Overview of Electrophysiologist | Cardiology

What is an electrophysiologist?

An electrophysiologist is eligible to perform specialized tests of your heart’s electrical system, such as electrophysiology or ablation. Blood pumping is a mechanical problem that involves the heart muscle and vessels. Many cardiologists deal with the mechanical function of the heart. Remembering to pump blood is an electrical problem. The heart has an electrical system that sends impulses for muscle contraction.

When there are problems with the electrical signals in the heart, the result is an arrhythmia-irregular heartbeat. These problems are treated by electrophysiologists.

Electrophysiologists can use many tests and treatments just like other cardiologists. However, electrophysiologists can also perform specialized tests called electrophysiology studies (EPS), which can also allow procedures such as pacemaker placement, insertion of an implantable cardioverter-defibrillator (ICD), or catheter ablation to treat arrhythmia.

Difference between a cardiologist and an electrophysiologist?

The heart has two main functions: to pump blood throughout the body and to do it efficiently and rhythmically. The actual pumping of blood is very mechanical and the problems that arise in this area are of a circulatory or structural nature.

Cardiologists are medical professionals who treat and correct problems such as coronary heart disease, congestive heart failure, cardiac arrest, or peripheral artery disease.

Heart rhythm disorders, on the other hand, arise from problems in the heart’s electrical system that controls the heartbeat. When there is a problem here called arrhythmia, the heart beats too fast, too slow, or with inconsistent manipulations.

Due to the nature of electricity, treating arrhythmias requires additional and specialized training by the physician, who must complete one to two years of additional training beyond the standard cardiology scholarship. Cardiac electrophysiologists are doctors who have completed this unique cardiovascular workout.

What does an electrophysiologist do?

The heart muscle produces electrical signals that travel through the heart muscle to contract. These signals are small but can be taken on an EKG machine. The electrocardiogram (ECG) can help, but often the signs that doctors need to see are so small that they cannot be seen or hidden on the ECG. The electrophysiologist can perform ablation studies and/or procedures on your heart’s electrical system and timing.

When do you need an electrophysiologist?

In a normal, healthy heart, the upper chambers (atria) and the lower chambers (ventricles) work together, alternately contracting and pumping blood. Sometimes your rhythm shoots up and you have an irregular heartbeat, either too fast (more than 100 beats per minute) or too slow (less than 60 beats per minute). An electrophysiologist can help you cope with arrhythmia, the most common of which is atrial fibrillation, where the upper two chambers shake without coordinating their contractions.

Purpose of electrophysiologists

A cardiologist may recommend an EP study when a standard EKG, Holter monitor, event recorder, stress test, echocardiogram, or angiogram do not provide adequate information to evaluate an abnormal heart rhythm known as an arrhythmia.

The EP study may also help diagnose suspected arrhythmia in a patient with arrhythmia symptoms, but this has not been found in other tests.

The purpose and great value of the EP study are that it provides the physician with more detailed information about the electrical activity of the heart than the non-invasive tests mentioned above because the electrodes are placed directly on the heart tissue.

EP studies may help assess:

  • Some tachycardia or bradycardia of unknown cause
  • Resuscitated patients after experiencing sudden cardiac death
  • Various symptoms of unknown causes such as chest pain, shortness of breath, fatigue, or syncope
  • Response to antiarrhythmic therapy

Conditions of electrophysiology

Common conditions that we treat in our laboratory, including atrial fibrillation and other types of arrhythmias. Using cardiac maps, our electrophysiologists can identify the cause of irregular heartbeat and often correct it by ablation. This procedure corrects electrical conduction problems that cause a problematic and abnormally fast heart rate.

Our electrophysiologists can perform additional treatments as needed in the laboratory. For example, if you are experiencing a cardiac defibrillator that provides a slow heart rate or electrical impulses, pacemakers can be set to help the patient’s heart return to a normal rhythm after experiencing a severe arrhythmia.

Electrophysiologists procedure

The EP study is an invasive test similar to angiography and is performed in a catheterization laboratory. After the patient is operated on under local anesthesia (or in some cases, general anesthesia), the catheter is inserted into a blood vessel through a site in the groin or neck and guided through the catheter and images of the myocardial fluoroscopy.

Once the catheter reaches the heart, the electrodes on its tip collect data and a variety of electrical measurements are made. This “electrical mapping” helps the cardiac arrhythmia specialist to locate the area where the current is interfering.

The electrophysiologist then administers various medications or electrical stimuli to determine the ability to terminate the arrhythmia and restore normal heart rhythm. Sometimes a specialist will perform cardiac ablation or insert an implanted cardioversion device (ICD) or pacemaker. The procedure usually takes about two hours.

Treatments of electrophysiologists

  • Atrial fibrillation ablation
  • Device interrogation
  • Electrical cardioversion
  • Monitoring
  • Implantable cardioverter-defibrillator (ICD)
  • Pacemaker implantation

Study of electrophysiologists

When an abnormal heartbeat is found, your doctor or cardiologist may recommend an electrophysiology study (EPS).

This study is performed by an electrophysiologist who inserts one or more specialized electrode catheters in the groin or neck into the blood vessel leading to the heart.

Using catheters, the electrophysiologist sends electrical signals to your heart and records the electrical activity of your heart.

The EPS will help determine:

  • Source of abnormal heartbeat
  • What medicines work to treat your arrhythmia
  • If you need an ICD (implantable cardioverter-defibrillator) or pacemaker
  • If you need catheter ablation (using a catheter to destroy a very small part of the heart that causes arrhythmia).
  • Your risk of complications such as cardiac arrest

New technology and Innovative procedures

Our ability to perform 3-D models of the heart in real-time can help us determine the best treatment options, such as medications, surgical procedures, or devices such as defibrillators or pacemakers with remote monitoring by specialized personnel.


Purpose and Stages of Cardiac catheterization | Cardiology

What is cardiac catheterization?

Cardiac catheterization is a procedure used to diagnose and treat certain cardiovascular conditions. During cardiac catheterization, a long, thin tube called a catheter is inserted into an artery or vein in the groin, neck, or arm and threaded into the heart through blood vessels.

Purpose of cardiac catheterization

The cardiac cath detects how well your heart is working, problems, and allows procedures to open blocked arteries. For example, during a cardiac cat, your doctor may say:

  • Take x-rays of narrow or blocked coronary arteries using a contrast catheter injected through a catheter. This is called coronary angiography or coronary arteriography.
  • Perform percutaneous coronary intervention (PCI), such as coronary angioplasty with stenting, to open narrow or blocked sections of the coronary artery.
  • Check the pressure in all four chambers of your heart.
  • Take blood samples to measure the oxygen content in all four chambers of your heart.
  • Estimate the capacity of the shrink chambers.
  • Look for defects in the valves or chambers of your heart.
  • Remove a small piece of heart tissue for examination under a microscope (biopsy).

Complications of cardiac catheterization

Like most procedures performed on the heart and blood vessels, cardiac catheterization carries some risks. Major problems are very rare.

Risks of cardiac catheterization:

  • Injuries
  • Bleeding
  • Myocardial infarction
  • Race
  • Damage to the area where the artery, heart, or catheter is inserted
  • Irregular heart rhythms (arrhythmia)
  • Allergic reactions to color or medication.
  • Kidney damage
  • Infection
  • Blood clots

If you are pregnant or planning to become pregnant, tell your doctor before doing this procedure.

Stages of cardiac catheterization

The catheter is guided by a small hollow plastic covering called a sheath. Once the catheter is in effect, your doctor will proceed with the necessary tests to confirm your condition.

Depending on what you are looking for, your doctor may do one of the following:

Coronary angiogram: During this procedure, contrast material or dye is injected through the catheter. Your doctor will use an X-ray machine as it travels through your heart’s arteries, chambers, valves, and vessels. Arteries

Heart biopsy: During this procedure, your doctor will take a sample of your heart tissue (biopsy) for a more detailed examination. If your doctor finds a malignant problem during catheterization, he may perform an additional procedure. These policies include:

Ablation: This procedure corrects cardiac arrhythmia (irregular heartbeat). Doctors use energy in the form of heat (radiofrequency energy) or cold (nitrous oxide or laser) to destroy heart tissue and stop irregular heart rhythms.

Angioplasty During the procedure: The doctor inserted a small inflatable balloon into the artery. The balloon is dilated to widen the narrowed or blocked artery. Angioplasty can be combined with the placement of a stent – a small metal coil that is placed in a blocked or blocked artery to prevent future narrowing problems.

Balloon valvuloplasty: During this procedure, doctors insert a balloon-tipped catheter into the narrow valves of the heart to open the confined space.

Thrombectomy (treatment of blood clots): During this procedure, doctors use a catheter that can remove blood clots and travel to organs or tissues.

How long does the procedure last?

The cardiac catheterization procedure generally takes 30 minutes, but preparation and recovery time can add several hours to your appointment (five to nine hours or more).

Before the cardiac catheterization

  • If you have diabetes, do not eat or drink anything for two hours before the test. Discuss this with your doctor. Not eating affects your blood sugar level and requires adjustments to your insulin dose.
  • Talk to your doctor about the medicine you are taking. They may ask you to stop taking them before the test, especially if you are taking antiplatelet medications such as comedian (warfarin) or aspirin, or Plavix. It is important to bring a list of your allergies, medications, and dosages to this procedure so the healthcare team knows what you are taking and how much you are taking.
  • We will give you a hospital gown. You will not use anything else during the process. Remove all clothing (including lingerie), jewelry, and glasses. The nursing staff or your doctor will notify you if you need to remove any dentures and/or hearing aids.
  • We ask that you sign consent forms for the process.
  • We prepare the catheter site (the area of ​​your body where the catheter enters).
  • We need to trim body hair and cleanse your skin with a special wash that kills germs.
  • We ask that you empty your bladder (P) before beginning your procedure.
  • When you are ready and ready for your procedure, we invite your family member or friend to come to the pre-operative room. They will stay with you until it is time for your policy.
  • If needed, you may have blood tests and a chest X-ray before the procedure.

During the cardiac catheterization

When you are at the Cardiovascular Intervention Center, you see television monitors, heart monitors, and blood pressure machines. You will be connected to an EKG to monitor your heart during the test.

You will be given an injection of anesthesia to numb the area around where the catheter will be inserted. It can be a bit uncomfortable. Tubes are then inserted to access the artery and/or vein. The catheter is gently passed through the artery, guided by X-rays, and reaches your heart. There should be no pain.

After the cardiac catheterization

After the procedure, your doctor will remove the catheters, sheath, and guidewire. A pressure bandage is applied to the area where the catheter is inserted to stop the bleeding. The pressure can be sustained by hand or with a sandbag or other device. You will be transferred to the recovery room, where you will lie down on the bed. Heart rate and blood pressure will be monitored.

Depending on your health before your cardiac catheterization and any additional procedures performed during your cardiac catheterization, you may need to spend the night in the hospital. You should follow your doctor’s instructions on what medications to take and when to start the activity.


About Cardiac Computerized Tomography (CT) Scan | Cardiology

What is a cardiac CT scan?

A cardiac CT scan of the heart is an imaging method that uses X-rays to create detailed images of the heart and its blood vessels.

However, unlike a traditional angiogram, which is an advanced X-ray of the arteries, the color is inserted into a small vein in the hand rather than the artery in the groin. You may also be given certain medications to slow your heart rate, which will make taking pictures easier.

  • This test is called a coronary calcium scan to see if there is calcium in your arteries.
  • This is called a CT angiogram if it looks at the arteries that carry blood to the heart. This test assesses whether these arteries are narrowed or blocked.
  • Tests sometimes look for problems with these structures along with scans of the aorta or pulmonary arteries.

When a cardiac CT scan is necessary?

A cardiac CT scan may be helpful if your cardiologist thinks you may not have coronary artery disease, but cannot explain what is causing your symptoms. Therefore, it is often used to rule out coronary heart disease rather than check for it. It is also helpful if you have a heart attack but your doctor doesn’t know why.

If your doctor thinks you have coronary artery disease, they are more likely to do a traditional angiogram.

Another reason you may need a coronary CT angiogram is if your doctor suspects that you have an abnormality in the structure of your heart.

Purpose of cardiac CT scan

A cardiac CT scan is a non-invasive procedure that is ideal for monitoring a patient with low-risk heart problems or symptoms of coronary artery disease. Doctors also use a cardiac CT scan to check for blockages and damage to the coronary arteries.

Doctors may request that patients undergo a cardiac CT scan before or after other coronary procedures.

Risk factors

A cardiac CT scan is a relatively low-risk procedure because it is non-invasive, rather than injected through the manual cannula.

During a cardiac CT scan, patients are exposed to more radiation than a normal X-ray because multiple images of the heart are taken, although the dose is usually lower than that of a standard coronary angiogram. Even if low doses of radiation are used, any radiation may slightly increase the risk of cancer in the future. The risk is slightly higher in younger patients.

Some people are allergic to the opposite and it is much higher if you have multiple other serious allergies. Allergic reactions to X-ray dye are usually mild and can be treated with medications.

There is a very small risk that patients will experience a severe reaction to the contrast medium and will experience:

  • Low blood pressure
  • Anaphylactic shock
  • Cardiac arrest

How cardiac CT scan is performed?

The cardiac CT scan is performed in the radiology department of the hospital or in a clinic that specializes in diagnostic procedures.

You will be given a beta-blocker before the scan. These drugs slow down your heart so that clearer pictures can be taken. Small, sticky discs called electrodes are placed on your chest to record the scan. The radiology technologist inserted an intravenous (IV) line into a vein so they could inject radioactive dye into your hand. You may feel a short or hot boil or a temporary metallic taste in your mouth when you inject the dye.

Before your cardiac CT scan, it is important to follow these instructions:

  • Fast for at least 4 hours
  • Sips of water may be taken
  • No smoking for at least 2 hours
  • No vigorous exercise for at least 4 hours
  • Avoid tea and coffee for at least 12 hours

Day of your cardiac CT scan,

  • Six hours before the test: do not eat anything that contains caffeine.
  • You can have breakfast and/or lunch. Drink water before your appointment.
  • Do not take metformin if you are taking it.
  • Take your other common medications unless prescribed by your doctor. Bring all your medications in the original bottles.

Before scanning, your heart must beat at a certain rate to ensure a correct diagnostic result. You may need to be given medication at your appointment if your heart rate is not at the required level. It comes in a tablet form called a beta-blocker. The radiographer performs pre-scan examinations, which determine it.

After cardiac CT scan

  • The ECG monitor and cannula are removed and you are asked to change your clothes again
  • If you have a beta-blocker, you will be asked to stay in the section for about 20 minutes for observation
  • You can go back to eating/drinking normally
  • You are advised to drink plenty of water within 48 hours after the scan to remove the color injection from your body


The cardiac CT scanner has a large opening that passes through a flat platform or table. Some call this opening the “donut hole.” The patient was lying on the table while scanning. When the machine is turned on, a donut-shaped X-ray tube from the machine rotates rapidly and the patient moves through it. X-rays pass through the patient at different angles and hit special detectors. Images taken during the scan produce cross-sectional or three-dimensional views of the heart and blood vessels in less time.

Specialists who handle cardiac CT scan

  • Department of Cardiology and Cardio surgeons

Overview of Electrocardiogram (ECG) Test | Cardiology

What is an electrocardiogram (ECG)?

An electrocardiogram is commonly called an ECG or EKG and it is a simple test used to check the rhythm and electrical activity of your heart. Sensors attached to the skin are used to detect the electrical signals your heart produces each time it beats. A machine records these signals, and the doctor sees if they are abnormal.

The ECG can be ordered by a cardiologist or any doctor who thinks you have a heart problem, including your GP. This test can be done by a hospital, clinic, or healthcare professional who is specially trained in surgery by your GP.

Despite the similar name, the ECG is not the same as the echocardiogram, which is a scan of the heart.

Natural electrical impulses coordinate the contractions of different parts of the heart, causing blood to flow. An ECG records these impulses to show the strength and timing of the electrical impulses as the heartbeats, the rhythm of the heartbeat (constant or irregular), and the passage through different parts of the heart. Changes in the ECG indicate heart conditions.

Purpose of electrocardiogram

Your doctor may recommend an EKG to assess the health of your heart. This is a common part of checkups, especially for those over 40.

An EKG by itself does not diagnose all types of heart conditions or predict future heart problems. Provides important information about your heart health-related to your age, physical exam, medical history, and other tests.

  • Identify abnormal heart rhythms that cause blood to clot.
  • Identifying heart problems includes a recent or ongoing heart attack, abnormal heart rhythms (arrhythmia), coronary artery occlusion, damaged areas of the heart muscle (from a previous heart attack), inflammation of the broken heart, and shock around the heart.
  • Identify non-cardiac conditions such as electrolyte imbalance and lung and lung diseases.
  • Heart attack, the progression of heart disease, or recovery from the effect of certain medications or pacemakers.
  • Eliminate hidden heart disease in patients undergoing surgery.

When are ECGs needed?

In some cases, having this test is very important. If you have symptoms of high blood pressure or heart disease, chest pain, shortness of breath, irregular heartbeat, or large heartbeat, you may need an electrocardiogram. You may need screenings or tests for professional purposes or if you have a personal or family history of heart disease, diabetes, or other accidents and want to start exercising.

How is the electrocardiogram test done?

You will be asked to remove all clothing and jewelry from your waist (including women’s bras) to place electrodes on specific areas of the chest wall, arms, and legs. The electrodes are held in place by rubber bands, suction cups, or adhesive pads.

Sometimes it is necessary to shave the skin where the electrode recording patches are placed to easily detect the electrical signal and reduce discomfort when removing the patches. For a standard 12-bottle ECG, the electrodes are placed in 4 positions on the 4 extremities and 6 on the chest wall. Sometimes additional leads are added for a 15-lead ECG.

You will be prompted to remain normal when the machine is turned on, and typically a sample (usually 3-4 seconds) from each electrode site is recorded. The ECG is usually constantly monitoring and may ask you to hold your breath for a short time during the procedure (to stop chest wall movement that interferes with the signal). The machine captures the electrical activity of the wires and then produces a graph with an up and down row that looks a bit like a geographic map but indicates the activity of your heart.

Types of electrocardiogram (ECG)

The types of an electrocardiogram are:

  • Standard (resting) ECG: The ECG measures the electrical activity of your heart while you lie down or rest in a semi-reclined position. This is the most common type of ECG.
  • Stress test (exercise ECG or tape test): This usually involves taking an ECG on a treadmill while you exercise. Show how exercise affects your heart. Helps diagnose and diagnose coronary artery disease and other types of heart disease. Medications are sometimes given instead of mimicking the effect of exercise on the heart.
  • Holter monitor (24-hour ECG or ambulatory ECG): This includes the use of an electronic ECG recorder 24 hours a day. It records the electrical activity of your heart for 24 hours. It can help diagnose arrhythmias (irregular or abnormal heartbeats).
  • Cardiac event recorders record an ECG for an extended period, a year or more. Portable cardiac event recorders record the electrical activity of the heart when you have symptoms. Adjustable loop recorders are mounted under the skin on your chest. They constantly record the electrical activity of your heart.

Risk factors for electrocardiogram (ECG)

Electrocardiograms (EKGs) are safe, non-invasive, painless, and accident-free tests. The electrodes (adhesive patches) that connect the sensors to your chest do not send electrical shocks.

People who undergo stress tests have a higher risk of having a heart attack, but this is related to exercise, not the EKG.

You may develop a mild rash or irritation of the skin where the electrodes are placed. If paste or gel is used to place the electrodes, you may have an allergic reaction. This irritation usually disappears without the need for treatment, once the patches are removed.

Procedure for electrocardiogram (ECG)

It is not necessary to limit food or drink before performing the ECG test. Always tell your doctor what medications you are taking before receiving the electrocardiogram and if you have any allergies to the adhesive tapes used to attach the electrodes.

When an ECG test is to be performed, the upper garment will need to be removed so that the electrodes adhere to the chest and extremities. (For women, wearing a special blouse with pants or a skirt can easily penetrate the chest.) If necessary, the selected sites can be shaved.

Electrodes (sensors) are attached to the chest, arms, and legs with suction cups or sticky gel. These electrodes detect the currents generated by the heart; they are measured and recorded by an electrocardiograph.

There are three main types of the electrocardiogram:

  • Resting ECG: You lie down for this type of ECG. No movements are allowed during the test, as electrical impulses generated by other muscles can interfere with those generated by your heart. This type of ECG usually takes 5 to 10 minutes.
  • Ambulatory ECG: If you have an ambulatory ECG or Holter, you must wear a portable recording device for at least 24 hours. Usually, you can turn it on when the monitor is connected. These types of ECG symptoms may not appear intermittently (stop-start) and on the resting ECG and are used to ensure that your heart is working properly in people recovering from a heart attack. Record your symptoms in a journal and note when they occur so that your own experience can be compared to an ECG.
  • Cardiac stress test: This test is used to record your ECG when you are riding an exercise bike or running on a treadmill. This type of ECG takes 15 to 30 minutes to complete.

Results of electrocardiogram

For most people, an electrocardiogram is just a series of lines. However, each line corresponds to an electrical signal sent from the heart. Doctors can read and understand these lines, which indicate the general condition of the heart.

The operating physician or healthcare professional places the electrodes on a person’s skin, usually around the chest, and at 10 different points on the extremities.

Each beat sends an electrical impulse. These electrodes select this pulse and record the activity as a waveform on a graph.

All of these take place in the eyelid, so an EKG is very important. An ECG can capture all these little details and record them for the doctor to analyze.

Specialists who handle electrocardiogram

  • Cardiac surgeons specialize in the surgical treatment of the heart and its vascular conditions. They are also known as cardiothoracic surgeons.
  • Pediatric cardiologists and cardiologists are interns or pediatricians who specialize in diagnosing and treating diseases or situations of the heart and its blood vessels.
  • Emergency medicine specialists specialize in the diagnosis and treatment of sudden illness or injury and difficulties of chronic illness.
  • Interventional cardiologists are cardiologists who specialize in diagnosing and treating conditions and diseases of the heart and its blood vessels. They use catheter-based non-surgical procedures and imaging techniques.
  • Primary care providers include interns, family practitioners (family medicine physicians), pediatricians, geriatricians, physician assistants (PA), and nurse practitioners (NP). Primary care providers provide comprehensive health services and treat a wide variety of ailments and conditions.
  • Thoracic surgeons train in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs, and esophagus. They are also known as cardiothoracic surgeons.

How accurate is Myelography | Neurology

What is myelography?

Myelography is an imaging test that involves inserting a spinal needle into the spinal canal and injecting contrast material into the area around the spinal cord and nerve roots (subarachnoid space) under real-time fluoroscopy.

Radiography (radiography) is an unplanned medical test that helps doctors diagnose and treat medical conditions. X-ray images produce images of the inside of the body by exposing a part of the body to a small dose of ionizing radiation. X-rays are the oldest and most widely used form of medical imaging.

Preparation for myelography

Always follow the instructions provided by your doctor and/or neurobiologist. In general, most references may include the following:

  • Arrange for someone to drive you to the hospital/radiology center and home after the test.
  • The neuroradiologist may ask you to bring previous and related X-rays, CT scans, or copies of MRI scans (eg, CDs) for review. Previous radiological studies can be compared with myelography images.
  • Do not eat anything after midnight before your myelogram appointment. Clear liquids are generally acceptable.
  • If you need to take any medicine on the day of your appointment, take it with a clear liquid (for example, water) unless your doctor gives you other instructions.
  • You may be instructed to keep jewelry and valuables at home.

Purpose of myelography

A myelogram is done to examine the spinal cord, subarachnoid space, or other structures for defects or changes. When standard X-ray, does not give clear answers about the cause of back or spine problems, the test is suggested. Myelograms can be used to evaluate many diseases, including:

  • Herniated discs (discs that bulge and press on nerves and/or the spinal cord)
  • Spinal cord
  • Brain tumors
  • Infection and/or inflammation of tissues around the spinal cord and brain
  • Spinal stenosis is the degeneration and swelling of the bones and tissues around the spinal cord that make the canal narrow
  • Ankylosing spondylitis is a disease that affects the spine, causing the bones to grow together
  • Bone spurs
  • Arthritic discs
  • Cysts are benign capsules that are filled with fluid or solid matter.
  • Tearing away or injury of spinal nerve roots
  • Arachnoiditis (inflammation of a delicate membrane that covers the brain.)

There may be other reasons for suggesting the myelogram test.

Before the myelography

Always follow the instructions provided by your doctor and/or neurobiologist. In general, most references may include the following:

  • Arrange for someone to drive you to the hospital/radiology center and home after the test.
  • You may be asked to bring previous and related X-rays, CT scans, or copies of MRIs (eg, CDs) for a neurobiologist to review. Previous radiological studies can be compared with myelographic images.
  • Do not eat anything after midnight before your myelogram appointment. Clear liquids are generally acceptable.
  • If you need to take any medicine on the day of your appointment, take it with a clear liquid (for example, water) unless your doctor gives you other instructions.
  • You may be instructed to keep jewelry and valuables at home.

During the myelography

  • The duration of the procedure varies, but on average it is 1 hour.
  • The technician will place you on the testing table, usually face down.
  • Computed tomography is performed following this procedure.
  • A technician and a radiologist will be available to answer any questions.

After the myelography

After the procedure, you will be taken to the radiology waiting area for your exam. It is important to keep the head slightly elevated for 24 hours after the myelogram. Use 1-2 pillows on the bed. Do not go to bed until the next morning or allow your head to be lower than the rest of your body.

Drink more fluids throughout the day. Drinks with alcohol and caffeine are restricted prior to the test. If you go home, you will be given discharge instructions.

What to expect from the procedure?

A myelogram will help to examine your spinal cord, spinal nerves, nerve roots, and bones in the spine by injecting contrast into your spinal fluid. As a result, it will also help to find whether anything is pressing against your spinal cord or nerves. There are a few different things that could be responsible for causing this pain and unwanted pressure in the spinal cord, including:

  • Herniated or bulging discs.
  • Arthritis in your spinal joints.
  • Tumors within, or adjacent to, your spine.
  • An infection, or other inflammatory processes.
  • Compared to an MRI, a myelogram, and the post myelogram CT scan, is able to show the bony details in a better way but is less capable of showing the soft tissue details in your spine.

How long should you rest after a myelogram?

  • After the test, it is usually not necessary to remove the contrast material from the spinal canal. Myographic contrast material is absorbed by your body and naturally eliminated by your kidneys through urination within 1-2 days.
  • Drink more fluids, 1 cup every hour until bedtime, unless your doctor prescribes it
  • Liquids help remove the contrast medium from your body and prevent headaches.
  • Avoid physical activity that leans down.
  • If possible, avoid coughing, sneezing, sneezing, and rapid movements for 24 to 48 hours.
  • You can immediately resume medication and diet before the test.
  • You will be in the radiology recovery room for about 2 hours.
  • Before you are discharged, the nurse will instruct you to take it home.
  • Have someone with you who can drive you home. You cannot drive home alone.

Side effects of myelography

Most patients do not experience side effects after myelography. The most common side effect is a headache, which usually goes away with rest and fluids within a day or two. Other side effects include nausea, dizziness, widespread pain, nausea, and/or vomiting.


Types, Purpose, and Risks of Electromyography | Neurology

What is electromyography?

Electromyography (EMG) is a diagnostic procedure that evaluates the health of the muscles and the nerve cells that control them. These nerve cells are called motor neurons. These transmit electrical signals that cause muscles to contract and relax. An EMG translates these signals into graphs or numbers, which helps doctors make a diagnosis.

An EMG is often prescribed by a doctor when someone shows signs of a muscle or nerve disorder. These symptoms can include tingling, numbness, or unexplained weakness in the limbs. EMG results can help the doctor diagnose the disorders of the muscle and neurological connection between nerves and muscles.

Some doctors may prescribe electromyography as an electrodiagnostic test.

Types of electromyography

There are two types of EMG: Superficial EMG and intramuscular EMG. Surface EMG assesses muscle function by recording surface muscle activity on muscle on the skin. Surface electrodes can only provide a limited estimate of muscle activity.

Purpose of electromyography

If a nerve or muscle disorder is doubted, the doctor may suggest electromyography. These symptoms can include:

  • Tingle
  • Numbness
  • Muscular weakness
  • Muscle pain
  • Some types of organ pain

Electromyography results are often necessary to confirm or rule out several conditions:

  • Muscle disorders, muscular dystrophy, or polymyositis
  • Diseases that interrupt the function of the nerve and the muscle, such as myasthenia gravis
  • Nerve disorders outside the spinal cord (peripheral nerves) such as carpal tunnel syndrome or peripheral neuropathy
  • Disorders affecting motor neurons in the brain or spinal cord, amyotrophic lateral sclerosis, or polio
  • Defects that affect the nerve root, such as a herniated disc in the spine

Before the electromyography

  • Your doctor will explain the procedure to you and welcomes any questions on the same.
  • Generally, fasting is not required before the test. In some cases, cigarettes and caffeinated beverages like coffee, tea, and cola are restricted before the test.
  • Tell your doctor about all the medicines you are taking (prescription and over-the-counter) and herbal medicines.
  • Tell your doctor if you have a pacemaker.
  • Wear clothing that allows access to the area to be examined or easily removed.
  • Avoid using lotions or oils on your skin for a few days before your procedure or the day of the test.
  • Depending on your medical condition, your doctor may request specific preparation for others.

During the electromyography

The electromyography can be performed on a patient basis or as part of your hospital stay. The steps may vary depending on your health problem and the practices of your healthcare provider. Talk to your healthcare provider about what to do during your exam.

EMG is performed by a healthcare provider who specializes in neurological disorders. This is usually a neurologist or physical therapist. EMG often occurs after a neural conduction study.

Generally, electromyography tests follow this procedure:

You will be asked to remove clothing, jewellery, hairpins, glasses, headphones, or other metal objects that may interfere with the test.

  • You will be given a gown to wear before the test.
  • Your position is adjusted before the test.
  • A neurologist finds the muscles that need to be studied.
  • The skin is cleaned with an antiseptic solution. Next, a clean, fine needle is inserted into the muscle. A metal plate is placed under you.
  • Multiple needles may be required to perform the test. You may feel some pain when placing the electrode. But it is often painless.
  • If the test is painful, tell the examiner as it may lead to complications.
  • You will be asked to relax and then do some full-strength muscle contractions.
  • The electrical activity of the working muscles is measured and displayed on the monitor. An audio amplifier can also be used to check the appearance and sound of electrical power. If the recorder is connected to an audio amplifier, you may hear a snowflake on the tin roof as you contract your muscles.

After the electromyography

After testing, the electrodes are removed. You may be given pain relievers. Warm compresses can be placed on the affected area immediately after the test.

Some muscle aches last a day or more after the test. Tell your healthcare provider if you have any symptoms at the injection sites:

  • Increased pain
  • Sensitivity
  • Inflammation
  • Pus

Your healthcare provider may give you other instructions after the test based on your specific situation.

Risks factors of electromyography

Both EMG and NCS are low risk. With EMG, there is a risk of infection or bleeding where the electrodes are inserted. If you are taking anticoagulants (blood thinners) or have hemophilia, inform the neurologist who performs this procedure in advance. A disorder that prevents blood from clotting.

If you are testing the chest muscles with EMG, there is a small risk of air entering the space between the chest wall and the lungs, causing pneumothorax (lung collapse).

If you have NCS, tell your neurologist ahead of time if you have a pacemaker or cardiac defibrillator because you are about to receive mild electrical shocks. Care must be taken in this case.

Results of electromyography

Your doctor can review the results with you after the procedure. However, if another healthcare provider requests an EMG, you may not know the results until you schedule your next appointment with your doctor.

If your EMG shows any electrical activity in your muscles at rest, you may have:

  • Muscle disorder
  • A disorder that affects the nerves that connect to the muscle.
  • Inflammation from injury
  • If your EMG shows abnormal electrical activity during muscle contraction, you may have a neurological disorder such as a herniated disc or ALS, or carpal tunnel syndrome.

Depending on your results, your doctor may discuss additional tests or treatments with you.


Overview of Electronystagmography (ENG) | Neurology

What is Electronystagmography (ENG)?

Electronystagmography (ENG or electrocardiogram) is used to evaluate people with vertigo (a false sense of spinning or movement that can cause vertigo) and some other disorders that affect hearing and vision. Electrodes are set at areas above and underneath the eye to record electrical activity.

By measuring changes in the electrical field within the eye, ENG can detect nystagmus (rapid, involuntary eye movement) in response to various stimuli. If nystagmus does not occur upon stimulation, there may be a problem within the ear, the nerves supplying the ear, or certain parts of the brain. This test may also be used to distinguish lesions in different parts of the brain and nervous system.

Purpose of an ENG

ENG detects disturbances in the parts of the inner ear responsible for steering, posture, and balance, as well as in the nerves that connect your brain to your eyes and ears.

Your doctor may recommend this test if you have any of the following symptoms:

  • Severe or persistent dizziness
  • Vertigo (meaning the room is spinning)
  • Problems with balance
  • Unexplained hearing loss

Your doctor may also perform ENG if you have any of the following conditions:

  • Usher syndrome: A genetic disorder that affects vision, balance, and hearing
  • Acoustic neuroma: A benign tumor of the auditory nerve (vestibular-cochlear)
  • Labyrinthitis: Inflammation of the inner ear
  • Meniere’s disease: A problem of the inward ear that influences equalization and hearing
  • Any suspected lesion on your inner ear

What are the risks of an ENG test?

There is very little risk of Electronystagmography (ENG). A few people may encounter wooziness or sickness during the test. Electronystagmography (ENG) ought not to be utilized in the event that you have a pacemaker. The device may interfere with the pacemaker function.

Rapid changes to the posture needed for the test may worsen back or neck problems. The test for calories in water may cause mild discomfort. If you have previously been diagnosed with a perforated tympanic membrane, you should not have a portion of water calories on the ENG test.

There may be various risks depending upon your specific affliction. Talk about any worries with your medical services supplier before the strategy. Certain factors or circumstances may interfere with ENG. These include:

  • Earwax
  • Impaired vision
  • Frequent blinking
  • Certain medicines, those are sedatives, tranquilizers, and anti-vertigo medicines

How to prepare for the test?

Before the tests, you’ll likely be asked to do the following:

  • Tell your doctor about the medications you are taking: It may ask you to stop taking it 72 hours before the test.
  • Abstain from caffeine and alcohol: No drinking or coffee for 48 hours before the completion date.
  • No food: Most doctors recommend avoiding eating at least 4 hours in advance.
  • Clean your ears: Ear blockage and earwax can distort the results, so a medical assistant may wash the ear canals before the procedure if they are not clear.
  • Prepare a trip afterwards: Usually, this is good advice for many medical procedures, just in case you do not want to drive.

The test can be distorted if you have double vision or blink a lot. Also, you shouldn’t have an Injex device if you have a pacemaker for your heart. You can usually go home after your recovery, although the test can also be taken during a hospital stay. The test takes up to 90 minutes.

What happens during an electronystagmography?

So now it’s time for ENG. You might be a little hungry, you might be tired, and you might be nervous. What can you expect? In fact, the procedure includes several tests. Prior to beginning, your primary care physician will clean your brow, sanctuaries, and cheeks with liquor. Then, you attach the electrodes to those areas using a paste.

In some testing facilities, instead of electrodes, you may be provided with a binocular camera that looks like virtual reality glasses. The tests performed with this system are known as videography or VNG. These devices capture your eye movements on video and can measure them just like electrodes.

The tests include:

  • The calibration test: Utilizing just your eyes, you will be gotten some information about 6 to 10 feet away or think to and fro between focuses on a divider. This test measures visual impairment, a condition in which your pupils have difficulty judging distances to targets.
  • The tracking test: Also known as the nystagmus test, it is similar to the sobriety test offered by the police. But in Muhandis, you are usually sitting or lying down. (Nystagmus is a condition in which your eyes are out of your control.) In this test, you try to stare at a steady light, directly in front of you or at an angle, without moving your eyes around you.

There are two related tracer tests:

  • The first is the pendulum tracking test. In it, you are tracking a light that moves back and forth like a pendulum without moving your head.
  • The other is the optokinetic test, in which you track multiple moving objects without turning your head. Things may move at high speeds and enter and leave your field of vision.

The positional test: Now is the time to move your head. Often your doctor will ask you to perform what is called the Dex-Halpike maneuver. While sitting at a table, you will turn your head to one side and quickly lie down with your head – supported by your doctor – about 20 degrees below the surface of the table. You’ll remain there for 30 seconds, at that point sit upstanding once more. You will repeat it with your head on the other side. Your doctor will notice the effect on your eyes.

The water caloric test: While lying down, your doctor will inject a stream of cold or warm water into one ear, then the other. (Air is sometimes used.) If you are not vertigo, your eyes should reflexively twitch. Your doctor may not perform all of the tests. On the off chance that you have neck or back issues, she may recommend something different.

After the electronystagmography test

  • Once the test is finished, your provider will remove the electrodes and wash off the electrode paste. Do not rub your eyes to prevent spreading the electrode paste.
  • Your provider will monitor you for any signs of weakness, dizziness, and nausea. You may need to rests or sit for a couple of moments to recuperate.
  • Your healthcare provider will tell you when to start any medications you stopped taking before the test. Your healthcare provider may give you other instructions after the procedure, depending on your specific situation.
  • You may also have vertical videography (VNG). This is a test that likewise identifies eye development. But it uses video cameras instead of electrodes.


If your ENG test results are abnormal, it could indicate a problem with your inner ear or the area of the brain responsible for controlling the movement of your eyes.

Other diseases or injuries to the auditory nerve can cause vertigo, including:

  • Vascular disorders that cause bleeding in the ear
  • Ear tumors
  • Genetic disorders
  • Damage to the inner ear
  • Ototoxic drugs
  • Multiple sclerosis
  • Viral infections such as chickenpox, measles, and influenza
  • Movement disorders
  • Chemical poisoning

Overview of Electroencephalogram (EEG) | Neurology

What is an electroencephalogram (EEG)?

An electroencephalogram (EEG), is a test that estimates the electrical activity of the brain. It can be done to diagnose or observe diseases that affect the brain, such as epilepsy and sleep disorders. Your doctor will inform you if you need an EEG. The loads are stretched and appear on the computer screen as a graph or a recording on paper. Then your healthcare provider will explain the reading to you.

During an electroencephalogram (EEG), your healthcare provider will usually estimate the activity of 100 pages or computer screens. He or she pays special attention to the primary waveform but also examines responses to stimuli such as brief bursts of energy and flashing lights.

Purpose of electroencephalogram

The electroencephalogram (EEG) is used to identify problems associated with certain brain disorders in the electrical activity of the brain. Measurements given by EEG are used to confirm or rule out various conditions:

  • Seizure disorders (such as epilepsy)
  • Head injury
  • Encephalitis (inflammation of the brain)
  • Brain tumor
  • Encephalopathy (a disease that causes brain dysfunction)
  • Memory problems
  • Sleep disorders
  • Stroke
  • Dementia

When someone is in a coma, an EEG can be done to determine the level of brain activity. This test can also be used to monitor activity during brain surgery.

Where is electroencephalogram (EEG) tests done?

The EEG is usually performed in the hospital at the outpatient clinic. People with epilepsy have told us that it would be helpful for them to go on a date with someone. Some people are very tired of this process and are less likely to have seizures during the test. It may help to plan how you will get home after your appointment.

You may be asked to bring some simple portable recording equipment with you. You will be shown how to operate it.

Risk factors

An electroencephalogram has been done for many years and is considered a safe procedure. The test does not cause any discomfort. Electrodes record activity. They do not produce any sensation. Also, there is no risk of electric shock.

Certain factors or conditions can interfere with the reading of the EEG test. Besides these:

  • Low blood sugar (hypoglycemia) created by fasting
  • Body or eye movement through the tests (but this will rarely, if ever, significantly prevent the interpretation of the test)
  • Lights, especially bright or flashing ones
  • Certain drugs, such as sedatives
  • Drinks such as coffee, cola, and tea (these beverages may occasionally alter EEG results, which does not significantly interfere with test interpretation)
  • Oily hair or the behavior of hair spray


Preparing for electroencephalogram

The patient is told when the electroencephalogram is scheduled.

  • If the patient is taking restrictive medications routinely to prevent seizures, antidepressants, or stimulants, they may be asked to stop taking these medications 1 to 2 days before the test.
  • The patient is told not to ingest caffeine before the test.
  • The patient should not use hair products (hairspray or gel) on the day of the test.
  • It is prudent to take the patient to the EEG site, especially if he or she wants to refrain from taking overdose medications.
  • If the patient has a sleep EEG, they may be asked to stay awake the night before the test.

During electroencephalogram

During an electroencephalogram, 20 electrodes are placed on your scalp while you lie on the exam table or in bed. Open your eyes first, then close them and relax. You may be asked to inhale deeply and quickly or to stare at a flashing light; both activities cause changes in brain wave patterns. If you are prone to epilepsy, you will rarely experience one during the test. If you are being evaluated for a sleep disorder, you may have a continuous EEG done at night while you sleep. This recording, which assesses other bodily functions such as breathing and pulse during sleep, is called polysomnography.

After electroencephalogram

Once the test is complete, the electrodes are removed and you are allowed to stand up. The results must be analyzed at a later stage by a neurologist (a doctor who specializes in brain disorders).

Generally, if there are no abnormalities in the electrical activity of the brain, the pattern of “peaks and valleys” traced by the electroencephalogram should be fairly regular. If excited, the pattern will show considerable variation and any deviation from the regular pattern may indicate abnormalities.


Once the electroencephalogram results have been analyzed, they are sent to your doctor, who will accompany you. The EEG looks like a series of wavy lines. The lines will look different depending on whether you are awake or asleep during the test, but each state will have a general pattern of brain activity. If the regular brain wave pattern is disturbed, it could be a type of epilepsy or another brain disorder.

Having an abnormal EEG does not mean you have epilepsy. The test records what is happening in your brain at that moment. Your doctor will do other tests to confirm the diagnosis.


Complications of electroencephalogram (EEG) include:

  • You move too much.
  • You take certain medicines. This involves medicines used to treat seizures (antiepileptic medicines), sedatives, tranquilizers, and barbiturates.
  • You took coffee, soda, or tea, or you ate extra foods that have caffeine before the test.
  • You are careless from severe drug poisoning or very low body temperature (hypothermia).
  • Your hair is dirty, oily, or treated with hair spray or other hair products. This can create a problem with how the electrodes are placed.

Know the Procedure of Angiography | Neurology

What is angiography?

Angiography is an X-ray procedure in which dye is added into the chambers of your heart or into the arteries that lead to your heart (coronary arteries). Then, doctors can measure blood flow and blood pressure in the chambers of the heart and see if the coronary arteries are blocked.

When imaging is taken, an iodine-based contrast medium usually enters the system. The medium highlights the movement of blood through the vessels.

Purpose of angiography

X-ray angiography is performed to specifically diagnose and diagnose vascular diseases of the body, including the brain and heart. Traditionally, angiography has been used to diagnose pathology in these vessels, such as blockage caused by plaque buildup.

However, in current decades, radiologists, cardiologists, and vascular surgeons have practiced X-ray angiography to guide minimally invasive surgery of the blood vessels and arteries of the heart. In recent years, diagnostic vascular imaging has often been performed using MRI, CT, and/or ultrasound and has become specialized for the treatment of X-ray angiography.

Types of angiography

There are several types of angiography used to diagnose a variety of problems:

  • Computed tomography angiography (CTA) uses X-rays, software, and hardware to produce horizontal or axial images or fragments of blood vessels for diagnosis.
  • Coronary angiography is a diagnostic image that uses color and special X-rays to show the inside of the coronary (heart) arteries. These images are used to identify chest pain and arterial narrowing that can lead to future heart attacks.
  • Digital subtraction angiography (DSA): Presents a picture of the blood vessels in the brain to know a problem with blood flow. In this procedure, a catheter (small, thin tube) is injected into an artery in the leg and sent to the blood vessels in the brain. Contrast dye is injected through the catheter, and X-ray images are obtained from the blood vessels.
  • Magnetic resonance angiography (MRA) uses magnetic resonance imaging (MRI) and contrast dye to reflect blood vessels. Doctors often use MRA to examine the heart and other soft tissues and assess blood flow.
  • Pulmonary angiography: An X-ray image of blood vessels used to diagnose various conditions, such as aneurysm, stenosis (narrowing of the blood vessels), or obstruction. The dye (contrast) is injected through a thin, flexible tube that is placed into the artery. This dye makes the blood vessels visible on X-rays.
  • Renal angiography: It is an X-ray image of the renal artery, which is generally used to evaluate the occlusion of the renal artery in patients with drug-resistant hypertension.
  • Radionuclide angiography (RNA) is a type of nuclear medicine procedure. A small amount of a radioactive substance called a radionuclide (radiopharmaceutical or radioactive tracer) is used to help in the examination of the studied tissue. Specifically, relaxation assesses the chambers of the heart on the movement of RNA.

Risk factors

Risk factors for angiography include:

All medical procedures have certain risks. The risks of angiograms are minimal. Accidents include injury to the catheter insertion site, internal bleeding, hematoma or arterial damage, and a small risk of stroke. An allergic reaction to the contrast dye can cause a rash, swelling, trouble breathing, or heart problems. This test should not be given to pregnant or bleeding women.

Every effort is made to ensure that these losses are minimal. Our nurse practitioners and interventional neuroradiologists will discuss your specific risks with you before angiography.

Procedure of angiography

Preparation for angiography

  • You are usually hospitalized as a day patient for this procedure
  • Bring your referral letter or application form and all X-rays taken during the last 2 years
  • Leave the X-rays with the radiology staff because the doctor will need to see them. The radiology staff will inform you when they are ready to be picked up.
  • Wear comfortable, loose clothing
  • Leave all jewelry and valuables at home
  • You may be requested not to eat for 4 hours before the angiogram
  • You will be allowed to drink clear liquids such as black tea, coffee, clear soup, or water for four hours before your angiogram. Having fluids is very important for the kidneys.

Once the person checks in, a nurse takes them to a private room where they can put on a hospital gown.

The nurse then inserts an intravenous line into a small vein in the person’s hand or wrist. They also monitor a person’s vitals, including their weight, body temperature, heart rate, and blood pressure.

During angiography

Before the angiography, a doctor will prescribe a mild sedative to help the person relax. It does not induce unconsciousness.

Then the doctor will disinfect and numb the area of the body where the catheter will be inserted. They made small incisions in the skin and inserted a catheter into the artery.

Once the catheter is inside the artery, the doctor will correctly guide them to the blood vessel they want to measure. They inject a contrast medium through a catheter and take X-ray images of the blood vessels. The person may feel a slight burning sensation when the doctor injects the contrast medium.

After angiography

You will be observed for 4 to 6 hours. During that time, the radiology nurse will discuss the instructions with you at home. A written form of these instructions will be provided to you. Follow these at home.

The radiologist will evaluate you before you are discharged. Then your doctor will discuss the test results with you.

If you have diabetes, do not take Glucophage (metformin hydrochloride) for 48 hours after the test to reduce the risk of kidney problems.

Side effects

After angiography, many people have:

  • Bruising
  • Soreness
  • A very small bump or group of blood near wherever the cut was made

These problems should get better in a few days or weeks, and you generally don’t need to worry.

You can take pain relievers like paracetamol for any discomfort if you need it.


Minor problems with the angiography procedure:

  • Excessive bleeding at the incision site
  • Infection at the incision site, which may need treatment with antibiotics
  • Mild to a moderate allergic reaction to contrast medium; This can usually be controlled through the use of allergy medications.

More serious complications can include:

  • Blood clots 
  • Kidney damage
  • Stroke
  • Blood vessel damage
  • A serious, life-threatening allergic effect (anaphylaxis) to the contrast dye

9 signs you should go see the doctor

  • Signs of infection such as fever or chills
  • Redness, swelling, growing pain, unnecessary bleeding, or any discharge from the site
  • Extreme sweating, nausea, or vomiting
  • Extreme pain
  • Extreme chest pain
  • Leg or arm feels cold, turns white or blue, or grows numb or tingly
  • Trouble breathing
  • Problems speaking or seeing
  • Weakness in the face