Services


In-Office Procedures

Some procedures can be performed in our office and do not require a hospital stay. An array of diagnostic procedures and tests can be completed in one or more office visits. Your physicians will explain what you can expect for your procedure, and any preparations you need to make. Some of the in-office procedures we offer are:

EKG/ECG

An electrocardiogram (ECG or EKG) is a test that records the electrical activity of the heart and represents the activity as a graph. Analysis of the graph can provide your physician with important diagnostic information. This test helps your physician determine if your heart rate and rhythm are normal or if heart damage has occurred. You will be asked to lie down and be still during the test. Small, tape-like patches called "electrodes" will be attached to your arms, legs and chest during the test.

2D Echocardiogram

This is a technique that sends sound waves (like sonar) 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 are working. This technique poses no risk to you and is performed in the same way as ultrasound pictures of a fetus are taken in pregnant women.

Carotid Ultrasound

Similar to cardiac ultrasound, this ultrasound technique sends sound waves into the neck to rebound from walls of the carotid vessels. The recorded waves show any potential blockage found in carotid arteries. This test is important in determining if you are at a high risk for stroke in connection with the blockages in your carotid arteries.

Nuclear Exercise Stress Test

A nuclear medicine stress test is performed in order to take pictures of your heart while you are stressed (exercising) as well as during rest. This test involves the injection of a radioactive "tracer" that allows the heart muscle to be seen through special images. This test can be extremely useful in diagnosing coronary heart disease, the presence of blockages in the coronary arteries that supply oxygen-rich blood to the heart muscle. The amount of radioactive "tracer" that is used is a very small amount and does not pose a health risk.

Nuclear Chemical Stress Test

A nuclear medicine stress takes pictures of your heart while you are receiving medications during rest. The medications are used to stress the heart. In addition, this test involves the injection of a radioactive "tracer" that allows the heart muscle to be seen through special images. This test also aids in diagnosing coronary heart disease, the presence of blockages in the coronary arteries that supply oxygen-rich blood to the heart muscle. The amount of radioactive "tracer" that is used is a very small amount and does not pose a health risk.

Holter Monitor

A Holter monitor is a 24-hour portable monitor of the electrocardiogram, used to detect heart rhythm problems.The electrocardiogram is key to helping our physicians diagnose irregular heartbeats called "arrhythmias." Arrhythmias (or dysrhythmias) are problems that affect the electrical system of the heart muscle, producing abnormal heart rhythms. Arrythmias can cause the heart to pump less effectively resulting in a number of medical problems. Electrodes (similar to small pieces of tape) are stuck onto your chest and attached to a Holter monitor, a small, battery-operated device you can carry in a pocket or small pouch worn around your neck or at your waist. It records your heart's electrical activity throughout the 24 hours you are connected.

Event Monitor

An Event monitor is a portable monitor of the electrocardiogram that can be worn for up to 21 days and is used to detect abnormal heart rates or rhythms. An event monitor only records your heart's electrical activity at certain times while you're wearing it and is similar to the Holter Monitor.

Stress Echocardiography

Stress echocardiography or "stress echo" is an echocardiogram done before and during or immediately after some form of physical stress (such as bicycle or treadmill exercise). This test is used to help diagnose coronary heart disease.

Exercise Stress Test

An exercise stress test determines if your heart muscle is getting enough blood and oxygen during physical activity. The test records your heart's electrical activity as it responds to an increased work load, such as exercising.

Lower Extremity Arterial Flow Study (LEAF study)

A lower extremity arterial flow study is used for checking the blood flow in your legs. This test uses cuffs similar to blood pressure cuffs for your arm which are wrapped around your arm and your leg on one side of your body. Four cuffs are wrapped around your leg – one at the upper thigh, one at the lower thigh, one at the upper calf and one at the ankle – to measure the blood pressure from the top of your leg to your ankle. A cuff is also wrapped around your upper arm to measure the blood pressure in your arm. The blood pressure in your arm is compared with the blood pressure in your leg. A drop in the blood pressure in your leg may indicate narrowing of an artery.


Hospital Procedures

Other procedures we perform require a stay in the hospital. Procedures that require surgery are performed in the hospital so that your recovery can be monitored to help ensure the best outcome.

Trans-esophageal Echocardiogram

This technique sends sound waves (like sonar) into the chest from a small tube that is inserted down your throat 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 are working. This technique does not hurt and poses no risk to you. This procedure is done in the same way as ultrasound pictures of a fetus are

Angiogram or Heart Catherization

An angiogram, or coronary angiography, is an X-ray examination of the blood vessels or chambers of the heart. Unlike an angioplasty, an angiogram is done simply for diagnostic purposes. A very small tube called a "catheter" is inserted into a blood vessel in your groin or arm. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart. A special fluid (called a contrast medium or IV dye) is injected into the tube. This fluid is visible by X-ray, and the pictures that are obtained are called angiograms. Another name for this test is "coronary arteriography."

Angioplasty

Angioplasty, also called "Percutaneous Coronary Intervention" (PCI or PTCA), encompasses a variety of procedures used to treat patients with diseased arteries of the heart. Coronary Heart disease can include symptoms such as chest pain caused by a build-up of fats, cholesterol, and other substances from the blood (referred to as plaque) that can reduce blood flow to a near trickle, or a heart attack caused by a large blood clot that completely blocks the artery.

Angioplasty is performed by threading a slender balloon-tipped tube – a catheter – from an artery in the groin to a trouble spot in an artery of the heart (this is referred to as coronary artery balloon dilation or balloon angioplasty). The balloon is then inflated, compressing the plaque and dilating (widening) the narrowed coronary artery so that blood can flow more easily. This is often accompanied by inserting an expandable metal stent (see "Arterial Stent," below).

Angioplasty is a common and safe procedure. The National Heart, Lung and Blood Institute reports that more than a million people in the U.S. have coronary angioplasty each year.

Read more about angioplasty at the National Library of Medicine's MedlinePlus.gov, a source of authoritative health information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations.

Arterial Stent

A stent is a wire metal mesh tube used to prop open an artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter which is then moved into the area of the blockage. When the balloon is inflated, the stent expands and locks in place to form a scaffold. The stent stays in the artery permanently and holds it open, which improves blood flow to the heart muscle and relieves symptoms (usually chest pain). Within a few weeks of placing the the stent, the inside lining of the artery grows over the metal surface of the stent.

Stents are used depending on certain features of the artery blockage. This includes the size of the artery and where the blockage is. Stenting is a common procedure; in fact, over 70 percent of coronary angioplasty procedures also include stenting.

Implantable Loop Recorder (ILR)

The ILR has the ability to record the electrical activity of the heart in two ways. First, it is activated according to heart rate ranges set on the device by your physician. If the heart rate drops below the lowest value set, the ILR will automatically start to record. In the same way, if the heart rate rises over the highest value set, the ILR will also record without the patient's knowledge.

The second way it records is through a "patient activator" whereby you can trigger a recording by pushing a button on the activator. The activator can be used when you experience symptoms such as skipped beats, lightheadedness, or dizziness. To start a recording, simply place the patient activator over the ILR and press the button. A green light will flash when recording is successful. The recording is stored in the ILR itself. Your physician can view both the automatic and triggered events during a routine office visit using a special programmer, which looks similar to a laptop computer.

ILRs are recommended for patients who experience symptoms such as syncope (fainting), seizures, recurrent palpitations, lightheadedness, or dizziness. The ILR is best used in patients who experience these serious symptoms regularly but not often enough to be captured by a 24-hour or 30-day external monitor. Because of the two-year battery life of the ILR, patients will experience extended and constant monitoring, giving the physician ample opportunity to capture any abnormal heart rhythm.

Patients are given a general or local anesthetic. A small incision (about 3-4 cm or 1.5 inches) is made just to the left of the breastbone. A pocket is created under the skin, and the ILR is placed in this pocket. No wires are inserted into the heart. The incision is closed with dissolvable sutures. Patients can go home the same day of the procedure with almost no restrictions on activity or work. The ILR is completely safe under the skin for more than the life of the battery without any adverse effects to the patient's health or well being.

Pacemaker

The normal, healthy heart has its own pacemaker that regulates the rate at which the heart beats. However, some hearts don't beat regularly and many times a pacemaker device can correct the problem.

A pacemaker is a small device that sends electrical impulses to the heart muscle to maintain a suitable heart rate and rhythm. A pacemaker may also be used to treat fainting spells (syncope), congestive heart failure, and hypertrophic cardiomyopathy. The pacemaker is implanted just under the skin of the chest during a minor surgical procedure.

The pacemaker is implanted just under the skin of the chest during a minor surgical procedure. Read more about pacemakers at the National Library of Medicine's MedlinePlus.gov, a source of authoritative health information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations.

PFO (Patent Foramen Ovale) Closures

The closure procedure for a Patent Foramen Ovale (PFO) is relatively painless and does not require any surgical incisions. The device used in the procedure, the PFO Occluder, is a wire mesh made out of nickel and a titanium alloy. The device is filled with securely sewn polyester fabric to help close the defect. Memory properties in the alloy, called Nitinol, allow it to be deformed and placed within a small catheter for insertion into the body through a large vein.

Once the catheter is placed across the hole in the heart, the closure device is delivered through the catheter into the atrial chambers, where it springs back open to its memorized shape and seals the hole. Patients are given a general or local anesthetic, and the procedure is performed under ultra sound guidance while the patient is awake.

In many cases the procedure takes only about 30 minutes to two hours, and patients are often able to go leave the hospital the same day or after an overnight stay, returning home with minimal restrictions on normal physical activity.