A consultation with a cardiologist involves taking a thorough history and performing a physical examination to assess overall cardiovascular risk and provide a plan to reduce one’s risk. In addition, the cardiologist will see patients for the evaluation of symptoms and findings such as palpitations, chest discomfort, hypertension, diabetes, and high cholesterol, shortness of breath, dizziness, and fainting.
An electrocardiogram, also known as an EKG, is a simple test that looks at the electrical activity of your heart. It is useful as a screening test for the detection and diagnosis of a broad range of cardiac conditions. Electrocardiography is useful in evaluating if there is any heart damage, cardiac rhythm disorders, metabolic abnormalities, and enlargement of the heart muscle.
An echocardiogram is a painless non-invasive test that uses ultrasound to image the heart muscle, valves, and chambers. A technologist will place a probe over various areas of your chest. Blood flow through the valves will be evaluated as well as the overall pumping motion of the muscle. There is no preparation for this 30 minute test.
Bubble Study: If an echo with bubble study is ordered, an IV is started and harmless micro bubbles are injected into the IV during the echocardiogram. This allows an alternative and thorough evaluation of blood flow in patients with stroke symptoms or congenital heart disease.
A vascular ultrasound is a painless non-invasive test that looks at veins and arteries for dilation, narrowing, plaque or blood clots.
A carotid ultrasound evaluates the neck arteries for plaque that could cause a stroke.
Venous, Arterial Ultrasound
Venous and arterial ultrasounds evaluate circulation in the arms and legs. A venous ultrasound is a painless test used to detect DVT (deep vein thrombosis) whereas an arterial ultrasound is used to detect PVD (peripheral vascular disease). A technologist moves a probe over the areas of interest to evaluate vessels and blood flow. There is no preparation for these 30 minute tests.
Abdominal Aorta Ultrasound
The abdominal aorta is evaluated to rule out an aneurysm (AAA). This is a painless non-invasive test that takes approximately 15 minutes. Preparation requires no food or drink except water 4 hours prior to the test. You may take your medications.
“Holter” Electrocardiographic Monitoring
A Holter monitor is a small device that is worn for 24 or 48 hours and records every heart beat in that time period using. It is used to evaluate symptoms of palpitations, skipped beats, dizziness, or arrhythmias. During the monitoring period, you may be asked to keep a diary of your symptoms to see if there is a correlation with an abnormal heart rhythm.
Event monitors are similar to Holter monitors. It is a small device worn for periods longer than 48 hours and is used to evaluate symptoms of palpitations, skipped beats, dizziness, or arrhythmias. Unlike Holter monitors though, event monitors don't continuously record the heart's electrical activity. For many event monitors, you need to start the monitor when you feel symptoms.
These tests are performed in individuals with chest discomfort, indigestion, shortness of breath, a history of smoking, high blood pressure, diabetes, a family history of heart disease, high cholesterol, or an abnormal level of blood lipids, and those with lightheadedness or dizziness.
Exercise Treadmill Testing
This test involves walking on a treadmill at increasing speed and elevation while your blood pressure, heart rate, and electrical activity of your heart are monitored for any changes. Most patients will walk an average of six to ten minutes. Preparation requires no caffeine intake for 24 hours prior, and nothing to eat for 4 hours prior to the test. Closed-toe, flat shoes are also required.
Exercise Echocardiography / Stress Echo
This test includes exercise treadmill testing with the addition of ultrasound imaging of the heart at rest and immediately post-exercise. At first, a complete echocardiogram of your heart is done in the resting state.
Once your peak exercise is obtained and your target heart rate achieved, images of your heart will again be taken with the ultrasound.
Nuclear Exercise Testing
Also known as exercise myocardial perfusion imaging, this test includes exercise treadmill testing and determines the degree and location of compromised blood flow to the heart as well as pumping function and existence of scarred heart tissue and results in important diagnostic and prognostic information. Healthy heart muscle, receiving normal blood flow, will accumulate more imaging agent than cardiac muscle supplied by diseased coronary arteries. The nuclear exercise test is used to determine the need for further angiographic procedures, to avoid unwarranted hospital admissions or discharges, and to assess for long term prognosis.
Adenosine Stress Testing
This is a “stress” test for individuals who cannot walk adequately to undergo a treadmill test. It is a type of nuclear stress test or myocardial perfusion imaging with a medication that is given intravenously instead of walking or in conjunction with limited walking on the treadmill.