Diagnostic Testing & Treatment Options

• Coronary artery disease
• Cardiac masses and thrombi
• Pericardial abnormalities
• Cardiomyopathy
• Congenital cardiac disease
• Arrhythmia
• Aortic disease

Heart Calcium Score (Coronary Artery Calcium Score)
Calcium in the coronary arteries is a sign of the extent of hardening of the arteries (atherosclerosis) and can now be measured by CT scanning in minutes with a low dose of radiation. This test requires no dye and there is no preparation. It is a very powerful method to assess cardiac risk. It is especially important in patients that have one or more of the traditional risk factors such as family history, high cholesterol, smoking, high blood pressure or diabetes.

Cardiac CT Angiography (CCTA)
Imaging the coronary arteries is a challenge because they are so small and are in almost constant motion. Newer scanners are now able to evaluate the degree of blockages, at times eliminating the need to go to the cardiac catheterization laboratory. The advantages to this non-invasive approach are reduced risk and the convenience of an office procedure taking less than one hour with no recovery. The resolution of the CT scanner is only a little less than the invasive catheterization. As with any x-ray test there is a risk from the radiation that needs to be balanced with the gain from the information. For many patients the CT study provides all the answers. If moderate to severe coronary blockage is suspected, further testing may be required with stress testing or cardiac catherization.

CT Angiography of Aorta & Peripheral Arteries
If your provider suspects disease of your aorta or it's branch arteries (peripheral arteries) a CT scan may be ordered to clarify the anatomy. CT scanning provides a very accurate picture of these arteries and any blockages that are present. It is an outpatient test requiring only an intravenous injection of dye and no recovery. This test is often used to guide your provider regarding the most appropriate treatment for peripheral artery disease. It is very useful in guiding peripheral catheter procedures and vascular surgeries.

• You will have an IV placed for intravenous injection of dye.
• If blood tests show some kidney dysfunction, you may be asked to take a medication called mucomyst and have an IV placed for a fluid infusion before and after your procedure. This is to help protect your kidneys from the contrast dye.
• If you kidney function is normal, your time commitment is <1 hour. If need fluid infusion, your time commitment is about 4 hours.

• Transthoracic Echocariography (TTE) or surface echocardiography is the most common type of cardiac ultrasound test and it is performed in an office setting. Ultrasound gel is applied to the chest. The heart is then imaged from a variety of positions. The entire test takes approximately 30-45 minutes. There is no preparation for this test.
• Transesophageal Echocardiography (TEE) is ordered in a few patients where it is necessary to get more detailed information. By passing the probe into the esophagus, the TEE provides a much clearer image of the heart and allows us to see parts of the heart not ordinarily visualized on surface echocardiography. This is because the sound waves during a TEE travel a much shorter distance, and do not have to pass through the skin, chest, muscle or bone. This is an outpatient test that requires special training obtained by several members of our practice and is performed in the hospital. A small probe is inserted into the esophagus (food tube) through your mouth while you are awake but sedated.

• Do not eat or drink anything except small sips of water for at least eight hours before the test.
• Notify the doctor performing the procedure if you are allergic or sensitive to any medications.
• The nurse will place an IV in your arm and electrodes on your chest. You will be brought into a special room where the test is performed and, you will be given oxygen and placed on your left side. An intravenous sedative will be given to relax you.
• Once you're relaxed, the probe will be passed and cardiac imaging will proceed.
• Once the test is completed, you will be brought to the recovery room to be monitored. Shortly thereafter you may go home.
• The entire test takes approximately 60 minutes, with an additional one hour to recover.
• Because you are sedated during the procedure you must arrange for someone to drive you home after the test.

• Angina
• Chest pains
• Shortness of breath
• Fatigue

• Safe
• Painless
• Non-invasive/Non-surgical
• Outpatient
• FDA-approved
• Fully covered by Medicare and most health plans

Permanent Pacemakers
Since the 1950's, the pacemaker has given life to millions of people worldwide. These devices are designed to supply minute electrical impulses to the heart, treating patients with slow heart rates. With current advanced technology, the implant procedure is safe and effective, and usually performed in less than one hour. The device itself is about the size and thickness of two half-dollar coins. The procedure is performed in a specialized x-ray suite in the hospital and typically requires an overnight stay. Patients are discharged the next morning.

Electrophysiology Study with Ablation
Improved technology has dramatically advanced the diagnosis and treatment of fast heart rhythm disorders. A minimally invasive catheter procedure can identify the exact location where the abnormal heart rhythm originates. Once the area of concern is identified, a special catheter can eliminate the problem without a surgical incision. Depending on the rhythm abnormality, some patients may be discharged the same day of the procedure, while others may be asked to stay overnight. Patients are typically back to work after a few days of rest.

Internal Cardioverter Defibrillator (ICD) Implantation
Dying suddenly from a lethal heart rhythm is a common mechanism of death. ICDs save lives by delivering rescue therapy to people who suffer from these otherwise fatal rhythms. The device, which is smaller than a deck of cards, is typically implanted in fewer than 90 minutes. Patients stay overnight in the hospital and are discharged by noon the next day.

Cardiac Resynchronization Therapy (CRT)
(Bi-Ventricular Pacing to improve symptoms of congestive heart failure)
Congestive heart failure (CHF) is a debilitating and life-altering disease that may result after the heart is weakened by a heart attack or other illness. As a pump, the heart is most efficient when all walls are contracting at the same time. Some patients with CHF have electrical abnormalities that disrupt this coordination. CRT helps correct electrical delays in the heart which synchronizes contraction of the walls of the heart. The results can be dramatic with most patients reporting significant improvement in their quality of life. The procedure is similar to a pacemaker implant, allowing for some extra time to implant a special heart failure wire. Patients are usually discharged from the hospital the following morning.

• Before the procedure: Your doctor may adjust your medications prior to the procedure. We ask that you not eat or drink after midnight before your procedure.
• The day of the procedure: In the short stay unit, an intravenous line will be placed and you will be prepared for the procedure. Once taken to the procedure suite, you will be greeted by a team including nurses and your provider who will care for you. At the conclusion of the procedure, you will be transported to the recovery area. Most procedures including device implantations require an overnight stay.
• After the procedure: Discharge instructions and follow-up appointments are provided before leaving. Activity restrictions depend on the procedure details. For EP studies and ablations, patients may be asked not to drive for 24 hours or perform any heavy lifting for up to 5 days, after which time, they are able to return to their routine activities. For device implantations, arm activity may be limited for a specified period of time. Patients are instructed to call our office at anytime with any concerns or questions.

Angioplasty is performed by an interventional cardiologist. Balloons and stents are used to stretch open the artery to improve flow. A stent is a permanently implanted spring-like metal device that serves as a scaffold to keep the artery open. In some cases, it may be necessary to use an atherectomy device to shave off excess plaque build up to allow for an optimal result.

Depending on several factors, your doctor may decide to place either a bare-metal stent or one coated with a drug that makes it less likely for the stent to re-narrow. The advantage of the drug-coated stent is a greatly reduced risk of stent re-narrowing and need for repeat procedures. Drug-coated stents reduce scar build-up within the stent and also delay the healing process during which the lining of the artery grows over the stent.

While the stent is directly exposed to the blood, there is risk for a blood clot to form on the stent unless patients are taking both aspirin and another mild blood thinner such as plavix or ticlid. All patients with stents should be on aspirin indefinitely. Patients that have drug-coated stents must take plavix or ticlid longer than patients with bare stents. It is generally recommended to take Plavix for at least one year after stent placement. It is important that the aspirin, Plavix or Ticlid are not discontinued for any period of time without discussing it with your cardiologist. If you must hold these medications for a surgery, the timing of surgery and length of time off these medications should be agreed upon by your cardiologist and surgeon.

• Your doctor may adjust your medications prior to the procedure.
• We ask that you not eat or drink after midnight before your procedure.
• The day of the procedure: In the short stay unit, an intravenous line will be placed and you will be prepared for the procedure. Once taken to the procedure suite, you will be greeted by a team including nurses and your provider who will care for you. Importance is placed on privacy and comfort during the procedure. At the conclusion of the procedure, you will be transported to the recovery area. Angioplasty generally requires an overnight stay.
• After the procedure: Discharge instructions and follow-up appointments are provided before leaving. Typically, patients are asked not to drive for 24 hours or perform any heavy lifting for 5 days, after which time, they are able to return to their routine activities.

What to expect:
After meeting with your doctor, you will be scheduled for an in-office visit to receive your monitor. A nurse will explain the use of the monitor and apply the adhesive electrodes to the chest. You will be given full instructions as to the care and function of the monitor. You may be asked to transmit information from the monitor over a telephone line during the monitoring period. This will be made clear at the time of your visit. When you have completed the test, simply return the device to the office location where it was first received.