Our Services

📊 Holter Monitor

A Holter monitor is a small, portable device that continuously records your heart's electrical activity (ECG) over 24 to 72 hours—or even up to 14 days in some cases. Unlike a standard ECG that captures just a few seconds, a Holter monitor tracks your heart rhythm during your normal daily activities, including sleep, exercise, and stress.

This helps your doctor detect intermittent arrhythmias, skipped beats, or other rhythm irregularities that might not show up during a short in-office test. The device is worn under your clothes with adhesive electrodes connected to a lightweight recorder.

You’ll be asked to keep a diary of symptoms such as palpitations, dizziness, or chest discomfort. When the monitor is returned, your doctor correlates any abnormal rhythms with your symptoms.

Holter monitoring is painless and non-invasive and is useful for diagnosing atrial fibrillation, PVCs, PACs, unexplained fainting, or slow heart rates.

Preparation

Shower before the monitor is placed, since you won’t be able to shower while wearing it. Wear a two-piece outfit with a loose-fitting top. Continue normal activities and keep a symptom diary. Do not get the monitor wet or remove any leads.

🫀 Echocardiogram (Cardiac Ultrasound, Echo)

An echocardiogram is a noninvasive, painless test that uses ultrasound waves to create live images of your heart. It allows your cardiologist to see how your heart is beating and pumping blood, and to examine the structure and function of the heart valves, chambers, and surrounding vessels.

Echo is one of the most commonly used tools in cardiology, providing critical information to help diagnose conditions like heart failure, valve disease, congenital heart problems, and cardiomyopathies.

There are several types of echocardiograms, including:

• Transthoracic echo (TTE) – the standard type, done by placing a probe on your chest
• Transesophageal echo (TEE) – provides clearer images using a probe inserted into the esophagus (often done under sedation)
• Stress echo – combines ultrasound with exercise or medication to see how the heart performs under stress
• Contrast echo – uses safe, injectable microbubbles to enhance image clarity in some patients

Echo testing is safe, does not involve radiation, and typically takes 30–60 minutes. At Cardiology Associates of Niagara, our experienced sonographers and cardiologists use the latest imaging technology to provide accurate, detailed assessments of your heart.

Preparation

Please take a shower before your appointment. No special preparation, fasting, or medication changes are needed before a standard echocardiogram. Wear comfortable clothing that allows easy access to your chest.

🏃‍♂️ Exercise Stress Test

A stress test (also known as an exercise stress test or treadmill test) helps your cardiologist see how well your heart performs when it’s working harder—such as during exercise. This test can detect problems like blocked arteries (coronary artery disease), abnormal heart rhythms, or poor exercise tolerance.

It’s often recommended if you have symptoms like chest pain, shortness of breath, or unexplained fatigue, or to assess your heart’s health after a cardiac event or before a procedure.

The most common type is the exercise treadmill stress test, where you walk on a treadmill while we monitor your heart rate, blood pressure, ECG, and symptoms. If you're unable to exercise, we may use medication to safely simulate the effects of activity on your heart—this is called a pharmacologic stress test.

In some cases, we combine stress testing with imaging, such as nuclear perfusion imaging or stress echocardiography, to get a clearer picture of blood flow to the heart muscle. These tests are safe, well-tolerated, and provide valuable information to guide your care and treatment.

Preparation

Please take a shower before the test and wear comfortable clothes and walking shoes. Avoid eating a large meal within 3 hours of the test. Continue taking your medications unless your doctor tells you otherwise. If you use an inhaler, bring it with you.

Medication Instructions Before Your Stress Test

Please do not take anti-ischemic medications for 24 hours before your stress test, unless your doctor tells you otherwise. These medications can affect the test results by altering your heart’s response to exercise or stress.

Common anti-ischemic medications include:

• Beta-blockers (Bisoprolol, Metoprolol, Carvedilol, Atenolol, Sotalol, Labetalol, Acebutolol, Propranolol)
• Calcium channel blockers (e.g., amlodipine, diltiazem, verapamil)
• Nitrates (e.g., nitroglycerin, isosorbide mononitrate)

If you’re unsure about your medications or have concerns, please contact our clinic before your test.

⏱️ 24-Hour Blood Pressure Monitor (Ambulatory BP Monitoring)

A 24-hour blood pressure monitor—also called ambulatory blood pressure monitoring (ABPM)—measures your blood pressure at regular intervals throughout the day and night while you go about your normal routine. This test gives your doctor a more accurate picture of how your blood pressure behaves over time, especially during sleep, work, and rest.

It's often used to confirm a diagnosis of high blood pressure (hypertension), assess whether your current treatment is working, or rule out “white coat” hypertension (elevated readings only in the clinic).

The device includes a cuff worn on your upper arm and a small recorder you wear on a strap around your waist or shoulder. It automatically inflates every 15–30 minutes during the day and every 30–60 minutes at night.

After 24 hours, the device is returned to the clinic, and the recorded data is analyzed to guide your diagnosis and treatment. ABPM is safe, noninvasive, and often more reliable than single clinic readings.

Preparation

Take a shower before the monitor is applied, as you won’t be able to bathe while wearing it. Wear a short-sleeved or loose shirt to make the cuff easier to apply. Go about your day as normally as possible and keep a simple diary of your activities and sleep times. Try not to tamper with the monitor or tubing.

💓 Stress Echocardiogram (Stress Echo)

A stress echocardiogram combines an exercise or medication-based stress test with ultrasound imaging of the heart. It helps your cardiologist assess how well your heart functions when it's working harder—such as during physical activity.

This test is especially useful for detecting coronary artery disease, evaluating heart muscle strength, and assessing how your heart valves respond under stress.

The test begins with a resting echocardiogram to capture baseline images of your heart. You’ll then walk on a treadmill (or receive medication if you’re unable to exercise) to raise your heart rate. Once your heart is working harder, we immediately perform a second set of echocardiogram images.

Comparing the “before” and “after” images helps your doctor identify areas of the heart that may not be getting enough blood due to blocked or narrowed arteries. A stress echo is safe, noninvasive, and provides important insight into your heart’s health and performance.

Preparation

Please take a shower before the test and wear comfortable clothes and walking shoes. Avoid eating a large meal within 3 hours of the test. Continue taking your medications unless your doctor tells you otherwise. If you use an inhaler, bring it with you.

Medication Instructions Before Your Stress Test

Please do not take anti-ischemic medications for 24 hours before your stress test, unless your doctor tells you otherwise. These medications can affect the test results by altering your heart’s response to exercise or stress.

Common anti-ischemic medications include:

• Beta-blockers (Bisoprolol, Metoprolol, Carvedilol, Atenolol, Sotalol, Labetalol, Acebutolol, Propranolol)
• Calcium channel blockers (e.g., amlodipine, diltiazem, verapamil)
• Nitrates (e.g., nitroglycerin, isosorbide mononitrate)

If you’re unsure about your medications or have concerns, please contact our clinic before your test.

🩸 Myocardial Perfusion Study (MPI, Nuclear Stress Test)

A myocardial perfusion study—also known as a nuclear stress test—is a safe and noninvasive imaging test that shows how well blood flows to your heart muscle during rest and stress. Using a small amount of a radioactive tracer, special cameras capture detailed pictures of your heart, helping detect areas with reduced blood flow caused by narrowed or blocked coronary arteries.

Stress Modalities Used

To stress your heart during the test, we use one of two methods:

• Exercise stress: You walk on a treadmill or pedal a stationary bike to raise your heart rate naturally.
• Pharmacologic stress: If you cannot exercise, we give medication (such as Persantine, regadenoson, or adenosine) that mimics exercise by increasing blood flow to your heart.

Both methods are safe and closely monitored by our experienced team.

Safety and Radiation Risk

The amount of radiation used in a myocardial perfusion study is very low—comparable to a few months of natural background radiation—and considered safe for most patients. We always use the lowest dose possible to obtain clear images while minimizing exposure. Your doctor will review your medical history to ensure this test is appropriate and safe for you.

Preparation — Before Your Test

• Inform the staff if you are pregnant, breastfeeding, or have any allergies.
• Shower on the day of the test before arriving at the clinic.
• Wear comfortable clothes and shoes suitable for walking or light exercise.
• Avoid caffeine and caffeine-containing products for at least 24 hours before your test. To avoid confusion, drink only water for 24 hours prior.
• Do not eat or drink anything for 4 hours before your appointment unless your doctor has given other instructions. You may have a light breakfast up until 4 hours prior.
• If you are an insulin-dependent diabetic, please notify the booking office so your appointment can be scheduled appropriately.

Medications

Please do not take anti-ischemic medications for 24 hours before your stress test unless your doctor tells you otherwise. These medications can affect the test results by altering your heart’s response to exercise or stress.

Common anti-ischemic medications include:

• Beta-blockers (Bisoprolol, Metoprolol, Carvedilol, Atenolol, Sotalol, Labetalol, Acebutolol, Propranolol)
• Calcium channel blockers (e.g., amlodipine, diltiazem, verapamil)
• Nitrates (e.g., nitroglycerin, isosorbide mononitrate)

If you’re unsure about your medications or have concerns, please contact our clinic before your test.

During the Test

• You will receive a small injection of a safe radioactive tracer.
• The test includes periods of rest and stress, either by exercise or medication.
• You may be asked to change positions or remain still during imaging.
• The test has two parts—images taken after stress and at rest—usually separated by 24 hours, with each appointment booked for approximately 1 hour.

After the Test

• Drink plenty of fluids to help flush the tracer from your body.
• You may resume your normal diet and activities unless otherwise advised.
• Border crossings within 24 hours may detect the tracer. If travel is unavoidable, carry documentation from the diagnostic lab.
• As a precaution, avoid prolonged close contact with pregnant women and young children for about 24 hours.