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Echocardiogram: An Echocardiogram is an ultrasound of the heart. This test uses high frequency sound waves to create images of the heart. The sound waves can detect the quality of blood flow to and from the heart. This test is used to diagnose or rule out heart disease and to follow previously diagnosed patients with heart conditions. This test is performed by a sonographer technologist and is a diagnostic test. A small amount of gel is used on the chest area to allow the transducer (a small hand held device) to glide smoothly over the chest area. The transducer sends and receives sound waves that convert to pictures on the ultrasound machine. You can see your heart beating, and may even be able to see or hear your heartbeat and blood flow. Various portions of the test is recorded and stored as part of the patients medical record. The test takes about 20-30 minutes and is painless.

Electrocardiogram: Also know as "EKG." This is a non-invasive diagnostic test that measures electrical activity of the heart. Many heart conditions can be detected by looking for certain patterns on the EKG.

A small area of chest hair may be shaved to prepare the area for the adhesive patches that attach to the chest area. Leads are attached to each extremity and on the front of the chest. The test takes about 5 minutes and is painless.

ABI : Known as Ankle Brachial Index. This is a non-invasive test that is done in our office. This test measures and compares the ratio of blood pressure in the ankle to that in the arm to determine how well your blood is flowing which will help determine your risk of PAD (peripheral artery disease).

EP Study : Electrophysiology Studies are done by Dr. Trevor Greene, in an outpatient hospital setting. EP studies are done to test the heart's electrical system. The electrical system is what generates the heart beat.

During this invasive procedure, an x-ray, referred to as fluoroscopy is done by inserting a catheter through a vein in the groin (or sometimes the arm). Electrical signals are sent through this catheter to the heart tissue to evaluate the electrical conduction system contained within the heart muscle tissue.

How do rhythm problems affect the heart? Problems may occur when the heart beats too fast, too slow, or with an irregular rhythm. The effects are often the same. One of the most common dysrhythmias is premature ventricular beats, or PVC's. PVC's are when the ventricle is contracting and pumping out blood before the atrium has completely pumped its blood volume into the ventricle. PVC's are harmless. Almost everyone has had them at one time or another. This can cause weakness, palpitations, or low blood pressure.

Some dysrhythmias occur only intermittently, and cannot be seen on a routine EKG, or a Holter monitor. It your physician suspects a problem with the heart's conduction system and cannot diagnose the problem with either of tests, then he/she may decide that an EP study would be appropriate.

Angiography: This is an invasive procedure also known as an angiogram where dye is injected into arteries and veins to detect blockages. The dye when injected will be seen and reviewed in the form of an x-ray. This procedure is done in the hospital setting as either an outpatient or an inpatient. A very small tube (catheter) is positioned in the artery through a small incision in the skin about the size of a pencil tip. A small amount of contrast material is injected (also known as dye). This is what makes the blood vessels visible on the x-ray.

This is a non-invasive procedure done in the inpatient or outpatient hospital setting. It relieves narrowing and obstruction of the arteries to the muscle of the heart (coronary arteries). This procedure is also know as PTCA which stands for percutaneous transluminal coronary angioplasty or PCI for percutaneous coronary intervention.

During this procedure, a small catheter is inserted into an artery in the arm, or groin and then advanced to the narrowing artery. Contrast (dye) is injected into the artery for x-ray images. The balloon is inflated for about one minute to enlarge the artery. This allows the plaques to compress and enlarge the opening of the coronary artery. The balloon is then deflated and removed from the body. This procedure usually takes anywhere from 30 to two hours. Most patients will go home the same day after being monitored, and are advised not to lift anything heavier than 20 pounds or perform vigorous exertion for the first one to two weeks after an angioplasty. Patients are told they may return to their normal activities two to three days after.

Carotid Doppler: A Carotid Doppler (ultrasound) involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Images are captured in real-time, which means they can show the structure and movement of the body's internal organs, along with the blood flowing through blood vessels. Doppler ultrasound is a special ultrasound technique that evaluates blood as it flows through a blood vessel, including the body's major arteries and veins in the abdomen, arms, legs and neck.

This type of diagnostic testing is performed to detect narrowing, or stenosis, or a carotid artery, which a condition that increases the risk of stroke. It may also be performed if an abnormal sound is her in the neck (carotid bruit) with a stethoscope, or it a patient has high blood pressure. Doppler images can help the physician to see and evaluate blockages to blood flow, narrowing of vessels, and tumors and congenital malformation.

Holter/Event Monitor: These devices recorded your heart rhythm. Holter Monitors record for 24 hours, while Event Monitors can be worn for longer periods (2 weeks to a month) and each event is recorded at the push of a button.

These type of devices are worn to detect the heart rhythm during day and night activities and at rest. You are given a diary to log symptoms or activities that you are doing at the time of the event which will help your physician treat your condition.

These monitors are hooked up to the patient in the office or hospital setting by placing sticky patches over the chest area with electrodes that are connected to the device which can be worn on your side that records your rhythms. The events that are recorded can be transmitted over the phone to your physicians office in order him/her to monitor your events.

Implantable Loop Recorder (ILR): Sometimes events do not occur as often, or are harder to catch. In this situation, your physician may suggest an ILR . This device is about the size of your pinkie. This procedure is don in the outpatient hospital setting and is implanted under the skin. The incision made is usually about one inch.

Anytime an event occurs, it is recorded and is read with radio waves by a programmer machine. This device can be worn for up to a year, as the battery life expectancy is about 14 months. The same procedure would be repeated for removal of the device. This device does not send out electricity, it is simply a recording device.

Cardiac Catheterization: This is a procedure is done on the heart to measure the blood pressure within the heart and to determine how much oxygen is in the blood, as well as detecting the pumping ability of the hearts muscle.

A heart cath is done as a diagnostic or non-invasive tool, usually as an outpatient at the hospital. A small catheter is inserted into an artery or vein (usually of the arm or let). It is then advanced into the various chamber of the heart or into the coronary arteries. From those same catheters, dye is injected (called an angiography which are x-ray pictures of the arteries) into the coronary arteries to detect narrowing (stenosis) or damaged arteries (coronary artery disease). If the diagnostic heart catheterization determines further treatment is needed, the procedure will then become invasive, and your physician will discuss your treatment options, which could be a coronary angioplasty or stenting of the diseased artery.

Why do I need one? A pacemaker is usually recommended for patients with an abnormally slow heartbeat (also known as bradycardia). When your heart beat is less than 60 beats per minute, it is usually considered irregular, and your body may experience fainting, dizziness, shortness of breath, or fatigue. A pacemaker can be inserted and programmed to keep the heart beating at a normal rate so that you may continue your every day activities without experiencing these symptoms.

A pacemaker consists of two parts that are placed inside the body: The pacemaker itself, and a pacing lead. A pacemaker is a small device that is placed under the skin usually as an outpatient procedure at the hospital, and the patient can go home the same day. A pacing lead is a wire that carries a tiny electrical pulse to the heart. The pacing lead is guided through a vein into the heart and a "pocket" is created under the skin where the pacemaker is placed and the lead is connected. The incision site may be red and swollen for a few days after surgery, but this is normal. There will be a slight bulge at the pacemaker site after insertion, but after the sited has healed, the swelling, and redness should disappear. If it does not, you should contact your physician immediately.

You will be given a pacemaker ID card that will identify you as a pacemaker wearer. This card has important information about the type of pacemaker you have. It is important that you keep this with you at all times!

Pacemaker follow-ups are very important! This is how your physician monitors how your pacemaker in functioning. This can be done in your doctors office and also by telephone. The frequency of monitoring changes during the lifetime of your pacemaker with more frequent checks as your pacemaker nears the expected time of replacement. Normally, the life of a pacemaker is XX years.

While pacemakers are used to tread a slow heart beat, ICD's are used to treat rapid heart rhythms. Somme common rapid heart rhythm's are: Ventricular Tachycardia (VT), Ventricular Fibrillation (VF), and Atrial Fibrillation (A Fib).

A defibrillator is one of three parts of a defibrillation system. (Defibrillator, leads, and a programmer). Two of these parts are places inside the body. These two parts work together to recognize a rapid heart rhythm, deliver one or more therapies until a normal rhythm is reached, and it stores data about each episode.

When the defibrillator detects that the heart rhythm is too fast, it sends an electric impulse to your heart, which can return your heart to a normal rhythm.

Defibrillators deliver three types of therapies: pacing, cardioversion, and defibrillation:

Pacing: When your heart beats too fast, your device is programmed to send pacing pulses to moderate your rhythm to a normal rate. You usually will not feel these pulses.

Cardioversion: Cardioversion shocks are stronger electric pulses that feel more like a hit to the chest or a "thump." You may feel a little lightheaded or dizzy when this occurs.

Defibrillation: This is a heavy shock when your heart beat becomes unstable or irregular. When this happens, it may cause you to faint. Many people that have had this occur say it feels like a "kick in the chest." This is usually over quickly.

A stent is made up of stainless steel wire mesh and are left in place in the coronary arteries by means of PTCA. This process is used to enhance long-term results in preventing Coronary Artery Bypass (CABG). Some stents are "medicated" which means the are coated with medications that help prevent the formation of plaque, which reduces the rate of restenosis (reoccurrence of the blockage) to the artery.

What is a Microvolt T-Wave Alternans Test? This is a non-invasive test to identify patients at risk of life-threatening heart rhythm disturbances that can lead to sudden cardiac death. This test is performed by using a treadmill to elevate your heart rate.

Depending on your test results, your physician may recommend further testing which usually involves and Electrophysiologist (a cardiologist that specializes in heart rhythms).

How is the test performed? The technician will apply electrodes or sensors to your skin at the chest and truck of your body. These electrodes will later be connected to a wire that connects to the equipment used for testing (HearTwave). You will then be asked to start walking on a treadmill in order to raise your heart rate. This portion usually lasts about 8-10 minutes. During this time, information is collected about your heart at three intervals: during rest, while you are walking, and after exercise.

Ablation Therapy: A procedure that destroys the specific area of the heart that begins the abnormally fast signals. Endocardial mapping is first done which locates the area of the heart that is causing the abnormal signals. Once the abnormality is found, either radiofrequency waves or small incisions are used to destroy or stop that heart tissue from sending any signals. Ablation therapy can be done by using a catheter or during open heart surgery.

With the catheter approach, a small catheter is inserted into a vein and guided into the heart.

When the specific heart tissue is located, the tissue is destroyed--either by heat (resulting from short bursts of radiofrequency or laser energy) or by small cuts that create scars. This procedure is done in the outpatient setting and is painless requiring local anesthesia.

Ablation therapy most of the time, cures arrhythmias. This is the only treatment for patients with ventricular tachycardia or some arrhythmias.

A biventricular pacemaker is designed to treat the delay in heart ventricle contractions. It keeps the right and left ventricle pumping together by sending small electrical impulses through the leads.

In a normal heart, both the upper (atria) and lower chamber (ventricle) pump at the same time. When a person has heart failure however, both chambers do not pump together. When the heart's contractions become out of sync, the left ventricle is not able to pump enough blood to the body. This eventually leads to an increase in heart failure symptoms, such as shortness of breath, dry cough, swelling in the ankles or legs, weight gain, increased urination, fatigue, or rapid or irregular heartbeat.

A Biventricular Pacemaker is usually recommended for heart failure patients who:

The Autonomic Nervous System (ANS) is the par of the Brain that controls all of our involuntary organs (heart, lungs, blood vessel, bladder, GI system). It accomplishes this by sending two classes of nerves to each organ it controls. 1) sympathetic nerves system, 2) parasympathetic nervous system. These systems exert opposite control on each organ to keep them in "balance". ANSAR is a unique method of testing the Autonomic Nervous System to tell us if it is working or not, but can also tell which part of the autonomic nervous system is not working well.

The testing itself is very simple. A trained technician will attach 3 EKG leads and a blood pressure cuff to start. They will then monitor your heart rate, blood pressure and respiration over a 15 minute period while doing 3 simple maneuvers; 1. Deep breathing 2. Valsalva 3. Standing. All interspersed with periods of rest in atrium.

Science has shown that people in 'balance" of their ANS feel and live longer. The testing can help show if proper classes of medication at appropriate dosages are being utilized to treat your particular issues.

Stress tests are performed to determine the amount of stress your heart can endure before developing an abnormal rhythm where your heart is not receiving enough blood flow. The most common stress test is the exercise stress test.

This is done to determine how your heart responds to exertion. Electrodes are hooked to your chest area which allows the physician or technician to monitor the EKG waves as your heart6 rate increases. You are asked to walk on a treadmill.

Stress test can determine if there is adequate blood flow to your heart when there is increased activity or exertion. It can also determine the likelihood of having coronary heart disease which would require further evaluation, identify abnormal heart rhythms, and it can also evaluate how effective your heart medication is on controlling your condition.

Adenosine Stress Test: This is used when people are unable to exercise or walk on the treadmill due to certain circumstances. Dobutamine and Adenosine are pharmacological drugs that are give intravenously to raise the heart rate as if the patient was exercising or "stressed".

1. No solid food after midnight. If your test is in the afternoon, nothing to eat 6 hours prior to the test. You are allowed water at any time.

2. All medications should be taken with water unless otherwise instructed by your physician.

3. Do not eat or drink products containing caffeine such as coffee, tea, soft drinks or chocolate for 24 hours prior to your test.

4. Do not smoke for 6 hours prior to the exam.

5. Do not apply any body powders or lotions.

6. Wear comfortable clothing. Women should not wear skirts or one piece dresses.

General Information:
A small intravenous (IV) line is started in the arm or the back of the hand. This will stay in place until the test in completed. There will be a resting scan done first. Images of your heart will be taken using a special camera placed above your chest. The Adenosine will be infused over a four (4) minute period. Your blood pressure and EKG will be monitored during the test. After your second scan, you may resume your normal diet, medications and activities.

The results of your test will be given to you at the time of your follow up appointment unless your test shows severe abnormalities, in which you will be contacted.

Doubutamine Stress Test: This test is relatively painless and does not require you to walk on a treadmill. The procedure involves the following:

1. No solid food after midnight. If your test is in the afternoon, nothing to eat 6 hours prior to the test. You are allowed water at any time.

2. All medications should be taken with water unless otherwise instructed by your physician. If you are taking a beta-blocker (Coreg, Tenormin, Lopressor, etc) you may need special instructions. Consult your doctor.

3. Do not eat or drink products containing caffeine such as coffee, tea, soft drinks or chocolate for 24 hours prior to your test.

4. Do not smoke for 6 hours prior to the exam.

5. Do not apply any body powders or lotions.

6. Wear comfortable clothing. Women should not wear skirts or one piece dresses.

General Information:
A small intravenous (IV) line is started in the arm or the back of the hand. This will stay in place until the test in completed. You will have resting images taken of your heart. The Dobutamine will be given through your IV for a period of 9-12 minutes while you are lying on the exam table. Your blood pressure and EKG will be monitored during the test. After your second, scan you may resume your normal diet, medications and activities.

The results of your test will be given to you at the time of your follow up appointment unless your test shows severe abnormalities, in which you will be contacted.

FOR FURTHER INFORMATION ON ANY OF THE ABOVE PROCEDURES, PLEASE CLICK ON THE LINKS BELOW.

Send mail to ncarr@bakergilmour.com with questions or comments about this web site. Last modified: 11/08/09

Send mail to ncarr@bakergilmour.com with questions or comments about this web site.
Last modified: 11/08/09