Diagnosing Arrhythmia

In addition to gathering your medical history and performing a thorough physical exam, there are many tests and tools available to help determine what type of arrhythmia you have and its severity. Some common diagnostic tests include the following:

Electrocardiogram (EKG)

An electrocardiogram provides physicians with important information about the heart’s rhythm by recording its electrical signals. In order to view the heart’s electrical signals, electrodes are placed in various places on the patient’s chest and limbs. An EKG is a non-invasive, painless and safe diagnostic tool in electrophysiology.

Holter monitor

A Holter monitor is a special type of EKG that is worn by a patient for up to seven days. The results of a Holter monitor can be very useful in diagnosing arrhythmias that are intermittent.

Event recorder

An event recorder is a small device with several electrodes on it. When a patient feels that they are in an arrhythmia, the device is placed on the patient’s chest and the arrhythmia is recorded. The patient can then send the recording to the physician over a telephone. The event recorder allows the physician to monitor infrequent arrhythmias over a longer period of time than a Holter monitor would allow, but is limited to arrhythmias the patient can feel and record.

Cardiac stress test

The exercise stress test – also called a stress test, exercise electrocardiogram, treadmill test, graded exercise test or stress ECG – is used to provide information about how the heart responds to exertion. It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while your electrocardiogram, heart rate and blood pressure are monitored.

The physician uses the stress test to:

  • Determine if there is adequate blood flow to your heart during increasing levels of activity
  • Evaluate the effectiveness of your heart medications to control angina and ischemia
  • Determine the likelihood of having coronary heart disease and the need for further evaluation
  • Check the effectiveness of procedures done to improve blood flow within the heart vessels
  • Identify abnormal heart rhythms
  • Help you develop a safe exercise program

There are many different types of stress tests, including:

Treadmill stress test

As long as you can walk and have a normal ECG, this is normally the first stress test performed. You walk on a treadmill while being monitored to see how far you walk and if you develop chest pain or changes in your ECG that suggest that your heart is not getting enough blood.

Dobutamine or adenosine stress test

This test is used in people who are unable to exercise. A drug is given to make the heart respond as if the person were exercising. This way the doctor can still determine how the heart responds to stress, but no exercise is required.

Stress echocardiogram

An echocardiogram (often called "echo") is a graphic outline of the heart's movement. A stress echo can accurately visualize the motion of the heart's walls and pumping action when the heart is stressed; it may reveal a lack of blood flow that isn't always apparent on other heart tests.

Nuclear stress test

This test helps to determine which parts of the heart are healthy and function normally and which are not. A small amount of radioactive substance is injected into the patient. Then the doctor uses a special camera to identify the rays emitted from the substance within the body; this produces clear pictures of the heart tissue on a monitor. These pictures are done both at rest and after exercise. Using this technique, areas of the heart that have a decreased blood supply can be detected.

Preparation for these types of stress tests will vary from preparation for the exercise stress test. Ask your doctor about any specific instructions.


An echocardiogram using ultrasound waves to visualize the structures of the heart. An exam can be used to diagnose structural abnormalities of the heart, assess valvular function and look for clots in the atria prior to an ablation procedure. Intra-cardiac echocardiography (ICE) is also used to guide physicians during various electrophysiology procedures.

Cardiac catheterization

A cardiac catheterization is a test to check your heart. This test can include a coronary angiogram, which checks the coronary arteries.

A cardiac catheterization can check blood flow in the coronary arteries, blood flow and blood pressure in the chambers of the heart, find out how well the heart valves works and check for defects in the way the wall of the heart moves.

A coronary angiogram is used to find out if you have disease in your coronary arteries. If you have atherosclerosis, this test can pinpoint the size and location of fat and calcium deposits (plaque) that are narrowing your coronary arteries.

Percutaneous coronary intervention (PCI) is similar to coronary angiogram, but it is used to open up a narrowed coronary artery with special tools.

The two common types of PCI are:

  • Angioplasty with and without coronary stents
  • Atherectomy

Results from a coronary angiogram help determine whether treatment with medicines, bypass surgery or percutaneous coronary intervention (PCI), such as angioplasty may be effective.

Other tests can be done during cardiac catheterization to find heart problems. An X-ray test called a ventriculogram measures how well blood flows through the left side of your heart. The test looks at the movements of the wall of the left ventricle and the heart valves.

Electrophysiology (EP) study

An EP study is a minimally invasive procedure that involves placing specialized catheters in the heart via a patient’s blood vessels. The specialized catheters allow a physician to see the electrical conduction of the heart with much greater detail than the surface EKG can provide. During an EP study, a physician can provoke an arrhythmia using several methods. An EP study can provide a definitive diagnosis of an arrhythmia and information essential in the selection of the appropriate treatment.

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The Adventist Heart Institute values your privacy and handles your personal information with care. Your email address and information is secure, confidential and will not be sold to any third party sources.

AHI Rebrand