At West Suburban Cardiologists, we take pride in providing state-of-the-art cardiac care. Many diagnostic tests and procedures can be completed in our office although invasive procedures require testing within one of our affiliated hospitals. We work hard in making your testing experience as easy as possible. We have included a few generalized instructions below for some of the testing you may require. Please remember that these are general guidelines. As always, please call if you have any questions or concerns about your specific test. We would be delighted to help in any way possible.

Our office Echocardiography labs are Accredited by:
INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF ECHOCARDIOGRAPHY LABORATORIES

For All Tests:

Check in at the front desk. For hospital based procedures (e.g.., cardiac catheterization, cardioversion, trans-esophageal echocardiography), please check in with the admitting office or cardiology section of the respective hospital. For questions of where to sign in, please call ahead.

Wear comfortable clothing and shoes. (Two piece outfit for women) For stress testing, we suggest wearing sneakers (avoid sandals, open toe shoes etc.). You may even wish to bring a change of clothes for exercise treadmill tests. Some patients build up quite a sweat! For outpatient testing that requires sedation (your doctor will discuss sedation with you when discussing the risks and benefits of the procedure or test), you will need someone to drive you home.

Unless instructed otherwise, take your usual morning medications with a half-glass of water. If you take insulin, check with your doctor about what to do with your morning insulin dose. It is also very helpful if you bring a list of your medications with you. Please remind your doctor of any drug allergies you have or past problems with similar tests.

Exercise Treadmill or Stress Echocardiogram

Exercise tests are performed for a number of reasons but most commonly in patients with chest discomfort or cardiac risk factors to determine if someone is likely to have coronary artery disease. These tests are also performed frequently in patients who have had angioplasty or bypass surgery.

Diagnostic stress testing usually consists of at least two parts: 1) The stress test itself which involves walking in a treadmill. For patients unable to exercise, a pharmacologic stress test can be performed which involves infusion of a medication to stress the heart chemically through an IV. 2) An imaging technique to look at the heart muscle's response to exercise (e.g., stress echo) or a thallium or 'nuclear' stress test which looks at blood flow through the arteries into the heart muscle. Some patients will only require the exercise treadmill portion of the test without the need for the imaging study.

For an exercise treadmill test with or without echocardiography, you may have a light breakfast/lunch.

These stress tests also combine an EKG portion with an imaging study. The stress portion of the study can be performed by either walking on a treadmill or by IV infusion of a pharmacologic agent (chemical stress test). If you are having a 'Pharmacologic' (using Dobutamine, Adenosine (Persantine) or another agent to chemically stress the heart) or if you're having a 'Nuclear' (sometimes called SPECT) stress test (e.g..,with Cardiolite or Thallium), please remember:

• Nothing to eat or drink for 4-6 hours prior to the test.
• If you are diabetic, you may have dry toast and juice or water. Please ask your doctor or nurse about what to do with your insulin dose.
• AVOID caffeine-containing products like coffee, tea, colas, chocolate, anacin, excedrin because they may interfere with the test (at least for 24 hours).
• If you have COPD or Asthma or take theophylline (Theodur, Theochron) or dipyridamole (Persantine, Dipridacot), please ask your doctor about special instructions. These medications are generally stopped 24-36 hours prior to the test.
  
  More Instructions for Adenosine Testing
  More Instructions for Dobutamine Testing

Most vascular ultrasound studies do not require patient preparation. The main exception is for patients referred for Renal Artery Ultrasound to determine if renal artery disease is present. This diagnostic test is frequently performed in patients with refractory high blood pressure for detection of renal artery stensosis.

• Nothing to eat or drink after midnight
• You may take your morning medications with a sip of water
• Bring a list of your medications and dosages

These two tests are almost always performed in the hospital and not in the office. Both require IV sedation. Cardioversion is performed to convert an abnormal heart rhythm (usually atrial fibrillation or flutter) into normal sinus rhythm. TEE is performed to get a better look at the heart muscle, valves, and other structures. Because both of these tests use sedation, please remember:

• Nothing to eat or drink after midnight.
• If you are diabetic, please ask your doctor or nurse about what to do with your insulin dose.
• Have someone available to drive you home if you're not staying overnight
• Alert your doctor about any swallowing or bleeding problems you might have

Cardiac Catheterization and Peripheral Angiography

Invasive testing is always done within the hospital and requires an angiographic suite- generally called a Catheterization Lab. Cardiac catheterization involves placing catheters within vascular structures. Through this technique, we can measure the pressures within the heart and other structures and also determine if blockages are present within arteries by injecting X-ray dye or 'contrast' (angiography or angiogram) through the catheter into an artery or vein. This is the only reliable technique that determines if blockages are present within an artery. While there are many reason to perform these tests, they are usually performed in patients at risk for coronary artery disease, those with heart failure, and in patients with chest pain and heart attacks.

For patients with coronary artery or other vascular disease, the diagnostic portion of the test may be followed immediately by a therapeutic procedure called 'Angioplasty'. Angioplasty is a generic term that refers to a group of procedures whereby blockages in arteries are treated with balloon catheters, stents, or other type if 'interventional' devices. These are non-surgical procedures (often call PCI-Percutaneous Coronary Interventions) performed by Interventional Cardiologists that are designed to open clogged arteries in order to improve blood flow to the heart muscle or other structures. Cardiac catheterization specifically refers to angiograms and interventions performed on the coronary or heart arteries. Similar procedures are done to evaluate blockages in the peripheral (non-heart) arteries such as the legs, kidneys, carotid, and subclavian arteries. When disease affects these systems, it is known as Peripheral Vascular Disease and can frequently be treated with the same non-surgical techniques as those used in the heart arteries.

Sometimes though, the disease is too extensive or prohibitively risky to treat with catheter therapy. In these situations, referal to a cardiac or vascular surgeon may be in order for a surgical solution to the problem such as open heart surgery (coronary Artery Bypass Grafting- CABG).

In general, all catheterizations require:

• Nothing to eat or drink after midnight
• You may take your morning medications with a sip of water
• Adjust your insulin per your doctor's recommendations
• If there is a possibility that you will go home after the test, you must have someone to drive you home

EP Studies and procedures are always performed in the hospital with the exception of pacemaker checks which can be done in the office. For diagnostic procedures, it is possible that the patient may go home the same day. For the majority of procedures however, at least an overnight hospital stay is required. Patient instructions for EP procedures are similar to those listed above for catheterization procedures:

• Nothing to eat or drink after midnight
• You may take your morning medications with a sip of water
• Adjust your insulin per your doctor's recommendations
• If there is a possibility that you will go home after the test, you must have someone to drive you home