Cardiac Diagnostic Services

Transesophageal echocardiogram (TEE)

What is a transesophageal echocardiogram (TEE)?

A TEE is a test used to detect abnormalities in the heart that are not easily seen on transthoracic echocardiogram (heart ultrasound).

How is the procedure done?

A flexible tube, with a camera-like device at the tip, is passed down your throat and into your esophagus (food pipe) until it is right behind your heart where it shows ultrasound pictures on the monitor.

Your throat will be sprayed with an anesthetic in order to make the passing of the tube easier. Minor sedation will be given. The tube does not interfere with breathing. The test is generally well tolerated with little discomfort.

How to prepare:

• Do not eat or drink anything after midnight before the day of your test.
• Please leave all valuables at home as the stay in hospital is about two to four hours.
• Please pre-arrange for someone to drive you home after the test as you will not be able to drive for 12 hours.
• Please arrive one hour prior to your appointment.
• Bring your Ontario health card.
• If you arrive more than 30 minutes late for your appointment, you may be rescheduled.
• The test takes approximately one hour.

If on medications:

• You may take all medications with small sips of water before 7:00 a.m. on the morning of the test.
• Consult your referring physician for doses if you are diabetic and on oral medications. Please hold oral hypoglycemic agents in the morning of the procedure.
• Consult your referring physician for doses if you are on insulin for the day of the procedure. It is recommended you may take half of your usual dose of long-acting insulin in the arm.
• Please bring all your medications to the appointment.

After the procedure:

• You will be observed after the test until most of the effects of the medications have worn off. You may feel drowsy for a short time after the procedure.
• You will not be able to eat or drink anything for one hour after the procedure. Following that, it is advisable to start slowly with cool drinks for the next hour. Hot liquids should not be consumed for three hours after the procedure. You may have a sore throat.
• If you feel any severe pain in your chest or abdomen or any difficulty breathing/swallowing you must contact your family doctor immediately.
• For the 24 hours following your procedure:
  • You must not drive,
  • have a responsible adult with you at all times,
  • do not operate any potentially dangerous devices, or
  • make any important decisions.
• If an emergent situation at home arises call 911.

Electrical cardioversion

What is electrical cardioversion?

Electrical cardioversion is a procedure in which an electrical shock is applied to the heart through the chest wall. The shock is given at a specific time during the hearts rhythm to correct your heart rhythm. It is carried out in a monitored setting.

How is the procedure done?

Electrical cardioversion is done using paddles or pads. Two paddles or hands free pads will be placed on your chest. An electrical shock is sent to your heart though these pads or paddles to restore a normal rhythm.

How to prepare:

• Do not eat or drink anything after midnight before the day of your procedure.
• Please leave all valuables at home as the stay in hospital is about two to three hours.
• Please pre-arrange for someone to drive you home after the procedure. You should not drive yourself home or use public transport on your own 24 hours after the cardioversion.
• Please arrive one hour prior to your appointment.
• Bring your Ontario health card.
• If you arrive more than 30 minutes late for your appointment, you may be rescheduled.

If on medications:

• You may take all medications with small sips of water before 7:00 a.m. on the morning of the procedure.
• If you have diabetes and on oral medications, please hold oral hypoglycemic agents in the morning of the procedure.
• If you are on insulin, you may take half of your usual dose of long-acting insulin in the arm or preferably contact your doctor for further instructions.
• Please bring all your medications in their original packing to the appointment.

After the test:

• You will be observed after the cardioversion until most of the effects of the medications have worn off. You may feel drowsy for a short time after the test.
• Sometimes the skin under the pads may be red, irritated or itchy. It may feel like a mild sunburn. Treat as you would do a sunburn.
• Once you are fully awake, you will be offered something to eat and drink.
• For the 24 hours following your cardioversion:
  • Do not drive,
  • have a responsible adult with you at all times,
  • do not operate any potentially dangerous devices, or
  • make any important decisions.
• Call your doctor if you feel any of the following:
  • lightheaded or dizzy
  • fainting spell
  • pulse or heart rate becomes irregular or very fast
  • shortness of breath
• Call 911 for chest pain or discomfort, changes in vision or speech or weakness in the face, arms or legs.

Regular exercise stress test

• Wear loose fitting, comfortable clothing including rubber sole walking/running shoes
• Avoid alcoholic beverages for a minimum of 24 hours before the test
• Avoid smoking for a minimum of two hours before the test
• Your stay at Osler will be about 45 minutes

Holter monitor

For tests that are monitoring for 24 or 48 hours:

• Avoid use of creams or powder on your chest or stomach the day of test
• Bring a current list of medication
• Your stay at Osler will be about 30 minutes

Echocardiogram

• Avoid use of creams or powder on your chest or stomach the day of test
• Your stay at Osler will be about 60 minutes

Exercise stress echocardiogram

• Wear loose fitting, comfortable clothing including rubber sole walking/running shoes
• Avoid use of creams or powder on your chest or stomach the day of test
• You stay at Osler will be about two hours

Dobutamine stress echocardiogram

• Avoid caffeine (coffee, tea, cola, chocolate, decaffeinated beverages) for 24 hours before the test
• An intravenous line will be inserted into your arm to deliver the medication
• Your stay at Osler will be about two hours

Contrast echocardiogram

• An intravenous line will be inserted into your arm to deliver the contrast agent
• Your stay at Osler will be about an hour and a half