Erythrocyte Sedimentation Rate (ESR)
Also Known As
 Sed Rate
 Sedimentation Rate
 Westergren Sedimentation Rate
 Wintrobe Sedimentation Rate
OVERVIEW
Sed rate, or erythrocyte sedimentation rate
(ESR), is a blood test that can reveal
inflammatory activity in your body. A sed
rate test isn't a stand-alone diagnostic tool,
but it can help your doctor diagnose or
monitor the progress of an inflammatory
disease.
When your blood is placed in a tall, thin
tube, red blood cells (erythrocytes) gradually
settle to the bottom. Inflammation can cause
the cells to clump. Because these clumps are
denser than individual cells, they settle to
the bottom more quickly.
The sed rate test measures the distance red
blood cells fall in a test tube in one hour.
The farther the red blood cells have
descended, the greater the inflammatory
response of your immune system.
WHY IT'S DONE
Sed rate tests might be useful when
evaluating unexplained fever, some types of
arthritis and symptoms that affect your
muscles.
Also, they can help confirm a diagnosis of
certain conditions, including:
 Giant cell arteritis
 Polymyalgia rheumatica
 Rheumatoid arthritis
 A sed rate test can also help
determine the severity of your
inflammatory response and monitor
the effect of treatment.
Because a sed rate test can't pinpoint the
problem that's causing inflammation in your
How you prepare
The sed rate is a simple blood test. You don't
need to fast before the test.
WHAT YOU CAN EXPECT
A phlebotomist, nurse or medical assistant
will use a needle to draw blood from a vein,
most likely a vein in your arm. After the test,
the site on your arm might be tender for a
few hours, but you'll be able to resume most
normal activities.
RESULTS
Results from your sed rate test will be
reported in the distance in millimeters (mm)
that red blood cells have descended in one
hour (hr). The normal range is 0 to 22
mm/hr for men and 0 to 29 mm/hr for
women. The upper threshold for a normal
sed rate value may vary somewhat from one
medical practice to another.
Your sed rate is one piece of information to
help your doctor check your health. Talk to
your doctor about what your sed rate results
mean in light of your symptoms and the
results of your other diagnostic tests.
ACCURACY OF TEST RESULTS
A number of conditions can affect the
properties of blood, thereby affecting how
quickly red blood cells sink in a sample of
blood.
So information about inflammatory disease
— what your doctor intends to learn from
the sed rate test — can be obscured by the
influence of other conditions. These
complicating factors include:

 Advanced age
 Anemia
 Pregnancy
 Kidney problems
 Thyroid disease
 Some cancers, such as multiple
myeloma
 Infection

Your doctor will take into account possible

complicating factors when interpreting the
results of your sed rate test.
ECHOCARDIOGRAM
Echocardiogram, also known as
echocardiography, or heart ultrasound is a
noninvasive, painless test that uses high-
frequency sound waves to visualize the
shape, size, and movement of the structures
of the heart. It is useful to evaluate patients
with chest pain, enlarged cardiac silhouettes
on X-rays, electrocardiogram (ECG)
changes unrelated to CAD, and abnormal
heart sounds on auscultation.
In this test, a transducer directs ultrahigh-
frequency sound waves toward cardiac
structure, which reflect these waves. The
echoes are converted to images that are
displayed on a monitor and recorded on a
strip chart or videotape. Results are
correlated with clinical history, physical
examination, and findings from the
additional test.
The techniques most commonly used in
echocardiography are M-mode (motion
mode), for recording the motion and
dimensions of intracardiac structures, and
two-dimensional (cross-sectional), for
recording lateral motion and providing the
correct spatial relationship between
structures.
The responsibilities of a nurse during
echocardiography includes explanation of
the procedure to the patient, monitoring
during tranesophageal and stress
examinations, and establishing intravenous
access for sonicated saline, microsphere
contrast, and medication
The different types of echocardiogram
are:
1. Transthoracic Echocardiogram
(TTE). It is the most common type of
echocardiogram and is noninvasive.
A device called transducer is placed
on the patient’s chest and transmits
ultrasound waves into the thorax.
These waves bounce off the
structures of the heart, creating
images and sounds that are shown in
a monitor.
2. Transesophageal Echocardiogram
(TOE). It is a special type of
echocardiography that uses an
endoscope to assist the transducer
down to the esophagus where it
produces a more detailed image of
the heart than a transthoracic
echocardiogram.
3. Stress Echocardiogram. An
echocardiogram that is performed
while the patient is using a treadmill
or stationary bicycle. This type can
be used to measure the function of
the heart both at rest and while
exercising.
4. Dobutamine Stress Echocardiogram.
For patients who are unable to
exercise on a treadmill, a drug called
dobutamine is given instead through
a vein that stimulates the heart in a
similar manner as exercise. This type
of echocardiogram is used to
evaluate coronary artery disease and
measures the effectiveness of cardiac
therapeutic regimen.
5. Doppler echocardiogram. Measures
and assess the blood flow through
the heart and blood vessels.
INDICATION
Echocardiogram is indicated for several
reasons, which includes:
 Detect and evaluate valvular
abnormalities
  Detect atrial tumors
 Measure the size of the heart
chambers
 Evaluate chambers and valves in
congenital heart disorders
 Diagnose hypertrophic and related
cardiomyopathies
 Evaluate cardiac function or wall
motion after myocardial infarctions
 Detect pericardial effusion and mural
thrombi
PROCEDURE
The following are the steps and processes on
how an echocardiography or
echocardiogram is performed:
 Place patient in a supine position.
Patient is placed in a supine position and a
conductive gel is applied to the third or
fourth intercostal space to the left of the
sternum. The transducer is placed directly
over it.
 Transducer is placed
The transducer directs ultra-high-frequency
sound waves towards cardiac structures,
which reflect these waves; the transducer
picks up the echoes, converts them to
electrical impulses, and relays them to an
echocardiography machine for display.
 Motion mode is used
In motion mode (M-mode), a single, pencil-
like ultrasound beam strikes the heart and
produces a vertical view, which is useful for
recording the motion and dimensions of
intracardiac structures.
 Change in position
In two-dimensional echocardiography, a
cross-sectional view of the cardiac structures
is used for recording the lateral motion and
spatial relationship between structures. For a
left lateral view, the patient is placed on his
left side.
 Transducer is angled.
The transducer is systematically angled to
direct ultrasonic waves at specific parts of
the patient’s heart.
 Record findings.
During the test, the screen is observed;
significant findings are recorded on a strip
chart recorder or a video tape recorder.
 Doppler echocardiography.
Doppler echocardiography also may be used
where color flow stimulates red blood cell
flow through the heart valves. The sound of
blood flow also may be used to assess heart
sounds and murmurs as they relate to cardiac
hemodynamics.
INTERFERING FACTORS
These are factors that may affect the
outcome of echocardiography:
Patient doing unnecessary movement during
the procedure.
Incorrect placement of the transducer over
the desired test area.
Metallic objects within the examination
field, which may hinder organ visualization
and cause unclear images
Patients who are dehydrated, resulting in
failure to demonstrate the boundaries
between organs and tissue structures.
Patients who have a severe chronic
obstructive pulmonary disease have a
significant amount of air and space between
the heart and the chest cavity. Airspace does
not conduct ultrasound waves well.
In obese patients, the space between the
heart and the transducers is greatly enlarged;
therefore, the accuracy of the test is
decreased.
NURSING RESPONSIBILITIES
The following are the nursing interventions
and nursing care considerations for a patient
undergoing a normal echocardiogram:
BEFORE THE PROCEDURE
The following interventions are done prior
and during the study:
Explain the procedure to the patient. Inform
the patient that echocardiography is used to
evaluate the size, shape, and motion of
various cardiac structures. Tell who will
perform the test, where it will take place,
and that it’s safe, painless, and is
noninvasive.
No special preparation is needed. Advise the
patient that he doesn’t need to restrict food
and fluids for the test.
Ensure to empty the bladder. Instruct patient
to void prior and to change into a gown.
Encourage the patient to cooperate. Advise
the patient to remain still during the test
because movement may distort results. He
may also be asked to breathe in or out or to
briefly hold his breath during the exam.
Explain the need to darkened the
examination field. The room may be
darkened slightly to aid visualization on the
monitor screen, and that other procedure
(ECG and phonocardiography) may be
performed simultaneously to time events in
the cardiac cycles.
Explain that a vasodilator (amyl nitrate) may
be given. The patient may be asked to inhale
a gas with a slightly sweet odor while
changes in heart functions are recorded.
DURING THE PROCEDURE
The following are the nursing considerations
during echocardiogram:
Inform that a conductive gel is applied to the
chest area. A conductive gel will be applied
to his chest and that a quarter-sized
transducer will be placed over it. Warn him
that he may feel minor discomfort because
pressure is exerted to keep the transducer in
contact with the skin.
Position the patient on his left side. Explain
that transducer is angled to observe different
areas of the heart and that he may be
repositioned on his left side during the
procedure.
AFTER THE PROCEDURE
The nurse should be aware of these post-
procedure nursing interventions after an
echocardiogram, they are as follows:
Remove the conductive gel from the
patient’s skin. When the procedure is
completed, remove the gel from the patient’s
chest wall.
Inform the patient that the study will be
interpreted by the physician. An official
report will be sent to the requesting
physician, who will discuss the findings with
the patient.
Instruct patient to resume regular diet and
activities. There is no special type of care
given following the test.
NORMAL RESULTS
Normal findings of echocardiogram will
reveal the following:
For mitral valve: Anterior and posterior
mitral valve leaflets separating in early
diastole and attaining maximum excursion
rapidly, then moving toward each other
during ventricular diastole; after atrial
contraction, mitral valve leaflets coming
together and remaining together during
ventricular systole.
For aortic valve: Aortic valve cusps
moving anteriorly during systole and
posteriorly during diastole.
For tricuspid valve: The motion of the
valve resembling that of the mitral valve.
For pulmonic valve: Movement occurring
posterior during atrial systole and ventricular
ejection, cusp moving anteriorly, attaining
its most anterior position during diastole.
For ventricular cavities: Left ventricular
cavity normally an echo-free space between
the interventricular septum and the posterior
left ventricular wall.
Right ventricular cavity: Normally an
echo-free space between the anterior chest
wall and the interventricular septum.

ABNORMAL RESULTS:
Abnormal echocardiogram findings will
show the following:

In mitral stenosis: Valve narrowing

abnormally because of the leaflets’
thickening and disordered motion; during
diastole, both mitral valve leaflets moving
anteriorly instead of posteriorly.
In mitral valve prolapse: One or both
leaflets ballooning into the left atrium during
systole.
In aortic insufficiency: Aortic valve leaflet
fluttering during diastole.
In stenosis: Aortic valve thickening and
generating more echoes.
In bacterial endocarditis: Disrupted valve
motion and fuzzy echoes usually on or near
the valve.
Large chamber size: May indicate
cardiomyopathy, valvular disorders, or heart
failure: small chamber size: may indicate
restrictive pericarditis.
Hypertrophic cardiomyopathy: Identified
by a systolic anterior motion of the mitral
valve and asymmetrical septal hypertrophy.
Myocardial ischemia or infarction: May
cause absent or paradoxical motion in
ventricular walls.
Pericardial effusion: Fluid accumulates in
the pericardial space, causing an abnormal
echo-free space.
In large effusions: Pressure exerted by
excess fluid restricting pericardial motion.
CARDIAC CATHETERIZATION
Cardiac catheterization reveals defects in the
heart chambers, the valves, and coronary
arteries. Using fluoroscopy, the cardiologist
inserts catheters into one or both sides of the
heart and measures pressures and cardiac
output. The cardiologist also may obtain
blood specimens for oxygen saturation
testing. By injecting contrast media, the
cardiologist can further define cardiac
structures, including the coronary arteries,
and assess cardiac wall motion. Depending
on the facility and the patient's condition,
cardiac catheterization may be performed as
either an inpatient or an outpatient
procedure.
INDICATIONS FOR CARDIAC
CATHETERIZATION
Include definitive or suspected myocardial
ischemia, syncope, valvular heart disease,
and acute myocardial infarction (MI). It also
may be indicated after an MI, coronary
artery bypass graft surgery, or percutaneous
transluminal coronary angioplasty in
patients having recurring symptoms, and
after a heart transplant to monitor for
rejection.
GETTING READY
To prepare the patient, teach him about the
procedure and answer his questions. Provide
booklets, videos, or other educational tools
to reinforce learning. The cardiologist will
discuss benefits and risks, such as
dysrhythmias, bleeding, stroke, or MI. Make
sure the patient has provided informed
consent.
Assess for allergies, especially significant
allergies such as a previous anaphylactic
reaction to one or more allergens, including
contrast media. Ask if he has a history of
asthma, which is associated with an
increased likelihood of a contrast reaction.
Also note if he's allergic to medications—
including lidocaine, the local anesthetic
commonly used for vascular access.
The patient may be instructed to fast for 3 to
8 hours before the procedure and withhold
or decrease the dosages of scheduled
medications (including insulin,
antihypertensive drugs, and diuretics). The
physician may prescribe pretreatment
prophylaxis for the patient with a history of
contrast media allergy. Establish two
peripheral venous access sites and infuse
I.V. fluids as ordered to prevent dehydration.
Obtain specimens for lab tests (complete
blood cell count, electrolytes, blood urea
nitrogen, creatinine, coagulation studies,
cardiac biomarkers, and urinalysis). Also
obtain a chest X-ray and an ECG.
The femoral and brachial arteries are
common catheter insertion sites, although
the radial artery also is an option. Assess and
mark pulses on the extremity that will be
used. Have the patient void. (He may wear
his dentures and eyeglasses during the test.)
Administer analgesics and sedatives as
directed.
DURING THE PROCEDURE
The test itself lasts 30 minutes to 1 hour, but
the entire procedure, including
precatheterization and postcatheterization
care, may take up to 4 hours. Tell the patient
what to expect, including the following
points:
He'll receive I.V. medication for anxiety and
pain as needed throughout the procedure.
The testing takes place in a cool, darkened
room. He'll lie on a special procedure table
where X-rays can be taken, either by
repositioning the table or by moving the X-
ray machine around him. He'll be attached to
equipment for continuous cardiac, BP, and
pulse oximetry monitoring.
He'll be awake throughout the procedure and
may be asked to cough or take a deep breath
at certain times. Tell him to immediately
report any unusual symptoms, such as chest
discomfort or trouble breathing.
When contrast media is injected into the left
ventricle, he may feel warm or flushed for
up to a minute

AFTER THE PROCEDURE

The catheters are removed and bleeding is
controlled with direct pressure or with a
vascular closure device. He'll be
continuously assessed and monitored in a
postcardiac catheterization recovery area.
Depending on his condition and the method
used to stop bleeding, he'll spend some time
on bed rest with the affected extremity
immobilized.

FOLLOW-UP CARE
Assess the patient for nausea or pain
(including back pain from lying still) and
provide medication as indicated. Assess the
catheter insertion site for bleeding or
hematoma with vital signs as ordered.
Instruct him to inform you immediately if he
experiences chest discomfort or other
anginal symptoms. Review the discharge
orders with the patient and family, including
activity restrictions, and educate them about
signs and symptoms of complications,
including MI, stroke, and insertion-site
bleeding or infection. If indicated, inform
the patient that he may need blood urea
nitrogen and creatinine monitoring after
discharge. Finally, instruct him to follow up
with his primary care provider.
ENZYME MARKERS
WHAT ARE ENZYME MARKERS?
Enzymes are highly specialized complex
proteins that aid chemical changes in every
part of the body. For example, they help
break down food so your body can use it
effectively. They also help your blood clot.
And they’re present in every organ and cell
in your body. Enzymes are necessary for
your body to function properly.
Enzyme markers are blood tests that analyze
specific enzyme activity in the body. Some
inherited diseases or conditions can cause
these enzymes to stop working or be less
efficient. Monitoring the rise or fall of
enzyme levels can aid in the diagnosis of a
variety of conditions.
Your doctor can order a blood test for
enzyme markers, or a routine blood test to
help uncover abnormalities. In some cases,
you may need to take a test multiple times
over the course of several days to measure
changes over time.
WHAT ARE THE COMMON TYPES
OF ENZYME MARKERS?
CPK isoenzymes
The CPK isoenzymes test measures the
creatine phosphokinase (CPK) in the blood.
CPK enzymes are in the heart, brain, and
skeletal muscles. Normal CPK levels vary
by age, gender, and race.
Each laboratory may have minor differences
in reference ranges, as well. In general, a
CPK level of approximately 200 units per
liter (U/L) or less is considered normal in an
adult. This is the total CPK level in your
body. More specific testing can be done, but
this is not routine.
CPK-1 resides mostly in the brain and lungs.
Increased levels of CPK-1 can be due to:
 brain cancer
 brain injury, stroke, or bleeding in
the brain
 pulmonary infarction, which is the
death of lung tissue
 seizure
 electroconvulsive therapy
CPK-2 levels rise following a heart attack.
Increased levels of CPK-2 may also be due
to:
 open heart surgery
 inflammation of the heart muscle
 heart injury
 defibrillation
 electrical injuries
 chest compressions after cardiac
arrest
High CPK-3 levels can be a sign of muscle
stress, a crush injury, or injury due to:
 muscle damage, dystrophy, or
inflammation
 intramuscular injections
 electromyography, which is a muscle
and nerve function test
 recent surgery
 seizures
 strenuous exercise
HEART ENZYMES
Some heart enzymes slowly enter your
blood if you’ve had a heart attack and your
heart is damaged as a result. A general test
for emergency room patients with heart
attack symptoms is a test for the presence of
certain proteins in your blood. A doctor may
check CPK-2, also known as CK-MB. This
marker is highly specific for heart muscle
injury and rises rapidly during a heart attack.
Normal CK-MB should be between 5-25
international units per liter (UI/L).

The preferred marker of heart injury,
though, is a protein called troponin.
Troponin should generally be less than 0.02
nanograms per milliliter (ng/mL). The level
takes longer to rise than CK-MB, but the
protein stays in the bloodstream longer.
LIVER ENZYMES
Elevated liver enzymes may be due to
inflammation or damaged liver cells.
Usually, elevated liver enzymes are related
to an acute injury, or a process that occurred
over a short period of time due to:
prescription medications, such as statins
over-the-counter (OTC) medications, such
as acetaminophen (Tylenol)
alcohol consumption
heart failure or heart attack
liver disease, such as hepatitis, fatty liver
disease, cancer, and cirrhosis
obesity
celiac disease, which is a digestive condition
viruses, such as cytomegalovirus infection;
hepatitis A, B, C, E viruses; mononucleosis;
and Epstein-Barr virus
inflammatory diseases, such as
dermatomyositis, pancreatitis, and
gallbladder inflammation
muscular diseases, such as muscular
dystrophy or polymyositis
ischemia, or lack of oxygen going to the
liver, such as during cardiac arrest
hemochromatosis, which is a disorder in
which there’s too much iron in the blood
underactive thyroid
Wilson disease, which is a disorder where
there’s too much copper stored in the body
physical trauma to the organ
There are several markers that can be used
to test liver function. These markers help
separate whether or not the injury is to the
liver parenchyma (liver cells) or to the
biliary system. For the purposes of this
article, the important tests are the liver
aminotransferases: alanine aminotransferase
(ALT) and aspartate aminotransferase
(AST).
ALT is primarily produced by the liver,
while AST can be from the liver, cardiac
muscle, skeletal muscle, kidney, and brain.
A normal ALT level is 29-33 IU/L for men,
and 19-25 IU/L for women. A normal AST
level may range from 10-40 IU/L for men
and 9-32 IU/L for women.
These reference ranges vary from hospital to
hospital. It’s important to compare your liver
enzyme levels to the reference ranges
provided by the lab.
HOW ARE ENZYME MARKER TESTS
PERFORMED?
The test is a routine blood test that takes
place in a laboratory. No fasting or special
preparation is necessary. But tell your doctor
before the test about all prescription and
OTC medications and supplements you take.
A BLOOD TEST INVOLVES THE
FOLLOWING STEPS:
A healthcare provider will use an antiseptic
to clean a small area of your arm, usually the
inside of your elbow or the back of your
hand.
They’ll then wrap an elastic band around
your upper arm to create pressure and make
it easier to access a vein.
They’ll insert a needle into your vein and
blood will flow into a small vial. You’ll
likely feel the stick of the needle or a
stinging sensation.
After filling the vial, the healthcare provider
will remove the elastic band and the needle.
They’ll place a bandage over the puncture
site and send the blood sample to a lab for
analysis.
The procedure should take only a few
minutes.

WHAT ARE THE RISKS ASSOCIATED

WITH ENZYME MARKER TESTS?
Your arm may be sore at the puncture site,
and you might have some mild bruising or
brief throbbing.

Most people have no serious or lasting side

effects from a blood test. Rare complications
include:

 Bleeding
 light-headedness
 fainting
 infection, which is a small risk
whenever the skin is broken
 Contact your doctor immediately if
you have any of these symptoms.

WHAT DO THE TEST RESULTS

MEAN?
Abnormal test results can indicate a variety
of problems from disease to a simple muscle
strain because enzymes are present in every
cell of your body. Your doctor will be able
to determine a proper course of treatment
based on your exact enzyme marker levels
and the symptoms you’re having.
RADIONUCLIDE TESTS
Radionuclide tests are one of several types
of tests performed to assess your heart
condition.
The test that is offered to you will depend on
your condition and symptoms, as well as on
what tests and equipment are available.
Radionuclide tests are considered safe.
However, during the test you will be
exposed to some radiation.
Every day we are exposed to a small amount
of radiation which occurs naturally in the
environment. Our risk of cancer can increase
if we're exposed to plenty of radiation, but
the amounts used in these tests are small.
Your doctor will only suggest you have the
test if he or she feels it's really necessary,
and if its benefits outweigh any risks.
TYPES OF RADIONUCLIDE TESTS
There are two types of radionuclide tests: a
myocardial perfusion scan and a
computerised tomography (CT) scan. There
are lots of different names for these tests.
The names we mention below are some of
the more common ones. If the name of your
test isn't mentioned here, check with your
doctor or radiographer what your test
involves.
MYOCARDIAL PERFUSION SCAN
This is also known as a thallium scan, MIBI
scan, MPS or technetium scan. A camera
takes pictures to:
look at the pumping action of your heart
look at the flow of blood to your heart
muscle
see how your heart functions when it has to
work harder - for example, when you're
being more active, or
help diagnose coronary heart disease (CHD).
What happens during a myocardial perfusion
scan?
THERE ARE TWO PARTS TO THE
TEST - STRESS AND REST.
For the stress part, you will be given an
injection of a small amount of isotope
(radioactive substance) and be asked to
exercise on an exercise bike or treadmill. Or,
you may be given a drug that stimulates
your heart to beat faster (this is useful if you
cannot do much exercise).
A large camera, positioned close to your
chest, picks up the gamma rays sent out by
the isotope as it passes through your heart.
The camera takes pictures of the different
parts of your heart.
For the rest part, you will be given a small
amount of isotope while you're resting. The
camera will then take the same sort of
pictures as before.
Various isotopes are used, including
technetium and thallium.
During the test, the staff will monitor your
heart rate and check your blood pressure.
WHEN MIGHT I BE OFFERED THIS
TEST?
You may be offered this test if you haven't
previously been diagnosed with CHD and
you go to A&E with chest pain. If the
doctors think it's very likely that your chest
pain is caused by CHD this test may be used
to confirm if you have CHD.
You may also be offered this test if you have You may be given a medicine to slow your
CHD and your doctor wants to find out if heart rate down. This is to ensure that the
you'll benefit from having a procedure such doctors are able to get the best possible
as an angioplasty or coronary bypass graft. image of your heart.

CT SCANS (COMPUTERISED
TOMOGRAPHY)
A CT scan is also known as a CAT scan. It's
a sophisticated type of X-ray, which can
produce detailed images of your heart. It can
look at:
the pumping action of your heart
the structure of your heart - its muscle,
valves and coronary arteries (the arteries that
supply your heart muscle with blood and
oxygen)
the flow of blood through your heart and
your coronary arteries.
A CT scan can see how well your heart is
working and can help to diagnose various
heart conditions such as an enlarged heart,
heart valve problems or coronary heart
disease (CHD).
How long the test is, depends on the type of
scanner used and why you are having the
scan.
WHEN MIGHT I BE OFFERED THIS
TEST?
You may be offered a CT scan if doctors are
not entirely sure that your chest pain is
caused by CHD. So this test is often used to
make sure that you don't have CHD.
If your doctor is reasonably sure that you do
have CHD, he or she is more likely to offer
you a myocardial perfusion scan or a
conventional angiogram.

This test can also measure how much

calcium there is in your coronary arteries -
this is called a coronary calcium scan. The
higher your calcium score, the higher your
risk of having CHD. If you have a high or
medium calcium score, you may need
further tests. If you have a low calcium
score, it's unlikely that you have CHD.

WHAT HAPPENS DURING THE

TEST?
You will need to lie on a bed under the CT
scanner. Usually, at the start of the scan,
some dye (called a contrast) will be injected
into your arm. This allows the camera to
easily see the heart's structure and blood
flow. This may cause a warm, flushing
sensation which some people find
unpleasant.