Coronary Angiogram
 ECG
 Echo
  EPS ( ELECTROPHYSIOLOGIC STUDIES )
  Holter
  PTCA
 TEE
  TMT
 

 CORONARY ANGIOGRAM
 
WHY IS THIS TEST DONE ?
This test helps in detecting if there is any narrowing of blood vessels supplying blood to the heart. If these are narrowed, you may have chest discomfort, or if suddenly blocked, a heart attack. Coronary Angiogram helps your doctor to decide on the best way to treat your condition – medical treatment, angioplasty, bypass surgery or a combination. Coronary angiogram will reveal the severity and location of blockages.

HOW LONG WILL THE TEST TAKE ?
The test will take approximately 30 minutes.

WHAT DOES THE TEST INVOLVE ?
You are admitted to the hospital in the morning. Preliminary preparations like shaving the hair on the site where the test will be performed is done. Generally the site is the right side of the groin. Both sides of the groin need to be prepared. You will be asked to change into the hospital dress. You will then be shifted to the Post Cath Ward.

A small amount of medication may be given in the form of a capsule/tablet, half an hour before, which will help you to relax. You will be asked to empty your bladder before the test begins. Usually the blood vessel at the top of the right leg will be used to get access to your heart. Occasionally the left leg or arm may be used.

A local anesthetic is given to numb the skin over the blood vessel of the right leg. After that you will feel very little discomfort. Usually the amount of discomfort is minor (like an injection prick). The procedure does not involve any cutting

A puncture is made with a needle and a tube is placed into the blood vessel of the groin, which allows a longer tube to be placed up to the heart. When the tube is in place, you may be asked to take a deep breath and hold it at different times.

Contrast material is injected into the blood vessels that supply the heart, which will show any narrowing of the coronary arteries. As this dye goes in, you may have a warm/flushed feeling all over, which will last for a few seconds.

Pictures are then taken of the heart’s pumping ability, as well as any narrowing of the blood vessels. The tube is then removed.

After the completion of the test, you will be kept under observation in the Post – Cath Ward for a period of 6 - 8 hours from where you will be shifted to your room. You will be asked to lie in bed, on your back, without moving your right leg for a period of 6 – 8 hours. This is an important precaution, as excessive movement can cause bleeding from the site of puncture. The site will be checked regularly for any sign of bleeding. Your attendants may visit you in the Post Cath Ward. You will be discharged the next day, if the results are normal.

WHAT ARE THE REQUIREMENTS FOR THE TEST ?
Medications may be taken as usual, unless told differently by the doctor. Antidiabetic drugs need to be stopped on the day of the procedure.
It is preferable to be on fast for atleast 4 hours before the procedure. After the test you may have light food. Since it is an invasive procedure, the risks involved, can be discussed with your consultant.

WHEN WILL THE REPORTS BE AVAILABLE ?
Manual reports will be available immediately. Printed reports can be obtained on the next day after the procedure. An immediate need for the further treatment may be identified and the doctor will discuss with you after the procedure. For any further queries, please contact the concerned resident or consultant.

Your Angiogram is scheduled for...............Please get admitted to the hospital on..........
 
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 ELECTROCARDIOGRAM (ECG)

WHY IS THIS TEST DONE ?
You can know the heart rate and also the rhythm of the heart. It can detect any irregularities of the heartbeat. It is the basic and most important test to detect any decreased blood supply to heart or for any evidence of heart attack. It also gives an idea of the various chambers of the heart.

HOW LONG WILL THE TEST TAKE ?
It takes 5 minutes to take an ECG.

WHAT DOES THE TEST INVOLVE ?
Graphic recording of the electrical events of the heart is called an ECG. A technician will use a gel to attach from approximately 10 to 15 leads at specific sites on the skin. These sites are selected on both arms and on the chest. The sites will be cleaned and perhaps shaved before the electrodes are attached. The machine then records the electrical activity of the heart under conditions the doctor has specified.
Do not move your limbs and hold your breath while the test is performed.

WHAT ARE THE REQUIREMENTS FOR THE TEST ?
None.

WHEN WILL THE REPORTS BE AVAILABLE ?
ECG is to be seen and interpreted by your doctor.

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 ECHOCARDIOGRAM

WHY IS THIS TEST DONE ?
To detect any structural and functional abnormality of the heart. All the chambers of the heart, their size, thickness and their function can be assessed easily by this simple, non-invasive and totally safe procedure. All the valves (their shape and function, narrowing or leakage or both) and main blood vessels arising or entering into the heart can be almost perfectly assessed by this test.

HOW LONG WILL THE TEST TAKE ?
The test usually takes 10 – 15 minutes. For children it may take half an hour to one hour.

WHAT DOES THE TEST INVOLVE ?
Examination of patients’ heart with a probe put on the left side of the chest. It is an ultrasound examination of the heart.
You will be asked to remove clothing above the waist. In case of female patients, a female attendant would be present. You will be lying on your back or on your left/right side. A technician will apply gel, which feels cold, to your chest and a transducer will be placed over the heart area.
When the test is completed, the gel can be wiped off easily.

WHAT ARE THE REQUIREMENTS FOR THE TEST ?
None. Any person irrespective of age, consciousness or any other disability can undergo this procedure safely. No dietary restriction is required. It can be repeated any number of times without any harm to the patient.

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 ELECTROPHYSIOLOGIC STUDIES (EPS)

WHY IS THIS TEST DONE ?
To determine if a patient requires a pacemaker. To determine if a person is prone to troublesome, disabling, or life-threatening fast heart rhythms and guide the appropriate treatment. To assess the results of prior therapy for fast heart rhythms.

HOW LONG WILL THE TEST TAKE ?
The studies usually take 11/2 hours, but can occasionally take longer. You can resume your normal activities the following day, unless advised otherwise by the consultant.

WHAT DOES THE TEST INVOLVE ?
EPS is a cardiac catheterization procedure that involves a detailed analysis of the electrical conduction system of the heart. This system is what generates the heartbeat. You are admitted to the hospital in the morning. Preliminary preparations like shaving the hair on the site where the test will be performed is done. Generally the site is the right side of the groin. Both sides of the groin need to be prepared. You will be asked to change into the hospital dress. You will then be shifted to the Post Cath Ward. A local anesthetic is given as well as a mild sedative. The procedure is not painful and you will not be put to sleep.

After being placed into the vein, these long thin tubes, called catheters, are then passed into the heart under X-ray guidance. These catheters measure the electrical signals generated by the heart. This gives a much more detailed analysis of these signals than does a simple ECG.

The catheters are used to rapidly pace the heart, i.e. make the heart beat fast. The electrical conduction system of the heart is also measured during the rapid pacing and the heart is observed during this rapid pacing to see if any abnormal heart rhythms develop.

Sometimes, an intravenous medicine is infused and the study is repeated to determine the effect of that medicine.

After the completion of the test, you will be kept under observation in the Post – Cath Ward, from where you will be shifted to your room. Your attendants may visit you in the Post Cath Ward.

WHAT ARE THE REQUIREMENTS FOR THE TEST ?
The test requires that you eat nothing after midnight the night before. Some of the medications may need to be withheld before the test, after checking with your doctor.These include some medicines that regulate the heartbeat, the powerful blood thinner coumadin as well as some diabetic medicines.

WHEN WILL THE REPORTS BE AVAILABLE ?
The reports will be available the next day of the procedure.

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 HOLTER

WHY IS THIS TEST DONE ?
To record any irregular heartbeats and also to detect silent ischemia. If the patient is on heart medication, the information from this recording will help your consultant judge how well the medication is working.

HOW LONG WILL THE TEST TAKE ?
It will be done over a 24-hour period and if necessary it can be extended up to 48 hours.

WHAT DOES THE TEST INVOLVE ?
A Holter ECG is basically a continuous electrocardiogram taken, while you are performing your normal daily activities. It is a simple painless procedure.

You will be asked to wear the recorder on a belt after attaching the various leads to your skin. The sites on your skin will be cleaned and perhaps shaved before the leads are attached. The recorder will be equipped with an event marker; the technician will show you how to press it, should you experience anything unusual, such as palpitation, giddiness or pain.

WHAT ARE THE REQUIREMENTS FOR THE TEST ?
Please do not tamper with the recorder, electrodes or lead wires and do not take a bath/ shower. Do not use an electric blanket, as it may interfere with the recording.

Please follow the safety measures listed below, while wearing the monitor,

DON’T get the monitor wet – don’t shower, bathe or swim with it on.
AVOID vigorous activity, because you may sweat profusely and this can cause the electrodes to loosen and fall off. This may result in needing to repeat the exam.

Your physician will ask you to keep a diary of your activities and feelings while you are wearing the recorder. This diary will help your physician establish a connection between your monitor tracing and your activities and feelings. The following is an example of how you may want to set up your diary entries:

Day Time Activity Feelings
Tuesday 10:30 am Went home from Legs tired,
hospital in auto. shortness of breath

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   PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY  (PTCA)

WHY IS THIS PROCEDURE DONE ?
It is a procedure done to dilate (widen) narrowed arteries. It is a less traumatic alternative to bypass surgery for some patients with coronary artery disease.

HOW LONG WILL THE PROCEDURE TAKE?
The procedure usually takes 45 minutes to 1 hour. Total hospitalization time is 4 days.

WHAT DOES THE PROCEDURE INVOLVE ?
It is a cardiac catheterization procedure. You are admitted to the hospital in the morning. Preliminary preparations like shaving the hair on the site where the test will be performed is done. You will be asked to change into the hospital dress. You will then be shifted to the Post Cath Ward.

PTCA is performed by placing a guiding catheter through an introducer sheath in to either the artery of the lower limb or upper limb and advancing the guiding catheter to the coronary artery via the aorta. Local anesthesia is given. The balloon catheter is advanced in, to position across the target lesion. When the balloon is inflated, you under may experience some chest pain due to the temporary occlusion of the vessel. Inflation may last from 30 seconds, up to several minutes, depending on the nature of the blockage and will be repeated until satisfactory results are obtained.

When the balloon is inflated, it compresses the plaque and enlarges the inner diameter of the blood vessel so that blood can flow more easily. Then the balloon is deflated and the catheter removed and final fluoroscope shots taken. The guiding catheter and wire are removed after the procedure. The introducer sheath may be left in for a day in case of any complication.

After the completion of the test, you will be kept under observation in the Post – Cath Ward for a period of 1day, from where you will be shifted to your room. You will be asked to lie on bed, on your back, without moving your right leg during most of the period. This is an important precaution, as excessive movement can cause bleeding from the site of puncture. The site will be checked regularly for any sign of bleeding. Your attendants may visit you in the Post Cath Ward.

WHAT ARE THE REQUIREMENTS FOR THE PROCEDURE ?
You can have a light breakfast, the morning of the procedure and morning medicines may be taken. Atleast 4 hours prior fasting is required. Do not use antidiabetic drugs on the day of the procedure.

WHEN WILL THE REPORTS BE AVAILABLE ?
Manual reports will be available immediately. Printed reports will be available the next day after the completion of the procedure.

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 TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE)

WHY IS THIS TEST DONE ?
To search for an abnormality in the heart-muscle, valves or major blood vessels arising from the heart, that could be responsible for causing a stroke, looking for infections on the heart valves and evaluating the aorta (the main blood vessel in the body) for a tear in its wall. It is used to take pictures of the heart, not accessible by a regular echocardiogram. It allows imaging of many structures with better resolution

HOW LONG WILL THE TEST TAKE ?
The test takes around 15 – 30 minutes.

WHAT DOES THE TEST INVOLVE ?
TEE is a partially invasive specialized echocardiac examination, whereby a flexible tube (endoscope) is inserted into the mouth and passed into the esophagus (food tube). The heart is then imaged from within the esophagus with an endoscope-mounted ultrasound transducer. This flexible tube is in place for 10 minutes. If you wear dentures, you will be asked to remove them and a local anesthetic gel is administered to the back of the mouth to numb that area and prevent gagging. A plastic bite guard will be placed in your mouth, through which the endoscope will pass. A blood pressure cuff will be placed around your arm and several patches will be placed on your skin. This will ensure that your blood pressure and heartbeat are monitored during the exam.

WHAT ARE THE REQUIREMENTS FOR THE TEST ?
Please take an appointment 1 day prior to the date when you want the exam to be performed.

DO NOT EAT or DRINK anything for 6 hours prior to the exam. Please arrive 30 minutes to 1 hour prior to the exam to allow sufficient preparation.

You may be given medication to help you relax during the exam. For this reason, a responsible adult who will provide you transportation back home must accompany you.

Since your throat will stay numb for a little time after the exam, it is important that you DO NOT EAT OR DRINK ANYTHING FOR 2-3 HOURS AFTER THE EXAM

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 TREADMILL TEST (TMT)

WHY IS THIS TEST DONE ?
To detect whether there is any decrease in the blood circulation to the heart resulting from blockages or hardening of the arteries of the heart. To determine if a person’s symptoms are due to heart disease rather than any other problem. To check that the treatment given to a patient for blocked arteries is working adequately or not. To assess a person’s exercise tolerance and to determine if exercise causes an abnormal heart rhythm.

HOW LONG WILL THE TEST TAKE ?
The test takes usually 30 minutes.

WHAT DOES THE TEST INVOLVE ?
The male patient will be asked to remove his upper clothing and the female patient will be asked to wear a hospital gown. The site where the ECG electrodes are going to be attached is shaved and the electrodes are fixed on the chest. Baseline ECG is taken. The patient is made to walk on a treadmill (a conveyor belt on which a patient walks). The speed as well as the elevation of the treadmill is altered at intervals and ECG, vital data and symptoms are monitored and recorded during the test. Any discomfort is to reported to the doctor immediately. The patient will be asked to relax for 10 minutes after the completion of the test.

WHAT ARE THE REQUIREMENTS FOR THE TEST ?
Medicines are to be taken on the advice of the consultant as some medicines need to be stopped and some to be continued. Medicines like beta-blockers, atenelol, calcium blockers have to be stopped 48 hours prior to the test. Medicines have to be stopped, after checking with your doctor.Patient needs to be fasting atleast for 2 hours prior to the procedure. Better avoid tea, coffee and smoking. It is preferable that you wear loose fitting comfortable clothes and comfortable shoes.
ECG reports, Echo reports also have to be brought with the person undergoing the test. It is essential that an attendant accompanies the patient.
 

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