Diagnostic Testing - The Chester County Hospital

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HOLTER MONITORINGA Holter monitor is a test, which diagnoses abnormal heart rhythms and records yourEKG for 24 hours while you perform your normal daily activities. The Holter monitor isa small, portable recorder that is attached with 5 electrodes onto your chest. Prior toelectrode placement, your chest will be prepped with an abrasive alcohol pad removingthe skin oils to ensure adequate contact. If necessary, men’s chests will be shaved toapply the electrodes securely. The monitor is placed in a pouch that can be worn aroundthe waist or over the arm. You will be given a diary to document the times of any abnormalsymptoms that you experience while wearing the monitor. While wearing the monitor beaware of the electrode connections and reattach them if needed. Do not get any part ofthe monitor wet and please avoid electric blankets, metal detectors, magnets, and areasof high voltage as this may affect the results of your test. Following the 24 hour timeperiod, do not turn the monitor off before returning it to the Cardiology Department.>The Holter monitor is applied in the Cardiology Department located at TheCardioVascular Center on the second floor of the Hospital. Your Holter monitor tape isscanned by a trained cardiology staff member and reviewed by a Cardiologist. The finalresults are available in 3 to 5 working days.Preparation Instructions: The Holter monitor must be worn for 24 hours continuously soplease bathe or shower prior to arriving at the Hospital.TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE)A transesophageal echocardiogram (TEE) is indicated if a normal transthoracicechocardiogram does not provide adequate images to obtain necessary information ofa patient’s cardiac anatomy. The TEE allows the cardiologist to view the heart posteriorlyin order to give more definition to the heart chambers and valves. This is done by insertinga long flexible tube into the mouth and down the esophagus. This tube or probe has atransducer at the end that sends ultrasound waves that echo off of the heart’s structures.As an outpatient, you will be admitted to the Ambulatory Care Center (ACC) prior to thetest. The ACC is located on the ground floor of the Hospital. In ACC, you will be assessedby a registered nurse and an intravenous line (IV) will be started. A member of theCardiology Department will arrive to transport you to the Echo Lab. Prior to the test, aCardiology registered nurse will place you on the monitoring equipment necessary for theprocedure. Electrodes will be placed on your chest to monitor your heart and a bloodpressure cuff will be placed on your arm. A small clip will be placed on your finger tomonitor the amount of oxygen in your blood and intravenous fluids will be started. TheCardiologist performing the test will obtain the consent for the test and then spray atopical anesthetic to the back of your throat to numb the area. The registered nurse willplace you on nasal oxygen and administer a sedative in the IV to help your relax. Onceyou are comfortable, the Cardiologist will insert the probe into your mouth. You will beasked to swallow and the probe will be directed into your esophagus. You will feel thetube moving but you should not be in pain. During this time, your vital signs will be >DIAGNOSTIC CARDIOLOGY TESTING| 3
monitored closely and your mouth will be suctioned.The TEE procedure takes about 30 minutes to complete. After the sedative is administeredyou will be monitored for approximately 30 minutes before returning to ACC.>This test is performed in the Echocardiography Laboratory on the second floor of theHospital in the Cardiology Department. The Cardiologist performing the test will give youthe preliminary results before you leave the Hospital.Preparation Instructions: To prepare for the TEE do not eat or drink anything for 6 hoursbefore the procedure. Plan on having someone drive you home if you are having this testas an outpatient. If you have any difficulty swallowing, please notify your physician.NUCLEAR CARDIOLOGY STRESS TESTThis test is a screening tool for coronary artery disease. It involves the insertion of anintravenous (IV) catheter and an injection of a radioactive isotope before and during thetest. The isotope is a chemical element that when injected moves into the heart muscle.Prior to the stress or exercise portion of the test, you will be placed under the nuclearmedicine camera where resting images of your heart are obtained. At this time, you willbe laying flat and the camera will come in close to view your heart. Then you will be takento the stress test area. Your skin will be prepped with an abrasive alcohol pad and thenten EKG electrodes will be placed on your chest. If necessary, men’s chests will beshaved to ensure good electrode contact.For the stress portion of the test, the cardiac technician will take an initial EKG and bloodpressure. We will then ask you to move to the treadmill. A Cardiologist will be presentduring the test to observe your EKG. The treadmill will increase in speed and inclineevery three minutes and additional blood pressures will be taken. The staff will bemonitoring your symptoms continuously. It is necessary to notify the staff when you canonly walk one more minute because at that time you will again be injected with theradioactive isotope. This additional minute of exercise allows the isotope to circulate toyour heart muscle for an accurate test. After the stress test there is a short recoveryphase and then you will be asked to have a rest in the waiting room. To complete thestudy, you will be placed under the nuclear medicine camera for more cardiac imaging.>The Nuclear Cardiology Stress Laboratory is located in the Nuclear Medicine Departmentadjacent to Radiology on the first floor of the Hospital. If there is any gross abnormalityin your test you will be notified following the stress portion. A Cardiologist following thesecond set of images will read the final results.Preparation Instructions: The nuclear cardiology stress test takes approximately threehours to perform. It is necessary to avoid caffeine for 12 hours prior to the test. Pleaseeat a light breakfast such as cereal with milk or a bagel and juice. You may bring a snackto eat following the test. Women, please wear a supportive bra. Remember to wearcomfortable walking shoes and a two piece outfit.4
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Diagnostic Testing - The Chester County Hospital

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