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Tests and procedures

  • Angiograms

    An angiogram—also called heart catheterization, cardiac catheterization or cardiac angiography—is a common test used to evaluate your heart muscles, valves and coronary arteries. It can give your doctor exact information about the way your heart functions.

    During an angiogram, a cardiologist (a heart doctor) will insert a catheter (a thin, flexible tube) into an artery in your leg or arm. He or she will then thread smaller catheters through it into your blood vessels to reach your coronary arteries. This part of the procedure is called heart or cardiac catheterization.

    Once catheters are located in your coronary arteries, a small amount of dye is injected into the catheter. The dye makes your coronary arteries visible on a monitor. The cardiologist can then look for narrowed or blocked arteries in your heart. The image of your arteries is called an angiography.

    You'll be awake during an angiogram. You may feel a warm, flushed feeling when the dye is injected.

    Ask your cardiologist when you will hear the results of the test.

    Possible treatments following an angiogram

    If an angiogram shows a narrowed or blocked heart artery, your cardiologist may recommend angioplasty and/or a stent.

    • Angioplasty is a procedure to help open up your blood vessels to improve the blood flow to your heart.
    • A stent is a device inserted into an artery to hold it open.
  • Source: Allina Health's Patient Education Department
    Reviewed by: Allina Health's Patient Education Department experts
    First published: 06/01/2007
    Last reviewed: 09/01/2010

  • Transesophageal echocardiogram

    A transesophageal echocardiogram (TEE) records ultrasound images of your heart.

    The transducer, about the size of a normal piece of food, is mounted on the end of a flexible tube, about the size of your index finger. The tube is placed in your mouth and guided down your esophagus (swallowing tube).

    You will be given medicine to help numb the back of your throat. This will make swallowing the tube easier.

    The TEE gives excellent pictures of your heart because the heart is next to your esophagus.

    The procedure will take 1½ to 2 hours.

    Before the procedure

    Take these steps to get ready for a transesophageal echocardiogram (TEE).

    • If you have diabetes, talk with your doctor about taking your medicine. Follow any special instructions.
    • Do not eat or drink anything eight hours before your procedure.
      • You may take your regular medicine(s) with a small sip of water.
      • If you are not staying in the hospital overnight, plan to have a responsible adult drive you home and stay with you for eight hours after the test.
      • You will sign a consent form.

      During the procedure

      Here is what to expect during a transesophageal echocardiogram (TEE).

      • In the exam room, you will be asked to undress to your waist. You will receive a hospital gown to wear.
      • If you wear dentures, you will be asked to remove them.
      • Electrocardiogram (ECG or EKG) patches will be put on your chest to monitor your heartbeat.
      • A blood pressure cuff will be put on your arm to monitor your blood pressure.
      • A probe will be put on a finger to monitor the amount of oxygen in your blood.
      • An intravenous (IV) line will be inserted in your hand or arm for fluids or medicines.
      • You will be awake during the test, but you will be given medicine to make you more comfortable and relaxed.
      • Your throat will be sprayed with a numbing medicine. This medicine will stop your gag reflex.
      • You will be asked to lie on your left side during this test while the doctor inserts the flexible tube. A bite block may be placed in your mouth to rest against your teeth.
      • The tip of the tube produces sound waves. The sound waves bounce off your heart and are changed into pictures on a screen.
      • The cardiologist will move the tube into place and take pictures of your heart and blood flow for 15 minutes. You may feel the tube move. It should not cause you pain or breathing problems.

      Bubble study

      A bubble study may be done during the TEE.

      A saline (salt water) solution is injected into an arm vein. Ultrasound tracks the solution as it flows through your heart.

      This is a painless test.

      After the procedure

      After a transesophageal echocardiogram (TEE), you can expect the following:

      • Your heart, blood pressure and oxygen levels will be monitored for about 30 minutes after the tube is removed.
      • Once you are awake and are alert, you will be sent back to your room or be able to go home. Have someone drive you home.
      • Do not eat or drink anything for two hours after your test.
      • Do not eat hot food or drink for six hours after the procedure.
      • Do not drink alcohol for 24 hours after the procedure.
      • Do not drive for 24 hours after the procedure.
      • You may have a dry, scratchy throat. You may drink lots of water and use cough drops to soothe your throat.
      • Your doctor will get the test results. He or she will either talk with you about the results or mail you the results.
    • Source: Allina Health's Patient Education Department, Transesophageal Echocardiogram, cvs-ahc-14178
      Reviewed by: Allina Health's Patient Education Department
      First published: 05/01/2009
      Last reviewed: 04/05/2017

    • Angioplasty

      Angioplasty—also called percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI)—is the method used to open a blood vessel to improve blood flow by stretching a vessel from the inside and sometimes placing a stent to help keep it open.

      • Percutaneous means that the procedure is done through the skin.
      • Transluminal means that it is done inside the artery.
      • Coronary means that it is an artery of the heart.

      Angioplasty helps more blood flow through your coronary arteries. If you have this procedure, here is what to expect:

      1. A cardiologist will use a catheter (a thin, flexible tube) with a tiny balloon at the tip. He or she will guide the catheter through a leg or arm artery.
      2. The tube is guided through the arteries of your body to the blocked heart artery.
      3. The balloon is slowly inflated many times.
      4. The inflated balloon squeezes the build-up of plaque against your artery wall and slightly stretches the vessel to improve blood flow.
      5. After the procedure, the balloon is removed from your body.

      In some cases a cardiologist may use a medical laser to remove blockage. This procedure is called laser angioplasty.

    • Source: Allina Health's Patient Education Department
      Reviewed by: Allina Health's Patient Education Department experts
      First published: 10/04/2002
      Last reviewed: 09/01/2010

    • Coronary stent

      During angioplasty, a cardiologist may insert a stent to help keep the coronary artery open.

      What is a coronary stent?

      A stent is a mesh tube made of stainless steel or metal alloy used to expand or open a narrowed section of your heart artery. It improves blood flow and relieves your symptoms.

      A balloon catheter is used to position the stent. You have the same feelings during the stent placement as when the balloon catheter was expanded.

      • The stent is placed on a balloon catheter (a tube-like device). The cardiologist (doctor specially trained in the study and treatment of heart and blood vessel disease) guides the catheter to the narrowed or closed artery.
      • When the catheter is in place, the cardiologist inflates the balloon. When the balloon is inflated, the stent expands into place into the artery and is left there. You may need more than one stent.
      • You will have X-ray images taken so the cardiologist can see the stent. He or she may need to make more inflations.
      • The cardiologist deflates the balloon catheter and removes it.
      • The stent stays in place to keep your artery open.

      It is important to carry your stent identification card with you.

    • Source: Allina Health's Patient Education Department, Coronary Stent, cvs-ahc-10049
      Reviewed by: Allina Health's Patient Education Department
      First published: 10/04/2002
      Last reviewed: 11/01/2007

    • Electrophysiology study (EPS)

      An electrophysiology study (EPS) is a detailed study of the heart's electrical system and is done to investigate an abnormal heart rhythm (arrhythmia).

      The heart's electrical system

      The heart has four chambers. Two upper chambers (atria) pump blood to the two lower chambers (ventricles). In order for the heart to pump, it requires an electrical impulse to start a heartbeat.

      Each heartbeat originates from the sinoatrial (SA) node—the heart's natural pacemaker—which is located in the upper right atrium. This impulse travels through the atria, signaling them to contract. The impulse is received by the atrioventricle (AV) node.

      The AV node acts as a relay center to delay the impulse before sending it from the atria to the ventricles. The impulse then spreads throughout the muscle of the ventricles, stimulating them to contract.

      Normally, impulses are generated from the sinus node at a rate of 60 to 100 beats per minute (bpm). That is called a normal sinus rhythm.

      Sometimes the heart will beat slower than 60 bpm (called bradycardia) or faster than 100 bpm (called tachycardia).

      Tachycardias that start in the upper chambers of the heart are called supraventricular tachycardia. Heartbeats that are too slow or too fast may cause fainting, fatigue, palpitations (fluttering in the chest), shortness of breath, chest pain or pressure.

      Before the study

      • Talk with your regular doctor about your medicine needs. Be sure to ask your doctor about your medicines if you have:
        • bleeding problems or if you take blood thinning medicines (such as warfarin)
        • diabetes [You may need to stop taking or adjust your regular dose of medicine for this test. Be sure to find out what dose(s) to take and when you can return to your usual medicine schedule.]
      • You may eat up to eight hours before your procedure.
        • Eat light meals, such as oatmeal or toast.
        • Avoid foods that are heavy or high in fat, such as meat or fried foods.
      • Do not use chewing tobacco six hours before your procedure.
      • You may have clear liquids up to two hours before your procedure.
        • Drink water, fruit juice without pulp, black coffee, tea, hard candies and gum.
        • Do not have milk, yogurt or alcohol.
      • The morning of the study, take the medicines your doctor has told you to take with a sip of water.
      • An intravenous (IV) line will be started to give fluids and medicines during your study. One or more blood tests, and EKG may be taken before the study.
      • The hair on your groin, neck, upper chest and back may be clipped. Your skin in those areas will be scrubbed.
      • After your questions have been answered, you will be asked to sign a consent form.
      • You will be taken to the Electrophysiology Lab on a transport cart.
      • Your family members will wait in the waiting area.

      During the study

      • After being positioned on the table in the Electrophysiology Lab, you will be connected to many monitors. You will also be gently secured to the table with soft restraints to help keep you safe.
      • The skin over the catheter sites will be prepped again. A sterile drape is placed over these sites.
      • You may be given a medicine to make you feel drowsy. The electrophysiologist will numb the skin over the catheter insertion sites. If you have any discomfort, tell the nurse.
      • Small hollow tubes will be placed through the skin and into veins in your groin, neck or both. The catheters are placed through the small hollow tubes and guided to your heart using X-ray. You won't feel the catheters advanced into your heart.
        A small catheter may be placed into the groin artery and will be used to monitor your blood pressure.
      • The electrophysiologist reviews the data and decides the right treatments for you. He or she will talk with you about all possible treatments. Options may include:
        • catheter ablation: This uses a special catheter to deliver high-frequency (hot) or freezing energy to destroy a portion(s) of heart tissue causing the arrhythmia.
        • a pacemaker: This permanent therapy may be required if your heart has a problem conducting impulses from the upper to lower chambers.
        • an implantable cardioverter defibrillator: This may be inserted if your heart has a life-threatening arrhythmia. It automatically monitors your heart and delivers a shock to restore the heart to a normal sinus rhythm.
      • At the end of the study the catheters and small hollow tubes will be removed. To prevent bleeding, pressure will be applied to the sites for about 10 to 30 minutes.
      • You will be brought back to your room or prepare to leave the hospital.

      After the study

      • You will need to stay in bed for two to five hours to keep the insertion sites from bleeding.
      • Keep your head flat while in bed.
      • Call your nurse if you feel warmth, pain or swelling at the catheter sites.
      • You will be able to eat and drink. At the end of the rest time you may get up and walk.
      • You may need to stay overnight at the hospital.
      • The IV line will be removed before you go home.

      When to call your doctor

      Call your doctor if you develop:

      • swelling
      • pain
      • drainage at the catheter sites
      • fever
    • heart cross section in color

      Parts of the heart that make a heartbeat.

    • Source: Allina Health's Patient Education Department, Electrophysiology Study (EPS), cvs-ah-11798
      Reviewed by: Allina Health's Patient Education Department
      First published: 10/04/2002
      Last reviewed: 04/01/2015

    • Pacemaker

      How your heart works

      Your heart beats (pumps blood) because special cells in your heart (the sinus node, your heart's natural pacemaker) produce electrical impulses. The impulses cause your heart to contract and pump blood. Your sinus node causes those impulses to travel down to the muscle walls of your heart, causing your heart to contract.

      Why your doctor wants you to have a pacemaker

      Sometimes, there may be an interference in the way the impulse travels. When this occurs, there may be problems that change your heart rhythm. They include either:

      • a heart beat that is slow
      • an irregular rhythm
      • a complete block of your heart's electrical impulse

      The pacemaker will make your heart beat regularly and give the cells in your body adequate oxygen and nutrition.

      Pacemaker

      A pacemaker helps your heart beat regularly and give your body the oxygen it needs.

      Before the procedure

      • You may eat up to eight hours before your procedure.
        • Eat light meals, such as oatmeal or toast.
        • Avoid foods that are heavy or high in fat, such as meat or fried foods.
      • Do not use chewing tobacco six hours before your procedure.
      • You may have clear liquids up to two hours before your procedure.
        • Drink water, fruit juice without pulp, black coffee, tea, hard candies and gum.
        • Do not have milk, yogurt or alcohol.
      • You may take some of your regular medicines with small sips of water. If you have diabetes, remind your doctor of your diet, medicine or insulin needs.
      • The area below your collarbone will be shaved, if needed.
      • A nurse will start an intravenous (IV) line in your arm.
      • The doctor may order certain blood tests be taken.
      • You will be asked to sign a consent form.

      During the procedure

      • You will receive an antibiotic (medicine) through your IV.
      • The doctor will numb the site with medicine.
      • The doctor will make an incision just below your collarbone for the pacemaker. The pacemaker and leads are attached. The leads are then positioned inside your heart.
      • The doctor will test the pacemaker to see if it is working properly.
      • The doctor will close the incision and put a dressing over it. 

      After the procedure

      • A chest X-ray and EKG will be done.
      • You will have your blood pressure, pulse and heart rhythm checked often.
      • A shoulder immobilizer may be placed on your procedure arm for 24 hours.
      • You will be on bedrest, as ordered by your doctor.
      • You may eat after you no longer need bedrest.
      • You will be given an informational booklet and an identification card before you leave the hospital.

      Care after a pacemaker implant

      After visit summary

      This is general information. Please see your After Visit Summary given to you by your provider for how to take care of yourself after surgery.

      Your health care team will work with you to understand any challenges you have after your hospital stay. This will help your team work toward a plan to make sure you have the right care and support to help manage your health after you leave the hospital.

      Your surgery

      You had a pacemaker placed in your chest to help your heart beat at a normal rate.

      What to expect after your surgery

      • A bruise and or nickel-sized lump around the incision site is normal. It may take two to three weeks for the bruising to go away.
      • Your skin may be discolored.
      • You may have mild discomfort.
      • Carry your device identification card in your wallet at all times and notify other health care providers that you have a pacemaker.

      Before the surgery

      • Tell your health care provider if you:
        • are pregnant
        • have a shellfish allergy
        • have a latex allergy
        • have diabetes
        • take a blood-thinner medicine
      • Remove any jewelry or piercings.
      • Arrange to have someone drive you home. You will not be able to drive after the surgery.

      Pain relief

      Take any prescription or over-the-counter medicine as directed.

      Activity

      • If you have an arm immobilizer, wear it as directed for the first 24 hours.
      • For your safety, you will need a responsible adult to drive you home and to stay with you for 24 hours.
      • For 24 hours:
        • Do not drive or use any machinery.
        • Do not make important decisions.
        • Do not drink alcohol.
      • You may take a shower 24 hours after the procedure. Use a mild soap.
      • For four weeks:
        • Do not reach or stretch your arm on your affected side.
        • Do not lift more than 10 pounds.
        • Do not take a tub bath, go swimming or use a hot tub.
      • Your health care provider will tell you when it’s OK for you to shower, drive, return to work, exercise and have sex.
      • Slowly return to your regular level of activity.
      • Rest as needed.
      • Avoid smoking.

      Incision care

      • Keep the wound site clean and dry for the first 24 hours.
      • Apply pressure slightly above wound site if you laugh, cough or sneeze for 24 hours.
      • If your incision site is covered with Aquacel® dressing:
        • You do not need to cover it.
        • Gently pat dry the dressing site after you take a shower or bathe. Do not rub or scrub the site.
        • Do not remove the dressing. It will be removed at your wound check appointment.
      • Follow any directions your health care provider gives you.

      Food and beverages

      • Eat well-balanced meals. Follow any instructions your health care provider gave you.
      • Avoid alcohol while you are taking prescription pain medicine.

      When to call your health care provider

      Call your health care provider if:

      • you have a temperature of 101 F or higher
      • you have new pain or pain you can't control
      • you feel you are getting worse
      • you have new or worsening shortness of breath or occurring when lying flat
      • you have a weight gain of three pounds in one day
      • you have a weight gain of five pounds in one week
      • you feel a tightening, pressure, squeezing or aching in your chest or arms
      • you feel chest discomfort with pacing
      • your heart rate is less than 50 beats per minute
      • your breathing rate is more than 30 breaths per minute
      • you have signs of infection at your incision site:
        • pain
        • swelling
        • redness
        • odor
        • warmth
        • green or yellow discharge
      • you are unable to get out of bed
      • you have nausea (upset stomach), bloating or vomiting (throwing up) that won't stop
      • you have any questions or concerns.

      Call 911 if you feel you are having a medical emergency.

      Follow-up appointment

      Please keep all follow-up appointments with your health care provider or specialist, even if you are feeling well.

    • Source: Allina Health's Patient Education Department, Permanent Pacemaker Insertion, cvs-ah-31235 (last reviewed 4/15) and Care after a Pacemaker Implant, cvs-ah-10024 (last reviewed 8/16)
      Reviewed by: Allina Health's Patient Education Department
      First published: 10/04/2002
      Last reviewed: 08/01/2016