(This page is intended only for the services of patients who belong to St. Louis Cardiology Consultants.)

Instructions Prior to Testing
If you are unsure about the instruction, please call our offices.

Stress test: Walking/chemical stress cardiolite or stress echocardiogram.

Do not take any beta-blocker 24 hours prior to the test. This includes atenolol (Tenormin), metropolol (Lopressor), Tropol XL, Coreg, propanalol (Inderlol), nadolol (Corgard), Pinolol, Ziac, Timolol, and Labetalol.

Do not take these calcium channel blockers 24 hours prior to the test: verapamil (Calan) or diltiazem (Cardizem, Tiazac or Cartia).

Do not take Persantine, Theophylline or Aminophylline 24 hours prior to the test.

If you are having an isotope stress test (thallium or cardiolite), please do not have any caffeine for 24 hours prior to the test. This includes decaffeinated or regular coffee, soda, chocolate or tea.

Do not eat or drink anything after midnight except sips of water only. For testing scheduled in the afternoon, you may have light caffeine-free breakfast before 7:00 am (toast, jello or juice).

If you are diabetic, cut insulin dose and/or diabetic pill in half the evening before the test. Do not take any insulin or diabetic pills the morning of your test.
If you are unsure about the instruction, please call our offices.

Bring a snack with you to eat halfway through the test.

Plan to be here for at least 4 hours if you are having a chemical stress test.

Wear loose, comfortable clothing and lace up walking shoes. Please wear short sleeves so we may have access to your arm to start an IV.

Do not wear any lotions, powders, creams, or necklaces on the day of your test.

To avoid being charged for the medicine that we order for the test, cancellation 24 hours prior to the test is required.

Echocardiogram: with Doppler or bubble study.

You do not have to be fasting.

Plan to be here for 1 hour.

Please wear short sleeves so we may have access to your arm to start an IV if needed.

Do not wear any lotions, powders, creams, or necklaces on the day of your test.

Transesophageal Echocardiogram:

Do not have this procedure if you have loose teeth or mouth sores.

Do not eat or drink for six hours before your test.

Be sure to take all your normal morning medications the day of your test. You do not have to stop taking blood thinners.

Drink only the smallest amount of water necessary to swallow your medicines.

Bring an up-to-date list of your medications with you on the day of your test, and let your nurse know what you have already taken that morning.

Be sure to notify the doctor or nurse if you have any allergies, difficulty in swallowing or problems with your mouth, esophagus or stomach.

Dentures should be removed.

You will not be allowed to eat or drink for a few hours after the procedure until you are alert and able to swallow safely.

Make arrangements in advance for transportation home; you will not be allowed to drive yourself home.

Heart Rhythm Monitoring: 24-hour Holter or 30-day event recorder.

You do not have to be fasting.

Plan to be here for 30 minutes.

Do not wear any lotions, powders, creams, or necklaces on the day of your test.

Carotid Ultrasound or ABI study:

You do not have to be fasting.

Plan to be here for 60 minutes.

Do not wear any lotions, powders, creams, or necklaces on the day of your test.

MUGA Scan:

You do not have to be fasting.

Plan to be here for an hour and a half.

Please wear short sleeves so we may have access to your arm to start an IV.

Do not wear any lotions, powders, creams, or necklaces on the day of your test.

Heart Catheterization:

Preliminary blood test and chest X-ray may be obtained prior to the heart catheterization.

If you are currently taking Coumadin, it may needed to be stopped 3-7 days before the procedure. Make sure to discuss this with our cardiologist/office.

Let us know if you have a history of X-ray dye allergy or kidney disease. You may need to be premedicated a few days before the procedure.

If you are diabetic, cut insulin dose and/or diabetic pill in half the evening before the test. Do not take any insulin or diabetic pills the morning of your test. If you are unsure about the instruction, please call our offices.

Do not eat or drink after midnight the evening before your test.

Be sure to take all your normal morning medications the day of your test (except for water pill, Coumadin and diabetic medicines).

Drink only the smallest amount of water necessary to swallow your medicines.

Bring an up-to-date list of your medications with you on the day of your test, and let your nurse know what you have already taken that morning.

Make arrangements in advance for transportation home; you will not be allowed to drive yourself home.

Pacemaker and Implantable Cardioverter Defibrillator (ICD) insertion:

Preliminary blood test and chest X-ray may be obtained prior to the pacemaker or ICD insertion.

If you are currently taking Coumadin or Plavix, they may needed to be stopped 3-7 days before the procedure. Make sure to discuss this with our cardiologist/office.

If you are diabetic, cut insulin dose and/or diabetic pill in half the evening before the test. Do not take any insulin or diabetic pills the morning of your test. If you are unsure about the instruction, please call our offices.

Do not eat or drink after midnight the evening before your test.

Do not take all your normal morning medications the day of your test.

Bring an up-to-date list of your medications with you on the day of your test.



Heart Catheterization/Balloon Dilation Procedure/Stent Procedure Discharge Instructions:

Activity:

No heavy lifting over 10 pounds for one week or as directed by your cardiologist.

No driving for two days after plastic tube removal from the puncture site.

No strenuous activity with affected leg for one week (i.e. jogging, swimming, running, raking, or mawing lawn).

No excercing or excessive use of stairs for one week.

Puncture Site Care:

Remove the dressing next day.

To prevent infection, a shower is prefgerred to a tub bath for at least one week.

Wash with soap and water daily in shower.

Do not apply any creams or lotions to puncture site.

Inspect your puncture site daily. Notify the office immediately of increased bruising, swelling, excessive pain, redness, drainage, foul odor or a fever (more than 100.5°F).

You amy develop scar tissue at the puncture site. This is normal and will feel like a small lump under the skin. You may feel this lump for some time.

Questions and Concerns:

If you are our patient and have any questions, please contact the office.

North County Patients:
Christian Hospital Office: 11133 Dunn Road, Suite 2346, St. Louis, MO 63136
314-653-5125

DePaul Office: 12255 DePaul Drive, Suite 460, Bridgeton, Missouri 63044
314-770-9888

Florissant Office: 261 Dunn Road., Florissant, MO 63031
314-839-5522

St. Charles Patients:
Kisker Office: 1475 Kisker Road, St. Charles, MO 63304
636-498-5890

Wall Street Office:
1551 Wall Street, St. Charles, MO 63303
636-669-2220

Illinois Patients:
Alton Office: 2 Memorial Drive, Suite 102, Alton, IL 62202
618-462-6612

After Hours: Physician Exchange: (314) 388-5511



Pacemaker Discharge Instructions:

Activity:

NO lifting of the affected arm above the shoulder for one week.

Wear your sling. After the first week, normal arm movement is allowed. However, keep your elbow below the level of your heart for the first month. This allows the lead wires to heal in the proper position.

NO lifting above 10 pounds with the affected arm for 4 weeks.

NO strenuous activities; this includes walking on a treadmill, golf, tennis, or aerobics for at least six weeks and until approved by your physician.

Avoid any sports and/or activities which may cause injury to your surgical site for one month.

Avoid isometric activities such as mowing grass, sweeping/scrubbing floor for 4 weeks.

DO NOT DRIVE UNTIL IT IS APPROVED BY THE CARDIOLOGIST.

DO resume your regular activities as much as possible. Walking is a great and safe exercise. It helps you to regain your strength after surgery. It is good for your heart health and it is also a great way to get out of the house.

It is safe to resume sexual activity as soon as you feel you are able and as long as there is no strain placed on the surgical site and/or affected arm for the first month.

Incision Care:

Keep your incision dry for the first 5 days, even while bathing. If you need to shower, you can cover the area with plastic and tape (cut a plastic storage bag in half; it works well).

After 5 days, clean your incision daily with mild soap and water. Gently pat the area dry, and avoid vigorous scrubbing directly on or near your incision. Then cover the incision with a dry dressing daily (either gauze and tape or an extra large band-aid work well).

Inspect your incision/device site daily. Notify the office immediately of any bleeding, increased bruising, redness, warmth, increased swelling, excessive pain, drainage, or a fever (more than 100.5°F).

There are no stitches in your incision (only on the inside, and these dissolve). You will see one of the following: Dermabond (surgical skin glue), Steri-Strips, or small metal skin staples.

Dermabond will gradually dissolve, but it must be kept dry for 5 to 7 days.

Steri-Strips will gradually peel away in about one week. If they do not, leave them in place and they will be removed in the office when you come in for your incision check.

Staples can remain in place for up to 2 weeks, and must only be removed by trained personnel in the office (this will be done at your incision check).

Keep your incision covered (other than to clean and inspect the site) until you are seen in the office.

Pacemaker Safety:

Avoid strong magnetic fields and flying sparks. These could interfere with the proper function of your device. NO MRI scans. Other examples are high security systems, large power transformers and ARC welding.

Airport Security: First, always have air travel approved by your physician. When passing through airport security, always have your ID card with you and present it at each security station. Always request a manual search instead of a wand search. The wands used are large magnets and can interfere with your device.

Most common household items are safe to use when you have a pacemaker. These include hair dryers, electric shavers, electric tooth brushes, toasters, curling irons, ovens, stoves/ranges, remote controls, hand held power tools and so on. These items should be kept at least 6 inches away from your device while in operation.

Cellular phones are safe, but need to be used on the side opposite your device, and not stored in your shirt pocket.

Microwaves and induction ranges (ceramic smooth top) are safe, but you need to keep the device at least 2 feet away while these items are in operation.

You will receive a temporary ID card at the hospital when you are discharged. This contains important information about your device. You will receive a permanent card from the manufacturer in about 4 to 6 weeks. Carry your ID card with you at all times.

We also recommend purchasing a Medic Alert bracelet or necklace.

Encourage family members and friends to become CPR certified if they are able.

Keep emergency number posted close to a telephone that is easily accessible.

Notify all physicians, including dentists, surgeons and eye care specialists that you have a pacemaker. Always notify emergency personnel that you have a pacemaker.

Call the office as soon as you are informed of a scheduled procedure or surgery.

Follow Up Appointments:

Your incision site check will take place in 2 weeks with the implanting physician.

Your care and device management will then be resumed by your regular cardiologist.

Your pacemaker will be checked in the office 3 months after it is implanted.

Questions and Concerns:

There will be many. If you are our patient, please contact the office.

North County Patients:
Christian Hospital Office: 11133 Dunn Road, Suite 2346, St. Louis, MO 63136
314-653-5125

DePaul Office: 12255 DePaul Drive, Suite 460, Bridgeton, Missouri 63044
314-770-9888

Florissant Office: 261 Dunn Road., Florissant, MO 63031
314-839-5522

St. Charles Patients:
Kisker Office: 1475 Kisker Road, St. Charles, MO 63304
636-498-5890

Wall Street Office:
1551 Wall Street, St. Charles, MO 63303
636-669-2220

Illinois Patients:
Alton Office: 2 Memorial Drive, Suite 102, Alton, IL 62202
618-462-6612

After Hours: Physician Exchange: (314) 388-5511



ICD Discharge Instructions:

Activity:

NO lifting of the affected arm above the shoulder for one week.

Wear your sling. After the first week, normal arm movement is allowed. However, keep your elbow below the level of your heart for the first month. This allows the lead wires to heal in the proper position.

NO lifting above 10 pounds with the affected arm for 4 weeks.

NO strenuous activities; this includes walking on a treadmill, golf, tennis, aerobics for at least six weeks and until approved by your physician.

Avoid any sports and/or activities which may cause injury to your surgical site for one month.

Avoid isometric activities such as vacuuming, mowing grass, sweeping or scrubbing floors for 4 weeks.

DO NOT DRIVE UNTIL IT IS APPROVED BY THE CARDIOLOGIST.

DO resume your regular activities as much as possible. Walking is a great and safe exercise. It helps you to regain your strength after surgery, it is good for your heart health, and it is also a great way to get out of the house.

It is safe to resume sexual activity as soon as you feel you are able and as long as there is no strain placed on the surgical site and/or affected arm for the first month.

Incision Care:

Keep your incision dry for the first 5 days, even while bathing. If you need to shower, you can cover the area with plastic and tape (cut a plastic storage bag in half; it works well).

After 5 days, clean your incision daily with mild soap and water. Gently pat the area dry, and avoid vigorous scrubbing directly on or near your incision. Then cover the incision with a dry dressing daily (either gauze and tape or an extra large band-aid work well).

Inspect your incision/device site daily. Notify the office immediately of any bleeding, increased bruising, redness, warmth, increased swelling, excessive pain, drainage or a fever (more than 100.5°F).

There are no stitches in your incision (only on the inside, and these spontaneously dissolve by themselves). You will see one of the following: Dermabond (surgical skin glue), Steri-Strips, or small metal skin staples.

Dermabond will gradually dissolve, but it must be kept dry for 5 to 7 days.

Steri-Strips will gradually peel away in about one week. If they do not, leave them in place and they will be removed in the office when you come in for your incision check.

Staples can remain in place for up to 2 weeks, and must only be removed by trained personnel in the office (this will be done at your incision check).

Keep your incision covered (other than to clean and inspect the site) until you are seen in the office.

ICD Safety:

Avoid strong magnetic fields and flying sparks. These could interfere with the proper function of your device. NO MRI scans. Other examples are high security systems, large power transformers and ARC welding.

Airport Security: First, always have air travel approved by your physician. When passing through airport security, always have your ID card with you and present it at each security station. Always request a manual search instead of a wand search. The wands used are large magnets and can interfere with your device.

Most common household items are safe to use when you have an ICD. These include hair dryers, electric shavers, electric tooth brushes, toasters, curling irons, ovens, stoves/ranges, remote controls, hand held power tools and so on. These items should be kept at least 6 inches away from your device while in operation.

Cellular phones are safe, but need to be used on the side opposite your device, and not stored in your shirt pocket.

Microwaves and induction ranges (ceramic smooth top) are safe, but you need to keep the device at least 2 feet away while these items are in operation.

You will receive a temporary ID card at the hospital when you are discharged. This contains important information about your device. You will receive a permanent card from the manufacturer in about 4 to 6 weeks. Carry your ID card with you at all times.

We also recommend purchasing a Medic Alert bracelet or necklace.

Encourage family members and friends to become CPR certified if they are able.

Keep emergency number posted close to a telephone that is easily accessible.

Notify all physicians, including dentists, surgeons and eye care specialists that you have an ICD. Always notify emergency personnel that you have an ICD.

Call the office as soon as you are informed of a scheduled procedure or surgery.

What To Do If a Shock Occurs:

Many patients with an ICD will experience a discharge or shock from the device at some point in time. Knowing what to expect, and what to do, can help.

If you start to feel dizzy, lightheaded, or that you are going to pass out, sit or lie down. You may be getting ready to receive a shock. If you are having these symptoms because of an abnormal heart rhythm, they will disappear or reverse once the ICD has fired to terminate the abnormal rhythm.

It is possible to be completely without symptoms before receiving a shock, but most people have at least some subtle warning signs that their abnormal heart rhythm is occurring, and that a shock may be imminent.

WHEN YOU RECEIVE YOUR FIRST SHOCK your cardiologist must be notified within 24 hours, and you will be given instructions when and where you will be seen.

AFTER A SHOCK, try to record the details of the event in a journal. What were you doing before the shock? What symptoms did you have? What happened after the shock? This information is very helpful to your physician when you are evaluated in the office.

WHEN TO CALL 911:

FOLLOWING A SHOCK EMS SHOULD BE CALLED IF:
YOU RECEIVE NUMEROUS SHOCKS (THREE OR MORE, OR THREE CONSECUTIVELY IN LESS THAN 2 MINUTES).

YOU BECOME UNRESPONSIVE OR CONTINUE TO HAVE SYMPTOMS FOLLOWING A SHOCK.

YOU DEVELOP WORSENING SYMPTOMS FOLLOWING A SHOCK.

Follow Up Appointments:

Your incision site check will take place in 2 weeks with the implanting physician.

Your care and device management will then be resumed by your regular cardiologist.

Your ICD will be checked in the office three months after it is implanted.

Questions and Concerns:

There will be many. If you are our patient, please contact the office.

North County Patients:
Christian Hospital Office: 11133 Dunn Road, Suite 2346, St. Louis, MO 63136
314-653-5125

DePaul Office: 12255 DePaul Drive, Suite 460, Bridgeton, Missouri 63044
314-770-9888

Florissant Office: 261 Dunn Road., Florissant, MO 63031
314-839-5522

St. Charles Patients:
Kisker Office: 1475 Kisker Road, St. Charles, MO 63304
636-498-5890

Wall Street Office:
1551 Wall Street, St. Charles, MO 63303
636-669-2220

Illinois Patients:
Alton Office: 2 Memorial Drive, Suite 102, Alton, IL 62202
618-462-6612

After Hours: Physician Exchange: (314) 388-5511