One of the newest noninvasive techniques for identifying heart disease, is possible with the use of high-speed Computed Tomography (CT). The Bon Secours Heart & Vascular Institute offers the latest generation GE Lightspeed 64-slice CT at St. Mary’s Hospital, Memorial Regional Medical Center, St. Francis Medical Center, and Reynolds Imaging Center. St. Francis Medical Center was the FIRST community hospital to offer this state-of-the-art technology in Central Virginia.

This is a non-invasive diagnostic procedure that produces detailed still and moving images of the heart using a combination of a large magnet, radiofrequencies, and a computer. An MRI scan enables the physician to see and detect abnormalities in the heart, irregularities in the heart’s blood flow, and abnormalities of the cardiovascular system, including cardiac tumors, diseases, and others. At the Bon Secours Heart & Vascular Institute, we offer state-of-the-art cardiac MRI testing that can reveal areas of heart tissue damaged by a heart attack (myocardial infarction) and area that are not receiving enough blood supply.

This is a noninvasive, risk-free test that uses ultrasound waves to assess cardiac structure and mobility, particularly of the valves. During the test, a small transducer is held against the chest. The transducer sends ultrasound waves that bounce off parts of the heart. A computer uses the information coming from the transducer to make an image of the heart. The image is displayed on a monitor, and it can be recorded on videotape or printed on paper.

The Echocardiogram gives doctors information about the heart, such as:

•  Size of the heart. The echo is used for measuring the size of the heart chambers and thickness of the heart muscle as well as any defects you may have been born with.

•  Pumping strength. The test shows whether the heart is pumping at full strength or is weakened. It can also help determine whether the various parts of the heart pump equally.

•  Valve problems. The echo shows the shape and motion of the heart valves. It can help determine if a valve is narrowed or leaking and shows how severe the valve problem is.

•  Other uses. The echo may be used to detect the presence of fluid around the heart, blood clots, or masses inside the heart, and abnormal holes between heart chambers. Sometimes, the echo is combined with an exercise or dobutamine stress test to see how well the heart pumps when it is accelerated.

2-Dimensional Echocardiograms (2-D). Provides information on the size, shape and movement of the heart. This type of echocardiogram can identify problems with the heart's valves and the pumping ability of its chambers. For example, persons with congestive heart failure have thickened ventricular walls and/or weakened heart contractions.

3-Dimensional Echocardiography (3-D). This enhanced ultrasound capability provides more specific diagnostic information. It used in conjunction with 2-D echocardiography to evaluate the heart from many viewpoints; as if holding the heart in your hand and rotating it to view the heart and valves to an extent that formerly could not have been done accept during open heart surgery. 3-D echo also provides better visualization of anatomy and function of the heart’s valves.

Doppler Echocardiograms. The Doppler echo allows doctors to assess the flow of blood through the heart. You may hear a swooshing or pulsating sound with this test. This is not the actual sound of your heart, but an amplified computerized audio signal. This type of test can detect back-flow of blood or difficulty moving blood across a thickened heart valve conditions that may indicate valvular disease.

M-mode Echocardiograms. The M-mode echo produces an image that looks more like a tracing than a heart. The M-mode echo helps measure the overall size of the heart chambers. These measurements can indicate problems with the heart's pumping ability. For example, persons with congestive heart failure have thickened ventricular walls and/or weakened heart contractions.

Transesophageal Echocardiograms. In this form of echocardiogram, the transducer is passed through the mouth and into the esophagus which is located just behind the heart so that a clearer picture of the heart can be obtained. This test is used to find small blood clots in the hearts chambers.

Echocardiogram Stress Test. The Stress Echo, as it is referred to, is performed to evaluate the function of your heart, mainly your left ventricle (main pumping chamber) when the heart is under stress. 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 with exercise, this often indicates that it is not receiving enough blood because of a blocked or narrowed artery. The Stress Echo shows areas of the heart muscle that do not receive an adequate blood supply. However, it does not provide images of the actual coronary arteries. This test can help evaluate the following:

•  Your risk for coronary artery disease.
•  If the symptoms you are experiencing (i.e., chest pain or pressure, shortness of breath, unexplained fatigue, palpitations, lightheadedness, etc.) are caused by a blockage to your heart or other heart conditions.
•  It can help detect heart problems that may not be present at rest.
•  It is used for cardiac clearance before surgery or other procedure.
•  If you have already been diagnosed with coronary heart disease, a stress test may enable the doctor to estimate the severity of the blockages.
•  If you have just undergone balloon angioplasty or bypass surgery, a stress test can help monitor the success of the procedure as well as determine an appropriate rehabilitation program for you.

Dobutamine Stress Echocardiograms. This test is designed for patients for whom an exercise stress test is not an option. A Dobutamine Stress Echo is a non-invasive ultrasound test which is used to visualize the heart in motion. To view the heart, your doctor will place a transducer on your chest which emits harmless sound waves to your heart. These sound waves generate pictures of your heart in motion and are displayed on an ultrasound machine connected to the transducer. Your doctor will examine the muscle movement of the heart (also called wall motion) while you are at rest. Then, your doctor will inject a medication called Dobutamine through an IV. This causes your heart to beat faster, simulating the effects exercise has on your heart. The doctor will then examine these pictures of your heart and compare them to the pictures taken while you were at rest.

This is a painless, non-invasive test whereby the doctor visualizes the electrical impulses of your heart. An ECG can be done in a resting state or an active state. The technician will place a total of approximately 10 electrode patches on the skin of your arms, legs and chest (sometimes it is necessary to shave small areas of body hair in order to get a good reading). These electrode patches are hooked up to an Electrocardiography machine which displays the electrical activity of your heart.

This test can give your doctor the following information about the functioning of your heart:

•  Heart attack. EKGs show whether you are currently having a heart attack or have had one in the past and can help differentiate between chest pain (angina) and a heart attack.

•  Heart rate and rhythm. EKGs exhibit how fast or slow your heart is beating, and if the beats are regular or irregular.

•  Heart structure. EKGs indicate the size and configuration of the heart, and possibly any defects you may have been born with.

Signal-Averaged ECG. This test is similar to a standard Electrocardiogram (ECG), but provides greater in-depth information by collecting many heart beats and analyzing them together. The Signal-Averaged Electrocardiogram essentially strengthens some signals while eliminating "background noise" from other signals. These signals are then filtered and averaged, providing an analysis that yields information about patient risk of future Ventricular Tachycardia (rapid heart activity) and/or Ventricular Fibrillation (irregular heart activity). These weak but very important impulses are called "late potentials" and are commonly not evaluated in a standard ECG. Late potentials arise from damaged or scarred areas of heart muscle. Recognizing the presence of these late potentials can be helpful in the following situations:

•  To determine risk for ventricular arrhythmia following heart surgery or a heart attack.
•  To determine the cause of fainting (called syncope).
•  To determine if scar tissue is present from a previous heart attack.

Holter (Ambulatory) Monitoring. The Holter Monitor is a small ambulatory, portable ECG machine that can provide the following information:

•  The heart’s rhythm over a 24-hour period, during normal activities, or recording gets triggered by the patient when a specific event occurs.
•  Correlate any symptoms (chest pain, palpitations, etc) the patient experiences with the heart’s electrical activity at that time.
•  Record any abnormal heart rhythms (arrhythmias) that occur, providing diagnostic information about the type of arrhythmia, how long it lasts, and what might trigger it.
•  Determine how well anti-arrhythmia medicines are working.

The Holter Monitor is worn over a 24-hour period while the patient does all of his/her normal activities. Small, sticky patches called electrodes are attached to the chest. Wires travel from the electrodes to a small portable box that is worn on the belt or shoulder strap. The box records and stores continuous heart rhythm data transmitted by the electrodes. The patient must keep a diary of activities, and of any symptoms, that occur while the Monitor is in place. This will allow the doctor to correlate activities with symptoms with the heart’s electrical rhythm at a specific point in time. The patient will also be advised of how to care for the Monitor while wearing it. When the 24-hour period is completed, or longer for the event Monitor, the patient returns the Holter Monitor to the hospital, and a technician does a computerized analysis of the Holter Monitor data to prepare a thorough report for the physician.

Event/loop Recording. Event/loop recorders can monitor heart activity for weeks to months, while the device is worn by the individual at home. A permanent record is kept only when the patient activates the recorder during periods when symptoms are felt.

This test allows your doctor to locate the source of an abnormal heart rhythm (arrhythmia), to determine its cause, and to determine the best way to treat the arrhythmia. Some symptoms associated with arrhythmia are palpitations, dizziness or fainting spells. Arrhythmias are usually a byproduct of damage to the heart from disease or age. People with otherwise healthy hearts can develop an arrhythmia, but it is rare.

The heart’s rhythm (or “beat cycle” or “contraction cycle”) is controlled by a natural pacemaker called the sino-atrial node (SA node). The SA node, located in the right atrium, creates an electrical impulse that travels first through the right and left atria, and then to the right and left ventricles, causing the heart to beat. Sometimes, abnormal electrical impulses occur in the heart, causing an abnormal rhythm called an arrhythmia. Arrhythmias can be too slow (Bradycardias), too fast (Tachycardias), or irregular.

During the Electrophysiology study, catheters are inserted into blood vessels in various locations, and advanced to the heart. Through these wires, electrical impulses are both delivered to and received from the heart assessing both normal and abnormal conditions. An attempt is made to duplicate the patient’s clinical arrhythmia by pacing the heart from different locations and at different rates. Once an arrhythmia has been initiated it is assessed and analyzed to determine its origin and pathway of conduction. Once determined, a decision is made on best cause of treatment, which may include medications, ablation with radiofrequency, or even device treatment where a Pacemaker or an Implantable Cardiac Defibrillator (ICD) may be implanted. At the end of the procedure the catheters are removed and pressure is placed on the puncture site to prevent bleeding.

Nuclear imaging is used to assess how organs function. Safe, small amounts of a radioactive solution are injected into the body. This gives off a small amount of radiation that is detected with a nuclear scanning camera. A computer processes the information and produces the images of the radioactivity distributed in the heart. The amount of radiation you will be exposed to is comparable to that from an X-ray or CAT (CT) scan.

If an area receives less blood than the rest of the heart (because of a blocked or narrowed artery), it will pick up a lower level of radioactivity and will show up as a lighter area, called a "defect."

Cardiac SPECT (single photon emission computed tomography) Scan.This non-invasive test is also called myocardial perfusion imaging. SPECT scans use small amounts of radioactive substances that are injected into a vein and special cameras to produce images of the heart in 3D. Using these computer images blood flow through the heart is measured and areas of abnormal heart muscle are detected.

MUGA (Multiple Gated Acquisition) Scan. Also called radionuclide angiography (RNA), this non-invasive test is used to evaluate the function of the heart ventricles. It measures how much blood is pumped out per heartbeat. A radioactive tracer solution attaches to red blood cells, which are visualized by a special camera and translated on a computer as they travel through the heart. This test is more accurate than an echocardiogram.

PET (Positron Emission Tomography). This is a type of nuclear imaging that can evaluate heart function as well as look for coronary artery disease. PET scans also examining how blood flows through the heart and evaluates damage to heart tissue after a heart attack.

This test is used to determine why a patient is fainting: (fainting is also called syncope). Fainting or syncope occurs by several different mechanisms. It is important to determine the cause of the syncope to understand the risks and severity of future fainting episodes. A tilt table can provide this information.

The most common type of syncope is vasovagal syncope due to an abnormal neurological reflex. While this cause of fainting can be frightening to those who witness it, fainting is rarely life-threatening. People with simple fainting experience a sudden drop in blood pressure, and/or heart rate often while they are standing or sitting.

Intravascular Ultrasound allows detailed evaluation of plaque (Atherosclerosis)--its distribution, location, size, effect on blood vessel diameter--that may be lining the inside of your arteries. This information is used to evaluate cardiovascular disease which assists in determining the next step in treatment if needed (i.e. angioplasty or bypass surgery).

Intravascular Ultrasound (IVUS) is an invasive diagnostic test using a catheter with a sound transducer (or sound probe) on the end. It is usually performed in conjunction with Angiography/Catheterization and/or Transcatheter interventions (e.g. PTCA, Stent, etc.) The catheter is threaded thru the artery in the groin to a specific location of the arterial system to further diagnose the extent of disease. High-frequency sound waves are used to create precise images of the inner arterial walls. These images are displayed in streaming video on a monitor. Once the diagnosis is made, the catheter with the ultrasound tip attached is carefully removed, and then pressure is applied over the groin area to stop any bleeding.

Intracardiac Ultrasound allows detailed evaluation of the inner surface of the heart and valves to determine if there is abnormal anatomy, vegetation (infection), or any abnormalities of the inner lining of the heart. Sometimes Intracardiac Ultrasound is used during other cardiovascular procedures (such as Pulmonary Vein Ablation or Atrial Septal Closures) to provide constant monitoring of the heart structures and pulmonary blood flow throughout the procedure.

Intracardiac Ultrasound is an invasive diagnostic test using a catheter with a sound transducer (or sound probe) on the end. The catheter is threaded thru the vein in the groin and up into the heart. High-frequency sound waves are used to create precise images of the interior heart surface. The catheter with the ultrasound tip attached is carefully removed, and then pressure is applied over the groin area to stop any bleeding.