Exercise Treadmill Test || Echocardiogram || Holter
Monitor ||
Event Monitor || Nuclear
Scans || 64 slice
Computed Tomography Angiography
Exercise Treadmill Test
(ETT)
The exercise treadmill test is done while you walk on a
treadmill. During the test, an electrocardiogram (EKG)
records the electrical activity of your heart. There are
many different treadmill protocols available. We use the
Bruce protocol. This is the standard protocol used in cardiology
practices to evaluate the heart and its response to exercise.
The test has many stages, each of which are three minutes
in duration, with each advancing stage, the speed and degree
of incline increases, causing your heart rate, respiratory
rate, and systolic blood pressure to rise. In general,
exercise testing is very safe, but because all tests, by
nature, carry a small risk, the test will be supervised
and interpreted by a cardiologist. If you develop chest
pain, or shortness of breath during the test, let the physician
know.
Echocardiogram
The echocardiogram is an ultrasound study which allows us
to visualize the heart, its size, valves, and chambers
to more adequately evaluate their functions. There is no
discomfort associated and no preparation involved. Your
echocardiogram takes approximately 30 to 60 minutes.
Holter Monitor
The holter monitor is an ambulatory electrocardiogram.
You will wear five electrodes attached to a recorder (about
the size of a walkman). This recorder will record every
beat that your heart makes, while attached to you. You
may not take a bath or shower while you are being recorded.
We recommend you bathe that morning. Holter monitors are
scheduled first thing in the morning or afternoon and must
be promptly returned the next day about the same time you
received the monitor. Failure to do so may result in the
loss of recorded information by the monitor.
Event Monitor
This is an extended duration ambulatory monitor which is
worn for approximately one week. Events/symptoms may be
transmitted via telephone. This is given for transient
episodes at the discretion of the physician.
Nuclear Scans
Myocardial perfusion imaging, Thallium scans
Myocardial refers to the heart. Perfusion is the passage
of blood through the circulatory system and imaging refers
to computer generated pictures. The test is done in two parts.
In the first part, the heart is stressed (the heart's arteries
are expanded using a special medication). Healthy or "normal" coronary
arteries dilate more than unhealthy or partially blocked
arteries. Once the blood vessels are dilated, a small amount
of radioactive imaging agent is injected. The imaging agent
tends to concentrate in those parts of the heart that have
the best blood flow. The imaging agent emits signals that
can be detected by a special type of camera. Images taken
by the camera show if any part of your heart is not getting
enough blood. In the second part, two sets of pictures are
taken. The first set shows the arteries of the heart when
the blood vessels are dilated. The second set shows the heart
during normal functioning, referred to as "rest".
The two sets of images are compared. A relatively healthy
heart shows little or no difference between images taken
during stress and those taken at rest. In a heart with partially
blocked arteries, images taken during stress are different
from those taken at rest.
64 slice Computed
Tomography Angiography (64 slice CTA)
64 slice CTA is a new, state-of-the-art, non-invasive, diagnostic
tool that allows cardiologists to image the heart, blood
vessels (coronary arteries) and other cardiac structures
non-invasively. The 64 slice CTA can produce three dimensional,
high quality diagnostic images of the heart, aorta, lungs,
and coronary circulation. Prior to the advent of CTA, we
needed an invasive angiogram (cardiac catheterization) in
order to see the coronary arteries but since 2005, we have
been able to offer this test and in many cases avoid
the risks of an invasive procedure. Further, we have diagnosed
many cases of significant coronary blockages missed by stress
testing.
At the time of the patient’s arrival in the CT suite,
the patient will be fully assessed by a cardiac trained nurse
(BLS/ACLS certified). The patient’s heart rate,
blood pressure, ECG, and history will be reviewed. An
intravenous line will be placed into the patient’s
arm for fluids and medication. Patients are often given beta-blockers
for a few days prior to the procedure to slow the heart rate;
this allows better image quality. IV Contrast is used so
be sure to tell your physician and nurse if you have an allergy
to dye or contrast. When the patient’s heart rate is
slow and stable, the CT examination is performed which only
takes a few minutes including the placement onto the table
and the actual image acquisition takes about 18 seconds to
perform and the patient can leave immediately after. Test
results are usually available within 24 hours
This is a picture of a normal coronary artery imaged with
CTA:
We can even see Coronary bypass grafts to determine if they
are open:
The procedure is very safe and accurate; in fact, we can
be 98% sure someone doesn’t have heart disease which
means this test which is better than current stress testing
modalities. Essentially, 64 slice CTA can quickly
and non-invasively exclude coronary artery disease, as well
as diagnose its presence.
Dr. Balk has been performing CTAs in Atlanta since 2005
and is one of North Atlanta’s highest volume operators
and is currently working with colleagues to develop an ER
program for rapid diagnosis of chest pain syndromes using
CTA.
Other Tests
Other tests we offer include:
- Stress Echo
- Carotid Doppler Studies
- Ankle-brachial Index Measurements
In the hospital we perform a number of diagnostic and therapeutic
procedures including:
- Cardiac Catheterization
- Percutaneous Coronary Interventions
- Pacemaker Implantation
- CT angiography
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