Diagnosing Heart Disease

Whatever health concerns you have, the expert staff at the Main Line Health Heart Center has the experience, skill and knowledge to accurately diagnose your condition and recommend appropriate treatment options.

Many diagnostic tests performed at the Heart Center are done on an outpatient basis at Bryn Mawr, Lankenau, Paoli, and Riddle Memorial Hospitals, depending upon the specific test and the patient's needs. Our invasive cardiology labs offer the most sophisticated technology available for advanced diagnostic and treatment procedures. Because we are one of the largest heart centers in the Delaware Valley, performing thousands of procedures each year, patients receive the most up-to-date care available delivered by the most experienced health care professionals.

The diagnostic tests performed at the Main Line Health Heart Center fall into three main categories, including tests that show:

• structure, function and blood flow
• electrical problems or arrhythmias
• circulation and how blood is pumped through the heart and body

Echocardiography

Echocardiography (ECHO) is a noninvasive test that uses high-frequency sound waves to provide a picture of a patient's heart valves and chambers. ECHO is used to assess the overall heart function and diagnose conditions such as valvular heart disease, myocardial disease, pericardial disease, cardiac masses, or congenital heart defects. It may also be used to evaluate the effectiveness of a previous medical or surgical intervention.

ECHO is sometimes combined with Doppler ultrasound to evaluate blood flow through the arteries and the moving heart. Doppler ultrasound will help doctors determine if a patient's heart valves are blocked or damaged in some way. It may also detect blood clots or tumors.

What to expect: During the test, a patient lies on a table, and a technician spreads thick gel on his or her skin. The technician moves a device called a transducer, which sends and receives the sound waves, across the patient's skin to produce images of the heart and transmit them to a monitor. The test takes about 45 minutes.

Transesophageal Echocardiography 

Transesophageal Echocardiography (TEE) also uses sound waves to show the heart’s image and evaluate the pumping action. However, during this test, the transducer is placed on a long, thin, flexible instrument called an endoscope that is inserted in the patient's mouth and passed down the esophagus. This test can show the size, shape, and movement of the heart in great detail and is used to assess the overall function of the heart's valves and chambers, as well as the aorta. It is often prescribed when standard ECHO studies do not show a clear enough picture of the heart.

What to expect: Patients must fast for at least four hours before a TEE test. (Consult your doctor regarding medications.) Prior to the test, patients are given a mild sedative to help them relax, and the throat is numbed with an anesthetic. Small, metal disks called electrodes are placed on the patient's chest. These electrodes are attached to an electrocardiogram (EKG) machine that monitors the patient's heart rate, blood pressure, and oxygen levels.

The doctor will insert the endoscope into the patient's mouth and down the throat. This is often the most uncomfortable part of the test. Once the endoscope is in place, however, the patient should not feel any pain. The test lasts approximately 90 minutes.

After the test, patients may have a sore throat and will often feel drowsy. For this reason, patients should arrange to have a friend or relative drive them home.

Intravascular Ultrasound 

Intravascular Ultrasound is a relatively new procedure that allows doctors to perform an ultrasound inside the blood vessels. A catheter is inserted into the artery and, using sound waves, produces a moving picture of the heart. Intravascular ultrasound is typically done in combination with another invasive treatment, such as angioplasty.

What to expect: Patients should not eat or drink anything after midnight the day before this test. (Consult your doctor regarding medications.) Prior to the test, patients are given a mild sedative to help them relax and an anesthetic to numb the area. Doctors will insert a catheter into an artery and guide it into the heart. The catheter has a transducer on the end that allows it to take pictures inside the heart.

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Electrocardiogram 

An electrocardiogram (ECG or EKG) examines the electrical activity in the heart by recording its electrical impulses. These impulses form certain wave patterns, and changes in those patterns can indicate a problem. This test will show problems in heart rhythms and may be used to diagnose atrial fibrillation, atrial flutter, or other SVAs (supraventricular arrhythmias).

What to expect: During an EKG, small, metal electrodes are placed on the patient's skin to pick up electrical impulses in the heart. The test is painless and is conducted while the patient lies on an exam table. The electrodes are usually placed on the chest, back, wrists, and ankles. The reading takes only a few minutes.

Holter Monitoring

A Holter monitor is a portable EKG that provides doctors with a constant reading of a patient's heart rate and rhythm over a longer period, usually 24 hours. Holter monitoring is used to detect abnormal heart rhythms while the patient conducts everyday activities. Patients are asked to keep a diary during this time to record any symptoms. The Holter monitor is battery-operated and has five to seven leads or wires attached to small, metal electrodes. Much like the electrocardiogram, these electrodes are attached to the patient's chest and record electrical activity in the heart over a 24-hour period.

Electrophysiology Study

An electrophysiology study is a way to assess the heart’s electrical function and allows the electrophysiologist to identify the site of the abnormal electrical activity that is causing the arrhythmia. This information is essential in prescribing an appropriate and effective treatment program.

What to expect: During the test, one or more thin flexible wires or catheters are inserted into the patient's groin, arm or neck under local anesthesia, and threaded into the heart. X-ray cameras are used to guide the wires into the correct position. Once the wires are in place, the electrical activity within various parts of the heart is measured. The electrophysiologist may also try to “start” the arrhythmia in order to identify the type and location of the problem.

Tilt Table Test

A tilt table test may be helpful in identifying the cause of syncope, or fainting, in some people. One common cause of fainting is called neurocardiogenic syncope, a condition whereby the nerves that control the action of the heart and blood vessels don't function properly. This can lead to a drop in blood pressure and a loss of consciousness.

What to expect: During the tilt table test, the patient lies flat on a special table and is gradually tilted to an upright position while monitoring the heart rate, blood pressure, and presence of symptoms. Based on the results of this test, additional information is garnered to help identify and treat the cause of syncope.

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• evaluate blockages in the coronary arteries that cause angina and heart attacks
• determine how well the heart muscle works (contractility)
• evaluate the function of the heart valves
• determine if there are any congenital (birth) defects

What to expect: Cardiac catheterization allows doctors to see the coronary arteries and the blood flow through them. It is performed in the cardiac catheterization laboratory by a cardiologist and specially trained staff. Light sedation and a local anesthetic are given to ensure patient comfort during the procedure. A long tube is inserted into an artery or vein in the arm or groin and is then threaded into the patient's heart. A contrast agent (dye) is injected into the catheters. As the dye flows through the arteries, X-rays are used to detect areas of narrowing within the artery.

After the procedure, pressure is applied at the puncture site, and a dressing is applied. To keep the puncture site from bleeding, patients must lie down and keep their arm(s) (if used as the site of catheter insertion) and leg(s) immobilized for a period of 4 to 6 hours. Depending on the results of the tests and how well the test is tolerated, the patient may go home on the same day as the procedure. If disease is found, or other conditions that require hospitalization exist, the patient may have to stay in the hospital longer.

As with any procedure, there are possible risks, which will be explained before the procedure. Treatment of coronary artery disease depends upon the number, severity and location of the blockages within the artery.

Stress Echocardiography

Stress echocardiography is a non-invasive test that shows how the heart performs during exercise, as well as the structure and blood flow of the heart. The test combines a treadmill stress test (TST) and an echocardiogram (ECHO). An echocardiogram uses sound waves to provide a picture of the heart's valves and chambers. The echocardiogram is performed at rest prior to exercise and again at peak heart rate after using the treadmill.

This test evaluates the presence of irregular heart rhythms and checks your overall level of conditioning. It also determines if there is a decreased supply of blood and oxygen to the heart at rest as well as with exertion.

What to expect: Patients should not eat or drink anything for at least 4 hours prior to the test, especially items that contain caffeine, such as coffee, tea, soda or chocolate. (Consult your doctor regarding medications.)

At the beginning of the test, electrodes are placed on the chest to monitor the heart's rate and rhythm. The patient walks on a treadmill, gradually increasing speed, and continues for about 15 minutes. The doctor continues to monitor the heart during this exercise and looks for changes in the EKG. Once the heart rate has peaked, the patient is asked to lie down to perform the ECHO. This will allow the doctor to see the heart in motion. The test takes 30-60 minutes.

Nuclear Medicine Stress Test

A nuclear medicine stress test allows doctors to evaluate the heart both while the patient is resting and after exercise. The test shows the size of the heart’s chambers, how well it is pumping blood and whether there is any damaged or dead muscle. It also helps to diagnose coronary artery disease.

What to expect: Similar to an exercise stress test, the nuclear stress test requires the patient to walk on a treadmill while hooked up to an EKG machine. Just before the end of the exercise, doctors will inject patients with a small amount of radioactive dye. This substance is not harmful. The patient will then lie down on an exam table while pictures are taken of the heart with a special camera. These pictures will show which area of the heart is not getting enough blood or oxygen.

After this, patients can leave the test area for several hours, but are asked not to eat or drink anything with caffeine. When the patient returns, he or she is injected again with a radioactive dye and pictures are taken while the patient is at rest. A comparison of the two pictures shows how the heart works both during exercise and at rest. It also shows which areas of the heart may not be getting enough blood or oxygen even after the patient stops exerting him or herself.