Test Instructions

What to Expect

Cardiologist Consultation

We are a group of cardiologists offering expert care in primary and secondary prevention of atherosclerotic heart disease, heart failure, valvular heart disease, electrophysiology, women’s health and cardiac imaging. We are committed to providing the very best in personal and individualized care to our patients while incorporating the very latest technology and innovation. Consultation request can be made through the individual Cardiologist offices or through our central booking office. Please indicate if you would like the patient seen by a specific Cardiologist or in the next available Consultation spot. Also indicate the urgency of the referral.

Talk to Us

Each day of the week, there is a Cardiologist assigned to manage urgent requests, abnormal tests, phone calls from physicians and Fast track Chest Pain Clinic. This physician can be reached by calling 705 740 6888 EXT 9 or 1 and asking to be directed to the Cardiologist of the day.

Dr. Katie M. Doucet
Dr. Michael Hartleib
Dr. Andrew Kelly
Dr. Rachelle Krause
Dr. John Reesor
Dr. Karen E. Wagner

You may request Cardiac Testing either by phone or by Faxing your request on the attached requisition to the number indicated. You may print patient instructions from this site. Your office will be contacted with the appointment time. We will contact the patient directly if requested to do so. All test results will be returned to you by FAX or by mail in a timely manner. Please call our office booking line if you have not received tests results as expected.

Test Information

The following is a break-down of the types of tests we perform and what is expected during these tests.

Ambulatory Blood Pressure Monitoring

An ambulatory blood pressure monitor is a portable blood pressure recording device which you wear at home, work and play. It is used to record blood pressure readings at specific times during a 24-hour period. The monitor consists of an arm cuff attached by a flexible rubber tube to a light-weight monitor. The monitor sits in a pouch held by a waist belt of shoulder strap. The advantage of this approach is that it overcomes “white coat” blood pressure readings at the doctor’s office, and more importantly, measures blood pressure while you’re sleeping. The device will record as many as 20-30 times over 24 hours. The analysis of this will help your doctors decide the best therapy for your blood pressure.

Special Note: This test is not insured by OHIP. The fee is $60.00.

How to prepare for ABP

Bring a list of medications
Be prepared to pay the fee of $60 by cheque, cash or debit (you will be given a receipt)
Wear a short-sleeved shirt if possible
Unless instructed otherwise, have a “normal day” – don’t try to limit activities

Additional Notes

Your name and health card number will be programmed into the monitor so we know it belongs to you when you return it.
You will be asked to sign an agreement acknowledging that you are responsible for the safety of the equipment while it is in your possession. You may be billed for lost or damaged equipment.
The technologist will take 3 manual blood pressure readings to calibrate the monitor.
The device will be programmed to take your blood pressure every half hour from 8am to 10pm and hourly thereafter through the night (this can be adjusted if necessary).
At the 24-hour time, you may remove the monitor from your arm and press the top button until the word “pause” is displayed (this will be demonstrated to you). Return all the equipment (cuff, hose, monitor, case, strap and information sheet along with a medication list) to the clinic. You or someone else may do this. It can be left at the reception desk in the main lobby. Your name is programmed in it.

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Device Clinic

Pace Maker and ICD Clinic

The Peterborough Regional Cardiac Rhythm Device Clinic provides follow-up for patients with Cardiac Implantable Devices such as Loop Recorders, pacemakers and Implantable Defibrillators. Registered Nurses and Cardiovascular Technologists who have special training and expertise in managing the devices and patients with cardiac rhythm problems, staff the clinic under the supervision of our Cardiologists. The clinic is open Monday to Friday from 8am to 4pm all working days of the year. Referral to this clinic happens automatically for patients implanted with device manufacturers.

What to expect at your first appointment after implantation

The following appointment has been made for the initial assessment of your pacemaker and for the removal of the stitch.

At the initial appointment following your implantation, the stitch will be removed and full assessment of your pacemaker will be done. The settings will be customized to your needs through external programming. Please bring with you a complete list of the current medications and their doses of the medications themselves in their bottles. This will be done under the supervision of a Cardiologist.

If you were taking a blood thinner prior to the implant and were asked to stop taking it before surgery, please start taking it again immediately following the surgery. If the blood thinner was Warfarin or Coumadin, have your blood test – INR, done 5 days after you resume the medication unless otherwise instructed.

You should leave the large, white bandage that was applied to the pacemaker site in the operating room, in place for 3-4 days. If you are removing this, please ensure that you DO NOT disturb the white tape that you will see beneath the bandage. These white tapes are holding the suture in-place. Please keep the entire area clean and dry until after this visit. Do not apply any creams of lotions to the wound area. You may take Tylenol or Advil for any postoperative discomfort if you have no contraindicators to taking these medications.

Please refrain from raising your arm on the side of your new pacemaker, above your shoulder level and do not lift objects more than 20lbs. You should avoid shoveling snow or performing any yard work that requires raking. You may move your arms in a normal and gentle range of motion.

You will receive an identification card at the time of your hospital discharge, with the model and serial numbers of your pacemaker and lead(s). This is a temporary card, a plastic card with this information will be sent to you by mail from the manufacturer. Keep this card in your wallet. You will also receive an information booklet about your new pacemaker when you leave the hospital.

We look forward to meeting you at the clinic for your first follow-up visit. If you have any questions or concerns that arise prior to this appointment, you may contact us at 705-775-3333.

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Echocardiography

Echocardiography (echo) is an imaging technology that uses ultrasound to create images of your heart. It is a diagnostic test used to examine the structure and function of your heart muscle, valves, and major vessels supplying and exiting from the heart. An ultrasound probe will be placed on your chest in various positions to obtain the necessary pictures.

A Sonographer will explain the test to you and answer any questions you may have.
You will be asked to remove all upper body clothing, put on a gown with the opening to the front, and lie down on an examination table.
Adhesive electrodes will be applied to your chest to monitor and record electrocardiogram (ECG) signals.
While lying on your left side the Sonographer will apply some gel, then probe on your skin.
Images of the heart will be recorded and various measurements will be taken.
The data will be reviewed by a Cardiologist after the test is completed. A report will be sent to the doctor(s) involved in your care.
For some studies an injection of a Contrast agent to enhance the image quality may be used.

Patient Instructions

Always bring your Health Card and undated medication list or the actual medications to every visit.
There is no specific preparation required for an echocardiogram. You can eat and drink as usual prior to the test. Take your usual medications, unless otherwise directed by your physician.
There are no restrictions after the echo.
The echocardiogram takes about 45 minutes to complete.
Do not use any scented skin products in the form of talcum, lotion, perfume, cologne, aftershave etc.
If you are a smoker, please wear clothing in which you have not smoked.
Wear clothing that is easy to remove (upper body) Contrast agents are a special material injected through an IV. They are microbubbles that are so small, they pass through the lungs and enter the heart. Image quality is improved in some cases. The contrast agent can be used with resting or stress test studies.

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Electrocardiography

An electrocardiography test, also known as an ECG or an EKG, records the electrical activity of your heart and can detect whether there may be any abnormal patterns associated with heart disease. It is completed by placing electrodes on the patient’s chest, which can then record the electrical changes that occur as the heart beats. It can also detect electrical abnormalities commonly known as “arrhythmia” that patients sometimes may or may not feel. It is done at most visits to your Cardiologist.

Exercise Stress Testing

Stress tests, whether exercise or other stressor, are performed to document your heart response to various forms of stress (see below). Symptoms, heart rate, blood pressure, ECG findings and any imaging (pictures) findings, are all considered in the interpretation of the test. The results are used to understand the cause of any symptoms and determine if you need treatment with medication, or intervention like a stent or a bypass operation.

Always bring your Health Card and updated medication list or the actual meds to every visit. For some stress tests you may be asked to reduce or withhold some meds in advance.
After informed consent, the stress test will begin, using walking or supine bike exercise or medication stress tests using dobutamine or persantine administered via intravenous.
Eat lightly in the hours preceding the test
Do not smoke within 2 hours of the test
You will be hooked up to ECG monitoring equipment and to a BP cuff.
Exercise or medication will start slowly and be increased to target heart rate or target dose. A Nurse or a Heart Technologist will be at your side continuously, monitoring your heart rate, ECG and blood pressure. The test can be stopped at any time if needed – you will be in constant communication with the staff conducting your test.
You will we monitored for a period of recovery.

The risk of serious complications of stress testing is low. Expert professional staff are on hand at all times to watch over you and respond to any issues that may arise.

Additional Modalities that may accompany your stress test

Images of your heart may be obtained using echo (ultrasound) or nuclear camera pictures to provide additional information that aids in interpretation of the exam. Non-exercise modalities can include using medications to simulate exercise – these include dobutamine, an agent that speeds up your heart while pictures are taken, or persantine, an agent that stresses your heart in a different way. Each of these would require an intravenous and injection. If you have a pacemaker, that device can sometimes be used to help with a stress test as well. Persantine tests require that you be free of caffeine – coffee, tea, decaf coffee or tea, chocolate and soft drinks for a full 24 hours before your test. It is very important that you comply with this requirement.

Note: Some echo testing images may be enhanced using a Contrast agent. Contrast agents are a special material injected through an IV. They are micro-bubbles that are so small they pass through the lungs and enter the heart. Image quality is improved in some cases. The contrast agent can be used with resting or stress test studies.

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Holters – 24H / 48H / 72H / 14 Day

Holter Monitors

A Holter monitor, is a type of ambulatory electrocardiography device, a portable device for cardiac monitoring, the monitoring of the electrical activity of the cardiovascular system, for at least 24 hours, often for two weeks at a time. The Holter’s most common use is for monitoring ECG heart activity, electrocardiography or ECG. Its extended recording period is sometimes useful for observing occasional cardiac arrhythmias which would be difficult to identify in a shorter period. When used to study the heart, much like standard electrocardiography, the Holter monitor records electrical signals from the heart via a series of electrodes attached to the chest. Electrodes are placed over bones to minimize artifacts from muscular activity. The number and position of electrodes varies by model, but most Holter monitors employ between three and eight. These electrodes are connected to a small piece of equipment that is attached to the patient’s belt or hung around the neck, keeping a log of the heart’s electrical activity throughout the recording period.

How to prepare for Holter Monitoring

You will be asked to verify information including address, phone number and referring doctors, in case we need to contact you.
You will be asked to sign an agreement of responsibility for the care and safety of the equipment and the timely return of it. *You are responsible for the equipment and you will be billed for any loss or damage.
Do not wear any creams, lotions, perfumes or cologne.
Wear loose fitting clothing that can be opened in the front to place the electrodes.
Bring a list of current medications and your health card.
Be prepared to wear the monitor continuously for the period of time it was requested.
A medical professional staff person will prepare your chest (men may need patches of shaving). They will apply electrodes and tape them in place. The wires will then be attached to the electrodes.
The wires will be attached to a monitor that stores the data and be placed in a pouch with a strap that will hang over your shoulder.
The monitor will collect every heart beat for the prescribed period of time.
You will be given a booklet to record any symptoms you have during the recording period. (see below)
Your name and health card number will be programmed into the equipment so we will know it is your monitor when it is returned.
Your patient diary has the clinic contact information, with instructions on when you are to remove and return the equipment, a place to list your medications and most importantly to record any symptoms. It is import to record an exact date and time with your symptoms, so we can look at that exact area of the study.

Removing and returning the equipment

There is no off button on the recorder. Peel the electrodes and tape off your skin. They can be discarded in the garbage. Minimal skin irritation when the tape and electrodes are removed is expected. If there is any significant skin damage please alert the staff and contact your doctor or pharmacy for further care. The monitor, wires, pouch and strap must all be returned.

Be sure not to use any scissors near the equipment.
Do not remove the batteries.
Keep pets away from all the equipment.
Do not get the equipment wet.
Return the monitor, leads and diary to Kawartha Cardiology, Main lobby (someone may do this for you)

14 Day Monitors

There are only 3 electrodes and wires. You will be given instructions on how to remove the monitor for bathing and replacing the electrodes. It is important to change the electrodes and tape every other day as the electrodes will dry out. It is very important to put specific date and times with all symptoms so we can find the exact spot in the recording.

Common Questions

Question – Why is there a green light flashing on the top of the monitor

Answer – This means the monitor is recording.

Question – Why is the screen blank?

Answer – The monitor has stopped working: call the office.

Question – How will you know it is my monitor when I return it?

Answer – Your name and health number are programmed into the monitor.

Question – I can’t return the monitor on the specified date or time. What should I do?

Answer – Contact the office. Monitors are booked to go out on another patient the day they are to be returned. Late fees will apply if no arrangements have been made.

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PATIENT DIARY

IVMC

Referral to IVMC – Integrated Vascular Management Clinic

This clinic offers urgent vascular care to the people of the region and the community. The goal is to identify and stratify risk, modify the risk factors, and prevent life threatening vascular events. These events include Heart attack, Stroke, heart Failure, and Rhythm Disorders. Diagnosis treatment and education are provided through this clinic.

The following are the Clinics within the IVMC

Chest Pain Fast Track Clinic – CPFT – Eligible patients are those who have suspected cardiac chest pain, but with no clear indication for immediate inpatient admission to hospital based on an emergency room assessment or clinical evaluation in another setting including Family Health Teams. An RN interviews, assesses, and plans the investigation in consultation with assigned vascular physician of the day or by established protocol. Each patient has an appropriate form of stress testing and other testing as required. Further treatment is determined based on the above. If there are no immediate cardiac concerns most patients will undergo a workup to look for vascular disease in other systems. Patients with high-risk findings at CPFT will be offered urgent cardiac catheterization.

Heart Failure Clinic – Heart Failure – CHF is an increasing health problem in our aging society. Unfortunately, heart failure has a bad prognosis and survival rates are worse than in many forms of cancer. However, new therapies are helping improve this situation and carefully structured heart failure clinics provide a pathway to optimizing care. At KCC we have Nurse Experts who focus on this patient population and work with the vascular physicians to optimize all aspects of patient care. They also collaborate with our Nurse Experts in the Implanted Cardiac Device Clinic at KCC, since many of the patients with heart failure also require defibrillators, pacemakers and cardiac resynchronization devices. Heart failure referrals typically come from the Emergency Room, at hospital discharge and Family Health Teams.

Rapid Access Clinic – RAC – Eligible patients for the Rapid Access Clinic, are those with cardiac concerns that are not considered emergencies, but important to evaluate. These patients are often complaining of fainting, near faints, racing heart, atypical chest pain, shortness of breath without evidence of heart failure, or other complaints of unclear origin. The IVMC RN contacts and triages each patient in consultation with the Cardiologist and organizes appropriate investigations.

Atrial Fibrillation Clinic – This is a special version of RAC. Due to the high risk for stroke and development of early dementia in atrial fibrillation patients who are not optimally managed, the nurses triage these patients on a priority basis.

Vascular Risk Optimization Clinic – VROC – Eligible patients are those with a risk factor profile for vascular disease requiring non-urgent vascular assessment and management. Our commitment is to manage the patient, including Cardiology consultation and to report to referring MD. The VROC allows the IVMC to manage Vascular Health and Disease at all stages of the continuum.

Post Stroke Management Clinic – This clinic is a special version of VROC tailored to patients with recent acute strokes whose stay in hospital is now over and they are ready to go home for further rehabilitation. Most patients in this clinic will undergo further investigation for vascular disease in other systems as well as optimization of existing risk factors.

These clinics combine to offer the health care providers and the people of our region, a varied means of timely access to cardiovascular care in the community. The level of service and expertise is reliable, innovative and greatly valued. Our nurses work closely with each patient to ensure understanding and comfort as they navigate their cardiovascular care.

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MUGA/Radionuclide Angiogram

A MUGA or RNA test is a non-invasive diagnostic test used to evaluate the pumping function of the ventricles or lower chambers of your heart.

How should I prepare?

There is no special preparation for this test.
There are no restrictions of food or medication.
Wear comfortable clothes that can be easily removed.

What happens during the test?

The test will be explained to you.
You will be given an injection of Gluceptate.
After 30 minutes, you will be given a second intravenous injection – this is a radioactive tracer.
You will then be attached to an ECG monitor.
You will be asked to lie on a bed/chair for 20 to 30 minutes under a Gamma Camera.
This camera will take computer generated images of your beating heart.
The computer-generated images will allow the Nuclear Medicine technologist to make calculations of your Ejection Fraction or how well your heart is pumping.
This information will be given to your physician to help guide your treatment.

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Myocardial Perfusion Imaging (MPI Nuclear)

Myocardial Perfusion Imaging, uses small amounts of radioactive tracers to evaluate blood flow to the muscle of the heart and to assess heart function. Special cameras, Gamma Cameras, are used to image the heart after the injection of tracer. These tests are done in 2 parts, a Stress test and a Resting test. It does not matter what order the tests are done in. The Stress test is done either on a treadmill, or by giving a drug called Persantine or Dobutamine. You will be hooked up to an ECG and an IV line will be started in your arm. During the test your heart rate and blood pressure will be monitored. The tracer will be given during the stress test through the IV line and you will have a set of images taken afterward to assess your heart’s response to stress. The Resting test is a second set of images without stressing the heart first. This may or may not require a second injection of the tracer. Both sets of images will then be compared to each other to look for changes.

It is very uncommon to have any reaction to these tracers. You will be required to keep your arms raised and or above your head for 10-20 minutes for each set of images. After several hours you will have the second part of your test. The Nuclear Technologist will give a reminder note with your return appointment details to you.

Instructions

These instructions are important and failure to comply with them could result in test cancellation due to the effect the substances may have on test results

When directed by your physician, 72 hours before the test stop medication know as Beta Blocker in advance of the test, these include names such as: Metoprolol, Nadalol, Pindolol, Propranolol, Sotolol.
24 hours before the test, stop taking caffeine in all forms. This includes: coffee (regular and decaf), tea, herbal teas, all soft drinks, all energy drinks, all forms of chocolate.
24 hours before test do not take: Anacin, Dristan, Excedrin, non-drowsy medications, Sinutab with Codeine, Tylenol 1,2,&3 (they contain caffeine).
24 hours before the test, do not take Cialis, Levitra, Viagra.
12 hours before the test, stop smoking or using any form of Nicotine.
If you are pregnant or nursing, please contact the Nuclear Department (705-745-9195).

How should I prepare?

Do not use any scented skin products, including: talcum, lotion, perfume, cologne, aftershave, etc.
Ensure you have your Health Card with you.
You should wear comfortable clothing and footwear for exercise.
Bring a list of all your medication(s).
Ask your doctor if you should stop certain medications before the test
Do not eat within 4 hours of your test, unless you are diabetic.

What happens during the test?

Your test will be conducted by a trained Cardiovascular Technologist (CVT) and/or Registered Nurse (RN) and a Nuclear Medicine technologist.
You will have the tests explained to you and you will be asked to sign a consent.
You will have an intravenous line started.
Your heart rate and blood pressure will be monitored.
The “tracer” will be injected through the IV line while you are exercising or having other medication infused.
You will have images taken on a specialized camera to assess your heart under stress.
A second set of images will be done later in the day (the time to return will be given to you after the first set of images).

The order of the above testing may vary. Sometimes, resting images may be done before Stress images.

Should you need to cancel

These tracers are very expensive and have a very limited shelf life. They cannot be saved for use at a later date. There is a long list of patients waiting to have this test. Therefore, if you are unable to keep your appointment; it is imperative that you call 705-745-9195 48 hours in advance so that we can book someone else in your place.

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Stress Echocardiography

This test is done by 2 para – medical staff – one staff, to obtain Echo images, and other staff, to manage the treadmill, or medications and to monitor your ECG and Blood Pressure. You will be asked to sign a consent for this test. The test is indirectly supervised by a physician in close proximity to the testing room. Stress echocardiography, combines stress testing with an echocardiogram (cardiac ultrasound), obtained immediately before and after exercise. Exercise is usually carried out on a treadmill. Alternatively, a bicycle (either upright or lying down) may be used to provide the exercise stress. This measures the pump function of the heart under stress, which can be used to prove or disprove the presence of coronary artery disease, and evaluate the functional significance. Sometimes a medication, dobutamine, is used to accelerate the heart rate in patients who are unable to exercise. Echocardiography, is used to measure the pump function of the heart before and during this pharmacologic (medication induced) stress test and identify lack of blood supply to the heart muscle. Side effects of dobutamine include, angina and cardiac arrhythmias. You are monitored carefully during the entire test to ensure that any symptoms are noted and managed.

How should I prepare?

Do not use any scented skin products, including: talcum, lotion, perfume, cologne, aftershave, etc.
Ensure you have your Health Card with you.
You should wear comfortable clothing and footwear for exercise.
Bring all of your medication with you, in their original bottles.
Ask your doctor if you should stop certain medications before the test.
If you are booked for a Stress echo and cannot walk on a treadmill, please notify us in advance of the test.
Stop medication know as Beta Blocker 72 hours in advance of the test, these include names such as: Metoprolol, Nadalol, Pindolol, Propranolol, Sotolol.

What happens during the test?

Your test will be conducted by a trained Cardiovascular Technologist (CVT) and/or Registered Nurse (RN) and/or Echosonographer.
You will have electrodes attached to your skin (tiny stickers) for an electrocardiogram (ECG); men may have their chest hair shaved to allow for a better connection. You will have a blood pressure monitor on your arm or wrist. Your breathing and symptoms will also be monitored.
You will undergo initial echo cardiogram (see separate instructions).
You will be asked to walk on a treadmill in order to achieve a target heart rate. A technologist will monitor you and encourage you to exercise.
If you are walking on the treadmill or using a supine bicycle, the speed and incline of the exercise machine will gradually increase until a target heart rate is achieved
When you have reached your target heart rate, you will be asked to quickly leave the treadmill and assume the position for immediate echocardiogram. The speed of acquiring the images is to obtain images of your heart motion while the heart is beating quickly and under the stress of exercise.
If you are unable to exercise, you will have an intravenous started and a medication (Dobutamine) will be given slowly to stimulate your heart until a target heart rate is achieved

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