Click here for our Nuclear Cardiology F.A.Q.

 
General F.A.Q.

1. Where is your office?
2. What are your office hours?
3. Where are you located?
4. Who should I contact for more information?
5. Who may I contact for billing or insurance questions?
6. What types of services are performed in the office?
7. What is the role of the physician's assistants in your practice?
8. How do I prepare for my office visit or test?
9. I have trouble walking. How can I take a stress test?
10. How about the CAT scans I hear about on the radio?
11. What is a heart murmur? I've been told I have one. Does it need treatment?
12. How do I know if I need cholesterol medication? What about the side effects?
13. Where can I get diet information?
14. I can't afford my medication. What can I do?
15. What about Viagra and heart disease?
16. What about homeopathic products and vitamins?
17. I've been told I have mitral valve prolapse. Do I need additional evaluation or treatment?
18. How do I know if I need antibiotics before dental work or other procedures?

1. Where is your office?
Our office is located in Franklin Square, NY. For detailed location information and directions, click here.
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2. What are your office hours?
Our office hours our by appointment, Monday through Friday. To make an appointment, please visit our contact page.
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3. Where are you located?
We are located in Franklin Square, NY. For detailed location information and directions, click here.
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4. Who should I contact for more information?
For general information contact Connie at general@sratnermd.com. Visit our contact page for more ways to contact us.
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5. Who may I contact for billing or insurance questions?
For billing information contact Brigid at billing@sratnermd.com. Visit our contact page for more ways to contact us.
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6. What types of services are performed in the office?
Visit our office & services page for a detailed list of our services.
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7. What is the role of the physician's assistants in your practice?
Our physicians assistants are professionals with extensive experience in cardiology. They have specialized training and advanced degrees and are skilled in the diagnosis and management of heart disease They assist Dr. Ratner in the office and hospital by providing education and counseling, diagnostic testing and direct patient care, working closely under Dr. Ratner's supervision at all times.
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8. How do I prepare for my office visit or test?
For a routine office visit, no special preparation is required. Please remember to bring any referrals or information your doctor may have given you. A list of your medications (with dosages) and the telephone number of your pharmacy would be helpful. Please bring your insurance card. You should take your normal medications.
       Fasting helps if precise determination of your blood sugar or cholesterol is required, but it isn't essential for a routine visit.
       For echocardograms, carotid or other vascular testing, no special preparation is needed. Wearing loose, comfortable clothing is helpful. For sonography of the abdomen, including the abdominal aorta, a 6 hour fast is needed.
       For stress tests, wear loose, comfortable clothing and rubber soled shoes or sneakers if you're going to walk on the treadmill. A four hour fast is requested. You should avoid caffeinated beverages (including soda) for 12 hours, and decaffeinated beverages if you're going to have a non-exercise stress test (also called a pharmacologic stress test, adenosine stress test or Persantine stress test). Certain medications are best avoided - check with your doctor or call us. If you use an inhaler, you should use it prior to the test or bring it with you. Any medications not taken prior to testing may be taken shortly thereafter, and you may wish to bring them with you. If you are diabetic, you should have some juice prior to coming. If you are on insulin, take only ½ your normal dose. Unless your doctor advises to the contrary, avoid oral diabetic medications prior to stress testing. We routinely call 24-48 hours prior to testing to provide instructions and answer questions about your test.
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9. I have trouble walking. How can I take a stress test?
There are a variety of ways to evaluate the heart's function and circulation, even for people who can't exercise. If you can walk slowly, it helps to do so for the stress test. Even if you can't, medications such as adenosine, dipyridamole (Persantine) or dobutamine can substitute for the treadmill and provide accurate and reliable information about your heart.
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10. How about the CAT scans I hear about on the radio?
This test, the Ultrafast CT, detects calcifications in the coronary arteries before blockages develop. It's experimental and generally not covered by insurance, including Medicare. The American College of Cardiology and the American Heart Association don't recommend the test because it often creates more questions than answers. Your risk of developing a heart problem is better determined by consulting a cardiologist and initiating appropriate treatment, rather than by tests you hear advertised on the radio.
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11. What is a heart murmur? I've been told I have one. Does it need treatment?
A murmur is a sound made by blood travelling through the heart, and may be a very benign or even normal condition. It can also be the sign of a problem. An experienced cardiologist can tell. Echocardiography (a painless ultrasound examination of the heart) is often helpful.
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12. How do I know if I need cholesterol medication? What about the side effects?
Cholesterol lowering medication has saved countless lives. But it's not for everyone. There are several different types and more than a dozen brands on the market. We look at each person as an individual to determine the need for treatment and to monitor the results as well as to avoid any potential side effects. Despite all the press, less than 1 person in 100 who takes a statin type medication (such as Lipitor or Zocor) has to stop it because of side effects.
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13. Where can I get diet information?
There are many resources. We provide informational literature, individual counseling and nutritional counseling and work with professional nutritionists when needed. There are many professional organizations that provide help as well, such as The American Heart Association.
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14. I can't afford my medication. What can I do?
Sometimes there are less expensive alternatives, and many pharmaceutical companies provice free medication to people with limited incomes. We can assist with this and you should feel free to discuss it with us.
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15. What about Viagra and heart disease?
The only definite "no" is people who take nitroglycerine containing medication. It's safe for pretty much everyone else. But like any physical activity, sex can be a problem for people with heart conditions, especially if you've been sedentary for a long time. You should check with your cardiologist.
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16. What about homeopathic products and vitamins?
Many are helpful. But some interfere with heart or other medications, and some are not helpful. For some, there just isn't enough information to know for sure. If you're taking any, bring a list (or bring the bottle) when you come in.
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17. I've been told I have mitral valve prolapse. Do I need additional evaluation or treatment?
Mitral valve prolapse has traditionally been overdiagnosed. It ranges from a completely benign condition to a more serious form. An experienced cardiologist can make a determination as to what's best for you. Echocardiography (a painless ultrasound examination of the heart) is often helpful.
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18. How do I know if I need antibiotics before dental work or other procedures?
Many people who have been told of heart murmurs need antibiotics to prevent infection. But it's not true for everyone. Check with your doctor.
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Click here for our General F.A.Q.

Nuclear Cardiology F.A.Q.

1. My doctor has asked me to undergo a nuclear stress test. What does this involve?
2. What is a nuclear cardiologist?
3. What training is involved/required for doing a nuclear test?
4. What is a nuclear test, exactly?
5. How can I be sure that my nuclear test is done by qualified professionals (doctor, nurse, technologist)?
6. Is this a dangerous test?
7. What are radiotracers, exactly, and are they dangerous?
8. How can I be sure that my nuclear test is done in a qualified lab?
9. Are nuclear tests considered invasive?
10. Are there different kinds of nuclear scans?
11. What is a stress test and why is it done?
12. What preparation is needed before I come for the stress test?
13. What happens to me during a nuclear scan, from start to finish?
14. Who gets a nuclear scan of the heart?
15. Can I ask for a nuclear stress test myself?
16. Why are nuclear cardiology procedures performed?
17. My doctor has recommended a nuclear stress test for me. Does this mean I have a heart problem?
18. What information does a nuclear stress test provide?
19. Where is the nuclear stress test of the heart given?
20. How long does it take?
21. What if the doctor finds a problem with my heart?
22. What kind of problems can this test can find?
23. Does my health insurance cover a stress test?
24. Why should I have a nuclear test and not an echocardiogram or heart catheterization?
25. How long have nuclear cardiology procedures been available?
26. What is the difference between nuclear cardiology and cardiac PET?
27. Will I get the result after my nuclear stress test is over?
28. How long will it take before my doctor gets the result of this test?
29. Can I get a copy of my nuclear stress test result?
30. I had a normal nuclear stress test 6 months ago, when should I undergo this test again?
31. I had an angioplasty done on my heart 2 months ago. Now I am doing well. I have no complaints, but my doctor wants me to undergo a nuclear stress test. Why does he want me to undergo this test?

1. My doctor has asked me to undergo a nuclear stress test. What does this involve?
A nuclear stress test is a diagnostic test to diagnose the presence of coronary artery disease, or narrowing of the arteries of your heart. This test if often performed in patients who have symptoms which suggest the presence of heart disease, or sometimes even in the absence of any symptoms if your doctor suspects that there is a possibility of this condition. This test is also performed in patients with known heart disease to monitor the favorable effects of treatment and progress of the heart condition.
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2. What is a nuclear cardiologist?
A nuclear cardiologist is a physician who has been trained and qualified to perform and interpret nuclear cardiology studies. These physicians may have certification in cardiology, internal medicine, nuclear medicine, radiology or other related fields, with special training in nuclear cardiology and cardiovascular imaging.
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3. What training is involved/required for doing a nuclear test?
ASNC, in cooperation with the American College of Cardiology, has developed guidelines for physician training in nuclear cardiology. These are available on the ACC and ASNC websites by clicking here. Another valuable document is ASNC's statement on physician training titled The Knowledge Base for Nuclear Cardiology Training. ASNC also has guidelines on training recommended for technologists perfoming nuclear cardiology procedures, available on the ASNC website by clicking here.
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4. What is a nuclear test, exactly?
A nuclear diagnostic test involves organs of the body and not specifically the heart. It will involve the injection of radiopharmaceuticals (radioactive elements) into the body and then later imaging that particular organ of interest. For the heart, these tests are performed to diagnose the presence of coronary artery disease, to assess the severity of coronary artery disease and to determine the squeezing power of the heart (ejection fraction). Terms used for cardiac nuclear tests include myocardial perfusion imaging and radionuclide scan, Cardiolite stress test, Myoview stress test, RNV; cardiac blood pooling imaging; nuclear heart scan; radionuclide ventriculography; and MUGA.

Examples of nuclear procedures
Normal nuclear cardiology study

Myocardial Infarction

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5. How can I be sure that my nuclear test is done by qualified professionals (doctor, nurse, technologist)?
By asking the physician, the nurse and the technologist in the lab what qualifications they have to be able to perform a particular study. That includes but is not limited to board certification, examinations taken, credentials, etc. See the discussion of Frequently Asked Questions on certification in nuclear cardiology for physicians and advanced certification in nuclear cardiology for technologists.
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6. Is this a dangerous test?
The risk of any adverse event such as a heart attack or death during a nuclear stress test is extremely small. To ensure your full safety, this test is performed in laboratories that are fully equipped to very carefully monitor patients during the test and to detect and treat any abnormal conditions that may develop during the course of testing. In order to minimize the risk of any adverse event during the test, the nuclear stress test starts with a brief interview and physical examination by a physician or a nurse and recording your medications ( both your heart medications and all other medications).
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7. What are radiotracers, exactly, and are they dangerous?
Radiotracers, also commonly termed radiopharmaceuticals, radionuclides or radioisotopes, are low-level radioactive materials which emit radiation or gamma rays which can be imaged with specialized equipment known as a gamma camera. These agents are injected into the body so that a nuclear scanner or camera can take pictures. Sestamibi, Tetrofosmin and thallium are radiotracers commonly used in nuclear tests of the heart. Performed by qualified professionals, tests with radiotracers are safe and effective. The dosages used in nuclear cardiology are very small and well within the limits of safety as determined by NRC (Nuclear Regulatory Commission), the agency which monitors the use of radioisotopes in medical practice. Pregnant women should not have a nuclear test because potential effects on the unborn fetus have not been conclusively determined. If you are pregnant or think you may be pregnant, you should let your doctor know about this before a test is done.
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8. How can I be sure that my nuclear test is done in a qualified lab?
As with the question on testing by qualified professionals, with regard to the facility, the patient should ask for confirmation that the laboratory has been accredited recently by a recognized accrediting body. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has a website with tools to help you make an evaluation of the laboratory you're considering and the Intersocietal Commission on the Accreditation of Nuclear Medicine Laboratories (ICANL) lists all facilities accredited by ICANL.
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9. Are nuclear tests considered invasive?
No, a nuclear test involves only a needle stick and is not considered an invasive procedure.
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10. Are there different kinds of nuclear scans?
Yes, nuclear scans are done for many different organs, such as kidneys, heart, lungs or thyroid glands. Each scan is done in a different way. For heart, there are different kinds of scans and different ways of doing them (called "protocols") depending on the patient's medical status, history and information desired from the test.
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11. What is a stress test and why is it done?
A stress test may consist of an exercise, usually on a treadmill, or a "drug simulated" stress, which uses drugs such as adenosine, dipyridamole or dobutamine. These tests are done to evaluate patients with documented or suspected heart disease. A stress test also helps in the detection of heart disease which may not be producing any symptoms.
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12. What preparation is needed before I come for the stress test?
You will be provided with instructions either by by your physician or by the staff from the nuclear cardiology laboratory when an appointment is made for a stress test. In general, you will be asked to come fasting in the morning. You will also be asked to avoid drinks containing caffeine (coffee, tea, cola drinks, chocolate or foods containing chocolate) for 24 hours prior to your stress test. If you have diabetes and cannot remain fasting for that long, let the stafff know about this and follow their instructions about your diabetes medications and light meal in the morning. You should bring a list of all your medications. Whether you should stop some of the medications before the stress test and whether your should take the morning dose of your medications depends upon the nature of medications and the practice of individual nuclear cardiology laboratories. You should follow their instructions in this regard.
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13. What happens to me during a nuclear scan, from start to finish?
See ASNC's Patient Information.
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14. Who gets a nuclear scan of the heart?
A nuclear stress test of the heart should be requested by a qualified physician who is practicing medicine. Indication to have a nuclear stress test of the heart is primarily based upon the judgement of your doctor that you need this test. This test is needed if your doctor thinks that you may have heart disease based upon your symptoms or presence of some conditions which predispose an individual to heart disease (such as high blood pressure, diabetes, high cholesterol, smoking and a family history of heart disease).
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15. Can I ask for a nuclear stress test myself?
No, this test has to be ordered by your physician. If you are concerned about heart disease or think you may have heart disease and want to have a nuclear test, you should discuss this with your doctor. He or she will order this test if he thinks this is an appropriate test for you.
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16. Why are nuclear cardiology procedures performed?
Nuclear scans are done in two circumstances: [1] to determine if heart artery blockages are present (coronary artery disease) in patients who have developed symptoms that suggest the possibility of heart trouble, such as chest pressure, or burning, or who are at significant risk of heart trouble (persons with diabetes or high cholesterol, for example), or [2] among patients with known heart trouble to determine their risk of an event in the future. That is, if a person has had a heart attack but a follow-up scan is normal or only mildly abnormal, the risk of another heart attack is low. However, a significantly abnormal scan would indicate an increased risk of another heart attack. If this were the case, the doctor would generally recommend a heart catheterization to determine what could be done to prevent such an event, for example, by coronary bypass surgery, angioplasty or stenting.
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17. My doctor has recommended a nuclear stress test for me. Does this mean I have a heart problem?
Not necesarily. The test is often ordered if there is any suspicion of heart disease based upon your physician's assessment. This is similar to ordering a mammogram in women beyond the age of 40 years or a colonoscopy beyond the age of 50 years. Sometimes a stress test is ordered to exclude heart disease in persons enageged in certain professions such as commercial airline pilots, fire fighters etc.
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18. What information does a nuclear stress test provide?
A nuclear stress test provides information related to the physiology of your heart. The test results can show the damaged areas of the heart and provide information about the narrowing or blocking of the arteries of your heart. This information is useful for predicting of the likelihood of an adverse cardiac event (such as a heart attack, need for a cardiac bypass surgery or risk of dying from heart disease) in future. Based upon the results of a nuclear stress test of the heart, your physician will be able to recommend options for treatment, if necessary.
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19. Where is the nuclear stress test of the heart given?
The nuclear test is performed in a nuclear medicine or a nuclear cardiology laboratory. It could be in a hospital or in an outpatient setting in your physician's office. The procedure can be safely performed in either setting.
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20. How long does it take?
The test normally takes from two hours to four hours. This depends on what protocol is most appropriate for any particular patient. In some cases, the test requires two sets of images to be obtained on two separate days. On each day it takes about 1.5-2.0 hours to complete the test.
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21. What if the doctor finds a problem with my heart?
The doctor who ordered the test will receive the results of the test. If the results indicate a problem with your heart, he or she will discuss the test result with you and recommend the treatment options. A wide variety of treatment options are currently available. These options include treatment with medications, angioplasty or heart bypass surgery. The choice of a particular treatment option or a combination of options depend upon several factors. An important factor is the severity of abnormality seen on the nuclear stress test. Your doctor will discuss these options with you.
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22. What kind of problems can this test can find?
Several problems may be identified by a nuclear stress test. Usually a heart test is performed to detect the presence of coronary artery disease, commonly called heart disease, or if there is any problem with blood flow to your heart muscle. This test can also show the area of the heart muscle damaged by previous heart attacks. This test also provides information about the squeezing power of your heart muscle. This is described by a number, designated as ejection fraction. Normal ejection fraction is 50% or above. An ejection fraction of 45-50% is considered borderline impairment of the squeezing power, whereas an ejection fraction below 45% is abnormal. If there is a problem with the amount blood going to the heart muscle you may need to be further evaluated by your doctor who will decide what the next step is.
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23. Does my health insurance cover a stress test?
Yes, all health insurance plans in the United States should cover nuclear cardiology tests.
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24. Why should I have a nuclear test and not an echocardiogram or heart catheterization?
The decision to have a nuclear stress test, echocardiogram or a catheterization is primarily based on the judgement of your doctor. Different tests provide different kind of information. Depending upon the condition of your heart, your doctor will choose the the test which is best for you. Sometimes more than one test is required to assess the heart condition. The order in which these tests should be performed is based upon the judgement of your doctor. An echocardiogram is used to evaluate the heart muscle and valves of the heart. A heart catheterization is used predominately to directly evaluate the heart arteries for blockages. A nuclear test shows how the heart is doing under stress (induced by exercise or by drugs). If significant blockages are present in the arteries a nuclear test will show this lack of blood flow. If the lack of blood flow is significant, a catheterization is often recommended. As a catheterization has the potential for problems and requires admission to a hospital, a nuclear test can be helpful to determine if a catheterization is needed.
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25. How long have nuclear cardiology procedures been available?
As described in ASNC's training document titled The Knowledge Base for Nuclear Cardiology Training, the basic principles underlying the field of nuclear cardiology were described in the 1920s, but the clinical development and widespread use of these techniques did not take place until the mid-1970s. Since that time, it has become one of the older and most established technologies to image the heart. With over six million procedures performed annually in the United States, physicians rely on this test to evaluate a large number of their patients.
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26. What is the difference between nuclear cardiology and cardiac PET?
Cardiac PET (Positron Emission Tomography) is actually a type of nuclear test of the heart. There are several methods and techniques for imaging the heart with nuclear technology. PET is one of them. Depending on the clinical question asked, a particular imaging modality, or type of test, would be preferred. PET scans are sometimes performed in patients with markedly weakened hearts.
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27. Will I get the result after my nuclear stress test is over?
The stress test report is sent to your doctor, who is the best person to explain to you the results of this test.
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28. How long will it take before my doctor gets the result of this test?
In most laboratories in the USA, the nuclear stress tests are interpreted by a physician by the end of the day or by the next morning. The test results are often conveyed to your doctor by mail/fax or electronically by the next day, depending upon the local practice. If a test report is needed urgently, your physician or his office can call the nuclear cardiology laboratory to get the test result sooner.
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29. Can I get a copy of my nuclear stress test result?
Yes, you can ask for a copy of the nuclear stress test report to be sent sent to you. However, these reports are oftern full of medical terminology and technical jargon. It is best that this report be explained to you by your physician.
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30. I had a normal nuclear stress test 6 months ago, when should I undergo this test again?
How soon a nuclear stress test should be repeated in somebody with a normal test result depends upon a number of factors such as age, gender and presence of risk factors which predispose an individual's risk of heart disease (such as high blood pressure, diabetes, high cholesterol, smoking or family history of heart disease). This also depends upon whether a person has had known heart disease which has been treated with angioplasty or heart bypass surgery. The decision to repeat a nuclear stress test is made by your doctor after taking all of these factors into consideration. Generally, if a nuclear stress is normal, in a person who is otherwise healthy, a repeat test is not needed for next 2-3 years unless there is a change in health status of the individual.
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31. I had an angioplasty done on my hearrt 2 months ago. Now I am doing well. I have no complaints, but my doctor wants me to undergo a nuclear stress test. Why does he want me to undergo this test?
There may be several reasons for this test. In some cases, the remaining heart arteries may also have some degree of blockage. The long term treatment of these blocked arteries depends upon whether these interfere with blood flow to the heart muscle on a nuclear stress test. In some cases the artery where angioplasty is done tends to become narrowed again over time. This condition is called restenosis. Restenosis can usually be detected by a nuclear stress test. Your doctor can explain the exact reason for asking for a nuclear stress test in your case.
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Heart Images

3-D image of a normal heart.
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3-D image of a the heart of a patient who had a heart attack.
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