A number of tests may be performed before transmyocardial revascularization (TMR). These tests will help the physician to determine the location and severity of the damage in the coronary arteries. The tests include:

• Medical history. Family medical matters can provide valuable insight into an individual’s future because many medical conditions, including heart disease, run in family. During a medical history, the physician will ask questions about the patient’s family medical history as well as personal medical history.
  
  
• Physical examination. A physical examination, or “physical,” allows the physician to inspect the body, looking for evident signs of heart disease or other illness.
  
  
• Electrocardiogram (EKG). This is a recording of the heart’s electrical activity as a graph on a moving strip of paper or video monitor. The highly sensitive electrocardiograph machine helps detect heart abnormalities, disease and damage by measuring the heart’s rhythms and electrical impulses.
  

  

• Echocardiogram. This test uses sound waves to visualize the structures and functions of the heart. A moving image of the patient’s beating heart is played on a video screen, where a physician can study and measure the heart’s thickness, size and function. The image also shows the motion pattern and structure of the four heart valves, revealing any potential leakage (regurgitation) or narrowing (stenosis). During this test, a Doppler ultrasound may be used to evaluate cardiac blood flow.
  
  
• Stress test. A stress test may be ordered so the physician can assess the heart’s reaction under physical stress. During an exercise stress test, an electrocardiogram is performed while the patient exercises in a controlled manner on a treadmill or stationary bicycle at varied speeds and elevations. During a pharmacological stress test, a medication (e.g., dobutamine) is given to the patient that causes the heart to react as if it were under the physical stress of exercise, although the patient is actually at rest. Using either technique, the reaction of the heart under stress can be measured and evaluated.
  
  
• Coronary angiogram. In some cases, this minimally invasiveinvasive catheter-based test will need to be performed to verify the location and severity of blockages in the coronary arteries. The test uses a special dye administered through a catheter to visualize the coronary arteries.