Diagnostic Procedures


An echocardiogram (echo) produces images of the heart by using sound waves. These images can help identify abnormalities of heart muscles or valves and fluid around the heart.

How it works

During an echo, harmless sound waves are bounced off your heart, then beamed back and converted to images on a screen. These images are used to see the structure and movement of the heart's valves and chambers. A Doppler echo may be used in the same way, bouncing sound waves off heart chambers and blood vessels to view blood flow patterns and valves.

Stress Testing

The stress EKG or stress test, conducted while you exercise on a treadmill or a stationary bicycle, measures your heart's health under the stress of physical activity. Your blood pressure and pulse are also monitored by a specially trained technician, an expert in using stress test equipment. The stress EKG aids in determining in how fit you are and how safe an exercise program is for you, or if a heart problem exists. The stress EKG provides even more specific information about how your heart and coronary arteries are functioning.

256 Slice Computed Tomography Angiography (CTA)

256 slice CTA is a state-of-the-art, non-invasive diagnostic tool that allows cardiologists to image the heart, blood vessels (coronary arteries) and other cardiac structures non-invasively.

The 256 slice CTA can produce three dimensional high quality diagnostic images of the heart and coronary circulation, and is more accurate than stress testing. At the time of the patient’s arrival in the CT suite, the patient will be fully assessed by a cardiac trained nurse (BLS/ACLS certified). The patient’s heart rate, blood pressure, ECG, and history will be reviewed. An intravenous line will be placed into the patient’s arm for fluids and medication. Patients are often given beta-blockers for a few days prior to the procedure to slow the heart rate; this allows better image quality. IV Contrast is used so be sure to tell your physician and nurse if you have an allergy to dye or contrast.

The examination takes only a few minutes, and the patient can leave immediately after. Test results are usually available within 24 hours. The procedure is very safe and accurate, and in many cases can replace traditional invasive coronary angiography.

A picture of a normal coronary artery imaged with CTA
A picture of a normal coronary artery imaged with CTA
An example of a patient with a blockage in a coronary artery diagnoses by CCTA
An example of a patient with a blockage in a coronary artery diagnoses by CCTA

Myocardial Perfusion Imaging (Nuclear Stress Test)

What is a nuclear stress test?

A nuclear stress test involves an injection of a small amount of radioactive material which circulates in the bloodstream and shows if your heart muscle is receiving adequate blood supply under stress and/or rest conditions.

How is the test performed?

The test usually consists of two stages, after exercising and under resting conditions.

As in a regular stress test, ECG electrodes will be attached to your chest. This will allow the physician to monitor your heart rate before, during and after you have exercised. A blood pressure cuff will be placed on your arm to monitor your blood pressure before, during and after you have exercise. Additionally, an IV line will be placed in your hand or arm vein. The IV will be removed when the exam is completed.

The exercise part of the exam is usually done with a treadmill. Exercising will begin slowly, and approximately every three minutes, the pace will gradually increase. As you exercise, your heart rate and blood pressure will change. This is normal and remember, you are being closely monitored throughout the exam.

Approximately fifteen minutes after the exercise is complete, pictures will be taken of your heart using a special camera able to trace the nuclear agent that has localized in your heart. You will be asked to lie down on a special table. The camera will rotate above and around your chest while special pictures are being taken, which will take approximately 20 to 30 minutes to complete. You may breathe normally while the pictures are being taken. It is very important that you hold very still while the camera takes pictures of your heart.

After 30 minutes or so, a second injection will be given. The resting pictures are taken in the same manner as the exercise pictures. The total time needed for the test may take from 2 to 3 hours.

What happens if you are unable to exercise?
Some people, due to a variety of disabilities, are unable to exercise adequately on a treadmill to achieve a diagnostic test result. In these cases, the physician may decide to use a drug to mimic the effect of exercise on the heart (pharmacologic stress).

Are there any special preparations for the study?

You should wear comfortable, loose-fitting clothing for exercise and comfortable shoes appropriate for walking.


The physician will instruct you not to eat or drink anything 4 hours prior to the scheduled test time. Also, you should not have caffeine 12 hours prior to the study. If you are diabetic or insulin-dependent, consult with the physician on such dietary restrictions and insulin use.


Consult with the physician regarding whether certain medications should be taken before, or held until after the test. Certain medications may interfere with the effectiveness of the study. If you have high blood pressure, it is important to take your blood pressure medication. Key points to remember:

  • There will be two parts of the exam.
  • You may receive an injection for both parts of the exam.
  • The radioactive material is ordered especially for you. If you are unable to keep your appointment for any reason, notify the office before the exam.
  • A written report of the test will be sent to your physician
  • If you are pregnant or suspect you may be, notify your doctor before taking the test.

Transesophageal Echocardiography

Transesophageal echocardiography (TEE) is a test that allows your doctor to record images of your heart from inside your esophagus. Since the esophagus lies just behind the heart, TEE may produce clearer pictures of the heart's movement than would standard echocardiography taken from outside the chest. During TEE, harmless sound waves bounce (echo) off your heart. These sound waves create images of your heart as it pumps blood through the valves and chambers. These images help your doctor identify and treat problems such as infection, disease, or defects in your heart's walls or valves.

How TEE Works

A flexible tube about the size of your index finger is inserted into your mouth and down your esophagus. At the tip of the tube is a small probe that produces sound waves. The sound waves bounce off your heart and are changed into pictures on a video screen. The doctor can move the probe up, down, and sideways to look at different parts of your heart from different angles. Your throat is numbed, so you should feel little or no discomfort during the procedure.

Before The TEE

Do not eat or drink 4-6 hours before your exam. Take any prescribed medications with a sip of water only. Arrange to have someone pick you up after the exam. Do not plan to drive yourself home, as you may be drowsy.

During The TEE

Your throat is sprayed with an anesthetic to numb it. You will be given a mild sedative through an IV line in your arm. You may also be given oxygen. Then you will be asked to lie on your left side. The doctor gently inserts the probe into your mouth. As you swallow, the tube is slowly guided into your esophagus. The tube is lubricated to make it slide easily.

How is the test performed?

You may feel the doctor moving the probe, but it should not be painful or interfere with your breathing. A nurse will monitor your heart rate, blood pressure, and breathing during the test, which usually takes approximately 20-40 minutes.