Electrophysiology

The five major symptoms of a heart attack are:

• Pain or discomfort in the jaw, neck or back.
• Feeling weak, light-headed or faint.
• Chest pain or discomfort.
• Pain or discomfort in the arms or shoulder.
• Shortness of breath.

However, there is a difference in how men and women experience a heart attack. (For more information on women and heart attacks, see below.) As with men, the most common heart attack symptom for women is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

If you think you, or someone you know, is having a heart attack, call 911 immediately.

When the blood supply to the heart muscle is cut off, a heart attack can result. Cells in the heart muscle do not receive enough oxygen and begin to die. The more time that passes without treatment to restore blood flow, the greater the damage to the heart.

Having high blood pressure or high blood cholesterol, being a smoker and having had a previous heart attack, stroke or diabetes can increase a person’s chances of having a heart attack.

According to the American Heart Association, about 785,000 Americans have an initial heart attack and another 470,000 have a recurrent heart attack each year. According to a CDC report, almost half of the cardiac deaths in 1999 occurred before emergency services and hospital treatment could be administered.

It is important to recognize the signs of a heart attack and to act immediately by calling 911. A person’s chances of surviving a heart attack are increased if emergency treatment is given to the victim as soon as possible.

If you’re a woman, you may not believe you are as vulnerable to a heart attack as a man – but you are. Women account for nearly half of all heart attack deaths. Heart disease is the number one killer of both men and women.

• There are differences in how women and men respond to a heart attack. Women are less likely than men to believe they’re having a heart attack and more likely to delay in seeking emergency treatment.
• Further, women tend to be about 10 years older than men when they have a heart attack. They are more likely to have other conditions, such as diabetes, high blood pressure and congestive heart failure, making it all the more vital they get proper treatment fast.
• Women should learn the heart attack warning signs.

If you feel heart attack symptoms, do not delay. Dial 911. Your family will benefit most if you seek fast treatment.

Cardiac catheterization is an essential tool for diagnosing and guiding the treatment of heart disease. It enables Long Island Community Hospital Cardiologist to visualize and assess the condition of the coronary arteries, and it provides vital information for treating blockages that can restrict blood flow to the heart. Click here to find out more.

An intracardiac electrophysiology study (EPS) is a test to look at the heart’s electrical function. It allows doctors to check for abnormal heartbeats or heart rhythms. For additional information, click here.

Why an echocardiogram is performed:

• Assess the overall function of your heart.
• Determine the presence of many types of heart disease, such as valve disease, myocardial disease, pericardial disease, infective endocarditis, cardiac masses and congenital heart disease.
• Follow the progress of valve disease over time.
• Evaluate the effectiveness of your medical or surgical treatments.

How to prepare:

• Eat and drink as you normally would the day of the test.
• Take all of your medications at the usual times, as prescribed by your doctor.
• Wear anything you like. You will change into a hospital gown before the test.

What happens during the test:

Before the test, the healthcare provider will explain the procedure. You will have the opportunity to ask questions. In general:

• Your test will take place in the Echo Room. The testing area is supervised by a physician.
• You will be given a hospital gown to wear. You’ll be asked to remove your clothing from the waist up.
• The sonographer will ask you to lie on your left side on an exam table. The sonographer will place a wand (called a sound-wave transducer) on several areas of your chest. The wand will have a small amount of gel on the end, which will not harm your skin. This gel helps produce clearer pictures.
• Sounds are part of the Doppler signal. You may or may not hear the sounds during the test.
• You may be asked to change positions several times during the exam so the sonographer can take pictures of different areas of the heart. You may also be asked to hold your breath at times.

How you can expect to feel:

You should feel no major discomfort during the test. You may feel coolness on your skin from the gel on the transducer and a slight pressure of the transducer on your chest.

Test duration:

The appointment will take about 30 to 40 minutes. After the test, you may get dressed and go home or go to your other scheduled appointments.

Receiving your results:

After a cardiologist has reviewed your test, the results will be entered into your electronic medical record or faxed. Your physician will have access to the results and will discuss them with you.

How to prepare for an exercise stress test:

• DO NOT eat or drink anything except water for 3 hours before the test.
• Avoid caffeinated products (cola, Mountain Dew, chocolate products, coffee or tea) for 24 hours before the test, as caffeine will interfere with the results of the test. Also avoid decaffeinated or caffeine-free products, which contain trace amounts of caffeine.
• DO NOT SMOKE ON THE DAY OF THE TEST, as nicotine will interfere with the results of your test.
• Since many over-the-counter medications contain caffeine (such as diet pills, NoDoz, Excedrin and Anacin), DO NOT take any over-the-counter medication that contains caffeine for 24 hours before the test.
• Make sure to bring a list of all your medications, including over-the-counter ones and supplements that you routinely take, to your appointment. Ask your physician, pharmacist or nurse if you have questions about other medications that may contain caffeine.
• Your physician may also ask you to stop taking other heart medications on the day of your test. If you have any questions about your medications, ask your physician.
• If you use an inhaler for your breathing, please bring it to the test.

NOTE: Do not discontinue any medication without first talking with your physician.

Guidelines for people with diabetes:
If you take insulin to control your blood sugar, ask your physician what amount of your medication you should take the day of the test.

What you should wear:
Please wear or bring comfortable clothes and shoes suitable for walking.

What happens during the test:
Your test will take place in the Stress Lab. The testing area is supervised by a physician:

• First, a registered nurse will place electrodes (small, flat, sticky patches) on these areas. The electrodes are attached to an electrocardiograph (EKG) monitor that charts your heart’s electrical activity during the test.
• The nurse will place an IV into a vein your arm.
• Before you start exercising, the nurse will perform a resting EKG, measure your resting heart rate and take your blood pressure.
• You will exercise on a treadmill. The lab nurses will ask you to start exercising and will gradually increase the intensity of exercise. You will be asked to continue exercising until you are exhausted.
• At regular intervals, the nurses will ask how you are feeling. Please tell them if you feel chest, arm or jaw pain or discomfort; shortness of breath; dizzy; lightheaded; or if you have any other unusual symptoms.
• The nurses will watch for any changes on the EKG monitor that suggest the test should be stopped.
• After the test, you will walk slowly for a few minutes to cool down. Your heart rate, blood pressure and EKG will continue to be monitored until the levels return to normal.

How you can expect to feel:
You will be encouraged to exercise until you are exhausted. It is normal for your heart rate, blood pressure, breathing rate and perspiration to increase.

Test duration:
The appointment will take about 60 minutes. The actual exercise time is usually between 7 and 12 minutes. You should avoid strenuous activity for the rest of the day. (Weight restriction: 400 lbs.)

Receiving your results:
After a cardiologist has reviewed your test, the results will be entered into your electronic medical record or faxed to the ordering doctor. Your physician will have access to the results and will discuss them with you.

How to prepare:
There is no special preparation required for this test; there are no medication or food restrictions. Wear comfortable clothes that can be easily removed, as you may be asked to wear a hospital gown during the test.

What happens during the test:

• First, an intravenous (IV) line will be inserted into a vein in your arm. A nuclear technologist will draw a small amount of blood, combine it with a radioactive tracer and reinject the mixture into your IV 20 minutes later. The radioactive tracer tags your red blood cells, so they can be detected by the camera.
• For the imaging part of the test, a technologist will attach three electrodes (small, round, sticky patches) to the skin of your chest.
• The technologist will ask you to lie on the exam table under the gamma camera. The camera is focused on the heart and analyzes the amount of radio-labeled red blood cells pumped out of the heart with each heartbeat. This test calculates your ejection fraction, a measurement of how well your heart pumps with each beat.
• A normal ejection fraction ranges from 50-70%. An ejection fraction of 65%, for example, means that 65% of the total amount of blood in the left ventricle is pumped out with each heartbeat. The ejection fraction may be lower when the heart muscle has become damaged due to a heart attack, heart muscle disease (cardiomyopathy) or other causes.

Side effects to consider:
The simple answer is there are none. Because the injected medications contain only a minimal amount of the carrier drug, there are no significant adverse or allergic reactions. The radioactive tracer used during the MUGA scan is a diagnostic dose of radiation that is similar to the dose you would receive during a chest X-ray and is not harmful.

Test duration:
The MUGA scan takes about one to two hours to perform. (Weight restriction: 400 lbs.)

What to do after the test:
You can resume your normal activities right after the test.

Receiving your results:
After the cardiologist reviews your test, the results will go into your electronic medical record or faxed. Your referring physician will have access to the results and will contact you to discuss them.

Medication guidelines:

• Bring a copy of all of your medications, including over-the-counter medications and supplements that you routinely take, to the test appointment.
• DO NOT take any over-the-counter medication that contains caffeine (such as Excedrin, Anacin, diet pills and NoDoz) for 24 hours before the test. Ask your physician, pharmacist or nurse if you have questions about other medications that may contain caffeine.
• If you have asthma: Your physician will tell you NOT to take theophylline (Theo-Dur) for 48 hours before the test. Please plan to bring your asthma inhaler mediation to the test.
• If you have diabetes: If you take insulin to control your blood sugar, ask your physician how much insulin you should take the day of the test.
• If you take heart medications: Your physician may also ask you to stop taking other heart medications on the day of your test. If you have any questions about your medications, ask your physician. Do not discontinue any medication without first talking with your physician.

What to wear for the test:
Please wear comfortable clothes and shoes suitable for walking/jogging during the test.

What you should expect during the test:
Your test will take place in the Cardiology Department. The testing area is supervised by a physician.

• A nuclear medicine technologist will place an IV into a vein in your arm or hand and inject a small amount of radioactive tracer. The tracer is not a dye or contrast. After the tracer is injected, you will wait about 45 minutes before the first set of “resting” images are taken.
• Then you will be asked to lie very still under the gamma camera with both arms above your head for about 15 to 20 minutes. The camera will record images that show blood flow through your heart at rest.
• A registered nurse will conduct a brief interview and then place electrodes on your chest, perform some EKGs and take your blood pressure.
• You will start walking on a treadmill. At regular intervals, the difficulty of the exercise will increase until you achieve the target heart rate or you develop symptoms. Then, a second dose of radioactive tracer will be injected into the IV. Your heart rate, EKG and blood pressure will be monitored throughout the test. If you are unable to achieve your target heart rate, a medication may be given to simulate exercise.
• About 20 minutes after exercising, you will be asked again to lie very still under the camera with both arms over your head for about 15 to 20 minutes. The camera will record images that show blood flow through your heart during exercise. These images will be compared to the first set.

Test duration:
The appointment will take about 4 to 5 hours. The actual exercise part of the test lasts about 7 to 12 minutes. Weight restriction is 400 pounds. If you weigh over 300 pounds, your test may be scheduled as a two-day test.

Receiving your results:
After the cardiologist reviews your test, the results will go into your electronic medical record or faxed. Your referring physician will have access to the results and will contact you to discuss them.

• DO NOT eat or drink anything except water for 3 hours before the test.
• Avoid all products containing caffeine for 24 hours before the test. In general, caffeine is found in coffee, tea, colas and other soft drinks as well as most chocolate products.
• Avoid decaffeinated or caffeine-free products for 24 hours before the test, as these products contain trace amounts of caffeine.
• Do not smoke on the day of the test, as nicotine will interfere with the results of your test.

Medication guidelines:

• Please bring a copy of all of your medications, including over-the-counter medications and supplements that you routinely take, to the test appointment. Please follow these guidelines about taking your medications the day of the test.
• Do not take any over-the-counter medication that contains caffeine (such as Excedrin, Anacin, diet pills and NoDoz) for 24 hours before the test. Ask your physician, pharmacist or nurse if you have questions about other medications that may contain caffeine.
• If you have asthma: Your physician will tell you NOT to take theophylline (Theo-Dur) for 48 hours before the test. Please plan to bring your asthma inhaler mediation to the test.
• If you have diabetes: If you take insulin to control your blood sugar, ask your physician how much insulin you should take the day of the test.
• If you take heart medications: Your physician may also ask you to stop taking other heart medications on the day of your test. If you have any questions about your medications, ask your physician. Do not discontinue any medication without first talking with your physician.

What you should expect during the test:

• Your test will take place in the Cardiology Department. The testing area is supervised by a physician.
• A nuclear medicine technologist will place an IV into a vein in your arm or hand and inject a small amount of radioactive tracer. The tracer is not a dye or contrast. After the tracer is injected, you will wait about 45 minutes before the first set of “resting” images are taken.
• Then you will be asked to lie very still under the gamma camera with both arms above your head for about 15 to 20 minutes. The camera will record images that show blood flow through your heart at rest.
• A registered nurse will conduct a brief interview and then place electrodes on your chest, perform some EKGs and take your blood pressure.
• Before the medication is infused into the IV, the nurse will discuss the possible side effects so you will know what to expect.
• You will lie on a stretcher for the duration of the test.
• Your heart rate, EKG and blood pressure will be monitored throughout the test.
• After waiting about 45 to 60 minutes, you will be asked again to lie very still under the camera with both arms over your head for about 15 minutes. The camera will record images that show blood flow through your heart during cardiac stress/activity. These images will be compared to the first set.

Test duration:
The appointment will take about 4 to 5 hours. Weight restriction is 400 pounds. If you weigh over 300 pounds, your test may be scheduled as a two-day test.

Receiving your results:
After the cardiologist reviews your test, the results will go into your electronic medical record or faxed. Your referring physician will have access to the results and will contact you to discuss them.

Why a Transesophageal Echocardiogram (TEE) Testis performed:

• Assess the overall function of your heart’s valves and chambers.
• Determine the presence of many types of heart disease, such as valve disease, myocardial disease, pericardial disease, infective endocarditis, cardiac masses and congenital heart disease.
• Evaluate the effectiveness of valve surgery.
• Evaluate abnormalities of the left atrium.

Before the test:
When this test is recommended, please tell your doctor if you have any problems with your esophagus, such as a hiatal hernia, problems swallowing or cancer. Please plan to bring someone with you on the day of the test so that you will have a ride home. You should not drive until the day after the test, as the sedation given during the test makes it unsafe for you to drive after the test.

How to prepare for the test:  

• DO NOT eat or drink anything for at least 6 hoursbefore the test. If you must take medication before the test, take it only with a small sip of water.
• Take all of your medications at the usual times as prescribed by your doctor. If it is 4 hours before the test, please take your medications with only a small sip of water. If you have diabetes and take medications to manage your blood glucose, please contact your doctor for specific instructions about taking your medication before the test.
• Plan for someone to drive you home. Someone should come with you the day of the test to drive you home. You should not drive until the day after the procedure. The sedation given during the test causes drowsiness, dizziness and impairs your judgment, making it unsafe for you to drive or operate machinery.

What you should wear:
You may wear anything you like. You will change into a hospital gown before the test. Please do not bring valuables.

What happens during the test:
Before the test, the healthcare provider will explain the procedure in detail, including possible complications and side effects. You will have the opportunity to ask questions.

• Your test will take place in the Echo Room. The testing area is supervised by a physician.
• You will be given a hospital gown to wear.
• The registered nurse will place three electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to an electrocardiograph (EKG) monitor that charts your heart’s electrical activity.
• A blood pressure cuff will be placed on your arm to monitor your blood pressure.
• A small clip, attached to a pulse oximeter, will be placed on your finger to monitor the oxygen level of your blood.
• A registered nurse will place an IV into a vein in your arm.
• You will be given a solution to gargle that will numb your throat or a spray of an anesthetic (pain-relieving medication) at the back of your throat.
• The doctor will put medications into your IV to help you relax. You may feel drowsy.
• You will be asked to lie on your left side on an exam table.
• A bite block will be placed in your mouth to remove any secretions.
• The doctor will insert a thin, lubricated endoscope into your mouth, down your throat and into your esophagus. This part of the test lasts a few seconds and may be uncomfortable. The endoscope does not interfere with your breathing. You may be asked to swallow at certain times to help pass the endoscope.
• Once the probe is in position, pictures of the heart are obtained at various angles (you will not feel this part of the test).
• Your heart rate, blood pressure and oxygen level of your blood will be closely monitored during and immediately after the exam.

How you can expect to feel during the test:
Because of the sedative, you may not be entirely awake for the test. We will keep you as comfortable as possible during the test. Tell the healthcare team if you feel uncomfortable at any time during the test. You may feel a temporary soreness or numbness in your throat after the test.

Test duration:
The test will take about 90 minutes. After you have recovered from the sedation given during the test, you may go home or go to your other scheduled appointments. Remember, you CANNOT drive yourself home after the test.

What to do after the test:
Wait at least one hour after the test (or until the numbness in your throat is gone) before eating or drinking. Start by drinking a cool liquid. If you don’t have any problems drinking cool liquids, you can eat and drink as you normally would.

Receiving your results:
After a cardiologist has reviewed your test, the results will be entered into your electronic medical record or faxed. Your physician will have access to the results and will discuss them with you. A nurse will call the next day to follow up on your experience and make sure you have an appointment to discuss the results with your doctor.

What Elective Cardioversion is:
If your heart has an irregular (uneven) beat or is beating too fast, cardioversion is a way to restore a regular rhythm. Most often, doctors use cardioversion to treat a fast, irregular heart rhythm called atrial fibrillation or atrial flutter. This procedure may be performed after a Transesophageal Echocardiogram (TEE).

Why it’s performed:
People have nonemergency or elective cardioversion to treat arrhythmias. The electrical signals that control your heartbeat start in the upper right chamber of your heart (atrium). In atrial fibrillation, very fast, irregular electrical signals move through both of the upper chambers of your heart. This can make your heartbeat fast and irregular. Some people who have atrial fibrillation don’t notice any changes in the way they feel. But others feel:

• A very fast heartbeat.
• Short of breath.
• Very tired.

How to prepare for electrical cardioversion:

• Do not eat or drink for at least 6 hours before your cardioversion.
• Please bring a copy of all your medications, including over-the-counter medications and supplements that you routinely take, to the test appointment.
• The staff will require appropriate documentation of anticoagulation lab results.
• Have someone drive you to your appointment and take you home. Arrange your schedule so you do not have to drive, operate machinery or make any important decisions for the rest of the day after your cardioversion.

During an electrical cardioversion:

• A registered nurse will place an IV in your arm, and you will receive sedation to make you sleepy. You won’t feel pain during the procedure.
• Your doctor will deliver an electrical shock through two pads. One is placed on your chest and the other on your back. Alternativelym, both pads may be placed on the front of your chest. The shock lasts less than a second and briefly stops (resets) your heart rhythm.
• Your doctor will check to see if your heartbeat is regular. Some people need only 1 shock. Some need more to restore a regular heartbeat.
• In most cases, patients wake up quickly and don’t remember the shock.
• The procedure takes about 30 minutes.

 After electrical cardioversion:

• A registered nurse will watch you carefully for an hour or more after the procedure.
• You can visit with family members, but you may feel sleepy for several hours.
• Your doctor will tell you if the cardioversion worked. Your doctor will talk to you about whether you need more treatment or need to take medication to maintain a normal rhythm.
• You can usually go home the day of your procedure.

Some questions to ask your doctor about cardioversion:

• Will I still need to take medicine for my abnormal heart rhythms?
• How many times can I have this procedure?
• What will you do if the cardioversion doesn’t work?