Services
Office Based Procedures:
ECG/Holter Monitoring:
Records the electrical activity of the heart at rest and during daily activities. This test alerts us to the possibility of any abnormalities in the heart and helps us determine whether further diagnostic testing is necessary.
Treadmill (Exercise Stress Test):
The heart is continuously monitored while the patient walks on a treadmill. The speed and incline of the treadmill increase every 3 minutes until a maximal level of exercise is achieved. The patient’s heart rate, blood pressure, oxygen saturation and ECG is monitored during exercise and during recovery. An abnormal blood pressure response, an abnormal ECG response or the development of symptoms (such as chest pain/tightness, shortness of breath or leg/calf pain may suggest significant coronary artery or peripheral arterial disease.
Transthoracic Echocardiography (TTE):
Uses high-frequency sound waves (ultrasound) to produce images of the heart. Images are obtained on the outside of the chest with the patient in a lying position. Imaging typically takes 20-30 minutes. TTE is very useful in providing structural information on the heart, including the size and function of the main pumping chambers (ventricles) as well as the structure and functional status of the heart valves.
Nuclear Stress Test:
(Also known as Myocardial Perfusion Imaging (MPI) or Radionuclide Stress Test) Patients will undergo an exercise treadmill test, or for those patients that are unable to walk, a pharmacologic stress test. With the heart at maximal stress, a radioactive isotope is injected into the bloodstream and taken up by the heart muscle cells. Imaging is then performed with a special (gamma) camera to determine any areas of the heart that may not be receiving an adequate blood supply. Either prior to the stress portion of the study or following the stress imaging, resting or non-stress imaging is also performed using the radioactive isotope. The rest and stress images allow us to determine whether there may be portions of the heart that are at risk for ischemia (inadequate blood supply) or infarction, whether there may have been a previous event or “silent” MI and the heart’s overall function. Most patients with an abnormal MPI suggestive of myocardium at risk will have the option of either medical management alone or medical management and diagnostic coronary angiography.
Peripheral Arterial Disease Screening:
Patients determined to be at risk for peripheral arterial disease (i.e. patients with hypertension, diabetes, tobacco use, age>65, etc.) will undergo an Ankle-Brachial Index (ABI) measurement. An abnormal ABI is highly suggestive of significant blockages involving the lower extremities. Patients’ with an abnormal ABI are often referred for further diagnostic testing which may include: Arterial dopplers, CT angiography or Lower extremity peripheral angiography.
Pacemaker/ICD Clinic:
The patients’ device (PM and/or ICD) is evaluated in the office to determine any abnormal heart rhythms, abnormal ICD firing as well as the battery life and overall functional status of the device. Basic re-programming or adjustments to the device can be made in the office.
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Hospital Based Procedures:
Transesophageal Echocardiography (TEE):
Uses high-frequency sound waves (ultra-sound) to produce images of the heart. Images are obtained by advancing a small tube through the mouth and throat until it reaches the esophagus. The procedure typically takes 30-45 minutes. The patient is typically sedated though not unconscious. TEE allows greater assessment of the heart, both it’s structure and function. TEE is particularly helping in detecting the presence of any blood clots in the heart chambers or infection involving the heart valves.
Cardiac Catheterization
A thin plastic tube (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. This test can measure blood pressure within the heart and how much oxygen is in the blood. It's also used to get information about the pumping ability of the heart muscle. Catheters are also used to inject dye into the coronary arteries. This is called coronary angiography or coronary arteriography. Catheters with a balloon or stent on the tip are used in the procedure called percutaneous coronary intervention to open arteries with significant blockages.
Peripheral Angiography/Percutaneous Endovascular Interventions |
Peripheral angiograms are most commonly done to test the arteries which supply the blood to the kidneys and legs. Because arteries do not show up on ordinary x-rays, arteriograms utilize a "contrast agent" or dye containing iodine, which is injected into the arteries via catheters to make them visible on radiographs. Problems with the arteries may lead to a variety of complications such as stroke, high blood pressure or leg pain. The type of treatment your particular condition may require will be determined by your angiogram.
In patients who are symptomatic with leg pain or have poorly controlled blood pressure, percutaneous balloon angioplasty and/or stent placement (PEI) is indicated for focal, flow-limiting arterial occlusive lesions in the arteries that supply the kidneys or lower extremities. |
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