Tests and Procedures

Imaging Services

The Chattanooga Heart Institute offers a wide range of imaging services. Because vascular disease does not just occur in the heart, we offer imaging services that allow doctors to detect vascular disease in any location of the body, sometimes even before symptoms occur.

Radiology

Radiology is the use of radiation to create an image of body tissues and organs. There are several forms of radiation testing available at the Chattanooga Heart Institute including x-ray, radiant dye, ultra-sound, and computed tomography (CT) scan. Once images are created, a radiologist and a cardiologist read and interpret the images to locate disease or injury and detect abnormalities.

Explanation of tests and procedures:

Amiodarone Clinic

Amiodarone is an antiarrhythmic medication used to treat conditions that affect the way the heart beats. Most commonly it is used to treat atrial fibrillation, a condition that causes irregular heart beats. The Amiodarone Clinic at The Chattanooga Heart Institute is set up for careful monitoring of patients using this medication to help avoid adverse side effects during treatment.

Anticoagulation Management

Coumadin, a prescription medication, is used to reduce the risk of blood clot formation that could possibly cause strokes or other serious health conditions. Potential candidates for this treatment include those who have irregular heartbeats (atrial fibrillation), have heart valve replacements and those who have had recent heart attacks.

Arterial (ALE/AUE) Examination

The arterial examination is a study to evaluate your arteries. By using high frequency sound waves to image the blood vessels, this test detects if any blockage exist within your arteries that might restrict blood flow. The test helps to determine the extent of the blockage and its location. Cuffs, similar to the ones used to determine blood pressure, will be placed on your arms and legs.

To prepare for the test, you will be asked to put on a patient gown. Wear tennis or walking shoes as you may be asked to walk on a treadmill for up to 5 minutes as part of your test. You will be asked to lie on your back so pressures can be taken of the artery. A gel applied during the procedure can be washed off with water. The test takes approximately 60 minutes.

Your test will be reviewed and the results sent to your physician who will then discuss them with you at your next appointment. If an abnormality is detected that requires immediate follow-up, your physician will be contacted immediately.

Cardiac Holter and Event Monitoring

Both of these tests use machines to monitor the rhythm of electrical currents that move from one part of the heart to another. Sensors are placed on the patient’s arms, legs and chest and are connected to an instrument that records the pattern of activity with a special tape recorder. Holter monitoring requires patients to wear the equipment for 24 to 48 hours and record a diary of activity. Event monitoring requires the patient to wear the equipment for 30 days. Patients have the ability to send information from event monitoring equipment to the hospital using a telephone receiver if severe symptoms occur.

Computed Tomography (CT)

Commonly called a CT scan or a CAT scan, this non-invasive procedure allows doctors to study cross-sections of soft tissues and organs. Our CT scanner uses cutting-edge technology to produce color, three-dimensional images of incredible clarity. Doctors use this detailed picture of a patient’s heart, veins, blood vessels and other organs to identify conditions such as coronary artery disease. The scan itself takes only about 30 seconds during which time the CT machine will take hundreds of images.

Echocardiography (Echo)

This procedure uses sound waves to take “moving pictures” of the heart. These images allow doctors to see a patient’s heart in motion. This test is painless and effective in establishing specific diagnoses and estimating the severity of cardiac diseases.

EKG (electrocardiogram)

An EKG is a non-invasive test that measures the electrical signals that control the rhythm of your heart. During an electrocardiogram you will rest on a bed or chair. Small metal discs called electrodes are attached to the skin on the chest and sometimes the arms and legs. Sometimes the areas where the electrodes are placed will need to be shaved by the technician to provide a clean, smooth surface on which to attach the electrodes. The electrodes are connected to a machine that translates the electrical activity onto paper. This report is then reviewed by a physician.

The heart is a muscular pump made up of four chambers. The two upper chambers are called atria, and the two lower chambers are called ventricles. An electrical system that occurs naturally causes the heart muscle to contract and pump blood through the heart to the lungs and the rest of the body. An EKG may show evidence of heart enlargement, signs of insufficient blood flow to the heart, heart rhythm problems, and changes in the electrical activity of the heart caused by an electrolyte imbalance.

Tell your health professional if you are taking any medications as certain medications can affect the results of the EKG. Remove all jewelry from your neck, arms and wrists. You will need to unbutton and possibly remove your clothing above the waist. If needed, you will be given a cloth or paper covering to use during the test. For best results, lie very still during the test and breathe normally. An EKG usually takes 5 to 15 minutes to complete. There is no risk associated with an EKG.

Enhanced External Counterpulsation (EECP) Clinic

This non-invasive treatment is beneficial for angina patients. It is administered by cuff wraps that fit around the patient’s calves, lower thighs and upper thighs. The cuffs are inflated and deflated to increase blood flow to the heart and reduce the work of heart muscles that pump blood into the arteries. Patients receive a series of five one-hour treatments over the course of seven weeks (totaling 35 treatments). These sessions are aimed at producing long lasting beneficial changes in the circulatory system.

MUGA (Gated Pool Study)

A MUGA examination allows your physician to calculate how well your heart is beating. This can then be used to determine the condition of the heart muscle and its response to any medication that is given.

When you arrive at our nuclear department, you will be given an injection of a medicine that will need to circulate in your body for 30 minutes. After this time, an IV will be started. You will be placed on a table under a camera and injected with a minute amount of radioactive material that will allow us to obtain images of your heart beating. (The radioactive tracer gives minimal exposure and is eliminated from the body in approximately 24 hours.)

The imaging process will take approximately 30 minutes. The entire study takes about 90 minutes.

Continue to take your scheduled medications if you are pregnant, or may be pregnant, or if you are nursing, tell your physician and technologist prior to the study. It is best for women of childbearing age to have the examination done during the first 10 days following the onset of the menstrual cycle.

Nuclear Cardiology

This test is performed in two phases and allows doctors to evaluate coronary blood flow. Patients begin by exercising on a treadmill. During this time, sensors attached to an electrocardiogram (EKG) are placed on the patient’s chest to monitor electrical activity in the heart. During exercising, the patient is injected with a low-level radioisotope. Doctors then use a special nuclear camera to take pictures of the heart. This test helps doctors pinpoint areas of the heart that aren’t getting enough blood and oxygen, determine the heart’s recovery time, detect irregular heart rhythms and to determine if the patient has had a heart attack.

Stress Echocardiography

Like with a regular echocardiography, sound waves are used to examine the heart’s movement. Four standard views of the heart are taken while the patient is at rest, and the same four views are taken after the patient performs an exercise treadmill test. The purpose is to make sure the heart is getting enough blood flow and oxygen when it is under stress—such as when the heart rate is increased during an activity like walking on the treadmill. These images help doctors discover and treat blockages and other conditions before they become serious or life threatening. Medication can be used to elevate the heart rate if a patient is unable to use the treadmill.

Thallium Stress Examination

The heart receives its blood from blood vessels called coronary arteries. If these arteries become partially blocked or narrowed by atherosclerotic heart disease or hardening of the arteries, the heart may not receive the blood it needs. At rest, the heart uses less blood than when it is working. We will be exercising your heart (which is why it is called a stress test) to determine if there is any decrease in blood flow to one area of the heart and how much heart muscle is involved.

This test will be performed when there is increased blood flow to your heart. This can be achieved through exercise or with the use of a medication. After you arrive for your test and answer a series of questions, a nurse will determine which type of stress test you will receive.

If you are having the exercise test, you will be connected to an EKG machine in a treadmill room and an IV will be started. You will then walk the treadmill, going as fast as you can, unless the doctor supervising stops you earlier. One minute before the exercise is stopped, you will receive an injection of radioactive material which will aid us in taking pictures of your heart.

If you are having a medicine stress test, you will lie on a stretcher and a medication will be injected to increase the blood flow to your heart. This medication will affect your heart as if it were exercising but it will not increase your heart rate. You will then receive an injection of radioactive material which aids in taking pictures of your heart.

With both the medicine and the exercise stress test, immediately after you finish your test you will lie under a special camera for approximately 30 minutes while a scan of your heart is done.

You will have a 3 to 4 hour break during which you may eat lightly, have something to drink, and take any medicine you may need. You may leave during your break but you must return for a second scan that will take about 30 minutes.

After both scans are completed, the doctor will compare the blood flow to your heart when it is working hard with the blood flow when it is at rest. This will allow the doctor to see changes that have occurred.

To prepare for the test, do not eat or drink anything except water at least 6 hours prior to the test. Do not have caffeine for 48 hours prior to the test. You will be able to eat after the first scan. If you are an insulin-dependent diabetic, call the Imaging Department at (423) 697-2328 for special instructions.

Because you will exercise, you should wear comfortable footwear and comfortable clothes, preferably slacks. For this portion of the test, you will need to undress from the waist up and put on a hospital gown so that the EKG patches can be applied to your chest.

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Regarding any medications you may be on, please follow these guidelines unless your cardiologist has instructed you otherwise.

If you have known coronary artery disease, have had angioplasty, PTCA, or bypass surgery, continue to take your medications the day before your test. Do not take medication the morning of your test but bring them with you so you can take them after the first part of the test.

If you are taking this test to determine if you have a problem with your heart, it is important that you do not take any medications the day of your test. If you are taking the medications listed below, follow these guidelines:

• Beta Blockers: do not take for 48 hours before the test
• Aminophylline/Theophylline products: do not take for 24 hours before the test.
• Calcium Blockers: do not take for 24 hours before the test.

Bring these and other medications with you so you can take them after the first part of the test.

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Your test will be reviewed and the results sent to your physician who will discuss them with you at your next appointment. The technologist cannot give out results.

If you are pregnant, or suspect you may be, a thallium stress exam may be inappropriate for you. Inform your doctor and the nuclear medicine technologist before undergoing the test. It is best for women of childbearing age to have the exam done during the first 10 days following the onset of the menstrual cycle. If you are nursing, it is important to inform your physician and the technologist performing the study.

Adverse reactions to thallium are extremely rare. The thallium that is administered during the stress examination is a radioactive tracer which gives minimal exposure and is eliminated from the body.

*Note: In certain circumstances, you may be changed to a Technetium stress examination which is similar to a Thallium stress examination except the testing period covers two days.

Transesophageal Echocardiography (TEE)

The transesophageal echocardiography enables doctors to view the heart through a small, flexible tube called an endoscope which is inserted through the esophagus. This probe is small enough and long enough to reach the heart and allows doctors to closely evaluate the heart and blood vessels within the chest. This test is used to assess the heart’s functions and structures and is also used during surgery to evaluate the effects of surgical intervention to the heart. For this procedure, the patient is sedated.

Ultrasound Examinations

Renal Artery Ultrasound
This ultrasound test checks the renal arteries that lead to the kidneys for narrowing or blockages which could lead to high blood pressure. It is also used to check the arteries after surgery, angioplasty or stenting.

This is a painless procedure. Ultrasound’s high frequency sound waves can neither harm you nor be felt. There are no known hazards associated with ultrasound procedures.

The test will be performed while you are lying on your back in a bed. You may be asked to roll from one side to another. A gel is applied to your abdomen and an ultrasound probe is run along the skin following the path of the arteries.

To prepare for the test, don’t eat or drink anything past midnight the evening before your appointment. Medication may be taken with a small amount of water. Wear comfortable clothing for easy access to abdomen area.

Your test will be reviewed and the results will be sent to your physician who will then discuss the test results with you at your next appointment. The technologists cannot give you your test results.

Carotid Ultrasound Examination

A carotid ultrasound uses high-frequency sound waves to make pictures of your carotid arteries. The sound waves will be directed to your carotid arteries from a small, hand-held transmitter. These signals can be analyzed so that the speed of the blood flowing through your carotid arteries can be measured. The test allows us to tell your physician if there are any blockages that would interrupt blood flow from your heart to your brain. This test will also reveal any plaque along the vessels that could cause a stroke.

You will not feel the sound waves nor will they cause you discomfort. You will be asked to lie flat on your back so that pictures can be made of the carotid arteries. The test is performed on the neck region and should take approximately 50 minutes. There are no known hazards associated with the ultrasound procedure.

There is no preparation for this test and no reason to discontinue food or medications. You should wear an open neck top as the technologist will examine you from just below your shoulders to the top of your neck, at ear level.

Your carotid ultrasound test will be reviewed and the results sent to your physician who will discuss the results with you at your next appointment.

Abdominal Ultrasound Examination

To prepare for the test, do not eat or drink anything past midnight the evening prior to your appointment. Medication may be taken with a small amount of water. This is a painless procedure. Ultrasound’s high frequency sound waves can neither harm you nor be felt. There are no known hazards associated with ultrasound procedures.

Your test will be reviewed and the results will be sent to your physician who will discuss the results with you at your next appointment.

Vascular Testing

This type of testing collects information about a patient’s blood vessels and the way blood passes through them. An ultrasound is commonly used to gather real-time information about blood flow activity. Doctors are able to utilize this information, along with blood pressure measurements, to gauge arterial and venous flow. The results from these tests help physicians diagnose disorders in the blood vessels.