Diagnostic Testing

Cardiovascular Examination
Electrocardiogram (EKG)
Stress/Echocardiogram (Echo)
Stress Testing
Nuclear Perfusion Imaging
Holter and Event Monitoring 
Carotid Studies

Hospital Procedures       

Cardiac Catheterization 
Coronary Angiography 
Angioplasty and Coronary Stenting
Permanent Pacemaker Implantation 
Renal Angiography and Stenting
Peripheral Angiography and Stenting
Trans-Esophageal Echo

Diagnostic Testing

Cardiovascular Examination When you schedule your examination one of our physicians, you will be scheduled to have a complete cardiovascular examination, which will include assessment of your blood pressure, pulse rate and regularity, respirations and general body habitus. Your examination will also include a complete assessment of the peripheral vascular system which may include in office testing such as EKG, Echocardiogram, Carotid Study, and possibly cardiac stress testing.

Electrocardiogram(EKG) An EKG or Electrocardiogram is a 12 lead record of the electrical activity of the heartbeat. Does it hurt? No. There is no pain or risk associated with having and electrocardiogram.

Stress/Echocardiogram (Echo) Echocardiogram is a test in which ultrasound is used to examine the heart. In addition to providing single dimension images, known as M-mode echo that allows accurate measurement of the heart chambers, the echocardiogram also offers far more sophisticated and advanced imaging. This is known as two-dimensional or 2-D Echo and is capable of displaying a cross-sectional "slice" of the beating heart, including the chambers, valves and major blood vessels that exit from the left and right ventricle.

What is Carotid Disease? Carotid artery disease, also called carotid artery stenosis is the narrowing of the carotid arteries, usually caused by the buildup of fat and cholesterol deposits, called plaque. Like the arteries that supply blood to the heart (the coronary arteries), the carotid arteries can also develop atherosclerosis on the inside of the vessels.

Over time, the buildup of fat and cholesterol narrow the carotid arteries, decreasing blood flow to the brain and increasing the risk of a stroke. A stroke is similar to a heart attack. It occurs when brain cells (neurons) are deprived of the oxygen and glucose (a sugar) carried to them by blood. Oxygen and glucose are essential for neurons to function and survive. If the lack of blood flow lasts for more than 3 to 6 hours, the damage is usually permanent.

Carotid Duplex Study is used to assess plaque within the artery walls. It is a two dimensional ultrasound image of the Carotid arteries in the neck. The test usually takes approximately 30 minutes.

Stress Testing Stress testing can be scheduled in our office to assess the heart's rhythm, rate, and ability to function as well as blood pressure monitoring; both at rest and during exercise.

We offer three different types of stress testing in our office.

Nuclear Perfusion Imaging During this procedure you will be asked to exercise on a treadmill. When you reach your maximum heart rate you're given an injection of a radioactive isotope (Technetium-99sestamibi). Images are taken with a special camera of your heart shortly before exercise and also a short time after exercise. This test shows how well blood flows in to the heart muscle and can detect narrowing of the coronary arteries or coronary artery disease.

Adenosine Stress Test is performed on people who cannot walk on the treadmill. This test utilizes a drug to stress your heart (Adenosine). Adenosine causes the body to respond as if it were exercising. It will show the blood flow to the heart using pictures taken with a special camera.

Exercise Stress Test is a non nuclear stress test or Treadmill test as it is popularly known is a simple stress test. You will be asked to walk on a treadmill and the activity of the heart is monitored through EKG.

 

Holter and Event Monitoring
24 hour Holter Monitoring is a portable heart monitor that produces a record of your heartbeats over an extended period of time usually 24 hours. It is often used to identify problems undetected by a single electrocardiogram. The recorded data will be analyzed by our doctors.

Event (loop) Monitoring is much like a holter monitoring however the device is very small and portable and can be worn for months. The monitor is activated when you have "an event", that is, you feel symptoms of your heart problem (arrhythmia).

 

Hospital Procedures

Cardiac Catheterization Cardiac Catheterization is a test to check you heart and coronary arteries. It is used to check blood flow in the coronary arteries, blood flow and blood pressure in the chambers of the heart, also, to find how well the heart valves work, and check for defects in the way the wall of the heart moves. A thin plastic catheter is inserted into an artery or vein in the arm or leg. From there it can be advanced into the chambers of the heart or into the coronary arteries. The purpose of this procedure is to find out if you have disease in your coronary arteries and, if so, pinpoint the size and location of the fat and calcium deposits (plaque) that may have built up in your coronary arteries from atherosclerosis. This is generally done to determine whether you may need bypass surgery or angioplasty.

Coronary Angiography Angioplasty this procedure may be done by attaching a small balloon to a catheter. Once the catheter has been guided to the proper location in a coronary artery, the balloon is inflated. The pressure from the inflated balloon presses the plaque against the wall of the artery to improve blood flow.

 

Coronary Stenting Stenting is usually done along with angioplasty. Once the plaque is compressed using angioplasty, a small expandable wire tube called a stent is inserted into the artery to hold it open. Reclosure of the artery is less likely to occur after angioplasty followed by stenting than after angioplasty alone. This is the most common procedure performed.

Atherectomy may be done during cardiac catheterization to open a partially blocked coronary artery. Once the catheter reaches the narrowed portion of the artery, a cutting device, a whirling blade (such as a rotoblade) is used to remove the plaque.

Surgical Consultation Our cardiologists do not perform surgery in the operating room. If surgery becomes necessary, our physicians work closely with the finest surgeons to ensure appropriate care and treatment.

 

Peripheral Angiography and Stenting Renal Angiography and Stenting Angiogram is an x-ray of the arteries. It is performed by puncturing the artery under local anesthetic, and injecting contrast (dye) to outline the blood vessels. A reduction in the blood supply to the kidneys can give rise to poor renal function and high blood pressure. The kidney arteries can become narrowed by atheroma (hardening of the arteries). In this case, the narrowed artery can be stretched with a balloon angioplasty and stenting to improve blood flow, this will help to reduce blood pressure and maintain better kidney function.

Renal Angiography and Stenting
Angiogram is an x-ray of the arteries. It is performed by puncturing the artery under local anesthetic, and injecting contrast (dye) to outline the blood vessels. A reduction in the blood supply to the kidneys can give rise to poor renal function and high blood pressure. The kidney arteries can become narrowed by atheroma (hardening of the arteries). In this case, the narrowed artery can be stretched with a balloon angioplasty and stenting to improve blood flow, this will help to reduce blood pressure and maintain better kidney function.

 

Permanent Pacemaker Implantation

 

A Pacemaker is a small device that sends

small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart or ventricles.

 

A pacemaker may also be used to treat fainting spells (syncope). They can also be used to treat congestive heart failure.
 
There are several different Types of Pacemakers:
 
Single Chamber Pacemaker
Dual Chamber Pacemaker
Biventricular Pacemaker
 
Your physician will decide what type of pacemaker you need based on your heart condition.
 

A pacemaker implant procedure can last from 2 to 5 hours. It is usually done under IV sedation

. A medication will be given through your IV to relax you and make you feel drowsy; you will not be asleep during the procedure.

 

You will need to remain in the hospital over night afterwards.   Under most circumstances you will be able to go home the next day.

 

Trans-Esophageal Echo Transesophageal Echocardiogram is a special ultrasound test that uses sound waves to take pictures of the heart. This type of echo can take clearer pictures of the heart than regular ultrasound especially in adults. The study is done by passing a special tube down the throat into the esophagus. The end of this tube is placed near the heart which allows very clear, detailed pictures to be taken. It is normally done under IV sedation.