Testing
At Reno Heart Physicians, our skills are specialized to meet your heart care needs. We offer several specialties and services that provide up-to-date cardiovascular care for all of our patients.
For your convenience, we can perform in-office procedures such as stress echos, echocardiograms, persantine or thallium treadmills, electrocardiograms and EECPs.
To read information about a specific test, click on it below.
Cardiac Positron Emission Tomography (PET) - NEW!
Exercise Myocardial Perfusion Scan
Persantine Myocardial Perfusion Scan (Thallium Study)
Enhanced External Counterpulsation (EECP)
Cardiac Positron Emission Tomography (PET)
A cardiac Positron Emission Tomography (PET) is used to evaluate the health of your heart by assessing the blood flow that it receives. PET scans of the heart can determine if heart muscle thought to be dead is just damaged or if it has improved in function. Through PET imaging, a physician is able to determine the presence of coronary artery disease more efficiently than other screening tests. The results of your study can assist the physician in making decisions about how best to manage your symptoms and/or risk factors.
An intravenous line (IV) is placed into a vein to allow administration of medication during the exam. You will be asked to lie on a scanning table while a small amount of a radiopharmaceutical will be given through your IV line that will allow the PET camera to take pictures of your heart during a resting phase and stress phase. The stress phase is performed with a pharmaceutical that makes your heart respond as if you were exercising. The test is usually completed in an hour. After your test is completed one of the nuclear certified cardiologists from Reno Heart Physicians will interpret the results. Results will be forwarded to your cardiologist or primary care physician.
Electrocardiogram
An electrocardiogram (EKG) measures your heart’s electrical activity. It can also reveal any rhythm abnormalities. An EKG can also provide general information about heart size and/or areas of the heart that are not receiving enough blood supply.
Electrodes (small sticky patches) and wires will be attached to your chest and shoulders (and, occasionally, limbs) to record your EKG. The electrical activity is measured and printed out for one of our Reno Heart physicians to interpret. The test takes approximately 5-10 minutes.
Exercise Treadmill Test
This test is done to evaluate the heart’s response to stress or exercise, using a treadmill. A resting EKG is first obtained. Then, under the supervision of our specially trained staff, the patient exercises on a treadmill, using a well-established protocol, until a certain maximum heart rate is obtained. Typically, every three minutes, the exercise intensity is increased, to make the heart work harder. Most people exercise for about 5-12 minutes. The patient’s heart rhythm, rate and blood pressure are monitored throughout the test. When the test is completed, the patient rests while heart rate and blood pressure are still being monitored. After the test is completed, one of the cardiologists from Reno Heart Physicians will interpret the results. Results will be forwarded to your cardiologist and primary care provider.
Total test time, including check-in, preparation and procedure is about 45 minutes to 1 hour.
Preparation for this test:
Do not eat or drink for 4 hours prior to your appointment. You must not have any caffeine for 24 hours prior to your test. (This includes decaffeinated coffee and tea.) Please note that caffeine is found in many products including iced tea, soft drinks, chocolate and some aspirin products.All medication may be taken, except for beta blockers. Beta blockers should not be taken for 24 hours prior to your appointment, unless you are taking a beta blocker for the treatment of atrial fibrillation, in which case you should continue taking this medication as you normally would. Please check with your physician about the advisability of being off your beta blocker medication.
Beta blockers include:
| Brand Name | Generic Name |
| Brevibloc | Esmolol Hydrochloride |
| Coreg | Carvedilol |
| Corgard | Nadolol |
| Inderal | Propranolol HCI |
| Kerlone | Betaxolol |
| Levatol | Penbutolol Sulfate |
| Lopressor | Metoprolol Tratrate |
| Normydyne / Trandate | Labetalol HCI |
| Sectral | Acebutolol Hydrochloride |
| Tenormin | Atenolol |
| Toprol XL | Metoprolol Succinate |
Please wear comfortable walking shoes and two piece, loose-fitting clothing without metal buttons or decorations. Women, please do not wear underwire bras
Echocardiogram
This test determines how well your heart pumps blood, as well as how well your valves are functioning.
An ultrasound technician, using a special probe and ultrasound gel, will take pictures of your heart. During an echocardiogram, a transducer (a small microphone-like device) is held against your chest. The transducer is able to "broadcast" high frequency sound waves into your chest cavity. These sound waves bounce off of your heart and the echoes are picked up on the echocardiogram machine, which makes pictures based on the sound waves. The image is displayed on a television screen, and it can be recorded on videotape or printed on paper. Test time is approximately 30-45 minutes.
Stress Echocardiogram
What is a Stress Echocardiogram?
A stress echocardiogram is a test that combines an ultrasound study of the heart with an exercise test. This test allows your doctor to learn how the heart functions when it is made to work harder.
The stress echocardiogram is especially useful in diagnosing coronary artery disease, the presence of blockages in the coronary arteries (the vessels that supply oxygen-rich blood to the heart).
How does it work?
During an echocardiogram, a transducer (a small microphone-like device) is held against your chest. The transducer is able to "broadcast" high frequency sound waves into your chest cavity. These sound waves bounce off of your heart and the echoes are picked up on the echocardiogram machine, which makes pictures based on the sound waves. The image is displayed on a television screen, and it can be recorded on videotape or printed on paper.
An echocardiogram is first done at rest, then during or immediately after an exercise test.
Your doctor then compares the images. Normally, all areas of the heart muscle pump more vigorously during exercise. If an area of the heart muscle does not pump as it should during exercise, this often indicates that it is not receiving enough blood because of a blocked or narrowed artery.
The exercise echocardiogram shows your doctor which areas of the heart muscle do not receive an adequate blood supply. However, it does not provide images of the actual coronary arteries. If your doctor suspects blocked or narrowed arteries, he or she may recommend additional tests.
Preparing for the Test
Do not eat or drink for three hours prior to the test. This will prevent the possibility of nausea, which may accompany vigorous exercise after eating. (If you are diabetic and take medications for diabetes, get special instructions from your doctor.)
If you are currently taking any heart medications, check with your doctor. He or she may ask you to stop certain medications a day or two before the test. This can help get more accurate test results.
Wear loose, comfortable clothing that is suitable for exercise. Men usually don’t wear a shirt during the test, and women generally wear a lightweight blouse or a hospital gown. You should also wear comfortable walking shoes or sneakers.
Before the test, you’ll be given an explanation of the test and you’ll be asked to sign a consent form. Feel free to ask any questions about the procedure.
What happens during the test?
The stress echocardiogram will be performed in the Reno Heart Physicians office.
The test is divided into three parts: First a resting echocardiogram is performed. Next, you walk on a treadmill, then another echocardiogram is performed while your heart is still beating rapidly.
Resting Echocardiogram
Several electrodes (small sticky patches) will be placed on your chest to obtain an electrocardiogram (ECG), a recording of your heart’s electrical activity. A blood pressure cuff will be applied to your arm.
You will be asked to lie on an examination table. To improve the quality of the pictures, a colorless gel is applied to the area of the chest where the transducer will be placed.
Our technician will move the transducer to various places over the left side of your chest. Pictures of your heart at rest are recorded on videotape.
Exercise Test
In this portion, you will walk on a treadmill. The treadmill moves slowly at first, then the speed and incline increase gradually.
You will be instructed to report any symptoms, such as chest pain, shortness of breath, leg fatigue, or dizziness. The doctor may end the test when you reach your peak heart rate, when you get too tired, or when you experience significant symptoms.
After-Exercise Echocardiogram
You will be helped back to the examination table. Our technician will record a second set of images immediately after you finish exercising.
Your doctor can then compare the two sets of images (before and after exercise) side by side to see how your heart responds to the stress of exercise.
How long does it take?
You should allow one and a half to two hours which includes preparation for the test, the exercise portion, and the imaging portion.
Is the Stress Echocardiogram safe?
The echocardiogram is very safe. The ultrasound waves are harmless and painless.
A small amount of risk does exist with the exercise test, because it stresses the heart. Possible rare complications include abnormal heart rhythms and a heart attack. Experienced personnel are available to handle any emergency.
Myocardial Perfusion Scan
This test, which looks for evidence of coronary artery disease, is similar to a routine treadmill test, although much more informative. An intravenous line (IV) is placed into a vein, followed by a small injection of a liquid tracer. Resting images of your heart are then obtained. Following this, you will complete a standard treadmill test under the supervision of one of our specially trained staff. Near completion of this test, a second tracer is given and comparison (e.g. a second set) images are obtained. Total time for this test is about 3 hours. After the test is completed, one of the nuclear certified cardiologists from Reno Heart Physicians will interpret the results. Results will be forwarded to your cardiologist and primary care provider.
Preparation for this test:
Do not eat or drink anything (including water) for 4 hours prior to your appointment. Small sips of water to take your medication are fine. You must not have any caffeine for 24 hours prior to your test. (This includes decaffeinated coffee and tea.) Please also note that caffeine is found in many products including iced tea, soft drinks, chocolate and some aspirin products. All medication may be taken, except for beta blockers. Beta blockers should not be taken for 24 hours prior to your appointment, unless you are taking a beta blocker for the treatment of atrial fibrillation, in which case you should continue taking this medication as you normally would. Please check with your physician about the advisability of being off your beta blocker medication.Beta blockers include:
| Brand Name | Generic Name |
| Brevibloc | Esmolol Hydrochloride |
| Coreg | Carvedilol |
| Corgard | Nadolol |
| Inderal | Propranolol HCI |
| Kerlone | Betaxolol |
| Levatol | Penbutolol Sulfate |
| Lopressor | Metoprolol Tratrate |
| Normydyne / Trandate | Labetalol HCI |
| Sectral | Acebutolol Hydrochloride |
| Tenormin | Atenolol |
| Toprol XL | Metoprolol Succinate |
Please wear comfortable walking shoes and two piece, loose-fitting clothing without metal buttons or decorations. Women, please do not wear underwire bras.
Note:
Medication for your test is ordered specifically for you. It cannot be used for others. Reno Heart Physicians requires 24 hours notice to cancel or reschedule this test. Failure to do so may result in being billed for the unused medication.
Pharmacologic Myocardial Perfusion Scan
This test also looks for evidence of coronary artery disease. An intravenous line (IV) is placed into a vein, followed by a small injection of a liquid tracer. Resting images of your heart are then obtained. Next, one of our specially trained staff will administer a medication called a coronary vasodilator through the vein. This medication takes the place of vigorous exercise to elevate your heart rate. A second tracer is then injected into the IV, and comparison images of your heart are obtained. Total time for this test is about 3-4 hours. After the test is completed, one of the nuclear certified cardiologists from Reno Heart Physicians will interpret the results. Results will be forwarded to your cardiologist and your primary care provider.
Preparation for this test:
Do not eat or drink anything (including water) for 4 hours prior to your appointment. Small sips of water to take your medication are fine. You must not have any caffeine for 24 hours prior to your test. (This includes decaffeinated coffee and tea.) Please also note that caffeine is found in many products including iced tea, soft drinks, chocolate and some aspirin products.Do not take any medications containing theophylline, including:
| Respid | Slo-Bid GyroCaps | Slo-Phyllin Gyrocaps |
| SustaireG | Theo-24 | Theo-Dur |
| Theo-Dur Sprinkle | Theobid Duracaps | Theochron |
| Theo-lair | Theolair-24 | Theophylline SR |
| Theospan Jr. Duracaps | Theospan-SR | Theovent Long Acting |
| Uniphyl | Acrolante | Bronkodyle |
| Constant T | Elixophyllin | Quibron-T/SF |
| Theox | Trental | Aminophylline |
Please wear comfortable walking shoes and two piece, loose-fitting clothing without metal buttons or decorations. Women, please do not wear underwire bras.
Note:
Medication for your test is ordered specifically for you. It cannot be used for others. Reno Heart Physicians requires 24 hours notice to cancel or reschedule this test. Failure to do so may result in being billed for the unused medication.
Holter Monitor / King of Hearts
This test determines the presence and severity of any heart rhythm abnormalities, especially those related to palpitations, dizziness or fainting. A technician will place EKG wires, which are attached to a small recorder, on your chest. You will be asked to wear this for 24 hours or sometimes longer. You will also be asked to keep a diary, to record any symptoms you may have while wearing the monitor. Your monitor will then be analyzed and correlated, along with any symptoms listed in your diary. A copy of this report will be forwarded to your cardiologist, as well as your primary care provider.
PADnet
PADnet tests for peripheral artery disease (PAD). The most common sympton of PAD is claudication (pain or discomfort in your legs while walking, which is relieved by rest). The test is performed in our office by a certified technician and takes about 45 minutes. Blood pressure cuffs will be placed on the arms, above the knees, and below the knees, ankles, and big toes on both sides. Your blood pressure will be taken on both arms, both ankles, and both toes. Additionally, the volume of blood traveling through your arteries is measured at all areas on your legs. The test is then given to a physician who will then interpret the results. If the report comes back abnormal, you will be set up with one of our trained vascular physicians who may order additional diagnostic testing. The test is completely painless.
Preparation for the test:
When coming in for this test, bring a short-sleeved shirt and a pair of shorts so that the technician will have access to your arms and legs. If you are a tobacco user, do not use any tobacco for 1 hour prior to the test. You can take all your normal medications.
EECP® Therapy: A Low-Risk Treatment for Angina
A low-risk treatment for angina, EECP® Therapy gently but firmly compresses the vasculature of the legs to increase blood flow to the heart, ultimately reducing or eliminating chest pain.
Usually triggered by physical exertion or emotional stress, angina occurs when the heart muscle needs more oxygen than is available from the blood supply nourishing the heart. This usually happens because narrowed or blocked arteries are restricting the flow of blood.
Invasive procedures, such as bypass surgery and balloon angioplasty, typically are recommended as treatment. A noninvasive option is now available. For suitable candidates, EECP® Therapy can relieve angina without surgery and hospitalization or the associated pain and recovery time.
During treatment, patients lie on a padded table in which sets of electronically controlled inflation and deflation valves are located. These valves are connected to specially designed adjustable cuffs that are wrapped firmly, but comfortably, around the patient's calves, lower thighs, and upper thighs, including the buttocks. The cuffs are inflated sequentially and rapidly from the calves toward the upper thighs while the heart is in its resting phase, and deflated just before the heart beats. The result is an increased supply of blood to the heart muscle and a reduction in the heart's workload.
Studies indicate that EECP® Therapy facilitates blood flow to the heart muscle in spite of blocked arteries. When EECP® Therapy increases blood flow to the heart, it is believed to open and expand networks of small blood vessels within the heart called collaterals. These channels can create "natural bypasses" around clogged arteries, boosting blood supply to oxygen-deprived areas of the heart. The permanent opening of these channels may account for the long-lasting benefits of EECP® Therapy, demonstrated in three follow-up studies of patients who had received EECP® Therapy. Most of the patients studied could not have been treated effectively with medication, angioplasty or bypass surgery.
Active Again
EECP® usually can reduce or eliminate the frequency and intensity of chest pain and remove the need for angina medication. People who have received EECP® Therapy report an overall improvement in the quality of their lives. After treatment, patients are usually able to enjoy everyday activities, which frequently include moderate exercise, walking, gardening and traveling.
If you would like more information regarding this treatment, call us at (775) 323-6700 and ask for Sandy in our EECP® Therapy center.
Hospital Procedures
Ablation
Ablation is a procedure that involves inserting catheters into a blood vessel, often through a site in the groin or neck, and winding the wire up into the heart. The journey from entry point to heart muscle is navigated by images created by a fluoroscope, an x-ray-like machine that provides continuous, “live” images of the catheter and tissue.
Once the catheter reaches the heart, electrodes at the tip of the catheter gather data and a variety of electrical measurements are made. The data pinpoints the location of the faulty electrical site. During this “electrical mapping,” the cardiac arrhythmia specialist, an electrophysiologist, may sedate the patient and instigate some of the very arrhythmias that are the crux of the problem. The events are safe, given the range of experts and resources close at hand, and are necessary to ensure the precise location of the problematic tissue.
Once the damaged site is confirmed, energy is used to destroy a small amount of tissue, ending the disturbance of electrical flow through the heart and restoring a healthy heart rhythm. This energy may take the form of radiofrequency energy, which cauterizes the tissue, or intense cold, which freezes, or cryoablates the tissue.
Our Reno Heart physicians are all highly trained in these procedures, and have performed thousands of these procedures safely. Although ablation procedures are safe and performed thousands of times a year across our country, complications can and do occur.Cardioversion
Cardioversion is a procedure in which to restore your heart’s normal rhythm. It can be either chemical (with medications) or electrical (with electricity). Chemical cardioversion is done with prescription medications. If this does not work, electrical cardioversion may be necessary.
Electrical cardioversion is done in a hospital setting, under brief anesthesia. Special pads are placed on your chest and back. You are also hooked up to an EKG machine with electrodes, to monitor your heart rhythm throughout the procedure. An intravenous line (IV) is started in which medications are delivered, to sedate you. After you are sedated, one of our Reno Heart physicians gives your heart a brief electrical shock. This shock briefly stops all electrical activity, including any irregular beats. Regular, normal heart beat rhythm then takes over. You will then be monitored for a few hours to make sure your heart maintains normal rhythm.
While this procedure is successful in many patients, occasionally in some patients, it takes more than one procedure to restore normal rhythm. There are also some patients where this procedure does not restore normal rhythm.
Cardiac Catheterization/Coronary Angiogram
A cardiac catheterization (also called a coronary angiogram) is a procedure to examine the arteries that supply blood to the heart. This procedure is done at one of the local hospitals. First, the skin over one of your arteries, either in the groin, your wrist or your arm, is numbed with local anesthetic. After the area is numbed, a small needle is inserted into the artery and access is gained into your arterial system. A small plastic catheter is then inserted into the artery and advanced under x-ray guidance to your heart. X-ray pictures are then taken of the arteries that supply blood to your heart, and of your main pumping chamber.
If your doctor determines that one or more of your arteries are significantly blocked with plaque, a coronary intervention (balloon angioplasty, stent and/or atherectomy) will be performed to open the artery, and increase blood flow to your heart muscle. This procedure is performed by placing a small balloon across the narrowing in the artery, and inflating the balloon to open the artery. Often, a stent, which is a small metal device is used to hold the artery open, is placed at that same time as well. Other devices to open the artery are occasionally used as needed by the physician.
Our Reno Heart physicians are all highly trained in these procedures, and have performed thousands of these procedures safely. Although coronary angiography and intervention procedures are safe and performed thousands of times a year across our country, complications can and do occur. The more critically ill the patient is at the time of the catheterization, the higher the risk becomes.
Pacemaker/ICD Implantation
A pacemaker is implanted to regulate heart rate and rhythm. An ICD (or implanted cardioverter defibrillator) is implanted in patients at risk for life-threatening arrhythmias. Implanted defibrillators monitor the heart rhythm and automatically treat, with electrical stimuli or shocks, rhythms recognized as abnormal.
Pacemaker and ICD implantation today are minimally invasive procedures. The procedure is done under local anesthesia, and generally takes about 1-2 hours. After the area under the patient's collarbone is numbed, a small incision is made (usually about 3 inches long,) and a “pocket” is fashioned in the tissue overlying the muscle. The leads are inserted through a vein near the site of the pocket, and advanced into the heart using fluoroscopy (x-rays) for guidance. The leads are then attached to the generator, the generator is placed in the pocket, and the incision is closed. For a short time after the implant, the electrode at the end of the lead will actually "grow into" the wall of the ventricle - this won't interfere with heart function. You won't sense any of this because the inside wall of the heart is not sensitive to pain.
Our Reno Heart physicians are all highly trained in these procedures, and have performed thousands of these procedures safely. Although device implantation procedures are safe and performed thousands of times a year across our country, complications can and do occur. The more critically ill the patient is at the time of the procedure, the higher the risk becomes.
Peripheral Angiography/Stent Placement
A peripheral angiogram is a procedure to examine the arteries that supply blood in the extremities. This procedure is done at one of the local hospitals. First, the skin over one of your arteries, either in the groin, your wrist or your arm, is numbed with local anesthetic. After the area is numbed, a small needle is inserted into the artery and access is gained into your arterial system. A small plastic catheter is then inserted into the artery and advanced under x-ray guidance to the particular area of concern. X-ray pictures are then taken of those arteries.
If your doctor determines that one or more of your arteries are significantly blocked with plaque, a coronary intervention (balloon angioplasty, stent and/or atherectomy) will be performed to open the artery, and increase blood flow. This procedure is performed by placing a small balloon across the narrowing in the artery, and inflating the balloon to open the artery. Often, a stent, which is a small metal device is used to hold the artery open, is placed at that same time as well. Other devices to open the artery are occasionally used as needed by the physician.
Our Reno Heart physicians are all highly trained in these procedures, and have all done hundreds of these procedures safely. Although peripheral angiography and intervention procedures are safe and performed thousands of times a year across our country, complications can and do occur. The more critically ill the patient is at the time of the catheterization, the higher the risk becomes.