Nuclear Cardiology
Nuclear Stress Testing 
This procedure is used in the evaluation and management of patients with chest
pain or shortness of breath who is suspected of having coronary disease or who
have had previous coronary procedures such as angioplasty, stent placement or
bypass surgery. We perform nuclear stress testing in our I.C.A.N.L. Accredited
office on a daily basis using the services of a full time nuclear technologist
and state of the art equipment. The test requires a 3-hour fast, followed by
treadmill or drug stress testing and is completed with a heart scan. The test
takes about 3 hours to complete due to the waiting time between scans.
Nuclear Pharmacological Stress Testing
This test provides information on the blood supply to the heart. It tells us
if you have had a previous heart attack or problems with blood supply to the
heart. This test requires no exercise. Medication (Adenoscan) will be given through
an IV. We perform nuclear pharmacological stress testing in our I.C.A.N.L.
Accredited office on a daily basis using the services of a full time nuclear
technologist and state of the art equipment. The test requires a 3-hour fast;
this test will take approximately 3 1/2 hours. DO NOT USE CAFFEINE (No
coffee, tea, pop or chocolate, including decaffeinated products), 24
HOURS PRIOR TO YOUR TEST.
Cardiovascular Testing
Cardiac Ultrasound or (Echo) 
Echocardiography (also known as Doppler Echo) is a sound picture or sonogram
of the heart and is used to evaluate patients for conditions that can produce
chest pain, shortness of breath or palpitations. The gowned patent lies on the
exam table with the left side down. A technician at our I.C.A.E.L. accredited
laboratory positions the sound probe under the left breast or chest. Images are
viewed in real time for preliminary diagnosis and recorded on videotape for later
analysis. No preparation is required for a resting echocardiogram, which requires
about 30 minutes to complete. When performed with a treadmill test, images are
taken before and after exercise. The exercise or stress echo does require a 4
hour fast.
Carotid Ultrasound
In this procedure, the technician positions a sound probe over the carotid arteries
on both sides of the neck. The carotid artery is the blood vessel, which carries
blood to the brain. Thickening or narrowing of the artery due to cholesterol
accumulation can be easily visualized. The test is used to evaluate patients
with stroke like symptoms or to assess the risk for future stroke.
Arterial and Venous Duplex Scan
Arterial and venous duplex scans are painless tests using
ultrasound waves to evaluate the arteries and/or veins of
the legs or arms. Your family physician or cardiologist may
ask you to have this test if he or she feels you are at high
risk for blockages in these arteries or if you have been
experiencing pain in your calves when you walk, which would
make it difficult for you to walk any distance. This is a
non-invasive test that is performed at our offices and takes
approximately 45 minutes to perform.
Stress Testing
A stress test, sometimes called a treadmill test or
exercise test, helps your physician find out how well your
heart handles work. As your body works harder during the
test, it requires more oxygen, so the heart must pump more
blood. The test can show if the blood supply is reduced in
the arteries that supply the heart. It also helps your physician
know the kind and level of exercise appropriate for a patient. The
length of time you walk is based on your heart rate, EKG,
blood pressure and ability to exercise. This test will take
approximately one hour. A person taking the test Is
hooked up to equipment to monitor the heart. Walks
slowly in place on a treadmill. Then the speed is increased
for a faster pace and the treadmill is tilted to produce
the effect of going up a small hill. Can stop the test
at any time if needed. Afterwards will sit or lie down
to have their heart and blood pressure checked.
Transesophageal Echocardiogram (TEE)
A transesophageal echocardiogram is a special type of echocardiogram
(ultrasound of the heart). This test uses a special
echocardiography transducer (ultrasound camera) that is inserted
through the mouth, through the back of the throat, and into
the esophagus. It is very similar to the scope used for upper
endoscopy by gastroenterologists. This test enables doctors
to obtain images of the heart from inside the esophagus (the
tube that goes from the mouth to the stomach). Since the
esophagus lies close to the heart, the TEE allows very clear
images of the heart structures and blood flow. This
test is performed in an hospital setting.
Arrhythmia Monitoring (Holter Monitoring)
Patients with evidence for irregular heart beating often
wear a 24-hour solid-state recorder known as a Holter Monitor
that is attached to the chest with electrodes and worn on
a belt. After the device is returned the following day, the
continuous EKG recordings it contains are downloaded to a
computer and analyzed for patterns of irregular heartbeat.
If the patient presses the event button at the time the symptoms
occur, an explanation for the complaints may emerge. In some
instances, when the irregular heart beat occurs less frequently,
a "transient event recorder" is needed. We offer
several types of these monitors. Some models do not require
patient activation because the device can automatically send
an abnormal recording to a central monitoring station.
Tilt Table Test
This is a simple test that helps the doctor determine a possible
cause for fainting spells. It determines how your body responds
to changes in position. During the test, you lie on a table
that can be moved to nearly upright position while your symptoms,
heart rate, and blood pressure are monitored.
Electrophysiology
Pacemaker Implantation
If your cardiologist diagnoses a problem with your heart’s
electrical system, he may suggest a pacemaker. These small
electronic devices keep track of your heartbeat and when
called upon, will generate an electrical signal similar to
the natural “pacemaker” of the heart. These signals
help keep your heart at a regular rate, and can increase
the rate when required, such as during exercise. Depending
on your problem, you may get a pacemaker with one or two
leads. The leads are positioned into the upper and/or lower
chamber of the heart.
A pacemaker uses batteries to send electrical impulses to
the heart to help it pump properly. An electrode is placed
next to the heart wall and small electrical charges travel
through the wire to the heart.
Most pacemakers are demand pacemakers. They have a sensing
device. It turns the signal off when the heartbeat is above
a certain level. It turns the signal back on when the heartbeat
is too slow.
Pacemaker Clinic
The Pacemaker Clinic offers follow-up services for pacemaker
patients. Pacemaker recordings can be transmitted to the
clinic by phone where they are reviewed by physicians to
ensure proper pacemaker performance. The clinic is
staffed by medical professionals trained in cardiology and
pacemaker care who are available to answer referring physician
and patient questions.
The Pacemaker Clinic helps optimize pacemaker therapy by:
- Providing patient support and education specific to pacemaker
therapy
- Identifying pacemaker malfunction early on
- Optimizing the pacemaker settings to best meet patient
needs while maximizing the life of the pacemaker battery;
predicting pacemaker battery end-of-life to ensure elective
and safe replacement.
Interventional Cardiology
Cardiac Catheterization
A catheter (a long, thin tube) is inserted into a large artery
(usually from the groin) and advanced to the arteries of
the heart. A dye is injected through the catheter into the
arteries of the heart while a series of x-ray images are
recorded. This allows visualization of the arteries and any
blockages that may be present. This test can measure blood
pressure within the heart and how much oxygen is in the blood.
It's also used to get information about the pumping ability
of the heart muscle. Catheters are also used to inject dye
into the coronary arteries.
Coronary Balloon Angioplasty
When a blockage in any of the arteries of the heart is identified
during a heart catheterization, many considerations are taken
in regards to “mechanical fixes”. One of the
options for treatment is a percutaneous balloon angioplasty
(PTCA). A balloon is placed at the location of the blockage
and inflated. This pushes the cholesterol buildup up against
the wall and restores greater blood flow through the artery. 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. Stents are wire
mesh tubes used to prop open arteries after the PTCA.
Stenting
When a blood clot, plaque or scar tissue cause an artery
to become narrow or completely blocked, blood circulation
is limited and the organs and tissues supplied by that artery
do not receive enough oxygen. Stenting is another option
in the treatments for blockage(s) in the arteries of the
heart. The stent is a metal mesh that is delivered to a blocked
artery through a balloon (PTCA). The device is placed at
the blockage, the balloon is inflated, which opens the stent.
This pushes the cholesterol buildup against the wall of the
artery and the stent reduces the chances that the blockage
will come back.
Helpful Links
American
Heart Institute
American
College of Cardiology
Pacemaker/Defribrilator
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