An echocardiogram is a noninvasive, harmless, convenient and valuable cardiac diagnostic procedure which uses reflected ultrasound waves to generate images of the heart including the shape, size, texture and motion of the heart chambers and valves, anatomic information about the pericardium and the large blood vessels and physiologic information about blood flow and pressure.   The test enables the anatomic and functional evaluation of the heart, essential to the diagnosis of many acquired and congenital cardiac disease conditions. Our laboratory has adopted the Appropriate Utilization Guidelines within the Standards for Echocardiography in Ontario developed by the Echo Working Group of the Cardiac Care Network of Ontario. ​ What to Expect — A clear water soluble gel is placed on your chest to help transmit the sound waves and a transducer which looks like a hand-held microphone is used to rove around your chest to obtain the best possible images recorded from various locations that view the heart and related structures from various angles. The procedure is painless and takes about 30 minutes to complete. ​ How to Prepare — No special preparation is required.

The 12-lead electrocardiogram (ECG) is a graphical record of the electrical activity of more than 110 year ago, this test is the most commonly used procedure for the diagnosis of heart disease and provides information about the heart’s rhythm, the health of the electrical conduction system of the heart, the size of the heart’s chambers, the thickness of heart muscle, scars from damage resulting from previous heart attack(s) and the presence of acute or of chronic ischemia, a condition in which the heart’s muscle is starved of oxygen because of reduced blood flow due to one or more narrowed or blocked coronary arteries. The 12-lead ECG can diagnose a heart attack in progress, can identify a risk of sudden cardiac death and can lead to a variety of other diagnoses such as hypothyroidism or electrolyte abnormalities, which can affect the heart. ​ What to Expect — The test is harmless and painless. Ten electrodes (small conductive stickies) are applied to the limbs and chest and are connected to a computer. The test takes less than 15 minutes to complete. ​ How to Prepare — No special preparation is required.

Holter Monitoring is a continuous recording of the ECG using a cellphone-sized device connected to the chest using 5 electrodes for periods of 24, 48 or 72 hours or 7 or 14 days. The test provides essential information about the heart’s rhythm and is used to investigate symptoms such as palpitations, skipped beats, lightheadedness and fainting and to detect arrhythmias associated with certain cardiac conditions which can result in syncope, stroke or sudden cardiac death. ​ What to Expect — The skin is cleaned and the electrodes are attached firmly to the chest. The device is worn under clothes, either on a belt or around the neck. You will be asked to record symptoms and activities in a diary and to depress the event marker on the device in case of symptoms. For longer-term recordings you will be provided with additional electrodes to allow you to remove the recorder to take a shower. ​ How to Prepare — No special preparation is required.

Similar to a Holter, this device is an event monitor with a looping memory which allows the last few minutes of recording to be saved along with several minutes of real-time recording, whenever the event marker button is depressed, usually at the time a symptom. Worn for 7-30 days, most versions of this test do not capture the ECG between activations, although some devices do have the capability to automatically detect and record a set of specified rhythm disturbances. What to Expect — The skin is cleaned and the electrodes are attached firmly to the chest. The device is worn under clothes, either on a belt or around the neck. You will be asked to record symptoms and activities in a diary and to depress the event marker on the device in case of symptoms. For longer-term recordings you will be provided with additional electrodes to allow you to remove the recorder to take a shower. How to Prepare — No special preparation is required.

A hand-held device is used to record a single channel ECG during a symptom in real time. This test is used primarily to diagnose symptoms suspected to be due to an arrhythmia, but may also be used as a rhythm surveillance device. What to Expect — You will be provided with a hand-held device, instruction on how to use it and a diary to record your symptoms. How to Prepare — No special preparation is required.

Cardiolite is a radioactive tracer which attaches to a protein in the blood, circulates to the heart through the flow of blood and is deposited in the heart muscle. A gamma camera is then used to create an image which provides information about the relative adequacy of supply of blood to various parts of the coronary circulation. Images obtained prior to and immediately after exercise are compared to detect scarring from heart damage and/or reduced blood flow due to narrowed arteries.   Additional information is gleaned from measurements of the heart cavity size and vigour of contraction. This information is important in the elucidation of chest pain and shortness of breath in individuals with an abnormal ECG, which reduces the diagnostic accuracy of the Stress ECG and in patients who cannot exercise on a treadmill, in whom a chemical called Persantine is injected into a vein to reproduce the effect of exercise. ​ What to Expect — You will have a small needle inserted into a vein in your arm.  A small amount of cardiolite is injected through the vein and you lie under the camera for several minutes to obtain a “before” image. You will then walk on a treadmill or receive an injection of Persantine into your vein. You will then receive a second injection and will lie under the camera for a few more minutes to obtain the “after” image.  ​ How to Prepare — You should not eat or drink for three hours before your test and you should not consume any coffee and caffeinated beverage for 24 hours before the procedure. Other instructions, such as the taking of medications will be provided to you individually, depending on you specific condition. ​ Travel Advice — If you plan to travel within 48 hours after a persantine test, you should know that detectors at airports and vehicular border crossings will detect the small amounts of residual radiation in your body and may cause delays in some cases.

This test is used to diagnose symptoms, to look for evidence of heart disease and sometimes to evaluate fitness. Your ECG including the heart rate, rhythm and ECG waveforms are is continuously monitored, your blood pressure is measured at 3-minute intervals, before, during and after a walk on a treadmill at preprogrammed standardized speeds and inclinations which increase progressively during the test you achieve a target rate or develop a symptom. ​ What to Expect — All stress tests are supervised by a physician who is on the premises during the procedure and is available to intervene if necessary. You will be asked to sign a consent form. You will be hooked up to an ECG machine using 10 electrodes as described in the 12-Lead ECG section above and you will be asked to walk on a treadmill while technician will stand beside you at all times and monitor your ECG, heart rate and blood pressure. Gradually the speed of the treadmill is increased so you have to walk more quickly. The test continues until you reach your target rate or until you experience a symptom, such as chest pain, shortness of breath or fatigue. Be sure to let someone know if you are feeling any discomfort or other symptoms. The test lasts about 30 minutes. ​ How to Prepare — Wear comfortable clothing and shoes. Do not eat for two hours before the test. If you’re a smoker, you should refrain form smoking for at least two hours before the test. ​ Continue all of your medications as usual unless otherwise instructed by your doctor or by the office.

A Stress Echocardiogram combines a Stress ECG and an Echocardiogram which provides information about the response of heart muscle function to exercise and pressure changes within the heart and in the lungs which cannot be obtained with any other non-invasive test.   Not only does this test increase the accuracy of detecting and evaluating the functional significance of coronary stenoses, but it also provides invaluable information heart function and pressure changes in various disease conditions which are impossible or very difficult to obtain by any other testing modality. ​ What to Expect — All stress tests are supervised by a physician who is on the premises during the procedure and is available to intervene if necessary. You will be asked to sign a consent form. You will be hooked up to an ECG machine using 10 electrodes as described in the 12-Lead ECG section above. Your will have a resting echocardiogram performed the same way as above.   You will be asked to walk on a treadmill while a technician stands beside you at all times and monitors your ECG, heart rate and blood pressure. Gradually the speed of the treadmill is increased so you have to walk more quickly. The test continues until you reach your target rate or until you experience a symptom, such as chest pain, shortness of breath or fatigue. The treadmill will be stopped abruptly, rather than gradually and you will be asked to quickly lie down on the test table right next to the treadmill and will have a second echocardiogram, to obtain immediate post-stress recordings. The test lasts about 45 minutes. ​ How to Prepare — Wear comfortable clothing and shoes. Do not eat for two hours before the test. If you’re a smoker, you should refrain form smoking for at least two hours before the test. ​ Continue all of your medications as usual unless otherwise instructed by your doctor or by the office.

This is the same as a Stress Echo, except that an inert suspension of microbubbles is injected into a vein in your arm during the echocardiogram to enhance the images and therefore the accuracy of the test. ​ What to Expect — You will be informed about the procedure by a doctor or a technologist and you will be asked to sign a consent form. A small needle will be inserted into a vein in your arm before the procedure and will be used to inject a few drops of contrast material at various times during the echo procedure. ​ How to Prepare — Wear comfortable clothing and shoes. Do not eat for two hours before the test. If you’re a smoker, you should refrain form smoking for at least two hours before the test. ​ Continue all of your medications as usual unless otherwise instructed by your doctor or by the office.

Office-based blood pressure measurements are notoriously inaccurate for many reasons, including the “white coat” effect and do not adequately reflect diurnal and activity-related variations. 24-hour ambulatory blood pressure monitoring (ABP) is recognized as one of the most effective and reliable ways to measure the blood pressure in clinical practice.   A small electronic device the size of a portable radio worn on a belt around the waist is attached to a blood pressure cuff which is inflated at 15-minute intervals during the day and 30-minute intervals at night. The approximately 80 individual pressure and rate data points displayed in numerical and graphical formats along with diurnal max/min/average information form the basis of important decisions, including the need for and the adequacy of antihypertensive therapy in a variety of clinical contexts. ​ What to Expect — You will be asked to press a button on the device indicating when you retire to bed and when you wake in the morning and to keep a record of your activities in a diary. ​ How to Prepare — No preparation is required. You should be aware that OHIP does not cover the cost of this test for which you will be charged $75.00 payable by cheque or in cash. Please feel free to discuss this with our staff or with your doctor if this fee poses a hardship.