Cardiovascular Testing

Tilt Table Test

The head-up tilt table test is a way to find the cause of fainting spells. The test involves lying quietly on a bed and being tilted at different angles (30 to 60 degrees) for a period of time while various machines monitor your blood pressure, electrical impulses in your heart and your oxygen level.
To Prepare for the Tilt Table Test:

• Take all your medications as prescribed.
• Do not eat or drink anything after midnight the evening before your test.
• When you come for your test, bring with you a list of all your current medications, including the dose.
• Plan to have someone drive you home after the test.
• If you have diabetes, ask for specific instructions on taking your medications and eating/drinking before the procedure.

Holter Monitoring

A Holter monitor is a small, wearable device that records your heart rhythm. You usually wear a Holter monitor for one to three days. During that time, the device will record all of your heartbeats. A Holter monitor test is usually performed after a traditional test to check your heart rhythm (electrocardiogram) isn’t able to give your doctor enough information about your heart’s condition. A Holter monitor has electrodes that are attached to your chest with adhesive and then are connected to a recording device.

Your doctor uses information captured on the Holter monitor’s recording device to figure out if you have a heart rhythm problem.

The Holter monitor may be able to detect irregularities in your heart rhythm that an electrocardiogram couldn’t, since an electrocardiogram usually takes only a few minutes. A Holter monitor may also be used if you have a heart condition that increases your risk of an abnormal heart rhythm, such as hypertrophic cardiomyopathy. Your doctor may suggest you wear a Holter monitor for a day or two, even if you haven’t had any symptoms of an abnormal heartbeat.

Aortic/Iliac Ultrasound

Duplex ultrasound offers the best noninvasive method for evaluating the hemodynamics of the aortoiliac arteries. Aortoiliac disease, also called aortoiliac occlusive disease, refers to disorders of the two major blood vessels that feed the lower half of the body, the aorta and the iliac artery.
Impaired circulation in these arteries can result in disorders of the pelvic organs, legs, or kidneys. Additionally, aortoiliac disease can result in an aortic abdominal aneurysm (AAA), a dangerous health condition.

An aneurysm is present when the aorta is dilated to more than one and one half the size of the normal aortic diameter size. Evaluation of by a vascular surgeon is recommended if an AAA measures four centimeters in size or greater, although endovascular repair or surgery is not usually considered until the diameter of the aneurysm is at least 5.0 to 5.5 centimeters. When treatment is not yet needed, it is important to have follow-up evaluations every six to 12 months to assess for aneurysm growth.

Aortoiliac disease occurs in one or more of the following locations:

• The lower abdominal aorta
• The iliac arteries
• The point where the aorta divides and becomes the iliac arteries.

*NO food or beverage seven (7) hours before your scheduled exam. It is therefore best to have the examination performed after an overnight fast, and it is important to avoid tobacco and caffeine prior to the test. A complete examination may take as long as an hour. Wear comfortable, loose-fitting clothing.

Renal Artery Duplex Ultrasound

A renal artery duplex ultrasound is accurate, non-invasive and cost-effective. Unlike angiography or CT scanning, no injection of X-ray contrast material is required, avoiding the risk of kidney damage from the contrast. Renal artery disease cannot be diagnosed without these specific tests.

Blood-flow velocities and flow patterns are evaluated with Doppler ultrasound in the aorta and renal arteries. Imaging of the kidneys can provide information about damage to the kidneys from chronic poor blood flow and the potential for recovery of kidney function with therapy.

Renal artery disease, including narrowing (stenosis) due to atherosclerosis, can result in reduced blood flow to the kidneys. Renal artery stenosis is the most common cause of hypertension (high blood pressure). Chronically, untreated renal artery disease is also an important cause of kidney failure.

* NO food or beverage seven (7) hours before your scheduled exam. It is therefore best to have the examination performed after an overnight fast, and it is important to avoid tobacco and caffeine prior to the test. Wear comfortable, loose-fitting clothing.​

Lower Extremity Venous Ultrasound

A lower extremity venous ultrasound is typically performed to evaluate for suspicion of deep vein thrombosis (DVT), superficial vein thrombosis (SVT) in the legs, venous insufficiency (varicose veins) or evaluation of leg ulcerations. Duplex scanning of the deep and superficial veins can detect obstruction. In addition, the function of valves in each segment of the evaluated veins can be assessed by determining the direction of blood flow using Doppler ultrasound.
In the lower extremities, blood returns to the heart through a network of deep and superficial veins. Normal venous flow patterns depend on open venous channels and the function of numerous valves within the veins. Venous insufficiency may occur if veins are obstructed from chronic thrombus or if the valves are incompetent. Untreated chronic venous insufficiency in the deep or superficial venous system can cause pain, swelling, skin changes and eventually tissue breakdown.

* Wear comfortable, loose-fitting clothing.

Upper Extremity Venous Ultrasound

An upper extremity venous ultrasound is typically performed to evaluate for suspicion of deep vein thrombosis (DVT) or superficial vein thrombosis (SVT) in the arms or neck. Thrombosis or clot formation in the veins of the upper limbs can lead to discomfort and swelling. Thrombosis can be a cause of long-term swelling, pain and other symptoms.
A number of factors can contribute to the risk of DVT. These include prior DVT or clotting disorders; trauma; recent major surgery; medical problems, including cancer and blood diseases; immobilization; obesity and others.

* Wear comfortable, loose-fitting clothing.

Abdominal Ultrasound

Abdominal ultrasound is an imaging procedure used to examine the internal organs of the abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys. The blood vessels that lead to some of these organs can also be looked at with ultrasound.

• An abdominal ultrasound is performed to help:
• Determine the cause of abdominal pain
• Determine the cause of kidney infections
• Diagnose a hernia
• Diagnose and monitor tumors and cancers
• Diagnose or treat ascites
• Learn why there is swelling of an abdominal organ
• Look for damage after an injury
  Look for stones in the gallbladder or kidney
• Look for the cause of abnormal blood tests such as liver function tests or kidney tests
• Look for the cause of a fever

Carotid Ultrasound

Carotid ultrasound is a painless and non-invasive test that uses high-frequency sound waves to create images of the insides of your carotid arteries. There are two common carotid arteries, one on each side of your neck. They each divide into internal and external carotid arteries.

The internal carotid arteries supply oxygen-rich blood to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp, and neck.

Carotid ultrasound is used to screen for blockages that may indicate an increased risk of stroke. Results from a carotid ultrasound can help your doctor determine what kind of treatment you may need to lower your risk.

Indications for a carotid ultrasound:

• Detect a collection of clotted blood that may slow and eventually stop blood flow.
• Detect a dissection of the carotid artery wall.
• Evaluate the carotid artery after pre and post-surgery.
• Evaluate the position and patency of a stent.

* Wear a comfortable, loose-fitting, open-necked shirt or blouse for your ultrasound exam.​

Venous Map

Venous mapping is a non-invasive Duplex ultrasound evaluation of the veins in your legs or arms. It is a preoperative exam to evaluate vein segments for dialysis fistula grafts, lower extremity arterial bypass grafts and coronary artery bypass grafts. The information is provided to the surgeon to help guide the planned surgical procedure.
When lower extremity arterial bypass surgery is required, a bypass graft using a vein often provides the best long-term result. Using the person’s own tissue reduces the risk of infection or thrombosis (clotting) of the graft. The great saphenous vein is the most commonly used vein, although other superficial veins may be used.

* Wear comfortable, loose-fitting clothing.

Saline Bubble Study

An ultrasound of the heart is called an Echocardiogram. It is done to get pictures of the heart and the areas around the heart. Better pictures are sometimes seen if a material called “contrast” is used during the ultrasound. One type of contrast is saline (sterile saltwater). When saline is used, it is called a “bubble study.”

During a bubble study, the nurse will shake (agitate) the saltwater until it forms small bubbles. The bubbles are then injected into the vein through an intravenous line (IV). In a normal heart, the bubbles are filtered by the lungs and are seen only on the right side of the heart. If the bubbles are seen on the left side, it shows that there is an opening between the two sides of the heart, which is abnormal.
The abnormality can be a Patent Foramen Ovale (PFO), Atrial Septal Defect (ASD) or a Ventricular Septal Defect (VSD). The bubble study helps to identify those abnormalities.

This is a safe and relatively painless procedure that helps your physician diagnose a variety of heart problems. It can be especially helpful if someone has had a stroke or what is called a transient ischemic attack (TIA) or cerebral vascular accident (CVA). The length of the exam varies and can take approximately 35-50 minutes depending on the number of images that are obtained.