Cardiac Laboratory

Monitoring The Health of Your Heart

Your heart is an organ that beats more than 100,000 times a day and pumps blood throughout your body. Your blood carries oxygen, which is needed by your heart and other muscles and organs to stay alive. Monmouth Medical Center's Cardiac Laboratory offers state-of-the-art diagnostic services to monitor the health of this muscular pump and provide your doctor with the information needed to determine if a heart problem exists.

The Cardiac Diagnostic Laboratory offers a full range of noninvasive cardiac testing, including echocardiography, both transthoracic and transesophageal, tilt table testing, and stress testing. Both exercise and pharmacological stress testing is offered, with options for nuclear or stress echocardiography imaging. Twenty-four hour holter monitors, ambulatory blood pressure monitors, event monitors, and signal-averaged electrocardiograms are also available for the diagnosis of cardiac problems.

The information on this website is provided to help you understand these cardiac procedures.


Commonly known as an EKG, this test measures the detailed activity of your heart through a graph that traces the variations in electric force which trigger the contractions of the heart. It is used in conjunction with several of the Cardiac Laboratory's diagnostic procedures.

Stress echocardiography, using either exercise or medication to increase the workload on your heart, is performed in the Cardiac Lab. Echo images are obtained at rest. With exercise, stress images are obtained within one minute of reaching the target heart rate.

For Dobutamine Stress Echo, an intravenous drug is administered to increase the heart rate to the age-predicted target as in exercise stress testing. Ultrasound images are obtained throughout the procedure.

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Cardiac Stress Testing

Also known as an exercise tolerance test, this procedure helps determine the cause of your chest pain or other symptom of heart trouble. This test may also be suggested as a screening test prior to undertaking an exercise program.

A cardiac stress test consists of two phases:

  • Exercise performed on a treadmill
  • A recovery period

When undertaking a cardiac stress test, the goal is to raise your heart rate to the maximum rate for your age group. During each phase, you will be connected to an EKG, monitored by a physician, and your blood pressure will be frequently monitored by a registered nurse.

In conjunction with the stress test, your physician also may order a nuclear imaging test, which involves the injection of a small dose of a radioactive substance that illuminates the area of the body to be studied.

To ensure the best results from your cardiac stress test, you are advised to:

  • Wear sneakers or flat walking shoes and comfortable exercise clothes
  • Eat a light meal prior to the test, but avoid coffee, tea, chocolate and other caffeinated food or drinks.

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Stress Echocardiography

Stress echocardiography can be performed utilizing either exercise or medication to increase the workload on your heart. Using the exercise method, an ultrasound image of your heart is taken before exercising and immediately after you reach the targeted heart rate. The medication method employs an intravenous drug called dobutamine, which is administered to increase your heart rate to the age-appropriate level. Ultrasound images of your heart are taken throughout the procedure.

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Pharmacologic (Drug) Stress Testing - Lexiscan, Persantine or Dobutamine

Usually performed on those unable to engage in physical exercise, this non-invasive diagnostic procedure combines nuclear imaging with a drug that increases the demand on your heart to match an exercise-type level.

A cardiologist and a registered nurse will closely observe you through a continuous electrocardiogram and blood pressure monitoring during the procedure.

To ensure the best results from this test, you are advised to:

  • Fast for at least four hours prior to your appointment
  • Avoid caffeine for at least 24 hours prior to the test.

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An echocardiogram uses ultrasound waves to examine your heart and requires no special preparation. It is performed by a nurse/sonographer, who places a small device called a transducer on your chest. The ultrasound waves transmit images of the heart structures on a monitor. These images then are viewed and interpreted by a cardiologist.

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Transesophageal Echocardiography (TEE)

This procedure uses ultrasound technology to allow the cardiologist to clearly visualize the anatomy of your heart and the function of your heart valves. Usually performed on an outpatient basis, a TEE involves the insertion of a small probe into the esophagus and requires mild sedation.

To prepare for this test, you are advised to:

  • Not eat or drink anything for at least six hours prior to the test.
  • Arrange for someone to drive you home.

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Signal Averaging

A type of EKG, this test is performed on recent heart attack patients and individuals who have experienced unexplained blackouts. No special preparation is required for signal averaging, which is used to identify people at high risk for dangerous heart rhythms.

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Tilt Table Testing

Tilt Table Testing is performed in the Cardiac Lab to diagnose a host of cardiovascular conditions including chronic fatigue syndrome, slow heart rate and fainting.

For this procedure, you will be connected to a cardiac monitor and an intravenous line will be inserted. You will be placed on your back on the tilt table, with safety belt across your chest and knees. The bed is tilted head up, to 80 to 85 degrees, for 15 to 20 minutes at the discretion of the attending cardiologist. Vital signs are documented every minute or as needed.

If no symptoms of low blood pressure, slow heart rate, or syncope (fainting) are identified during the baseline study, a graded Isoproterenol (Isuprel) drip may be started or a nitroglycerin tablet under the tongue may be given. Isuprel is an adrenaline-like medication that can bring on symptoms in susceptible patients. The test is ended when a patent becomes symptomatic or achieves a target heart rate.

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Taking A Longer Look - At-Home Monitoring

In addition to the cardiac procedures performed in the Cardiac Laboratory, Monmouth Medical Center also offers a number of diagnostic tests that monitor your heart at home, while you go about your normal daily routine. These procedures include:

Within a few days of undergoing these procedures, your physician will receive a complete report interpreted by a Monmouth Medical Center cardiologist. Your physician can then use this information to develop a treatment plan.

Holter Monitoring

This diagnostic tool performs a continuous EKG that is recorded on a small computer disk as you rest, play and work. This test provides your physician with a much broader picture of your heart's rate and rhythm.

The procedure involves placing seven electrodes connected to a small, lightweight recorder on your chest by an EKG technician. You will be asked to keep a short diary of your activities and symptoms as you wear the recorder, worn under your clothing, for 24 hours.

You are advised not to bathe, shower or open the recorder during this time period. The next day, you will return the recorder, and a cardiologist will use the EKG measurements and the diary to determine how your heart reacts to various activities.

Event Monitor

Performed for individuals whose symptoms occur sporadically and cannot be diagnosed through traditional holter monitoring, event monitoring involves at-home EKG readings for a one-month period. You will be instructed to hold the monitor over your chest when symptoms occur. The data is then stored and transmitted by telephone to a monitoring station for interpretation by a cardiologist.

Ambulatory Blood Pressure Monitor

Similar to the holter monitor, this diagnostic procedure monitors your blood pressure continually over a 24-hour period. You will be asked to keep a diary of activities and symptoms during this time frame, which then will be correlated with any changes in the blood pressure readings.

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