Services

Nuclear Medicine Stress Test

Procedure Description
Your doctor has ordered a nuclear medicine stress test to image your heart under stress (while exercising) and at rest. This test involves the injection of a radioactive "tracer" that allows the heart muscle to be seen on the Nuclear Medicine camera. This test is especially useful in diagnosing coronary artery disease, the presence of blockages in the coronary arteries that supply oxygen-rich blood to the heart muscle. The radioactive tracer used is administered in a very small and safe amount. However if you are pregnant, suspect you might be pregnant or are nursing be sure to let the technologist know.

Upon arrival you will be given a description of the test and asked to sign a consent form.
An IV will be inserted in a vein in your arm. You will receive an injection of the radioactive tracer which allows imaging of your heart. You will then be asked to wait for approximately 45 minutes.
For the first scan, you will be asked to lie down on the scan table on your back with both arms above your head. The camera will move slowly around you. This scan takes about 15 minutes. If you have problems with arm mobility or claustrophobia please discuss this with your doctor prior to the test.
You will then be brought into the Stress Laboratory. Several electrodes will be placed on your chest to record your heart’s activity during the test. The technologist may need to shave your chest. In order to maintain excellent contact between the skin and electrodes, the technologist will lightly scrub the skin under each electrode.
If you are walking on the treadmill, the exercise portion will become progressively more difficult until your target heart rate is reached. You will then receive a second injection of the radioactive tracer.
If you are having a pharmaceutical stress test instead of the treadmill, you will receive your second tracer injection during the medication infusion.
If you experience symptoms of chest pain, discomfort, dizziness, or shortness of breath during the procedure, let the nurse practitioner know immediately.
After the stress portion, you will be offered a light snack. The waiting time between the stress portion and second scan is 30 minutes to 1 hour depending on the type of test administered.
You will then lie on the scanning table again with your arms above your head for the second scan.
The two sets of pictures will then be compared to determine if there is a blockage in blood supply to the heart muscle.

Procedure Preparation
The Nuclear Medicine Stress Test takes approximately four hours to complete. You are encouraged to bring a book, or some other means to pass the time quietly. You will be able to drive yourself home after the test is completed.

Wear loose comfortable clothing with walking or tennis shoes. You will be asked to remove everything above the waist and given a patient gown to wear.
Do not eat anything after midnight the night before the procedure (or as instructed by VCC staff)
Follow your doctor’s instructions with regards to your medications. List of beta blockers
DO NOT HAVE ANY CHOCOLATE, CAFFEINE, OR DECAFFEINATED PRODUCTS FOR 24 HOURS PRIOR TO TEST TIME. This includes "caffeine-free" products and some prescription and over-the-counter medications. If you have questions, contact your pharmacist.

Stress Echocardiography

Procedure Description
A stress echocardiogram consists of a complete echocardiogram (as described above) together with a treadmill test. The echocardiogram is used to compare the pumping function of your heart before and immediately after exercise. The test takes approximately 1 hour in the following order:

Complete echocardiogram
Treadmill portion to raise your heart rate
Brief echocardiogram at a high heart rate

For the treadmill part of the test you will be hooked up to a 12 lead EKG, a blood pressure cuff and an oxygen monitor. In order for the EKG electrodes to sense the tiny voltages from your heart’s conduction system, it is necessary to obtain excellent contact between the electrodes and your skin. For this reason, the technician will lightly scrub the skin surface under each electrode – many patients will have their chest shaved in certain places before hand.
Once the EKG technician has obtained baseline recordings, the cardiac sonographer will perform the resting echocardiogram.
The actual exercise portion of the stress test initially consists of a slow walk up a 10% grade on the treadmill. Following a standard protocol, the incline and speed will increase every 3 minutes. Most patients are able to tolerate 6-12 minutes, however the end point is highly individualized and will depend on your response to exercise.
At your peak heart rate, the treadmill will be stopped and you will be asked to quickly lie down for the second set of echocardiogram pictures. This portion takes approximately 1 minute.

Procedure Preparation
Preparation for the stress echocardiogram is as follows:

Wear comfortable walking or running shoes.
Do not eat, drink or smoke for 2 hours immediately prior to your appointment
Do not wear oils or body lotion. You may wear deodorant.
Unless your doctor has instructed otherwise, do not take any heart or blood pressure pills in the beta blocker family for 24 hours prior to your appointment.

Echocardiography

Procedure Description
An echocardiogram (or echo-doppler) is a cardiac ultrasound. Your doctor has ordered this test to measure the size and function of cardiac structures such as the heart valves and pumping chambers. The procedure will take approximately 30-45 minutes. Upon arrival, you will be escorted to the echo lab and asked to remove all clothing above the waist, and to put on a gown with the opening in the front. The cardiac sonographer will then assist you into a comfortable position lying on your left side, and attach a 3 lead EKG to keep track of your heart rhythm. The echocardiogram is then conducted with the lights dimmed, and you will occasionally hear “whooshing” sounds as the sonographer measures the flows in your heart. The images are obtained by sliding a small gel covered probe over the front of your chest. Occasionally it may be necessary to insert an IV to inject a contrast which enhances your images. The sonographer will inform you if this is the case.

Procedure Preparation

You make eat, drink and take your medications as usual for this test.
You may wear deodorant.

Holter Monitor

Procedure Description
Your doctor has ordered a holter monitor to record your heart rate and rhythm for 24hours. The holter monitor consists of 7 EKG electrodes with wires attached to a recording device. The recorder is the size of a walkman, and can be worn on a shoulder strap or belt. In order to obtain the most accurate recording, the technician must ensure excellent contact between your skin and the electrodes. Accordingly, your skin will be lightly scrubbed underneath each electrode. Some patients will require shaving. You will be asked to keep a diary of activities and symptoms for the 24 hour period, as there may be a correlation between what you are doing, how you feel, and your cardiac activity. The appointment takes approximately 15 minutes.
Procedure Preparation

You make eat, drink and take your medications as usual for this test
Do not wear lotions or body oils on your chest. You may wear deodorant.

24 Hour BP Monitor

Procedure Description
Your doctor has ordered a blood pressure monitor which you will wear home for 24 hours. The BP cuff will inflate on your arm every 20 minutes during the day, and once per hour at night. The BP monitor will provide a useful trend of data recorded during your regular activities, as well as while you are sleeping. This appointment takes approximately 15 minutes.
Procedure Preparation

You make eat, drink and take your medications as usual for this test.
You may wear deodorant.

30 Day Event Recorder

Procedure Description
You doctor has ordered a 30 day event recorder to capture events that may occur infrequently. The event recorder is a small device attached to 4 EKG leads, which you will wear for approximately 1 month. The event recorder does not record continuously, but if you feel an event you activate the record function. You will be instructed on how to change the electrodes so you may shower, and how to transmit the information if you record any cardiac events. This appointment will take approximately 15 minutes.

Procedure Preparation

You make eat, drink and take your medications as usual for this test.
Do not wear lotions or body oils on your chest. You may wear deodorant.

Microvolt T-Wave Alternans Testing

Procedure Description
Microvolt T-Wave Alternans testing identifies patients at risk of life-threatening heart rhythm disturbances. "T-Wave" testing will enable your physician to determine if you have a specific underlying electrical disorder that may put you at risk for sudden cardiac death. The test requires a mild elevation of you heart rate for a brief period of time. At VCC this is done using the treadmill. As with any treadmill test, excellent contact between your chest and the electrodes is imperative. Since Microvolt T-Wave Alternans testing analyzes smaller signals however, the chest prep is slightly more vigorous. The exercise portion of the test will last approximately 8-10 minutes. Information about your heart is gathered before, during and after the test.

Procedure Preparation
Preparation for the Microvolt T-Wave Alternans Test is as follows:

Wear comfortable walking or running shoes.
Do not eat, drink or smoke for 2 hours immediately prior to your appointment
Do not wear oils or body lotion. Do not use moisturizing soap. You may wear deodorant.
Do not take any heart or blood pressure pills in the beta blocker family for 24 hours prior to your appointment

Beta Blockers
Acebutolol   Innopran   Propanolol
Atenolol   Kerlone   Sectral
Betaxolol   Lebetalol   Tenoretic
Carvedilol   Levatol   Tenormin
Coreg    Lopressor   Timolide
Corgard   Metaprolol   Toprol
Esmolol   Nadolol   Trandate
Inderal    Penbutolol   Zebeta
Inderide   Pindolol   Ziac- Bisoprolol