The following is a list of cardiac tests that your doctor may order while you are in the hospital. During any of these tests, if you feel any unusual symptoms, such as chest pain, dizziness or shortness of breath, let your technician know. After your test is finished, your doctor will review your results with you and decide if any further tests or treatments are needed.
An electrocardiogram is a test that measures heart rate and rhythm. It also can measure the type of heartbeat that you are having. It can spot possible blockages and show if you are having or have had a heart attack.
The test is painless and only takes a few minutes to perform. You will need to relax, lie on your back (if able) and tell the technician if you are having any discomfort. An EKG technician will apply small electrodes (sticky pads) on your chest, legs and arms. You will lie still, and the EKG machine will print a copy of your EKG. No special preparation is needed for this test.
Signal Average EKG
This also is an electrocardiogram but may take a little longer for the EKG technician to perform. This test gives more detailed information regarding your heart rate and EKG pattern than a regular EKG. No special preparation is needed for this test.
Holter Monitor (24 or 48 hour)
A Holter monitor is a test that can measure heart rate, rhythm and type of heartbeat by recording your heart’s electrical pattern over a period of 24 to 48 hours. This test can help by showing any abnormal rhythms, heart rate or missed beats (palpitations). An EKG technician will apply small electrodes on your chest after cleaning your skin with alcohol pads.
Men may have some chest hair shaved. The electrodes are connected to a small recorder that you carry with you during the test.
No special preparation is needed for this test. Do not take a bath or shower while wearing this monitor, as this could harm the test results. You may be given a diary to write down any symptoms that you have while wearing the monitor.
An echocardiogram (echo) uses sound waves to make a moving picture of your heart. This test will help evaluate the blood flow, valve movement and pumping action of your heart.
You will lie quietly on a bed and the technician will perform the test. Gel will be applied to your chest, and the technician will gently guide a small probe (looks like a microphone) over your chest to obtain pictures. You may feel slight pressure on your chest as the technician moves the probe. No special preparation is needed for this test.
Treadmill (Stress Test)
The treadmill test evaluates what your heart does during activity and if enough oxygen is getting to your heart muscle during exercise. Heart rate, rhythm and blood pressure are monitored during the entire test. EKG electrodes (sticky pads) are placed on your chest, and a blood pressure cuff is wrapped around one of your arms. You will be asked to walk on a treadmill. As you do, the speed and slope will increase. You will probably walk less than 15 minutes, but the total length of the test may be longer.
Preparation for a Stress Test:
- Some of your medications may be restricted before your test.
- Do not eat foods or drink beverages that contain caffeine, even if they say “caffeine-free.” Caffeine is found in chocolate, tea, coffee and soda.
- Your food will be restricted before the test.
- Wear sturdy walking shoes.
- Discuss any concerns with the nurse or doctor performing your test.
During and After the Test:
- Let your doctor or nurse know if you are having chest pain, dizziness or other symptoms.
- Once you have finished walking, your EKG and blood pressure will be checked for several more minutes while you are resting.
Pharmacological (Drug) Stress Test
If you and your doctor have decided that you are unable to walk for a regular treadmill test, you will lie on a bed in the stress lab. You will receive an IV and be given medication. The medication will raise your heart rate, similar to exercise.
Your heart rate, rhythm and blood pressure will be monitored throughout the test. It is important to let your doctor or nurse know if you are having any symptoms, such as chest pain, dizziness or shortness of breath.
You may or may not be able to take all of your medications before the test. There will be food restrictions and no caffeine for 24 hours.
Isotope Stress Test
An IV is started in your arm before your treadmill stress test. A chemical called an isotope (radioactive substance) will be put in the IV during the test. The isotope sticks to your blood cells and will help show images of your heart and how much blood gets into your heart muscle.
At the end of your stress test, you will be taken to the Nuclear Medicine department to scan pictures of your heart muscle. You will lie quietly on a stretcher, with a camera overhead. You may be scanned twice with this procedure, in the same day or two days in a row. If a shadow is seen on your heart muscle picture, it means no blood went to that part of the muscle. The scan will give your doctor additional information concerning your heart.
You may not be able to take all of your medications before the test. There will be food restrictions and no caffeine for 24 hours.
Stress Echocardiogram (Stress Echo)
This test combines a stress test procedure and an echocardiogram. An echo is performed before and after your stress test. An echo test uses sound waves that show your heart’s activity at rest and after exercise. In addition to the stress test, this will help your doctor see if there are any changes in your heart muscle after exercise. Your doctor will decide if your heart is getting enough oxygen and if the heart valves are working properly.
You will have some restrictions with medications, food and caffeine before this test.
Dobutamine Stress Echo
This test combines a pharmacological (drug) stress test and an echocardiogram. The medication will cause your heart muscle to pump faster, similar to exercise. If you and your doctor have decided that you are unable to walk for a regular treadmill test, you will lie on a bed in the stress lab. You will receive an IV and be given medication.
An echo test is performed before the IV is started, as well as after the medication is given. This will help your doctor see if there are any changes in your heart muscle and if your heart is getting enough oxygen.
You will have some restrictions with medications, food and caffeine before this test.
Transesophageal Echo (TEE)
This test is a more detailed echocardiogram. You will have an IV started and lie in a hospital bed. Your throat is sprayed and will be numb. A mild sedative is given and you may sleep through this test.
Your doctor will gently put a small, flexible, lubricated tube into your mouth and down your esophagus (swallowing pipe). You’ll be able to breathe normally. The end of this tube has a small probe that can provide echo images. The tube can be moved around slightly to see your heart at different angles. You should feel little or no discomfort with this procedure. Your heart rate, blood pressure and breathing will be monitored during this test.
Preparation for a TEE:
- Do not eat or drink after midnight the night before the test.
- You may take your regular medicines with a small amount of water (1/4 cup or less) before the test.
- If you have dentures, they are removed before the test is started. The nurse will help you with them after you are awake.
- If you have sleep apnea please bring CPAP machine tubing and mask. Please put your name on the CPAP machine.
- You will not be allowed to eat or drink until the medicine used to numb your throat wears off. This usually takes 30 to 60 minutes.
- You may not drive yourself home after your test. Before coming for your test, arrange for someone to take you home afterwards.
The tilt table test checks if changes in your body position affect your blood pressure. This test often is given to people who have fainted and may bring back fainting symptoms.
- Your heart rate and blood pressure are monitored for any changes. An IV will be started, and you may receive additional medication during the test.
- You are placed on a table that is slowly tilted upward, and you will be upright for part of the test. You are held securely in place by large, seatbelt-like straps on the table.
- You will have food, caffeine and possibly medication restrictions before this test.
Cardiac CatheterizationUnderstanding Your Heart” for a description of coronary arteries.) A soft, hollow tube is threaded up to the heart through an artery in your leg or arm. The catheter carries dye that is released in a coronary artery so X-ray pictures can be taken to reveal areas that are clogged or narrowed. The doctor can see, on an X-ray screen, the exact spot where the artery is blocked.
The doctor also will be able to measure:
- pressures inside the heart.
- how well the valves of your heart are working.
- how well the muscle of your heart contracts and pumps. This is called an ejection fraction. A normal ejection fraction is 50 percent to 70 percent.
Before your cardiac catheterization procedure, you will:
- need to notify your physician or nurse if you are allergic to shellfish or iodine.
- not eat or drink anything after mid night, except for your medications with a small sip of water.
- empty your bladder before you leave your room or holding area.
- be asked to sign a consent form that lets us know that you understand the procedure and the risks and benefits.
- have blood work drawn and your medical history checked by the staff admitting you.
- be given an aspirin if you have not already taken one.
- be taken to the procedure room, where two to three staff members will be working for you.
During your procedure, you will:
- be placed on a heart monitor, have a clip placed on your finger or toe to read the level of oxygen in your blood and a blood pressure cuff placed on your arm that will inflate automatically.
- have the hair shaved at the area where the doctor will be working. This area could be the groin or arm. The groin is the most common site.
- have this area cleaned with a special soap and covered with a sterile sheet.
- be asked to keep your arms under the sheet and not to bend or move your legs.
- be given medicine through your IV to help you relax. You may become very sleepy.
- be given a local anesthetic (numbing medicine) by the doctor to numb the area where he or she will be putting catheters into the artery. Once the medicine takes effect, you should not feel any pain. You may feel dull pressure where the doctor is working with the catheters. The doctor will inject dye into the coronary arteries, once the catheters are in place. The doctor will be able to see any blockages on the X-ray screen.
- feel warm all over from the dye. This feeling will only last for 10 seconds.
- not feel the catheter because you do not have nerve endings in the coronary arteries.
If your coronary arteries are normal, you will not need further treatment. If blockages are found, your doctor may recommend that you have an angioplasty or a stent procedure to open the blockages. These procedures often can be performed at the time of the angiogram. The doctor also may recommend coronary artery bypass surgery and/or medical treatment for blockages found.
After your cardiac catheterization procedure, you will:
- be moved to a recovery area.
- be placed on a heart monitor, automatic blood pressure cuff and oxygen monitor (a finger clip).
- be asked to empty your bladder.
- have the catheter removed from the artery and have firm pressure applied for 10 to 20 minutes. This is to prevent bleeding.
- have your blood pressure and pulses in your feet checked by a nurse every 15 minutes for the first hour.
- have a bandage applied to the insertion site. You may have a closure device at the site where the doctor did the procedure if the artery is big enough and the doctor thinks it is appropriate. You will be given written information on this.
- need to tell the staff right away if you feel a warm, wet feeling at the catheter site; you could be bleeding.
- be on bed rest for four to six hours. If a closure device is used, bed rest will be only one to two hours.
- need to drink a lot of fluids to help flush the dye out of your body.
- need to put your hand over the bandage and press firmly if you need to cough or sneeze.
- possibly have a bruise at the site; this is normal.
- possibly feel a lump at the site. If the lump is walnut size or bigger, let the nurse know.
- have pain medicine available.
- go back to your room. At the time of discharge, you will be given instructions for what to do when you go home: eating, activities, care of the catheter site, medications, etc.