Testing
Each of our diagnostic tests may require certain preparations. Your doctor will inform you of these preparations when your test is scheduled. For all tests below (except for blood tests) we ask all patients to wear loose, comfortable clothing to their test and avoid wearing cologne, perfume or jewelry. For all tests below, please take your usual medications unless instructed otherwise by your physician. DO NOT DISCONTINUE any medication without first talking with your physician.
FOR ALL STRESS TESTS (Exercise stress echo, exercise stress test and myocardial perfusion imaging): Do not have anything to eat or drink for three hours before the study and NO CAFFEINE-CONTAINING FOOD, DRINKS or medications for 24-hours prior to nuclear myocardial perfusion stress testing). Wear or bring comfortable clothing and rubber-soled shoes.
Ambulatory Blood Pressure Monitor
24-hour Ambulatory Blood Pressure Monitoring (ABPM) allows your physician to review your blood pressure range for 24 (or occasionally 48) hours. Your physician may recommend this type of testing whenever there is a question of whether your blood pressure might only be elevated at the doctor’s office (“white-coat hypertension”) or if there is a question of response to blood pressure medications.
In addition to the monitor, patients will be given a diary to monitor their symptoms or activity that the doctor can use to correlate with potentially very high or low blood pressures. Allow 30 minutes for hook-up in our office with explanation of its use. Patients need to return to the office approximately 24 hours later to return the device. The blood pressure measurements are then analyzed by the physician.
ABPM is thought of as more accurate than office measurements and home monitoring by patients with their own cuff. It can be useful not only for confirming whether hypertension is present or not but also in assistance in hypertension management. ABPM can be used to document the presence of “white-coat” or masked hypertension, resistant and labile hypertension. In addition, ABPM can identify whether a patient is a “dipper” (ABP decreases > 10% during sleep) or nondipper. This distinction is important, as nondipping status has been linked to increased risk for cardiovascular events and end-organ damage.
Please click here for more information about Blood Pressure Monitors.
Sometimes, being able to periodically check your blood pressure at home can be helpful. Having an accurate home BP monitor is important and you can click here to see which devices have been validated for clinical accuracy as determined through an independent review process.
Atherosclerosis Screening with Carotid IMT
Carotid IMT (intima-media thickness) ultrasound allows your physician to find the earliest signs of plaque buildup in arteries (atherosclerosis). Atherosclerosis is the process that ultimately can lead to heart attacks and strokes. Using an easy, quick and painless ultrasound technique, the earliest signs of hidden plaque buildup (first seen as increased thickness of the artery wall) can be recognized. Much more sensitive than regular carotid ultrasound vascular imaging, this special technique, Carotid IMT, has been shown to correlate with future risk of stroke and heart attack.
COR Medical Group, the offices of Drs. Jeffrey Caren and Mark Urman, was the first private medical office in not only the Greater Los Angeles area but actually in all of California (and one of the first private offices in the US) offering CardioHealth®, the latest technology to find the earliest signs atherosclerosis. The CardioHealth® technology is the result of well-validated standardization of the Carotid IMT technique which itself has been around for several years but up until now had not gained widespread use due to difficulty with reliable, reproducible and accurate imaging technique and interpretation (except in a handful of very experienced research centers nationwide). However, the technology behind CardioHealth® has overcome these obstacles to allow routine reliable and accurate clinical testing which is why Drs. Caren and Urman are among the first to have adopted it in their practice for their patients.
It is important to discuss with your cardiologist if you are an appropriate candidate for Carotid IMT imaging. Unlike CAT scans of the heart, there is no radiation exposure and testing takes just a matter of minutes. Results of the carotid IMT ultrasound imaging study and a full CardioHealth® Report including your risk factors for cardiovascular disease are available soon thereafter.
“You are as old as your arteries.”
– Attributed to Physician Sir William Osler (known as the “father of modern medicine”), early 20th century.
Click here for more information on Carotid IMT, atherosclerosis screening and CardioHealth®
Click here to help understand your risk for developing heart disease within the next 10 years (for patients who have NOT been diagnosed with heart disease or diabetes)
Echocardiogram (Echo)
Echocardiography (commonly known as an echo) is a technique that uses sound waves to create images of the heart. These images allow physicians to assess the valves of the heart, as well as the size and function of the chambers. This test is performed by moving a transducer across the chest to produce images of the chambers and valves within the heart. Your doctor may ask you to undergo an echo in order for the cardiologist to:
- Assess the overall function and size of your heart.
- Determine the presence of heart disease.
- Follow the progress of valve disease or heart failure over time.
- Evaluate the effectiveness of medical or surgical treatments.
This test requires you to lie on your left side (and briefly on your back as well) for approximately 30 – 45 minutes although you should plan on spending at least one hour from your arrival at the office until you leave.
Please click here for more specific information on having an echocardiogram.
The medical director of our echocardiography lab is Mark K. Urman, MD, FACC, FASE, FAHA who was among the first cardiologists in Los Angeles to become board-certified in echocardiography (1996) and was named a Fellow of the American Society of Echocardiography (FASE) in 2005.
Our echocardiography lab was one of the first accredited in the US (2008) and has maintained its accreditation since and remains accredited through 2017.
For more information on echocardiography visit:
Electrocardiogram (ECG or EKG)
During an electrocardiogram, electrodes are placed on your upper body and legs to obtain an “electrical image” of the heart. This routine non-invasive test evaluates the heart rhythm, determines whether the electrical system of the heart is functioning properly, and whether parts of the heart might be enlarged or damaged. This test generally takes less than 5 minutes.
There are several reasons for your doctor to recommend an ECG, some of which may include:
- To determine the cause of chest pain, palpitations, dizziness or shortness of breath
- To make sure the blood is receiving adequate blood flow
- To ensure that the heart is strong enough to withstand surgery
- To see if the heart is enlarged for patients with a history of high blood pressure
Please click here for more specific information.
For more information visit: www.cardiosmart.org
For more information on “DIY” (“do-it-yourself”) EKG’s click here
Event Monitor (Event Recorder)
Event Monitoring is a painless way to record your heartbeat away from the doctor’s office.
An event monitor (also sometimes referred to as an event recorder) is a small limited electrocardiogram (ECG) that you wear or carry with you to record irregular heartbeats, which are reviewed by your doctor at a later time. There are two main types: 1) a “non-looping” recorder which is essentially a small “card” and can be carried in a purse or pant pocket and put over the heart while pressing a button when symptoms occur, or; 2) a “memory-loop” recorder which is worn at all times (and is always recording) for several weeks where patients can simply press a button during or after they experience symptoms. You will usually carry these monitors for two to four weeks and which type of device you are given depends on your symptoms and will be decided by your doctor.
We also now have the latest technology, Zio® Patch which is a very small self-adhesive recorder that is worn for two weeks to record all of your heart beats during that time. It has a small button that can be pushed during symptoms to see if abnormal heart rhythms correlate with symptoms.
Your physician may recommend an event recorder whenever you experience symptoms like dizziness, palpitations, skipped beats or other sensations which may occur during normal day to day activities, but not necessarily while you’re in the physician’s office or on a daily basis. Allow 15 – 30 minutes for hook-up in our office with explanation of its use.
Please click here for more specific information on event recorders.
For more information on Zio® Patch, click here.
For more information on event recorders: www.cardiosmart.org
Exercise Stress Echo
An exercise stress echocardiogram produces images of the heart while the patient is at rest and during exercise in order to determine the size and function of the heart, including its chambers and valves. The test is used to:
- Determine how well your heart tolerates activity and your level of fitness
- Evaluate the function of your heart and valves
- Determine your likelihood of having coronary artery disease (blocked arteries)
- Evaluate the effectiveness of your cardiac treatment plan.
What happens during the test?
The technician will first perform a resting EKG, resting echocardiogram, measure your resting heart rate and take your blood pressure. You will then be asked to start exercising and gradually increase your rate of exercise until you are exhausted. Then you will get off the treadmill and quickly return to the exam table and lie on your left side so the technician can perform another echocardiogram. The appointment will take about one hour.
Please click here for more specific information and to review the consent form.
For more on stress testing visit: www.cardiosmart.org
Exercise Stress Test
This test requires you to exercise on a treadmill while your heart rhythm is continuously monitored with an electrocardiogram (ECG). The test may be performed to:
- Determine how well your heart tolerates activity and your level of fitness
- Evaluate the function of your heart and valves
- Determine your likelihood of having coronary artery disease (blocked arteries)
- Evaluate the effectiveness of your cardiac treatment plan.
What happens during the test?
The technician will first perform a resting EKG, measure your resting heart rate and take your blood pressure. You will then be asked to start exercising and gradually increase your rate of exercise until you are exhausted. This test will take approximately 45 minutes to one hour (including getting you hooked up, explaining the test and monitoring you after exercise). For patients who cannot walk on a treadmill, we can arrange for non-exercise (pharmacological stress test) protocols.
Please click here for more specific information and to review the consent form.
Holter Monitor
24-hour Ambulatory ECG (Electrocardiographic) Monitoring (Holter) allows your physician to review your heart’s activity for 24 hours. Your physician may recommend this type of testing whenever you experience symptoms such as dizziness, palpitations, skipped beats or other sensations which may occur during normal day to day activities, but not necessarily while you’re in the physician’s office.
In addition to the monitor, patients will be given a diary to monitor their symptoms that the doctor can use to correlate with irregularities within the heart. Allow 30 minutes for hook-up in our office with explanation of its use. Patients need to return to the office approximately 24 hours later to have the device removed.
Zio® Patch
We also now have the latest technology, Zio® Patch which is a very small self-adhesive recorder that is worn for two weeks recording all of your heart beats. It has a small button that can be pushed during symptoms to see if abnormal heart rhythms correlate with symptoms. While this might not be appropriate for all patients, it has become a helpful and important additional option to help evaluate our patients.Please click here for more specific information on Holter monitoring.
Please click here for more information on Zio® Patch
For more on Holter monitors visit: www.cardiosmart.org
Lab Tests
Our medical assistants are trained and experienced at drawing blood. Blood Drawing blood generally takes less than 5 minutes and routine results are usually available within 24 to 48 hours. Some specialized testing can take longer. You will be contacted if results come back abnormal, and can choose to be contacted for normal results as well.
There are several reasons for your doctor to recommend blood work, some of which include:
- To evaluate your risk of developing heart disease.
- To determine the effectiveness of medication for patient with artery blockages or heart attack
- To determine the overall health of patients with certain symptoms
Myocardial Perfusion Imaging
– Exercise or Pharmacological Nuclear Stress Testing (SPECT)
– Cardiac PET Stress Testing
During myocardial perfusion imaging, electrodes are placed on your upper body to obtain an electrocardiogram (ECG or EKG) and to monitor your heart rhythm continuously during the stress test. The stress test will be performed with the patient exercising on a treadmill (SPECT) or a medication (Lexiscan or adenosine) for those who are unable to exercise with SPECT tests or with all PET scans.
* Our office at 355W is an accredited lab for nuclear cardiology and PET imaging (CV Nuclear, LLC). Click here for more information on Nuclear/PET IACNL accreditation. *
In a myocardial perfusion study, a small amount of a short-acting radioactive material called a tracer or isotope is given through an IV in your arm prior to and during stress testing. Computer-generated images of the heart will be taken at rest and after exercise or adenosine/Lexiscan. The camera will allow us to visualize the blood supply to your heart muscle and observe its function before and after exercise or stress.
This test will take approximately 2 – 3 hours for SPECT (only 1 hour for PET) and is done in our other office in the same building on the third floor: 8635 West Third Street in Suite 355-W.
Please click here for more specific information and to review the consent form
www.cardiosmart.org
If you have any questions about any of the above tests that your doctor has recommended for you or you are scheduled for, please feel free to call our office at (310) 659-0714.
