EKG, Holter monitoring, Echocardiogram, Cardiac Catheterization, Nuclear Cardiology, Electrophysiology Study, Telemetry Monitoring, Exercise testing, Lab
EKG is a shortened version of the word electrocardiogram. Electrocardiography is a testing method commonly used to determine if the heart has been damaged. An electrocardiogram is a graphic record of the heart's electrical impulses. There are several different types:
Holter monitoring is also called ambulatory electrocardiography. A Holter monitor is a machine about the size of a camera. It has leads (wires) that are attached to electrodes (small round sticky pads) placed on your chest. The monitor makes a tape recording of your heart beating for a 24-hour period.
The Holter monitor recording shows how your heart works during activity and rest. You may need Holter monitoring if you have problems with your heart such as chest pain or abnormal heartbeats. If you have recently had a heart attack you may need Holter monitoring. Caregivers may also want you to have this test if you are on heart or blood pressure medicine.
You will keep a diary to write the times you do different activities such as eating or drinking. Also, write in your diary when you feel strong emotions like anger or fear. Record symptoms, such as dizziness or pain that you have during these activities or when you feel strong emotions.
An echocardiogram is a painless test to check for problems inside and around your heart. It is often just called an "ECHO." It is also called echocardiography or ultrasound cardiography. It works like the sonar used by whales and submarines to find objects under water.
Harmless sound waves are sent into the heart through the chest. Parts of the heart, like the walls, valves, muscles and blood vessels send echoes back to the machine. The motion of the echoes is traced on a machine and recorded on film. This recording tells caregivers about how your heart looks and works. You may need an ECHO because of problems with your heart muscles, valves or if you have fluid around your heart. No special care is needed before the test. If you are an outpatient, you will be able to go home right after the test.
To perform the test, you will be asked to take off the clothing on your upper body or over your chest. You will lie down on a bed. A caregiver will put lubricating gel on a transducer, which is a hand-held instrument that sends sound waves into your chest. It is moved around your chest and you may be asked to change positions. This allows the sound waves to be sent into your chest from different directions. The ECHO usually takes less than 45 minutes.
A cardiac catheterization is a test to look inside your heart. A catheter (long, thin, bendable tube) is put into an artery between your abdomen and the top of your leg. Using a TV screen and x-rays, the catheter is gently threaded (pushed) into your heart. The catheter is moved around inside your heart and blood vessels. This lets caregivers see how well your heart is working.
During the cath, caregivers can learn how strong your heart muscles are. The pressure in the chambers inside your heart will be checked. The valves between the chambers of the heart can be checked. The arteries in your heart will be checked to see if they re blocked. You may go home after the heart cath or you may stay in the hospital overnight.
You will lie on a movable x-ray bed. There will be large x-ray machines and other equipment in the room. Your caregiver will clean the skin over an artery, and the skin may be clipped to see the area better. Sheets will be put over you to keep the area clean. Local anesthesia may be put into your skin near the artery for pain relief.
You will be given dye through an IV to help your heart and arteries show up better on x-rays. You may feel warm all over or just in your head as the dye is put into the catheter. You may get a headache or feel sick to your stomach. You may feel as though your heart is skipping beats or beating extra beats. These are normal feelings and will go away soon. Tell your caregiver if you feel chest pain or angina while you are getting the dye.
The catheter will be taken out of the artery and a tight pressure bandage put on it. Caregivers will put pressure on the bandage to stop bleeding.
After your cath, you will be taken back to your room or to a recovery area. Do not get out of bed until your caregiver says it is OK. Caregivers will take your vital signs every 15 minutes for 1 to 2 hours. The pulses in your feet will also be checked often. Your toes will be checked to see if they are warm. Caregivers will watch you closely for problems that can happen after a heart cath.
The Nuclear Cardiology Department performs Stress Tests with Radioisotopes. This test is actually a two-fold exam. Two specialties are combined to acquire maximum knowledge of your heart's function.
The first part is a routine stress test that evaluates the heart's action during physical or pharmacological stress. It tests the heart in relation to demand for oxygen and records this data on an EKG.
The second part involves the use of nuclear cameras to scan for radioisotope. This radioisotope is administered during the first part of the exam and is not a dye. It is injected through an IV line approximately one minute prior to the end of the stress test. The radioisotope is carried to the heart by the blood, allowed to circulate for 30 minutes and can then be visualized as it flows to your heart.
This procedure, on the average, results in an effective radiation dose of 0.42-0.70 rem. For an adult, the average annual effective dose from all naturally occurring sources (food, air, water, ground and materials) is approximately 0.30 rem. The radioisotopes used in this procedure are excreted through the kidneys. This process can be aided with increased intake of water. Although this is very safe, if you are pregnant or nursing please advise your physician.
The significant differences you will notice from the other GXT exercise test are:
- An IV will be started prior to the exam.
- You will remain in the lab for a scanning by a special nuclear camera.
- You will return in two to four hours for a second set of images. Depending on the type of radioisotope, you will be advised by the technician as to whether you may have food or drink during that time.
There are many reasons for this type of testing such as diagnosing the cause of chest pain; identifying abnormal heart rhythms during stress; determining the effect of a previous heart attack; and evaluating the effectiveness of some medications. It is also used for prevention measures like screening high-risk groups, and setting up exercise programs.
An electrophysiology study, also known as an E.P. Study, gives your physician highly detailed information about your heart's electrical system so that together you can make an informed decision on treatment options.
The risks involved with an E.P. Study are low and will be explained by your physician in detail prior to the procedure. It is important to remember that your physician feels these risks are far outweighed by the benefit of knowing the exact condition of your heart.
According to your physician's orders, blood will be drawn, a urine specimen collected and an EKG performed. If you have had any previous reaction to a medication, please inform your nurses and physicians so preventative measures can be taken. The area where the catheter will be inserted will be clipped. In most cases this will be the groin, in some cases, the arm, chest or neck area. An intravenous (IV) line will be started and you will be asked to sign a consent form. Just before you are taken to the E.P. Lab, you will be asked to use the bathroom to empty your bladder. You will then be transported to the E.P. Lab on a stretcher or in a wheelchair. Your family will be directed to wait in the waiting area just outside the E.P. Lab.
In the E.P. Lab, you will be asked to move onto a x-ray table. The table has a large camera above it and television screens close by. The equipment in the E.P. Lab also includes heart monitors and various instruments. E.P. Studies can be quite lengthy, depending on the particular arrhythmia you have and the findings, a complete study can last from two to six hours. After being positioned on the x-ray table, you will be connected to a variety of monitors. The site used for insertion of the electrode catheters will be cleaned with an antiseptic solution and covered with sterile sheets or towels.
Most likely you will be given a sedative to help you relax. This may be increased as needed to help you remain comfortable. It is not uncommon to doze off during the procedure.
During preparation, which takes about 20 minutes, the technologist will tell you what is about to happen and answer any questions you might have.
Your doctor will inject a local anesthetic to numb the skin around the insertion area. A catheter is then inserted, usually in a vein, in your groin, arm, neck or chest. One or more catheters are inserted into the body and advanced toward the heart, while the staff follows their progress on a television screen. The catheters are positioned inside the heart.
The E.P. Study can define the exact location of the abnormal electrical activity and will help determine the best treatment option for your problem. When the procedure is completed, you will be transported to the holding area. A technologist will then remove the catheters and hold firm pressure on the insertion site for about 10-20 minutes to prevent bleeding. A bandage will be placed over the insertion site. You will be taken to an outpatient room.
Immediately following the E.P. Study, your physician will briefly inform you about your results and meet your family in the waiting room to discuss the procedure. Your physician will meet with you before discharge to give you more detailed information about the results of your procedure. You may have some swelling and possibly a small bruise at the site of the catheterization. Your doctor or the nurse will check this area carefully.
During this phase of your recovery, you will be required to lie flat with your leg or arm extended for 3 hours, depending on your physician's orders. It will be necessary to use a bedpan or urinal until your physician allows you to be up. Whether you are allowed to eat or drink soon after the study depends on your condition. A telephone and television will be provided for your convenience and your family is welcome.
Based on your personal medical history and the information gained from your E.P. Study, your doctor will advise you regarding the various treatment options for your cardiac condition.
About the study:
The heart has it's own electrical system. This electrical system, in the normal heart, produces impulses (signals) which start in the right upper chamber of the heart (the right atrium) at the sa node (the heart's natural pacemaker). The impulse travels from the sa node to an area in the middle of the heart called the a-v node (so called because it lies between the atria (a) and the ventricles (v). The impulse then travels through the ventricles (the heart's lower chambers) which causes the heart to "beat". In the normal heart, the impulses are fired 60-100 times per minute from the sa node in a very regular rhythm.
When people exercise, the rate speeds up, and when people rest, the rate slows back to normal. During this increase and decrease in rate, the rhythm remains stable and regular - in the normal heart. When people have irregular, unstable heart rhythms that cause them to feel badly or faint, it is likely that the electrical system of the heart is not functioning normally. In such cases, the physician may order an EP study.
These are done to identify abnormalities in the heart's electrical system. These abnormalities include:
- Electrical signals that are sent out too slowly from the top part of the heart
- Signals that are blocked and cannot reach the bottom of the heart
- Signals that start from the wrong part of the heart
- Signals that travel the wrong path from the top of the heart to the bottom
Any of these abnormalities can affect the heart's ability to pump blood to the body.
E.P. Studies are frequently considered for the following conditions:
- unexplained fainting (syncope)
- "heart racing" leading to syncope or near syncope
- frequent episodes of rapid irregular heart rhythm (atrial fibrillation, Ventricular tachycardia or ventricular fibrillation)
- an episode of "sudden death"
- certain types of cardiomyopathy (a disease of the heart muscle fibers) with a known higher-than-average risk for heart rhythm problems
During the test, your heart is monitored so that the doctor can watch the heart rate and rhythm. Two or three small catheters (tubes) are inserted into a large vein in your groin and guided to the heart. (This is similar to an arteriogram, except that during the arteriogram, the catheter is inserted into an artery, whereas during the E.P. Study, the catheter is inserted into a vein).
The catheters are used to record the heart's electrical activity and to study the conduction of the heartbeat. Electrical stimuli are used to pace the upper and lower chambers of the heart to look for rapid, abnormal heart rhythms. During the test, the catheters may be moved to different locations in the heart. From this information, the doctor can tell how well the heart's pacemaker (the sa node) is functioning, and how well the heart beats. It tests the ability of the heart to speed up, then slow back down normally.
Remember that the reason a person has this test is because the heart may have had a rapid irregular rhythm. The doctor "tests" the heart to try to find the source of the irritability. The doctor paces the heart at different spots and at different rates to gain the information he/she needs.
Depending on the information gained from the test, the doctor may prescribe an appropriate drug to control the irregular rhythm. This test may be repeated in 1-2 days to see if the drug has helped to control the rhythm problem. For more information on the Electrophysiology Study, call the Huntsville Hospital Cath Lab at 265-8186.
Your physician has ordered that you be placed on telemetry (also known as cardiac monitoring). Telemetry is used to monitor the heart's activity.
Three or four small electrode pads will be placed on your chest and sides. Wires coming from the telemetry box will connect to the small pads. The telemetry box may be placed in a telemetry pouch and clipped to your pajamas or placed in your pocket.
Possible Reasons for Telemetry:
- To detect abnormalities of the heart
- To evaluate chest pain
- To monitor effectiveness of medications
- To correlate symptoms with heart activity
Exercise testing will evaluate the heart's function during physical stress. It will test the heart in relation to its demand for oxygen and this will be recorded on an EKG. Your blood pressure will be taken and an EKG will be recorded periodically as the level of exercise increases. The test continues until you reach a target heart rate determined by your age and sex or at your physician's recommendation. Should you experience chest pain or fatigue-this, too, will be an indication to stop.
This test can be performed in many ways. The most common is the use of a treadmill. You will be encouraged to work hard and continually exercise throughout the stress test.
There are many reasons for exercise testing, such as diagnosing the cause of chest pain, identifying abnormal heart rhythms during exercise, determining the effect of a previous heart attack as well as evaluating the effectiveness of some medications. It is also used for preventive measures like screening high-risk groups, and setting up exercise programs.
A complete blood count (CBC) is a commonly ordered laboratory blood test. A CBC is a group of tests that measures some of the different parts of the blood. Blood is made up of red blood cells (RBCs), white blood cells (WBCs), platelets and plasma. RBCs carry oxygen and food to the cells of the body and take away wastes. WBCs help fight infections. Platelets, plasma and other proteins in the blood help your blood clot when you are cut or hurt.
A CBC is usually done when you have a check-up. It is also done to check your health before surgery. A CBC can be helpful to find out why your skin is paler than usual. I t can also help find out why you feel weak or tired. Other reasons for a CBC may be if you have fever, pain or swelling or you bruise easily.
The normals for a CBC are different for men, women and children. Your physician will explain what your test results mean for you.
Cardiac enzymes are blood tests that tell about your heart. Enzymes are proteins in your body that speed chemical and biologic reactions. When a person has damage to the heart, such as in a heart attack, these enzymes are released into the blood stream. An increase of the heart enzymes is one way your caregivers can tell if you have had a heart attack.
If you have chest pain, the results of these tests can help caregivers tell if the pain is caused by a heart attack. Each cardiac enzyme and isoenzyme has a specific time when it will rise above normal, reach its highest point and return to normal. The pattern of these changes helps caregivers find out if you had a heart attack. The pattern may also help them find out how much of the heart was damaged.