| Comprehensive Cardiac Care: |
|
| Consultations |
Hypertension Management |
| Cardiac and Vascular Ultrasound |
Cholesterol Management |
| Cardiac & Peripheral Angiograms |
Cardiac Arrhythmias |
Pacemaker Implantation and
Follow-up Analysis |
Nuclear Imaging |
| Peripheral Intervention |
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| Treadmill Test (Exercise Stress Test): |
|
 Exercise
testing is a non-invasive procedure that provides
diagnostic and prognostic information and evaluates
an individual's capacity for exercise. The treadmill
test is basically continuous EKG monitoring during
physical exertion, with close attention to the
blood pressure, O2 saturation and heart rate.
Its major use is to detect significant coronary
artery disease (Blockages in the coronary arteries).
Frequently the test is used to evaluate patients
with chest pain, shortness of breath, fatigue,
and arrhythmia's (irregular heartbeats). It also
provides assessment of the exercise capacity,
circulation to the legs, O2 saturation, blood
pressure and heart response to exercise. The test
is performed according to standard protocols.
The most commonly used is the Bruce protocol.
It consists of three-minute stages with gradually
increasing speed and slope. This allows physicians
anywhere in the world to communicate and compare
test results. One of the end-points of the exercise
test is to achieve at least 85% of the age predicted
maximum heart rate. If the patient has a significant
narrowing of the coronary arteries, the exercise
may elicit chest discomfort (angina pectoris)
or changes in the EKG.
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| Echocardiogram: |
|
 This
is a simple office test that uses ultrasound to
image the heart. The test provides a detailed
analysis of the structure and function of the
heart. The information provided includes: size
and thickness of the walls of the heart, the strength
of the heart muscle as a pump and birth defects
of the heart. It assesses heart valves for blockage
or leakage, or follows the function of artificial
valves. The echo allows the physician to see how
your heart is working and determine if it could
be causing symptoms. In essence an echocardiogram
provides vital information that is necessary in
most patients with known heart disease or patients
with symptoms that suggest it. Coastal Cardiology
has the latest equipment available, as well as
caring and skillful technologists who operate
it.
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| Stress Echocardiogram: |
|
 This
test combines the treadmill test and the echocardiogram.
A resting echocardiogram is done then repeated
immediately after the exercise. Both digitized
studies are compared side by side. Patients with
blocked coronary arteries have transient abnormal
motion as part of their heart muscle after exercise,
which can be seen with the echocardiogram. If
patients cannot exercise a chemical test may be
substituted for the treadmill exercise.
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| Cardiac Catheterization (Coronary Angiography): |
|
 Cardiac
catheterization is an x-ray test that uses radiographic
contrast (dye) to visualize the coronary arteries
and pinpoint the presence and severity of blockages
and, more importantly, to determine the best treatment
available. If the test reveals a blockage you
will be offered one of the following treatment
modalities: medication only, angioplasty, stent,
atherectomy, or bypass surgery. The test can be
done on an outpatient basis. The patient is mildly
sedated but awake during the procedure. A local
anesthetic is used to numb the area (usually the
right groin). Soft plastic tubes (catheters) are
inserted into the artery then advanced under x-ray
guidance. The dye is injected into the heart chambers
and coronary arteries - pictures are taken from
different angles. This is the best test available
to find and visualize the blockages.
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| Nuclear Stress Test |
|
 A
nuclear stress test shows how well blood flows
through your heart and arteries while you are
resting and during physical exertion. In this
test, a small amount of a radioactive substance
is injected into your body. This substance allows
images of the heart to be recorded so your doctor
can see how well the heart is pumping blood,
if a part of the heart has been damaged, and
if any of the arteries that feed the heart are
blocked.
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| Coronary Angioplasty |
|
Coronary angioplasty is an invasive procedure
used to treat angina and coronary artery disease.
These procedures are performed in the cardiac
catheterization laboratory. Much like a cardiac
catheterization a small tube or catheter is
placed in an artery, usually from the leg but
occasionally from the arm. An angioplasty is
often performed after a cardiac catheterization
is done and reveals serious narrowing in the
coronary arteries.
Patients are most often referred for angioplasty
after presenting with an abnormal stress test,
angina pectoris, unstable angina pectoris or
a myocardial infarction (MI or heart attack).
In general narrowing of the lumen of the coronary
artery must be at least 70% before an angioplasty
is considered. You will be awake and often sedated
and so you will be sleepy. A catheter is placed
into the coronary artery and an angiogram is
taken. A small wire is chosen and is placed
down the artery past the narrowing into the
artery. A small balloon is then passed over
the wire to the narrowing and inflated to open
the balloon and compress the blockage in the
artery. You may fell angina or chest pain during
this portion of the procedure, this is common
and usually resolves within minutes of deflating
the balloon. The balloon is inflated for one
half a minute to ten minutes. If the artery
is opened and blood flow near normal the balloon
and wire are removed and a final angiogram is
taken. If the results are acceptable the catheters
are removed and you will return to your room.
After a few hours the blood thinners are allowed
to dissipate and a staff member will remove
the sheath (tube) in the artery. You will need
to lay flat for an additional 4 to 12 hours.
The success of angioplasty procedures varies
depending on the patient. There are also a number
of potential complications and you need to discuss
these with your doctor before the procedure.
Angioplasty has an initial success rate of
approximately 90%, of the patients with a good
initial result about 50 to 60% do well for a
long period of time with no chest pain or angina.
One third to one half of patients will have
angina and require repeat angioplasty or bypass
surgery. Angioplasty does not cure the disease
of atherosclerosis but rather is a procedure
performed to control ischemia and symptoms.
You will still need to take some medicine and
control your risk factors. Keeping blood pressure,
blood sugar and cholesterol under control are
all very important. You must stop smoking.
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| Peripheral Angioplasty |
|
Peripheral angioplasty is a procedure that
has grown rapidly in the last two decades. The
same atherosclerosis that involves the heart
arteries can involve any artery in the body.
The most common arteries to be involved are
those which supply the legs (causing cramps
when walking, known as claudication), those
to the brain known as the carotid arteries (causing
strokes) and the arteries to the kidneys (causing
high blood pressure).
The same risk factors for coronary artery disease
are associated with peripheral vascular disease.
Controlling these factors can help control symptoms.
There are noninvasive tests, which may help
your doctor learn if the blood flow through
the arteries is blocked and if so may order
an angiogram. The procedure of peripheral angioplasty
is performed using a catheter and a balloon
to expand a narrowed artery. Stents are often
used to help keep an artery opened. The procedure
is performed under local anesthesia and sedation.
You may have your procedure as an outpatient
or stay overnight. Light activity may be resumed
shortly after the procedure and full activity
in about one week.
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