CARDIOVASCULAR SERVICES

Mary Rutan’s Cardiovascular Services staff

MARY RUTAN HOSPITAL
CARDIOVASCULAR SERVICES

The Cardiovascular Services Department is staffed from 0700 until 1730 Monday through Friday and from 0700 until 1530 weekends and holidays.  The Respiratory Care Department provides ECG coverage from 1730 until 2300 daily and from 1530 until 2300 weekends and holidays. Trained nursing staff provides ECG coverage from 2300 until 0700 daily.

Vascular Clinic: In conjunction with Mid-Ohio Cardiology and Vascular consultants, MRH offers vascular evaluation and treatment management on most Tuesdays. Appointments can be made by calling 1-800-851-7342. 

Cardiac Rehab: MRH Cardiovascular Rehab has been developed in order to provide a medically safe, individually prescribed, exercise program for people for heart disease and/or lung disease.  The intent of rehab is to recondition the patient’s cardiovascular system as well as improve their overall fitness. Currently, eight monitored Phase II patients can exercise together in addition to two or three unmonitored Phase III patients.  Hours of operation are Monday through Thursday 0600-1900, Friday 0600-1630, and Saturday 0800-1200.


AT MARY RUTAN HOSPITAL
TESTS OFFERED IN THE CARDIOVASCULAR DEPARTMENT

EKG (Electrocardiogram)

Description:

    Records the electrical activity of the heart.

Procedure:

    Electrodes are placed on the chest and the heart rate and rhythm is recorded.

Patient Preparation:

    None

Signal Average EKG(SAEKG)

Description:

    Monitors for changes in electrical activity of the heart (late potentials), that may precipitate ventricular dysrhythmias.

Procedure:

    Electrodes are placed on the patient’s chest and back. While lying down a ECG computer analyzes 250 heart beats.

 Patient Preparation:

    None

Considerations:

    Test is invalid on someone whose baseline EKG shows left bundle branch block

Holter Monitor

Description:

    Provides a 24-hour, 3-lead recording of the patient's heart rhythm.

Procedure:

    Four electrodes are placed on the chest. These leads are connected to a "digital recorder" which records each heart beat for the next 24 hours. The patient is asked to keep a diary of daily activities while wearing the monitor.

Patient Preparation:

    Patient should be advised to shower prior to exam as they will not be permitted to shower while wearing the monitor.

Event Recorder (King of Hearts)

Description:

    A small monitor is worn by the patient over an extended period of time (1-4 weeks). It is used for patients who have symptoms which occur intermittently.

Procedure:

    AN ambulatory ECG monitor with two electrodes attached to the patient’s chest is worn on a belt or hung around the neck with a cord.  The patient activates the monitor when they experience symptoms (i.e. weakness, palpitations).  When the  monitor is activated, it records their current heart rate and rhythm. The rhythm recordings are then sent to the Cardiovascular Department via the telephone.

Patient Preparation:

    None

Ambulatory Blood Pressure Monitor

Description:

    Provides a printout of blood pressures taken over a 24-hour period.

Procedure:

    A blood pressure cuff is placed on the arm and connected to a small automatic blood pressure device. The blood pressure is recorded every 30 minutes through the day and every 60 minutes through the night.

Patient Preparation:

    Inform the patient that many insurance companies do not cover this device.

Arterial Doppler

Description:

    Evaluates for arterial insufficiency.

Procedure:

    A series of blood pressures and arterial waveforms are documented using doppler.  These measurements are taken at rest, then after a brief walk. Changes in the waveforms and pressures may indicate arterial occlusion.

Patient Preparation:

    None

Venous Duplex

Description:

    This exam evaluates the blood vessels and their transportation of blood from the arms and legs back to the heart. 

Procedure:

    Ultrasound waves are used to study the structure and function of the venous system

Patient Preparation:

    None

Carotid Duplex

Description:

    This exam evaluates the transportation of blood, oxygen, and nutrients from the heart to the brain. Ultrasound waves are used to study the structure and function of the carotid arteries.

Procedure:

    Patient lies on a table while ultrasound is used to evaluate the arteries.

Patient Preparation:

    None

Echocardiogram (echo)

Description:

    Ultrasound waves are utilized to evaluate cardiac structures and their function.

Procedure:

    The patient lies on their left side while ultrasound is used to evaluate the heart.  During the exam, cardiac doppler may be used to evaluate blood flow in the heart.

Patient Preparation:

    None

Contrast Agent : OPTISON

    An injectable sterile suspension of microspheres of human serum albumin with octafluoropropane which creates an echogenic contrast effect in the blood.  OPTISON is indicated for use in patients with suboptimal images to opacify the left ventricular cavity and improve delineation of left endocardial borders.

CONTRAINDICATED in patients with hypersensitivity to blood, blood products, or albumin.

Transesophageal Echocardiogram (TEE)

Description:

    An echocardiogram is done with a special probe inserted into the esophagus. The close proximity of the probe to the heart allows certain heart structures to be seen more clearly.  TEE may be ordered to evaluate valves and their function, check for intracardiac thrombus, and search for vegetation within the heart.

Procedure:

    During the test, an IV is started. Demerol and Versed are given to sedate the patient. The posterior pharynx is anesthetized with viscous Lidocaine and Topex spray. Heart rhythm, blood pressure, and O2 saturation are monitored during the test. The probe is passed into the esophagus and ultrasound images are taken of the heart.  After the test, the patient should be NPO for one hour.

Patient Preparation:

    The patient should be NPO for 8 hours prior to the exam.

Considerations:

  1. TEE should not be performed on anyone with esophageal disease.
  2. The patient will need transportation home following the exam.

Routine Stress Testing (Exercise Stress, Treadmill Stress, Graded Exercise Test)

Description:

    Used to evaluate for CAD, document dysrhythmias and exercise capacity.

Procedure:

    The patient is exercised in a progressive fashion on a treadmill until target heart rate is reached.  During the exercise, the heart rate and rhythm are monitored. EKG's are done every minute and the blood pressure is checked. Changes in the EKG (ST depression), blood pressure (hypotension), and the patient (chest pain or weakness) may indicate a cardiac problem.

Patient Preparation:

  1. Lab work - A serum potassium is required if the patient is taking diurectics.  If the potassium is below 3.5, the patient needs to have the K+ supplemented.
  2. The patient may take routine medications, but beta-blockers (Tenormin, Lopressor, Inderal) should be held for 48 hours before the exam.
  3. The patient may eat up until 2-3 hours before the test.
  4. Have the patient wear comfortable clothes and shoes.

Considerations:

  1. Patient should have the capacity to reach target heart rate with exercise.
  2. If the patient has an abnormal baseline EKG (left bundle branch block, T-wave changes), a different test should be ordered.
  3. Patients on Lanoxin need to be evaluated with a different test.

Stress Echo

Description:

    Combines routine stress testing with echo to evaluate for CAD, diastolic dysfunction, and/or valvular incompetency.

Procedure:

    Resting images are taken with echo and saved on a digital computer.  The patient is evaluated with a routine stress (see above).  When the target heart rate is reached, the patient moves quickly to a table where the cardiac images are repeated.  These images are placed side-by-side on the computer.  The cardiologist then evaluates for any changes in the images that occur with exercise.

Patient Preparation:

    Same as for a Routine Stress Test.

Considerations:

  1. The patient should be able to reach target heart rate.
  2. The patient needs to be able to move quickly from the treadmill to the bed.

Dobutamine Echo

Description:

    Used to evaluate for CAD, valvular deficiencies, and diastolic dysfunction.

Procedure:

    Echo images are taken of the heart while the patient is at rest. These images are saved on a digital computer.  A Dobutamine infusion is then started.  Dobutamine increases the heart rate and contractility. The Dobutamine is increased in an incremental fashion from 5mcg/kg/min up to 50mcg/kg/min. at each level, images are taken of the heart. When the target heart rate is reached, peak images are saved.  Throughout the test, the cardiologist studies the wall motion and function of the heart.  A decline in wall motion or function may indicate a cardiac problem. In instances where the target heart rate is not reached with Dobutamine, doses of Atropine may be given. Heart rate and rhythm, EKG's, and blood pressure are monitored throughout the exam.

Patient Preparation:

  1. Lab work - A serum potassium is required if the patient is taking diurectics.  If the potassium is below 3.5, the patient needs to have the K+ supplemented.
  2. The patient may take routine medications, but beta-blockers (Tenormin, Lopressor, Inderal) should be held for 48 hours before the exam.
  3. The patient may eat up until 3 hours before the test.

Considerations:

    Dysrhythmias can be potentiated by the Dobutamine. Another test may be considered if the patient has poorly controlled dysrhythmias.

Resting Thallium

Description:

    Perfusion images are taken of the heart without exercise.  May be done after a myocardial infarction.

Procedure:

    Thallium is injected and images are taken of the heart after injection and then again after 4 hours.

Patient Preparation:

  1. The patient should eat 3 hours before the exam.  They can not eat between images, but can have a cup of fluid to drink.
  2. Serum HCG should be drawn on post-menopausal patients

Resting MUGA

Description:

    Used to evaluate wall motion abnormalities and ejection fraction.

Procedure:

    PYP and radioactive isotopes are injected through an IV. The patient does not exercise.

Patient Preparation:

  1. The patient may eat up until 3 hours before the exam.
  2. Serum HCG should be drawn on post-menopausal patients

Spect Sestimibi (Stress Mibi)

Description:

    Myocardial perfusion imaging used to assess:

  • Regional myocardial blood flow
  • Disease with reversible/nonreversible defects
  • Myocardial viability
  • Whether coronary artery disease is present
  • Response to CAD therapy
  • Severity of CAD
  • Risk of subsequent cardiac events
  • Myocardial involvement in cardiomyopathic processes

Procedure:

    Combines routine stress testing with nuclear medicine images.  The procedure begins with an IV injection of a radioactive agent called Cardiolyte or Sestimibi.  This agent is taken up by the heart muscle in direct proportion to blood flow to the myocardium.  As this agent decays, it emits low levels of radioactivity, which makes the heart visible under a special camera.  This data is subjected to computer analysis, contrast enhancement, background subtraction, and image quantification. The rest and stress images are then compared and interpreted by a cardiologist.  The stress ECG is also interpreted.

Patient Preparation:

    Same as for a Routine Stress Test.

Considerations:

  1. The patient should have the capability to reach target heart rate with exercise.
  2. The patient should be able to lie flat on their back and raise their left arm up above their head in for 15-20 minutes while the cameras circulate and acquire images.
  3. The patient should be made aware that the test will be time-consuming (approximately 2½ to 3 hours).
  4. Imaging equipment will accommodate weights up to 350 pounds.
  5. Patients with LBBB or ventricular pacing should be assessed with a pharmacologic agent.

Spect Pharmacological Sestimibi

Description:

    Pharmacologic sestimibi used for the same indications as a Stress Mibi in patients who are unable to obtain 85% of their age-predicted maximum heart rate through exercise. Vasodilation can be achieved through the use of Dipyridamole or Adenosine. ( In some cases, Dobutamine may be used to affect myocardial stress via an inotropic effect.)

Procedure:

    Combines nuclear medicine images with an intravenous injection of a vasodilator.  The dosage is calculated according to the patient's weight.

Patient Preparation:

  • The patient should have no caffeine for 24 hours prior to the test.
  • No Theophylline products for 48 hours prior to the test.
  • Otherwise, same as for a Routine Stress Test.

Considerations:

  • The patient should be able to lie flat on their back and raise their left arm up above their head in for 15-20 minutes while the cameras circulate and acquire images.
  • The patient should be made aware that the test will be time-consuming (approximately 2½ to 3 hours).
  • Imaging equipment will accommodate weights up to 350 pounds.
  • Dipyridamole and/or Adenosine are contraindicated in patients with:
      • Known asthma
      • Systolic blood pressure less than 100mmHg
      • Acute MI less than 48 hours prior
      • Unstable angina

Spect Dobutamine Sestimibi

Description:

    A pharmacologic agent is used to evaluate for CAD when Dipyridamole or Adenosine is contraindicated.

Procedure:

    Combines nuclear medicine images with a Dobutamine infusion. Dobutamine increases the heart rate and contractility. The Dobutamine infusion is increased in an incremental fashion from 5mcg/kg/min up to 50mcg/kg/min.  in instances where the target heart rate is not reached, doses of Atropine may be used.  Heart rate and rhythm, ECG's, and blood pressure are monitored throughout the exam.

Patient Preparation:

  1. Lab work - A serum potassium is required if the patient is taking diurectics.  If the potassium is below 3.5, the patient needs to have the K+ supplemented.
  2. The patient may take routine medications, but beta-blockers (Tenormin, Lopressor, Inderal) should be held for 48 hours before the exam.
  3. The patient may eat up until 3 hours before the test.

Considerations:

  1. Dysrhythmias can be potentiated by the Dobutamine. Another test may be considered if the patient has poorly controlled dysrhythmias.
  2. The patient should be able to lie flat on their back and raise their left arm up above their head in for 15-20 minutes while the cameras circulate and acquire images.
  3. The patient should be made aware that the test will be time-consuming (approximately 2½ to 3 hours).
  4. Imaging equipment will accommodate weights up to 350 pounds.
  5. Dobutamine is contraindicated in patients with:
     
      • deopathic hypertrophic subaortic stenosis
      • cute myocardial infarction

Low-Moderate Risk Cardiac Catheterization

Description:

    Provides images of the heart structures to identify blockages or narrowing present in the coronary arteries, measure intracardiac pressures, evaluate valve competency and heart muscle function.

Procedure:

    Long thin catheters are guided through an artery to the left heart where non-ionic contrast is injected to opacify the left ventricle.  Pressure measurements are taken in the various cardiac structures. The coronary arteries are then cannulated and injected with contrast while selective angiographic digital images are taken. Selective pressure measurements may also be taken on the right side of the heart with a Swan-Ganz catheter.

Patient Preparation:

  1. NPO after midnight – Medications with sip of water
  2. ECG if none done in last 2 weeks
  3. CBC, Chem 7, PT/PTT if not available within last 30 days

Considerations:

  1. Patient should be able to lie flat on their back.
  2. Imaging table will accommodate weights up to 350 pounds.
  3. Patients with dye allergies pre-medicated with Benadryl & Prednisone.
  4. Diabetics taking insulin or oral hypoglycemic medications will be given special instructions by the doctor.
  5. Patient should have someone to drive them home and stay with them the night after the test.

Low-Moderate risk peripheral vascular angiography

Description:

    Dye is injected into the arteries under local anesthetic and x-rays are taken. The x-rays reveal the arteries and the presence of any narrowing or blockages.   

Procedure:

    Long thin catheters are guided through an artery to the aorta where non-ionic contrast is injected to opacify different arteries throughout the vasculature. Selective angiographic digital images are taken. Selective pressure measurements may also be taken.

Patient Preparation:

  1. NPO after midnight – Medications with sip of water
  2. ECG if none done in last 2 weeks
  3. CBC, Chem 7, PT/PTT if not available within last 30 days

Considerations:

  1. Patient should be able to lie flat on their back.
  2. Imaging table will accommodate weights up to 350 pounds.
  3. Patients with dye allergies are pre-medicated with Benadryl and Prednisone.
  4. Diabetics taking insulin or oral hypoglycemic medications will be given special instructions by the doctor.
  5. Patient should have someone to drive them home and stay with them the night after the test. .

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