|Tests and Procedures|
We offer a variety of tests and proceedures using the latest technology to help assess your heart health inlcuding:
- Noninvasive Cardiovascular Diagnostic Testing and Procedures
- Cardiac Catheterization Laboratory Procedures and Testing
- Vascular Diagnostic Procedures and Testing
Cardiac Positron Emission Tomography (PET) - Positron emission tomography (PET) is a scan that uses information about the energy of certain elements in your body to show whether parts of the heart muscle are alive and working. A PET scan can also show if your heart is getting enough blood to keep the muscle healthy. A PET scan is very accurate because it actually shows your heart at work. Renown Institute for Heart & Vascular Health has the only dedicated cardiac PET camera in Northern Nevada.
Cardioversion - A medical procedure in which an abnormally fast or irregular heart rhythm is restored to a regular, normal rhythm. Depending on the specific medical history and symptoms of the patient, the physician may recommend an electrical or a chemical cardioversion. An electrical cardioversion is a brief procedure, performed in a hospital setting, whereby an electrical shock is delivered to the heart to restore it to a normal rhythm. A chemical cardioversion refers to using antiarrhythmic medications to convert the heart to a normal rhythm.
Echocardiography or Echocardiogram - A diagnostic method in which a hand-held device is placed on the chest and high-frequency sound waves (ultrasound) are used to produce images of the heart’s size, structure and motion. An “echo” provides valuable information about the health of the heart and helps gather information about abnormal rhythms (arrhythmias).
Electrocardiography (EKG or ECG) - A quick, painless test that records the electrical activity of the heart. It may be taken at rest or during exercise. It is the standard clinical tool for diagnosing arrhythmias (abnormal rhythms) and to check if the heart is getting enough blood or if areas of the heart are abnormally thick.
Enhanced External Counterpulsation (EECP) – A noninvasive, outpatient therapy for chronic, stable anginal symptoms (chest pain). EECP treatment increases blood flow to the heart through compression of blood vessels in the lower limbs.
Exercise Stress Testing - A stress test, sometimes called a treadmill test or exercise test, helps a doctor find out how well your heart handles work. As your body works harder during the test, it requires more oxygen, so the heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart. It also helps doctors know the kind and level of exercise appropriate for a patient.
History of illness - The cardiac work-up of a heart patient begins with a series of questions during which important information is gathered. This may cover some, or all, of the following areas:
- Chief or predominant complaint
- Other heart related complaints
- Past illness or history
- Family history
- Review of systems or non-cardiac complaints
- Social history
Holter/Event/Transtelephonic Monitoring - The Holter monitor is a device that records the heart rhythm continuously for 24 hours. Electrodes (sticky patches) on the chest are connected to wires from the Holter monitor. The monitor is carried with the patient for the recording period. The heart rhythm is recorded onto a cassette tape or flash card technology and then processed at a heart center. 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 diary comes with the Holter for the patient or caregiver to write down the time and type of symptoms so the rhythm can be reviewed.
Event monitors are small devices that are used by patients over a longer period (weeks to months, typically one month). Two electrodes on the chest connect two wires to the event recorder. The monitor is always on but will only store the patient’s rhythm when the patient or caregiver pushes the button. Most monitors will save the rhythm for several seconds of rhythm before the button is even pushed. The rhythm is also saved for a period after the button is pushed. A few specialized monitors are used only after the patient has symptoms. The intent is for most event monitors to be worn as much as possible every day to increase the chances of recording the patient’s rhythm when he/she has symptoms.
Transtelephonic monitors are small devices that transmit the patient’s rhythm live over the phone. An example is shown in Figure 3. These devices do not save a recording of rhythm for later playback like an event monitor. The transtelephonic devices are commonly used by pacemaker/ICD patients for routine scheduled checks over the phone. (An ICD is an implantable cardioverter-defibrillator or shock device used for treating life-threatening rhythm problems.)
Implantable Loop Recorders (ILRs) - Some patients have serious but very infrequent symptoms that can't be recorded by regular event recorders because they occur so rarely. In these cases, it may become necessary to implant a special event recorder called an ILR under the patient’s skin. An ILR is the size of an adult’s little finger. It is implanted under the skin by a one-inch incision on the chest. The battery lasts 14 months. It is always watching the patient’s rhythm.
Nuclear Cardiology - Exercise testing and nuclear imaging are common tests that are used to diagnose the presence of obstructions in the coronary vessels and to evaluate their severity.
Nuclear cardiology provides detailed information about your heart through the use of safe, radioactive drugs, generally thallium. During a nuclear test, your heart is ‘stressed or exercised" either by exercising on a treadmill or with medications. A small amount of thallium is injected into the bloodstream and its movement is traced by a special nuclear imaging camera. (See photo below) Thallium flows freely through normal arteries and less so through narrowed arteries.
Pacemaker/Internal Cardiac Defibrillator (ICD) Clinic - Renown Institute for Heart & Vascular Health provides on-going follow up care and education for patients with permanent pacemakers or ICDs.
Stress echocardiography – An ultrasound of the heart performed in conjunction with a stress test to evaluate the heart at rest and immediately after exercise.
Balloon angioplasty - Angioplasty is a medical procedure to open narrowed or blocked blood vessels of the heart. These blood vessels are called the coronary arteries. Angioplasty is not considered to be a type of surgery. It is called a percutaneous coronary intervention (PCI).
Alternative names: Balloon angioplasty; Coronary angioplasty; PTCA; Percutaneous transluminal coronary angioplasty
Balloon angioplasty with stents - During a coronary angioplasty, doctors insert a long, slender tube called a catheter through an incision in the groin and guide it into the heart. With a balloon angioplasty, a small balloon at the tip of the catheter is inflated to stretch the artery open.
Cardiac pacing - Cardiac pacing is the use of a small electrical current to artificially produce a heartbeat. A pacing box at the bedside creates a current and a specialized wire on the inside or outside surface of the heart delivers the electrical stimulation to the heart. Temporary pacing systems are used for a short period of time (days or weeks) and the pacing wire is put in at the bedside (no surgery is required). Treatment of certain long-term heart rhythm problems requires insertion of a small pacing box inside the body. This is attached to a pacing wire that sits in the heart (surgery is needed).
Diagnostic cardiac catheterization - This is a procedure to examine blood flow to the heart and test how well the heart is pumping. A doctor inserts a thin plastic tube (catheter) (KATH'eh-ter) into an artery or vein in the arm or leg. From there it can be advanced into the chambers of the heart or into the coronary arteries.
Electrophysiology studies for arrhythmias - Under sterile conditions, thin tubes called electrode catheters are inserted into veins in the groin or neck area and threaded into the heart. The heart's electrical conduction system is measured. Electrical impulses are applied to the heart to provoke and analyze a fast heart rate. This study can diagnose symptomatic and potentially life-threatening slow and fast heart rates.
Internal Cardiac Defibrillator (ICD) implantation – An implantable cardioverter defibrillator (ICD) is a small device that's placed in your chest or abdomen. This device uses electrical pulses or shocks to help control life-threatening, irregular heartbeats, especially those that could lead the heart to suddenly stop beating (sudden cardiac arrest).
Permanent pacemaker implantation - The pacemaker system is made up of two parts - the generator and the leads. The pacemaker generator constantly monitors your heart for the electrical signals that keep your heart beating. If no signals are detected within the programmed amount of time, (chosen by your doctor and based on your condition) the pacemaker will send an electrical impulse to make your heart beat. The generator also contains the pacemaker's battery, which generally needs to be replaced every 3-6 years.
The leads (or wires) connect the generator to the heart muscle, convey the heart's electrical signals to the generator, and (when necessary) deliver electrical shocks to the heart. The leads are typically placed into the right side of the heart through veins in the chest area, under the collarbone.
Pulmonary arterial hypertension (PAH) - An increased pressure in the pulmonary arteries. These arteries carry blood from your heart to your lungs to pick up oxygen.
PAH causes symptoms such as shortness of breath during routine activity (for example, climbing two flights of stairs), tiredness, chest pain, and a racing heartbeat. As the disease worsens, its symptoms may limit all physical activity.
Radiofrequency catheter ablation - Catheter ablation is a medical procedure used to treat some types of arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of the heartbeat.
During catheter ablation, a long, thin, flexible tube is put into a blood vessel in your arm, groin (upper thigh), or neck. This tube is called an ablation catheter. It's guided into your heart through the blood vessel.
A special machine sends energy through the ablation catheter to your heart. The energy destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start. Radiofrequency (RF) energy usually is used for catheter ablation. This type of energy uses radio waves to produce heat that destroys the heart tissue. Studies have shown that RF energy is safe and effective.
Tilt table testing - A tilt table test is used to evaluate the cause of unexplained fainting (syncope). During a tilt table test, you lie on a table that moves from a horizontal to a vertical position. Your heart rate and blood pressure are monitored throughout the tilt table test.
Transesophageal Echocardiography (TEE) – A special ultrasound imaging procedure in which a transducer placed on the end of a tube is passed down a patient’s throat and into the esophagus. Since the esophagus is close to the heart, the images from this procedure can provide clear pictures of the heart and its structures.
Ankle Brachial Index (ABI) test -This test is done by measuring blood pressure at the ankle and in the arm while a person is at rest. Measurements are usually repeated at both sites after 5 minutes of walking on a treadmill. The ankle-brachial index (ABI) result is used to predict the severity of peripheral arterial disease (PAD). A slight drop in your ABI with exercise means that you probably have PAD. This drop may be important, because PAD can be linked to a higher risk of heart attack or stroke.
Carotid Doppler – An ultrasound to evaluate the blood flow from the aorta to the kidney
Coated or medicated stents - A tiny cage coated with a drug to prop open an artery and prevent it from closing again. The stent is a minute metal mesh tube. It is inserted into a coronary artery usually just after an angioplasty has been done to open the vessel. The stent slowly releases the drug with which it is coated. The drug may, for example, be sirolimus. Coated stents reduce the risk of artery re-narrowing, or restenosis, after angioplasty which occurs about a third of the time when bare metal stents are used.
Drug-eluting stents - Stents that are coated with medication that is slowly released (eluted) to help prevent the growth of scar tissue in the artery lining. This helps the artery remain smooth and open, assuring good blood flow through it. Drug-eluting stents were developed because in some of those who get bare-metal stents, tissue growth over the stent eventually leads to re-blockage.
PADnet test – the PADnet vascular diagnostic system uses automated noninvasive tests to help identify obstructive vascular disease and determine what further treatment strategy is necessary
Peripheral angiography/peripheral angioplasty/peripheral stenting – Peripheral angiography is an outpatient diagnostic study for patients who may have blocked blood vessels in their lower bodies and extremities. Peripheral angiograms provide a “mapping” of blood flow through the arteries in the extremities. During the peripheral angiogram, a catheter is inserted into an artery or vein and passed down your legs. Through the catheter, a dye is injected into the peripheral arteries. As the dye is injected, x-rays are taken which allow the cardiologist to see blood flow through the arteries.
Peripheral Vascular Disease - Refers to diseases of blood vessels outside the heart and brain. It's often a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys.
Renal Artery Doppler - An ultrasound to evaluate the blood flow from the aorta to the kidney.
Venous Doppler – An ultrasound to evaluate the veins of the arm or leg for possible blood clots.