Patient Services

What is a Carotid Sonogram?
A Carotid sonogram provides images of the carotid arteries, located on both sides of the neck.  The test measures the velocity of the blood flow through these arteries to screen for plaque buildup.  This test is designed to assess the risk for stroke and TIA, most commonly caused by carotid artery stenosis.  Early detection & treatment can help decrease the possibility of stroke.  Carotid sonography is also a useful tool to evaluate other cardiovascular diseases.

How the test is performed:
The technologist applies a water soluble acoustic gel on your neck over your carotid arteries. A painless instrument, a transducer, is moved around your neck to visualize the inside of the carotid artery.  An ultrasound monitor visually depicts the inside of the carotid artery and the rate of blood flow.
How to prepare for the test:
There is no special preparation for the test. 

How the test will feel:
The screening is painless and non-invasive.  The acoustic gel may initially feel warm when applied to your neck. 


What is an Echocardiogram?
An Echocardiogram is a test that uses sound waves to create moving pictures of the heart. The picture is much more detailed than x-ray image and involves no radiation exposure.  This test is designed 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.

How the test is performed:
A trained sonographer performs the test, then your physician interprets the results. An instrument that transmits high-frequency sound waves called a transducer is placed on your ribs near the breast bone and directed toward the heart. The transducer picks up the echoes of the sound waves and transmits them as electrical impulses. The echocardiography machine converts these impulses into moving pictures of the heart.

Echocardiography  works well for most patients, allowing doctors to see the heart beating and to visualize many of the structures of the heart. Occasionally, because the lungs, ribs, or body tissue may prevent the sound waves and echoes from providing a clear picture of heart function, the sonographer may administer a small amount of a ultrasound contrast agent through an IV to better see the inside of the heart.

How to prepare for the test:
There is no special preparation for the test.

How the test will feel:
You will be asked to disrobe from the waist up and will lie on an examination table on your back. Electrodes will be placed onto your chest to allow for an ECG to be done. A gel will be spread on your chest and then the transducer will be applied. You will feel a slight pressure on your chest from the transducer. You may be asked to breathe in a certain way or to roll over onto your left side.

What are Peripheral Vascular Studies?
There are a number of peripheral vascular studies.

Peripheral Arterial Studies

Doppler ultrasound and segmental blood pressure evaluation provide information related to severity of vessel disease in the arms or legs.  It allows for accurate assessment of blood flow, plaque buildup, dilated (aneurysmal) segments in the extremities and other abnormalities.

Duplex testing is also used to evaluate the effectiveness of peripheral bypass and hemodialysis access grafts, which allows for identification of graft stenosis prior to occlusion.

Peripheral Venous Studies
Duplex ultrasonography is an effective way to evaluate the deep and superficial venous system for thrombosis.

Deep vein thrombosis (DVT) can be diagnosed with a very high rate of accuracy, and serial examinations allow for assessment of thrombus propagation.
Air Plethysmography (APG) can be used for the evaluation of chronic venous insufficiency.  Chronic venous insufficiency may lead to valvular incompetence causing varicose veins, hyperpigmentation of the skin and, ultimately, venous ulceration.  APG can identify the etiology of this condition, allowing the clinician to direct treatment appropriately.

Carotid Artery Studies
Duplex ultrasound technology provides a noninvasive, highly accurate and safe method to evaluate the carotid arteries for plaques and degree of stenosis.  A high degree of blockage is a risk factor for stroke.  Carotid stenosis is also a marker for coronary artery disease and is therefore an excellent prescreening tool.

Abdominal Vascular Studies
Ultrasonography can be used to assess several vascular structures in the abdomen. The aorta and iliac arteries can be evaluated for presence of aneurysms.  Repeated studies over time may be used to evaluate diameter change in a cost-effective manner. Stenosis of the renal arteries, causing renovascular hypertension or renal insufficiency, can be detected. Stenosis of the mesenteric arteries, causing post-prandial pain and weight loss, can be detected. Evaluation of the inferior vena cava, iliac, hepatic and portal veins can be performed to assess flow and level of obstruction.


What is a Exercise Treadmill Test?
A Exercise Treadmill Test, otherwise known as a Stress Test, is a general screening tool to test the effect of exercise on your heart. The test gives a general sense of how healthy your heart is.  During the test, the electrical activity of the heart is measured while you walk on a treadmill. This measures the heart's reaction to your body's increased demand for oxygen.

How the test is performed:
You will be asked to walk on an exercise machine.  An electrocardiogram (ECG) is used to record the activity of your heart, and blood pressure readings are taken. The response of the heart to this increased workload is monitored.  The test continues until you reach a target heart rate, unless complications such as chest pain or an exaggerated change in blood pressure develop with activity.  Monitoring continues after exercise for 10 to 15 minutes or until the heart rate returns to baseline.

How to prepare for the test:
Do not eat, smoke, or drink beverages containing caffeine or alcohol for 3 hours before the test.
Continue all medications unless instructed otherwise.
Wear comfortable shoes and loose clothing to permit exercise.
Tell your doctor if you are taking sildenafil citrate (Viagra, Levitra or Cialis) and have taken a dose within the past 24 hours. A medication called nitroglycerin, which is sometimes given during a stress test to relieve chest pain, should not be given to a person who has recently  taken Viagra, or a drug like Viagra, because it can cause a serious drop in blood pressure.

How the test will feel:
Electrodes (conductive patches) will be placed on your chest, arms, and legs to record the heart's activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.
The blood pressure cuff on your arm will be inflated every few minutes, producing a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before exercise starts.

You will start walking on a treadmill. The pace of the treadmill will be increased.

What is a Holter & Event Monitor?

Holter monitoring or Event Monitoring provides a continuous recording of heart rhythm during normal activity. The monitor is usually worn for 24 hours to obtain a recording of a complete day however, your physician may request that you wear it for a 48 hour period.

How the test is performed:
Electrodes (small conducting patches) are placed on your chest and attached to a small recording monitor that you can carry in a pocket or in a small pouch worn around your neck. The monitor is battery operated.
Your heart electrical activity is recorded (much like the recording of an ECG), usually for a 24-hour period while you keep a diary of your activities. The recording is then analyzed, a report of the heart's activity is tabulated, and irregular heart activity is correlated with your activity at the time.
It is very important that you accurately record your symptoms and activities so that the doctor can correlate them with your Holter monitor findings.

 How to prepare for the test:
There is no special preparation for the test. The recording monitor will be started by the health care provider, and you will be given instructions on how to replace electrodes should they become loosened. Instructions will also be given on how to record activity for the diary.
Tell your doctor if you are allergic to any tape or other adhesives. Shower or bathe before you start the test -- you will not be able to do so while you are wearing a Holter monitor.

How the test will feel:
There is no discomfort associated with the test. Hair may need to be shaved from the chest for electrode placement. You must keep the monitor close to the body, either in a pocket or in a pouch worn around the shoulder or neck.
Continue normal activities while wearing the monitor.


What is a Nuclear Exercise Treadmill Test?

Nuclear Exercise Treadmill Test ( nuclear stress test) lets doctors see pictures of your heart while you are resting and shortly after you have exercised. The test can give information about the size of the heart's chambers, how well the heart is pumping blood, and whether the heart has any damaged or dead muscle. Nuclear stress tests can also give doctors information about your arteries and whether they might be narrowed or blocked because of coronary artery disease. 

This test is similar to the standard treadmill exercise test. Your doctor will give you a small amount of a radioactive substance (sestamibi or thallium) just before the end of the exercise part of the test. This radioactive substance is not harmful to your body or your organs. The results of the nuclear stress test can show doctors if the heart is not working properly while you are resting, exercising, or both. If the test shows that blood flow is normal while you are resting but not normal while you are exercising, then doctors know that your blood flow to your heart is not adequate during times of stress. The heart normally pumps more blood during times of physical exertion. If the test results are not normal during both parts of the test (rest and exercise), part of your heart is permanently deprived of blood or is scarred. If doctors cannot see the radioactive substance in one part of your heart, it may mean that a section of heart muscle has died, either because of a previous heart attack or because the coronary arteries supplying blood to that area of the heart are blocked.  Pharmacological testing with Dobutamine or Adenosine is performed in patients who are physically too weak or debilitated to walk on the treadmill.

 
How the test is performed:
Just like the exercise stress test, you will have small metal disks called electrodes placed on your chest and back. The electrodes are attached to leads, which are attached to an electrocardiogram machine. Doctors will then have you walk on a treadmill.

After your doctors have the information they need from the exercise part of the test, you will step off of the treadmill and go into another room. You will be given an injection of a radioactive substance, and you will be asked to lie on an examination table, which has a gamma-ray camera above it. The camera is used to take pictures of your heart. The camera can pick up traces of the radioactive substance in your body and then send a picture to a television monitor.

After this part of the test is over, you can leave the testing area for 3 or 4 hours. Doctors will ask you not to exercise or drink or eat anything with caffeine, such as coffee, tea, sodas, or chocolate. When you return, doctors will give you another injection of the radioactive substance. You will be asked to lie down on the examination table, and the gamma-ray camera will take pictures of your heart while you are resting. This will give your doctor an idea of how your heart works during both exercise and rest.

After the test is over, you may eat, drink, and go back to your normal activities right away.

 How to prepare for the test:
Patients are generally asked not to eat or drink anything for four to six hours before the test, and to wear comfortable clothes/shoes for exercising.
How the test will feel:
Electrodes (conductive patches) will be placed on your chest, arms, and legs to record the heart's activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.

The blood pressure cuff on your arm will be inflated every few minutes, producing a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before exercise starts.

You will start walking on a treadmill or pedaling a stationary bicycle. The pace of the treadmill will be increased.  Aside from some possible discomfort as the radionuclide substance is injected (twice),this is a painless test.