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Non-Invasive Cardiology

Electrocardiography (ECG or EKG)

An electrocardiogram or ECG (also called an EKG) is a common, painless test that records the electrical activity of the heart and converts it into lines called "waveforms" that can be seen on a monitor or printed out on paper. The waveforms created by the ECG can be divided into time segments to measure the rate of movement of the heart's electrical impulses.

An ECG can tell if the heart is beating normally or detect heart disease or problems with the electrical conduction system of the heart. It records the rate and regularity of heartbeats, can tell the size and position of the chambers of the heart. An ECG also can record signs of damage to the heart and the effects of drugs or devices such as pacemakers.

For more information visit:
http://www.hrsonline.org/PatientInfo/SymptomsDiagnosis/HeartTests/index.cfm

Holter Monitoring/Event Recording

A Holter Monitor is a machine that your doctor will order which will continuously record your heart rhythms for 24 hours or more. The monitor is worn continuously throughout the day and night and because it is worn for an extended time period, it can help physicians determine if there is a problem with the heart that would not normally be detected with a regular EKG which only checks the patient's heart rhythym for less than a minute.

For more information visit:
www.hospitalsoup.com/medical/holter-monitor-testing
www.americanheart.org/presenter.jhtml?identifier=3005149

Echocardiography

Echocardiography is a diagnostic test that uses ultrasound waves to make images of the heart chambers, valves and surrounding structures. It can measure cardiac output and is a sensitive test for inflammation around the heart (pericarditis). It can also be used to detect abnormal anatomy or infections of the heart valves.

Transthoracic (adult and pediatric), Transesophageal

An echocardiogram, often referred to in the medical community as a cardiac ECHO or simply an ECHO, is a sonogram of the heart. Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart. The latest ultrasound systems now employ 3D real-time imaging.

In addition to creating two-dimensional pictures of the cardiovascular system, an echocardiogram can also produce accurate assessment of the velocity of blood and cardiac tissue at any arbitrary point using pulsed or continuous wave Doppler ultrasound. This allows assessment of cardiac valve areas and function, any abnormal communications between the left and right side of the heart, any leaking of blood through the valves (valvular regurgitation), and calculation of the cardiac output as well as the ejection fraction.

For more information visit:
http://en.wikipedia.org/wiki/Echocardiography

Stress Echocardiography (Exercise and Pharmacologic)

Patients with coronary artery blockages may have minimal or no symptoms during rest. However, symptoms and signs of heart disease may be unmasked by exposing the heart to the stress of exercise. During exercise, healthy coronary arteries dilate (develop a more open channel) than an artery with a blockage. This unequal dilation causes more blood to be delivered to heart muscle supplied by the normal artery. In contrast, narrowed arteries end up supplying reduced flow to it's area of distribution. This reduced flow causes the involved muscle to "starve" during exercise. The "starvation" may produce symptoms (like chest discomfort or inappropriate shortness of breath), EKG abnormalities and reduced movement of the heart muscle. The latter can be recognized by examining the movement of the walls of the left ventricle (the major pumping chamber of the heart) by Echocardiography.

For more information visit:
http://www.heartsite.com/html/echo_stress.html

Stress Testing

ECG and Exercise

The exercise cardiac stress testing (ECST) is the most widely used cardiac (heart) screening test. The patient exercises on a treadmill according to a standardized protocol, with progressive increases in the speed and elevation of the treadmill (typically changing at three-minute intervals). During the exercise cardiac stress testing (ECST), the patient's electrocardiogram (EKG), heart rate, heart rhythm, and blood pressure are continuously monitored.

If a coronary arterial blockage results in decreased blood flow to a part of the heart during exercise, certain changes may be observed in the EKG (the electrocardiogram), as well as in the response of the heart rate and blood pressure.

Pharmacologic

There are a diversity of pharmacologic stress tests. Typically this refers to a pharmacologic cardiac stress test whereby certain medications are administered in order to stimulate the heart to mimic the physiologic effects of exercise.

For more information visit:
http://www.medterms.com/script/main/art.asp?articlekey=10287

Stress Echocardiography

Patients with coronary artery blockages may have minimal or no symptoms during rest. However, symptoms and signs of heart disease may be unmasked by exposing the heart to the stress of exercise. During exercise, healthy coronary arteries dilate (develop a more open channel) than an artery with a blockage. This unequal dilation causes more blood to be delivered to heart muscle supplied by the normal artery. In contrast, narrowed arteries end up supplying reduced flow to its area of distribution. This reduced flow causes the involved muscle to "starve" during exercise. The "starvation" may produce symptoms (like chest discomfort or inappropriate shortness of breath), EKG abnormalities and reduced movement of the heart muscle. The latter can be recognized by examining the movement of the walls of the left ventricle (the major pumping chamber of the heart) by Echocardiography.

For more information visit:
http://www.heartsite.com/html/echo_stress.html

Nuclear Stress Testing

An isotope stress test is also known as a nuclear, thallium, Cardiololite, Myoview or dual isotope stress test, depending upon the method used.

During exercise, healthy coronary arteries dilate (develop a more open channel) more than an artery that has a blockage. This unequal dilation causes more blood to be delivered to heart muscle supplied by the normal artery. In contrast, narrowed arteries end up supplying reduced flow to its area of distribution. This reduced flow causes the involved muscle to "starve" during exercise. The "starvation" may produce symptoms (like chest discomfort or inappropriate shortness of breath), and EKG abnormalities. When a "perfusion tracer" (a nuclear isotope that travels to heart muscle with blood flow) is injected intravenously, it is extracted by the heart muscle in proportion to the flow of blood.

The amount of tracer uptake helps differentiate normal muscle (which receives more of the tracer) from the reduced uptake demonstrated by muscle that is supplied by a narrowed coronary artery. In other words, areas of the heart that have adequate blood flow quickly picks up the tracer material. In contrast, muscle that has reduced blood flow picks up the tracer slowly or not at all. Analysis of the images of the heart (taken by a scanning camera) can help identify the location, severity and extent of reduced blood flow to the heart. The reduced blood flow is known as ischemia (pronounced is-keem-ya).

For more information visit:
http://www.heartsite.com/html/isotope_stress.html

Cardioversion

Cardioversion is a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm. Most elective or "non-emergency" cardioversions are performed to treat atrial fibrillation or atrial flutter, benign heart rhythm disturbances originating in the upper chambers (atria) of the heart. Cardioversion is used in emergency situations to correct a rapid abnormal rhythm associated with faintness, low blood pressure, chest pain, difficulty breathing, or loss of consciousness.

For more information visit:
http://www.hrsonline.org/PatientInfo/Treatments/#Cardio

Tilt Table Test

The Tilt Table Test is used to determine a cause of syncope (fainting or loss of consciousness). There can be different reasons people experience syncope. For some people it is related to an abnormal nervous system reflex causing the heart to slow and the blood vessels to dilate (open up) lowering the blood pressure. When this happens there is a reduced amount of blood to the brain causing one to faint. This type of syncope is called vasovagal, neurocardiogenic or abnormal vasoregulatory syncope and is considered benign (not dangerous or life-threatening), except for the injuries that can happen when one faints unexpectedly. The Tilt Table Test is performed to reproduce (bring on) symptoms of syncope while the person is being closely monitored.

For more information visit:
http://www.hrsonline.org/PatientInfo/SymptomsDiagnosis/HeartTests/TiltTableTest/index.cfm

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