Test and Consultation Instructions
If you’re a new patient, your first visit will typically be for a diagnostic test, such as an echocardiogram, stress test, or Holter monitor. After your test is complete, you’ll meet with a cardiologist on a separate day to review the results and discuss whether any further testing or follow-up is needed.
Electrocardiogram (ECG)
A simple, painless test that monitors and records cardiac activity and rhythm of the heartbeat using the heart’s electrical signals.
Instructions
We do ask that you refrain from wearing perfumes, colognes or scented lotions on the day of your appointment. There are no pretest dietary restrictions, and you should continue to take any prescribed medications as normal, unless otherwise advised by your doctor.
Test Process
- The entire test will take about 10 to 15 minutes.
- An electrocardiogram is a safe and painless test done while you are lying face-up on an examination table. In preparation, a technician will place electrodes on your chest, arms, and legs. The technologist may be required to shave these areas to help the electrodes stick. Patients can be provided with a gown for comfort and privacy.
After the Test
- Following an ECG, you may develop redness where the electrodes were attached. This mild redness often goes away quickly and without treatment.
- Patients are typically able to return to work or other activities immediately following an ECG.
Ambulatory Blood Pressure Monitoring (ABPM)
ABPM is a simple and non-invasive test that measures your blood pressure over a 24-hour period while you go about your normal daily activities. A blood pressure cuff is placed on your arm and connected to a lightweight monitor worn on your waist or shoulder. The monitor automatically records your blood pressure at regular intervals throughout the day and night. This test provides a more accurate picture of your blood pressure compared to a single reading in the clinic. It helps your doctor determine if you have high blood pressure, if your medication is working effectively, or if your blood pressure changes between day and night.
Instructions
You can continue your usual activities, but it’s best to keep your arm still when the cuff inflates.
Test Process
After the Test
At the end of the 24 hours, you’ll return the device to the clinic for analysis.
Note: This test is not covered by OHIP.
Holter Monitoring (Ambulatory ECG Monitoring)
A Holter Monitor is a small, wearable device that keeps track of your heart rhythm. Similar to an ECG (electrocardiogram), which only records the heartbeat for a few seconds, a Holter Monitor will record for longer to diagnose arrhythmias. Your doctor may want you to wear a Holter Monitor for 1 to 14 days. During that time, the device records all of your heartbeats. Your doctor uses information captured on the Holter Monitor to figure out if you have a heart rhythm problem. You’ll be asked to keep a diary of all your daily symptoms while you’re wearing the monitor so that symptoms can be correlated with what is captured on the monitor.
Instructions
A Holter Monitor is a small, portable device that is worn while you do your normal daily activities in order to monitor the heart over a longer period of time. You will be asked to sign a responsibility form to ensure that you will return the device on time and in working condition.
Prior to being equipped with the Holter, we suggest taking a shower as you will not be able to shower during the period in which you are wearing the device (typically 24, 48 or 72 hours).
We do ask that you refrain from wearing perfumes, colognes or scented lotions on the day of your appointment. There are no pretest dietary restrictions, and you should continue to take any prescribed medications as normal, unless otherwise advised by your doctor.
Test Process
- Holter Monitoring is a painless procedure. In preparation, a technician will place electrodes on your chest, arms, and legs. The technologist may be required to shave these areas to help the electrodes stick.
- The technician will instruct you on how to record symptoms as they occur in a Patient’s Diary, which will be provided for you and requested by your technician when you return the device.
- A Holter Monitor is a delicate and expensive medical device. As such, you will be asked to sign a responsibility form to ensure that you will return the device on time and in working condition.
After the Test
- Following a Holter Monitor, you may develop redness where the electrodes were attached. This mild redness often goes away quickly and without treatment.
- Patients are typically able to return to work or other activities immediately following an ECG.
- Please arrive 10 minutes before your test to register at the reception desk.
Echocardiography (ECHO)
An echocardiogram (also known as an ‘echo’) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen.
Echocardiograms can be done in different ways. These types include transthoracic, transesophageal, contrast and stress echocardiograms. A Doppler echo shows blood flow through the heart and blood vessels. It can be done during any of these types of echocardiograms.
A transthoracic echocardiogram is a safe, painless, and important test that helps your doctor understand how your heart is working.
Types of echocardiograms:
The different types of echocardiograms are:
- Transthoracic echocardiogram (TTE). This is the most common type. Views of the heart are obtained by moving the transducer to different locations on your chest or abdominal wall.
- Stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed by having you exercise on a treadmill. This test is usually done to find out if you might have decreased blood flow to your heart (coronary artery disease).
- Doppler echocardiogram. This test can be done during a TTE, TEE, or a stress echocardiogram. It is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through your heart and blood vessels. Doppler measurements may be displayed in black and white or in color.
- A Contrast Echocardiogram is a specific type of echocardiogram which uses a special ultrasound enhancing agent that is injected into one of the veins in your arm to help show structures in the heart better. It allows the inside of the heart to be seen more clearly on the ultrasound pictures. Additional note for Contrast Echo: There is an extremely small risk (less than 1 in 10,000) of developing an allergic reaction to the agent used. Uncommon but possible side effects can include dizziness, weakness, fatigue, palpitations, headaches, and nausea. Also, the contrast agent used is not the same contrast agent used for CT, MRI or angiography.
Additional note for Contrast Echo:
There is an extremely small risk (less than 1 in 10,000) of developing an allergic reaction to the agent used. Uncommon but possible side effects can include dizziness, weakness, fatigue, palpitations, headaches, and nausea. Also, the contrast agent used is not the same contrast agent used for CT, MRI or angiography.
Why is it Done?
It helps guide diagnosis, treatment, and follow-up. Your doctor may order an echocardiogram if you have:
- Shortness of breath, chest pain, or palpitations
- A heart murmur
- A known heart condition (like valve disease or heart failure)
- High blood pressure or other risk factors for heart disease
Instructions
No special preparation is usually needed.
You can eat and drink as normal.
Take your medications as prescribed (unless your doctor gives other instructions).
Wear a comfortable two-piece outfit, you’ll need to undress from the waist up.
Test Process
- You will lie on a table on your side.
- A sonographer (ultrasound technician) will place small sticky patches (electrodes) on your chest to monitor your heartbeat.
- A gel will be applied, and a handheld device (probe) will be moved over your chest.
- You may be asked to take deep breaths or change positions.
- The test is painless, though you may feel a little pressure from the probe.
- The test usually takes 30–45 minutes.
After the Test
- There are no restrictions afterward, you can drive and return to your usual activities.
- A cardiologist will review the images and send a report to your doctor.
- Your doctor will discuss the results with you at a follow-up appointment.
Safety and Comfort
- An echocardiogram is very safe, it does not use X-rays or radiation.
- There are no known risks.
- If you feel discomfort during the test, let the sonographer know.
Exercise Stress Test
An important tool in the evaluation and management of patients with known or suspected coronary heart disease. While stress testing can be performed in a variety of ways, the most commonly used are electrocardiography and exercise on a treadmill combined with imaging.
Instructions
Please wear comfortable clothes and running shoes as there will be physical activity during the test. We also ask that you refrain from wearing perfumes, colognes or scented lotions on the day of your appointment. There are no pretest dietary restrictions, and you should continue to take any prescribed medications as normal, unless otherwise advised by your doctor.
Test Process
- Exercise Stress Testing appointments usually last around 30 to 40 minutes (This includes patient preparation and recovery).
- The test begins with a cardiovascular technologist placing electrodes on your chest and abdomen area. The technologist may be required to shave these areas to allow for a better electrical connection. Patients will also be provided with a gown if needed.
- You will be instructed to walk on a treadmill for as long as you can, usually around 7 to 9 minutes, as this increases the effectiveness of the test.
- ECG images will be taken throughout the test.
- Exercise Stress Test is generally a very safe procedure, although it may trigger symptoms or arrhythmias. You will be advised to immediately notify the technologist if you experience symptoms such as chest pain, shortness of breath or light-headedness. Our medical team and emergency equipment are available at all times.
After the Test
- Following the test, patients may experience some mild skin irritation from the electrodes. This usually goes away quickly and without treatment.
- Patients are typically able to return to work or other activities immediately following an exercise stress test.
- Please arrive 10 minutes before your test to register at the reception desk.
Resting MUGA
(Multigated Acquisition) Scan
A Resting MUGA scan is a 1.5 hour non-invasive nuclear cardiology test that evaluates how well the heart’s ventricles pump blood at rest. It provides information about the heart’s function, specifically the left ventricular ejection fraction. A small amount of radioactive tracer (Technetium-99m) is injected into the bloodstream, where it is detected by the gamma camera as it circulates through the heart.
Instructions
There is no specific preparation required for a MUGA scan. You can eat and drink as usual prior to the test. Take your usual medications unless otherwise instructed by your physician. Wear loose, comfortable clothing and please leave jewelry at home. Patients should not be around pregnant women, infants and small children for the rest of the day after the test is completed.
Nuclear Stress Test
(Myocardial Perfusion Imaging)
Nuclear stress myocardial perfusion imaging (MPI) is a 3-4 hour non-invasive nuclear cardiology test that assesses blood flow to the heart muscle and helps diagnose coronary artery disease.
A small amount of a radioactive tracer, known as Myoview, is injected into the patient’s bloodstream, where it is absorbed by heart tissue. A single photon emission computed tomography (SPECT) gamma camera detects the radiation emitted by the tracer to generate images of the heart. Two image sets are obtained: one following the tracer injection at rest, and another after injection during a stress test, which may involve either physical exercise on a treadmill or drug-induced stress using persantine (dipyridamole) to simulate exercise.
Instructions
Eating/Drinking: Consume a light meal at least 2 hours prior to the test. Bring a snack/drink to your appointment. Avoid all beverages and foods containing caffeine (coffee, tea, decaffeinated drinks, soft drinks, energy drinks, hot chocolate, chocolate) for 24 hours prior to the test. Avoid all medications containing caffeine such as Anacin, Diurex, Dristan, Excedrin, Fioricet, Fiorinal, Goody’s, Midol and Tylenol (1, 2 and 3) for 24 hours prior to the test.
Medications: Bring a list of all your medications with you to the test. Take all medications as usual unless otherwise instructed by your physician (i.e. beta-blocker and calcium-channel blocker medication may need to be held 24 hours prior to the test). If you use inhalers or any puffer medications, bring them with you to the clinic. Do not take erectile dysfunction medications (Viagra, Cialis, Levitra) 48 hours prior to the test.
Clothing: Wear loose, comfortable clothing and shoes with non-skid soles (for treadmill). Please leave jewelry at home. Do not apply lotions, creams, or powders on the chest area the day of your test. Patients should not be around pregnant women, infants and small children for the rest of the day after the test is completed.
Cardiac Consultation
An opportunity for you to be evaluated by a specialist of cardiology, who has the expertise and training to help evaluate your condition and identify any potential concerns. The cardiologist will ask questions about medical history, physical activity and other information that will help provide an assessment. Should it be determined that further tests are warranted, your cardiologist will request tests.
Instructions
Bring ALL OF YOUR PRESCRIPTION MEDICATIONS for the cardiologist to review. We do ask that you refrain from wearing perfumes, colognes or scented lotions on the day of your appointment. There are no pretest dietary restrictions, and you should continue to take any prescribed medications as normal, unless otherwise advised by your doctor. Arrive 10 minutes before your appointment to register at the reception desk.
Consultation Process
- Request for Consultation: All requests for cardiac consultations must be made by a referring physician, who makes the request on your behalf. The administrative team will provide you with an appointment time based on availability and urgency of request. Prior to your arrival, the cardiologist will receive all required medical information on your cardiac status and indications in order to provide a thorough assessment.
- Follow-Up Appointment: Based on the cardiac consultation and subsequent test results, the cardiologist may request additional test(s) or request that you come in for a follow-up appointment. The cardiologist will provide a detailed explanation of the results, as well as the prognosis and treatment plan if required.
- Cardiac Re-Assessment: A cardiac re-assessment may be requested based on the determination and results of tests. Your cardiologist will review your progress and make any changes to your treatment plan as required.
2D Colour Doppler
Echocardiography (Echo)
An echocardiogram uses ultrasound waves to produce images of your heart. This common test allows your doctor to see your heart beating and pumping blood. Your doctor may suggest an echo for problems with the valves or chambers of your heart.
A Contrast Echocardiogram is a specific type of echocardiogram which uses a special ultrasound enhancing agent that is injected into one of the veins in your arm to help show structures in the heart better. It allows the inside of the heart to be seen more clearly on the ultrasound pictures.
Instructions
Other than wearing loose-fitting clothing, there are no special restrictions or preparation prior to a 2D Doppler echocardiogram. Although the gel is water soluble and should not stain, it can be messy and could get on your clothing, so please be aware and dress appropriately.
We do ask that you refrain from wearing perfumes, colognes or scented lotions on the day of your appointment. There are no pretest dietary restrictions, and you should continue to take any prescribed medications as normal, unless otherwise advised by your doctor.
Additional note for Contrast Echo: There is an extremely small risk (less than 1 in 10,000) of developing an allergic reaction to the agent used. Uncommon but possible side effects can include dizziness, weakness, fatigue, palpitations, headaches, and nausea. Let the technologist know if you have any previous allergic reaction to echo contrast (called perflutren), blood, blood products, albumin, if you are pregnant or breastfeeding, or if you have had any recent procedures.
Test Process
- The test will take about 45 minutes.
- You will be asked to remove your shirt and put on a gown to keep you comfortable and maintain privacy.
- While lying on an examination table, a technician will apply a colourless gel to your chest, and then a transducer will be moved back and forth across different areas to obtain multiple views of your heart.
- You may be asked to move from your back and to the side. Instructions may also be given for you to breathe slowly or to hold your breath. This helps in obtaining higher-quality pictures.
- With Doppler echocardiograms, as the transducer moves over your heart, you will hear a “whooshing” sound, much like that of a washing machine. This sound relates to the movement of blood within your heart chambers.
- The images are constantly viewed on the monitor and recorded for a permanent record of the examination. This is reviewed by the physician prior to completion of the final report.
Patient Resources & Support
We’re here to help you feel prepared and informed. For answers to common questions, visit our FAQ page. For general information about appointments, accessibility, parking, and support, our Patient Resources page is a great starting point.
Frequently Asked Questions
