Midcoast Cardiovascular AssociatesProcedure Instructions

Midcoast Cardiovascular Associates


Procedure Patient Instructions

Hospital Based Procedures:
a. Stress tests – Two basic type of hospital-based stress exist. They differ based on the type of stress used: (1) Physical stress –exercise which is most often obtained with treadmill exercise and (2) Chemical stress –Two types of chemical stress agents are utilized Lexiscan and Dobutamine

i. Lexiscan which is a vasodilator is used primarily with Nuclear Medicine based studies called Cardiolytes’ the most common is called a Lexiscan Cardiolyte. Lexiscan is administered via an IV injection. The stress portion of the test lasts 3 minutes. Once Lexiscan has been given a radioactive tracer call Sestemibi is given. Thirty minutes up to 2 hours later a 20-minute scan identifying areas of cardiac perfusion or heart circulation will be  performed. This scan will be compared to another scan which is performed prior to stress. Comparing the two scans , one at rest and the other after stress will identify areas of your heart with inadequate blood flow.

ii. Dobutamine is an adrenergic agonist agent, which increases your heart rate with its infusion. It is used Primarily for Dobutamine stress echo’s which an infusion of Dobutamine is administered as a continuous infusion with titrating increasing dosage until the target heart rate is obtained. Echo images are obtained at 4 stages during the infusion (prior to infusion, low dose, peak dose and recovery). Comparison of the various echo images will identify areas of your heart with inadequate blood flow.

b. Patient Instructions prior to hospital based stress testing

i. Lexiscan stress testing. Don’t eat anything (NPO) for 6 hours prior to test. Take all medications as prescribed the morning of the test with a sip of water. ABSOLUTELY NO CAFFEINE!!! (Including Excedrin, coffee, chocolate, etc.) 24 hours before test. Caffeine reverses the effect of Lexiscan and may make and abnormal test appear normal and therefore not reveal significant blockage that actually exist.

ii. Dobutamine Stress Echo– NPO for 6 hours prior to test. Take all medications as prescribed the morning of the test with a sip of water. Hold all Beta blocker medication 24-48 hours prior to test (Atenolol, Metoprolol, Propranolol, Inderal, Bystolic).

iii. Treadmill Stress echo – NPO 3-4 hours prior to test. Take all medications as prescribed the morning of the test with a sip of water. Hold all Beta blocker medication 24-48 hours prior to test (Atenolol, Metoprolol, Propranolol, Inderal, Bystolic).

iv. Treadmill stress test– NPO 3-4 hours prior to test. Take all medications as prescribed the morning of the test with a sip of water. Hold all Beta blocker medication 24-48 hours prior to test (Atenolol, Metoprolol, Propranolol, Inderal, Bystolic).

c. Catheterization Lab Procedures
A variety of cardiac procedures are preformed in the catheterization laboratory or hybrid endovascular suite. Most of these procedures are preformed under conscious sedation, which is a form of light anesthesia. You should arrive to “Same Day Surgery” 1-2 hours prior to your scheduled procedure time. In preparing for your procedure the area of your body, which will be accessed, will be shaven (commonly groin, wrist or elbow for vascular or cardiac procedures and chest for pacemakers and defibrillators). An IV will be started and consents for the specific procedure will be reviewed and you will be required to sign or consent prior to proceeding. Although we should have reviewed this is detail in the office, if you have any questions or concerns I will be available prior to procedure to address yours specific questions.

Patient instructions for catheterization or hybrid procedures
i. Cardiac Catheterization’s-Patient is to take all medication as prescribed with a sip of water the morning of procedure especially Aspirin and Plavix, Hold Metformin or Glucophage the day of the procedure and 72 hrs. Following the procedure. Hold Coumadin/Warfarin 3-4 days prior to procedure. Hold Xarelto, Eliquis and Pradaxa 2-3 days prior to procedure. If you are diabetic and take insulin, please take ½ your normal dose. Do not eat after midnight the night prior to procedure or at least 8 hours. Pre-op labs need to be obtained within 7 -14 days prior to procedure. If on Warfarin you will need INR 1-2 days prior to procedure.

ii. Coronary Angioplasty or Stent– Patient is to take all medication as prescribed with a sip of water the morning of procedure especially Aspirin and Plavix, Hold Metformin or Glucophage the day of the procedure and 72 hrs. Following the procedure. Hold Coumadin/Warfarin 3-4 days prior to procedure. Hold Xarelto, Eliquis and Pradaxa 2-3 days prior to procedure. If you are diabetic and take insulin , please take ½ your normal dose. Do not eat after midnight the night prior to procedure or at least 8 hours. Pre-op labs need to be obtained within 7 -14 days prior to procedure. If on Warfarin you will need INR 1-2 days prior to procedure.

iii. Aortogram with run off or peripheral artery procedures– Patient is to take all medication as prescribed with a sip of water the morning of procedure especially Aspirin and Plavix, Hold Metformin or Glucophage the day of the procedure and 72 hrs. Following the procedure. Hold Coumadin/Warfarin 3-4 days prior to procedure. Hold Xarelto, Eliquis and Pradaxa 2-3 days prior to procedure. If you are diabetic and take insulin, please take ½ your normal dose. Do not eat after midnight the night prior to procedure or at least 8 hours. Pre-op labs need to be obtained within 7 -14 days prior to procedure. If on Warfarin you will need INR 1-2 days prior to procedure.

iv. Pacemaker/Implantable Cardiac Defibrillator– AS this is a surgical procedure, it is important be off all types anticoagulants (blood thinners) for an adequate time before plan procedure. If you are on Plavix and or Aspirin please hold for 5 days prior to procedure. Hold Coumadin/Warfarin 3-4 days prior to procedure. Hold Xarelto, Eliquis and Pradaxa 2-3 days prior to procedure. Do not eat anything after midnight the night or at least 8 hours before your procedure. Pre-op labs need to be obtained within 7-14 days of procedure. If on Warfarin will need INR 1-2 days prior to procedure.

v. Cardioversion– Unlike any other procedure Cardioversions require full anticoagulation for at least 3-4 weeks prior to procedures. The goal of cardioversion is to restore normal rhythm and if you are inadequately anticoagulated you are at higher risk of stroke during cardioversion. It is imported to continue all medication prior to procedure. Your INR should be greater than 2.0 or anticoagulated with direct thrombin inhibitors ( Pradaxa, Xarelto or eliquis) for at least 3 consecuative weeks prior to procedure. Do not eat anything after midnight the night prior to procedure or at least 12 hours  prior to procedure. Pre-operative labs should be checked 7 days prior with INR day of procedure if you treated with warfarin.

vi. Hybrid procedures – include complex combination surgical and endovascular procedures Hybrid) and endovascular Abdominal Aortic Aneurysm repair- These procedures differ than the others in that they are preformed under general anesthesia. Do not eat anything after midnight the day prior to the procedure or at least 12 hours prior to procedure. Depending on the specific procedure preoperative anticoagulation will differ and specific instructions will be given to you at your preoperative visit.

vii. Transesophageal Echo– This is used to get a more detailed ultrasound of your heart. The ultrasound probes is passed through your mouth and into you stomach similar to endoscopy. Although I do not preform this procedure you will be referred to one of my colleagues and need to follow their specific preoperative instructions. In general, do not eat anything after midnight night or at least 12 hours prior to procedure. Take all medications with a sip of water the morning of procedure.

Office based procedures

a. TMST/Stress Echo– Do not eat anything for 6 hours prior to your schedule test. Take all medications as prescribed the morning of the test with a sip of water. The diagnostic accuracy of this test is largely based on attaining appropriate heart rate during exercise, it is important to hold all medication that adversely effect your heart rate prior to your test. Therefore it is important to hold all Beta blocker medication 24-48 hours prior to test (Atenolol, Metoprolol, Propranolol, Inderal, Bystolic).
b. Endovenous ablation– Do not eat anything 4-6 hours prior to procedure. Take prescribed Valium dose 30 minutes prior to arrival to office. If you take Valium you cannot drive yourself home and must arrange alternative transportation for your procedure. Take all medication as prescribed with a sip of water the morning of procedure.
c. Echo-No special preparation needed
d. Holter– No special preparation needed

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