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Non-Invasive Testing

Evaluating Your Heart Disease 

If you have chest pain, an irregular heartbeat, a history of heart disease, or valve disease, you may be referred to the New England Heart & Vascular Institute for an evaluation. The team in our Non-Invasive Cardiology department has extensive experience in the latest technologies to evaluate and diagnose heart disorders. This evaluation might include any of the testing described below.

The results of your evaluation can determine if you need additional testing, require a procedure or if your condition can be managed with medication. If you need a procedure, this imaging technology helps our interventional cardiologists and cardiovascular surgeons in planning the best approach. 

Diagnosis, Treatment and Technologies

electrocardiogram (EKG)

An EKG measures the electrical activity in the heart.  It can determine if a heart attack has happened, predict if one is about to happen, and monitor changes in your heart rhythm. An EKG is conducted by placing small electrode patches to the skin of your chest, arms and legs. It is a quick and painless procedure that can be done in an outpatient setting.

Stress testing

A stress test can involve exercise stress testing, nuclear stress testing, a stress echo cardiogram, or a PET stress test. These all help evaluate how your heart handles exertion. There are several ways to conduct a stress test. In general, however, you are connected to a EKG machine which monitors your heart while you walk on a treadmill or receive medication to raise your heart rate. Heart rate, blood pressure, breathing pattern and fatigue are also all measured during the test. 

During a nuclear stress test, you’re given a small injection of a radioactive substance and a special camera takes pictures of your heart during the exercise. Similarly, a stress echo takes detailed readings of your heart function before and after exercise. Both of these tests show a higher level of detail regarding how the heart responds to exertion.

Stress tests are important tools for patients experiencing chest pain, arrhythmias, or blocked arteries. It is also helpful in determining a safe level of activity for someone who has had a heart attack. 

Cardiac CT

A computed tomography (CT) scan is used to help determine plaque buildup in the arteries (calcium score), fluid buildup around the heart, or other abnormalities. It is also frequently used to plan for valve replacement and cardiac ablation procedures.

A cardiac CT is a painless exam. The scanner makes sweeping arches over the patient’s chest to take the images. The patient lies on a table during the exam and is injected with a contrast dye, which often causes a warm, flushing sensation.

Transthoracic echocardiogram (TTE)

A transthoracic echocardiogram (TTE or echo) is an ultrasound that produces real-time images of the heart, providing information about the size, structure and function of the heart. This allows physicians to see the overall health of your heart, including the function of your heart valves and chambers. First, a cooled gel is applied to the chest. Then, a small, hand-held wand is placed over the surface of the chest and transmits high-frequency sound waves to create the picture.

Transesophageal echocardiogram (TEE) and 3D TEE

A transesophageal echocardiogram (TEE) is similar to a TTE in producing real-time images of the heart. This lets the doctor see pictures of the heart without the ribs or lungs getting in the way. A TEE is done when your doctor needs a closer look at your heart or does not get all the necessary information needed from a regular echo.  During a TEE, the patient is placed under sedation while a long, thin scope with a small ultrasound probe at the end is placed down the patient’s esophagus. In addition to evaluating the heart’s structure, a TEE helps guide interventional procedures such as the WATCHMAN™ device and MitraClip® procedure.   

Cardiac MRI

Cardiovascular magnetic resonance imaging, also known as cardiac MRI, is a non-invasive, no-radiation option for patients. Cardiac MRI uses a magnetic field and radio waves to get clear, sharp pictures of the heart and major blood vessels. Cardiac MRI provides detailed information on the type and severity of heart disease to determine appropriate diagnosis and specialized therapy of heart problems, such as coronary heart disease, heart valve problems, cardiomyopathy (abnormal heart function) or damage from a heart attack.

Cardiac PET Scan

Cardiac PET imaging provides diagnostic accuracy, excellent quality, and the ability to detect disease before symptoms are present. This extremely effective imaging tool is used to diagnose cardiac disease with higher accuracy and lower radiation exposure than traditional stress testing. During this test, you will be asked to lie down on a scanning table developed especially for the PET camera. Medication is administered through an IV line in a vein in your arm. Small pads called electrodes will be placed on your chest to monitor the electrical activity of your heart throughout the study. A small amount of radiopharmaceutical is given through your IV line, enabling the PET camera to capture images of your heart.

Holter/Event monitoring

A Holter monitor is a portable device, similar to an EKG, which measures your heart’s activity for an extended period of time (24 to 48-hours or even longer in some instances). You may be put on a Holter monitor if you have an irregular heartbeat, or to monitor how well you are responding to treatment for an arrhythmia. 

For longer evaluations you may be fitted with an event monitor or a Zio patch cardiac monitor. An event monitor is similar to a Holter monitor but is worn for a longer period of time and records information when activated by the patient. The Zio patch cardiac monitor is an emerging technology that can monitor heart function for an extended period of time with just one patch attached to the chest. Patients wearing the Zio patch can shower with it on.

Wearing a Holter or event monitor is painless. Our non-invasive technicians will apply the monitor’s electrodes to your chest and provide all the necessary information and considerations to take while you wear the monitor. You may be asked to keep a diary of your activity and any symptoms you may have while wearing the device. Your provider will receive the results of your test and discuss them with you. 

Long-Term Cardiac Monitoring

For patients who need long-term heart monitoring, CMC offers implanted monitors including the Reveal LINQTM Insertable Cardiac Monitoring (ICM) System and the Confirm RxTM Insertable Cardiac Monitor.  An ICM is placed under the skin and continuously monitors heart rhythm to help identify potential problems not detected by other tests or monitors.  The device then wirelessly transmits data for your doctor to review.  Once a day, the device syncs with a wireless monitor that stores the data for your doctor to review.

Cardiac PET & Cardiac MR

New programs at CMC help provide answers

More detailed images of the heart help patients who may not otherwise get answers from traditional testing.

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Our non-invasive cardiology team has extensive experience in the latest technologies to evaluate and diagnose heart disorders. You can count on us for excellent care at locations throughout New Hampshire. 

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