Myocardial perfusion images are combined with exercise to assess the blood flow to the heart muscle. Exercise is in the form of walking on a treadmill. In the event that a person cannot exercise on the treadmill, a chemical stress test is performed using the drug dipyridamole, adenosine, or dobutamine.

A small amount of imaging agent (Cardiolite or Thallium) is injected into the blood stream through a vein in the arm during rest and during exercise or chemical stress. A scanning device is used to measure the uptake of the imaging agent by the heart. If there is a significant blockage of a coronary artery, a decrease in blood flow will be detected and subsequently demonstrated by abnormalities of the images (pictures) obtained by scanning the heart.

Nuclear cardiology studies also evaluate how well the heart muscle pumps. In patients with coronary artery disease and in those who have had a heart attack, the assessment of the pumping function of the heart (also known as the ejection fraction) is essential in the prediction of both long term and short- term survival.

• Wear comfortable clothing and footwear. Such as: slacks, shorts, jogging suit and tennis shoes for walking. Women should be sure to wear separate top and bottom.
• All patients may take blood pressure medications with enough water to get the pill down. Bring all other medications with you.
• Nothing to eat after midnight unless you are diabetic. Diabetics may eat a light breakfast before 6:00am and may take ½ of insulin dose and bring the rest of the insulin with you. Bring all other medications with you also.
• No caffeine (coffee, tea , chocolate or colas/soft drinks containing caffeine)
• The nuclear stress test is in two parts. The first part will take approximately one hour. This includes preparation, the actual exercise and the first scan. You will be allowed to leave and return in three hours for the second scan, which should take 15-20 minutes.
• Please do not bring small children with you to wait during your procedure.
• Our lab orders the imaging agent from a pharmacy the afternoon before your test and they will not allow us to return unused dosages. If you find that you are not able to keep your appointment and must cancel, our office must receive 24 hours advance notice or the cost of the imaging agent may be passed on to you.

While the patient walks on the treadmill, the electrical impulses of the heart are recorded. During the test, patches with wires are applied to the chest and connected to the ECG monitor. Comfortable clothing and comfortable footwear are recommended for this test.

Stress echocardiogram combines a treadmill stress test with an echocardiogram to produce images following exercise. The test is another method of evaluating an individual for blocked arteries and abnormal heart function. Please wear comfortable clothing and comfortable footwear.

  Procedures Performed in a Cardiac Catheterization Lab in the Hospital

Cardiac catheterization is performed in a cardiac catheterization lab in the hospital. A cardiac catheterization is an x-ray study of the heart to diagnose coronary artery disease, valvular heart disease and cardiomyopathy (heart muscle disease). Coronary artery disease is any abnormal condition of the arteries in the heart that interferes with the flow of blood to the heart muscle. Most coronary artery disease is caused by a build up of atheroma (fatty material) in the artery walls. This development and accumalation in the arteries is called atherosclerosis.

During cardiac catheterization, your cardiologist inserts a long, thin tube into a blood vessel in the upper leg (groin) or the arm. The tube is gently directed to the heart and to the origin of the coronary arteries. Liquid contrast containing iodine is then injected into the coronary artery while x-rays are taken. The contrast is seen in the coronary arteries as a white line and any disruption in the white line may indicate fatty buildup inside the artery walls.

During the same procedure, contrast may be injected into the heart’s pumping chambers to see how well the heart muscle is contracting and to see how well the valves are working. Pressure measurements are also taken and interpreted by a computer and subsequently reviewed and analyzed by your cardiologist.

Your cardiologist may recommend coronary angioplasty (PTCA) to improve blood flow if the cardiac catheterization reveals a blockage or restriction in the blood flow in a coronary artery.

P – percutaneous; means accessing the blood vessel through the skin

T – transluminal; means the procedure is performed within the blood vessel

C – coronary; identifies that the coronary artery is being treated

A – angioplasty; means“to remodel”the interior of the blood vessel with balloon inflation

Your cardiologist performs balloon angioplasty during cardiac catheterization by inserting a small tube with a balloon into the narrowed coronary artery and inflating the balloon to open the blockage in the coronary artery.

After balloon angioplasty, your cardiologist may decide to place a stent. Stent placement is performed to keep the artery open following balloon angioplasty. A stent is a scaffold placed over a delivery balloon catheter and positioned in the narrowed site of the artery. The stent is implanted in the artery wall by inflating the stent delivery balloon. The stent delivery balloon catheter is then removed and the stent remains to hold the artery open.

• Do Not Eat or Drink anything after midnight the night before your procedure. The morning of the procedure you may drink just enough water to take your morning medications.
• Bring all your medications to the hospital with you.
• Bring a pair of slippers and a robe. Pack a small bag in case you need to stay the night.
• Make arrangements for a friend or family member to bring you to the hospital and to drive you home. It is preferred that someone stays with you while you are at the hospital and stays with you at your home during the night after your procedure.
• Bring your insurance cards with you to the hospital.
• Leave all valuables at home. Remove all fingernail and toenail polish.
• Do not bring small children with you to wait during your procedure.
• Please call our office if you have any questions.