Diagnostic Tests in La Crosse

Learn about the variety of tests we provide to help diagnose a variety of heart diseases and conditions: 

• Ambulatory blood pressure monitor
• Electrocardiogram (EKG)
• Coronary CT angiogram
• Echocardiogram
• Coronary calcium score
• Stress test

Ambulatory blood pressure monitor

What is an ambulatory blood pressure monitor?

An ambulatory blood pressure monitor (ABPM) test is a diagnostic procedure that involves the use of a portable device to measure and record your blood pressure over a 24-hour period or longer. Unlike a traditional blood pressure measurement taken at a doctor's office, ABPM provides continuous monitoring of your blood pressure throughout your normal daily activities, including during sleep.

During an ABPM test, a small, lightweight device is attached to your arm with a cuff that inflates and deflates at regular intervals to measure your blood pressure. The device is programmed to take readings automatically, typically every 15 to 30 minutes during the day and every 30 to 60 minutes at night. These readings are stored in the device's memory for later analysis by your healthcare provider.

The purpose of ABPM is to obtain a comprehensive and accurate assessment of your blood pressure patterns over a longer period, as it can vary throughout the day. It can help identify any abnormal fluctuations, such as high blood pressure or low blood pressure that may not be apparent during a single visit to the doctor's office.

How to prepare for ambulatory blood pressure monitoring

Your heart care team will provide you with specific instructions for how to prepare for your ambulatory blood pressure monitoring. Some general tips include:

1. Choose a 24-hour period that best represents your normal routine. This may mean choosing a weekday rather than a weekend.
2. Wear suitable clothing: Choose loose-fitting clothing that can easily accommodate the blood pressure cuff. Avoid tight sleeves or restrictive clothing that may interfere with the proper placement of the cuff.
3. Avoid caffeine and nicotine: For at least 24 hours before the monitoring, avoid consuming caffeine and nicotine. These substances can affect your blood pressure and may influence the results.
4. Follow medication instructions: Ask your care team whether you should continue taking your medication during the monitoring period. They may advise you to maintain your regular medication schedule or make specific adjustments.
5. Keep a diary: You may be asked to keep a record of your activities and symptoms during the monitoring period. Note the time and details of any physical activities, emotional stress, meals, or other relevant events. This information can help correlate blood pressure readings with your daily routine.
6. Relaxation and sleep: Try to maintain a normal routine during the monitoring period. Engage in activities that help you relax and ensure you get a good night's sleep before the procedure. Avoid excessive physical exertion or stressful situations that can influence your blood pressure readings.
7. Shower and clean the skin: Before attaching the device, shower or bathe to ensure your skin is clean and free from lotions, oils, or any other substances that could interfere with proper adhesion.
8. Maintain a normal routine: During your monitoring period, try to go about your usual daily activities while keeping the device in place. However, follow any specific instructions given by your healthcare provider, such as avoiding water exposure if the device is not waterproof.

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Electrocardiogram (EKG)

What is an electrocardiogram?

An EKG, or electrocardiogram, records the electrical signals in your heart. It's a common and painless test used to quickly detect heart problems and monitor your heart's health.

An EKG is a painless, noninvasive way to diagnose many common heart problems in people of all ages. During the test, small, adhesive electrodes will be attached to your chest, arms, and legs to record the electrical activity of your heart. The electrodes are connected to an EKG machine that prints out a graph displaying your heart's electrical signals. Your health care provider may use an EKG to determine or detect:

• Abnormal heart rhythm, or arrhythmias
• If blocked or narrowed arteries in your heart ― coronary artery disease ― are causing chest pain or a heart attack
• Whether you have had a previous heart attack
• How well certain heart disease treatments, such as a pacemaker, are working

You may need an EKG if you have any of these signs or symptoms

• Chest pain
• Dizziness, lightheadedness or confusion
• Heart palpitations
• Rapid pulse
• Shortness of breath
• Weakness, fatigue or a decline in ability to exercise

If your symptoms tend to come and go, they may not be captured during a standard EKG recording. In this case, your health care provider may recommend remote or continuous EKG monitoring.

There are two monitor types:

• Holter monitor — a Holter monitor is a small, wearable device that records a continuous EKG, usually for 24 to 48 hours.
• Event monitor — this portable device is similar to a Holter monitor, but it records only at certain times for a few minutes at a time. You can wear it longer than a Holter monitor, typically 30 days. You generally push a button when you feel symptoms. Some devices automatically record when an abnormal rhythm is detected.

How to prepare for an EKG

Preparing for an electrocardiogram (EKG or ECG) involves a few simple steps to ensure accurate results. Here's a guide to help you prepare for an EKG:

1. Communicate with your care team: Inform your healthcare provider about any medications you are taking, including over-the-counter drugs, supplements, or herbal remedies. Some medications can affect the electrical activity of your heart, so your team may advise you to temporarily stop or adjust certain medications before the test.
2. Dress appropriately: Wear loose, comfortable clothing that allows easy access to your chest and limbs. You may need to remove your shirt or wear a hospital gown during the procedure.
3. Avoid lotions and oils: Before the EKG, avoid applying lotions, oils, or powders to your chest area. These substances can interfere with the electrodes' ability to stick to your skin, affecting the quality of the EKG tracings.
4. Inform the technician about any physical limitations: If you have difficulty lying flat on your back or if you have any physical limitations that may affect your ability to assume the required positions during the procedure, let the technician know. They can make accommodations or suggest alternative positions if necessary.
5. Communicate any concerns: If you have a fear of enclosed spaces (claustrophobia) or anxiety about medical procedures, inform the healthcare provider or technician beforehand. They can offer reassurance and support to help you feel more at ease during the EKG.
6. Limit physical activity and caffeine intake: Avoid strenuous exercise or any activity that may elevate your heart rate for a few hours before the test. Additionally, it's best to avoid consuming caffeine before the EKG, as it can affect your heart rate and potentially interfere with the results.
7. Follow specific instructions: Depending on the type of EKG being performed, your healthcare provider may provide specific instructions for preparation. For example, if you're having a stress test (exercise EKG), you may need to avoid eating or drinking for a few hours before the test. Always follow the instructions given by your healthcare provider.

If you have any specific concerns or questions about preparing for an EKG, it's best to consult with your healthcare provider or the technician conducting the test. They can provide personalized guidance based on your individual circumstances.

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Coronary CT angiogram

What is a coronary CT angiogram?

A coronary CT angiogram uses advanced CT technology and an injected dye to obtain high-resolution 3D pictures of the moving heart and major vessels. The 3D pictures are used to detect blockages in the coronary arteries.

During a coronary CT angiogram, X-rays pass through the body and are picked up by detectors in the scanner, producing 3D images. These images enable your care team to determine whether plaque or calcium deposits are present in artery walls.

How to prepare for a coronary CT angiogram

Preparing for a coronary CT angiogram (CTA) involves a few steps to ensure a safe and successful procedure. Here's a general guide on how to prepare:

1. Consult with your care team: Talk to your care team about why you need a coronary angiogram CT, the procedure involved, and any specific instructions they may have for you. They will provide personalized guidance based on your medical history and specific needs.
2. Provide your medical history: Inform your healthcare provider about any medical conditions you have, including allergies, kidney problems, diabetes, or thyroid disorders. Also, let them know about any previous reactions to contrast dye or iodine, as this may affect the procedure.
3. Medication review: Inform your healthcare provider about all the medications you are currently taking, including prescription drugs, over-the-counter medications, and supplements. They may provide specific instructions on whether to continue or adjust your medication regimen before the procedure.
4. Fasting: You may be required to fast for a certain period before the coronary angiogram CT. Typically, this means avoiding food and beverages, including water, for a few hours prior to the procedure. Your healthcare provider will provide specific fasting instructions.
5. Contrast dye and allergies: If you have a known allergy to contrast dye or iodine, inform your healthcare provider. They may take precautions, such as prescribing medications or using alternative imaging techniques to minimize the risk of an allergic reaction.
6. Clothing and personal items: Wear comfortable clothing on the day of the procedure, preferably loose-fitting garments that are easy to remove. You may be asked to change into a hospital gown. Leave any jewelry, watches, or other metal objects at home or remove them before the procedure, as they may interfere with the imaging process.
7. Transportation: Arrange for transportation to and from the medical facility. You may be given a sedative or other medication to help you relax during the procedure, which can impair your ability to drive afterward.

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Echocardiogram

What is an echocardiogram?

An echocardiogram uses sound waves to produce images of your heart. This common test allows your health care provider to see your heart beating and pumping blood. Your health care provider can use the images from an echocardiogram to identify heart disease.

Your health care provider may suggest an echocardiogram to:

• Check for problems with the valves or chambers of your heart.
• Check if heart problems are the cause of symptoms such as shortness of breath or chest pain.
• Detect congenital heart defects before birth (fetal echocardiogram).

Depending on what information your health care provider needs, you may have one of several types of echocardiograms:

• Transthoracic echocardiogram — in this standard type of echocardiogram:
  • A sonographer spreads gel on a device called a transducer.
  • The sonographer presses the transducer firmly against your skin, aiming an ultrasound beam through your chest to your heart.
  • The transducer records the sound wave echoes from your heart.
  • A computer converts the echoes into moving images on a monitor.
  • If your lungs or ribs block the view, you may need a small amount of an enhancing agent injected through an IV line. The enhancing agent, which is generally safe and well-tolerated, will make your heart's structures show up more clearly on a monitor.
• Transesophageal echocardiogram — if your health care provider wants more detailed images or it's difficult to get a clear picture of your heart with a standard echocardiogram, your health care provider may recommend a transesophageal echocardiogram. In this procedure:
  • Your throat will be numbed, and you'll be given medications to help you relax.
  • A flexible tube containing a transducer is guided down your throat and into the tube connecting your mouth to your stomach (esophagus).
  • The transducer records the sound wave echoes from your heart.
  • A computer converts the echoes into detailed moving images of your heart, which your doctor can view on a monitor.
• Doppler echocardiogram — sound waves change pitch when they bounce off blood cells moving through your heart and blood vessels. These changes, or Doppler signals, can help your health care provider measure the speed and direction of the blood flow in your heart.
  Doppler techniques are generally used in transthoracic and transesophageal echocardiograms. Doppler techniques also can be used to check blood flow problems and blood pressure in the arteries of your heart that a traditional ultrasound may not detect. The blood flow shown on the monitor is colorized to help your health care provider pinpoint any problems.
• Stress echocardiogram — some heart problems, particularly those involving the arteries that supply blood to your heart muscle, or the coronary arteries, occur only during physical activity. Your health care provider may recommend a stress echocardiogram to check for coronary artery problems. However, an echocardiogram can't provide information about any blockages in the heart's arteries. In a stress echocardiogram:
  • Ultrasound images of your heart are taken before and immediately after you walk on a treadmill or ride a stationary bike.
  • If you're unable to exercise, you may get an injection of a medication to make your heart pump as hard as if you were exercising.

How to prepare for an echocardiogram

Preparing for an echocardiogram involves a few simple steps. Here's a guide to help you prepare:

1. Consult with your care team: Talk to your care team about why you need an echocardiogram, what to expect during the procedure, and any specific instructions they may have for you.
2. Dress comfortably: Wear loose-fitting clothing that allows easy access to your chest. You may be asked to remove your shirt or wear a hospital gown during the procedure.
3. Medication review: Inform your healthcare provider about all the medications you are currently taking, including prescription drugs, over-the-counter medications, and supplements. They will advise you on whether to continue taking your medications as usual or if any adjustments are necessary for the test.
4. Avoid caffeine and nicotine: For a few hours before the echocardiogram, avoid consuming caffeine and nicotine. These substances can affect your heart rate and potentially interfere with the test.
5. Follow specific instructions: Your healthcare provider may provide additional instructions based on the type of echocardiogram being performed. For example, if you're having a stress echocardiogram, you may be asked to avoid eating or drinking for a specific period of time before the test. Always follow the instructions given by your care team.
6. Relaxation and comfort: Before the procedure, try to stay relaxed and calm. Anxiety and stress can affect your heart rate and blood pressure. Taking deep breaths and practicing relaxation techniques may help you feel more comfortable during the test.

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Coronary calcium score

What is a coronary calcium score?

A coronary calcium score is a specialized X-ray test that provides pictures of your heart that can help your health care provider detect and measure calcium-containing plaque in the arteries.

Plaque inside the arteries of your heart can grow and restrict blood flow to the muscles of the heart. Measuring calcified plaque with a coronary calcium score may allow your health care provider to identify possible coronary artery disease before you have signs and symptoms. Your health care provider will use your test results to determine if you may need medication or lifestyle changes to reduce the risk of heart attack or other heart problems.

Your health care provider may order a coronary calcium score to better understand your risk of heart disease or if your treatment plan is uncertain.

A coronary calcium score uses a specialized X-ray technology called "multidetector row" or "multislice" CT, which creates multiple images of plaque deposits in the blood vessels. The imaging test provides an early look at plaque levels.

Plaque is made up of fats, cholesterol, calcium and other substances in the blood. It develops gradually over time, long before there are any signs or symptoms of disease. These deposits can restrict the flow of oxygen-rich blood to the muscles of the heart. Plaque also can burst, triggering a blood clot that can cause a heart attack.

A coronary calcium score can guide treatment if you have a low to moderate risk of heart disease or if your heart disease risk isn't clear. Your health care provider can tell you if you could benefit from having a coronary calcium score based on your risk factors.

A coronary calcium score also may motivate people at moderate risk to make important lifestyle changes and follow treatment plans.

When is a coronary calcium score not used?

A coronary calcium score requires exposure to radiation. While the exposure is generally considered safe, the scan isn't recommended if the risk of radiation exposure outweighs any potential benefit.

According to guidelines from the American College of Cardiology and the American Heart Association, a coronary calcium score may not be recommended for these people:

• Men under 40 and women under 50 because it's unlikely calcium can be detected at younger ages.
• People who have a low risk of heart disease because detectable calcium is highly unlikely if you don't have a family history of heart attacks at an early age.
• People who already have a known high risk for heart disease, especially heavy smokers or those with diabetes or high cholesterol because the coronary calcium score will likely not provide any additional information to guide treatment.
• People with symptoms or a diagnosis of coronary artery disease because the procedure won't help health care providers better understand the disease progression or risk.
• People who already had an abnormal coronary calcium coronary calcium score.

How to prepare for a coronary calcium score

Your heart care team will provide you with specific instructions for how to prepare for your coronary calcium score test. Some general tips include:

1. Consult with your doctor: Talk to your healthcare provider about the specific type of coronary calcium score you will be undergoing. They can provide you with detailed instructions based on your individual needs.
2. Follow dietary or fasting guidelines: In some cases, you may need to follow specific dietary instructions before the coronary calcium score. This might involve avoiding food or beverages for a certain period before the test. For example, you may be asked to avoid caffeine or certain medications that could interfere with the results.
3. Inform about medications: Make sure to inform your doctor about all the medications you are currently taking, including prescription drugs, over-the-counter medications, and any supplements. Some medications may need to be adjusted or temporarily discontinued before the scan.
4. Dress comfortably: Wear loose-fitting clothing and avoid wearing any metal objects, such as jewelry, as they may interfere with the imaging process. You may be asked to change into a hospital gown before the scan.
5. Time considerations: Check with the healthcare facility to determine the length of the procedure and plan your schedule accordingly. Some coronary calcium scores may take longer than others, so be prepared for the time commitment.
6. Stay relaxed: It's natural to feel a bit nervous before a medical procedure. Engaging in relaxation techniques, such as deep breathing or meditation, can help calm your nerves and make the process more comfortable.

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Stress test

What is a stress test?

A stress test, also called an exercise stress test, shows how your heart works during physical activity. Because exercise makes your heart pump harder and faster, an exercise stress test can reveal problems with blood flow within your heart.

A stress test usually involves walking on a treadmill or riding a stationary bike. While you exercise, your heart rhythm, blood pressure and breathing are monitored. Or you'll receive a drug that mimics the effects of exercise.

Your health care provider may recommend a stress test if you have signs or symptoms of coronary artery disease or an irregular heart rhythm, or arrhythmia. The test also may guide treatment decisions, measure the effectiveness of treatment or determine the severity if you've already been diagnosed with a heart condition.

Your health care provider may recommend a stress test to:

• Diagnose coronary artery disease — your coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. Coronary artery disease develops when these arteries become damaged or diseased — usually due to a buildup of deposits containing cholesterol and other substances, or plaques.
• Diagnose arrhythmias — heart arrhythmias occur when the electrical impulses that coordinate your heart rhythm don't function properly, causing your heart to beat too fast, too slowly or irregularly.
• Guide treatment of heart disorders — if you've already been diagnosed with a heart condition, an exercise stress test can help your health care provider find out how well treatment is working. It also can be used to establish your treatment plan by showing how much exercise your heart can handle.
• Determine the timing of cardiac surgery, such as valve replacement — in some people with heart failure, stress test results can help your health care provider determine whether you need a heart transplant or other advanced therapies.

Your health care provider may recommend a test with imaging, such as a nuclear stress test or echocardiographic stress test, if an exercise stress test doesn't pinpoint the cause of your symptoms.

How to prepare for a stress test

Your heart care team will provide you with specific instructions for how to prepare for your stress test. Some general tips include:

1. Medication instructions: Inform your doctor about all the medications you are currently taking, including prescription drugs, over-the-counter medications, and supplements. Some medications may need to be adjusted or temporarily discontinued before the test, particularly if they can affect your heart rate or blood pressure.
2. Dietary instructions: In most cases, you'll be asked to avoid eating or drinking for a few hours before the stress test. However, follow your healthcare provider's instructions regarding fasting or dietary restrictions, as they may vary depending on the specific test protocol.
3. Clothing and footwear: Wear comfortable clothing and shoes suitable for exercise. It's recommended to wear loose-fitting clothes and comfortable athletic shoes that provide good support and traction.
4. Physical activity: Avoid strenuous exercise or physical exertion on the day of the test. Engaging in vigorous activities can affect the results and make the test more challenging.
5. Avoid stimulants: It's advisable to avoid consuming stimulants, such as caffeine or nicotine, for at least a few hours before the test. These substances can increase your heart rate and potentially interfere with the accuracy of the results.
6. Inform the staff: Inform the healthcare staff about any specific health concerns or limitations you may have, such as joint problems or difficulty walking. This allows them to make necessary accommodations and ensure your safety during the test.
7. Follow pre-test instructions: Your healthcare provider may provide you with specific pre-test instructions, such as the time to arrive at the facility or any additional preparations you need to make. Follow these instructions carefully to ensure a smooth testing experience.

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