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Angina Testing Overview:

What to Expect on Your First Visit:

First office visits typically last 45-60 minutes.  Your doctor will review your intake form with you and gather a detailed medical history.  A partial physical exam is usually performed and medical records are often requested from your primary care physician and/or other doctors.  Specialty laboratory testing may be recommended.  Most clients are offered an initial protocol consisting of nutritional supplementation, dietary and life style recommendations.

First Visit: Blood Test:

To assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.

Patients are required to fast for 14 hours before the test. Water may be drunk freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up to 8pm the previous evening. On the day of the appointment, any prescribed medication should be taken with water as normal.

Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the clinic, and separate arrangements will be made.

First Visit: Urine Analysis:

To establish exactly how the kidneys are functioning. Patients are required to collect urine over a period of 24 hours. This should be as near the date of the blood test as possible, but must not include the 14 hours fasting period prior to the appointment.

A recommended timetable is that the first urine of the day should be excluded, than all subsequent urine for the next 24 hours collected in clean plastic containers. (If collection starts at 8am, this process must be followed until 8am the following day.) Eg. Appointment 10am Friday, fasting commences Thursday 8pm. Urine collection starts Wednesday 8am. until Thursday 8am.

Containers should be clearly labeled with the patient’s names and brought to the clinic at the time of their appointment.

First Visit: Resting ECG for Doctors Report

The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse.

The doctor in charge reports any findings in his medical notes.

Specific Angina Testing:

Angina is a common symptom of heart disease. It is most often described as an unpleasant feeling or discomfort, like a tightness or weight on the chest. It usually only lasts a few minutes and can be relieved by rest and/or medication. With proper treatment, patients may have angina for years without serious complications.

A. Exercise Stress Test/ Stress Echocardiogram

What is an Exercise Stress Test?

An exercise electrocardiography is a procedure that screens your heart’s responses to physical exertion and need for oxygen. This test is a useful tool for determining the appropriate degree of exercise or physical activity for a person. During this procedure, the electrical heart activity, heart rate, heart rhythm and blood pressure are observed and recorded by an electrocardiograph while walking on a treadmill or while pedaling on a stationary bike. Electrocardiograph electrodes will be attached to the skin during the test.

Indications and Contraindications

An Exercise Electrocardiogram 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 (blocked arteries); and
• Evaluate the effectiveness of your cardiac treatment plan.

Exercise electrocardiograph also evaluates the cardiovascular abnormalities of athletes in competitive sports. This test is done to evaluate undiagnosed conditions, physical fitness, ventilation, gas exchange and cardiovascular function.

The Exercise Electrocardiograph is contraindicated to patients who have the following conditions:

• Unstable angina
• Arrhythmias
• Aortic valve stenosis
• Impaired lung and motor function
• Myocardial infarction
• Congestive heart failure
• Anemia
• Patients who are recently taking Viagra

How do you prepare for an Exercise Stress Test?

Do not eat or drink anything except water for 4 hours before the test. Also avoid smoking for 4 hours  before the exercise stress test. Do not drink or eat caffeine products (cola, Mountain Dew, chocolate products, coffee or tea) for 24 hours before the test.

Notify the physician of any medications as you might be asked to discontinue them before testing. 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 the medication is needed to treat chest discomfort:

• Beta blockers [for example: atenolol (Tenormin), metoprolol (Lopressor, Toprol), Propranolol (Inderal)]
• Isosorbide dinitrate (for example: Isordil, Sorbitrate)
• Isosorbide mononitrate (for example: Ismo, Indur, Monoket)
• Nitroglycerine (for example: Deponit, Nitrostat, Nitropatches)

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.

Wear comfortable clothes. Bring shoes suitable for walking. Do not bring valuables. You will be given a locker to store your belongings during the test.

How does it feel? How long will it take?

You will be encouraged to exercise until you are exhausted. It is normal for your heart rate, blood pressure, breathing and perspiration to increase. This information will allow your physician to assess your heart's ability to function.

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.

If you begin to notice chest discomfort, excessive shortness of breath, lightheadedness, irregular heart beats or other symptoms of concern, tell the stress lab personnel immediately

The appointment will take about 60 minutes. The actual exercise time is usually between 7 and 12 minutes. You might feel a tingling sensation while the electrodes are being attached to your skin. The blood pressure cuff that will be put on your arm may feel tight at times when your blood pressure is being recorded.

Expected effects after the test:

The Exercise Electrocardiograph is relatively safe with very minimal after-effects. It is very rare to experience mild chest pain and discomfort, dizziness, and shortness of breath.

Special instructions after the test:

Patient must lie in supine position after the test in order to rest. You may be able to do your normal activities after the test. However, avoid taking a hot shower for one hour after the test to avoid dizziness and fainting.

Interpretation of Results:

After the cardiologist reviews your test, the results will go into your electronic medical record. Your physician will have access to the results and will discuss them with you.

Normal findings: Patient is able to reach and maintain a maximal heart rate of 80% of target heart rate for a specific age and gender. Absence of cardiac symptoms and electrocardiograph changes. No arrhythmias, ABGs or hemodynamic pressures.

Abnormal findings: Unsteady blood pressure, presence of heart murmurs, irregular heartbeats and abnormal electrocardiogram tracings.

Notes:

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 4 hours before the test.

If you take pills to control your blood sugar, do not take your medication until after the test is complete.

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

Exercise electrocardiograph works by increasing the heart rate to an appropriate target heart rate, depending on the age and gender of the patient. Chemical stress testing is recommended to patients who are unable to exercise.

In order to properly diagnose cardiovascular disease, complete physical examination, electrocardiogram results, medical history and symptoms of heart disease must all be evaluated

B. Doppler Echocardiography/ Doppler Ultrasound

What is the Doppler Echocardiograph/Doppler Ultrasound?

A special type of ultrasound scan, called a Doppler ultrasound, is used to detect the speed and direction of blood flow in certain regions of the body by using sound waves flowing through the blood vessels. This test is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through your heart and blood vessels

Indications and Contraindications

A Doppler ultrasound may help in diagnosing many conditions such as:

• Blood clots and narrowed or blocked blood vessels
• Blocked or narrowing artery
• Leg pain
• Evaluation of stroke
• Congenital heart disease
• Arterial plaque build up (coronary artery disease symptoms, e.g. angina)
• Abnormal veins
• Monitor blood flow on liver and kidney transplants and blood vessel surgeries

A Doppler ultrasound may not be performed on postoperative patients with wound dressings.

How do you prepare for a Doppler Echocardiograph?

An ultrasound scan doesn't require any special preparation beforehand. It may be necessary for you to avoid nicotine products for at least one hour before the test to prevent result inaccuracies. Items that may interfere during the ultrasound, such as jewelries and other metallic objects, must be removed before the test.

How does it feel? How long will it take?

An ultrasound scan usually takes around 15 to 20 minutes. This test is non-invasive, therefore it is painless. You will not feel anything at all, except for the cold feeling of the gel as soon as it is applied to your skin. You will feel very little to none discomfort during the test.

Expected effects after the test:

The ultrasound scan is a safe, non-invasive procedure that doesn't pose any known risks, side effects or complications

Special instructions after the test:

After the procedure, you will be given paper towels (or something similar) to wipe off the gel. You can then get dressed. The scan itself is painless, drug-free and non-invasive, so there is no 'recovery time' needed. You can go about your normal business as soon as you've finished the scan.

Interpretation of Results:

Normal Findings:

• No findings of blood clots in the veins.
• No findings of narrowing and blockage of arteries
• Absence of abnormal growth
• Normal position, size and movement of the veins

Abnormal Findings:

• Blockage and narrowing of arteries and blood vessels
• Presence of blood clots
• Aneurysm
• Abnormal veins
• Abnormal blood flow
• Coronary artery diseases (e.g. atherosclerosis)

Notes:

A lubricant is used for good transmission of sound waves to and from the body.

Other names for ultrasound scan include sonogram and ultrasonography.

This test requires you to remain still. If you have problems staying still, it might necessary for you to be sedated. Avoid driving after the procedure if you will be receiving sedatives during the test. Have a responsible adult drive you home afterwards.

It is difficult to perform this procedure on an obese patient due to altering effects of the fatty tissues.

The Right Diagnosis and Treatment for Angina

Once the comprehensive review is completed for each patient, our doctors and our team of medical professionals will evaluate your diagnosis. At this point, our doctors will spend one on one time with you to interpret and explain your results. Together you will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and fits into your lifestyle.

Patients Medical’s  Personal Approach to Angina

Our doctors and our team at Patients Medical will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way.

We work in conjunction with your existing doctors. Any gaps between specialists are filled to ensure we support your overall health and well-being. While we treat serious medical conditions such as Alzheimer’s, Diabetes, Parkinson’s, Multiple Sclerosis, anxiety, depression, and heart disease; the primary objective of our staff is prevention and early detection of disease.

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, New York, NY 10017.