Patient Instructions:

FOR ALL STRESS TESTS:

• No coffee, tea, soda or chocolate for 12 hours prior to test.

• DO NOT EAT 4 hours before the test.

• If you have DIABETES, ask your doctor if you should take your morning medications before the test.

• If you are on a BETA BLOCKER, check with your doctor about holding this medication 24 hrs. before the test.

• FOR ANY NUCLEAR STRESS TEST, YOUR ISOTOPE DOSE IS CUSTOM ORDERED FOR YOUR WEIGHT. PLEASE GIVE THE OFFICE 48 HRS NOTICE IF YOU MUST CANCEL.

Regular Stress Test or Stress Echo

• Test Time: 30 minutes

• Preparation: Wear comfortable clothes for walking on a treadmill.

• Purpose: This test measures your physical condition and heart function. You will be asked to walk on a treadmill that gradually increases in speed every three minutes until you have reached your target heart rate or if you indicate you can't walk anymore. For a stress echo you will have ultrasound pictures of your heart taken before you walk on the treadmill and within a minute after completing the treadmill portion.

Nuclear Stress Test

• Time: 3 hours

• Preparation: Wear comfortable clothes for walking on a treadmill.

• Purpose: For some people a regular treadmill test does not provide enough information about your heart and heart circulation. In this test you will be given an intravenous injection of a radioisotope. Next, you will have pictures of your heart taken under a special camera for about 30 minutes. Following the first set of pictures you will be asked to walk on the treadmill and you will be injected with a radioisotope just prior to the end of the test. You will be asked to EAT. Another set of pictures will be taken 30 minutes later.

Adenosine or Persantine Stress Test

• Test Time: 3 hours

• Preparation: Check with your doctor to find out if any other medications should be held with these tests. You may not be able to take this type of stress test, if you have ASTHMA.

• Purpose: This test is performed on people who cannot walk on a treadmill. You will be injected with a radioisotope and then placed under a special camera for 30 minutes. You will then receive an injection of persantine or adenosine for 6 minutes, be injected again with the isotope, eat and have pictures taken again in 30 minutes. You may be asked if you are able to WALK on a treadmill briefly. If you feel you CANNOT WALK AT ALL, please let the technicians know.

Dobutamine Stress Nuclear or ECHO

• Test Time: Nuclear 3 hrs Echo 1 hr.

• Preparation: See above under Adenosine.

• Purpose: This test is identical to an adenosine stress nuclear or stress echo. This test is primarily for patients with moderate to severe ASTHMA where you are given increasing amounts of dobutamine to increase your heart rate and either nuclear or ultrasound pictures are taken before and after administration of the drug.

MUGA

• Test Time: 2 hours

• Preparation: None

• Purpose: You will be injected with a nuclear isotope. Next you will have pictures of your heart taken under a special camera to detect the strength of your heart muscle.

Echocardiogram

• Test Time: 20 minutes

• Preparation: Wear loose fitting clothes.

• Purpose: This test uses ultrasound waves to take pictures of the heart muscle and valves.

Carotid Ultrasound Test

• Time: 20 minutes

• Preparation: Wear loose fitting shirt.

• Purpose: To take an ultrasound picture of the main arteries of the neck to see if there is any plaque or blockage.

24 Hour Holter

• Test Time: 15 minutes

• Preparation: Wear a loose fitting shirt.

• Purpose: Detect any irregular heart beats during 24 hours. You will be asked to complete a diary to tell us if you have any symptoms (dizziness, palpitations) during the test.

Event Monitor

• Test Time: 15 minutes

• Preparation: None

• Purpose: To allow you to trigger the device if you have any irregular heart beats or symptoms such as palpitations or dizziness during the test. You will be given instructions on how you will send this information over the phone to us when you have symptoms.

Ambulatory Blood Pressure Monitor

• Test Time: 15 minutes

• Preparation: None

• Purpose: This allows us to detect what your blood pressure is doing during 24 hours to see if you have a blood pressure problem or if your BP medications are working properly.

Instructions for Cardiac Catheterization

A cardiac catheterization is a test performed in the hospital where a thin tube or catheter is inserted into an artery and guided to the heart. A special dye (which is visible with x-ray) is injected through the catheter. The xrays show where any problems may be.

Purpose:

• To show if any of the coronary arteries are blocked
• To show if the heart valves are working properly
• To show if the heart muscle has been damaged by disease
• To show if you were born with a heart defect.

Before the Procedure:

Report any allergies you have. Since x-ray dye contains iodine it is important to report any allergies to x-ray dye or shellfish. If you are allergic, the catheterization can be performed but additional medications to prevent any reaction may need to be given prior to the test.

Do not eat or drink anything for 6 to 8 hours before the test. If you are diabetic you may need to check with your primary care doctor regarding how you are to take your diabetic medications on the night before and morning of the test. The area where the catheter is inserted will be shaved if need be. You will be given both oral and intravenous medication before and during the procedure to help you relax.

The test is performed in the cardiac catheterization suite at the hospital. You will go to admitting on the day of the test to register and on to short stay. The cardiac catheterization normally takes approximately one half hour once you are in the catheterzation lab. If a blockage is identified which can be fixed you may go on to an additional procedure such as an angioplasty or stent.

Cardiac Catheterization the Actual Procedure

The area where the catheter will be inserted is anesthetized . A small puncture is made in the artery and a small tube or introducer sheath is placed in the artery. The catheter passes through the sheath and is guided to the heart. X-ray dye is injected through the catheter and x-rays of the heart and coronary arteries are taken.

After the Procedure

After the catheterization you will either go on to have a stent or angioplasty or you will have the catheter removed in the cath lab and a small seal will be inserted in the leg to help close the hole made in the artery. Stitches may be used if the approach is made through the arm.

You will be watched for bleeding and discharged home where you should continue to keep your leg straight or arm still for at least 6 hours after the procedure. You may notice a bruise or small lump in the groin or arm area. This is normal unless the area increases in size or discomfort.

IF YOU EXPERIENCE ANY OF THE FOLLOWING CALL IMMEDIATELY:

• Numbness or pain in the arm or leg where the procedure was done

• Difficulty breathing

• Chest or back pain

• Palpitations or irregular heart beat

• Bleeding at the insertion site

You may return to usual activities in 1-2 days. Do not push or lift more than 10 pounds for a least 1-2 weeks after the procedure unless told otherwise. Ask the doctor if you have further questions.

Instructions for Coronary Angioplasty and Stent

A coronary stent or angioplasty is a procedure performed in the hospital where a thin tube or catheter is inserted into an artery and guided to the heart. A special dye (which is visible with x-ray) is injected through the catheter. The xrays show where any problems may be.

Purpose:

To either compress fatty deposits to open an artery (ANGIOPLASTY) OR

To insert a small coil or mesh tube either medicated or nonmedicated in the blocked artery to keep it open (STENT)

Before the Procedure:

Report any allergies you have. Since x-ray dye contains iodine it is important to report any allergies to x-ray dye or shellfish. If you are allergic, the catheterization can be performed but additional medications to prevent any reaction may need to be given prior to the test.

Do not eat or drink anything for 6 to 8 hours before the test. If you are diabetic you may need to check with your primary care doctor regarding how you are to take your diabetic medications on the night before and morning of the test. The area where the catheter is inserted will be shaved if need be. You will be given both oral and intravenous medication before and during the procedure to help you relax. The test is performed in the cardiac catheterization suite at the hospital. You will go to admitting on the day of the test to register and on to short stay. The cardiac catheterization normally takes approximately one hour

Coronary Angioplasty or Stent

The Actual Procedure

The area where the catheter will be inserted is anesthetized . A small puncture is made in the artery and a small tube or introducer sheath is placed in the artery. The catheter passes through the sheath and is guided to the heart. X-ray dye is injected through the catheter and x-rays of the heart and coronary arteries are taken. In an angioplasty a balloon tipped catheter is inserted into the artery until it reaches the blockage. The balloon is inflated and deflated seeveral times to compress the fatty deposits. You may feel some chest pain when the balloon is inflated. When a stent is placed a balloon is inserted initially to expand the stent where it locks in place and the balloon tipped catheter is removed. A stent remains in the artery permanently.

After the Procedure

After the stent or angioplasty or you may have the catheter removed in the cath lab and a small seal will be inserted in the leg to help close the hole made in the artery. Stitches may be used if the approach is made through the arm. In some cases the sheath is left in place and you will need to keep your leg straight until the sheath is removed. Under rare circumstances additional support of the coronary circulation may be necessary following the procedure called an intra-aortic balloon pump . This is a special device to assist in keeping the artery open after a stent or angioplasty and will require you to be satched in the ICU rather than the post-angioplasty suite.

You will be watched overnight for bleeding and discharged home where you should continue to keep your leg straight or arm still for at least 6 hours after the procedure. You may notice a bruise or small lump in the groin or arm area. This is normal unless the area increases in size or discomfort.

IF YOU EXPERIENCE ANY OF THE FOLLOWING CALL IMMEDIATELY:

• Numbness or pain in the arm or leg where the procedure was done

• Difficulty breathing

• Chest or back pain

• Palpitations or irregular heart beat

• Bleeding at the insertion site a temperature of more than 101.5 F

• Warmth, tenderness or redness around the incision.

You may return to usual activities in 1-2 days. Do not push or lift more than 10 pounds for a least 1-2 weeks after the procedure unless told otherwise. Ask the doctor if you have further questions.