Services provided at ACI
Cardiac
Catheterization
Cardioversion
Carotid
Doppler Ultrasound
Coumadin/Cholesterol/Liver Function
Test (LFT) Clinic
Duplex Scan
Abdominal Aorta
Duplex Scan
Lower Extremity
Holter
Monitor/Event Monitor
ICD
MTWA
Nuclear Stress
Test
Pacer Clinic
Pacer
Implantation
Pulse volume
recording (PVR)
Renal Artery
Duplex Scan
TEE
(Transesophageal Echocardiogram)
Transthoracic
Echocardiogram
Holter Monitor/Event Monitor
Both monitors are an EKG device that is worn
either for 24 hours (holter monitor) or 30
days (event monitor) and record your heart
rhythm for any abnormalities. Abnormal heart
rhythms may cause symptoms such as
palpations, “racing heart”, dizziness,
lightheadness, chest pain or loss of
consciousness (called syncope). Choice of
monitor depends on the frequency and /or
duration of your symptoms.
Pre and post
instructions
Pre instructions:
Wear loose-fitting clothes such as a shirt
that buttons down in the front. This makes
it easier for our staff nurse to place the
electrode pads to your chest and attach the
EKG wires. Male patients may require areas
to be shaved to apply the electrode pads.
You may wear it with a shoulder strap or
belt. You will be given a diary to record
any symptoms and events that may occur while
wearing the monitor.
Post instructions:
If the 24-hour holter monitor was ordered
you will be bringing the monitor back to our
office. Dr Aldrich will then read it.
If you will be wearing the 30 day event
monitor you will be given complete
instructions by our staff nurse on the
device and a pre-paid package to send the
device back to the company when complete.
Our office will be notified of any events
that may occur while using the device. A
final report will be sent to us for Dr
Aldrich to review.
< return to top
___________________________________________________________
Transthoracic Echocardiogram
An echocardiogram is an
ultrasound of the heart. This
test provides information on the
heart’s structures and function.
It is a very safe and painless
procedure with no special
preparation needed.
Pre and post
instructions
There is no preparation need or
post instructions for this
procedure. This test will take
approximately 40 minutes.
<
return to top
___________________________________________________________
TEE (Transesophageal
Echocardiogram)
Transesophageal echocardiogram
is a procedure to evaluate
cardiac structures and function.
It records images of the heart
from inside the esophagus. TEE
allows for a better view of the
heart than the standard
transthoracic echocardiogram.
Additionally, a TEE can evaluate
excess fluid in the sac around
the heart, detect heart tumors
and blood clots within the heart
chambers. This procedure is
standard prior to heart valve
surgery, and
cardioversion.
Pre
and post instructions
Pre instructions:
Do not eat or drink after
midnight the night before.
Take no medications the morning
of procedure.
You need someone to drive you
home or make arrangements for
transportation.
Wear clothing that is easy to
get off/on.
Do not wear any jewelry.
What will happen?
Adhesive skin electrodes will be
applied to the chest and then
attached to a heart monitor.
An IV will be started and a mild
sedative will be given through
the IV by an anesthesiologist.
An ultrasound probe will then be
inserted and passed into the
esophagus.
The entire procedure will last
approximately 20 to 30 minutes.
Post procedure:
Recovery time is approximately 2
hours.
You will not be able to eat or
drink any thing for
approximately 2 hours after the
procedure unless directed
otherwise from your physician.
After 2 hours if cold liquids
are taken without any problems,
then you may resume eating.
Mild throat soreness for several
hours after the test is normal.
Do not drive or operate heavy
machinery for at least 12 hours
after test.
<
return to top
___________________________________________________________
Cardioversion
A cardioversion is a
procedure to correct an abnormal
heart rhythm (such as atrial
fibrillation or atrial flutter)
by shocking (using electrical
impulses) the heart back to
normal rhythm.
Pre and post
instructions
Pre instructions:
PT/INR will be drawn either the
day before or the morning of
your procedure.
Do not eat or drink anything
after midnight the night before
your procedure.
Take your morning medications
with sips of water only.
What to expect:
First your cardiologist will
perform a
TEE to rule out a clot
in the left atrium. If no clots
are visualized the cardioversion
will proceed.
An IV will be started for fluids
and medications. A mild sedative
will be given through the IV by
an anesthesiologist. You will
also have adhesive skin
electrodes applied to the chest
and then attached to a heart
monitor. Large patches will also
be placed on your chest. These
will deliver the shocks needed
to convert your heart into
normal sinus rhythm.
The procedure will take
approximately 15 to 30 minutes.
Post procedure:
Recovery time is approximately 2
hours.
You will not be able to eat or
drink any thing for
approximately 2 hours after the
procedure unless directed
otherwise from your physician.
After 2 hours if cold liquids
are taken without any problems,
then you may resume eating.
Mild throat soreness for several
hours after the test is normal.
Do not drive or operate heavy
machinery for at least 12 hours
after test.
You may have red or irritated
skin from the large patches that
delivered the shocks.
<
return to top
___________________________________________________________
MTWA
Microvolt T- wave alternans is a
non-invasive test to identify
people at risk for an arrthymia
that can cause sudden cardiac
death. Most people who suffer
cardiac arrest have a
pre-identifiable electrical
disorder that puts them at risk.
MTWA test requires elevation of
your heart rate and rhythm via
an EKG while walking on a
treadmill for a short time.
Pre and post instructions
What to do:
Do not eat or drink anything for
2 to 3 hours before the test.
Diabetic patients may have a
snack 2 to 3 hours before the
test and take half of your
normal insulin dose.
DO NOT TAKE ANY BETA BLOCKERS
CALCIUM CHANNEL BLOCKERS 48
HOURS PRIOR TO THE TEST.
Medication list.
You may take your other
medications the morning of your
test.
Do not use any body lotions or
creams the day of the test.
Wear comfortable walking shoes
and a tee shirt.
Post procedure:
The test will take approximately
40 minutes to complete.
There are no special post
instructions.
You will be scheduled for a
follow-up visit approximately 1
week later to receive the
results.
Consent
form for MTWA
What to expect:
Dr Aldrich will be on the
premises during the test.
A technologist will prepare you
for the test. They will prep the
skin with a mild abrasive and
then apply 14 electrodes, take
your blood pressure, and take
EKG readings. Using a low level
exercise or a chemical stress
test, the technologist will
attempt to get your heart rate
between 100 to 110 beats per
minute for 2 1/2 minute. Once
that has been achieved then the
technologist will slowly
increase your heart rate to 110
to 120 beats per minute for 1
1/2 minute.
<
return to top
___________________________________________________________
Nuclear Stress Test
Nuclear stress testing is a
diagnostic test to determine
heart function and if the heart
muscle is receiving adequate
blood supple. There are two
parts to this test, rest and
stress.
CARDIOLITE will be injected into
your vein while you are at rest,
and a special camera will take
pictures of your heart.
The stress test portion of the
test is performed on a treadmill
or the use of chemicals (Persantine
or Dobutamine) with continuous
EKG monitoring. CARDIOLITE will
be injected during exercise or
after the injection of chemicals
and another set of pictures will
be taken of your heart. Pre and
post instructions.
Nuclear stress test
Pre and post instructions
Pre instructions:
Rest day: this will take
approximately 1 hour to
complete. There is no
preparation. You may eat and
take all your medications. You
will receive an injection of
Cardiolite and you will have to
wait between 30 to 60 minutes to
allow the tracer to get into
place.
Stress Day: a technologist will
prepare you for the test. They
will apply 10 electrodes,
establish an IV, take your blood
pressure, and take EKG readings.
Dr Aldrich or a Nurse
Practitioner will be present
during the test. After the
exercise test is complete,
pictures will be taken of your
heart. This day takes
approximately 1.5 hours to
complete.
Important things to remember:
NO CAFFEINE OR DAIRY PRODUCTS 24
HOURS PRIOR TO TEST. This
includes decaffeinated coffee,
teas, chocolate, soda or
decaffeinated soda and eggs.
PLEASE DO NOT TAKE ANY BETA
BLOCKERS OR CALCIUM CHANNEL
BLOCKERS 48 HOURS PRIOR TO THE
TEST.
Medication list.
All other medications are ok to
take the day of the test.
Do not eat 2 to 3 hours before
the test. Diabetic patients may
have a snake 2 to 3 hours before
the test and take half of your
normal insulin dose.
Wear comfortable clothes and
walking shoes, no sandals,
flip-flops, or slip on type
shoes.
Consent form for
nuclear stress
tests.
<
return to top
___________________________________________________________
Pacer Implantation
A pacemaker is a treatment for
dangerously slow heart beat. A
slow heart rate or heart block
can cause symptoms of weakness,
confusion, dizziness, fainting
shortness of breath and death.
Having a pacemaker implanted is
a minor surgical procedure. It
is preformed with mild sedation
and local anesthetic.
Pre and
post instructions
Pre instructions:
Lab work will need to be drawn
several days prior to procedure.
Do not eat or drink after
midnight the night before.
Take no medications the morning
of procedure.
You need someone to drive you
home or make arrangements for
transportation.
Wear clothing that is easy to
get off/on.
Do not wear any jewelry.
Post procedure:
You may be able to be discharge
that day from the hospital.
Pain at the incisional site is
usually mild and transient and
usually responds to Tylenol.
However, you may be given a
prescription for a mild pain
reliever.
You may not shower for 48 hours
after the procedure and you need
to keep it clean and dry.
Avoid excessively exerting the
arm on the side to the pacer
insertion for six weeks.
Regular checks will be needed
for your device at your
pacer
clinic.
What to expect:
An IV will be started for fluids
and medications. A mild sedative
will be given through the IV per
an anesthesiologist. You will
also have adhesive skin
electrodes applied to the chest
and then attached to a heart
monitor.
It is performed with mild
sedation and local anesthetic. A
2-inch incision is made under
the collarbone. The pacer wires
are then inserted into a vein
and advanced through that vein
under fluoroscopic guidance into
the heart. The other end of the
pacer wire is then attached to
the generator that is implanted
under the skin at the incision
site. The site is then sutured
or surgical glue will be used to
close the incision.
<
return to top
__________________________________________________________
ICD
Implantable cardioverter/defibrillator
is commonly referred to as an
ICD. This device continuously
monitors the heart rhythm and is
implanted in patients who have
had ventricular fibrillation
(VF) or ventricular tachycardia
(VT) or patients who are felt to
be at high risk for these
sometimes fatal rhythms. These
devices can also act like a
standard pacemaker and pace the
heart if it is to slow. When an
abnormally fast rate is detected
by the ICD, it either
electrically paces the heart
very fast or deliveries a small
electrical shock the heart to
convert the heart back to normal
rhythm. If a shock is delivered
it will be felt by the patient
as a strong jolt in the chest.
If a shock is felt call your
cardiologist immediately. If you
experience multiple shocks
admission to the hospital is
usually required. The device is
implanted in an operating room
under deep sedation. Patients
are discharged the following
day. The incision is like the
insertion of a regular
pacemaker.
Pre and post
instructions
Pre instructions:
Lab work will need to be drawn
several days prior to procedure.
Do not eat or drink after
midnight the night before.
Take no medications the morning
of procedure.
You need someone to drive you
home or make arrangements for
transportation.
Wear clothing that is easy to
get off/on.
Post procedure:
However, you may be given a
prescription for a mild pain
reliever.
You may not shower for 48 hours
after the procedure and you need
to keep it clean and dry.
Avoid excessively exerting the
arm on the side to the pacer
insertion for six weeks.
Regular checks will be needed
for your device at your
pacer clinic.
What to expect:
An IV will be started for fluids
and medications. A mild sedative
will be given through the IV per
an anesthesiologist. You will
also have adhesive skin
electrodes applied to the chest
and then attached to a heart
monitor.
A 2-inch incision is made under
the collarbone. The pacer wires
are then inserted into a vein
and advanced through that vein
under fluoroscopic guidance into
the heart. The other end of the
pacer wire is than attached to
the generator that is implanted
under the skin at the incision
site. The site is than sutured
or surgical glue will be used to
close the incision. You will be
discharge the following day from
the hospital after a chest x-ray
and your ICD is checked by the
pacer rep.
<
return to top
___________________________________________________________
Pacer Clinic
ACI has monthly interrogations
of pacermakers/ICD. Regular
checks (interrogations) are
needed for these devices. The
frequency of your evaluation
will be determined by your
individual needs and type of
device. By identifying problems
in advance, we are able to
maximize your pacemaker
function. Devices can last 5 to
10 years. Pre and post
instructions.
Pre and post instructions
There are no instructions
What to expect:
A telemetry “wand” is used to
assess the function of the lead
wires from the device to the
heart, that the battery level is
ok, and assess if any abnormal
heart rhythms occurred. Devices
can last 5 to 10 years.
Your pacer check will take about
10 to 15 minutes.
The pacer rep will determine how
often you will need to be
evaluated.
<
return to top
___________________________________________________________
Cardiac Catheterization
Cardiac catheterization is a
common invasive diagnostic test
to evaluate the coronary
arteries, heart valves, muscle
disease and cardiac congenital
abnormalities. This procedure
does not treat or cure heart
disease, but it does give the
cardiologist very precise
information about your heart.
This procedure may be ordered if
you are having chest pain, have
a positive nuclear stress test
and prior to having heart valve
surgery.
Cardiac Catheterization
Pre and post instructions
Pre instructions:
Lab work will need to be drawn
several days prior to procedure
along with a chest x-ray.
Do not eat or drink after
midnight the night before.
Take no medications the morning
of procedure.
You need someone to drive you
home or make arrangements for
transportation.
Wear clothing that is easy to
get off/on.
Post procedure:
The groin insertion site with be
closed with an Angio-Seal
device.
You may shower only, no hot tub,
bath tub or swimming until the
site is healed.
You may feel a lump and/or mild
tenderness at the site.
Remove the dressing after 24
hours. Clean site with mild soap
and water and apply a clean
dressing.
Modify activity for 48-72 hours,
no straining, lifting greater
than 10 lbs.
What to expect:
An IV will be started for fluids
and medications. A mild sedative
will be given through the IV per
an anesthesiologist and you will
remain awake throughout the
procedure. Adhesive skin
electrodes will be applied to
the chest and then attached to a
heart monitor.
The cardiologist will than
insert a catheter into your
groin and gently guide to the
heart at the origin of the
coronary arteries. Dye will then
be injected into the arteries
and x-ray pictures will be
taken. Dye will also be injected
into the heart chambers to
evaluate the heart muscle
function, pressures and heart
valves. After the
catheterization you are
monitored for several hours. In
most cases you will be
discharged home the same day.
<
return to top
__________________________________________________________
Coumadin/Cholesterol/Liver
Function Test (LFT) Clinic
Your coumadin and cholesterol
lowering medications can be
monitored with just a few drops
of blood obtained from a
finger-stick puncture. The
results will be given to you in
minutes with directions on any
changes needed with medication
dosing. Your physician or ARNP
supervises all instructions.
Pre and post instructions
PT/INR dose not require any
preparation. You are asked to
fast for the Cholesterol and LFT
test (nothing by mouth after
midnight).
Test results will be available
with in minutes.
There are no post instructions.
<
return to top
___________________________________________________________
Carotid Doppler Ultrasound
A carotid ultrasound is ordered
to evaluate the carotid arteries
for narrowing, or stenosis, a
condition that substantially
increases the risk of stroke.
This test maybe ordered on
patients with known coronary
artery disease, diabetes,
hypertension, advanced age, high
cholesterol, symptoms of
transient ischemic attack (mini
strokes), family history of
stroke, or if a carotid bruit is
heard with a stethoscope on
exam.
Pre
and post instructions
Pre instructions:
No preparation needed. You
should wear comfortable,
loose-fitting clothing for your
ultrasound. An open necked shirt
or blouse is ideal. You will
need to remove all clothing and
jewelry in the area to be
examined
There are no post
instructions
What to expect:
For most ultrasound exams, you
are laying face-up on an exam
table. A gel is applied to the
area of the body being studied
to help the transducer make
secure contact with the body and
eliminate air pockets between
the transducer and the skin. The
technologist then presses the
transducer firmly against the
skin and sweeps it back and
forth over the area to be
examined. The test usually takes
about 30 minutes.
<
return to top
___________________________________________________________
Renal Artery Duplex Scan
A renal artery ultrasound allows
visualization of the arteries to
the kidneys located in the
abdominal area. This evaluation
detects any blockage or
narrowing and also measures the
speed of blood flow through
these arteries. This test also
includes on evaluation of the
abdominal aorta.
Pre
and post instructions
Pre instructions:
Nothing by mouth after mid
night. You may take your
medications with sips of water
the morning of test.
You should wear comfortable,
loose-fitting clothing for your
ultrasound. An open necked shirt
or blouse is ideal. You will
need to remove all clothing in
the area to be examined
There are no post instructions
What to expect:
For most ultrasound exams, you
are laying face-up on an exam
table. A gel is applied to the
area of the body being studied
to help the transducer make
secure contact with the body and
eliminate air pockets between
the transducer and the skin. The
technologist then presses the
transducer firmly against the
skin and sweeps it back and
forth over the area to be
examined. The test usually takes
about 30 minutes.
<
return to top
___________________________________________________________
Duplex Scan Abdominal Aorta
This test is an ultrasound of
the abdominal aorta to exclude
or document aneurismal diseases.
The aorta is the main artery
from the heart through the chest
and abdomen. An abdominal aortic
aneurysm forms when the walls of
this artery gets weak and
dilates. If the size of the
aneurysm gets to large, you are
at risk for the aorta to
rupture.
Pre
and post instructions
Pre instructions:
Nothing by mouth after
mid-night. You may take your
medications with sips of water
the morning of test.
You should wear comfortable,
loose-fitting clothing for your
ultrasound. An open necked shirt
or blouse is ideal. You will
need to remove all clothing in
the area to be examined
There are no post
instructions
What to expect:
For most ultrasound exams, you
are laying face-up on an exam
table. A gel is applied to the
area of the body being studied
to help the transducer make
secure contact with the body and
eliminate air pockets between
the transducer and the skin. The
technologist then presses the
transducer firmly against the
skin and sweeps it back and
forth over the area to be
examined. The test usually takes
about 30 minutes.
<
return to top
___________________________________________________________
Duplex Scan Lower Extremity
The lower arterial Doppler study
is a simple, non-invasive test
to detect blockage of blood flow
in the legs. It provides an
overview of the location, extent
and severity of vascular
disease.
Pre
and post instructions
Pre instructions:
Nothing by mouth after
mid-night. You may take your
medications with sips of water
the morning of test.
You should wear comfortable,
loose-fitting clothing for your
ultrasound. You will need to
remove all clothing covering
your legs.
There are no post instructions.
What to expect:
You will have to remove your
shoes, socks and pants to
perform the test. A gel is
applied to the area of the body
being studied to help the
transducer make secure contact
with the body and eliminate air
pockets between the transducer
and the skin. The technologist
then presses the transducer
firmly against the skin and
sweeps it back and forth over
the area to be examined. The
test takes about 30 to 60
minutes.
<
return to top
___________________________________________________________
Pulse volume recording
(PVR)
A PVR study is a non-invasive
vascular test in which blood
pressure cuffs and a hand-held
ultrasound device is used to
obtain information about
arterial blood flow in the arms
and legs. The test is ordered to
determine the presence, severity
and general location of
peripheral arterial occlusive
disease.
Pre and post instructions
Pre instructions:
You may take your medications as
usual.
There are no dietary
restrictions.
Refrain from smoking at least
one hour before test.
You should wear comfortable,
loose-fitting clothing for your
ultrasound. You will need to
remove all clothing covering
your legs.
You will be lying face-up on an
exam table with your extremities
at the same level as your heart.
There are no post
instructions
What to expect:
The technologist will examine
your legs and check your pulse
at several points. Blood
pressure cuffs are placed on
both arms and several points on
your legs; high thigh, above the
knee, at the ankle, and at the
foot and toe level. Each cuff is
inflated in turning order to
measure blood volume in the
arteries. Clear gel is applied
to the legs to help conduct
sound waves. The blood pressure
cuffs are tight slightly, and an
ultrasound transducer is held
against the skin in different
locations to measure blood
pressure. This test may take 60
to 90 minutes.
<
return to top
|
