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Procedures
Interventional:
Diagnostic Cardiac Catheterization
Coronary Balloon Angioplasty
Peripheral Angioplasty
Coronary Stent Placement
Rotoblater and Atherectomies
Permanent Pacemakers
Defibrillator Implantation
Electrophysiologic Investigation
AICD (Automatic Implantable Cardioverter Defibrillator)
Outpatient:
Treadmill Testing
Electrocardiogram (EKG and ECG)
Peripheral Vascular Testing (carotid, abdominal, renal, arterial, and venous doppler).
24-Hour Holter Monitoring
Echocardiography (both Transthoracic and Transesophageal)
Pacemaker and Defibrillator Checkups
A Fully-Equipped Laboratory
High-Complexity Diagnostics
Nuclear Cardiology
Cardioversion
Event Recording and Assessment of Rhythm Disturbances
External Counterpulsation Therapy
Transcranial Doppler
Diagnostic Cardiac Catheterization
A diagnostic cardiac Catheterization, also called coronary angiography or heart catheterization, is a procedure that provides detailed information about the function of the heart and its arteries. By combining that information from blood tests and other diagnostic tests with a cardiac catheterization procedure, your doctor can accurately diagnose a heart condition and the most effective treatment plan.
Coronary Balloon Angioplasty
Percutaneous transluminal coronary angioplasty (PTCA), or balloon angioplasty, is a procedure used to open narrowed coronary arteries. It is performed with a local anesthesia while the patient is awake. Patients whose angina has not been relieved by medications are generally the best candidates for PTCA. There are several other commonly used treatments for opening blocked arteries such as the Rotoblator procedure (tiny rotating blades) or Atherectomies (cutters) to cut away plaque buildup on the artery walls, or Stents (a little metal "scaffold") that widens obstructed arteries.
Peripheral Angioplasty
Peripheral angioplasty is performed much like that of PCTA or percutaneous transluminal coronary angioplasty, but to open blocked arteries or remove blood clots in the patient's legs.
Coronary Stent Placement
The Stent is a stainless steel device (scaffold) which compresses the plaque, much like in the coronary balloon angioplasty procedure. It is implanted by guiding a thin, balloon-tipped catheter through the artery to the blockage. The collapsed stent is part of the catheter tip, and when the balloon is inflated the stent expands into place allowing the flow of blood once again through the coronary arteries. After a couple of weeks tissue forms around the stent and it becomes a permanent support for the artery.
Rotoblater and Atherectomies
The rotoblator is a procedure used to clear blocked arteries. Your doctor guides a thin catheter through the artery to the blocked area. The catheter contains a small, specially designed, rotating blade which chips off hard plaque buildup on the artery walls. The chips of plaque are then small enough to be absorbed and expelled into the blood stream. The atherectomy procedure is similar however it contains a cutter which shaves the plaque away from the artery wall. The plaque is then removed through the catheter. Both procedures are used to effectively clear blocked arteries.
Permanent Pacemakers
A pacemaker is a battery-operated device that helps maintain a normal heart rhythm. It sends electrical signals to the heart to stimulate contracting or pumping of the heart muscle. It is designed specifically for patients who have irregular or very slow heart rates and symptoms of fainting or fatigue.The rate is set by the doctor. The pacemaker generator is placed under the skin on the chest wall below the collarbone. It contains a battery and wires(leads) which are positioned inside the heart and transmit the signal from the battery to the heart thus causing the contracting.
Defibrillator Implantation
An implantable cardiovertor defibrillator system or implantable cardiac devices (ICD), is a small electronic device that monitors heart rhythm and delivers a shock to correct a potentially fatal heart rhythm if it should occur. The generator is surgically implanted beneath the skin and muscle beneath the collarbone. Wire electrodes attach the pulse generator to the heart. Some of the wires are inserted through veins into the inside of the heart and can sense the heartbeat. Other wires may be attached directly to the heart. These wires are used to deliver the shock, if necessary, which converts the heart back to its normal rhythm.
Electrophysiologic Investigation
Electrophysiology testing makes it possible to study heart rhythm disturbances under controlled conditions. By using special insulated wires called catheters, your doctor is able to identify the rhythm disturbance and choose the best treatment method. The procedure is performed in the cath lab. It involves inserting thin plastic catheters into the large blood vessels in your groin and arm, then guiding them to the heart with the help of a special X-ray machine. When the catheters are in place in your heart, a doctor who specializes in electrophysiology will stimulate the heart artificially with electrical impulses delivered through the catheters. Your doctor will watch the heart's reaction to determine the extent of rhythm disturbance.
AICD (Automatic Implantable Cardioverter Defibrillator)
An AICD is a computerized device implanted in the abdominal wall. It detects and generates electrical impulses through leads placed on or in the heart that sense a cardiac disturbance such as the onset of a recurrent heart attack or heart failure (tachycardia or fibrillation). The primary purpose of the AICD is to deliver a counter-shock to the heart in order to stabilize and resuscitate the patient's normal heart rhythm.
Transcranial Doppler
Transcranial Doppler (TCD) technology dramatically simplifies the detection of PFO’s. Patent Foramen Ovale (PFO) is increasingly being recognized as a cause of up to 56% of cryptogenic stroke and TIA’s, as well as a possible cause of migraine headaches. Other benefits of TCD include increased cost effectiveness and less patient discomfort compared to transesophageal echocardiography (TEE).
Transcranial Doppler (TCD) allows for non-invasive monitoring of cerebral blood flow. Embolic signals are detected after an injection of agitated saline (micro air bubbles) into an arm vein. This safe non-invasive procedure is done during resting conditions and during Valsalva.
Treadmill Testing
Commonly referred to as the Stress Test, Treadmill Testing takes about 45 minutes and evaluates the heart's response to increased activity. It is used in several ways to diagnose coronary artery disease, to monitor the progress of your treatment or as part of a routine physical exam.
Electrocardiogram (EKG and ECG)
The EKG records the heart's electrical activity to detect abnormal heartbeats (rhythmias). It can even show a heart attack in progress.
Peripheral Vascular Testing (carotid, abdominal, renal, arterial, and venous doppler)
Peripheral Vascular Testing (carotid, abdominal, renal, arterial, and venous doppler)
24-Hour Holter Monitoring
The Holter monitor is used in diagnosing heart rhythm disturbances that may occur at times when you are away from the doctor. It is used in conjunction with a written diary or log of your daily events and activities. The Holter monitor allows doctors to relate those symptoms to actual variations in heart rhythms, providing them with further diagnostic information for determining the most course of treatment.
Echocardiography (both Transthoracic and Transesophageal)
This test uses ultrasound-high frequency sound waves-to create a videotape of the heart's chambers, valves, wall motion, and blood flow patterns. This can be done by applying the ultrasound probe to the chest wall or by passing the probe down the patient's throat in order to image the patient's heart from inside the chest (transesophageal).
Pacemaker and Defibrillator Checkups
The heart is required to maintain a fast enough heartbeat and rhythm to keep blood flowing throughout the body. Pacemakers and Defibrillators are devices sometimes implanted in the body to keep the heart beating properly. Period checkups are required of these devices.
A Fully-Equipped Laboratory
The lab is fully-equipped to take chest X-rays to determine the size of the heart and condition of the lungs, cardiac enzyme counts to determine if heart muscle is damaged, cholesterol, triglyceride, and/or glucose (blood sugar) levels to help identify risk factors for heart disease, and blood samples for further diagnosis.
High-Complexity Diagnostics
A common high-complexity outpatient diagnostic test is cardiac catheterization, also called coronary angiography or heart catheterization. These procedures provide more detailed information about the function of the heart and its arteries than other diagnostic tests. However, by combining information from blood and other diagnostic tests with a cardiac cath procedure, your doctor can more accurately diagnose a heart condition and prescribe the most effective treatment plan.
Nuclear Cardiology
Using a high resolution detector-camera in conjunction with a pharmacologic radionuclide and treadmill test, your doctor can perform four different nuclear cardiology studies of the heart.
1. Cardiac Blood Pool Imaging, also known as a MUGA,
to evaluate the left and right ventricul function including
wall motion and blood ejection fraction.
2. A Myocardial Perfusion test can assess coronary
artery disease utilizing the treadmill and pharcologic
agent.
3. Radionuclide Angiocardiography to assess right
ventricular ejection fraction
4. Shunt Evaluation to assess abnormal intracardiac
communications.
Cardioversion
With the patient sedated, pads are applied to the chest and an electrical impluse is delivered to correct some types of abnormal heart rhythm. Event Recording and Assessment of Rhythm Disturbances Event recording is often necessary when the normal pacing of the heart is disturbed. There are several treatments which help in the assessment of a rhythm disturbance. They are: Electrocardiogram or 24 Hour Holter Monitoring which records the heart rate in the doctor's office or while you go about your daily activities, or an echocardiogram whereby images are made of the heart through sound waves otherwise known as ultrasound. In some cases it may also be necessary to stimulate the heart through electrical Cardioversion to restore normal rhythm.
Event Recording and Assessment of Rhythm Disturbances
Event recording is often necessary when the normal pacing of the heart is disturbed. There are several treatments which help in the assessment of a rhythm disturbance. They are: Electrocardiogram or 24 Hour Holter Monitoring which records the heart rate in the doctor's office or while you go about your daily activities, or an echocardiogram whereby images are made of the heart through sound waves otherwise known as ultrasound. In some cases it may also be necessary to stimulate the heart through electrical Cardioversion to restore normal rhythm.
External Counterpulsation Theraphy
External Counterpulsation (ECP) is a non-invasive outpatient treatment for coronary artery disease that has not responded to conventional medical and/or surgical therapy. ECP therapy is intended to help relieve persistent anginal symptoms in those individuals who cannot be treated effectively with medication, or who are unsuitable, or unwilling to undergo invasive procedures such as angioplasty or bypass surgery.
ECP therapy typically consists of 35 one-hour treatments performed one to two times daily, 5 days per week. Using three sets of cuffs that wrap around the calves, thighs, and buttocks, serial inflations of the cuffs are performed, increasing blood flow and oxygen back to the heart. It is also believed that the pressure created by ECP therapy promotes the development of new pathways or collateral vessels that form natural bypass networks around narrowed or blocked arteries. As a result of this treatment, most patients experience a reduction in the frequency and severity of anginal symptoms, as well as, increased activity/exercise tolerance. Most patients tolerate ECP therapy with few side effects.
ECP Therapy is best suited for patients with the following conditions:
• Patients with persistent anginal symptoms despite conventional
therapy including angioplasty &/or bypass sugery
• Patients who are not candidates for invasive or surgical
treatments due to other medical conditions
• Patients who are not willing to have surgery or other invasive
procedures
• Patients with very small coronary (heart) vessels, in particular
diabetic patients
• Patients who are not provided adequate relief with Nitrates
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