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Cardiologists Offer Full Range of Diagnostic and Nonsurgical Treatments

Cardiac catheterization involves threading a catheter through the femoral artery in the thigh into the left side of the heart. It is used to check for blockages inside the coronary arteries. Because it is an invasive procedure, it is used only when the physician is unable to get necessary information by using the simpler, less expensive tests.

Echocardiography, like the EKG, is a common screening test. It uses an ultrasound image and Doppler sound waves to examine blood flow through the heart's valves and chambers. This tells the physician about the size of the heart and also reveals much about other structures in and around the heart. During a basic echo, electrodes are placed on the patient's chest to record the heart's electrical activity. Then a device called a transducer is passed across the left side of the chest. This test usually takes 45 minutes to an hour.

EKG is a painless procedure that takes about 10 minutes. Just about anyone who sees a cardiologist can expect to have one on the first visit. The patient lies quietly while electrodes are placed on the wrists, chest and ankles. The resulting signals provide information about the strength of the heart and its rhythms. Sometimes, the physician may want even more information. Then he or she might order other, more involved forms of EKG testing that take anywhere from 30 minutes in the hospital to 30 days at home with a portable monitor about the size of a small cassette player.

Electrophysiology studies, like cardiac catheterization, are used only when simpler tests are inadequate. During an electrophysiology study, electrodes are threaded through blood vessels to the heart. The results tell the physician about the heart's electrical impulses.

Holter monitoring and cardiac event monitoring are EKGs that are done over a long period of time. A patient receiving holter monitoring wears electrodes attached to a portable monitor, about the size of a small cassette player, for 24 hours. The test can be done at home. Cardiac event monitoring is done the same way, although it takes longer - sometimes as long as a month.

Nuclear tests involve injecting the patient with a small amount of radioactive material and taking pictures of the heart. One type, the Gated heart scan, takes about an hour. The radioactive material identifies red blood cells, and these are counted as the heart pumps. The results tell doctors how well the heart is pumping blood through the body.

Stress testing tells the cardiologist how the patient's heart and blood pressure respond to physical activity. During the test, the patient exercises on a treadmill or pedals a stationary bicycle while the physician monitors the heart's electrical activity. Test results can indicate possible blockage of an artery and where the blockage is occurring. In addition, results are useful in determining whether the patient should undergo an angiogram, also known as cardiac catheterization. There are several different types of stress testing, including some that use medication to mimic the effect of physical activity on the heart. This is used for patients who are unable to exercise.

Transesophageal echocardiogram is a more sophisticated type of echo. A tube about the size of the index finger, equipped with an ultrasound probe, is placed in the patient's esophagus. This technology produces images of the heart's valves and structures that are clearer than those provided by a regular echo. This test is especially useful for checking for blood clots in the heart.