The initial visit will take about 45 minutes. Each follow-up visit takes approximately 15 minutes.
• Take your medication (Coumadin) as directed by your physician or the clinic nurses.
• Do not self-adjust this medication.
• Be sure to keep your scheduled appointment - it is important to have a blood test on a regular schedule.
• If you must miss your appointment, please notify us as soon as possible. Also, it is important that you be rescheduled close to your missed appointment date.

During the test

• The nurse will call you from the waiting room.
• Your blood pressure, heart rate and weight will be recorded at the beginning of each visit.
• The nurse will ask you specific questions at each visit to determine any problems or issues that may be associated with taking Coumadin, or that may influence the results of the test at that visit.
• The nurse will cleanse your finger with an alcohol swab and perform a quick fingerstick to obtain a small drop of blood.
• The blood drop will be placed on a test strip (similar to a blood sugar test strip) and inserted into the machine.
• The nurse will place a pressure band-aid over the fingerstick site for you.
• Within a few seconds, the machine will perform the test and flash the results onto the display on the machine.
• The nurse will let you know the results and discuss any issues. If your Coumadin dosage needs to be adjusted, the nurse will give you new instructions for the dosage to take until your next visit.
• The nurse will record the blood test results, along with any other pertinent information, on a test record.
• Based on the test results and guidelines established by our physicians, a return appointment time frame will be stated.
• If your test is too low or too high, you will need to come back sooner for the next test.
• If your test is within the right range, you will come back for retesting in a month’s time.

After the test

• You will check out at the cashier window and receive your return appointment date and time.
• You may call the nurses at the clinic at any time if you are having a problem related to your Coumadin dose, or you are having symptoms that they have told you to report. If they do not answer the phone, they are with a patient. Please leave them a voice mail message with your name and phone number, and they will return your call.

Additional Resources

• Frequently Asked Questions from the manufacturer

Digital Holter monitor

Digital Holter monitor is a small recording device, about the size of a pager, that records your heart rate and electrical pattern for an extended amount of time (usually 24 – 48 hrs). The test report is analyzed and reviewed by your provider and is used to develop or change a plan of treatment (usually medications).

Preparation

• Wear a shirt or blouse that opens in the front
• Continue your medications as directed by your provider

During the test

• A small area of your chest will be cleaned and shaved if needed, and sticky pads (electrodes) will be applied to your chest
• Cable and wires will be connected to the electrodes.
• You may perform your usual daily activities EXCEPT – NO BATHING OR SHOWERS
• You may take a sponge bath only. KEEP THE ELECTRODES, CABLES, WIRES AND RECORDER DRY AT ALL TIMES
• DO NOT ATTEMPT TO OPEN THE RECORDER.
• Keep the diary provided to you by the technician and write down any activities, symptoms, and the times of any activities or symptoms. Bring the diary back to the technician when you return wearing the recorder.
• Try to sleep on your back so that the wires and cables will stay connected. If one comes off, you can attempt to put it back on. If you cannot get it back on, call the technician when the office opens and let them know.

After the test

• The recorder disc is scanned, and a computer report is sent to your provider.
• After your provider reviews the scan and develops a plan of care, the nurse will contact you with the results and any instructions. You should expect the results in 10-14 days.

Electrocardiogram (ECG)

ECG (Electrocardiogram) is a test that records the electrical impulses of the heart. The test is painless and takes only a few minutes to complete.

Preparation

• A small area of the chest may need to be shaved
• Wear a shirt or blouse that opens in the front

During the test

The technician will place sticky pads (electrodes) on your chest, arms, and legs.

After the test

• Your provider reviews and interprets the ECG
• Test results will be communicated to you in a confidential manner, either by your provider during your visit, or by their nurse in about 5-10 days

Event monitor

An event monitor is a small recording device that is similar to the Holter monitor except that you wear the device for 30 days. After an event, the recorder will beep and you will need to call the 1-800 number that is provided to you to send the recorded event. The monitoring service then faxes the recording to your provider’s office, or to the provider on-call.

Preparation

• Wear a shirt or blouse that opens in the front
• Continue your medications as directed by your provider

During the test

• Your chest area will be prepared and sticky pads (electrodes) will be applied to your chest and connected to the monitoring device
• You will be instructed by the technician about the use of the monitor and about transmitting event recordings
• You may perform your usual daily activities
• You will be provided with a supply of extra electrodes and shown how to reapply them after bathing or replace them if one comes off.

After the test

• You will mail the recording device back as instructed by the technician
• Your provider will make recommendations about your care based on the results of the test.
• You may expect to hear from the nurse about the test within 14 days or at your next appointment

Exercise stress test

The exercise stress test is a test designed to observe the electrical activity of your heart under the stress of exercising on a treadmill. This test can detect changes in your ECG in response to an increasing exercise load, and helps your provider detect signs of heart problems, such as a decreased amount of blood flow to certain areas of your heart muscle. During the test, you are observed for changes in your heart rate or rhythm and changes in your blood pressure.

Preparation

• Allow plenty of time for the test preparation, completion and recovery period.
• Wear comfortable attire and walking or running shoes.
• Avoid eating a heavy meal for at least two (2) hours before the test. Avoid stimulants like coffee, tea and alcohol before the test.
• Take your medications prior to the test as directed by your provider or the person scheduling the test for your provider.

During the test

• Your chest area will be cleaned and shaved if needed, and sticky pads (electrodes) will be applied to your chest, connected to wire and cables and to the machine.
• You will walk on an exercise treadmill for a period of time determined by your response to the test.
• While you are exercising, your heart rate and rhythm and your blood pressure will be recorded every 3 minutes.
• Tell the technician if you feel that you need to stop walking at any time during the test.
• Electrocardiograms (ECG’s) will be recorded throughout the test.

After the test

• Your heart rate and rhythm and blood pressure will be monitored for 5 –10 minutes after you complete the exercise portion of the test. This is called the recovery period.
• At the end of the test, the electrodes will be removed from your chest.
• The completed test and computer report will be sent to your provider to review.
• You may resume your usual activities after the test unless instructed otherwise.
• If you are seeing your provider the same day, they will tell you about the stress test at that time.
• If the stress test is done on a day that you don’t see your provider, the nurse will contact you with information about the results after the provider reviews it, usually 7-14 days.

Nuclear exercise stress test

Nuclear exercise stress test is a commonly performed cardiology test. During the test, a small amount of radioactive substance (isotope) is injected into the patient’s bloodstream. The isotope circulates to the heart muscle during exercise. The imaging done after the exercise portion of the test shows areas of the heart that take up none, or only a small portion, of the substance. In this way, the test can indicate whether there are areas of the heart muscle that have diminished blood flow.

Preparation

• If you need to cancel, please give us 48 hours notice by calling 940.382.8080. The medication for this test is very expensive and can only be used at your scheduled appointment time.
• Allow plenty of time for the test (usually about four hours but can be longer) for preparation, completion and recovery period.
• Do not eat or drink anything after midnight the night prior to the test.
• Absolutely no caffeine for 24 hours before the test.
• Wear comfortable walking shoes and a two-piece outfit (blouse or shirt and pants).
• If you are diabetic, you may take your medication before 6:00 AM. With your medication, you may have two pieces of dry toast, a small glass of orange juice, and a small glass of water.
• Please do not wear cologne or scented lotions to your appointment.
• Co-insurance is expected at the time of service. Please call our office for financial arrangements.

Other Preparation

• Your family may wait in the waiting room with you  but cannot enter the testing room.
• One of the technicians will talk with you prior to the test about the risks of the test and will ask you to sign the permit. They will also ask you questions about your medications and other medical information.
• You will lay down on a hard, narrow table with your arms folded under your head while an X-ray scanner goes back and forth across you chest area for a period of time.
• You will then be sent back to the waiting room until the next part of the test (the stress test) begins.

During the Test

• An intravenous line (IV) will be started in one of your arms before the test begins.
• You will be given the radioactive medication through your intravenous line (IV).
• You will lay down on a hard, narrow table with your arms folded under your head.
• A large X-ray scanner will go back and forth across your chest area for a period of time while the images are scanned.
• You will then be sent back to the waiting room to sit until the next part of the test (the stress test) is ready to begin.
• Your chest area will be cleansed and shaved if needed and sticky pads (electrodes) will be applied to your chest as for an ECG.
• For the Pharmacologic test, you will sit or lay on a reclining table for a period of time as determined by your response to the test.
• For the Exercise test, you will sit on a chair until the test begins and during the recovery time, and will walk on a treadmill during the test.
• Your heart rate and rhythm and your blood pressure will be monitored every 3 – 5 minutes.
• The technician will be beside you during the test. If you feel any unusual symptoms during the test, please let him (her) know.
• All needed stress test information will be recorded during the test.
• After the exercise/ pharmacologic exercise portion of the test, you will lay on a hard, narrow table with your arms folded behind your head for the last scanning portion of the test.
• A large round X-ray scanner will go back and forth across your chest area for a period of time while the images are scanned.

After the Test

• Your heart rate and rhythm and blood pressure will be monitored for 5 –10 minutes after you complete the exercise portion of the test. This is called the recovery period.
• At the end of the test, the sticky pads (electrodes) will be removed, your chest area will be cleansed, and your I.V. will be removed from your arm.
• After the exercise/ pharmacologic exercise portion of the test, you will lay on a hard, narrow table with your arms folded behind your head for the scanning portion of the test.
• A large round X-ray scanner will go back and forth across your chest area for a period of time while the images are scanned.
• The completed test, computer report and images will be reviewed by one of our cardiologists and will be sent to your provider to review.
• You may resume your usual activities after the test unless you are told otherwise.
• It is usually your provider’s nurse who contacts you with results of the test or to let you know to come in to discuss it with your provider. You usually will hear from the nurse within 10 – 14 days.

Nuclear pharmacological stress test

Nuclear pharmacological stress test is a test designed for patients who are unable to exercise well enough to increase their heart rate to a level for an accurate test to be performed. Through an I.V., a medication is given that will increase your heart rate as if you were exercising.

This test detects changes in your ECG in response to an increasing exercise load, and helps your provider detect signs of heart problems that may not be noticed at rest. During the test, you are observed for changes in your heart rate or rhythm, and changes in your blood pressure. This test is done in association with imaging (see the information about imaging). The imaging portion of the test shows areas of the heart that take up none, or only a small portion, of the substance. In this way, the test can indicate whether there are areas of the heart muscle that have diminished blood flow.

Preparation

• If you need to cancel, please give us 48 hours notice by calling 940.382.8080. The medication for this test is very expensive and can only be used at your scheduled appointment time.
• Allow plenty of time for the test (usually about 4 hours but can be longer) for preparation, completion and recovery period.
• Do not eat or drink anything after midnight the night prior to the test.
• Absolutely no caffeine for 24 hours before the test.
• Wear comfortable walking shoes and a two-piece outfit (blouse or shirt and pants).
• If you are diabetic, you may take your medication before 6:00 AM. With your medication, you may have two pieces of dry toast, a small glass of orange juice, and a small glass of water.
• Please do not wear cologne or scented lotions to your appointment.
• Co-insurance is expected at the time of service. Please call our office for financial arrangements.

Other preparation

• Your family may wait in the waiting room with you but cannot enter the testing room.
• One of the technicians will talk with you prior to the test about the risks of the test and will ask you to sign the permit. They will also ask you questions about your medications and other medical information.
• You will lay down on a hard, narrow table with your arms folded under your head while an X-ray scanner goes back and forth across you chest area for a period of time.
• You will then be sent back to the waiting room until the next part of the test (the stress test) begins.

During the test

• An intravenous line (IV) will be started in one of your arms before the test begins.
• You will be given the radioactive medication through your intravenous line (IV).
• You will lay down on a hard, narrow table with your arms folded under your head.
• A large X-ray scanner will go back and forth across your chest area for a period of time while the images are scanned.
• You will then be sent back to the waiting room to sit until the next part of the test (the stress test) is ready to begin.
• Your chest area will be cleansed and shaved if needed and sticky pads (electrodes) will be applied to your chest as for an ECG.
• For the pharmacologic test, you will sit or lay on a reclining table for a period of time as determined by your response to the test.
• For the exercise test, you will sit on a chair until the test begins and during the recovery time, and you will walk on a treadmill during the test.
• Your heart rate and rhythm and your blood pressure will be monitored every 3 – 5 minutes.
• The technician will be beside your during the test. If you feel any unusual symptoms during the test, please let him (her) know.
• All needed stress test information will be recorded during the test.
• After the exercise/ pharmacologic exercise portion of the test, you will lay on a hard, narrow table with your arms folded behind your head for the last scanning portion of the test.
• A large round X-ray scanner will go back and forth across your chest area for a period of time while the images are scanned.

After the Test

• Your heart rate and rhythm and blood pressure will be monitored for 5 –10 minutes after you complete the exercise portion of the test. This is called the recovery period.
• At the end of the test, the sticky pads (electrodes) will be removed, your chest area will be cleansed, and your IV will be removed from your arm.
• After the exercise/ pharmacologic exercise portion of the test, you will lay on a hard, narrow table with your arms folded behind your head for the scanning portion of the test.
• A large round X-ray scanner will go back and forth across your chest area for a period of time while the images are scanned.
• The completed test, computer report and images will be reviewed by one of our cardiologists and will be sent to your provider to review.
• You may resume your usual activities after the test unless you are told otherwise.
• It is usually your provider’s nurse who contacts you with results of the test or to let you know to come in to discuss it with your provider. You usually will hear from the nurse within 10 – 14 days.

Pacemaker and ICD testing

Pacemaker and ICD testing is done in our office on a daily basis. Both pacemakers and ICD’s (Implantable Cardioverter Defibrillators) implanted by our physicians at the hospital are checked with routine frequency in our Pacemaker/ ICD Clinic.

It is important for a patient with a newly implanted device to keep the clinic appointment that is set when they leave the hospital. The patient may then be scheduled to come to the clinic for an appointment on a regular interval, or may be scheduled to use an “at home” testing device.

Important: If you have an ICD and it delivers a shock to you, please report it to our clinic technician. If you have more frequent shocks, or several shocks in a brief time period, report these to our clinic technician or to your provider. If it occurs during the night or on a weekend, go to the Emergency Department for further evaluation.

Preparation

• No special preparation is needed.
• You will have several small “sticky pads”(electrodes) applied to your chest area.
• Be sure to keep your scheduled appointment. If you must miss your appointment, please call us to reschedule it. We can use that time slot for another patient.

During the test

• The technician applies a wand over the device site and it “talks” with the device. Information transmitted from the device is analyzed, and a report can be printed. The test is painless and takes about 10-15 minutes to complete.
• If your device is new, the technician will talk with you about it and answer any questions that you might have.
• If the test indicates the need for any adjustments to be made, the technician is qualified to make them while you are here.
• If there is any urgent problem noted with your device, it can be addressed while you are in the clinic.

After the test

• The technician will tell you if the test is okay, or will briefly discuss any issues that need to be reviewed by a physician.
• If you are seeing your provider the same day, they will tell you about the test results at that time.
• If the test is done on a day that you don’t see your provider, the nurse will contact you with information about the results after the provider reviews it, usually 7-10 days.

Additional resource

• "Daily Living" from Medtronic

Pacemaker implantation

Pacemakers are devices used to treat dangerously slow heartbeats. A pacemaker detects every heartbeat a patient has, and does not allow the heartbeat to drop below a preset rate. The pacemaker can be programmed or set in a variety of ways to best fit the needs of each individual patient. Once a pacemaker is inserted, most patients are not aware of when the pacemaker is pacing their heart, but they usually do notice an improvement in their symptoms. It usually requires a hospital stay of 1-2 days. The hospital and your provider’s nurse will inform you of specific instructions for this procedure.

Reveal LINQ™ insertable cardiac monitor

The Reveal LINQ insertable cardiac monitor (ICM) is a wireless and powerfully small insertable cardiac monitor ideal for patients experiencing infrequent symptoms that require long-term monitoring or ongoing management.

Stress echocardiogram

A stress echocardiogram is a test done to visualize the heart muscle as it pumps, and the valves in the heart as they open and close after you have been exercising. During the test, sound waves are measured as they bounce off the structures of the heart. This is done by applying a hand-held wand (transducer) to the skin of the chest over the area of the heart. The test is painless but is does involve exercising on a treadmill or having medication injected to increase your heart rate. It takes about 30 - 45 minutes to complete. The test is used to detect abnormal heart valve function and poor pumping function of the heart that may be present after exercise, but not noted at rest.

Preparation

• Wear a shirt or blouse that opens down the front.
• If you are a woman, you will put on a patient gown, opened down the front, for the test.
• No dietary or medication restrictions

During the test

• You will have some sticky pads (electrodes) applied to your chest and connected to the machine
• You may have an intravenous line (IV) inserted into your arm for medication
• You will be asked to turn onto your left side
• The technician will apply the transducer, using warmed gel, to the skin over your chest area and perform a scan with you at rest.
• You will then exercise on a treadmill, or you will be given a medication to increase your heart rate as if you were exercising. As quickly as possible after the exercise part of the test, the technician will assist you onto the table and ask you to turn onto your left side.
• Warm gel will be applied to the transducer before applying it to the skin over your chest, and another scan will be done before your heart rate can return to normal after the exercise
• Limit your talking and movement during the scanning portion of the test

After the test

• The technician will remove the pads and provide you with a towel or cloth to wipe off the excess gel that remains on your chest area
• If you have an intravenous line (IV), the technician will remove it
• You may resume your usual activities after the test.

Transradial cardiac catheterization

If you have had a cardiac catheterization from the femoral (groin) approach, you have received advanced quality care.  You have also experienced the challenge of recovery from a groin puncture.  This experience may have been uneventful and accompanied by minimal discomfort as is the experience for the vast majority of patients undergoing cardiac catheterization from this approach.  You may have had the femoral artery closed with a special device that limited the amount of time you were required to be at rest.  This is the expected course of events and is the outcome most U.S.  cardiologists strive for and achieve.

So, why consider a change in approach?  There are three reasons to consider a change:

• Safety
• Patient comfort
• Cost

Let’s consider safety.  When things go as planned and expected with the femoral approach, outcomes are wonderful.  As with all procedures, including transradial cardiac catheterization, there is a risk of complications with the femoral approach to cardiac catheterization.  The major risks are bleeding and injury to the artery.  Powerful blood thinners are used during cardiac catheterization, especially if interventions such as stent placement are undertaken.  With the puncture of an artery, there is always the risk of bleeding.  The femoral artery is a larger and more difficult artery to compress and control than the radial artery.  Recognized complications include hematomas (collections of blood in the tissue around the artery) and pseudo aneurysm (balloon-like out pouches in a layer of the arterial wall).  These problems are usually more uncomfortable and annoying than life threatening but bleeding can be catastrophic.  These complications are less common and less threatening in transradial approaches.  Injury to the radial artery can also occur, but thrombosis or clotting off of the radial artery is the more common significant complication of this approach.  The thrombosis of the radial artery is often without symptoms or requiring specific action.

Most patients undergoing femoral catheterization are kept at bed rest for 2 to 4 hours to lessen the risk of bleeding and arterial injury after the procedure.  Transradial patients are allowed to sit up and walk as soon as the sedation given during the procedure has worn off.  This is important to patients with back or breathing issues.  Quicker and more comfortable mobility are important to many patients.

Fewer severe complications and early mobilization results in shorter, less expensive hospitalizations.  While on a private, individual (out of pocket) basis this consideration may not seem relevant, on a larger volume basis the cost savings are substantial.

The transradial approach is not advisable or possible for all patients.  The radial artery may be too small to pass a catheter or may go into spasm when accessed. This can cause pain for the patient and an inability for the operator to pass the catheter.  Anatomical anomalies in the arteries between the radial puncture site and the coronary artery, or other target vessel, can prevent passage of the catheter to the needed site.  Patients with previous bypass grafting may be more difficult to perform cardiac catheterization from the transradial approach.  The femoral approach may be the better choice for these and other circumstances.

Is the transradial approach for cardiac catheterization right for you?  Maybe.  Factors benefit and risks must be considered on an individual basis.   Discuss it with your doctor.  I have developed a special interest in and have a preference for this approach to catheterization. 

Ricky L. Harris, DO, FACC

Transthoracic echocardiogram (TTE)

Transthoracic echocardiogram (TTE) is a test done to visualize the heart muscle as it pumps, and the valves in the heart as they open and close. During the test, sound waves are measured as they bounce off the structures of the heart. This is done by applying a hand-held device (transducer) to the skin of the chest over the area of the heart. The test is painless and takes about 30 minutes to complete. The test is used to detect abnormal heart valve function and poor pumping function of the heart, and to identify blood clots within the heart chambers or tumors in the heart.

Preparation

• Wear a shirt or blouse that opens down the front.
• If you are a woman, you will put on a patient gown, opened down the front, for the test.
• No dietary or medication restrictions.

During the test

• You will have some sticky pads (electrodes) applied to your chest and connected to a machine.
• The technician will ask you to turn onto your left side, and will apply a warm gel to the transducer before applying it to the skin over your chest.
• Limit your talking and movement during the test.

After the test

• The technician will remove the pads and provide you with a towel or cloth to wipe off the excess gel that remains on your chest area.
• You may resume your usual activities after the test.
• If you are seeing your provider the same day, they will tell you about the test results at that time.
• If the test is done on a day that you don’t see your provider, the nurse will contact you with information about the results after the provider reviews it, usually 7-10 days.