Preparing for a Heart Test, Study or Procedure
Facing a heart condition can be a difficult and sometimes frightening process. As you prepare for a heart test, study or procedure, Cedars-Sinai's doctors and nurses will work to provide you with compassionate care that aims to make you a partner in the healthcare process. The information below is designed to support you and help you prepare for a heart procedure.
Heart Tests and Studies
Cardiac catheterization involves threading a long, thin tube (a catheter) through an artery or vein in your leg or arm and into the heart. Once this has been done, various procedures may be conducted to diagnose or treat coronary artery disease. The catheter may be used to inject dye into the heart and its arteries to assess blood flow (angiography), or to conduct electrophysiological studies that evaluate the electrical conduction system of the heart and any abnormal heartbeats by sending electrical impulses through the catheter.
- Do not eat or drink anything for two hours before the test. If you have diabetes, discuss this with your doctor. Not eating can affect your blood sugar and adjustments may need to be made to your insulin dosage.
- Discuss any medicines you are taking with your doctor. He or she may want you to stop taking them before the test, especially if you are taking a blood-thinner such as Coumadin® (warfarin) or anti-platelet medicines such as aspirin or Plavix®. It is important to bring a list of your allergies, medicines and dosages to the procedure, so the healthcare team knows exactly what you are taking and how much.
- We will give you a hospital gown. You will not wear anything else during the procedure. Please take off all clothing (even underwear), jewelry and glasses. The nursing staff or your physician will tell you if you need to remove any dentures and/or hearing aids.
- We will ask you to sign consent forms for the procedure.
- We will prepare the catheter site (the area on your body where the catheter will go in).
- We may need to trim body hair and we will clean your skin with a special wash that kills germs.
- We will ask you to empty your bladder (pee) before you go to your procedure.
- When you are prepared and ready for your procedure, we will invite your family member or friend to come to the pre-op room. They can stay with you until it’s time for your procedure.
- When the procedure room is ready, we will take you to the Catheterization Lab (Cath Lab). Your family and friends will wait in the waiting room.
- If necessary, you may have blood tests and a chest X-ray prior to the procedure.
Before the procedure, you may have blood tests and a chest X-ray. In addition, a needle with a tube attached (an intravenous or IV line) will be inserted in your arm. This allows drugs to be given, if needed, during the test. It may also be used to give you a relaxing drug before and during your procedure.
The catheter will be inserted into a small area on one or both legs. This area will be clipped of hair and cleaned with an antiseptic solution to prevent infection.
Once you are in the Cardiovascular Intervention Center, you will see television monitors, heart monitors and blood pressure machines. You will be connected to an electrocardiogram to monitor your heart during the test.
You will be given an anesthetic shot to numb the area around where the catheter will be inserted. This may be mildly uncomfortable. Afterward, tubes will be inserted to gain access to the artery and/or vein. A catheter is gently threaded through the artery and, guided by X-rays, into your heart. There should be no pain.
If you only have a diagnostic heart catheterization, angiography or an electrophysiological study, you will most likely be able to go home the same day. If an intervention will also be done, it may be necessary that you stay overnight. Your doctor will let you know after the procedure.
- After the test, the catheters are removed.
- Firm pressure will be applied where the catheter was removed to stop any bleeding. In some cases, a device is used to seal the incision site to help stop the bleeding and to decrease the amount of time you will have to lie still to recover.
- For a few hours, you will need to rest in your room. You may feel sleepy until the sedative has worn off.
- It is important to try to lie still and not bend your knee too much for about 4 to 6 hours if the catheter was placed in the upper leg. You should keep your head relatively flat. Your doctor or nurse will discuss with you how long you need to lie flat. You don't need to keep your affected leg stiff—you can move your foot and arms and wiggle your toes.
- You must use the urinal or bedpan for elimination.
- If you have to sneeze or cough, press your fingers over the area where the catheter was inserted.
- The nursing team will continue to monitor your heart rate and blood pressure and regularly check the place where the catheter was inserted.
- After you have rested and are considered stable for discharge, you will be able to go home.
Caution—call the nurse immediately if you feel:
- Sudden pain at the site.
- Warm, sticky sensations or fluid or blood on the affected leg. Pressure will be reapplied for as long as needed to stop the bleeding.
Discharge Instructions (Same Day Discharge)
- You will not be permitted to drive for 24 hours after your procedure.
- Arrange for a responsible adult to drive you home after you are released from the hospital. Someone should be with you for 12 hours after going home.
- If bleeding occurs, lie down immediately and use your hand to apply firm pressure continuously over the insertion site until bleeding stops. Notify your doctor immediately.
- Do not lift any heavy objects or do any strenuous activities for two weeks following your procedure.
- You may resume your normal diet and previous drugs after your procedure, unless your doctor tells you otherwise.
- You may shower the next day. Apply a clean bandage (band-aid) to area until healed. Do not take a tub bath or submerge in water for one week.
An echocardiogram uses high frequency sound waves (ultrasound) to create a moving picture of your heart as it works. Depending the type of test you have, your doctor can learn about the size, shape and function of your heart muscle. An echocardiogram also shows how the heart valves are working and how blood flows through your heart, giving your doctor valuable information about the overall function of your heart.
The transthoracic echocardiogram (TTE) and the transesophageal echocardiogram (TEE) are two of the most common echocardiograms.
Transthoracic echocardiogram (TTE)
This is a simple, painless test that bounces harmless sound waves off the heart. These sound waves become images on a video screen. Your healthcare provider can then see a moving picture of your heart. This test shows how the valves work. It can confirm whether a valve is narrowed or leaking. It can also show the size of the chambers and whether your heart muscle pumps normally.
If you are having a TTE:
- Wear comfortable clothing. You will be asked to change into a patient gown and will be lying on an exam table.
- Your cardiologist may have other instructions for you depending on the type of echocardiogram you are going to have.
Transesophageal echocardiogram (TEE)
Similar to a TTE, this echocardiogram also uses sound waves bounced off the heart to create a moving picture of the heart and blood vessels. A long, flexible tube about the width of a little finger is inserted into the mouth, then into the esophagus. This probe has a tiny device at its tip called a transducer that sends and records the sound waves. These sound waves are converted into images on a television monitor and recorded. The images are sometimes clearer than those from a regular echocardiogram because they are taken from closer to the heart.
If you are having a TEE:
- Please do not eat or drink anything for 8 hours before the test. You may take your regularly scheduled medications during this time with a small sip of water only.
- Wear comfortable clothes and shoes.
- An IV will be inserted. You will be receiving sedation.
- Make sure your doctor is aware of all the medications you are taking before you arrive for the test.
- If you are not staying in the hospital after this test is done, you must arrive to the medical center with a responsible adult who can stay with you, wait in the waiting room and drive you home after the test. You are not allowed to drive for 24 hours after the test, and you are not allowed to take a taxi, Uber or bus home alone.
Nuclear studies use small amounts of a radioactive material injected into a vein to create images of how blood flows through your heart. The radioactive material does not harm your body or organs but allows doctors to see the size of your heart's chambers, how well your heart pumps blood and whether your heart has any muscle damage. Nuclear stress tests can also give doctors information about whether your arteries are narrowed or blocked from coronary artery disease. The images, created by a special camera and a computer, help your cardiologist decide whether more investigation is needed into the symptoms of heart disease as well has helping to diagnose and treat your condition. These studies may be done either while you are at Cedars-Sinai or as an outpatient.
Complications may occur in only one case out of every 1,000 to 2,000 tests done. These complications involve rare skin rashes, large fluctuations in blood pressure, irregular heart beats (arrhythmias) and difficulty breathing or asthma-like reactions. These, and any additional risks that may apply specifically to you, will be explained in advance by your doctor and the health care provider doing the test.
Technetium Pyrophosphate Scan
This scan uses the radioactive isotope Tc-99m pyrophosphate to evaluate whether an unusual type of abnormal heart muscle function (cardiomyopathy) is present. An intravenous injection of pyrophosphate is made at rest, followed about an hour later by a set of images taken while you lie down under a camera.
These images are recorded on a computer for analysis.
The images take about 15 minutes. The entire procedure, from injection to end of imaging, takes about two hours.
Thallium Scan
In this common type of scan, the radioactive isotope thallium is injected into your vein at rest and at the end of an exercise or pharmacologic stress test. Images are taken after each injection that show how the blood is flowing through your the arteries in your heart. If the arteries have blockages, there is not enough blood flowing through them during stress, resulting in an abnormality on the scan.
This test can also identify regions of damage or scarring of the heart muscle due to previous heart attack. scarring of the heart muscle due to blocked coronary arteries or a previous heart attack.
The S. Mark Taper Foundation Imaging Center has more information about thallium scans, including how to prepare and what to expect.
Sestambi Scan
Like the thallium scan, the sestamibi or tetrofosmin scan shows how well supplied with blood and your heart is. Sestamibi (Cardiolite) and tetrofosmin (Myoview) refer to the type of radioactive isotope (Tc-99m sestamibi or Tc-99m-tetrofosmin) used in this test to make the flow of blood visible. Thallium, sestamibi and tetrofosmin stress tests are more accurate and informative than a standard exercise stress test.
The S. Mark Taper Foundation Imaging Center has more information about the sestambi scan, what to expect and how to prepare.
Wall Motion Tests
This test generates a moving picture of your beating heart and allows your doctor to see how well your heart is pumping. As with other diagnostic tests, you will be connected to an electrocardiograph monitor so that your heart can be watched throughout the procedure.
A small needle will be put into your vein. You will then receive two injections.
The first sticks to your red blood cells for a short time. The second, given about 20 minutes later, is a radioactive substance. Without the first injection, the radioactive substance would not attach to the red blood cells, and it would not be possible to track the flow of blood through your heart's chambers.
After the second injection, you will lie on a special table under a camera for about 15 minutes, during which time images of your heart are obtained. Doctors will use these images to measure the pumping function of the heart (ejection fraction—the fraction of blood pumped out of the heart during each beat).
Depending on the type of wall motion study, additional briefer images in different positions may also be obtained.
- Do not eat or drink anything that has caffeine, including coffee, tea, decaffeinated products, chocolate, cocoa, soda or some over-the-counter pain relievers for 24 hours before the procedure. Caffeine is sometimes included in unexpected places, so it is wise to read the labels of anything you eat, drink or swallow for 24 hours before the test.
- The following drugs may be stopped before a stress test: beta-blockers (Inderal, Lopressor or metoprolol, Sectral, Tenormin or atenolol, coreg or carvedilol, Visken or Corgard®, etc.), calcium-channel blockers (Norvasc®, Calan®, Cardizem, Isoptin® or Procardia and nitrates (Isordil®, Imdur®, or Nitro-bid, etc.) Be sure to ask your doctor before stopping these drugs and follow his or her instructions. Other drugs may need to be discontinued before the test, such as asthma drugs. If you take insulin to control your blood sugar, discuss this with your doctor and find out how much insulin you should take the day of the test.
For nuclear studies that are combined with a stress test, the following should be observed:
- Nothing to eat or drink for four hours before the test.
- Wear good walking shoes, preferably ones with rubber soles.
If you are pregnant (or suspect that you might be), let your doctor or nurse know. These tests should not generally be done on pregnant patients.
Complications may occur in only one case out of every 1,000 to 2,000 tests done. These complications involve rare skin rashes, large fluctuations in blood pressure, irregular heart beats (arrhythmias) and difficulty breathing or asthma-like reactions. These, and any additional risks that may apply specifically to you, will be explained in advance by your doctor and the health care provider doing the test.
A stress test is an exam that shows how well your heart works during physical activity. The exam can be used to measure the blood flow to the heart, and to see any areas where the heart has been damaged (such as by a heart attack).
Cardiac Stress Test
This is the most common type of stress test performed. The non-invasive test is performed by asking the patient to walk on a treadmill or ride a stationary bike while their heart beat is monitored using an electrocardiogram.
During the Test:
- Small pads called electrodes will be placed on your upper body to record the electrical activity of your heart. Your heart rate, blood pressure, breathing rate and oxygen level will be monitored
- The test should last roughly 15-20 minutes. You will be asked to slowly start to exercise and gradually increase the speed of the treadmill or the resistance on the stationary bike, until you reach your target heart rate
- Various measurements and reading will be taken throughout the test. During the stress test, it is important to let the doctor or nurse know if you have unusual feelings in your chest, arms, neck or jaw, lightheadedness or dizziness, heart palpitations (the feeling that your heart is beating too fast), or shortness of breath.
- After the test, you will rest until your heart rate and blood pressure return to normal levels. You will get dressed and the nurse will take you back into the waiting room.
- You should be able to return to normal activity after the test.
Learn more about how to prepare and what to expect during a stress test
Exercise Stress Echocardiograms
A stress echocardiogram compares the performance of your heart at rest to the performance of your heart during exercise. The test involves an echocardiogram (ultrasound), an electrocardiogram (EKG) and a stationary bike attached to a bed. The bike allows you to pedal while lying flat on the bed, and it allows the sonographer to conduct the echocardiogram while you exercise.
This 90-minute test is used to measure your symptoms, the changing of your heart function during peak stress and your blood-pressure response to exercise. It is also used to monitor for cardiac arrhythmias (abnormal heart beats).
During the Test:
- Small pads called electrodes will be placed on your upper body to record the electrical activity of your heart. Your heart rate, blood pressure, breathing rate and oxygen level will be monitored.
- The sonographer will acquire a resting transthoracic echocardiogram prior to exercise to measure your heart at rest.
- An intravenous line will be placed in your arm in case any medications are needed during the test or in event of an emergency.
- The physician will instruct you about how much pedaling you will need to do, and the sonographer will take more images during your exercise.
- During the stress test, it is important to let the doctor or nurse know if you have unusual feelings in your chest, arms, neck or jaw, lightheadedness or dizziness, heart palpitations (the feeling that your heart is beating too fast), or shortness of breath.
- After the test, you will rest until your heart rate and blood pressure return to normal levels. You will get dressed and the nurse will take you back into the waiting room.
Dobutamine Stress Echocardiogram
This test is used if you are unable to exercise or your doctor wants to measure your heart’s response to this medication. This procedure is very similar to that of exercise stress echocardiogram, except a medication called dobutamine is administered through an intravenous line and mimics the effects of exercise on the heart by increasing the heart rate and contractility (pumping mechanism).
A coronary calcium scan (CCS) is a noninvasive exam which looks for specks of calcium (called calcifications) in the walls of the coronary arteries. The coronary arteries are the vessels that supply oxygen-containing blood to the heart wall. Calcium is an early sign of coronary artery disease. The calcium score gives an idea of whether coronary artery disease is present despite a lack of symptoms or is likely to develop in the next few years.
A coronary calcium scan is simple and easy for the patient, who lies quietly in the scanner machine. There is no injection. The test involves two breath holds and takes only about five minutes. To measure how much calcium has accumulated in the coronary arteries, we use a state-of-the-art 128-slice dual-source CT scanner which is many times faster than a conventional CT scanner.
- Before, during and after a coronary calcium scan
- Why choose the S. Mark Taper Foundation Imaging Center for a CT study?
- The SHAPE Program—dedicated to heart attack prevention
A tilt-table study is used to check for changes in heart rate and blood pressure when your body's position is changed.
This test is most commonly done for patients with syncope, a condition where a person has periods of losing consciousness or nearly fainting.
- Wear comfortable clothing or your hospital gown.
- Do not eat or drink anything for at least 6 hours before the test. If you have diabetes, be sure to ask your doctor about this. Not eating can affect your blood sugar levels.
- Check with your doctor about all of the medicines that you normally take. You may continue to take your heart drugs. However, your doctor may request that you stop taking certain drugs.
Heart Procedures
Interventional coronary procedures are used to open narrowed arteries in your heart to help improve blood flow and reduce symptoms, without the use of surgery. The procedures can be completed at the time of diagnostics testing or may require the patient to schedule a separate appointment. Similar to cardiac catheterization, a tube is threaded through either the femoral or radial artery to access the coronary arteries.
Common interventional coronary procedures performed include:
- Implanting a stent
- Angioplasties
- Atherectomy
- Brachytherapy
- Valve repair or replacement
Though the procedure is not surgical in nature, proper precautions after the procedure are important.
Bed rest is needed after the procedure. Depending on the procedure access point, you may need to lie still for up to 4 hours before getting up. The most important thing to remember is not to bend the leg on the side of the puncture site if the upper leg site was used for the procedure.
- You must use the urinal or bedpan for elimination until the doctor allows you to get up.
- If you sneeze or cough, press your fingers over the groin area.
- The nurse will check your vital signs and the insertion site frequently.
The procedure may be performed from the arm at the wrist or elbow, your doctor will decide the best approach. If the arm is used, then limited activity of the arm is necessary for 4-6 hours.
When a person has atrial fibrillation, he or she has a greater risk of developing blood clots. This happens because the heart isn't able to completely pump the blood out of the upper chambers of the heart.
Your doctor will probably recommend that you take drugs to keep your blood from clotting before you have a cardioversion procedure. This is done to avoid having a blood clot that can become dislodged once the heart starts beating normally again.
Between 75-93% of people who have atrial fibrillation and who undergo cardioversion are successfully returned to a normal heart rhythm. (The difference in the success rate is due to factors such as how long the individual has had atrial fibrillation and the size of his or her left atrium.) If a person has had atrial fibrillation for less than one year, there is about a 90% rate of success in bringing the heart back to a normal rhythm after cardioversion. On the other hand, if a person has had atrial fibrillation for more than five years, the success rate drops to about 50%.
A person who is going to have cardioversion is usually given an antiarrhythmic drug 24 to 48 hours before the procedure. This helps bring the heart back to a normal rhythm for the critical first few hours after cardioversion. During this time, a recurrence of the atrial fibrillation is most likely. Taking the antiarrhythmic drug may even help restore a normal heart rhythm without cardioversion. If not, the drug may mean that less energy has to be used during cardioversion.
If You Have a Pacemaker or Implanted Defibrillator or Cardioverter
Cardioversion can damage the device that generates the electrical pulse, the leads that come from the device, or the tissue of the heart itself. All of these things can cause the pacemaker not to work correctly. Your doctor will take special precautions to lower the risk of damage. These include being careful to place the electrode paddle on the patient's back at least six inches away from the pacemaker's battery. After a cardioversion, the doctor will evaluate the pacemaker to be sure it still works normally.
Complications from Cardioversion
As with any procedure, complications sometimes follow external cardioversion. These can include:
- Reduced blood flow from the heart (low blood pressure).
- Fluid inside the pericardium, the membrane that covers the heart inside the chest (pericardial effusion).
- Setting off other irregular heart rhythms or disturbing the heart's ability to conduct the electrical impulses that make it beat.
Get Help or Make an Appointment
Call or send a message to the Heart team. You can also have us call you back at your convenience.