Peripheral angioplasty is a minimally invasive procedure. These procedures are performed under local anesthesia. This is a procedure in which a thin, flexible tube called a catheter is inserted through an artery and guided to the place where the artery is narrowed.

When the tube reaches the narrowed artery, a small balloon at the end of the tube inflates for a short time. The pressure from the inflated balloon presses the fat and calcium (plaque) against the wall of the artery to improve blood flow.

In angioplasty of the aorta (the major abdominal artery) or the iliac arteries (which branch off from the aorta), a small, expandable tube called a stent is usually put in place at the same time. Reclosure (restenosis) of the artery is less likely to occur if a stent is used. Stents are less commonly used in angioplasty of smaller leg arteries like the femoral, popliteal, or tibial arteries, because they are subject to trauma and damage in these locations.

Doppler Vascular Imaging is a noninvasive test that can be used to estimate your blood flow through blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. A regular ultrasound uses sound waves to produce images, but can't show blood flow.

A Doppler ultrasound may help diagnose many conditions, including:

• Blood clots
• Poorly functioning valves in your leg veins, which can cause blood or other fluids to pool in your legs (venous insufficiency)
• Heart valve defects and congenital heart disease
• A blocked artery (arterial occlusion)
• Decreased blood circulation into your legs (peripheral artery disease)
• Bulging arteries (aneurysms)
• Narrowing of an artery, such as in your neck (carotid artery stenosis)
  

A Doppler ultrasound can estimate how fast blood flows by measuring the rate of change in its pitch (frequency). During a Doppler ultrasound, a technician trained in ultrasound imaging (sonographer) presses a small hand-held device (transducer), about the size of a bar of soap, against your skin over the area of your body being examined, moving from one area to another as necessary.

This test may be done as an alternative to more invasive procedures, such as arteriography and venography, which involve injecting dye into the blood vessels so that they show up clearly on X-ray images.

Carotid ultrasound is a painless and harmless test that uses high-frequency sound waves to create pictures of the insides of your carotid arteries. You have two common carotid arteries, one on each side of your neck. They each divide into internal and external carotid arteries.The internal carotid arteries supply oxygen-rich blood to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp, and neck.

Carotid ultrasound shows whether a waxy substance called plaque has built up in your carotid arteries. The buildup of plaque in the carotid arteries is called carotid artery disease.Over time, plaque can harden or rupture (break open). Hardened plaque narrows the carotid arteries and reduces the flow of oxygen-rich blood to the brain.If the plaque ruptures, a blood clot can form on its surface. A clot can mostly or completely block blood flow through a carotid artery, which can cause a stroke.

A piece of plaque or a blood clot also can break away from the wall of the carotid artery. The plaque or clot can travel through the bloodstream and get stuck in one of the brain's smaller arteries. This can block blood flow in the artery and cause a stroke.A standard carotid ultrasound shows the structure of your carotid arteries. Your carotid ultrasound test might include a Doppler ultrasound. Doppler ultrasound is a special test that shows the movement of blood through your blood vessels.Your doctor might need results from both types of ultrasound to fully assess whether you have a blood flow problem in your carotid arteries.

Who Needs Carotid Ultrasound?

A carotid ultrasound shows whether you have plaque buildup in your carotid arteries. Over time, plaque can harden or rupture (break open). This can reduce or block the flow of oxygen-rich blood to your brain and cause a stroke.

Our Doctor may recommend a Carotid Ultrasound if you:

Had a stroke or mini-stroke recently. During a mini-stroke, you may have some or all of the symptoms of a stroke. However, the symptoms usually go away on their own within 24 hours.

Have an abnormal sound called a carotid bruit (broo-E) in one of your carotid arteries. The doctor can hear a carotid bruit using a stethoscope. A bruit might suggest a partial blockage in your carotid artery, which could lead to a stroke.

Anyone has an increased risk of stroke, if you have diabetes and/or high blood pressure.

What To Expect Before Carotid Ultrasound?

Carotid ultrasound is a painless test. Typically, there is little to do in advance of the test. Your doctor will tell you how to prepare for your carotid ultrasound.

What To Expect After Carotid Ultrasound?

You usually can return to your normal activities as soon as the carotid ultrasound is over.

A simple test called an ankle-brachial index (ABI) often is used to diagnose peripheral arterial disease (P.A.D). The ABI compares blood pressure in your ankle to blood pressure in your arm. This test shows how well blood is flowing in your limbs.

ABI can show whether P.A.D. is affecting your limbs, but it won't show which blood vessels are narrowed or blocked.

A normal ABI result is 1.0 or greater (with a range of 0.90 to 1.30). The test takes about 10 to 15 minutes to measure both arms and both ankles.

Treadmill Test

A treadmill test can show the severity of symptoms and the level of exercise that brings them on. You'll walk on a treadmill for this test. This shows whether you have any problems during normal walking.

You may have an ABI test before and after the treadmill test. This will help compare blood flow in your arms and legs before and after exercise.

Some people have heart rhythm problems that occur only during certain activities, such as sleeping or physical exertion. Using a Holter or event monitor increases the chance of recording these problems. Holter and event monitors are medical devices that record the heart's electrical activity. Doctors most often use these monitors to diagnose arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

Holter and event monitors are similar to an EKG (electrocardiogram). An EKG is a simple test that detects and records the heart's electrical activity. It's a common test for diagnosing heart rhythm problems. However, a standard EKG only records the heartbeat for a few seconds. It won't detect heart rhythm problems that don't occur during the test. Holter and event monitors are small, portable devices. You can wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than an EKG.

Although similar, Holter and event monitors aren't the same. A Holter monitor records your heart's electrical activity the entire time you're wearing it. An event monitor records your heart's electrical activity only at certain times while you're wearing it.

Types of Holter and Event Monitors:

Holter Monitor

Holter monitors sometimes are called continuous EKGs (electrocardiograms). This is because Holter monitors record your heart rhythm continuously for 24 to 48 hours.

You can clip the Holter monitor to a belt or carry it in a pocket. Wires connect the device to sensors (called electrodes) that are stuck to your chest using sticky patches. These sensors detect your heart's electrical signals, and the monitor records your heart rhythm.

Event Monitors

Event monitors are similar to Holter monitors. You wear one while you do your normal daily activities. Most event monitors have wires that connect the device to sensors. The sensors are stuck to your chest using sticky patches.

Unlike Holter monitors, event monitors don't continuously record your heart's electrical activity. They only record during symptoms. For many event monitors, you need to start the device when you feel symptoms. Some event monitors start automatically if they detect abnormal heart rhythms.

Different types of event monitors work in slightly different ways. The doctor will explain how to use the monitor before you start wearing it.

Who Needs a Holter or Event Monitor?

The doctor may recommend a Holter or event monitor if he or she thinks you have an arrhythmia. An arrhythmia is a problem with the rate or rhythm of the heartbeat. Holter and event monitors most often are used to detect arrhythmias in people who have:

• Issues with fainting or feeling dizzy. A monitor might be used if causes other than a heart rhythm problem have been ruled out.
• Palpitations that recur with no known cause. Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or fast. You may have these feelings in your chest, throat, or neck.
• People who are being treated for heart rhythm problems also may need to use Holter or event monitors. The monitors can show how well their treatments are working.
• Heart rhythm problems may occur only during certain activities, such sleeping or physical exertion. Holter and event monitors record your heart rhythm while you do your normal daily routine. This allows your doctor to see how your heart responds to various activities.

What To Expect While Using a Holter or Event Monitor?

Your experience while using a Holter or event monitor depends on the type of monitor you have. However, most monitors have some factors in common.

Recording the Heart's Electrical Activity

All monitors record the heart's electrical activity. Thus, maintaining a clear signal between the sensors (electrodes) and the recording device is important. In most cases, the sensors are attached to your chest using sticky patches. Wires connect the sensors to the monitor. You usually can clip the monitor to your belt or carry it in your pocket. A good stick between the patches and your skin helps provide a clear signal. Poor contact leads to a poor recording that's hard for your doctor to read. Oil, too much sweat, and hair can keep the patches from sticking to your skin.

You may need to shave the area where your doctor will attach the patches. If you have to replace the patches, you'll need to clean the area with a special prep pad that your doctor will provide. You may need to use a small amount of special paste or gel to help the patches stick to your skin. Some patches come with paste or gel on them.

Too much movement can pull the patches away from your skin or create "noise" on the EKG (electrocardiogram) strip. An EKG strip is a graph showing the pattern of the heartbeat. Noise looks like a lot of jagged lines; it makes it hard for your doctor to see the real rhythm of your heart. When you have a symptom, stop what you're doing. This will ensure that the recording shows your heart's activity rather than your movement. The doctor will tell you whether you need to adjust your activity level during the testing period. If you exercise, choose a cool location to avoid sweating too much. This will help the patches stay sticky.

Keeping a Diary

While using a Holter or event monitor, the doctor will advise you to keep a diary of your symptoms and activities. Write down what type of symptoms you're having, when they occur, and what you were doing at the time.

The most common symptoms of heart rhythm problems include:

• Fainting or feeling dizzy
• Palpitations. These are feelings that your heart is skipping a beat, fluttering, or beating too hard or fast. You may have these feelings in your chest, throat, or neck.
• Make sure to note the time that symptoms occur, because the doctor will match the data with the information in your diary. This allows the doctor to see whether certain activities trigger changes in your heart rate and rhythm.
• Also, include details in your diary about when you take any medicine or if you feel stress at certain times during the testing period.

What To Expect After Using a Holter or Event Monitor?

After you're finished using a Holter or event monitor, you'll return it to your doctor's office or the place where you picked it up.The doctor will tell you when to expect the results. Once your doctor has reviewed the recordings, he or she will discuss the results with you.

A Doppler ultrasound test may also help your doctor check for injuries to your arteries or to monitor certain treatments to your veins and arteries.

Before the test begins, the doctor or a technician will use a needle to insert an intravenous (IV) line into a vein in your arm. Through this IV line, he or she will put radioactive tracer into your bloodstream at the right time.

You also will have EKG (electrocardiogram) patches attached to your body to check your heart rate during the test. (An EKG is a simple test that detects and records the heart's electrical activity.)

For an exercise stress echocardiogram (echo) test, the sonographer will take pictures of your heart using echocardiography before you exercise and as soon as you finish.

A sonographer (a person who specializes in using ultrasound techniques) will apply gel to your chest. Then, he or she will briefly put a transducer (a wand-like device) against your chest and move it around.

The transducer sends and receives high-pitched sounds that you probably won’t hear. The echoes from the sound waves are converted into moving pictures of your heart on a screen.

Once you have been connected to the EKG electrodes you will exercise on a treadmill. During the test, the exercise level will get harder. You can ask the nurse or physician to stop whenever you feel the exercise is too much for you.

Exercise Stress EKG

The EKG records the heart's electrical activity. A blood pressure cuff is used to record the patient's blood pressure while he walks on a treadmill.

While you're exercising the nurse will ask you how you're feeling. You should tell him or her if you feel chest pain, short of breath, or dizzy.

The exercise will continue until you reach a target heart rate, or until you:

• Feel moderate to severe chest pain
• Get too out of breath to continue
• Develop abnormally high or low blood pressure or an arrhythmia (an irregular heartbeat)
• Become dizzy

The nurse will continue to check your heart functions and blood pressure after the test until they return to normal levels.The "stress" part of a stress test (when your heart is working hard) usually lasts about 15 minutes or less. However, there's prep time before the test and monitoring time afterward.

What To Expect During an Electrocardiogram?

An electrocardiogram (EKG) is painless and harmless. A nurse or technician will attach 12 soft, sticky patches called electrodes to the skin of your chest, arms, and legs. The patches are about the size of a quarter.This helps detect your heart's electrical activity from many areas at the same time.After the patches are placed on your skin, you'll lie still on a table while the patches detect your heart's electrical signals. A machine will record these signals on graph paper or display them on a screen.The entire test will take about 10 minutes.

Echocardiogram, or echo, is a painless test that uses sound waves to create moving pictures of your heart. The pictures show the size and shape of your heart. They also show how well your heart's chambers and valves are working.

Echo also can pinpoint areas of heart muscle that aren't contracting well because of poor blood flow or injury from a previous heart attack. A type of echo called Doppler ultrasound shows how well blood flows through your heart's chambers and valves.

Echo can detect possible blood clots inside the heart, fluid buildup in the pericardium (the sac around the heart), and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to your body.

Who Needs Echocardiography?

The doctor may recommend echocardiography (echo) if you have signs or symptoms of heart problems.

For example, shortness of breath and swelling in the legs are possible signs of heart failure. Heart failure is a condition in which your heart can't pump enough oxygen-rich blood to meet your body's needs. Echo can show how well your heart is pumping blood.Echo also can help your doctor find the cause of abnormal heart sounds, such as heart murmurs. Heart murmurs are extra or unusual sounds heard during the heartbeat. Some heart murmurs are harmless, while others are signs of heart problems.

The doctor also may use echo to learn about:

• The size of your heart. An enlarged heart might be the result of high blood pressure, leaky heart valves, or heart failure.
• Echo also can detect increased thickness of the ventricles (the heart's lower chambers). Increased thickness may be due to high blood pressure, heart valve disease, or congenital heart defects.
• Heart muscles that are weak and aren't pumping well. Damage from a heart attack may cause weak areas of heart muscle. Weakening also might mean that the area isn't getting enough blood supply, a sign of coronary heart disease.
• Heart valve problems. Echo can show whether any of your heart valves don't open normally or close tightly.
• Problems with your heart's structure. Echo can detect congenital heart defects, such as holes in the heart. Congenital heart defects are structural problems present at birth.
• Blood clots or tumors. If you've had a stroke, you may have echo to check for blood clots or tumors that could have caused the stroke.

The doctor also might recommend echo to see how well your heart responds to certain heart treatments, such as those used for heart failure.

What To Expect Before Echocardiography?

No special preparations are needed for most types of echo. You usually can eat, drink, and take any medicines as you normally would. If you're having a stress echo, you may need to take steps to prepare for the stress test. Your doctor will let you know what steps you need to take.

What To Expect During Echocardiography?

Echocardiography (echo) is painless; the test usually takes less than an hour to do.

For most types of echo, you will remove your clothing from the waist up. You will be given a gown to wear during the test. You'll lie on your back or left side on an exam table or stretcher.A doctor or sonographer (a person specially trained to do ultrasounds) will apply gel to your chest. The gel helps the sound waves reach your heart. A wand-like device called a transducer will then be moved around on your chest.The transducer transmits ultrasound waves into your chest. A computer will convert echoes from the sound waves into pictures of your heart on a screen. During the test, the lights in the room will be dimmed so the computer screen is easier to see.

The patient lies on his left side. A sonographer moves the transducer on the patient's chest, while viewing the echo pictures on a computer.The sonographer will record pictures of various parts of your heart. He or she will put the recordings on a computer disc for a cardiologist (heart specialist) to review.During the test, you may be asked to change positions or hold your breath for a short time. This allows the sonographer to get better pictures of your heart.

At times, the sonographer may apply a bit of pressure to your chest with the transducer. You may find this pressure a little uncomfortable, but it helps get the best picture of your heart. You should let the sonographer know if you feel too uncomfortable.

What To Expect After Echocardiography?

You can go back to your normal activities right after having echocardiography (echo).