Chattahoochee Valley Cardiology

Exercise Stress Test

What is an exercise stress test?

A nuclear exercise stress test is a diagnostic test used to evaluate blood flow to the heart. During the test, a small amount of radioactive tracer is injected into a vein. A special camera, called a gamma camera, detects the radiation released by the tracer to produce computer images of the heart.

Combined with exercise, the test can help determine if there is adequate blood flow to the heart during activity versus at rest.

Can I eat or drink on the day of the test?

DO NOT eat or drink anything after Midnight before the test. If you must take medications, drink only small sips of water to help you swallow your pills.

Avoid all products containing caffeine for 24 hours before the test. In general, caffeine is found in coffee, tea, soft drinks and chocolate products.

Also avoid decaffeinated or caffeine-free products for 24 hours before the test, as these products contain trace amounts of caffeine.

Should I take my medications the day of the test? 

Please bring a copy of all of your medications, including over-the-counter medications and supplements, that you routinely take to the test appointment.

Please follow these guidelines about taking your medications the day of the test.

  • Medications with caffeine: DO NOT take any over-the-counter medication that contains caffeine (such as Excedrin®, Anacin®, diet pills and No Doz®) for 24 hours before the test. Ask your physician, pharmacist or nurse if you have questions about other medications that may contain caffeine.
  • If you have asthma: Your physician will tell you NOT to take theophylline (Theo-Dur®) for 48 hours before the test. Please plan to bring your asthma inhaler mediation to the test.
  • If you have diabetes: If you take insulin to control your blood sugar, ask your physician how much insulin you should take the day of the test. Your physician may tell you to take only half of your usual morning dose and to eat a light meal four hours before the test. If you take pills to control your blood sugar, do not take your medication until after the test is complete. Bring your diabetes medications with you so you can take it when the test is complete. Do not take your diabetes medication and skip a meal before the test. If you own a glucose monitor, bring it with you to check your blood sugar levels before and after your test. If you think your blood sugar is low, tell the lab personnel immediately. Plan to eat and take your blood sugar medication following your test.

If you take heart medications: DO NOT take the following heart medications on the day of the test unless your physician tells you otherwise, or unless it is needed to treat chest discomfort the day of the test:

  • Isosorbide dinitrate (for example: Dilatrate, Isordil)
  • Isosorbide mononitrate (for example: Imdur, ISMO, Monoket)
  • Nitroglycerin (for example: Minitran, Nitropatches, Nitrostat)
  • Dipyridamole (Persantine): Stop taking 48 hours before the test.

Your physician may also ask you to stop taking other heart medications on the day of your test. If you have any questions about your medications, ask your physician. Do not discontinue any medication without first talking with your physician.

What should I wear for the test?

Please wear comfortable clothes and shoes suitable for walking during the test.

What to expect during the test

  • The testing area is supervised by a Physician Assistant.
  • A nuclear medicine technologist will place an IV into a vein in your arm or hand to do the injection of the radioactive tracer.
  • Next, a technician will place electrodes on your chest to monitor your EKG
  • You will start walking on a treadmill. At regular intervals, the difficulty of the exercise will increase until you achieve the target heart rate. Then, a dose of radioactive tracer will be injected into the IV. The tracer is not a dye or contrast. Your heart rate, EKG and blood pressure will be monitored throughout the test. If you are unable to achieve your target heart rate, a medication may be given to simulate exercise.
  • About 30 minutes after exercising, you will be asked to lie very still under the camera with both arms over your head for about 15-20 minutes. The camera will record images that show blood flow through your heart during exercise. These images will be compared to the resting images.
  • At this time, you will be allow to leave for lunch and given a time to return for your resting studies.
  • Upon return a small amount of radioactive tracer will be injected into the IV. After the tracer is injected, you will wait about 20 minutes before the last set of “resting” images are taken.
  • Then you will be asked to lie very still under the gamma camera with both arms above your head for about 15 to 20 minutes. The camera will record images that show blood flow through your heart at rest.

How long will the test last?

It is difficult to determine the time of each test. This depends on how long you are able to walk, whether or not you need to be given medication to stimulate your heart, and/or whether or not any images need to be repeated. So we ask our patients to plan on spending an enjoyable full day with us.

How do I get the results of my test?

After Dr. Hubbuch has had a chance to review the results, he or someone from the office will call you to discuss the results with you or answer any questions you may have. If any complication is noted you will be contacted the next day. All patients should have a 2-4 week follow up from the test. Even if the results appear normal it is important that you keep your appointment so that we can further evaluate any problem you may be having.

What is a pharmaceutical exercise stress test?

A harmaceutical stress test is the same as an exercise stress test, except that you will not be walking on the treadmill. Instead you will be given a medication such as Lexiscan or Adenosine to stimulate you heart. As with the exercise stress test, you will be monitored throughout the test.


What is an echocardiogram?

An echocardiogram (also called an echo) is a graphic outline of the heart's movement. During an echo test, ultrasound (high-frequency sound waves) from a hand-held probe placed on your chest provides pictures of the heart's valves and chambers to help the sonographer evaluate the pumping action of the heart. Echo is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart's valves.

Why is an echocardiogram performed?

The test is used to:

  • Assess the overall function of your heart
  • Determine the presence of many types of heart disease, such as valve disease, myocardial disease, pericardial disease, infective endocarditis, cardiac masses and congenital heart disease
  • Follow the progress of valve disease over time

Evaluate the effectiveness of your medical or surgical treatments

Can I eat or drink on the day of the test?

Yes. Eat and drink as you normally would the day of the test, unless you are scheduled for additional tests that require you to go without eating or drinking.

Should I take my medications the day of the test?

Take all of your medications at the usual times, as prescribed by your doctor.

What should I wear on the day of the test?

You may wear anything you like. You will change into a hospital gown before the test.

What happens during the test?

  • Before the test, the healthcare provider will explain the procedure in detail, including possible complications and side effects. You will have the opportunity to ask questions.
  • Your test will take place in the Echo Lab.
  • You will be given a hospital gown to wear. You’ll be asked to remove your clothing from the waist up.
  • A cardiac sonographer will place three electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to an electrocardiograph (EKG) monitor that charts your heart’s electrical activity during the test.
  • The sonographer will ask you to lie on your left side on an exam table. The sonographer will place a probe (called a sound-wave transducer) on several areas of your chest. probe will have a small amount of gel on the end, which will not harm your skin. This gel helps produce clearer pictures.
  • Sounds are part of the Doppler signal. You may or may not hear the sounds during the test.
  • You may be asked to change positions several times during the exam so the sonographer can take pictures of different areas of the heart. You may also be asked to hold your breath at times.

How will I feel during the test?

You should feel no major discomfort during the test. You may feel a coolness on your skin from the gel on the transducer, and a slight pressure of the transducer on your chest.

How long does the test take?

The appointment will take about 40 minutes. After the test, you may get dressed and go home or go to your other scheduled appointments.

How do I get the results of my test?

After Dr. Hubbuch has had a chance to review the results, he or someone from the office will call you to discuss the results with you or answer any questions you may have.

Holter Monitoring

What is a Holter Monitor?

A Holter monitor is a small, wearable device that keeps track of your heart rhythm. Your doctor may want you to wear a Holter monitor for one to two days. During that time, the device will record all of your heartbeats.

A Holter monitor test is usually performed after a traditional test to check your heart rhythm (electrocardiogram) if the electrocardiogram doesn't give your doctor enough information about your heart's condition.

Your doctor uses information captured on the Holter monitor to determine whether or not you may have a heart rhythm problem. If standard Holter monitoring doesn't capture your irregular heartbeat, your doctor may suggest a wireless Holter monitor, which can work for weeks.

While wearing a Holter monitor may be a little inconvenient, it's an important test that may help your doctor diagnose your condition.

Why it's done

If you have signs or symptoms of a heart problem, such as an irregular heartbeat (arrhythmia) or unexplained fainting, your doctor may order a test called an electrocardiogram. An electrocardiogram is a brief, noninvasive test that uses electrodes taped to your chest to check your heart's rhythm.

However, sometimes an electrocardiogram doesn't detect any irregularities in your heart rhythm because you're only hooked up to the machine for a short time. If your signs and symptoms suggest that an occasionally irregular heart rhythm may be causing your condition, your doctor may recommend that you wear a Holter monitor for a day or so.

Over that time, the Holter monitor may be able to detect irregularities in your heart rhythm that an electrocardiogram couldn't detect.

Your doctor may also order a Holter monitor if you have a heart condition that increases your risk of an abnormal heart rhythm. Your doctor may suggest you wear a Holter monitor for a day or two, even if you haven't had any symptoms of an abnormal heartbeat.

Can I eat or Drink?

Yes, Eat and drink as you normally would while wearing the Holter monitor.

Should I take my medication while wearing the Holter monitor?

Take all your medications at the usual time, as prescribed by your physician.

What should I wear?

Wear comfortable clothes that are loose-fitting. A button-up shirt is helpful vs. one that must be pulled over the head.

What should I do while wearing the Holter monitor?

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 which makes it harder for your doctor to see the real rhythm of your heart. The nurse 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.

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.

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. (This is why the nurse may need to shave the area where she/he will attach the patches.)

Other everyday items also can disrupt the signal between the sensors and the monitor. These items include magnets, metal detectors, microwave ovens, electric blankets, toothbrushes and razors. Avoid using these items. Also avoid areas with high voltage.

Cell phones, tablets, and MP3 players (such as iPods) may interfere with the signal between the sensors and the monitor if they're too close to the monitor. When using any electronic device, try to keep it at least six inches away from the monitor.

Keeping a diary

While using a Holter or event monitor, the nurse 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 your doctor will match the data with the information in your diary. This allows your 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.

How should I feel during the test?

You should feel no major discomfort during while wearing the Holter monitor.

How long does the test take?

Depending upon what your physician orders, you will wear the monitor for 24-48 hours.

How do I get the results of my test?

After Dr. Hubbuch has had a chance to review the results, he or someone from the office will call you to discuss the results with you or answer any questions you may have. 

Cardiac Catheterization

What is a Cardiac Catheterization?

Cardiac catheterization (also called cardiac cath or coronary angiogram) is an invasive imaging procedure that allows your doctor to evaluate your heart function. Cardiac catheterization is used to:

  • Evaluate or confirm the presence of coronary artery disease, valve disease or disease of the aorta
  • Evaluate heart muscle function
  • Determine the need for further treatment such as an interventional procedure or coronary artery bypass graft (CABG) surgery

During a cardiac catheterization, a long, narrow tube called a catheter is inserted through a plastic introducer sheath (a short, hollow tube that is inserted into a blood vessel in your leg or arm). The catheter is guided through the blood vessel to the coronary arteries with the aid of a special x-ray machine.

Contrast material is injected through the catheter and x-ray movies are created as the contrast material moves through the heart’s chambers, valves and major vessels. This part of the procedure is called a coronary angiogram (or coronary angiography).

Coronary artery disease is the narrowing or blockage of the coronary (heart) arteries. After an interventional procedure, the coronary artery is opened, increasing blood flow to the heart. The digital photographs of the contrast material are used to identify the site of the narrowing or blockage in the coronary artery.

Additional imaging procedures, called intra-vascular ultrasound (IVUS) and fractional flow reserve (FFR) may be performed along with cardiac catheterization in some cases to obtain detailed images of the walls of the blood vessels. Both of these imaging procedures are currently only available in specialized hospitals and research centers.

With IVUS, a miniature sound-probe (transducer) is positioned on the tip of a coronary catheter. The catheter is threaded through the coronary arteries and, using high-frequency sound waves, produces detailed images of the inside walls of the arteries. IVUS produces an accurate picture of the location and extent of plaque.

With FFR, a special wire is threaded through the artery and a vasodilator medication is given. This test is functionally performing a very high quality stress test for a short segment of the artery.

Will I be awake during the procedure?

Yes. You will be given a mild sedative to relax you, but you will be awake and conscious during the entire procedure. The doctor will use a local anesthetic to numb the catheter insertion site.

Cardiac catheterization is not considered a surgical procedure because there is no large incision used to open the chest, and the recovery time is much shorter than that of surgery. In some cases, surgery may be recommended afterward, depending on the results of the procedure.

Where is the catheterization performed and who performs it?

Cardiac catheterizations are performed in the Cardiac Catheterization Laboratory. Catheterizations are performed by a specially-trained cardiovascular invasive physician and a cardiovascular team of cardiology fellows, nurses and technicians. The Cardiac Catheterization Lab is located on Level 1. If you park on the orange level in the Butler Pavilion parking garage, you will be on Level 1. After passing the elevators in the Butler Pavilion, make a right into the hospital. Someone will be at the desk to assist you.

Can I eat or drink before my procedure?

No, we ask that you not eat or drink after midnight. However, if your test is scheduled late in the day you physician may allow you to eat a light breakfast. Discuss this with your physician.

How long does the procedure last?

The cardiac catheterization procedure itself generally takes 30 minutes, but the preparation and recovery time add several hours to your appointment time (five to nine hours or longer). If you have an interventional procedure you may need to say overnight. We ask that you please plan on staying overnight.

Should I take my medications?

Your physician will advise you on what medications to take the day of your procedure. It is of the utmost importance that you bring all your medications in their original bottles with you to the hospital.

What should I wear?

Wear comfortable loose-fitting clothes as your groin area maybe slightly sore. Do not wear tight jeans or clothing. We suggest you pack a bag for a possible one-night stay.

What are the possible risks?

The cardiologist will discuss the specific risks and potential benefits of the procedure with you. Some of the possible risks of cardiac cath includes:

  • Allergic reaction to the medication or contrast material used during the procedure
  • Irregular heart rhythm
  • Infection
  • Bleeding at the catheter insertion site
  • Continued chest pain or angina
  • Mild to moderate skin reactions (like a sun-burn) from X-ray exposure
  • Kidney failure
  • Heart attack, blood clots, stroke or death
  • Acute closure of coronary artery
  • Emergency coronary artery bypass graft (CABG) surgery

There may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand why the procedure is recommended and what all of the potential risks are.

When will I get my results?

After completing your procedure, the physician will speak with both you and your family regarding your results.

Other additional information

It is imperative that you have someone with you who can speak with the physician and drive you home. If you do not have an escort, the physician will not perform the procedure.

As mentioned above, you must have all your medications in their original bottles.

If you are allergic to any medications, tell the nurse upon arrival.

If you are on blood thinners, discuss this with your physician 3-7 days prior to the test. If you do not discuss this with your physician, your procedure maybe rescheduled due to the blood thinners.

After your procedure, you will need to lay flat for several hours. We have a beautiful and comfortable waiting room for family and friends. Out of respect for our other guests and staff, we ask that only one or two family members be in the room with you at the same time. The nurses will be in and out checking your vital signs and puncture area.

If you have any additional questions or concerns, please contact at our office at 706-565-7382.