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Diagnostic Monitoring & Procedures

When patients need cardiac services, they trust St. Joseph's. We lead the way in the prevention, detection and treatment of heart disease. Our care is recognized by HealthGrades, Excellus, the Society of Chest Pain Centers and the Society for Thoracic Surgeons. Below you will find common diagnostic monitoring procedures that a cardiologist would perform in order to find out what treatment  - whether it be medical, interventionalelectrophysiological or surgical - is right for you. 


Cardiac Stress Testing with or without Nuclear Imaging

Cardiac stress tests compare the pace and track of blood flow while the patient is at rest with the same patient's circulation observed during maximum physical exertion. This test shows any abnormal blood flow to the heart's muscle tissue, which can be used to diagnose heart disease, or to provide a prognosis (a statement about the prospect of surviving and recovering from a disease) after a heart attack.

The cardiac stress test is done with heart stimulation, either by exercise - typically on a treadmill - or with the aid of medication. The level of stimulation is tracked by an electrocardiogram (EKG)  machine, which is connected to the patient via electrodes, as the “stress” is progressively increased by adjusting the difficulty (steepness of the slope) and speed.

Nuclear imaging can also be used during a cardiac stress test. By injecting the patient with a radiotracer (a non-hazardous dye that appears in x-ray images), physicians are able to more effectively see areas of reduced blood flow within the heart. This is done by taking x-ray pictures of the patient’s heart before and after exercise, where the radiotracer will capture images of the blood flow.

Cardiac Catheterization

To learn more about catheterization and other interventional procedures, visit our Catheterization Labratory page or our catheterization procedures page.

Cardiac catheterization is one of the most useful and accurate tests to diagnose cardiovascular problems. It is used to determine the health of the coronary arteries, heart valves and heart muscle.  It may also be used to treat heart conditions, such as narrowed heart valves and coronary arteries.

During a cardiac catheterization procedure, a small incision is made in the groin or arm. A long thin tube called a catheter is then inserted and then guided through the blood vessels to the heart. The procedure is usually performed while you’re awake, but you will be given medications to help you relax. An intravenous line will be inserted in your hand or arm, and will be used to give you any additional medications you might need during your procedure. Recovery time for a cardiac catheterization is quick, and there's usually a low risk of complications.

Sometimes immediatly following the diagnostic procedure, the operating physician will decide to perform angioplasty or a stent procedure.

Drug Infusion for Pulmonary Hypertension

Pulmonary hypertension is usually diagnosed by a right heart catheterization, which is done in our cardiac catheterization lab. During the procedure, the doctor inserts a catheter (long, thin, hollow tube) up the vein into the heart and through the pulmonary artery (the main artery carrying blood into the lungs) and takes pressure measurements to confirm the exact pulmonary pressure. The doctor will also take various pressures and blood samples from different chambers of the heart and lungs to determine other causes of pulmonary hypertension. 

Drug infusion for pulmonary hypertension - or a pulmonary vascular re-activity study - is a way that your doctor will infuse a drug to test the dilatation capacity of the pulmonary arteries, which will determine which, if any, drug will be effective in the treatment of pulmonary hypertension in your case. 


An echocardiogram (echo) is a noninvasive (the skin is not pierced) procedure used to assess the heart's function and structures. During the procedure, a transducer (like a microphone) sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the chest at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or "echo" off of the heart structures. These sound waves are sent to a computer that can create moving images of the heart walls and valves.

An echocardiogram may be performed for further evaluation of signs or symptoms multiple heart problems or to simply assess the heart’s overall function and general structure.

Endomyocardial Biopsy

An endomyocardial biopsy (EMB) is when a small sample of the heart tissue is removed in order to test it. This is used as a diagnostic tool for patients who present with abnormal systolic or diastolic function (heart beats) or to diagnose a problem with a heart transplant or mass within the heart structure.

In order to get a sample of the heart tissue, typically a small-thin tube called a catheter is inserted through the arm, along with a lead wire. This tube travels through the blood vessels until it reaches the heart. An EMB is usually performed with fluoroscopic guidance – or aided by an X-ray “movie.”

Intravascular Ultrasound

Intravascular ultrasound (IVUS) is a medical imaging test, which uses a long thin tube called a catheter with a miniaturized ultrasound probe on the end to see inside of the blood vessels. By doing so, the physician can determine the amount of plaque (a buildup of substances such as cholesterol) in the blood vessels.

Once inside the blood vessel, sound waves are emitted from the catheter tip and the catheter also receives and conducts the return echo information out to the external computerized ultrasound equipment which constructs and displays a real time ultrasound image of a thin section of the blood vessel. In this way the physician can “see” inside your blood vessels.

The arteries of the heart (the coronary arteries) are the most frequent imaging target for IVUS. IVUS is used in the coronary arteries to determine the amount of build up at any particular point which, if left untreated can lead to a heart attack and stenosis (narrowing) of the artery. IVUS is of use to determine both plaque volume within the wall of the artery and/or the degree of stenosis of the artery lumen (inside space of the tubular artery structure).

Peripheral Vascular, Carotid and Renal Angiography

Angiography is a procedure to x-ray blood vessels. This is traditionally done by injecting a radio-opaque contrast agent (a non-hazardous dye that shows up in x-rays) into the blood vessel via a long thin tube called a catheter and then taking x-rays using fluoroscopy, a study of a moving body structure – similar to an X-ray “movie.”By using a fluoroscope (an x-ray source and fluorescent screen between which a patient is placed), physicians are able to capture real-time moving images of the inside of the blood vessels – and see how well – or poorly – blood is flowing through them.  Angiography can be done on a number of body locations, including peripheral vascular – blood vessels in your arms and legs, carotid – the main artery that carries blood from the heart to the brain, and renal – blood vessels leading to and from your kidneys. 

Transesophageal Echocardiograms (TEEs)

A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. Instead of having the transducer on the patient’s chest, with a TEE, a specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus (feeding tube connecting the mouth and the stomach).

Because a traditional echo travels through the front of the chest and lungs to reach the heart, at times obesity and emphysema may create technical difficulties by limiting the transmission of the ultrasound beams to and from the heart. Since the esophagus sits behind the heart, with TEE the echo beam does not have to travel through the front of the chest, offering clearer image of the heart, particularly, the back structures, such as the left atrium, which may not be seen as well by a standard echo taken from the front of the heart.

A TEE is extremely useful in detecting blood clots, masses and tumors that are located inside the heart. It can also gauge the severity of certain valve problems and help detect infection of heart valves, certain congenital (present at birth) heart diseases (like a hole between the upper chambers of the heart, known as an ASD or atrial septal defect) and a tear (dissection) of the aorta (major artery of the body). TEE is also very useful in evaluating patients who have had mini or major stokes as a result of blood clots.

Electrophysiology Testing

Cardiac electrophysiology (EP) is the science of understanding, diagnosing and treating the electrical activities of the heart. An EP test is an invasive study which allows doctors to assess the heart's electrical system and induce arrhythmias (irregular heartbeats) under controlled conditions. During the EP study, sinus rhythms and baseline cardiac intervals are recorded. The study is done to investigate the cause, location of origin and best treatment for various abnormal heart rhythms.

This type of study is performed by a an electrophysiologist and using a single or multiple catheters situated within the heart through a vein or artery. These catheters sense electrical impulses and may also be used to stimulate different areas of the heart. Doctors can then locate the sites that are causing arrhythmias. In order to reach the heart with a catheter, a site will be prepared that will allow access to the heart via an artery or vein, usually through the groin. This site is then described as the insertion point.Once the catheter is in, the EP study begins. An X-ray machine will be used to give the doctor a view of the heart and the position of the electrodes on the ends of the catheters.

The next step is pacing the heart. This means the doctor will speed up or slow down the heart. The doctor will pace each chamber of the heart one by one, looking for any abnormalities. Then the electrophysiologist tries to provoke arrhythmias (abnormal heart beats) and reproduce any symptoms the patient has had. Lastly, the electrophysioligst may administer various drugs to induce arrhythmia (abnormal heart beat). If an abnormal heart beat is a result of the drugs, the electrophysiologist will search out the source of the abnormal electrical activity.

For more information on our electrophysiology procedures, visit our electrophysiology page or our electrophysiology procedures page

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