Cardiac Diagnostics

Electrocardiogram (ECG)

What is it?
An electrocardiogram (ECG) is a routine test that is used to record the electrical activity of your heart. A healthy heart should show a specific pattern, so when there are changes in this pattern, it is an indication that there is a problem.

Why is it done?
This test can help your doctor identify any abnormalities in your heart’s rhythm. Once the problem is identified, your doctor can prescribe a treatment plan that best meets your health care needs.

How is the test done?
You will be given a gown and asked to remove any clothing above your waist.

You will lie on an examination table and a technician will place small disks, called electrodes, on your chest. The electrodes are attached to wires (or leads) that connect to the electrocardiogram machine. The electrocardiogram machine will trace the path of electrical energy through your heart and will provide a print-out for your doctor to review.

How should I prepare?
No special preparation is needed before an electrocardiogram. On the day of your test, please ensure that you bring your Ontario Health Card to your appointment.

Is there any pain or risk associated?
An electrocardiogram is a pain-free test that presents no risk of injury to the patient.

How long will the test take?
This test will take approximately 10 minutes.

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Exercise Stress Test

What is it?
An exercise stress test records the electrical activity of your heart at rest, during exercise, and after exercise.

Why is it done?
This test will help your doctor see how your heart performs during physical activity and identify possible heart complications during exercise.

How is the test done?
A technician will apply small disks, called electrodes, to your chest and a blood pressure cuff around your arm. The electrodes are attached to wires (or leads) that are connected to the electrocardiogram machine. While hooked up to the machine, you will be asked to walk on a treadmill. Every two to three minutes, your doctor or technician will increase the speed and incline which will cause you to work harder. This test will allow your doctor to see changes in your heart’s electrical pattern or in your blood pressure levels, which may indicate that your heart isn’t getting enough oxygen. You will also be monitored for chest pain or unusual shortness of breath.

How should I prepare?
Be sure to ask your doctor about any medication you are taking and whether or not you should stop taking it before the test. Do not eat or drink anything for two hours before your test, especially items that contain caffeine, such as coffee, tea, soda, or chocolate.

Do not use body creams or powder on your chest prior to the test. Wear loose-fitting, comfortable clothes and flat, soft-soled shoes, such as running shoes. Be sure to also bring your Ontario Health Card to your appointment.

Is there any pain or risk associated?
There are some risks associated, but your doctor will explain these to you before you have the test. Be assured that a doctor will be present at all times during the test.

How long will the test take?
This test will take approximately 30 minutes.

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Holter Monitor

What is it?
Holter Monitoring is a test that records your heart beat for 24, 48, or 72 hours and provides your doctor with a constant reading of your heart rhythm.

Why is it done?
The Holter Monitor is a battery-powered device with highly sensitive electrodes that can pick up electrical impulses in your heart. It records what your heart is doing when you feel chest pains or irregular heart beats. The printout can then help your doctor diagnose any problems you may be experiencing and prescribe a treatment plan that best meets your health care needs.

How is the test done?
You must visit the hospital for approximately 20 minutes to be fitted for your monitor and receive instructions on how to use it. A technician will place small disks, called electrodes, on your chest. The electrodes will be attached to wires (or leads) that will connect to a small device that looks like a cassette recorder, which you will wear on a belt around your waist. You must continue with your normal routine and keep a log of your daily activities including what you do and at what times. You MUST NOT shower or bathe for the duration of the test because it is important to keep the monitor and electrodes dry.

NOTE : If one of the leads come off, feel free to tape it back to the same spot by using scotch or masking tape.

How should I prepare?
You should bathe before you visit the hospital to be fitted for your Holter Monitor because you will be unable to shower or bathe for the duration of the test. Please ensure that you bring your Ontario Health Card to your appointment.

Is there any pain or risk associated with the test?
There is no pain or risk associated with this test.

How long will the test take?
Holter Monitoring can be a 24, 48, or 72-hour test.

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Echocardiogram (cardiac ultrasound)

What is it?
An echocardiogram is a test that uses sound waves (also called ultrasound) to produce a moving picture of your heart. These sound waves are sent through a wand-like device, called a transducer, and into your body. They bounce off your heart and return to the transducer as echoes. These echoes are then turned into moving images of your heart that can be viewed on a television monitor.

Why is it done?
Depending on the type of echocardiogram that is performed, this test allows your doctor to learn about the size and shape of your heart muscle and evaluate its function, valves, and the flow of blood through your heart. This test allows your doctor to diagnose any problems you may be experiencing and prescribe a treatment plan that best meets your health care needs.

How is the test done?
You will be given a gown and asked to remove any clothing above your waist and lie on an examination table. A technician will apply a thick gel and place the transducer to the left side of your chest. He or she will press firmly and move the transducer across your chest. You may be asked to change your position, breathe in or out, or hold your breath during the test, but most of the time you will be asked to lie still.

How should I prepare?
There is no special preparation needed before an echocardiogram. On the day of your test, please ensure that you bring your Ontario Health Card to your appointment.

How long will the test take?
This test will take approximately 30-45 minutes.

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Transesophageal Echocardiogram (TEE)

What is it?
A transesophageal echocardiogram is a test that uses sound waves to produce a moving image of your heart. Unlike a standard echocardiogram where the image is produced from the outside of the chest, this test produces an image from the inside. It involves the insertion of a soft, tube-like device, approximately the diameter of your little finger, into your mouth and down your food pipe (esophagus) until it is positioned directly behind your heart. The tube has a transducer on the end that bounces sound waves off of your heart to create moving images on a television monitor.

Why is it done?
This test can show your doctor the size, shape and movement of your heart muscle and the aorta, the main blood vessel supplying blood to your body. This test will also show how blood is flowing through your heart and how your heart valves are working. A TEE will give your doctor exceptionally clear images of your heart, and it is usually done when your doctor cannot get a clear picture using standard echocardiography.

How is the test done?
The doctor will begin by spraying your throat with an anaesthetic that will make it feel numb. While lying on the examination table, an intravenous line (or IV) will be put in your arm and you will be given a mild sedative to relax you. Small disks, called electrodes, will be placed on your chest to monitor your heart rhythm during the test.

A small tube, called a probe, will be put down your throat. Once in place, the transducer on the end of the probe will take pictures of your heart at different angles.

After the test, a nurse will stay with you until most of your sedative has worn off.

How should I prepare?
You must not eat or drink anything after midnight the night before your test. On the day of your test, please ensure that you bring your Ontario Health Card to your appointment.

Is there any pain or risk associated?
You may experience a sore throat for one day following your test.

How long will the test take?
This test will take approximately 30-45 minutes.

Discharge Instructions
You CANNOT drive a motor vehicle for 24 hours; therefore, you must arrange for a responsible adult to drive you home following your test.

You may begin drinking clear fluids two hours after your test. If you experience no difficulty swallowing, you may continue with your regular diet.

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Stress Echocardiogram

What is it?
A stress echocardiogram combines a standard exercise stress test and an echocardiogram.

Why is it done?
By comparing ultrasound images of your heart before and after you exercise, your doctor can tell how well your heart is pumping. This test can detect the presence and/or the significance of CAD (blocked arteries). It allows your doctor to diagnose any problems you may be experiencing and prescribe a treatment plan that best meets your health care needs.

How is it done?
A technician will apply small disks, called electrodes, to your chest and a blood pressure cuff around your arm. You will be asked to exercise on a treadmill, and, once your heart rate reaches a certain rate, you will be asked to lie down on an examination table.

A technician will apply a thick gel to your chest and will use sound waves through a wand-like device, called a transducer, to look at moving images of your heart.

How should I prepare?
Be sure to ask your doctor about any medication you are taking and whether or not you should stop taking it before the test. If possible, Beta Blockers should not be taken one day before or the morning of this test.

• Do not discontinue any medication without first talking to your doctor.
• Do not eat or drink anything for two hours before your test, especially coffee, tea, soda or chocolate.
• Do not use body creams or powder on your chest prior to the test.
• Wear loose-fitting, comfortable clothes and flat, soft-soled shoes, like running shoes
• Please ensure that you bring your Ontario Health Card to your appointment.

Is there any pain or risk associated?
There are some risks associated, but your doctor will explain these to you before you have the test. Be assured that a doctor will be present at all times during the test.

How long will the test take?
This test will take approximately 60 minutes.

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Dobutamine Stress Echocardiogram

What is it?
During this test, you will be given a medication called dobutamine through an intravenous (IV) line in your hand. It will cause your heart to work as though you were doing exercise. You will also have ultrasound images of your heart recorded before the medication is given to you and again while the medication is being given to you.

Why is it done?
This test is used to determine how well your heart is pumping. This test can detect the presence and/or the significance of blocked arteries (CAD). This will help your doctor prescribe a treatment plan that best meets your health care needs.

How is the test done?
A technician will place small disks, called electrodes, on your chest. These are attached to wires (or leads) and connected to an electrocardiogram machine. An intravenous (IV) line will be inserted into your arm. A technician will apply a thick gel to your chest and will use sound waves through a wand-like device called a transducer to look at moving images of your heart while it’s in a resting state. Your doctor or nurse will then administer the dobutamine medication through your IV, which will cause your heart to react as though you were exercising. Ultrasound images will be taken again while the dobutamine is being administered. You will be closely monitored at all times.

NOTE : The dobutamine may cause a warm, flushing feeling and, in some cases, a mild headache. If you begin to experience any of these symptoms, chest discomfort, excessive shortness of breath, or irregular heartbeats, tell the doctor immediately.

How should I prepare?
Be sure to ask your doctor about any medication you are taking and whether or not you should stop taking it before the test. If possible, Beta Blockers should not be taken one day before or the morning of this test. Do not discontinue any medication without first talking to your doctor.

• Do not eat or drink anything for two hours before your test, especially items that contain caffeine, such as coffee, tea, soda, or chocolate.
• Do not use body creams or powder on your chest prior to the test.
• Wear loose-fitting, comfortable clothes and flat, soft-soled shoes, like running shoes.
• Please ensure that you bring your Ontario Health Card to your appointment.

Is there any pain or risk associated?
There are some risks associated, but your doctor will explain these to you before you have the test. Be assured that a doctor will be present at all times during the test.

How long will the test take?
This test will take approximately 90 minutes.

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Nuclear Stress Test

What is it?
A nuclear stress test is an assessment of blood flow to your heart during rest and exercise.

Why is it done?
Your doctor needs to know how efficiently your heart is being supplied with the adequate amount of blood. When your heart is forced to work hard, the arteries will open up and deliver more blood, and therefore, more oxygen. If the arteries are plugged with plaque, it is harder for the blood to get through and less oxygen is delivered to that part of the heart. By injecting you with a substance and tracing its presence through your heart, your doctor can tell if and where your arteries are plugged.

How is the test done?
When you arrive, the technologist will give you a small injection of a substance called Tetrofosmin. One hour after your injection, you will be asked to lie on an examination table so a gamma-ray camera can move around your chest and take pictures of your heart. During this time (approximately 15 minutes), it will be necessary for you to hold your arms above your head.

One hour after the pictures are taken, the stress test can begin. A technician will place small disks, called electrodes, on your chest. These are attached to wires (or leads) and connect to an electrocardiogram (ECG) machine.

The doctor supervising your stress test will either ask you to walk on a treadmill, which will cause your arteries to open up and deliver more blood, or give you a medicine called Persantine, which will also cause your arteries to open, but without exercise.

Once your heart rate has reached a certain level, the technologist will give you a second injection of Tetrofosmin. You will be asked to wait one hour before the final set of pictures can be taken. If you completed the stress test on a treadmill, you will be permitted to leave the department to get something to eat during this time. However, if you were given Persantine, we strongly recommend that a friend or family member accompany you and bring food to you, as we prefer you not leave the department.

Once the final set of pictures have been taken, you may go home.

How should I prepare?
Be sure to ask your doctor about any medication you are taking and whether or not you should stop taking it before the test. If possible, Beta Blockers should not be taken one to two days prior to this procedure. Do not discontinue any medication without first talking to your doctor.

• Avoid items that contain caffeine, such as coffee, tea, soda, and chocolate for two days before the test.
• Do not eat anything the morning of the test. If you are diabetic, check first with your doctor.
• Do not use body creams or powder on your chest prior to the test.
• Wear loose-fitting, comfortable clothes and flat, soft-soled shoes, like running shoes.
• Please ensure that you bring your Ontario Health Card to your appointment.

How long will the test take?
This test will take approximately four to five hours.

Is there any pain or risk associated?
There are some risks associated, but your doctor will explain these to you before you have the test. Be assured that a doctor will be present at all times during the test.

NOTE : Any woman who is pregnant or thinks she may be pregnant should inform her doctor before proceeding with this test.

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