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An ECG stress test, also known as an exercise tolerance test or cardiac stress test, evaluates the adequacy of the blood flow to the heart as increasing amounts of exercise are performed in a closely monitored setting. Normally, the heart rate and blood pressure increase during exercise, and the electrocardiogram (ECG: a recording of the electrical activity of the heart) should show little change, except for the increase in heart rate. However, in the presence of certain kinds of heart conditions, the stress of exercise can cause abnormal changes in the heart rhythm, blood pressure, or ECG. In this way, the stress test can help the doctor assess for the presence of some types of heart disease.
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 An echocardiogram (also called 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. The cardiologist will look at the images and generate a report to your physician.
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.
This test is done to:
- Look for the cause of abnormal heart sounds (murmurs or clicks), an enlarged heart, unexplained chest pains, shortness of breath, or irregular heartbeats.
- Check the thickness and movement of the heart wall.
- Look at the heart valves and check how well they work.
- See how well an artificial heart valve is working.
- Measure the size and shape of the heart's chambers.
- Check the ability of your heart chambers to pump blood (cardiac performance). During an echocardiogram, your doctor can calculate the how much blood your heart is pumping during each heartbeat (ejection fraction). You might have a low ejection fraction if you have heart failure.
- Detect a disease that affects the heart muscle and the way it pumps, such as cardiomyopathy.
A small amount of gel will be rubbed on the left side of your chest to help pick up the sound waves. A small instrument (transducer) that looks like a microphone is pressed firmly against your chest and moved slowly back and forth. This instrument sends sound waves into the chest and picks up the echoes as they reflect off different parts of the heart. The echoes are sent to a video monitor that records pictures of your heart for later viewing and evaluation. The room is usually darkened to help the technician see the pictures on the monitor.
At times you will be asked to hold very still, breathe in and out very slowly, hold your breath, or lie on your left side. The transducer is usually moved to different areas on your chest that provides specific views of your heart. The test usually takes 30 to 45 minutes. When the test is over, the gel is wiped off and the electrodes are removed.
- Stress echocardiogram - During this test, an echocardiogram is done both before and after your heart is stressed by having you exercise or by injecting a medicine that makes your heart beat harder and faster. A stress echocardiogram is usually done to find out if you might have decreased blood flow to your heart (coronary artery disease, or CAD).
- Transesophageal echocardiogram (TEE) - A Transesophageal echocardiogram (TEE), like the transthoracic echocardiogram uses sound waves to make pictures of your heart and valves. For this test, the probe is passed down the esophagus instead of being moved over the outside of the chest wall. TEE shows clearer pictures of your heart, because the probe is located closer to the heart and because the lungs and bones of the chest wall do not block the sound waves produced by the probe.
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Echocardiograms are performed at the Union Square, Upper East Side, Greenpoint and Park Slope offices.
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 An electrocardiogram (also called EKG or ECG) is a test that records the electrical activity of your heart through small electrode patches attached to the skin of your chest, arms, and legs. An EKG may be part of a routine physical exam or it may be used as a test for heart disease. EKGs are quick, safe and painless and are routinely performed if a heart condition is suspected. An EKG can be used to further investigate symptoms related to heart problems.
Your doctor uses the EKG to:
- Assess your heart rhythm.
- Diagnose poor blood flow to the heart muscle (ischemia).
- Diagnose a heart attack.
- Evaluate certain abnormalities of your heart, such as an enlarged heart.
Our EKG department keeps a file of the EKG’s performed at Beth Israel Medical Center for later comparison with future EKG recordings.
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 Electrophysiology testing makes it possible to study heart rhythm disturbances under controlled circumstances. By using special insulated wires called catheters, the doctor is able to identify rhythm disturbance and choose the best method of treatment. Intravenous catheters are placed, usually from the vein in the groin area, so that they can be advanced into the right side of the heart. In the right side of the heart, recordings can be made that give a very clear picture of the normal sequence of electrical activation within the heart.
In addition, the heart can be submitted in a variety of ways in an attempt to elicit abnormal rhythm if they exist. After the catheters are in position, the doctor will evaluate the heart rhythm disturbance by giving the heart small electrical impulses (by artificial pacemaker through one of the catheters) to make it beat at a different rates. This offers important information regarding arrhythmia mechanism, prognosis, risk of serious symptoms and response to medications.
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Enhanced External Counterpulsation, (EECP) treatment is a noninvasive outpatient procedure to relieve or eliminate angina. For many patients, EECP treatments reduce the frequency and intensity of chest pain or eliminate it all together, allowing the patient to participate in everyday activities and improve their quality of life.
This form of treatment works by stimulating the body’s natural process of creating pathways around blocked arteries in the heart by expanding networks of tiny blood vessels that help increase blood flow to the heart muscle. EECP treatments are administered with the patient reclining on a padded treatment table, wrapped in compressive air cuffs applied to the calves, lower and upper thighs, including the buttocks. Treatment duration is typically one hour per day, five days per week for seven weeks, for a total of thirty-five hours.
For more information or to refer a patient, please contact The Alice Lawrence Center for Health and Rehabilitation at .
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