Thank you for choosing Porter Cardiology as your center for cardiac testing. Our goal is to be able to provide you and your family with the best care at all possible times. All test results will be available to your primary care provider and/or referring provider within 24 hours of the completion of the test.
Consults
Our cardiologists see patients for scheduled outpatient consults in our practice. We also provide acute inpatient or emergency room consults at Porter Medical Center.
Heart Monitoring
To properly diagnose your problem, your cardiologist may recommend using a monitoring device to record your heart’s activity over a period of time. This can help identify the cause of the abnormal rhythm. There are many different types of monitoring devices, including:
Holter Monitor – This is a small portable electrocardiogram (ECG) machine that records the heart’s electrical activity over a 24-48 hour period. It tracks every heartbeat throughout the monitoring period, providing diagnostic information about the type of arrhythmia, how long it lasts, and what might trigger it. The monitor works by attaching small electrodes to the chest. Wires travel from the electrodes to a small portable box that you wear on your belt or shoulder strap. The box continuously records and stores heart rhythm data transmitted by the electrodes. After use, it is returned to your physician who will review the findings.
Event Recorder – A device similar to a Holter monitor: it is used to record the heart’s activity for a much longer period of time – from 14 to 30 days. You can wear the recorder as you go about your normal activities and press a record button if you feel symptoms. The device is about the size of a pager and can be clipped to a belt or placed in a pocket. Wires connect the device to electrodes worn on the chest. After use, it is returned to your physician who will review the findings. The recorder can be used to determine if recurrent symptoms – such as dizziness, chest pain, palpitation or fainting spells – are caused by an abnormal heart rhythm.
Nuclear Stress Test
What to Expect During a Nuclear Stress Test
A nuclear cardiology test takes detailed pictures of your heart twice, once when it is at rest and once when it is “stressed” (usually after exercise, like walking on a treadmill). For patients who may be unable to walk on a treadmill, we can give you medication that simulates exercise.
During the test:
- We inject a small amount of a radioactive tracer, called a radionuclide.
- The heart absorbs the tracer.
- A high-resolution camera takes still and moving pictures of your heart, first at rest and then after exercise.
- We analyze your results, examining your heart structure and function and determining an exact diagnosis.
What is a Nuclear Stress Test Used For?
The detailed information we gain from a nuclear cardiology test is invaluable in providing an accurate diagnosis and helping us plan effective treatment. Your doctor may recommend a nuclear cardiology study in order to evaluate:
- How efficiently your heart pumps blood
- If your arteries are narrowed, blocking the flow of blood to your heart
- Evidence of heart disease
- To help determine what type of treatment may be most effective for you (whether you need medication, a catheterization or a procedure such as angioplasty)
Exercise Tolerance Test
What to Expect During an Exercise Tolerance Test
A healthcare professional will place approximately 10 electrode patches on the skin of your arms, legs and chest. These electrode patches are hooked up to the electrocardiography or ECG machine, which measures the heart’s electrical activity. Your blood pressure is also monitored.
A healthcare professional will first take an ECG reading while you are at rest. Then, you will be asked to exercise on a treadmill or stationary bike. The exercise will begin slowly, and then steadily the speed will change to increase the workload on the heart.
ECG measurements are taken continuously. Once you have reached a pre-determined, optimum heart rate, the procedure will end.
What is an Exercise Tolerance Test Used For?
Stress tests are used to evaluate your exercise tolerance and determine if there is a narrowing in an artery leading to the heart muscle – a warning sign of a possible heart attack.
Transthoracic Echocardiography
What to Expect During a Transthoracic Echocardiogram
An echocardiogram is a noninvasive test that uses sound waves to look at the structure and function of your heart. A transducer, which is a medical device, converts electrical energy into sound waves that are then directed into your body. When the sound waves reach your heart, they are reflected back to the body surface where they are received by the transducer and electronically converted into a picture. The transducer is moved back and forth on the skin, but there is no unpleasant sensation. A gel, similar to mineral oil, is used to keep the transducer in close contact with the skin.
What is a Transthoracic Echocardiogram Used For?
The test is performed to evaluate the valves and chambers of the heart in a noninvasive manner. The echocardiogram allows doctors to evaluate heart murmurs, check the pumping function of the heart, and evaluate patients who have had heart attacks. It is a very good screening test for heart disease in certain groups of patients.
Treadmill Stress Echocardiograms
What to Expect During a Treadmill Stress Echocardiogram
An exercise echocardiogram involves transthoracic echocardiography (see above) performed at baseline while you are resting and immediately after or during physical exercise. The physical exercise that is utilized may involve treadmill testing, in which case echocardiographic images are obtained before and immediately after exercise.
What is a Treadmill Stress Echocardiogram Used For?
Stress echocardiograms are commonly used for detection of coronary artery disease, or in determining the impact that a heart attack may have had on cardiovascular function. Stress echocardiograms are less commonly performed to evaluate pulmonary artery pressures in patients with lung disease or pulmonary hypertension and to evaluate the significance and progression of valvular heart disease.
Transesophageal Echocardiography
What to Expect During Transesophageal Echocardiography
For this procedure the ultrasound transducer has been miniaturized so that the crystals creating the ultrasound energy are approximately the size of a fingernail. This crystal array is then mounted on a gastroscope that is virtually identical to the type of instrument a gastroenterologist (stomach doctor) would use to look for ulcers or other disease in the GI system.
A transesophageal echocardiogram is more complex than transthoracic or stress echocardiography. To perform a transesophageal echocardiogram the patient must swallow the endoscopic probe. Because this procedure can be associated with discomfort, it is performed after the patient has been sedated. The medicines used for sedation are identical to those used by a gastroenterologist when performing this procedure and may include combinations of Demerol, Versed, Fentanyl or other sedatives and narcotics.
The procedure is performed under what is called “conscious sedation” that implies a level of sedation the patient can still respond to instructions and is capable of conversation after the procedure. A topical anesthetic is sprayed into the throat to limit discomfort. One side-effect of the sprays used for topical anesthesia is that they may induce a sensation that the throat is swelling, although no actual swelling occurs. The entire mouth, throat, and tongue will be numb and taste and temperature sensation diminished for a three to four hour period. Additionally, the medicines used for conscious sedation impair judgment and reflexes and cause variable degrees of drowsiness. For this reason patients are monitored by a Registered Nurse in Surgical Services until they have returned to near baseline. Outpatients must have a family member or other responsible adult to provide transportation home. You should not make important decisions, operate dangerous equipment or drive for eighteen hours after the procedure.
Because of the need to place the probe into the mouth and esophagus patients may occasionally experience mild throat discomfort for a day after the procedure. The entire procedure requires approximately 90 minutes to complete. The majority of this time will encompass explanation of explaining the procedure, obtaining informed consent, starting an IV for administration of medicine and observation following the procedure. The probe is in place for an average of 15 minutes.
What is Transesophageal Echocardiography Used For?
Transesophageal echocardiography provides a superior resolution of many structures of the heart not attained with transthoracic echocardiography and in some instances not attained with any other diagnostic test. Anatomically, the esophagus connects your mouth down with your stomach. In doing so it is adjacent to your aorta (the main blood vessel leading from the heart) and the left atrium of the heart. Because of the proximity of and lack of interference from the chest wall or lung, the resolution of the pictures obtained is substantially greater than that from transthoracic echocardiography. Additionally, because the probe is behind the left atrium of the heart the image of the mitral valve is enhanced.
A common indication for performing a transesophageal echocardiogram is to look for masses or clots in the heart. Because the ultrasound probe is now separated from the heart only by the wall of the esophagus, the accuracy for finding a clot inside the heart is increased dramatically. Specific times in which a transesophageal echocardiogram is necessary and cannot be replaced by other tests include, evaluation of artificial mitral valves, looking for clots inside the left atrium or other causes for a patient to have had a stroke, evaluation of the aorta which may have been damaged by atherosclerotic disease or a tear in its lining (aortic dissection) or infections in the heart.