The Cardiopulmonary Department provides a broad range of diagnostic and therapeutic services for inpatient and outpatient referrals. As a department we are committed to quality and to actively searching for ways to improve the service we offer the patients referred to us and to the physicians making these referrals.

Cardiology Testing

Echocardiography Testing

Neurology

Vascular

Respiratory

  • Pulmonary function test
  • Routine pulmonary function tests - flow volume loops, diffusion, lung volumes
  • Bronchial challenge tests
  • Oximetry - for home oxygen assessments

Cardiopulmonary Clinics

  • Asthma Education Center »
  • Cardiac Device Clinic
  • Cardiovascular Care Program »
    • Healthy Heart Program
    • Cardiac Rehab Program
    • Heart Function Clinic
  • Pulmonary Rehabilitation Program (PReP) »

 

Cardiology

Graded Exercise Stress Test

Purposes:

  • To diagnosis the presence or absence of coronary artery disease.
  • To monitor the progression of ischemia, or the absence of ischemia following treatment.
  • To assess exercise tolerance, and/or set exercise prescriptions.

The Test:
Heart waveforms and blood pressure are monitored while walking or running on a treadmill, or cycle. The test always starts slowly, however, individuals will be asked to exercise for as long as they are able. The test is preformed by a Cardiology Technologist who is specialized in this area of testing, and under the supervision of a Cardiologist. The test, including set-up, exercise time and recovery is usually 30-45 minutes in length.

Preparation:
No food, caffeine or cigarettes 2 hours prior to testing. Bring comfortable exercise clothing and shoes. You must bring a complete list of your current medications.

Graded Exercise Metabolic Stress Test

Purposes:

  • To set-up an individualized exercise prescription.
  • To monitor the respiratory response to exercise, especially in cases of suspected exercise induced asthma, and abnormal shortness of breath and fatigue with exercise.

The Test:
Heart waveforms, blood pressure, oxygen saturation and breathing are monitored while you exercise on a treadmill or cycle. You will have a mask over your mouth and nose that analyzes the air you breath out and your respiration rate.

Preparation:
No food, caffeine or cigarettes 2 hours prior to testing. Bring comfortable exercise clothing and shoes. You must bring a complete list of your current medications.

Ambulatory Holter Monitoring

Purposes:

  • Arrhythmia evaluation for those with or with out symptoms.
  • Typical symptoms that would be referred for Holter monitoring are dizziness or palpitations.

The Test:
Heart rhythm will be monitored for a 24 to 48 hour time period. The monitor which is about the size of the palm of your hand is attached to your chest via five sticker electrodes.

Preparation:
Wear loose comfortable clothing. One-piece clothing is not recommended. Keep in mind that you cannot get the monitor wet while you’re wearing it, therefore, showering prior to being set-up is preferred by most individuals. You must bring a complete list of your current medications.

Cardiac Device Monitors (Loop Recorders)

Cardiac Event Monitors (also called Loop Recorders) are small portable devices worn by a patient during normal activity for up to 14 days. The device has a recording system capable of storing several minutes of the individual’s electrocardiogram (ECG) record. The patient can initiate ECG recording during a symptomatic period of arrhythmias or the device can be set so it can also automatically trigger an ECG recording when certain arrhythmias occur. Cardiac Event Monitors have primarily been used to diagnose and evaluate cardiac arrhythmias.

Cardiac Event Monitors can be medically necessary for any of the following conditions:

  • To document an arrhythmia instead of using a Holter Monitor or if a Holter Monitor fails to document a suspected arrhythmia; or
  • To document the benefit after initiating drug therapy for an arrhythmia; or
  • To document recurrence of an arrhythmia after discontinuation of drug therapy; or
  • To document the results after an ablation procedure for arrhythmia; or
  • To evaluate syncope and lightheadedness.

Ambulatory Blood Pressure Monitoring

Purposes:
To evaluate your blood pressure response to your activities of daily living.

The Test:
Your blood pressure will be monitored for up to 22 hours. A BP cuff around your arm will measure your blood pressure every 30 minutes during the day and every 60 minutes at night.

Preparation:
You must bring a complete list of your current medications. This test is not covered by OHIP and has a fee of $75.

Electrocardiogram

Purposes:
To assess the electrical activity of your heart at one point in time. It will not diagnose Coronary Artery Disease if you are not having an ischemic attack at the time the ECG is being done. Previous heart attacks with heart muscle damage can be identified, as well as any arrhythmias occurring at the time of recording.

The Test:
You will be connected to the ECG machine with 12 sticker electrodes and asked to lay still for several seconds. The test takes under five minutes.  No appointment is necessary.

Preparation:
None.

Nuclear Cardiology

Nuclear Cardiology is a medical specialty that utilizes small doses of radioactive injections for diagnosis, maintenance and prevention of coronary artery disease (CAD). It uniquely provides important information about the physiology and anatomy of the heart using such procedures as myocardial perfusion imaging (MPI) and radionuclide angiograms (RNA/SYMA/MUGA).

Myocardial Perfusion Imaging

Purpose:
To determine the extent and severity of coronary artery disease.

The Test:
Images are taken of the heart at rest and following either treadmill exercise or pharmacological stress agents (Persantine). Safe radioactive intravenous injections such as Thallium, Cardiolite or Myoview are used so that these images of blood flow to the heart muscle can be taken by a gamma camera. The procedure usually
takes about 4-5 hours.

Preparation:
Have a light breakfast, no caffeine after midnight prior to the test, and bring a complete list of your current medications, and comfortable clothes and shoes.

Resting Syma

This study measures the contractile function of the heart muscle, mainly the left ventricle. Wall motion, cardiac enlargement, hypertrophy, and pumping (ejection fraction) can be easily identified.

The test involves two injections (pyrophosphate and a radioactive tracer) that are given about 20 minutes apart and do not cause any reaction. A gamma camera is then used to image the heart.
The test takes about 45 minutes and there are no pre-test instructions.

Echocardiography

Transthoracic Echocardiogram

Purpose:
To assess the structure and function of the heart and related structures through ultrasound. In ultrasound sound waves are used to make an image of an organ, it's structure and the blood flow inside the organ.

The Test:
An ultrasound probe will be passed over the outside wall of your chest. An adult test takes from 30-60 minutes. For a pediatric test you must allow yourself 60 to 180 minutes, especially for conscious sedation studies. Conscious sedation means that a medication will be given by mouth to children aged three weeks to three years.

Preparation :
No preparation is required for studies for age 13 and up. For age four to 12 allow one hour for the test, and for younger children bring something that will help them lay still for the hour. For children aged three weeks to three years sedation will be used. Children who will be sedated must not have food, milk or formula six hours prior to your appointment time. Breast milk is allowed up to four hours prior to the appointment time. Clear fluids or water are allowed up to two hours prior to the appointment. Once your child wakes up in the morning try to keep them up. Bring a favourite blanket or pacifier or anything else that may help your child go to sleep. You may also bring your child’s favorite DVD to watch.

Transesophageal Echocardiogram

Purpose:
To assess the structure and function of the heart and related structures.

The Test:
This is test is an ultrasound of the heart done using a small tube, which is easily swallowed. It allows us to see clear pictures of the heart and related structures from inside your body. Sedation will be used, as well as analgesic agents to relax your throat and reduce any discomfort this test may cause. The procedure is done by a cardiologist. Allow three to four hours at the hospital, even though the actual procedure is only 15-20 minutes in length you will be monitored before and after the test. An IV will be set-up as the sedation is
delivered intravenously.

Preparation:
Bring a list of all current medications. You must take nothing by mouth from midnight the night before the test. You will need a ride home since you will not be permitted to drive following the light sedation used for the test.

Neurology

Electromyography and Nerve Conduction Studies

Purpose:

  • To evaluated the status of the peripheral neuromuscular system.
  • To evaluate symptoms such as numbness, tingling and weakness.

The Test:
The study of nerve conduction assumes that when a nerve is stimulated electrically, a reaction should occur somewhere along the nerve. The nerves are stimulated by passing electrical currents to the surface of the skin, or into the skin using needle electrodes. These needle conduction studies may be performed by the neurologists and may cause mild discomfort as the physician will insert a small needle electrode into a muscle. The time relationship between the stimulus and the response is displayed, measured and recorded. The needle conduction studies also use an auditory signal.

Preparation:
Do not wear any lotion on the day of the test. If you are having a needle conduction study, it is important to be relaxed during the study.

Evoked Potentials

Purpose:
To measure the electric responses of the nervous system to motor or sensory stimulation. This test is most sensitive for the detection of lesions in the spinal cord and brain.

The Test:
The potentials consist of a sequence of waves, each of which has a specific latency, amplitude and polarity. Multiple stimuli are delivered by electrical stimulation of the skin, visual stimuli, auditory stimuli or motor cortex stimuli to produce these potentials. Recordings are made by surface electrodes over the limbs, spinal cord, or brain. By averaging many stimulus-response trials, the evoked potential rises out of the background.

Preparation:
Do not wear hair gels or sprays on the day of the test.

Electroencephalogram


Purpose:

  • To Record and interpret the electrical activity produced by the brain.
  • To determine brain function.
  • To monitor for seizure activity.

The Tests:
Non-invasive electrodes are applied to your scalp while you are lying down. In a routine test 20 minutes of brain activity is recorded. You will be asked to perform three minutes of hyperventilation. Your brain's response to a flash strobe light will also be evaluated. A sleep deprived study requires that you stay awake for 12 hours prior for a minimum 30 minute EEG study. In addition to the procedures done in the routine study, we will also try to capture some light sleep stages. Routine EEG recordings on children usually includes natural sleep. Sleep induced studies using a sedative agent for conscious sedation is a special procedure done on children under specific circumstances and requires an order by a CVH physician.

Preparation:
Requisitions from your physician are required. Appointments are booked through the cardiopulmonary department. A current list of medications is required. For the sleep deprived studies you MUST NOT SLEEP from midnight on the day of the test. In addition, you must not have any caffeine after midnight. A sleep induced study requires that the child not eat 6 hours prior to the study, this includes milk. Clear fluids are allowed up until two hours prior to the EEG. Conscious sedation recordings on children require that the child not eat for 6 hours prior to the study, this includes milk. Clear fluids are allowed up to 2 hours prior to the EEG. The parent or guardian will be given full instructions at the time of the booking.

Vascular

Purpose:
To perform ultrasound and waveform testing on arteries and veins in the arms, legs and neck.

Peripheral Arterial Study

Performed on the arteries of the arms or legs. This test is done to diagnose
hardening of the arteries. This test takes 60 minutes.

Venous Duplex

This test is done on the veins in the arms or legs and is done to detect the
presence of blood clots or deep vein thrombosis. This test takes 30 minutes.

Carotid Duplex or Doppler

The Tests:
This test is done on the carotid artery on both sides of the neck. It is done to
look for narrowing in the carotid arteries, and is typically done on patients
that have had TIAs or strokes.

Preparation:
None.

Pulmonary Function Lab


There are two full pulmonary function labs that are open Monday to Friday from 8:00 a.m. to 5:00 p.m.. A physician referral is required and booking appointments can be done through the cardiopulmonary department main number: 905-813-2712.

Diagnostic tests that are offered include:

  • Routine pulmonary function tests - flow volume loops, diffusion, lung volumes
  • Bronchial Challenge Tests - by administering methacholine
  • Oximetry - for home oxygen assessments

Sleep Lab

The Sleep Lab is open 7 days a week with twelve patients studied each night. The lab is staffed by Registered Polysomnographic Technologists who set up patients for the study and analyze the data. The main sleep disorder that is studied in the lab is called “Obstructive Sleep Apnea” or “OSA”. The physician who oversees the lab is Dr. Tetsuo Inouye and he and 3 other Respirologists (Dr. Diane Flood, Dr. Ronald Grossman and Dr. Frank Ritacca) diagnose all the patients referred to the Sleep Lab.
A referral from a physician is required for the test. The requisition can be downloaded, completed by the referring physician and faxed to the Cardiopulmonary Department at 905-813-4546. Questions about the Sleep Study or about an appointment can be directed to the Sleep Lab booking line at 905-813-1100 ext 5295. To speak to the Sleep Lab Technologists directly a call can be made directly to 905-813-1100 ext 6060.

Credit Valley Pro Health

This joint venture with Professional Respiratory Inc. offers home respiratory product services to members of our community. The office is open Monday to Friday from 8:00 a.m.to 5:00 p.m. and can be accessed by calling the main number for the cardiopulmonary department: 905-813-2712.
Services include:

  • Home oxygen set-ups
  • CPAP sales and accessories

Cardiopulmonary Clinics

Cardiac Device Clinic

Purpose:

  • To assess and adjust pacemaker and internal defibrillator devices.
  • To educate patients before and after cardiac device implants or adjustments.
  • To offer telephone transmission follow-up for nursing home residents.

Preparation:
Always bring your pacemaker I.D. card and a current list of medications.

 

Cardiovascular Rehabilitation Program »

Purpose:

  • To educate individuals with, or at risk for, heart disease on heart healthy lifestyle modifications.  The program consists of individual consults with multidisciplinary team members, group education sessions and individualized exercise assessment and programming

There are 3 separate programs

  • Primary Prevention/Healthy Heart Program – for individuals with multiple risk factors for heart disease.  The goal is to prevent or delay the onset of significant heart disease or cardiac events.
  • Secondary Prevention/Cardiac Rehab Program- for individuals already diagnosed with significant heart disease, or individuals who have had a recent cardiac event, including surgery and angioplasty.  The goal is to educate individuals on healthy lifestyle choices and to maximize event/disease management and thus enhance quality of life.
  • Heart Function Clinic – for individuals diagnosed with congestive heart failure.  The goal is to prevent hospital admissions and promote quality of life for individuals with CHF.

See Cardiovascular Rehabilitation Program specific web page for further details by clicking here »

Asthma Education Center

See Asthma Education Center specific web page for further details by clicking here »

Pulmonary Rehabilitation Program (PReP)

See Pulmonary Rehabilitation Program specific web page for further details by clicking here »

 

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