Diagnostic Testing & Treatment Options

Click on a test below for more information:


Echocardiography is a non-invasive imaging test of the heart in which pictures are acquired using ultrasound waves. There is no radiation risk for this kind of test. The information gives detailed analysis of structure and function of the heart.

There are two types of echocardiograms:

  • Transthoracic Echocariography (TTE) or surface echocardiography is the most common type of cardiac ultrasound test and it is performed in an office setting.  Ultrasound gel is applied to the chest. The heart is then imaged from a variety of positions. The entire test takes approximately 30-45 minutes. There is no preparation for this test.
  • Transesophageal Echocardiography (TEE) is ordered in a few patients where it is necessary to get more detailed information. By passing the probe into the esophagus, the TEE provides a much clearer image of the heart and allows us to see parts of the heart not ordinarily visualized on surface echocardiography. This is because the sound waves during a TEE travel a much shorter distance, and do not have to pass through the skin, chest, muscle or bone. This is an outpatient test that requires special training obtained by several members of our practice and is performed in the hospital. A small probe is inserted into the esophagus (feeding tube) through your mouth while you are awake but sedated.

What to expect (for your TEE)

During the test you will be given an intravenous sedative to make you comfortable. In most patients, transesophageal echocardiograms are performed with very low risk and the details of the test will be reviewed with you by our cardiologist and the staff. All patients are closely monitored by medical professionals throughout the test. As with any test involving sedation, patients are also monitored for a period of time after the test to make sure they have fully recovered.


  • Do not eat or drink anything except small sips of water for at least eight hours before the test.
  • Notify the doctor performing the procedure if you are allergic or sensitive to any medications.
  • The nurse will place an IV in your arm and electrodes on your chest. You will be brought into a special room where the test is performed and, you will be given oxygen and placed on your left side. An intravenous sedative will be given to relax you.
  • Once you’re relaxed, the probe will be passed and cardiac imaging will proceed.
  • Once the test is completed, you will be brought to the recovery room to be monitored. Shortly thereafter you may go home.
  • The entire test takes approximately 60 minutes, with an additional one hour to recover.
  • Because you are sedated during the procedure you must arrange for someone to drive you home after the test.

Stress Tests


  • Exercise treadmill testing (ETT)
  • Nuclear Stress Test
  • Echo Stress Test

Stress Testing is used to stress the heart to bring out symptoms or signs of heart disease under controlled circumstances and careful monitoring. Information obtained during this test is useful in the diagnosis and management of many heart conditions including chest pain, coronary blockages, heart rhythm disturbances and shortness of breath. Exercise usually involves walking on a treadmill while recording your electrocardiogram (EKG) and blood oxygen content. After each 3-minute stage, the treadmill goes a little higher and faster until a target heart rate is reached. This test is very safe.  Heart imaging with Echo (Echo Stress Test) or Nuclear Cameras (Nuclear Stress Test) is used in conjunction with exercise to increase the diagnostic precision of the test. In those situations where patients cannot walk on a treadmill, intravenous medication such as Dobutamine, Adenosine or Dipyridamole is used to stress the heart.


  • Medications are often held for the day prior to the test. Please check with our office if there is any question, especially if you are taking a beta blocker medicine such as Metoprolol, Atenolol or Carvedilol.
  • Do not eat or drink anything except water for four hours before the test.
  • If performing a stress test using Adenosine or Dipyridamole you should avoid caffeine the day prior to the test.
  • If you use an inhaler, bring it to the test.
  • Please wear comfortable clothes and shoes.
  • Time requirement:  ETT – about 30 minutes; Echo stress test – about 60 minutes; Nuclear stress test – about 4 hours.

Heart Rhythm Monitoring

Patients with symptoms such as lightheadedness, dizziness, rapid heat-beating sensations (palpitations) or fainting spells may have a heart rhythm abnormality. Depending on the symptoms, some patients will benefit from a test that monitors and records the rhythm of the heart. The goal is to match the patient’s heart rhythm with their symptoms to better direct treatment. Technology allows for us to continually monitor the heart in a painless and non-intrusive manner. The information stored in the monitor will be accessed and a full report is given to your doctor. We use holter monitors, event monitors (loop recorders), and CardioNet MCOT™  depending on the clinical situation.

What to expect:
After meeting with your doctor, you will be scheduled for an in-office visit to receive your monitor.  A nurse will explain the use of the monitor and apply the adhesive electrodes to the chest. You will be given full instructions as to the care and function of the monitor.  You may be asked to transmit information from the monitor over a telephone line during the monitoring period. This will be made clear at the time of your visit. When you have completed the test, simply return the device to the office location where it was first received.

Heart Catheterization and Angioplasty

Heart catheterizations involve the placement of small plastic tubes called catheters into the heart and its surrounding veins and arteries. Using specialized catheters, we measure the pressures in the heart and take x-ray pictures of the heart and its coronary arteries (angiogram). The data is integrated with all of your other testing to develop a comprehensive and individual plan of therapy. Depending on the results of this study, you may go on to another procedure called angioplasty or stenting to open a blocked artery.

Angioplasty is performed by an interventional cardiologist. Balloons and stents are used to stretch open the artery to improve flow. A stent is a permanently implanted spring-like metal device that serves as a scaffold to keep the artery open. In some cases, it may be necessary to use an atherectomy device to shave off excess plaque build up to allow for an optimal result.

Depending on several factors, your doctor may decide to place either a bare-metal stent or one coated with a drug that makes it less likely for the stent to re-narrow. The advantage of the drug-coated stent is a greatly reduced risk of stent re-narrowing and need for repeat procedures. Drug-coated stents reduce scar build-up within the stent and also delay the healing process during which the lining of the artery grows over the stent.

While the stent is directly exposed to the blood, there is risk for a blood clot to form on the stent unless patients are taking both aspirin and another mild blood thinner such as plavix or ticlid. All patients with stents should be on aspirin indefinitely. Patients that have drug-coated stents must take a second platelet blocking medication such as clopidogrel (Plavix), prasugrel (Effient) or ticagrelor (Brilinta) longer than patients with bare stents. It is generally recommended to take a second platelet blocking medication for at least one year after stent placement. It is important that the aspirin and other platelet blocking medication are not discontinued for any period of time without discussing it with your cardiologist. If you must hold these medications for a surgery, the timing of surgery and length of time off these medications should be agreed upon by your cardiologist and surgeon.

What to expect:

  • Your doctor may adjust your medications prior to the procedure.
  • We ask that you not eat or drink after midnight before your procedure.
  • The day of the procedure: In the short stay unit, an intravenous line will be placed and you will be prepared for the procedure. Once taken to the procedure suite, you will be greeted by a team including nurses and your physician who will care for you. Importance is placed on privacy and comfort during the procedure. At the conclusion of the procedure, you will be transported to the recovery area. Angioplasty generally requires an overnight stay.
  • After the procedure: Discharge instructions and follow-up appointments are provided before leaving. Typically, patients are asked not to drive for 24 hours or perform any heavy lifting for 5 days, after which time, they are able to return to their routine activities.

Cardiac MRI (CMR)

Magnetic Resonance Imaging (MRI) takes advantage of the natural magnetism of the body to image organs and blood vessels. CMR offers new levels of excellence in the diagnosis and management of cardiac care. It does not involve radiation and delivers unparalleled image quality. This test provides accurate assessment of cardiac masses, visualization of congenital abnormalities, evaluation of ventricular and valvular function, characterization of the aorta and pulmonary veins, and is becoming recognized as a "gold standard" for myocardial viability. With the addition of Dr. Donnevan Blake, Cardiology Associates and Bellin Health offer the area’s only facility that has a cardiac capable MRI scanner and a cardiologist credentialed in interpreting the studies.

Cardiac MRI can aid in the treatment of patients with the following indications:

  • Coronary artery disease
  • Cardiac masses and thrombi
  • Pericardial abnormalities
  • Cardiomyopathy
  • Congenital cardiac disease
  • Arrhythmia
  • Aortic disease

CT Imaging

In the past several years, a technology revolution has allowed 3 dimensional imaging of the live, beating heart using CT (“CAT scan” or Computerized Tomography). This is a non-invasive method of imaging the heart and vascular system in 3 dimensions using x-rays. The power of modern CT scanners makes it possible to acquire detailed information on coronary artery anatomy, heart structure and function and anatomy of the great vessels. The speed of the scanner allows imaging within a few seconds. The study requires special computer processing and analysis. Cardiology Associates’ interpreting physicians are specially credentialed in cardiac CT. We interpret all cardiac CT studies performed at Bellin Health Hospital Center. As with all x-ray studies, patients are exposed to some radiation.  As scanners have improved, the dose to patients has reduced, however radiation exposure needs to be considered as part of the very small risk of the study.

Heart Calcium Score (Coronary Artery Calcium Score)

Calcium in the coronary arteries is a sign of the extent of hardening of the arteries (atherosclerosis) and can now be measured by CT scanning in minutes with a low dose of radiation. This test requires no dye and there is no preparation. It is a very powerful method to assess cardiac risk. It is especially important in patients that have one or more of the traditional risk factors such as family history, high cholesterol, smoking, high blood pressure or diabetes.

Cardiac CT Angiography (CCTA)

Imaging the coronary arteries is a challenge because they are so small and are in almost constant motion. Newer scanners are now able to evaluate the degree of blockages, at times eliminating the need to go to the cardiac catheterization laboratory. The advantages to this non-invasive approach are reduced risk and the convenience of an office procedure taking less than one hour with no recovery. The resolution of the CT scanner is only a little less than the invasive catheterization. As with any x-ray test there is a risk from the radiation that needs to be balanced with the gain from the information. For many patients the CT study provides all the answers. If moderate to severe coronary blockage is suspected, further testing may be required with stress testing or cardiac catherization.

CT Angiography of Aorta & Peripheral Arteries

If your physician suspects disease of your aorta or it’s branch arteries (peripheral arteries) a CT scan may be ordered to clarify the anatomy. CT scanning provides a very accurate picture of these arteries and any blockages that are present. It is an outpatient test requiring only an intravenous injection of dye and no recovery.  This test is often used to guide your physician regarding the most appropriate treatment for peripheral artery disease.  It is very useful in guiding peripheral catheter procedures and vascular surgeries.

Preparation for CT angiography:

  • You will have an IV placed for intravenous injection of dye.
  • If blood tests show some kidney dysfunction, you may be asked to take a medication called mucomyst and have an IV placed for a fluid infusion before and after your procedure. This is to help protect your kidneys from the contrast dye.
  • If you kidney function is normal, your time commitment is <1 hour. If need fluid infusion, your time commitment is about 4 hours.

Electrophysiology – Heart Rhythm Management

Dr. Munagala and Dr. Jazayeri are board certified electrophysiologists. See the following for details regarding some of the procedures they perform.

Permanent Pacemakers

Since the 1950's, the pacemaker has given life to millions of people worldwide. These devices are designed to supply minute electrical impulses to the heart, treating patients with slow heart rates. With current advanced technology, the implant procedure is safe and effective, and usually performed in less than one hour. The device itself is about the size and thickness of two half-dollar coins. The procedure is performed in a specialized x-ray suite in the hospital and typically requires an overnight stay. Patients are discharged the next morning.

Electrophysiology Study with Ablation

Improved technology has dramatically advanced the diagnosis and treatment of fast heart rhythm disorders. A minimally invasive catheter procedure can identify the exact location where the abnormal heart rhythm originates. Once the area of concern is identified, a special catheter can eliminate the problem without a surgical incision.  Depending on the rhythm abnormality, some patients may be discharged the same day of the procedure, while others may be asked to stay overnight. Patients are typically back to work after a few days of rest.

Internal Cardioverter Defibrillator (ICD) Implantation

Dying suddenly from a lethal heart rhythm is a common mechanism of death. ICDs save lives by delivering rescue therapy to people who suffer from these otherwise fatal rhythms. The device, which is smaller than a deck of cards, is typically implanted in fewer than 90 minutes. Patients stay overnight in the hospital and are discharged by noon the next day. 

Cardiac Resynchronization Therapy (CRT)

(Bi-Ventricular Pacing to improve symptoms of congestive heart failure)
Congestive heart failure (CHF) is a debilitating and life-altering disease that may result after the heart is weakened by a heart attack or other illness.  As a pump, the heart is most efficient when all walls are contracting at the same time. Some patients with CHF have electrical abnormalities that disrupt this coordination.  CRT helps correct electrical delays in the heart which synchronizes contraction of the walls of the heart.  The results can be dramatic with most patients reporting significant improvement in their quality of life. The procedure is similar to a pacemaker implant, allowing for some extra time to implant a special heart failure wire. Patients are usually discharged from the hospital the following morning.

What to expect:

  • Before the procedure: Your doctor may adjust your medications prior to the procedure. We ask that you not eat or drink after midnight before your procedure.
  • The day of the procedure: In the short stay unit, an intravenous line will be placed and you will be prepared for the procedure. Once taken to the procedure suite, you will be greeted by a team including nurses and your physician who will care for you. At the conclusion of the procedure, you will be transported to the recovery area. Most procedures including device implantations require an overnight stay.
  • After the procedure: Discharge instructions and follow-up appointments are provided before leaving. Activity restrictions depend on the procedure details. For EP studies and ablations, patients may be asked not to drive for 24 hours or perform any heavy lifting for up to 5 days, after which time, they are able to return to their routine activities. For device implantations, arm activity may be limited for a specified period of time. Patients are instructed to call our office at anytime with any concerns or questions.

EECP® (Enhanced External Counterpulsation)

This is a non-surgical treatment for Angina & Coronary Artery Disease. It is an alternative to bypass surgery and angioplasty. It works by stimulating the opening or formation of small blood vessels (collaterals) to create natural bypasses around narrowed or blocked arteries and restore flow to the affected area. This effect has been demonstrated on Nuclear Stress tests that illustrate the improved blood flow to the heart muscle. Studies have shown that these new collateral vessels remain functioning long after the EECP treatments are done.

As a result, EECP can often reduce or even eliminate:

  • Angina
  • Chest pains
  • Shortness of breath
  • Fatigue


  • Safe
  • Painless
  • Non-invasive/Non-surgical
  • Outpatient
  • FDA-approved
  • Fully covered by Medicare and most health plans