Services

We specialize in all areas of cardiovascular health including prevention and treatment for Coronary Artery Disease, Heart Failure, Arrythmias, Anticoagulation Clinics (Monitoring of Coumadin, Warfarin, and newer agents, Pacemaker and Defibrillator Clinic (monitor pacemaker and AICD devices), and Vascular Diseases. Below you will find descriptions of some of the health issues we diagnose, as well as descriptions of the equipment and procedures we use.    
 

Coronary Diseases and Treatments

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Hypertension (HTN)
Hypertension (HTN) or high blood pressure, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed (diastole) between beats. Normal blood pressure is within the range of 100-140mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.
Hypertension is a major risk factor for stroke, myocardial infarction (heart attacks), heart failure, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and is a cause of chronic kidney disease. Even moderate elevation of arterial blood pressure is associated with a shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment is often necessary in patients for whom lifestyle changes prove ineffective or insufficient.

Coronary Artery Disease (CAD)
Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients.
CAD is the leading cause of death worldwide. While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises.

Heart Failure (HF)
Heart failure (HF) often called congestive heart failure (CHF) is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body.  Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests. Treatment commonly consists of lifestyle measures (such as smoking cessation, light exercise including breathing protocols, decreased salt intake and other dietary changes) and medications. Sometimes it is treated with implanted devices (pacemakers or ventricular assist devices) and occasionally a heart transplant.

Atrial Fibrillation (AF or A-fib)
Atrial fibrillation (AF or A-fib) is the most common cardiac arrhythmia (irregular heart beat). It may cause no symptoms, but it is often associated with palpitations, fainting, chest pain, or congestive heart failure. It may be identified clinically when taking a pulse, and the presence of AF can be confirmed with an electrocardiogram (ECG or EKG) which demonstrates the absence of P waves together with an irregular ventricular rate.
Atrial fibrillation may be treated with medications to either slow the heart rate to a normal range ("rate control") or revert the heart rhythm back to normal ("rhythm control"). Synchronized electrical cardioversion can be used to convert AF to a normal heart rhythm. Surgical and catheter-based therapies may be used to prevent recurrence of AF in certain individuals. People with AF often take anticoagulants such as warfarin to protect them from stroke, depending on the calculated risk. The prevalence of AF in a population increases with age, with 8% of people over 80 having AF. Chronic AF leads to a small increase in the risk of death. A third of all strokes are caused by AF.

Procedures

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Coronary Stenting
A coronary stent is a tube placed in the coronary arteries that supply the heart, to keep the arteries open in the treatment of coronary heart disease.

Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size using water pressure.

Testing and Equipment

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ECHO
Echocardiography is used in the diagnosis and management of patients with suspected or known heart diseases. It is one of the most widely used diagnostic tests in cardiology and can provide a wealth of helpful information, including the size and shape of the heart pumping capacity and the location and extent of any tissue damage.

Nuclear stress test
Typically, a radiotracer (Tc-99 sestamibi, Myoview or Thallous Chloride 201) may be injected during the test. After a suitable waiting period to ensure proper distribution of the radiotracer, photos are taken with a gamma camera to capture images of the blood flow. Photos taken before and after exercise are examined to assess the state of the coronary arteries of the patient.
Showing the relative amounts of radioisotope within the heart muscle, the nuclear stress tests more accurately identify regional areas of reduced blood flow.

Carotid Doppler Ultrasound is used to measure blood flow velocities within the cervical carotid arteries, as well as the vertebral arteries and sometimes the subclavian arteries by means of non-invasive ultrasonic scanning. This can be useful for estimating the effects of atherosclerotic disease in the carotid arteries.

Venous Doppler Ultrasound is used to evaluate blood flow of the upper (arms) and lower (legs) extremities to determine if there is a deep vein thrombosis (DVT) or venous insufficiency.

Arterial Doppler Ultrasound is used (like the carotid) to measure blood flow velocities in the arties in the upper (arms) and lower (legs) extremities estimating the effects of atherosclerotic disease.

Cardiac Stress Testing
A stress echocardiogram, also known asa stress echo or SE, utilizesultrasound imaging of the heart to assess the wall motion in response to physical stress. By comparing images of the heart after moderate excercise, we can assess heart wall motion.

Coronary CT
Coronary CT (Computed Tomography) is a procedure used to assess the extent of occlusion in the coronary arteries, usually in order to diagnose coronary artery disease. Thepatient is injected with an intravenous dye (iodine) and then their heart isscanned using a high speed CT scanner, allowing radiographers to assess the blood flow to their heart muscle.

 

Pulse Volume Recording (PVR)
Pulse volume recording, or PVR is a test that measures blood flow in the leg arteries. PVR can be used to diagnose PAD in the legs, determine how severe the disease is, and find the general location of the blockage. The PVR test is fast and painless, and does not require entering the body.