Electrocardiogram (ECG)

Electrocardiogram (ECG)

What Is It?
Also known as EKG, ECG is a diagnostic procedure that determines the heart’s electrical activity. ECG also helps in detecting recent heart attacks.
How Is It Done?
ECG is safe and painless. The procedure takes 10 to 15 minutes. During ECG, the examiner will attach tiny electrodes to the skin, particularly in the chest, ankles, and wrist. She will ask you to remain still while she runs the procedure. When done, the result of the test comes out readily available.
How Should I Prepare for It?
1 – People who have hairy chests may require shaving for electrode attachment. 2 – Avoid putting emollients or heavy creams onto the skin. Creams and oils outstrip the electrodes.

Exercise treadmill test (ETT or TMX)

What Is It?
Exercise Treadmill Test (ETT) is a method of cardiac monitoring during exertion. It investigates whether there is a blockage or narrowing in your coronary arteries.
How Is It Done?
The procedure takes 20 to 30 minutes. First, the examiner will check your vital signs. Then, she will attach tiny electrodes onto the chest, which connect to an ECG machine. The device will monitor your heart’s activity while you exercise on a treadmill. The treadmill will start slow until it increases its speed and resistance. It will also slope after a few minutes to evaluate your heart under increasing stress.
How Should I Prepare for It?
1- Wear comfortable clothing and footwear. 2 People who have hairy chests may require shaving for electrode attachment. 3 – Avoid heavy meals 2 to 3 hours before the test. 4 – Notify your doctor if you are on any medication, particularly heart medications. Some drugs influence the test results.  

Exercise stress echocardiography (ESE)

What Is It?
Exercise Stress Echocardiography (ESE) examines the heart using an ultrasound probe before and after exercising on a treadmill. ESE investigates the cause of breathlessness or chest pain during exertion. It also checks if the heart muscles contract properly or whether the heart receives an adequate supply of oxygen during extreme activity.
How Is It Done?
The procedure takes 45 minutes. You will be in a supine position. The examiner will check your heart by placing a transducer on your chest with gel. After that, you will exercise on a treadmill to stress the heart. The treadmill will start slow until it increases its speed and resistance.It will slope after a few minutes to assess your heart under the maximal workload. After reaching the maximal workload, the treadmill terminates, and the examiner re-scans your heart.
How Should I Prepare for It?
1- Wear comfortable clothing and footwear. 2 – Avoid heavy meals 2 to 3 hours before the test. 3 – Notify your doctor if you are on any medication, particularly heart medications. Some drugs influence the test results.

24 hour ambulatory blood pressure monitoring

What Is It?
24 Hour Ambulatory Blood Pressure Monitoring is blood pressure monitoring for 24 hours, day and night, in the comfort of your home.The test aims to monitor and record blood pressure continuously and accurately. It is the gold standard for assessing if you have high blood pressure.
How Is It Done?
The clinician will wrap the blood pressure cuff around your arm and the recorder to your waist. The machine takes blood pressure every 15-30 minutes, although the timings can be variable and adjusted. Then, you will record the readings and if there are any uncommon symptoms during the 24-hour observation.
How Should I Prepare for It?
There is no special preparation needed for the test.
24 hour ambulatory blood pressure monitoring

Dobutamine stress echocardiography (DSE)

What Is It?
Dobutamine Stress Echocardiography (DSE) checks the heart function and oxygen supply while the heart undergoes physical strain.The procedure detects coronary artery disease, heart valve problems, and muscular changes following a heart attack. DSE is for people who are unable to perform stress echo on a treadmill due to health conditions, arthritis, or restricted mobility.
How Is It Done?
A nurse will check your vital signs and weight. She will also place a cannula in your arm and run an infusion drip containing dobutamine. Dobutamine is a drug that stimulates the heart’s activity, imitating the effects of physical effort. The doctor and nurse will titrate the infusion carefully until you achieve your target heart rate. Your heart’s activity and blood supply are continuously monitored throughout the entire duration of the procedure. Following the test, you will stay in the clinic for 20 minutes to monitor your vital signs or until the effect of the drug wears off.
How Should I Prepare for It?
1 – Avoid heavy meals 2 to 3 hours before the test. 2 – Notify your doctor if you are on any medication, particularly heart medications. Some drugs influence the test results.

24-hour holter ECG monitor (can aso be done over multiple days)

What Is It?
24-Hour Holter Monitor is a tiny device that checks and records the heart’s electrical activity continuously for 24 hours. It is an investigatory test to assess palpitations and dizziness. It also evaluates the functionality of cardiac devices, such as pacemakers or defibrillators.Moreover, the Holter monitor determines how well cardiac medications are working in controlling your symptoms. The device should be worn at all times and not to be removed even during sleep.
How Is It Done?
A technician will fit the device for you. She will attach electrodes on your chest and place the Holter monitor around the waist or neck. The technician will explain how to use the device and record your symptoms.
How Should I Prepare for It?
1 – Shower before fitting a Holter monitoring device. The device should be with you at all times, unattached. 2 – Wear comfortable, loose clothing. 3 – People who have hairy chests may need shaving for electrode attachment. Also, do not put any cream, oil, or emollients.
Transthoracic echocardiogram

Transthoracic echocardiogram

What Is It?
Transthoracic Echocardiogram is the use of ultrasound (or sound waves) to check the heart’s function and activity. The procedure has various clinical indications and provides useful information about the heart, such as its size, valve problems, pumping strength, and presence of fluid in the heart.
How Is It Done?
The test takes 30 to 45 minutes. You will lie on your back or left side. The ultrasound probe is held against your chest wherein it transmits high-frequency sound waves and bounce off the heart showing the internal pictures of the heart. The examiner will navigate the probe to different regions on the chest to obtain specific images of the heart.
How Should I Prepare for It?
There is no special preparation required for the test. You can eat or drink before the procedure.

Cardiac event recorders

What Is It?
Cardiac Event Recorder is a portable device that records the heart’s electrical activity in an ambulatory setting. Unlike other ambulatory electrocardiographic monitors, a cardiac event recorder only works when you activate the device during the ”actual symptom”. It records abnormal heart rhythms and cardiac symptoms, and the recordings are forwarded and shared with your cardiologist.
How Is It Done?
A technician will fit the device for you and put electrodes on the chest. A cardiac event recorder can be placed around the wrist. Thus, there is no need for electrode attachment. The technician will provide you with full instructions on how to use the cardiac event recorder and how to send the recordings.
How Should I Prepare for It?
1 – Wear comfortable, loose clothing. 2 – People who have hairy chests may need shaving for electrode attachment. Also, do not put any cream, oil, or emollients.

Tilt table test

What Is It?
Tilt Table Test is a diagnostic test for unexplained fainting or light-headedness. It helps examine what causes the blood pressure drop or decrease in heart rate.
How Is It Done?
The examiner will place a cannula in your arm. She will also take your blood pressure and perform a baseline ECG. Next, you will lie on a table with safety straps. The examiner will move and tilt the table at various angles while your symptoms and vital signs are monitored. If your blood pressure and heart rate do not drop during the test, the examiner may administer a drug. If the drug lowers your blood pressure or heart rate, the test will end.
How Should I Prepare for It?
1 – Do not eat or drink 4 hours before the test. If the procedure is in an afternoon slot, take a light breakfast. 2 – Notify your doctor if you are on any medication, including herbal supplements. 3 – Consider having company on the day of the procedure. 4 – Avoid alcohol or caffeine 24 hours before the test. 5 – People who have hairy chests may need shaving for electrode attachment. Also, do not put any cream, oil, or emollients on.

Carotid intima-media thickness test

What Is It?
Carotid Intima-Media Thickness Test measures the extent of atherosclerosis or plaque formation in the carotid artery, particularly in the intima layer. Early detection and treatment of atherosclerosis reduce the risks of stroke and heart disease.
How Is It Done?
The procedure is performed using ultrasound. The doctor applies gel on the neck (carotid) region. The ultrasound probe is held against the area wherein it transmits high-frequency sound waves and bounce off the heart showing the internal images of the carotid artery.
How Should I Prepare for It?
1 – Wear comfortable, loose clothing. Avoid turtle necks or any top that covers the neck area. Also, do not wear dangling earrings and any other jewelry.

Cardiac computed tomography (cardiac CT)

What Is It?
Cardiac Computed Tomography (CT) is an imaging test that examines the heart using X-rays and a contrasting agent. It provides accurate and detailed images of the heart.
How Is It Done?
You will lie on a table, which moves towards the center of the machine. The sonographer will place a cannula where a contrasting dye will be injected to produce more defined images of the heart and coronary blood vessels.
How Should I Prepare for It?
1 – Notify examiner knows if you are allergic to iodine or shellfish. 2 – Wear loose, comfortable clothing.
Cardiac computed tomography (cardiac CT)

Coronary calcium score

What Is It?
Coronary Calcium Score measures the number of calcium deposits in the coronary arteries. The amount of calcified plaques in the heart arteries contributes to the Agatston Score, which determines your risk of having a stroke or heart attack.
How Is It Done?
The procedure involves the use of X-rays. Coronary Calcium Score test is similar to CT scanning, but less detailed and there is no need for contrast media.
How Should I Prepare for It?
1- Wear comfortable, loose clothing. 2 – Avoid caffeine, smoking, and strenuous activity on the day of the procedure.

Cardiopulmonary exercise test

What Is It?
Cardiopulmonary Exercise is an evaluation test to assess an individual’s fitness using measurement of breath gases during an exercise test.
How Is It Done?
The examiner will place electrodes on your chest to monitor your heart activity during exercise. You will also wear a special facial mask. You will then run on the treadmill with increasing resistance. The examiner will monitor, record, and assess your vital signs while doing the treadmill.
How Should I Prepare for It?
1- Wear comfortable, loose clothing and footwear. 2 – Avoid caffeine, smoking, and strenuous activity on the day of the procedure. 3– No eating 2 to 3 hours before the procedure.

Coronary angiogram

What Is It?
Coronary Angiogram is an interventional procedure that uses X-rays to examine for the presence of plaque in the blood vessels of the heart.
How Is It Done?
A coronary angiogram is a day-case procedure. It involves the use of local anesthesia. The surgeon will make a cut in the groin or arm, where the catheter passes going to the heart. When the catheter tip reaches its desired position, the surgeon injects some dye while X-ray films are taken and recorded.
How Should I Prepare for It?
1 – Notify your doctor if you are on any medication, particularly blood-thinning medications or anticoagulants.

Electrophysiological (EP) study

What Is It?
Electrophysiological (EP) Study. People with abnormal heartbeat and rhythm may undergo Electrophysiology (EP) to determine the cause of the arrhythmia. When the cause and origin of the abnormal heart rhythm are identified, the doctors may perform cardiac ablation.
How Is It Done?
The examiner will place electrodes on your chest to monitor your heart activity during the procedure. Using a local anesthetic agent, the cardiologist will make a cut in the groin, where the catheter passes going to the heart, inducing arrhythmia or abnormal heart rhythm. By stimulating the heart through catheters, it will detect which part of it generates abnormal heart rhythm.
How Should I Prepare for It?
Notify your doctor if you are on any medication, particularly heart drugs, blood-thinning medications, or anticoagulants.

Myocardial perfusion imaging (MIBI or PET)

What Is It?
Myocardial Perfusion Imaging is a diagnostic test that measures muscle strength and blood flow to the heart muscle. The procedure detects if there is narrowing or blockages in the arteries of the heart.
How Is It Done?
There are two ways to perform myocardial perfusion imaging – through exercise and medication. Myocardial Perfusion Imaging involves the use of radioactive material that the heart absorbs. Areas of the heart that consumes the radioactive material have good blood flow. While, the radioactive material doesn’t appear if there are narrowed arteries, damaged heart muscle, or regions with insufficient blood supply.
How Should I Prepare for It?
1 – Avoid caffeine, smoking, and strenuous activity on the day of the procedure. 2 – Notify your doctor if you are pregnant or expecting. 3 – No eating 3 to 4 hours before the test. 4 – Wear comfortable, loose clothing and footwear.

Permanent pacemaker (PPM) insertion

What Is It?
A permanent pacemaker is indicated for people with chronic heart rhythm problems, such as heart block, tachycardia-bradycardia syndrome, and atrial fibrillation with sinus node dysfunction.
How Is It Done?
The examiner will place electrodes on your chest to monitor your heart activity during the procedure. Using local anesthesia, your doctor will make a small cut on the left side of the chest where the pacemaker device is fitted, and the wires are inserted into a vein leading to the heart.
How Should I Prepare for It?
1- Notify your doctor if you are on any medication, particularly heart drugs, blood-thinning medications, or anticoagulants. 2 – You may need to fast before the test. 3- Consider transportation arrangements.
Coronary angiogram

Coronary angiogram

What Is It?
Coronary Angiogram is an interventional procedure that uses X-rays to examine for the presence of plaque in the blood vessels of the heart.
How Is It Done?
A coronary angiogram is a day-case procedure. It involves the use of local anesthesia. The surgeon will make a cut in the groin or arm, where the catheter passes going to the heart. When the catheter tip reaches its desired position, the surgeon injects some dye while X-ray films are taken and recorded.
How Should I Prepare for It?
1 – Notify your doctor if you are on any medication, particularly blood-thinning medications or anticoagulants.

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