Echocardiogram Testing an Echocardiogram (Echo) Is a Graphic Outline of the Heart’S Movement

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Echocardiogram Testing An echocardiogram (echo) is a graphic outline of the heart’s movement. During an echo test, ultrasound (high- frequency sound waves) from a handheld probe placed on your chest creates “pictures” of the heart’s valves and chambers and helps the sonographer (technician) evaluate the pumping action of the heart. An echo test is often combined with Doppler ultrasound and color Doppler technology to evaluate blood flow across the heart’s valves.

Why is an echocardiogram performed? The test is used to: • 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.

Can I eat or drink on the day of the test? Yes. Eat and drink as you normally would on the day of the test.

Should I take my medications on the day of the test? Take all of your medications at the usual times, as prescribed by your doctor.

What should I wear on the day of the test? You may wear anything you like. You will change into a hospital gown before the test. Your chest will be exposed partially during the test. Please do not bring valuables. You will be given a locker to store your belongings during the test.

What happens during the test? • Before the test, the health care 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 Lab. The testing area is supervised by a physician. • You will be given a hospital gown to wear, and you’ll be asked to remove your clothing from the waist up. • A cardiac sonographer 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 during the test. • The sonographer will ask you to lie on your left side on an exam table. The sonographer will place a probe (called a sound-wave transducer) on several areas of your chest. The probe 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 will I feel during the test? You should feel no major discomfort during the test. You may feel a coolness on your skin from the gel on the transducer, and a slight pressure of the transducer on your chest.

How long does the test take? The test takes about 40 minutes. After the test, you may get dressed and go home or go to other scheduled appointments.

How do I get the results of my test? After a cardiologist has reviewed your test, the results will be entered into your electronic medical record or faxed to your physician. Your physician will have access to the results and will discuss them with you. Echocardiogram with Strain Imaging An echocardiogram (echo) is an ultrasound test that images the moving heart. A cardiac sonographer (technician) will move a hand-held device called a transducer over the chest area. High-frequency sound waves are sent to the heart and transmitted back to the ultrasound machine as live moving images. This technology provides your doctor with a comprehensive evaluation of the heart’s function and structure, including the chambers and valves.

Strain imaging evaluates the function of the heart muscle (myocardium) using cardiac ultrasound. This method is used to identify subtle changes in heart function.

Why is an echocardiogram with strain imaging performed? The test may be used to: • Screen and follow patients who receive cardio-toxic medications during cancer treatment • Evaluate patients who have received radiation to the chest • Evaluate and monitory patients with cardiomyopathy (i.e. hypertrophic, ischemic), heart failure (i.e. pre and post bi-ventricular pacemaker implant), pericardial disease

Can I eat or drink on the day of the test? Yes. Eat and drink as you normally would the day of the test.

Should I take my medications the day of the test? Take all of your medications at the usual times, as prescribed by your doctor.

What happens during the test? • Before the test, the health care 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 Lab. 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. • A cardiac sonographer 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 during the test. • The sonographer will ask you to lie on your left side on an exam table. The sonographer will place a probe (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 will I feel during the test? You should feel no major discomfort during the test. You may feel a coolness on your skin from the gel on the transducer and a slight pressure from the transducer on your chest.

How long does the test take? The appointment time is scheduled for one hour. After the test, you may get dressed and go home or go to your other scheduled appointments.

How do I get the results of my test? After a cardiologist has reviewed your test, the results will be entered into your electronic medical record. Your physician will have access to the results and will discuss them with you. Transesophageal Echocardiogram (TEE) A transesophageal echo (TEE) test is a type of echo that uses a long, thin tube (endoscope) to guide the ultrasound transducer down the esophagus (the “food pipe” that goes from the mouth to the stomach). This lets the doctor see pictures of the heart without the ribs or lungs getting in the way. A TEE is done when your doctor needs a closer look at your heart or is not able to get the information needed from a regular echo. A combination of a TEE, Doppler ultrasound, and color Doppler tests may be needed to get complete information about how blood flows through your heart’s valves.

Why is this test performed? The test is used to: • Check how well your heart’s valves and chambers are working. • Look for problems, such as valve disease, myocardial disease, pericardial disease, infective endocarditis, cardiac masses and congenital heart disease. • See how well your heart valves are working after surgery. • Check for abnormalities in the top left chamber of your heart (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.

Can I eat or drink on the day of the test? • DO NOT eat or drink anything for at least six hours before the test. Water is OK up to two hours before the test. • If you must take medication before the test, take it only with a small sip of water.

Should I take my medications the day of the test? Take all of your medications at the usual times, as prescribed by your doctor. If it is four 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 impaired judgment, making it unsafe for you to drive or operate machinery.

What should I wear on the day of the test? You may wear anything you like. You will change into a hospital gown before the test. Please do not bring valuables. You will be given a locker to store your belongings during the test. What happens during the test? • Before the test, the health care 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 Lab. The testing area is supervised by a physician. • You will be given a hospital gown to wear. • The sonographer 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 device called a pulse oximeter, will be placed on your finger to monitor the oxygen level of your blood. • You will be given a solution to gargle that will numb your throat. A nurse will spray 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 dental suction tip 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 will I 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 health care 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.

How long does the test take? 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.

Can I eat 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.

How do I get the results of my test? After a cardiologist has reviewed your test, the results will be entered into your electronic medical record. Your physician will have access to the results and will discuss them with you. Exercise Stress Echocardiogram Why is this test performed? The test is used to: • Determine how well your heart tolerates activity. • Evaluate the function of your heart and valves. • Determine your likelihood of having coronary artery disease. • Evaluate the effectiveness of your cardiac treatment plan.

Can I eat or drink on the day of the test? • Yes. However, DO NOT eat or drink anything except water for four hours before the test. • Avoid all products that contain caffeine for 24 hours before the test. In general, caffeine is found in coffee, tea, colas and other soft drinks, most chocolate products, as well as strawberries (these contain a small amount of caffeine), as caffeine will interfere with the results of the test. Also avoid decaffeinated or caffeine-free products for 24 hours before the test, as these product contain trace amounts of caffeine. • DO NOT SMOKE ON THE DAY OF THE TEST, as nicotine will interfere with the results of your test.

Should I take my medications the day of the 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. Ask your physician, pharmacist or nurse if you have questions about other medications that may contain caffeine.

DO NOT take the following heart medications on the day of your test unless your physician tells you otherwise or if it is needed to treat chest discomfort the day of the test: • Beta blockers [e.g., atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), Propranolol (Inderal)] • Isosorbide dinitrate (e.g., Dilatrate®, Isordil®, Sorbitrate®) • Isosorbide mononitrate (e.g., Ismo®, Imdur®, Monoket®) • Nitroglycerin (e.g., Minitran®, Nitropatches®, Nitrostat®) • 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. Often, your physician will tell you to take only half of your usual morning dose and to eat a light meal four hours before the test. If you take pills to control your blood sugar, do not take your medication until after the test is complete. Do not take your diabetes medication and skip a meal before the test.

If you own a glucose monitor, bring it with you to check your blood sugar levels before and after your test. If you think your blood sugar is low, tell the lab personnel immediately. Plan to eat and take your diabetes medication following your test.

What happens during the test? • Your test will take place in the Echo Lab. The testing area is supervised by a physician. • First, a cardiac sonographer will gently rub 10 small areas on your chest and 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. • Before you start exercising, the sonographer will perform a resting EKG, measure your resting heart rate and take your blood pressure. • The sonographer will ask you to lie on your left side on an exam table so he or she can perform a resting echocardiogram (also called an “echo”). An echocardiogram is a graphic outline of the heart’s movement created from ultrasound vibrations echoed from the heart’s structures. The sonographer will place a probe (called a transducer) on your chest to view an outline of the heart’s movement. • After the echo test, you will exercise on a treadmill or stationary cycle. The lab personnel 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 lab personnel 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 any other unusual symptoms. • The lab personnel will watch for any changes on the EKG monitor that suggest the test should be stopped. • When you cannot exercise any longer, you will get off the treadmill. • Quickly return to the exam table and lie on your left side so the sonographer can perform another echocardiogram. • If you were exercising on a bike, the sonographer may perform the echo test while you are still pedaling. You may be asked to quickly return to the exam table for another echocardiogram after exercising. • 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 are returning to normal.

How will I feel during the test? 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.

As you stop exercising suddenly, it is normal to feel a little unsteady when getting off the treadmill and onto the exam table for the echocardiogram. How long does the test take? The test will take about 60 minutes. The actual exercise time is usually between seven and 12 minutes.

Why is this test performed? The test is used to: • Determine your likelihood of having coronary artery disease • Identify abnormal heart rhythms • Evaluate the effectiveness of your cardiac treatment plan • Help you develop a safe exercise program

Can I eat or drink on the day of the test? The exercise stress test involves exercising on a treadmill while you are closely monitored. • Yes. However, DO NOT eat or drink anything except water for four hours before the test. • Avoid all products that contain caffeine for 24 hours before the test. In general, caffeine is found in coffee, tea, colas and other soft drinks, most chocolate products, as caffeine will interfere with the results of the test. Also avoid decaffeinated or caffeine-free products for 24 hours before the test, as these product contain trace amounts of caffeine. • DO NOT SMOKE ON THE DAY OF THE TEST, as nicotine will interfere with the results of your test.

Should I take my medications the day of the test? Since many over-the-counter medications contain caffeine (such as diet pills, No Doz®, Excedrin® and Anacin®), DO NOT take any over-the-counter medication that contains caffeine for 24 hours before the test. Ask your physician, pharmacist or nurse if you have questions about other medications that may contain caffeine.

DO NOT take the following heart medications on the day of your test unless your physician tells you otherwise or if it is needed to treat chest discomfort the day of the test: • Isosorbide dinitrate (for example: Dilatrate®, Isordil®) • Isosorbide mononitrate (for example: Imdur®, Ismo®, Monoket®) • Nitroglycerin (for example: Minitran®, Nitropatches®, Nitrostat®) • 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.

What should I wear on the day of the test? Please wear or bring comfortable clothes and shoes suitable for walking. Please do not bring valuables. You will be given a locker to store your belongings during the test. • Your test will take place in the Stress Lab. The testing area is supervised by a physician. • First, a stress lab technician will gently rub 10 small areas on your chest and 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. • Before you start exercising, the technician will perform a resting EKG, measure your resting heart rate and take your blood pressure. • You will exercise on a treadmill. The lab personnel 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 lab personnel 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 any other unusual symptoms. • The lab personnel 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 are returning to normal.

How will I feel during the test? 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.

How long does the test take? The test will take about 60 minutes. The actual exercise time is usually between seven and 12 minutes.

How do I get the results of my test? After a cardiologist has reviewed your test, the results will be entered into your electronic medical record or will be faxed to your physician. Your physician will have access to the results and will discuss them with you. Dobutamine Stress Echocardiogram The dobutamine stress echo test involves the injection of a medication called dobutamine while you are closely monitored. The medication stimulates your heart in a similar way as exercise. Important: If you have a pacemaker/defibrillator, it must be checked before your dobutamine stress echo test. Please call your doctor.

Why is this test performed? The test is used to evaluate your heart and valve function when you are unable to exercise on a treadmill or stationary cycle. The test is used to: • Determine how well your heart tolerates activity. • Determine your likelihood of having coronary artery disease. • Evaluate the effectiveness of your cardiac treatment plan.

Can I eat or drink on the day of the test? • Yes. However, DO NOT eat or drink anything except water for four hours before the test. • Avoid caffeinated products (cola, Mountain Dew®, chocolate products, coffee, and 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.

Should I take my medications before the test? DO NOT take these heart medications for 24 hours before the test, unless your physician tells you otherwise, or if it is needed to treat chest discomfort: • Beta blockers (e.g., atenolol (Tenormin®), carvedilol (Coreg®), metoprolol (Lopressor®, Toprol®), propranolol (Inderal®)) • Isosorbide dinitrate (e.g., Dilatrate®, Isordil®, Sorbitrate®) • Isosorbide mononitrate (e.g., Ismo®, Imdur®, Monoket®) • Nitroglycerin (e.g., Minitran®, Nitropatches®, Nitrostat®) • Your physician may also ask you to stop taking other heart medications on the day of your test. • Bring your medications with you the day of the 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. Ask your physician, pharmacist or nurse if you have questions about other medications that may contain caffeine. • If you have any questions about your medications, ask your physician.

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. Often, your physician will tell you to take only half of your usual morning dose and to eat a light meal four hours before the test. • If you take pills to control your blood sugar, do not take your medication until after the test is complete. • Do not take your diabetes medication and skip a meal before the test. • If you own a glucose monitor, bring it with you to check your blood sugar levels before and after your test. If you think your blood sugar is low, tell the lab personnel immediately. Plan to eat and take your diabetes medication following your test.

What should I wear on the day of the test? You may wear anything you like. Before the test, you will change into a hospital gown. Please do not bring valuables with you the day of the test. You will be given a locker to store your belongings during the test.

What happens during the test? • Your test will take place in the Echo Lab. The testing area is supervised by a physician. • First, a cardiac sonographer (technician) will gently rub 10 small areas on your chest and 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. • An intravenous line (IV) will be inserted into a vein in your arm, so the dobutamine medication can be delivered directly into your bloodstream. • The sonographer will perform a resting EKG, measure your resting heart rate and take your blood pressure. • The sonographer will ask you to lie on your left side on an exam table so he or she can perform a resting echocardiogram (also called an “echo”). An echocardiogram is a graphic outline of the heart’s movement created from ultrasound vibrations echoed from the heart’s structures. The sonographer will place a wand (called a transducer) on your chest to view an outline of the heart’s movement. Images will be taken periodically throughout the test. • The physician or nurse will administer the dobutamine medication into the IV while the technician continues to obtain echo images. • The medication will cause your heart to react as if you were exercising. Your heart rate will rise and you may feel it beating more strongly. It may cause a warm, flushed feeling, and in some cases, a mild headache. • At regular intervals, the lab personnel 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 any other unusual symptoms. • The lab personnel will watch for any changes on the EKG monitor that suggest the test should be stopped. • The IV will be removed from your arm once the test is completed. Your heart rate should return to normal in 5-10 minutes. How long does the test take? The test will take about one hour. The actual infusion time is usually about 15 minutes. You should plan to stay in the waiting room for at least 30 minutes after completing the procedure, or until all of the symptoms you experienced have resolved.