Tests & Procedures

Tests & Procedures

Abdominal Ultrasound Examination
Arterial (ALE/AUE) Examination
Cardiac Holter and Event Monitoring
Carotid Ultrasound Examination
Computed Tomography (CT)
Echocardiography (Echo)
EKG (electrocardiogram)
MitraClip®
MUGA (Gated Pool Study)
Nuclear Stress
PET
Renal Artery Ultrasound
Stress Echocardiography
Transesophageal Echocardiography (TEE)
Vascular Testing

DIAGNOSTIC SERVICES

Diagnostic Services

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.

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 your arms, legs and chest and are connected to an instrument that records the pattern of activity with a special tape recorder. Holter monitoring requires you to wear the equipment for 24 to 48 hours and record a diary of activity. Event monitoring requires you to wear the equipment for 30 days. You have the ability to send information from event monitoring equipment to the hospital using a telephone receiver if severe symptoms occur.

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.

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 your 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 your heart in motion. This test is painless and effective in establishing specific diagnoses and estimating the severity of cardiac diseases.

EKG (electrocardiogram)

ekg electrocardiogramAn 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.

MITRACLIP® – Advanced, minimally invasive treatment for mitral regurgitation

CHI Memorial and The Chattanooga Heart Institute are the first in the Chattanooga region to offer MitraClip® – a breakthrough technology for people who suffer from mitral valve regurgitation but are too high risk for surgical valve repair or replacement.  MitraClip® therapy is the world’s first transcatheter mitral valve repair – meaning no surgical incisions are needed to deliver this lifesaving therapy.

What is Mitral Regurgitation?

Mitral regurgitation occurs when the heart’s mitral valve leaflets don’t close tightly. Heart valves work like one-way gates, allowing blood to flow in one direction between the chambers of the heart and then on to fueling your brain and other parts of your body. When these gates don’t close properly, blood can flow backwards (or regurgitate) making the heart work harder to push blood through the body. This cause shortness of breath, feelings of fatigue and worsening heart failure because of the extra strain on the heart.

People with mitral regurgitation may not realize they have the condition, because it’s often mild and progresses slowly. It’s often suspected when your doctor hears a heart murmur. Elderly people may also not realize they’re suffering from the condition since they attribute their feelings of breathlessness and general decline to old age or other health issues.

When left untreated, mitral regurgitation continues to worsen – leading to complications including atrial fibrillation, heart failure and pulmonary hypertension or high blood pressure in the arteries leading to the heart and lungs.

Identifying the Symptoms

The symptoms of mitral regurgitation are progressive, meaning they will worsen gradually as the heart works overtime to pump blood through the body. The signs and symptoms of mitral regurgitation can include:

  • Blood flowing forcefully through your heart, called a heart murmur
  • Shortness of breath or breathlessness when you lie down or especially with physical activity
  • Fatigue or extreme tiredness, especially during increased activity
  • Heart palpitations, or a sensation of a rapid, fluttering heart beat (also known as atrial fibrilaiton)
  • Swollen feet or ankles
  • Coughing, especially when lying down
  • Excessive urination

Lifesaving Treatment – Without Open Heart Surgery

CHI Memorial is the leading provider of cardiac care, and our physicians exceed national standards for education, training and skill. That’s why we’re the first to offer this exclusive treatment for mitral regurgitation – we’re always working to provide a higher level of care for you.

Treatment for mitral regurgitation depends on the severity of your condition and if your symptoms are getting worse. If your doctor determines that open heart surgery isn’t an option for you – because of your age, advanced heart failure or other serious medical conditions – you may be eligible for the minimally invasive transcatheter mitral valve repair called MitraClip®. MitraClip® can improve your heart’s function, minimize symptoms, and help you enjoy a longer and higher quality of life.

The MitraClip® device is a small clip about the size of a dime that’s attached to your mitral valve to stop the backward leaking of blood. It treats mitral regurgitation by letting your mitral valve close more completely, helping to reestablish normal blood flow.

The CHI Memorial MitraClip® team accesses the mitral valve using a thin, flexible tube called a catheter. After the catheter is in place, the clip is guided through a vein in the leg to reach your heart. The MitraClip® is positioned over the leaky valve until it’s in the desired position. The arms of the clip are extended, and it’s passed down below the mitral valve before being pulled back up again into place. The clip grasps the mitral leaflets and then is closed. The doctors use advanced imaging systems to ensure there’s a reduction in your mitral regurgitation, and then the delivery system is removed.

Unlike surgery, MitraClip® doesn’t require opening the chest or stopping your heart. Most people who receive MitraClip® spend one night in the hospital and are released to home the next day. Although you may feel better immediately after the procedure, doctors recommend taking it easy for five to seven days to allow the site where the catheter was inserted to heal properly.

Improvements You Can Feel and See

Clinical data has shown that people who receive the MitraClip® see an immediate reduction in their mitral regurgitation – resulting in reduced hospitalizations and overall improvement in congestive heart failure – in addition to experiencing a lessening of symptoms soon after the procedure. Many patients report an immediate improvement in their shortness of breath and feelings of fatigue, leading to a much higher quality of life.  It’s important to talk with your doctor about what to expect following the procedure.

Is MitraClip® Right for Me?

If you or someone you love has been diagnosed with severe mitral valve regurgitation and are not a candidate for open heart surgery, MitraClip® may be an appropriate therapy. MitraClip® is FDA approved only for patients who are considered too sick for surgery. CHI Memorial’s MitraClip® team – including cardiothoracic surgeons, imaging cardiologists, interventional cardiologists and nurse navigators – work together to determine what treatment is right for you based on your current health condition and the presence of one or more surgical risk factors.

For more information or to schedule an appointment for an evaluation, please call CHI Memorial’s MitraClip® Valve Coordinator at (423) 495-4327.

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 Stress

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. This test exercises your heart to determine if there is any decrease in blood flow to one area of the heart and how much heart muscle is involved.

An IV will be started and you will be injected with a radiopharmaceutical. After 30-45 minutes, you will lie on an exam table for approximately 20 minutes for a scan of your heart.

If you’re having the exercise stress test, you’ll be connected to an EKG machine and will walk on a treadmill as long as you can. You’ll then be injected with a second dose of the medication and taken to a scan room for another 20 minute scan.

If you are having the medicine stress test (which utilizes a vasodilator medication), you’ll be connected to an EKG machine while sitting down. You’ll be injected with a medication that will cause arterial (coronary vessels) vasodilation and increase coronary blood flow. You will then be given a second dose of the radiopharmaceutical medication, wait 30-60 minutes, then will have a second scan which will last 15-20 minutes. The vasodilator medication increases blood flow in normal coronary arteries with little increase in stenotic arteries (vessels with blockage). This causes a difference in myocardial perfusion intensity so that at the end of the test, the imaging physician can potentially identify the part of the heart muscle which is not getting enough blood flow due to a blockage. This test may increase heart rate and lower blood pressure, briefly cause shortness of breath, headache and flushing but all these symptoms will usually resolve within a few minutes.

The approximate time of your visit will be three hours. If you experience chest pain, or any other problems during your stress test, our medical staff is well trained to assist you and there is always a cardiologist present for your safety.

IMPORTANT: Do not eat or drink anything (except water) for at least 6 hours before your test. You may drink as much water as you wish unless you are on fluid restriction. Do not have any caffeine (coffee, chocolate, tea, etc.) for 24 hours before your test.

If you are insulin-dependent diabetic, call the Cardiac Imaging Department at (423) 697-2187 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. We suggest you wear a light sweater or jacket as imaging room temperatures must be kept cool.

IMPORTANT INSTRUCTIONS ON YOUR MEDICATIONS:

Some medications should not be taken the day before and day of the test. Please read these instructions thoroughly to ensure your test can be performed satisfactorily.

For all patients: Nitroglycerin patches should be removed the night before the test.

Reminder: Bring your medications with you the day of the test.

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.

PET

Cardiac PET (Position Emission Tomography) exams help evaluate the blood supply and function of the heart. It is useful in detecting how adequate the blood supply is to the heart muscle.

How is this test performed?

After you have arrived and registered for your test, a technologist will ask you some questions about your medical history. An IV will be inserted in your hand or arm.

You’ll have tabs placed on your chest for an EKG which will monitor electrical activity of your heart throughout the study. You’ll lie down on the scanner table on your back with both arms above your head (if you’re able). You’ll be given a small amount of radiopharmaceutical through your IV that allows us to image your heart at rest. Shortly after that, you’ll be given a pharmaceutical called a vasodilator that will increase the flow of blood to the arteries of the heart, similar to the effect of exercise and your heart will be imaged a second time.

How should I prepare for the test?

Do not eat or drink anything (except water) for at least 6 hours before your test. You may drink as much water as you wish unless you are on fluid restriction. Do not have any caffeine (coffee, chocolate, tea, etc.) for 24 hours before your test.

 

IMPORTANT INSTRUCTIONS ON YOUR MEDICATIONS:

Some medications should not be taken the day before and day of the test. Please read these instructions thoroughly to ensure your test can be performed satisfactorily.

If you are insulin-dependent diabetic, call the Cardiac Imaging Department at (423) 697-2187 for special instructions.

We suggest you bring a jacket or sweater with you as the imaging area must be kept cool.

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.

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 you are at rest, and the same four views are taken after you perform 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 you are unable to use the treadmill.

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, you are sedated.

Vascular Testing

This type of testing collects information about your 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.