Diagnostic Testing

The Carle Heart Center provides the latest in diagnostic cardiology capabilities. The Carle Heart Center's comprehensive ECHO program was the first in the region to offer transesophageal echocardiography(TEE), exercise stress echocardiograpy, Dobutamine stress echocardiograms and Dobutamine transesophogeal echocardiograms. We also offer a pediatric ECHO program in conjunction with Carle's Department of Pediatrics. The Carle Heart Center performs more than 35,000 ECGs, more than 8,100 ECHO tests and more than 6,800 vascular studies each year.

The Carle Center offers variety of diagnostic tests to determine the exact causes of cardiac conditions:

Cardiac Tilt Table Test
Coronary Angiogram (Cardiac Catheterization)
Dobutamine Stress Echocardiogram
Echocardiogram
Electrocardiogram
Electrophysiology Study (EPS)
Exercise Tolerance Test
Peripheral Vascular Laboratory
Stress Echocardiogram
Tranesophageal Echocardiography (TEE)

Cardiac Tilt Table Test
The tilt table test helps physician determine the reasons for a patient’s lightheadedness or fainting spells (syncope). During this test, the Heart Center team will examine how the patient’s heart rate and blood pressure respond to changes in body position. This test does not require sedation. The test is usually painless, although some of the patient’s symptoms may be reproduced.

Coronary Angiogram (Cardiac Catheterization)
The purpose of a coronary angiogram is to locate any blocked or narrowed areas in the coronary arteries and to determine how well a patient’s heart muscle and valves function. During a coronary angiogram, a thin, flexible tube called a catheter is inserted into an artery in a numbed area of the arm or groin. Dye is then injected through the catheter into the coronary arteries and the left ventricle - the main pumping chamber of the heart. With the help of specialized x-ray equipment, the cardiologist can visualize the dye in the arteries on a television screen. While checking the heart valve another catheter is inserted into the right side of the heart and pressure measurements are taken. This data is recorded for further study.

Blocked or narrowed arteries are of special concern because they can cause several problems. Arteries can become blocked over time by a build-up of fats, cholesterol and other debris, called plaque. Narrowed arteries allow less blood and oxygen to reach the heart than is needed. When blood can’t flow through arteries, chest discomfort (angina) may result. If the blood flow to the heart becomes totally blocked, a heart attack occurs.

Dobutamine Stress Echocardiogram
A Dobutamine stress echocardiogram is a cardiac ultrasound examination used for the detection of coronary artery disease, especially in people who are unable to exercise.

This test takes its name from Dobutamine, a medication given by IV that can simulate exercise by making the heart beat faster and stronger when given in the appropriate dosage. If coronary artery disease is causing a reduced flow of blood and oxygen through the arteries, abnormalities in the motion of the heart’s left ventricular wall will show up during an ultrasound exam.

The test will take a minimum of 2 hours. An echocardiogram technologist and a registered nurse will assist the cardiologist in this procedure. A resting Echocardiogram is done prior to the stress portion so a comparison can be made.

Echocardiogram
In an echocardiogram, sound waves produce images which provide information concerning the structure and function of the heart. It gives the doctor information on the structural parts of the patient’s heart. This includes information about heart valves, whether they leak or are restricted in their movement and also the size of the heart chambers and how they will function. A sonographer records this information and allows the physician to detect problems with the functioning of the heart. Doppler ultrasound, a special type of echocardiogram, provides information on the pressure and speed of blood flow through your heart.

Electrocardiogram
An electrocardiogram, often called an EKG or ECG, is a diagnostic tool that records the electrical impulses corresponding to the mechanical activity of the heart. This recording can provide physicians with valuable information regarding the function of a patient’s heart. Using an EKG, a physician can identify many possible cardiac problems - even if a patient shows no symptoms - and can generate a history of heart function. An EKG is a painless procedure that takes less than 20 minutes.

Specialized Electrocardiograms
Sometimes a standard 12-lead electrocardiogram does not give the physician enough information. When more information is needed, two types of electrocardiograms may be suggested.

The signal averaged electrocardiogram is useful in helping the physician identify those patients who may be at greatest risk for developing sudden cardiac death or severe heart rhythms originating from the bottom of the heart. During this test, electrodes are placed on the patient’s chest and back. The patient will be asked to lie quietly for approximately 20 minutes while the machine reads and averages approximately 200 of the patient’s heartbeats.

The esophageal electrocardiogram is used to help a physician determine the relationship of the electrical activity at the top of a patient’s heart to that at the bottom. For this test, the patient will swallow an electrode in the form of a pill which will be positioned in the esophagus behind the heart. Electrodes will also be placed on the patient’s arms and legs. This electrocardiogram provides three lines of information - one from the pill electrode, one from the limb leads and one that is a combination of the other two lines. This information helps the physician spot irregular or fast heart beats that may not be seen on the traditional 12-lead electrocardiogram. The pill electrode is removed by gently pulling on the wire.

Electrophysiology Study (EPS)
Electrophysiology is the study of the electrical system of the heart. These studies allow the electrophysiologist (a doctor who specializes in the study of the heart’s electrical impulses) to observe a the heart’s electrical conduction system. Each study involves the careful placement of 2-4 thin catheters near important structures of the heart’s electrical system. The electrophysiologist measures the intervals of the electrical impulses, paces the heart at different heart rates and watches it recover. The physician then tries to induce heart rates and rhythms that might be causing symptoms, such as dizziness, chest discomfort or loss of consciousness.
Click here to learn more about electrophysiology.

Exercise Tolerance Test
An exercise tolerance test, or stress test as it is often called, is a sensitive evaluation of how the cardiovascular system responds during exercise. Important data can be obtained from this test, particularly information about blood flow to the heart. The test is usually performed on a treadmill, but other exercise methods may be used. The entire test takes about 1 hour, although the exercise portion is usually limited to just 15 minutes.

The exercise tolerance test may be ordered by a doctor for any of the following reasons:

• to evaluate symptoms (chest pain, discomfort, dizziness, fatigue, etc.)
• you have a family history of heart disease
• as part of a routine physical examination or preoperative exam
• to prescribe an exercise program
• to determine the effectiveness of medications
• to establish safe limits for physical activities
• to check your progress following open heart surgery or angioplasty or other treatments

Radionuclide Exercise Test
The doctor may order a combination stress test and isotope scan to obtain more information about a patient’s heart than the standard stress test provides. In addition to the procedure outlined above, the patient will receive intravenous (IV) injection of an isotope through a vein in the hand. An isotope is a radioactive substance that will circulate to the heart. Do not be alarmed about the radioactivity. There are no known side effects associated with this substance, and the amount of radiation received is minimal.

When completion of the exercise portion of the test, the patient is transported to the Nuclear Medicine Department, where a special camera will be used to "photograph" the patient’s heart. This procedure generally takes a minimum of 1 hour, but may take as long as 3 hours.

Exercise Stress Echocardiography
Your doctor may order a combination stress test and echocardiogram. An ultrasound scan of the heart is performed before and after exercise to carefully evaluate heart function. Computerized images are recorded while the heart is beating at a fast rate as a result of the exercise.

Peripheral Vascular Laboratory
The Peripheral Vascular Laboratory provides evaluation of the blood flow in the arteries and veins of the legs, arms, neck and abdomen. All of the procedures conducted here are noninvasive, meaning that no needles, injections or dye are used. Most tests performed in this laboratory use ultrasound, a painless sound wave that produces no radiation or side effects. Specially trained technicians conduct all of the tests, which, in turn, are interpreted by cardiologists or vascular surgeons. No special preparation is required for any of the following procedures.

Lower Extremity Arterial Evaluation
This test is used to determine if there is any obstruction to arterial blood flow in the legs or feet. Most testing includes:

• using ultrasound to listen to blood flow in both legs
• measuring blood pressure in the arms and legs
• measuring oxygen levels on the surface of the skin in various areas of the legs

Other testing such as exercise response may be performed as ordered by the physician

Upper Extremity Arterial Evaluation
This test is used to determine if there is obstruction to blood flow in the arteries of the arms. Testing includes:

• using ultrasound to listen to blood flow in both arms
• measuring blood pressure in both arms

Other testing may include measuring blood flow during arm movement and blood pressure measurement of the fingers.

Arterial Imaging
This test uses ultrasound to provide an image of the arteries in the arms or legs. This test may be ordered for:

• evaluation of arterial blockage
• evaluation of possible aneurysm
• follow-up of arterial bypass grafts

Peripheral Venous Evaluation
These studies are used to detect the presence of venous thrombosis (blood clot) in the veins of the arms or legs and the presence of venous insufficiency (poor blood flow in the veins or poor function of the veins).

Venous Duplex Imaging
This study uses ultrasound to provide an image of the veins in the arms or legs to determine if there is any obstruction to blood flow (blood clots).

Venous Reflux Study
This test uses a small sensor placed near each ankle to determine the presence of venous insufficiency (weak or damaged veins).

Special Studies
In addition to these vascular studies, your doctor may order a special procedure not listed here. Prior to your test, you will be informed of any special preparation required.

Stress Echocardiogram
Exercise echocardiography with wall motion analysis - stress echocardiogram for short - is a new and convenient way to detect and treat heart problems.

This procedure combines an echocardiogram with a specially designed computer system that the doctor uses to analyze the heart by looking at the motion of the walls. Any abnormal wall motion may indicate a blockage in the coronary arteries and corrective measures should be taken immediately. Using this test, the doctor has the ability to obtain important information about the patient’s heart function without injections or radiation.

Tranesophageal Echocardiography (TEE)
Transeophageal echocardiography (TEE) is an examination of your heart using ultrasound waves. This test allows the physician to examine the structure of the heart and its valves as well as the blood flow through the heart in more detail than can be visualized with a standard echocardiogram.

To perform this test, a long, flexible transducer will be passed through the patient’s mouth to the esophagus until it is aligned with the heart. The transducer picks up sound waves that bounce off the heart structures. In turn, sophisticated equipment is used to convert the waves into an image of the heart which appears on a video screen.