12-Lead ECG Stress Test - -- The patient either walks on a treadmill or is given IV medication which simulates exercise while connected to an ECG machine.
- The patient begins at a very slow pace (1.7 mph) and low grade (0-10%) and speed and grade increases incrementally every 3 minutes until the patient shows positive signs (see below) or simply stops due to physical exhaustion. .
- Positive tests for CHD are ST elevations, ST depressions, and/or T wave
inversions which are usually accompanied by chest pains or shortness of breath.
Treadmill stress test similar to 12-lead ECG
radioactive isotopes (e.g., Thallium-201) are given IV and pictures of the heart are
taken using a gamma camera at rest and immediately following stress test
Areas of the heart that receive the radioactive substance and thus sufficient blood
flow will "glow" whereas the area of the heart not receiving blood will be "dark".
Rest pictures are compared to exercise pictures to determine extent of coronary
A catheter is inserted into the femoral artery (i.e., groin area) or arm.
The tip of the tube is positioned in both the right and left coronary arteries and contrast medium or dye is injected.
X-ray pictures are obtained to identify areas of significant blockage.
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Balloon tip catheter with drug-eluting stent is introduced into the atherosclerotic lesion of the coronary artery
Balloon tip is inflated, opening artery and pressing the stent into the wall of the artery
Balloon tip is deflated and removed leaving stent in place.
Coronary Artery Bypass Graft (CABG)
- Median sternoptomy is performed and catheters introduced to right atrium and arch of aorta and connected to heart lung machine
- heart is stopped by cardioplegia
- graphs using saphenous vein, radial artery, and/or internal mammary artery are used to form an anastomosis beyond coronary lesion
- minimally invasive heart surgery using "The Port Access Techniques" where
heart lung machine and cardioplegia are also being used.