INVASIVE CARDIOLOGY

Cardiac Catheterization

Cardiac Catheterization is a procedure that examines the heart and is used to help physicians diagnose a heart problem and choose the most effective treatment. During this procedure, a physician can measure pressures inside the heart, evaluate the arteries delivering blood to the heart, and determine how well the heart is pumping. This is sometimes called a coronary angiogram.

Electrophysiology

Electrophysiologic Studies
Conducted to identify the location of your heart’s electrical pathways. Electrical wires are inserted into a catheter and guided through blood vessels in your arm or leg to your heart. While inside the chambers of the heart, the wires record abnormal impulses or heartbeats. Once the abnormality is discovered, it may be treated with radiofrequency catheter ablation.

Radiofrequency Catheter Ablation
A procedure used to treat some types of rapid heart beating. A catheter with an electrode at its tip is guided to the area of the heart muscle, where there is an extra pathway and a mild, painless radiofrequency energy, is transmitted to the pathway and this causes heart muscle cells in a very small area to die, which stops the area from conducting the extra impulses that cause the heart to beat too rapidly.Pacemaker Implantation and Management
Implantation of a small, battery-operated device that helps the heart beat in a regular rhythm.

Implantable Defibrillator Placement and Management
An ICD is a small electronic device, about the size of a deck of cards, that is placed inside the body. It constantly monitors your heart rhythm. If it senses a dangerous, rapid heart rhythm, it delivers one or more pulses or shocks to the heart and restores a more normal rhythm.

Percutaneous Coronary Interventions

Atherectomy
Atherectomy is a procedure performed to treat blockages in the arteries. The narrowed arteries are widened by inserting a catheter carrying a device, such as a rotating drill or a cutter into the artery.

Balloon angioplasty
Balloon angioplasty, also known as PTCA or coronary angioplasty, is a procedure used to treat blockages in the coronary arteries. A catheter with a small balloon is inserted into the blocked artery and dilated to open the artery that supplies the heart muscle with blood.

Coronary Stent
A coronary stent is a cylindrical, wire mesh device that is placed by a catheter into a previously blocked artery to help keep it open.

Alcohol Septal Ablation
Alcohol septal ablation is a percutaneous, minimally-invasive treatment performed by an interventional cardiologist to relieve symptoms and improve functional status in severely symptomatic patients with hypertrophic cardiomyopathy who meet strict clinical, anatomic and physiologic selection criteria.

Valvuloplasty
Valvuloplasty is a non-surgical procedure that may be used to open a narrow valve within the heart.

Patent Foreman Ovale
A patent foramen ovale is a small, flap-like opening in the dividing wall (septum) between the upper two chambers of the heart – the left atrium and the right atrium. In most people, the two flap-like sections of the septum, which form the foramen ovale, fuse together after birth. However, in approximately 15-20% of individuals, the foramen doesn’t fuse together and remains open or “patent”. If the blood that crosses the PFO contains debris or a clot, it can enter the arteries which supply the brain and cause a stroke or transient ischemic attack (TIA). Nowadays, there is a non-surgical method to treat PFO using a device called a septal repair implant. PFO closure is performed in the cardiac catheterization laboratory by a physician.

Peripheral Artery Disease

Millions of people across the country are walking less than they used to because of leg pain. This leg pain can be caused by PLAQUE BUILD-UP inside the arteries of the leg, a condition called Peripheral Artery Disease (PAD). If left untreated, PAD can lead to amputation and is associated with a greater risk of heart attack and stroke.

Symptoms of PAD:

  • Dull, cramping pain in the hips or legs during exercise or at rest
  • Change in skin temperature and color
  • Infections or sores that do not heal
  • Hair loss on feet and legs
  • Numbness or tingling in the legs, feet or toes

New treatment options can remove the plaque and restore normal blood flow to alleviate leg pain.

Peripheral Vascular Catheterization or Intervention

Catheterizations, angioplasties or stent placement performed in a vessel outside the heart, such as those leading to the arms, legs, kidneys or brain.

NON-INVASIVE CARDIOLOGY

Cardiac Ultrasound Imaging


Echocardiography
This is an ultrasound test that sends sound waves into the chest to rebound from the heart’s walls and valves. The recorded waves show the shape, texture and movement of the valves on an echocardiogram. They also show the size of the heart chambers and how well they’re working.

Transesophageal Echocardiography (TEE)
Transesophageal echocardiography is a special type of ultrasound imaging procedure. A transducer placed on the end of a tube is passed down a person’s throat and into the esophagus. With the esophagus being close to the heart, images from TEE can give very clear pictures of the heart and its structures.

Abdominal Aorta Ultrasound
An abdominal aorta ultrasound is an imaging of the abdominal aorta that looks for potential aneurysms.

Computed Tomography Angiography (CTA)

CTA is an x-ray technique that produces a more detailed image of the body’s organs than a regular x-ray.

CTA detects:

  • Presence of plaque (fatty deposits) in vessels of the heart or elsewhere in the body
  • The quality of that plaque (soft, unstable, more likely to rupture or more stable and hardened)
  • Presence and amount of calcium build-up in the vessels of the heart or elsewhere in the body
  • Cause of atypical chest pain

Cardiac Calcium Scoring
A cardiac calcium score is a screening tool that measures how much-calcified plaque is present in the heart arteries of an individual. There is a direct correlation between the amount of calcium in these arteries and the likelihood of a future cardiac event such as heart attack or stroke.

Doppler Studies

Carotid Doppler
An ultrasound to evaluate blood vessels in the neck that lead to the brain.

Arterial Doppler
Also called ABI, is a comparison of blood pressures of the arms and ankles. May involve a short walk on the treadmill, followed by an ultrasound to evaluate blood flow in the legs.

Venous Doppler
An ultrasound to evaluate the veins of the arm or leg for blood clots.

Electrocardiograms (ECG)

A test that records your resting heart rhythm and is used to help physicians diagnose arrhythmias.

Exercise Stress Testing

Also known as a treadmill test, in which EKG and blood pressure readings are monitored while walking on a treadmill.

Nuclear Cardiac Imaging

Nuclear Cardiac Imaging is a test that produces images of the heart at work (during exercise) and at rest. During a test, you are given an injection of a small dose of a harmless radioactive tracer. Next, you spend time exercising on a treadmill or stationary bicycle and then resting. A specialized camera (called a “gamma camera”) detects the tracer as it passes through the chambers of your heart, creating the pictures. The pictures may reveal problems in the heart muscle and blood vessels, especially when the images of the heart at work and at rest are compared.

Outpatient Telemetry Monitoring

Holter Monitoring
Holter monitoring is usually conducted over a 24-hour period while the patient goes about his or her usual daily activities. It is a continuous recording of the electrocardiogram, which is useful for detecting arrhythmias that may not appear during a resting electrocardiogram.Event (Loop) Monitoring
Like Holter monitoring, event monitoring involves wearing a very small, portable EKG recorder. However, a holter monitor is worn for a few days at most; an event monitor can be worn for months. An event monitor is activated when you have “an event,” that is, you feel the symptoms of your heart problem (an arrhythmia, for example). The recorded data can be sent over the phone to your doctors for analysis.

Transtelephonic pacemaker monitoring
Transtelephonic pacemaker monitoring is used to record the heart rate and rhythms for brief periods, which are sent to a recorder by telephone.

PADnet

PADnet is an easy to use system that uses automated means to obtain Ankle-Brachial Index (ABI)/Toe- Brachial Index (TBI) values and Pulse Volume Recording (PVR) waveforms.In just 15 – 20 minutes, during a regular office visit, the non-invasive ABI, TBI and PVR tests help identify obstructive peripheral disease and determine whether medical or surgical treatment is necessary.

CONDITIONS

Congestive Heart Failure

Congestive heart failure can be broken into two categories: systolic and diastolic. In order to understand these, you will need some background about heart function. During a normal heart pumping cycle the heart goes through phases. The heart has a right and left ventricle and a right and left atrium. The atria are at the top of the heart and the ventricles are at the bottom of the heart. The left ventricle is the main pumping chamber of the heart. The contraction of the ventricles is called ventricular systole (pronounced sis-toe-lee) and the relaxation of the ventricles is known as ventricular diastole (pronounced die-as-toe-lee). The same is true for atria. When the ventricles are contracting, the atria are relaxing, and vice versa.

Systolic Heart Failure may be present when there is a problem with the left ventricle and the way is pumps blood (also called left ventricular systolic dysfunction). In patients with some forms of cardiomyopathy, the left ventricle becomes dilated, stiff, or thickened and cannot properly pump the body’s circulating blood. If the left ventricle is weak, the blood will back up into the lungs causing fluid accumulation and shortness of breath or into the extremities causing swelling.

Diastolic Heart Failure may be present when there is a stiff or thickened heart muscle that cannot properly relax to allow for adequate filling of the ventricle. Then overflow of circulating blood is the backed up into the lungs and extremities as well. Symptoms are shortness of breath and swelling.

Congenital Heart Disease

Over 1 million Americans have some form of congenital heart disease. These range from simple holes in the heart to extensive cyanotic heart disease, or “blue babies.” These patients, even those that have been surgically repaired, typically require lifelong follow-up in a clinic with specialists who are specifically trained in the care of patients with congenital heart disease.

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