Cardiac Diagnostic Testing

Cardiac diagnostic testing is used to assess cardiovascular health and find heart disease.

Cardiac Diagnostic Testing

 Cardiac diagnostic testing is used to assess cardiovascular health and find heart disease.

Diagnosing a heart problem usually requires a combination of blood tests, heart monitoring, and imaging tests. Together these are known as cardiac diagnostic testing. At C-diagnostics we provide rapid access to many cardiac diagnostic tests including, electrocardiogram (ECG), Holter monitoring, 24-hour blood pressure monitoring, exercise tolerance test (ETT), 2-Day myocardial perfusion imaging (MPI), and echocardiograms. Click on each option below to learn more about these tests.

Simple Exercise Treadmill Stress Tests (ETTs/ESTs)

.The ETT, sometimes referred to as “a treadmill test” is a simple diagnostic test that helps doctors to evaluate known, suspected, or potential heart problems. It allows us to monitor your heart’s response to a standardized protocol of exercise and can help determine if further or more complex heart testing is needed to manage your health.

What Happens During this Test

This test involves a series of 3-minute exercise intervals performed on a treadmill. The speed and incline of the treadmill will rise at the beginning of each interval, gradually increasing the workload on your heart. In effect, you will need to “walk faster up a bigger hill” every three minutes. A technician will remain at your side throughout the test and a physician will be in direct visual contact with you throughout the entire procedure.

The technician will obtain a baseline pulse, blood pressure, and heart tracing (ECG); this will be closely monitored throughout the duration of your test. While you exercise, any changes to your ECG or vital signs will be carefully tracked and documented. You will exercise on the treadmill until you achieve your age-predicted target heart rate or until you exhibit symptoms such as tiredness, shortness of breath, or chest discomfort and indicate you can no longer continue.  The supervising physician may also elect to abort the test if they identify any reason(s) why it is not desirable or safe for you to continue.  The length of time you will spend exercising on the treadmill is dependent on many variables; on average, patients spend between 5-15 minutes exercising for this test.

You will meet with a Physician to review the results of this test immediately after your ETT; please allow one and a half hours for total appointment time.

How to Prepare for this Test

Medications → Some medications must be withheld prior to your test. Please carefully review Please refer to the Exercise Treadmill Stress Test Patient Handout and follow the directions if you are taking any of the medications listed.

Skin Preparation → Prior to starting the test, special stickers (called electrodes) will need to be affixed to your chest and abdomen to monitor your ECG. On the morning of your test, please do not apply any oils, powders, or lotions to your skin. If you have hair on your chest, each area required for electrode placement will be shaved. Should you wish to shave the areas yourself, please shave the areas as indicated by the dots on this Diagram. After the shave, skin will be cleaned with rubbing alcohol and abraded lightly with a very fine sandpaper strip.

Clothing → Wear comfortable clothes such as running shoes and shorts/jogging pants. Shirts should be short-sleeved and loose-fitting. Please note that we will require access to your sternum (middle chest) to properly obtain and monitor your ECG tracing; should you wish to wear a bra, you are welcome to do so, however, we ask that you wear one that minimizes the area of the chest covered by the bra’s material. Dresses, vests, suits, and corsets are not advised.

Diet → To ensure that your test is successful and to avoid gastric discomfort, be sure to eat a light meal only before your test. For example, if your test is in the morning, have toast and fruit for breakfast; if your test is in the afternoon, have a sandwich for lunch.

Exercise Myocardial Perfusion Imaging (MPI) - The Sestamibi Test

An exercise MPI test, also called a nuclear stress test or a sestamibi cardiac scan (MIBI), is a radioactive imaging study used to compare blood flow to the heart muscle during minimal activity (the ‘resting state’) with blood flow to the heart muscle after a period of exercise (the ‘stressed state’). There are 2 phases of this study – the Stress Test and the Rest Test. You will be given 2 appointment times as each test must be completed on a different day, though they can be done in either order.

For the Stress Test, your heart will be ‘stressed’ as you exercise on a treadmill. As part of the procedure, you will be given a radioactive injection so that images of your heart can be taken with a medical imaging camera. During your Rest Test, you will receive the same injection, however, there will be no need to exercise on the treadmill; then, similar images of your heart will be taken with the same camera used during your Stress Test. Together, both sets of images allow the radiologist to compare the blood flow in your heart during different levels of activity. This can give your doctor a strong sense of whether you have any blocked arteries or heart disease.

What Happens During the Stress Test

Before the Stress Test begins, your medications and any symptoms will be reviewed with a member of staff. A trained professional will then use a needle to start intravenous (IV) access in your arm or hand; a plastic cannula will be left in your vein for the duration of your test.

The IV is required for this test as it will be used to give your body the radioactive injection that makes it easier to see your heart scan. This isotope is called Technetium-99m, also known as CardioLite. Once your IV is in place, a member of staff will accompany you to the treadmill lab where you will begin your test.

Staff will begin by obtaining a baseline blood pressure and ECG; you will then begin to exercise on the treadmill following a predetermined exercise protocol where the workload on your heart will gradually increase. The Cardiolite will be injected into your vein through the IV when you reach your age-predicted target heart rate.

After the treadmill, you will rest for 15-30 minutes to allow the isotope to be fully absorbed by your heart muscle; you will then be sent for your scan which takes roughly 10-15 minutes. The total test time is approximately 2 hours.

For additional information about why the radioactive injection is used, please click here

For additional information about completing your test with C-health, please click here

How to Prepare for the Stress Test

It is recommended that you wear sports attire such as running shoes, a loose fitting shirt with no metal or buttons, and shorts or jogging pants to your stress appointment. Braziers with or without an underwire are permitted on the treadmill, however, all bras must be removed prior to camera imaging. Dresses, vests, suits, and corsets are not advised.

Do NOT eat or drink for 2 hours before the stress test (this includes: water, candy, gum, and medication(s)).

For accurate test results, some medications such as beta blockers and certain calcium channel blockers must be stopped prior to testing. Please refer to the Cardiac Medication Adjustment for Myocardial Perfusion Imaging patient handout and follow the directions if you are taking any of the medications listed.

Some diabetes medications should NOT be taken on the morning of the test while others may need to be adjusted. Patients with diabetes will be given early morning appointments to minimize disruptions to diabetes management. If you have diabetes, please refer to the C-health information sheet titled: Diabetes Medication Adjustment for Myocardial Perfusion Testing for guidance on how to adjust your medication(s) appropriately for your test.

If you are unsure whether these medication changes apply to you, or if you have questions about this process, please contact your C-health physician before altering your medication regimen.

What Happens During the Rest Test

No exercise is required for this part of the test. A small amount of the Cardiolite will be injected into a vein on your arm or hand. There are no major side effects to this material. Some people get a metallic taste in their mouths following administration. You will wait 1 hour while the injection circulates through your body. Then you will have another set of images of the heart taken; this scan takes about 25 minutes. The total test time is roughly 1 hour and 30 minutes, however, you should plan on 2 hours from arrival to the end of the appointment.

For the resting images of your heart, you will be given another injection of a small amount of Cardiolite. There are no major side effects to this material. Some people get a metallic taste in their mouths following administration. The Cardiolite tracer will accumulate in your heart muscle over the next hour. After an hour has passed, an image will be taken of your heart. This scan takes about 25 minutes. The total test time is 1 hour and 30 minutes but plan on 2 hours from arrival to the end of the appointment.

How to Prepare for the Rest Test

Please wear a loose-fitting t-shirt with no metal or buttons. Do NOT eat or drink for 4 hours before the rest test (this includes: water, medication(s), candy, and gum).

All cardiac medications should be taken as normal with a small SIP of water before the fasting period begins.

Some diabetes medications should NOT be taken on the morning of the test while others may need to be adjusted. Patients with diabetes will be given early morning appointments to minimize disruptions to diabetes management. If you have diabetes, please refer to the C-health information sheet titled: Diabetes Medication Adjustment for Myocardial Perfusion Testing for guidance on how to adjust your medication(s) appropriately for your test.

If you are unsure whether these medication changes apply to you, or if you have questions about this process, please contact your C-health physician before altering your medication regimen.

NON-Exercise Myocardial Perfusion Imaging (MPI) - The Dipyridamole Test

A non-exercise MPI test, also called a pharmaceutical nuclear stress test or a dipyridamole stress test (DIPY), is a radioactive imaging study used to compare blood flow to the heart muscle during minimal activity (the ‘resting state’) with blood flow to the heart muscle after a period of stress (the ‘stressed state’).

Unlike with an exercise MPI, the dipyridamole stress test shows how your heart responds to increased stress when it is not possible or ideal for you to walk on a treadmill. In some cases, your doctor may request this test because your mobility concerns make using a treadmill unsafe or impractical (ex: if you typically walk with a cane or walker). Other times, this test is requested because the pattern on your ECG makes it difficult to accurately assess the heart during exercise.

There are 2 phases of this study – the Stress Test and the Rest Test. You will be given 2 appointment times as each test must be completed on a different day, though they can be done in either order. At your Stress Test, your heart will be ‘stressed’ with medication rather than by physical exercise. As part of the procedure, you will be given a radioactive injection so images of your heart can be obtained with a special camera.

During your Rest Test, you will receive the same injection, however, there will be no other medication administered; then, similar images of your heart will be taken with the same camera used during your Stress Test. Together, both sets of images allow the radiologist to compare the blood flow in your heart during different levels of stress and demand. This can give your doctor a strong sense of whether you have any blocked arteries or heart disease.

How to Prepare for this Test

Please do not take any of the following medications on the morning of your test:

  • All Beta Blockers and certain Calcium Channel Blockers
  • Atenolol (Tenormin, Tenoretic)
  • Diltiazem (Cardizem)
  • Metoprolol (Lopressor)
  • Verapamil (Isoptin, Chronovera)
  • Acebutolol (Sectral)
  • Monocor (Bisoprolol)
  • Nadolol (Corgard)
  • Timolol (Blocadren)
  • Propranolol (Inderal)
  • Labetalol (Normodyne)
  • Sotolol (Sotacor)
  • Pindolol (Visken)

On the morning of your stress test please do not have any caffeine to eat or drink, and do not apply any oils, powders, or lotions to your skin.

What Happens During the Stress Test

Before the Stress Test begins, your medications and any symptoms will be reviewed with a member of staff and intravenous (IV) access will be started in your arm or hand. The IV is required as it will allow your care team to inject three agents during the test:

  1. Dipyridamole (the medication used to induce stress)
  2. Technetium-99m (the radioactive injection, also known as CardioLite, that makes it easier to see your heart scan)
  3. Aminophylline (the reversal agent for dipyridamole)

After you have an IV, a staff member will accompany you to the treadmill lab. There, you will meet the supervising physician who will review the test protocol with you and answer any questions you may have. One staff member will obtain and monitor your blood pressure and ECG throughout the test. A nurse or paramedic will be present to administer the dipyridamole and Aminophylline to you while a nuclear radiology technician will administer the radioactive injection. Emergency equipment and trained personnel are available to deal with any unusual situations that may arise and the physician will be present in the room throughout the entire procedure.

After all three agents are administered, you will be asked to rest for 15-30 minutes before your heart scan to allow the isotope to be fully absorbed by your heart muscle. You will then be sent for your scan which takes roughly 10-15 minutes; the total test time is approximately 2 hours. Most patients are able to continue about their day as normal after this test.

For additional information about why the radioactive injection is used, please click here

How to Prepare for the Stress Test

It is recommended that you wear a loose fitting shirt with no metal or buttons, and shorts or jogging pants to your appointment. Braziers (with or without an underwire) are permitted, however, all bras must be removed prior to camera imaging. and shorts or jogging pants to your stress appointment. Dresses, vests, suits, and corsets are not advised.

This test will not be successful if you have any caffeine in your system at the time of your appointment. As such, we ask that you do NOT drink any caffeinated or decaffeinated drinks for 36 hours before the test! In addition, do NOT eat or drink for 2 hours before the test (this includes water, medication(s), candy, and gum). 

For accurate test results, some medications such as beta blockers and certain calcium channel blockers must be stopped prior to testing. Please refer to the Cardiac Medication Adjustment for Myocardial Perfusion Imaging patient handout and follow the directions if you are taking any of the medications listed.

Some diabetes medications should NOT be taken on the morning of the test while others may need to be adjusted. Patients with diabetes will be given early morning appointments for the rest and stress studies to minimize disruptions to diabetes management. If you have diabetes, please refer to the C-health information sheet titled: Diabetes Medication Adjustment for Myocardial Perfusion Testing for guidance on how to adjust your medication(s) appropriately for your test.

If you are unsure whether these medication changes apply to you, or if you have questions about this process, please contact your C-health physician before altering your medication regimen.

What Happens During the Rest Test

A small amount of the Cardiolite will be injected into a vein on your arm or hand, however no other agents will be given on this day. There are no major side effects to this material. Some people get a metallic taste in their mouths following administration. You will wait 1 hour while the injection circulates through your body. Then you will have another set of images of the heart taken; this scan takes about 25 minutes. The total test time is roughly 1 hour and 30 minutes, however, you should plan on 2 hours from arrival to the end of the appointment.

How to Prepare for the Rest Stress Test

Please wear a loose-fitting t-shirt with no metal or buttons. Do NOT eat or drink for 4 hours before the rest test (this includes: water, medication(s), candy, and gum).

All cardiac medications should be taken as normal with a small SIP of water before the fasting period begins.

Some diabetes medications should NOT be taken on the morning of the test while others may need to be adjusted. Patients with diabetes will be given early morning appointments to minimize disruptions to diabetes management. If you have diabetes, please refer to the C-health information sheet titled: Diabetes Medication Adjustment for Myocardial Perfusion Testing for guidance on how to adjust your medication(s) appropriately for your test.

If you are unsure whether these medication changes apply to you, or if you have questions about this process, please contact your C-health physician before altering your medication regimen.

Exercise Stress Tests

The treadmill stress test is used to assess the response of the heart muscle to increased physical activity in a controlled setting. This test helps evaluate known, suspected or potential heart problems. The results of this test will also be used to determine your proper exercise prescription if you are to be enrolled in an exercise program. It involves monitoring your heart’s response to a standardized protocol of exercise.

How to Prepare for this Test

Please do not take any of the following medications on the morning of your test:

  • All Beta Blockers and certain Calcium Channel Blockers
  • Atenolol (Tenormin, Tenoretic)
  • Diltiazem (Cardizem)
  • Metoprolol (Lopressor)
  • Verapamil (Isoptin, Chronovera)
  • Acebutolol (Sectral)
  • Monocor (Bisoprolol)
  • Nadolol (Corgard)
  • Timolol (Blocadren)
  • Propranolol (Inderal)
  • Labetalol (Normodyne)
  • Sotolol (Sotacor)
  • Pindolol (Visken)

Wear comfortable clothes for exercise including running shoes or soft-soled walking shoes, shorts, or jogging pants. Men will exercise without a shirt; women, please wear a short-sleeved button closing loose top or baggy T-shirt, and a bra without an underwire. Bring a towel to wipe yourself down with after the test.

On the morning of your treadmill stress test please do not apply any oils, powders, or lotions to your skin.

On the day of your test, eat a light meal before coming to the clinic for your treadmill session.

What Happens During this Test

This test will be performed on a treadmill. Self-adhesive electrodes will be attached on your chest prior to beginning the test. While exercising, the workload on your heart will gradually increase. The speed and incline of the treadmill will be increased at three-minute intervals. In effect, you “walk faster up a bigger hill”.

During the procedure, your pulse, blood pressure and heart tracing will be carefully monitored until you achieve your age-predicted target heart rate or until you exhibit symptoms such as tiredness, shortness of breath or chest discomfort and indicate you can no longer continue. The exercise technician will remain at your side and the physician will be present in the room, or in direct visual contact with you, throughout the procedure.

Emergency equipment and trained personnel are available to deal with any unusual situations that may arise.

Carotid Ultrasound

A Carotid Ultrasound sometimes referred to as a Carotid Doppler, is a painless procedure that measures the amount and ease of blood flow in the arteries that send blood from the heart up into the brain. This test involves placing a probe, called a transducer, on your neck to help identify if there are any limitations to blood flow. Blockages in the neck can be a risk for stroke, but may also cause other symptoms such as fainting.

This test is administered by North West Cardio Diagnostics (NWCD), located onsite within C-diagnostics.

To learn more about Carotid Artery Disease, click here

To learn more about the Carotid Ultrasound test, click here

Cardiopulmonary Diagnostic Services 

At C-diagnostics we are committed to providing access to full pulmonary function testing to provide comprehensive care to Albertans. 

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