Routine Non- Invasive Diagnostic Testing & Therapeutic Cardiology Out Patient Procedures

Ankle-brachial index test is a comparison of your blood pressure measured at an ankle and your blood pressure measured at an arm, which can indicate blockage of blood flow to the legs.

After removing your socks and shoes you will lie on an examining bed. The technician will attach blood pressure cuffs to arms, ankles, and toes. The sonographer will warn you when the cuffs inflate. 

You can take the following steps to prepare for your appointment:

• DO NOT wear a long sleeve shirt.
• DO NOT wear pantyhose
• An ankle brachial index usually takes about 10 to 15 minutes.

An echocardiogram uses sound waves to produce images of your heart. This commonly used test allows your doctor to see how your heart is beating and pumping blood. Your doctor will look for heart size, pumping strength, damage to the heart muscle, valve problems, and heart defects.

Transthoracic echocardiogram is a standard, noninvasive echocardiogram. A technician (sonographer) spreads gel on your chest and then presses a device known as a transducer firmly against your skin, aiming an ultrasound beam through your chest to your heart. The transducer records the sound wave echoes your heart produces. A computer converts the echoes into moving images on a monitor. Doppler echocardiogram is when sound waves bounce off blood cells moving through your heart and blood vessels, they change pitch. These changes (Doppler signals) can help your doctor measure the speed and direction of the blood flow in your heart. Doppler techniques are used in most transthoracic echocardiograms, and can check blood flow problems and blood pressures in the arteries. 

After undressing from the waist up, you'll lie on an examining bed. The technician will attach sticky patches (electrodes) to your body to help detect and conduct the electrical currents of your heart. During the echocardiogram, the technician will dim the lights to better view the image on the monitor. You may hear a pulsing "whoosh" sound, which the machine is recording the blood flowing through your heart. Most echocardiograms take 45 minutes, but the timing may vary depending on your condition. During a transthoracic echocardiogram, you may be asked to breathe in a certain way or to roll onto your left side. Sometimes the transducer must be held very firmly against your chest. This can be uncomfortable — but it helps the technician produce the best images of your heart.

No special preparations are necessary for a standard transthoracic echocardiogram.

The primary purpose of a carotid ultrasound is to screen for a narrowing of the carotid arteries that indicates an increased risk of stroke. Narrowing is usually caused by plaques — a buildup of fats, cholesterol, calcium and other substances that circulate in the bloodstream. Early detection of narrowing of the carotid arteries enables your doctor to begin treatments that improve blood flow to the brain and decrease your risk of stroke. 

Other uses of carotid ultrasound: your doctor also may order a carotid ultrasound to:

1. Evaluate the structure and function of the artery after surgery to remove plaques (carotid endarterectomy)
2. Evaluate the placement and treatment effect of a stent, a mesh tube used to improve blood flow through an artery and support a weakened artery
3. Detect other abnormalities in the structure of a carotid artery that may disrupt blood flow

You can take the following steps to prepare for your appointment:

1. Wear a comfortable shirt with no turtleneck and don’t wear a necklace.

During the procedure you'll likely lie down on your back during the procedure. The ultrasound technician (sonographer) may gently adjust the position of your head to improve access to the side of your neck. The sonographer will apply a warm gel to your skin above the site of each carotid artery. The gel helps eliminate the formation of air pockets between your skin and the transducer. The sonographer then gently presses the transducer against the side of your neck in order for the instrument to send and receive sound waves. You shouldn't feel any discomfort during the procedure. If you do, tell the sonographer. A carotid ultrasound usually takes about 15 to 30 minutes.

Vascular ultrasound is a noninvasive ultrasound method (also called a duplex study) used to examine the blood circulation in the arms and legs. Non- invasive means the procedure does not require the use of needles, dyes, radiation or anesthesia.

During a vascular ultrasound, sound waves are transmitted through the tissues of the area being examined. These sound waves reflect off blood cells moving within the blood vessels, allowing the reading physician to calculate their speed. The sound waves are recorded and displayed on a computer screen.

Your physician has recommended that you have this test to evaluate the blood flow to specific part in your body. Vascular ultrasound can be used to evaluate:

• Locate and identify blockages (stenosis) and abnormalities like plaque or emboli and help plan for their effective treatment. 
• Evaluate the success of procedures that graft or bypass blood vessels.
• Determine if there is an enlarged artery (aneurysm).
• Detect blood clots (deep venous thrombosis (DVT) in the legs or arms.
• Determine the source and severity of varicose veins.

Your ultrasound test is performed by specially trained technologists and interpreted by your cardiologist. You will lie on the bed during the test. A small amount of water-soluble gel is applied to the skin over the area to be examined. The gel does not harm your skin or stain your clothes. A small device called a transducer is placed over the gel-coated area to be examined. The transducer produces images on the ultrasound screen. There may be some minor discomfort during the exam when the technologist applies pressure to your arms or legs. You may hear noises when the technologist listens to the blood flow and records the measurements. 

The ultrasound takes about 30 to 45 minutes to complete. 

There is no special preparation before the test

Some heart problems — particularly those involving the coronary arteries that supply blood to your heart muscle — occur only during physical activity. For a stress echocardiogram, ultrasound images of your heart are taken before and immediately after walking on a treadmill. If you're unable to exercise, you may get an injection of a medication to make your heart work as hard as if you were exercising.

After undressing from the waist up and putting a gown on. The treadmill technician will attach sticky patches (electrodes) to your body to help detect and conduct the electrical currents of your heart. The sonographer will obtain images of your heart (left ventricle) before getting on the treadmill. The cardiologist will then be present when you're on the treadmill. We will encourage you to do your best, if you have trouble on the treadmill just tell us. We are trying to get your heart rate to a certain point. Once you reach that point we ask that you lie on the bed and the sonographer will obtain images of your heart beating fast.

During a stress echocardiogram, exercise or medication — not the echocardiogram itself — may temporarily cause an irregular heartbeat. Serious complications, such as a heart attack, are rare.

If you'll be walking on a treadmill during a stress echocardiogram, you should wear:

• Comfortable clothing
• Don’t wear a dress
• Comfortable shoes
• No heels 

Your doctor may recommend you have an ultrasound of the aorta if you're at risk of an abdominal aortic aneurysm. Aortic ultrasound screens for a potential abdominal aortic aneurysm, an enlargement or ballooning of the large artery that supplies blood to the abdomen, pelvis and legs.

Risk factors for abdominal aortic aneurysm include:

• Being Male
• Age of 60 years or older
• A history of atherosclerosis-a thickening of the walls of your arteries
• A family history of abdominal aortic aneurysm
• Smoking
• High blood pressure (a systolic pressure of 140 to 159 millimeters of mercury or mm Hg, and a diastolic pressure of 90 to 99 mm Hg
• An aneurysm in one of your other arteries
• Chronic lung disease

Food and liquids in your stomach can make it difficult for the ultrasound technician (sonographer) to get a clear picture of your aorta. Fasting instructions will be given before the exam. 

DAY BEFORE EXAMINATION: Clear liquids at noon and evening meals. Eat no solid foods. Drink four 8-ounce glasses of water between 1:00 p.m. and 9:00 p.m. 

At 5:00 p.m., drink one bottle (10 ounces) of Citrate of Magnesia. 

At 8:00 p.m., take two Biscodyl (Dulcolax) pills. 

Nothing to eat or drink after midnight (may take medications with water at anytime).

What is a nuclear exercise stress test?

Can I eat or drink on the day of the test?

Should I take my medications the day of the test?

• Medications with caffeine: DO NOT take any over-the-counter medication that contains caffeine (such as Excedrin®, Anacin®, diet pills and No Doz®) for 24 hours before the test. Ask your physician, pharmacist or nurse if you have questions about other medications that may contain caffeine. 
• If you have asthma: Please bring your asthma inhaler medication to the test. 
• If you have diabetes: If you take medications to control your blood sugar, do not take your medication until after the test is complete. Bring your diabetes medications with you so you can take it when the test is complete. Do not take your diabetes medication and skip a meal before the test. Plan to eat and take your blood sugar medication following your test. 

What should I wear for the test?

• Please wear comfortable 2 piece clothing and shoes suitable for walking during the test. Ladies, it's preferable you not wear dresses or skirts.  
• Please DO NOT wear sandals.
• Do not wear any clothing that has metal on the shirt. This includes metal snaps on shirts.

What to expect during the test

How long will the test last?

What if I need to reschedule my test?

How do I get the results of my test?

Fees for medical services at our office will be due and payable at the time of your visits. By asking you to do this we can cut down the cost of billing and bookkeeping; and hopefully, keep your medical fees down. Our office, of course, will assist you when requested in helping you to collect your entitled reimbursement to the best of their ability. 

Our billing office will file all claims to third party contractors after you meet your co-pay and deductible. Should you have any questions concerning your account, please call our billing office number at (361) 887-2970.