Cardiovascular Testing and Services

Cardiovascular Testing and Services

We are proud to offer our patients excellent quality and convenience in cardiac and vascular testing. All of our procedures are performed by highly skilled and trained registered sonographers, registered nuclear technologists, and/or registered nurses and medical assistants, under the support of our physicians.

Our nuclear and echocardiology laboratories are accredited by the Intersocietal Accreditation Commission www.intersocietal.org. State of the art cardiovascular imaging and diagnostic testing allows NCMA physicians the ability to conduct comprehensive clinical cardiovascular consultations, determining your best course of treatment.

For your convenience, same day appointments are often available. We treat all our patients with respect and courtesy. Our laboratories offer a professional experience without the congestion of a hospital setting. Our goal is to make each visit as comfortable and pleasant as possible.

Cardiac Ultrasound Imaging and Testing

Vascular Ultrasound Imaging and Testing

Nuclear Cardiology

Additional Cardiac Tests and Treatments

 


Cardiac Ultrasound Imaging and Testing


Echocardiography – Adult Transthoracic

This is a noninvasive, highly accurate and quick assessment of the overall health of the heart using ultrasound imaging. This test is also known as a ‘cardiac echo’ or ‘echo.’ It allows assessment of cardiac dimensions, cardiac valve areas and function, abnormal communications between the left and right side of the heart, leaking of blood through the valves (valvular regurgitation), and a calculation of the ejection fraction — which is a number that represents the effectiveness and performance of your heart.

The test is done while you are lying on your left side. The sonographer will place three electrodes on your chest so an EKG can be simultaneously recorded. An ultrasound transducer with warm gel is placed on your chest that allows the ultrasound signals to travel to the heart and back, producing images. You will hear a “swooshing” sound when the Doppler is turned on which represents blood flow within your heart. These ultrasound images of the heart are displayed on a monitor and then digitally recorded.

Test time ½-1 hour. You do not need to do anything to prepare for this test.

BETA BLOCKERS
Acebutolol (Sectral) Penbutolol (Levatol)
Atenolol (Tenormin) Pindolol (Visken)
Betaxolol (Kerlone) Propanolol (Inderal)
Bystolic (Nebivolol) Sotalol (Betapace)
Carvedilol (Coreg, Coreg CR) Tenoretic
Labetolol (Trandate, Normadyne) Timolol (Blocadren)
Metroprolol (Lopressor, Toprol XL) Zebeta (Bisoprolol)
Nadolol (Corgard) Ziac
CALCIUM CHANNEL BLOCKERS
Diltiazem SR (Cardizem SR, Cardizem CD, Dilacor XR, Tiazac)
Verapamil SR (Calan SR, Verelan, Isoptin SR)

 

Stress Echocardiogram

This is a highly specialized test for determining very specific information about the coronary arteries. These are the arteries that supply blood to the muscle of the heart. With similar elements to an ordinary exercise (treadmill) test and an echocardiogram, this test employs noninvasive methods and possesses a higher degree of accuracy in its assessment of coronary artery disease.

Multiple electrodes on the your chest measure your vitals while you exercise on a treadmill, which gets faster and steeper every three minutes, until you reach a target-heart-rate based on your age. The cardiologist is present during the treadmill portion of the test. Ultrasound imaging occurs pre- and post-exercise. Your doctor can use the results of your Stress Exercise Echocardiogram test to decide whether you need treatment or additional tests to evaluate the health of your heart.

Test time 1 hour.  Have a light meal 4 hours before test, and then have only NON-CAFFEINATED liquids.  Decaf coffee is OK.  PLEASE STOP ANY BETA-BLOCKERS AND SUSTAINED CALIUM CHANNEL BLOCKERS YOU ARE TAKING 48 HOURS PRIOR TO TEST.  See list of medications below.  Wear comfortable shoes and clothes. You will be walking on a treadmill.

BETA BLOCKERS
Acebutolol (Sectral) Penbutolol (Levatol)
Atenolol (Tenormin) Pindolol (Visken)
Betaxolol (Kerlone) Propanolol (Inderal)
Bystolic (Nebivolol) Sotalol (Betapace)
Carvedilol (Coreg, Coreg CR) Tenoretic
Labetolol (Trandate, Normadyne) Timolol (Blocadren)
Metroprolol (Lopressor, Toprol XL) Zebeta (Bisoprolol)
Nadolol (Corgard) Ziac
CALCIUM CHANNEL BLOCKERS
Diltiazem SR (Cardizem SR, Cardizem CD, Dilacor XR, Tiazac)
Verapamil SR (Calan SR, Verelan, Isoptin SR)

 

Stress Doppler Echocardiogram

This test uses ultrasound imaging technology along with treadmill exercise to assess specific information about valvular disease and pressures in the heart and lungs. Doppler information acquired before and after exercise can reveal the severity of heart valve disease.

Multiple electrodes are placed on your chest and you are exercised on a treadmill, which gets faster and steeper every three minutes, until you reach a target heart rate based on your age. The cardiologist is present during the treadmill portion of the test. Ultrasound imaging occurs pre and post exercise. Your doctor can use the results of your Stress Doppler Echocardiogram test to decide whether you need treatment or additional tests to evaluate the health of your heart.

Test time 1 hour. Have a light meal 4 hours before test, and then have only liquids but no caffeinated beverages (tea, coffee, cola). Decaf coffee is OK. PLEASE STOP ANY BETA-BLOCKERS AND SUSTAINED CALIUM CHANNEL BLOCKERS YOU ARE TAKING 48 HOURS PRIOR TO TEST. See list of medications below. Wear comfortable shoes and clothes. You will be walking on a treadmill.

BETA BLOCKERS
Acebutolol (Sectral) Penbutolol (Levatol)
Atenolol (Tenormin) Pindolol (Visken)
Betaxolol (Kerlone) Propanolol (Inderal)
Bystolic (Nebivolol) Sotalol (Betapace)
Carvedilol (Coreg, Coreg CR) Tenoretic
Labetolol (Trandate, Normadyne) Timolol (Blocadren)
Metroprolol (Lopressor, Toprol XL) Zebeta (Bisoprolol)
Nadolol (Corgard) Ziac
CALCIUM CHANNEL BLOCKERS
Diltiazem SR (Cardizem SR, Cardizem CD, Dilacor XR, Tiazac)
Verapamil SR (Calan SR, Verelan, Isoptin SR)

 

Dobutamine Stress Echo

This is a highly specialized test for determining very specific information about the coronary arteries.  These are the arteries that supply blood to the muscle of the heart.  With elements similar to a Stress Echocardiogram, this test employs noninvasive methods and possesses a higher degree of accuracy in its assessment of coronary artery disease.
This test is for people who are unable to exercise on a treadmill and is performed while you are lying on your left side. An ultrasound transducer with warm gel is placed on your chest which allows the ultrasound signals to travel to the heart and back, producing images.  A medicine called Dobutamine is administered through an I.V. to stimulate the heart as it would during actual exercise. The cardiologist is present during the Dobutamine infusion. This is a valuable diagnostic tool for determining the health of heart valves and chambers, and many types of heart disease. The test may also be carried out to monitor the heart’s health after surgery and/or other medical procedures.

Test time 1½-2 hours.  Have a light meal 4 hours before test, and then have only liquids but no caffeinated beverages (tea, coffee, cola).  Decaf coffee is OK.  PLEASE STOP ANY BETA-BLOCKERS AND SUSTAINED CALIUM CHANNEL BLOCKERS YOU ARE TAKING 48 HOURS PRIOR TO TEST.  See list of medications below.  Wear comfortable clothes as you will be lying down during the test.  Please drink 2 glasses of water 2 hours before your test so that you are well hydrated.

 

A-V Optimization Imaging Study

This non-invasive procedure is used to improve the timing and efficiency of the heart wall contraction. Echocardiography imaging is used to maximize pacemaker effectiveness as it reflects on filling of the left ventricle. This is obtained by a pacemaker representative or pacemaker nurse adjusting and optimizing your pacemaker settings in a manner that will alter the timing of blood flow from the left atrium (top chamber) into the left ventricle (lower chamber).

The test is done while you are lying on your left side. An ultrasound transducer with warm gel is placed on your chest which allows the ultrasound signals to travel to the heart and back, producing images. Throughout the procedure, echocardiography imaging will be performed to assess how your heart function responds to these adjustments. After reviewing the settings and coinciding echo data, the sonographer and pacemaker representative or pacemaker nurse will determine which pacer change will provide the greatest benefit to your heart function and quality of life.

Test time ½-1 hour. You do not need to do anything to prepare for this test.

 

Echocardiogram with Bubble Study

An echocardiogram with a bubble study is a technique used to obtain additional information regarding possible intracardiac shunts (holes in the inner walls of the heart).

A nurse places an I.V. in your arm.  Under the supervision of the cardiologist, the nurse injects agitated saline into the arm while the sonographer is imaging your heart with ultrasound. Tiny bubbles within the saline can be tracked as they pass through the veins into the heart chambers to show if any bubbles do not follow the normal blood flow pathway through your heart. While this test requires an injection, it is a safe alternative to more invasive procedures. It reveals valuable information concerning heart health and causes very little discomfort to the patient.

Test time 1 hour. You do not need to do anything to prepare for this test.


 


Vascular Ultrasound Imaging and Testing


Carotid Duplex

This procedure is performed to evaluate patients who have had symptoms of a stroke, mini-stroke, TIA (transient ischemic attack), or have existing carotid artery disease. The symptoms include certain types of visual disturbances, facial drooping and/or tingling, confusion, inability to speak in a normal fashion, or loss of muscle control on one half of the body. Your doctor may listen to the vessels in your neck with a stethoscope and hear a louder than usual noise called a ‘bruit.’ These signs and/or symptoms may be the result of narrowing or blockages of the carotid arteries that supply blood to the brain.

This pain-free test involves lying on your back with warm gel on your neck.  A vascular sonographer will scan each side of your neck with a transducer to image the vessels, identifying plaque within the arteries, and calculating blood velocities using Doppler ultrasound. You will hear a “swooshing” sound when the Doppler is turned on which represents your blood flow.

Test time ½ – 1 hour. You do not need to do anything to prepare for this test.

 

Venous Duplex – Lower and Upper Extremity

Venous duplex to check for DVT (deep vein thrombosis) is a test that employs ultrasound waves to image and evaluate the veins in your legs or arms. Your doctor may ask you to have this test if he or she feels you are at risk for blood clots in your veins or obstructions to the venous flow. If there is a blood clot or obstruction that causes reduced blood flow through the vein, symptoms include pain and swelling of the extremity.
Test time ½ – 1 hour.

Venous duplex for venous insufficiency is an examination of the lower extremity veins in patients who present with signs of venous insufficiency such as varicose veins, skin discoloration, swelling, and painful or aching legs. Valves are present in the veins, which help the blood flow empty out of the legs and back towards the heart. If the valves do not work properly, venous blood flow “leaks” back down into the legs causing pain, swelling, varicose veins, and in more severe cases, skin breakdown and ulceration. Venous blood flow that is “leaking” down into the legs is called venous reflux.  This test helps to determine the ideal treatment plan for patients who would benefit from procedures that relieve symptoms of venous insufficiency.  Test time 1 – 1½ hour.

You will by lying on your back.  A vascular sonographer will place warm gel and an imaging transducer on your legs or arms, scanning up and down to visualize and analyze your veins. The sonographer may perform several compression maneuvers on your legs, checking for normal or abnormal venous flow. You will hear a “swooshing” sound when the Doppler is turned on which represents your blood flow.

You do not need to do anything to prepare for this test.

 

Ankle/Brachial Index (ABI)

This simple test assesses whether the blood circulation to your legs is normal, mildly abnormal, moderately abnormal, or severely abnormal.

While positioned on your back, blood pressure cuffs are placed on your arms and at your ankles. A Doppler ultrasound transducer is used to locate your arm and ankle arteries to assist in obtaining the blood pressures. You will hear a “swooshing” sound when the Doppler is turned on which represents your blood flow.

Test time ½ hour, during which you may be asked to perform simple exercises.  You do not need to do anything to prepare for this test.

 

Arterial Duplex – Lower and Upper Extremity

Your physician may order this test to check arm or leg blood circulation. You may be experiencing arm pain or leg pain with walking or leg cramps when you are laying down, or in severe cases you could experience constant leg or foot pain. Blood pressures will be taken at your arms and ankles to obtain an Ankle/Brachial Index (ABI). This simple test assesses how much blood is reaching your extremities.

You will by lying on your back. An imaging transducer with warm gel will be used on various locations of your arms or legs to evaluate the blood flow, checking for atherosclerotic plaque and/or blockages. You will hear a “swooshing” sound when the Doppler is turned on which represents your blood flow.

Test time 1 – 1½ hour, during which you may be asked to perform simple exercises. You do not need to do anything to prepare for this test.

 

Aorta-Iliac Duplex

The aorta is the main artery in your abdomen that supplies blood flow to the lower part of your body. At the level of the belly button, it splits into the iliac arteries, which supply blood flow to your legs. This test is performed to evaluate for widening of the abdominal aorta (aneurysm) or to follow a known aneurysm for expansion. It is used to check for suspected narrowing of the aorta or iliac arteries causing poor circulation to your legs. Or it can follow up aorta or iliac arteries that have been treated with a stent, balloon angioplasty, or bypass graft.

You will be lying on your back. The vascular sonographer will use an imaging transducer with warm gel to scan your abdomen and visualize the arteries, checking for areas of narrowing or widening and recording measurements of the blood flow. You will hear a “swooshing” sound when the Doppler is turned on which represents your blood flow.

Test time 1 – 1½ hour.  For this test you are asked to avoid eating, drinking, and chewing gum 8 hours prior to this test. A small amount of water for medications is OK.  If you have diabetes, please take ½ of your usual dose on the day before your test and the day of your test. If you feel weak, light-headed, or nauseated, please check your glucose and if it is below 100 or above 300, call the office at 707-573-6166 and ask to speak with a nurse.

 

Renal Artery Duplex

Renal artery duplex is an ultrasound evaluation of the arteries that supply blood flow to the kidneys. If there is not enough blood flow to your kidneys, you may develop high blood pressure that is difficult to treat with medications.

You will be lying on your back or turned up on your side during the exam. The vascular sonographer will use an imaging transducer with warm gel to scan your abdomen and visualize the renal arteries, checking for areas of narrowing and recording measurements of the blood flow. You will hear a “swooshing” sound when the Doppler is turned on which represents your blood flow.

Test time 1 hour.  For this test you are asked to avoid eating, drinking, and chewing gum 8 hours prior to this test.  If you have diabetes, please take ½ of your usual dose on the day before your test and the day of your test. If you feel weak, light-headed, or nauseated, please check your glucose and if it is below 100 or above 300, call the office at 707-573-6166 and ask to speak with a nurse.

 

Mesenteric Artery Duplex

Mesenteric artery duplex is an ultrasound evaluation of the arteries that supply blood flow to the intestines, which are involved in food digestion. If there is not enough blood flow to help digest your food, you may feel abdominal pain or cramping after eating a meal.

This test is done while you are lying on your back. The vascular sonographer will use an imaging transducer with warm gel to scan your abdomen and visualize your abdominal aorta and the mesenteric arteries, checking for areas of narrowing and recording measurements of the blood flow. You will hear a “swooshing” sound when the Doppler is turned on which represents your blood flow.

Test time 1 hour. For this test you are asked to avoid eating, drinking, and chewing gum 8 hours prior to this test. If you have diabetes, please take ½ of your usual dose on the day before your test and the day of your test. If you feel weak, light-headed, or nauseated, please check your glucose and if it is below 100 or above 300, call the office at 707-573-6166 and ask to speak with a nurse.

 

Dialysis Access Duplex

This is an ultrasound evaluation for patients who have dialysis accesses or “shunts” in their arms and is an easy way to monitor the blood flow through dialysis accesses. If the blood flow is obstructed in a dialysis access, patients experience sudden pain and swelling. Dialysis access duplex can also easily identify cases where the blood is not flowing enough through the dialysis access, and the reason for the low flow which helps the surgeon plan for treatment that would improve the blood flow to ideal levels.

The vascular sonographer will use an imaging transducer with warm gel to visualize the access, note any area of narrowing, take measurements of the blood flow, and see any areas of abnormality. You will hear a loud “swooshing” sound when the Doppler is turned on which represents your blood flow.

Test time 1 hour. You do not need to do anything to prepare for this test.

 

Vein Mapping Duplex

Vein mapping is a simple duplex exam of the upper or lower extremity veins that identifies quality veins that can be used for bypass planning. This is used for patients with arterial disease who need a bypass graft to improve blood flow to their legs. It is also used to plan for patients who need dialysis access placement in their arms. It may also be used for planning for heart bypass surgery.

The test is done while you are lying on your back. The vascular sonographer will use an imaging transducer with warm gel to visualize the veins and make measurements of the vein. These measurements tell the surgeon whether the vein is good enough for bypass surgery, or too small to use.
A tourniquet placed on the upper arm may cause slight discomfort, but the test is otherwise entirely pain-free.

Test time 1 hour. You do not need to do anything to prepare for this test.

 

Photoplethysmography (PPG) for Thoracic Outlet Syndrome

Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet – the space between your collarbone and your first rib – become compressed. This can cause pain in your shoulders and neck and numbness in your fingers. Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job, or sports-related activities, certain anatomical defects, such as having an extra rib, and pregnancy. Even a long-ago injury can lead to thoracic outlet syndrome in the present.

The test for thoracic outlet syndrome involves the vascular sonographer monitoring PPG waveforms (which represent the blood flow in the lower arm or hand) while the patient performs maneuvers designed to produce the symptoms.

Test time 1 hour. You do not need to do anything to prepare for this test.

 

Cold Water Immersion Test for Raynaud’s

Raynaud’s is a condition resulting in a particular series of discolorations of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events. Skin discoloration occurs because an abnormal spasm of the blood vessels causes a diminished blood supply to the local tissues. Initially, the digit(s) involved turn white because of the diminished blood supply. The digit(s) then turn blue because of prolonged lack of oxygen. Finally, the blood vessels reopen, causing a local “flushing” phenomenon, which turns the digit(s) red. This three-phase color sequence (white to blue to red), most often upon exposure to cold temperature, is characteristic of Raynaud’s.

The test for Raynaud’s involves the vascular sonographer monitoring PPG waveforms of fingers and/or toes at room temperature and after immersion of the limbs in an ice bath.

Test time 1 hour.  You do not need to do anything to prepare for this test.

 


 

Nuclear Cardiology

Nuclear Cardiac Imaging with Treadmill Stress

This procedure is a highly specialized test for determining very specific information about the heart muscle and the coronary arteries that feed the heart muscle. This test involves an injection of a small amount of a radioactive tracer, which is chemically directed to the heart.

While you are lying on your back, a camera rotates across your chest, tracking the substance, allowing images of the heart to be obtained. Electrodes will be placed on your chest and you will be exercised on a treadmill, which gets faster and steeper every three minutes, until you reach a target heart rate based on your age. The pre- and post-exercise images produced in this test are interpreted by one of our cardiologists with advanced training in nuclear cardiology.
Test time 2-3 hours.

If you are not diabetic, please follow the RESTRICTIONS and DIRECTIONS directly below:

1. RESTRICTIONS:

  • NO CAFFEINE OR CAFFEINATED BEVERAGES FOR 24 HOURS BEFORE TEST including decaf coffee, tea and colas. (See Foods, Meds, and Drugs containing caffeine lists below.)
  • CLEAR LIQUIDS ONLY FOR 4 HOURS PRIOR TO TEST, which means absolutely NO SOLID FOODS.

2. DIRECTIONS:

  • Before your test time, drink 2-3 glasses of water over a period of 2 hours.
  • TAKE YOUR MEDICATIONS EXCEPT THOSE ON THEMEDICATION RESTRICTION LIST BELOW.
  • BRING WITH YOU THE MEDICATIONS THAT YOU DID NOT TAKE BEFORE YOUR TEST.
  • Wear comfortable clothes and walking shoes.
  • Bring a light meal to eat after stress portion of test.
  • Check in at Suite #200 fifteen (15) minutes before your appointment. The nuclear tech will come for you at the appointed time.
  • A reminder call will be made 48 hours before your appointment.
  • To reschedule your appointment call 707-573-6199.

If you are diabetic, please follow the RESTRICTIONS and DIRECTIONS directly below:

1.  RESTRICTIONS:

  • NO CAFFEINE OR CAFFEINATED BEVERAGES FOR 24 HOURS BEFORE TEST including decaf coffee, tea and colas. (See Foods, Meds, and Drugs containing caffeine lists below.)
  • CLEAR LIQUIDS ONLY FOR 4 HOURS PRIOR TO TEST.

2.  DIRECTIONS:
IF YOU HAVE A MORNING APPOINTMENT:

  • Take ½ usual morning dose of insulin or full dose oral med with one slice plain toast and 6 oz juice.
  • Bring ½ morning dose of insulin and blood sugar monitor with you.
  • Don’t forget to bring a snack.

IF YOU HAVE AN AFTERNOON APPOINTMENT:

  • Eat breakfast. Take usual dose insulin or oral medication.
  • Follow above instructions for lunch if needed (depending on your blood sugar level and usual midday medication dose).
  • If you take oral diabetic meds “as needed”, please bring them along.
  • Before your test time, drink 2-3 glasses of water over a period of 2 hours.
  • TAKE YOUR MEDICATIONS EXCEPT those on the MEDICATION RESTRICTION list below.
  • BRING WITH YOU THE MEDICATIONS THAT YOU DID NOT TAKE BEFORE YOUR TEST.
  • Wear comfortable clothes and walking shoes.
  • Bring a light meal to eat after exercise.
  • Check in at Suite #200 fifteen (15) minutes before appointment. The nuclear tech will come for you at the appointed time.
  • A reminder call will be made 48 hours before your appointment.
  • To reschedule your appointment, call 707-573-6199.

MEDICATION RESTRICTIONS:

STOP the following BETA BLOCKER medications 48 HOURS before test:

  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Betaxolol (Kerlone)
  • Bystolic (Nebivolol)
  • Carvedilol (Coreg)
  • Labetolol (Trandate, Normadyne)
  • Metoprolol (Lopressor, Toprol XL)
  • Nadolol (Corgard)
  • Penbutolol (Levatol)
  • Pindolol (Visken)
  • Propanolol (Inderal, Inderal LA)
  • Sotalol (Betapace)
  • Tenoretic
  • Timolol (Blocadren)
  • Zebeta (Bisoprolol)
  • Ziac

IMPORTANT –PLEASE BRING THE MEDICATION THAT YOU DID NOT TAKE WITH YOU, so you may take them after your test.

Foods Containing Caffeine
Chocolate (chocolate and chocolate-coated candy, baking chocolates, chocolate cake, chocolate pudding, chocolate milk, brownies)

Prescription Drugs Containing Caffeine

  • Cafergot (all forms)
  • Esgic (all forms)
  • Fioricet
  • Fiorinal (all forms)
  • Norgesic
  • Norgesic Forte
  • Synalgos-DC
  • Wigraine (all forms)

OTC Drugs Containing Caffeine

  • Anacin
  • NoDoz
  • Vivarin
  • Excedrin

 

Nuclear Cardiac Imaging with Pharmacological Stress

This procedure is a highly specialized test for determining very specific information about the heart muscle and the coronary arteries that feed the heart muscle. This test involves an injection of a small amount of a radiopharmaceutical tracer, which is chemically directed to the heart; in conjunction with a pharmacological stimulant to simulate the effects that exercise have on the heart.

While you are lying on your back, a camera rotates across your chest, tracking the substance, allowing images of the heart to be obtained. The pre and post pharmaceutical stress images produced in this test are interpreted by one of our cardiologists with advanced training in nuclear cardiology.

Test time 2-3 hours.

If you are not diabetic, please follow the RESTRICTIONS and DIRECTIONS directly below:

1. RESTRICTIONS:

  • NO CAFFEINE OR CAFFEINATED BEVERAGES FOR 24 HOURS BEFORE TEST including decaf coffee, tea and colas. (See Foods, Meds, and Drugs containing caffeine lists below.)
  • CLEAR LIQUIDS ONLY FOR 4 HOURS PRIOR TO TEST, which means absolutely NO SOLID FOODS.

2. DIRECTIONS:   

  • TAKE YOUR MEDICATIONS EXCEPT FOR THOSE ON THEMEDICATION RESTRICTION LIST BELOW.
  • IF YOU ARE ASTHMATIC, USE YOUR INHALERS AS DIRECTED AND BRING YOUR INHALER WITH YOU.
  • Before your test time, drink 2-3 glasses of water over a period of 2 hours.
  • Wear comfortable clothes, you will be reclining during the test.
  • BRING WITH YOU THE MEDICATIONS THAT YOU DID NOT TAKE BEFORE YOUR TEST.
  • Bring a light meal to eat after stress portion of test.
  • Check in at Suite #200 fifteen (15) minutes before your appointment. The nuclear tech will come for you at the appointed time.
  • A reminder call will be made 48 hours before your appointment.
  • To reschedule your appointment call 707-573-6199.

If you are diabetic, please follow the RESTRICTIONS and DIRECTIONS directly below:

1.  RESTRICTIONS:

  • NO CAFFEINE OR CAFFEINATED BEVERAGES FOR 24 HOURS BEFORE TEST including decaf coffee, tea and colas. (See Foods, Meds, and Drugs containing caffeine lists below.)

2.  DIRECTIONS: 
IF YOU HAVE A MORNING APPOINTMENT:

  • Take ½ usual morning dose of insulin or full dose oral med with one slice plain toast and 6 oz juice.
  • Bring ½ morning dose of insulin and blood sugar monitor with you.
  • Don’t forget to bring a snack.

IF YOU HAVE AN AFTERNOON APPOINTMENT:

  • Eat breakfast. Take usual dose insulin or oral medication.
  • Follow above instructions for lunch if needed (depending on your blood sugar level and usual midday medication dose).
  • If you take oral diabetic meds “as needed”, please bring them along.
  • TAKE YOUR MEDICATIONS EXCEPT for those on the MEDICATION RESTRICTION list below.
  • IF YOU ARE ASTHMATIC, USE YOUR INHALERS AS DIRECTED AND BRING YOUR INHALER WITH YOU.
  • Before your test time, drink 2-3 glasses of water over a period of 2 hours.
  • Wear comfortable clothes, you will be reclining during the test.
  • BRING WITH YOU THE MEDICATIONS THAT YOU DID NOT TAKE BEFORE YOUR TEST.
  • Check in at Suite #200 fifteen (15) minutes before appointment. The nuclear tech will come for you at the appointed time.
  • A reminder call will be made 48 hours before your appointment.
  • To reschedule your appointment, call 707-573-6199.

MEDICATION RESTRICTIONS:

STOP the following PULMONARY/ASTHMA meds 48 HOURS before test:

  • Aminophylline
  • Aquaphyllin
  • Bronchonoid
  • Constant-T
  • Elixophyllin
  • Lodrane
  • Marax
  • Quibron
  • Slo-Bid
  • Slo-Phyllin
  • Tedral
  • Theo-bid
  • Theo-Dur
  • Theolair
  • Theophyl
  • Trental
  • Uniphyl

STOP the following drugs containing Theophylline:

  • Aerolate
  • Constant-T
  • Elixophyllin
  • Primatene (Tablets)
  • Quibron (all forms)
  • Respbid
  • Slo-bid
  • Slo-Phyllin
  • T-Phyl
  • Tedral SA
  • Theo-24
  • Theo-Dur
  • Theo-Organidin
  • Theo-Sav
  • Theoclear
  • Theolair
  • Theostat
  • TheoX

STOP these meds 48 HOURS before test:
Verapamil (Calan, Verelan, Isoptin)
Aggrenox

If you have questions about these instructions, please call the cardiologist’s office before your appointment.  IMPORTANT – PLEASE BRING THE MEDICATIONS THAT YOU DID NOT TAKE WITH YOU, so you may take them after your test.  If you are Asthmatic don’t forget your inhalers.

Foods Containing Caffeine
Chocolate (chocolate and chocolate-coated candy, baking chocolates, chocolate cake, chocolate pudding, chocolate milk, brownies)

Prescription Drugs Containing Caffeine

  • Cafergot (all forms)
  • Esgic (all forms)
  • Fioricet
  • Fiorinal (all forms)
  • Norgesic
  • Norgesic Forte
  • Synalgos-DC
  • Wigraine (all forms)

OTC Drugs Containing Caffeine

  • Anacin
  • NoDoz
  • Vivarin
  • Excedrin

 


Additional Cardiac Tests and Treatments

Electrocardiogram (ECG or EKG)

An electrocardiogram is a painless test that records the heart’s electrical activity. An EKG shows how fast or slow your heart is beating, whether the rhythm of your heartbeat is steady or irregular (arrhythmias), and checks the strength and timing of the electrical signals. An EKG can also help detect symptoms of heart disease (heart attacks, heart failure) and check how well medical devices that are implanted into the heart are working.  You will be lying on your back with multiple electrodes placed on your chest, arms and legs.

Test time ½ hour. You do not need to do anything to prepare for this test.

 

Holter Monitor and Event Recorder

A Holter Monitor is a device that records the heart rhythm continuously for 24 to 48 hours. This means that it records each and every heartbeat over that time. Five electrodes placed on your chest are connected to wires from the Holter monitor. The monitor is carried with you for the recording period. From this recording, a wide variety of information can be obtained including heart rates during day and night, abnormal heart beats, and recording of rhythm during any symptoms during the recording.  No showering while wearing Holter.

An Event Recorder is different from a Holter Monitor in that it only records when your have symptoms. When you experience the symptom of interest, you press a button that freezes the recording, which is later transmitted by telephone to an interpreting center. The monitor is carried with you for the recording period. From this recording, a wide variety of information can be obtained including heart rates during day and night, abnormal heart beats, and recording of rhythm during any symptoms during the recording.  A major advantage of event recorders is that they can be used for up to 30 days, until the transient symptom being looked for occurs.  Two electrodes placed on your chest are connected to wires from the event recorder.  You will change the electrodes about every 2 days and will possibly need to transmit event recorder results via landline telephone to the company.

Test time ½ hour. You do not need to do anything to prepare for this.

 

BioZ

BioZ Impedance testing is a noninvasive test to help assess, diagnose and treat patients with medical conditions such as heart failure and high blood pressure. It is based on thoracic impedance. It sends a small current through the patient’s chest to show the difference in the blood in the aorta when the heart is contracting and when it is at rest.

Sensors are placed on each side of your neck and chest. A cable from the BioZ monitor will then be connected to the sensors. Information about your height, weight and age will be entered into the BioZ monitor. Your BioZ measurements will be taken as you lie on your back and remain still for two to five minutes. When the test is complete, your BioZ report will be printed for your physician to review, and the cable and sensors will be removed.  The digital readouts produced by the monitor allow cardiologists to determine whether or not a patient’s blood flow is normal and whether blood vessels coming out of the heart are constricted or normal. This data is used to adjust medication accordingly. It literally shows how effective the heart is each time it beats.

Test time ½ hour. You do not need to do anything to prepare for this.

BETA BLOCKERS
Acebutolol (Sectral) Penbutolol (Levatol)
Atenolol (Tenormin) Pindolol (Visken)
Betaxolol (Kerlone) Propanolol (Inderal)
Bystolic (Nebivolol) Sotalol (Betapace)
Carvedilol (Coreg, Coreg CR) Tenoretic
Labetolol (Trandate, Normadyne) Timolol (Blocadren)
Metroprolol (Lopressor, Toprol XL) Zebeta (Bisoprolol)
Nadolol (Corgard) Ziac
CALCIUM CHANNEL BLOCKERS
Diltiazem SR (Cardizem SR, Cardizem CD, Dilacor XR, Tiazac)
Verapamil SR (Calan SR, Verelan, Isoptin SR)

 

Cardiac Stress Test (Treadmill Only)

The stress test is used to evaluate the heart and vascular system during exercise. It helps answer if coronary artery disease is present as well as the presence and severity of any other underlying heart diseases. This test does not involve ultrasound imaging or nuclear imaging. Multiple electrodes are placed on your chest and you are exercised on a treadmill, which gets faster and steeper every three minutes, until you reach a target heart rate based on your age.  The cardiologist is present during this test.

Test time 1 hour.  Have a light meal 4 hours before test, and then have only liquids but no caffeinated beverages (tea, coffee, decaf, cola).  PLEASE STOP ANY BETA-BLOCKERS AND SUSTAINED CALIUM CHANNEL BLOCKERS YOU ARE TAKING 48 HOURS PRIOR TO TEST.  See list of medications below.  Wear comfortable shoes and clothes.  You will be walking on a treadmill.

 

External Enhanced Cardiac Pulsation Treatment (EECP)

This is a noninvasive procedure that can reduce the symptoms of angina pectoris, presumably by increasing coronary blood flow in ischemic areas of the heart. EECP involves the use of the device that inflates and deflates a series of compressive cuffs wrapped around your calves, lower thighs, and upper thighs. Inflation and deflation of the cuffs are modulated by events in the cardiac cycle via computer-interpreted ECG signals.

Test time 1 hour (35 sessions).  Your will need to reduce your liquid intake the morning of your treatment.