The cardiovascular consultation is the starting point for your relationship with your cardiologist.
Cardiovascular consultation is your opportunity to describe to your HCC physician the problems or concerns that prompted the consultation. It is important to be well prepared for your consultation. Think about the main issues that you would like addressed by the cardiologist, and even consider writing them down in advance. Please bring a list of your current medications, as well as diagnostic tests that you may have already undergone.
This initial visit is a comprehensive evaluation not only of your current symptoms, but of your past medical history as well. It will involve a detailed review of all significant medical issues, including a review of your family history, lifestyle, habits (such as diet, smoking, and alcohol use), and other risk factors for heart disease. After the history is obtained, your physician will then perform a comprehensive physical examination.
Your examination may include other ancillary tests such as chest X rays, electrocardiograms (ECGs), and laboratory tests. If indicated, your physician may also recommend further diagnostic testing such as stress tests, nuclear stress tests, echocardiograms, or CT scanning of the heart.
After completion of your examination and pertinent diagnostic testing, your HCC physician will then outline a treatment plan which may include recommendations for lifestyle changes (diet, exercise, weight loss, etc.), as well as the potential need for medications, interventional procedures and/or surgery to treat your cardiovascular issues.

Houston Cardiology Consultants provides the following preoperative evaluation services:

Coronary Bypass Surgery
Surgical Valve Replacement
Non-Cardiac Surgery

The cardiologist often plays a pivotal role in evaluating patients for cardiac as well as non-cardiac surgery. The pre-operative assessment is a specialized form of Cardiovascular Consultation which will focus on assessing the cardiovascular risk factors for surgery and the potential benefits of surgery. It will involve identifying those risk factors, as well as potentially minimizing them in the preparation for surgery.

Depending on your cardiovascular and general health issues, as well as the type of surgery that is being considered, your physician may recommend pre-operative testing such as:

• Electrocardiogram (ECG)
• 2-Dimensional and Color Flow Doppler Echocardiogram to assess your heart muscle and valvular function.
• Holter monitor or other assessment of heart rhythm.
• Stress testing to assess for significant coronary artery disease.
• Evaluation of non-cardiac risk factors, such as pulmonary function tests.

After completion of the examinations described above, your HCC cardiologist will then be prepared to discuss what would be reasonable expectations from surgery, as well as what can be done to minimize the operative risk. If this pre-operative consultation is your initial introduction to your cardiologist, you should both look at this as an opportunity not just to prepare for surgery, but to discuss long term health goals as well.

Interventional cardiology is an ever expanding specialty which began with diagnostic cardiac catheterization, but has now expanded to include remediation of the diseases of the heart, valves and entire vascular system.

Houston Cardiology Consultants provides the following services:

• Coronary Angioplasty and Stents
• Structural Heart Disease
• Peripheral Angiography and Endovascular Therapies

Coronary Angioplasty and Stents:

A coronary angiogram has been performed and a blockage has been noted in any one of your arteries or multiple arteries through catheters directed inside the arteries. A multitude of wires, balloons and other devices may be used to clean a blockage from the artery and a stent which is a laser cut scaffold made of metal, may be permanently implanted into the artery to help keep the artery open indefinitely. This procedure has revolutionized the practice of cardiology and has kept many patients alive and angina free, as well as prolonging the life of numerous individuals suffering heart attacks.

Structural Heart Disease:

Structural heart disease involves the different structures within the heart not including the coronary arteries that have been previously described that supply blood to the heart. Using specialized, minimally invasive devices we are now able to close tiny holes in the heart, repair damaged heart valves, and block pockets that may form blood clots inside the heart without the prolonged recovery and discomfort associated with traditional open heart surgery.

Peripheral Angiography and Endovascular Therapies:

Using techniques similar to those used in the heart the aorta and all the major arteries that arise from this including the major arteries that supply the legs, the carotid arteries that supply the brain can now be repaired with minimally invasive devices. This may be a therapy for not only blockages within these arteries but also aneurysms or dissections which are small tears within these arteries.

Aortic, Carotid and Peripheral Vascular Disease

Endovascular Therapies:

As cardiovascular specialists we have extended our expertise beyond just the heart to the entire vascular system.

Aortic Disease:

The aorta is the main artery that extends from the aortic valve at the level of the heart through the thoracic cavity and the abdominal cavity into the legs and supplies arterial oxygenated blood flow to the entire body. We specialize in repairing, through minimally invasive endovascular techniques, aneurysms (abnormal enlargement), dissections and tears of the aortic arch, the descending thoracic aorta and the abdominal aorta including abdominal aortic aneurysms.

Carotid Disease:

Carotid disease is one of the leading causes of stroke. A blocked carotid artery is easily diagnosed with a carotid ultrasound. These carotid blockages are now easily treated with a very low complication rate using similar endovascular techniques to fixing coronary arteries. Special stents are available that are implanted into the carotid arteries to remediate these blockages. During these procedures we use special baskets and devices to protect the brain from any clots or debris that may result.

Peripheral Vascular Disease:

Peripheral vascular disease, very commonly accompanies, coronary artery disease. Patients will often report pains in the lower extremities especially with walking. It may progress to an extent where some patients may even have pain at rest or poorly healing wounds or ulcers of their feet. We are now able to easily remediate blockages in the leg arteries using various atherectomy devices as well as angioplasty and stents including drug coated stents similar to those used in the coronary arteries. In addition we have available several investigational devices for management of all peripheral vascular disease including stent grafts for managing aortic disease, stents for managing carotid disease, drug-coated balloons and stents for managing peripheral vascular disease, and artherectomy devices to clean out the plaque in the lower extremity arteries. We also have available cell therapy protocols for patients who are not candidates for standard revascularization therapy for critical limb ischemia and non- healing wounds.

The cardiovascular consultation is the starting point for your relationship with your cardiologist.

Cardiovascular consultation is your opportunity to describe to your Houston Cardiology Consultants physician the problems or concerns that prompted the consultation. It is important to be well prepared for your consultation. Think about the main issues that you would like addressed by the cardiologist, and even consider writing them down in advance. Please bring a list of your current medications, as well as diagnostic tests that you may have already undergone.

This initial visit is a comprehensive evaluation not only of your current symptoms, but of your past medical history as well. It will involve a detailed review of all significant medical issues, including a review of your family history, lifestyle, habits (such as diet, smoking, and alcohol use), and other risk factors for heart disease. After the history is obtained, your physician will then perform a comprehensive physical examination.

Your examination may include other ancillary tests such as chest X rays, electrocardiograms (ECGs), and laboratory tests. If indicated, your physician may also recommend further diagnostic testing such as stress tests, nuclear stress tests, echocardiograms, or CT scanning of the heart.

After completion of your examination and pertinent diagnostic testing, your HCC physician will then outline a treatment plan which may include recommendations for lifestyle changes (diet, exercise, weight loss, etc.), as well as the potential need for medications, interventional procedures and/or surgery to treat your cardiovascular issues.

ECG or EKG – Electrocardiogram Procedure

An electrocardiogram, also called an ECG or EKG, is a simple test that detects and records the electrical activity of the heart. Many heart problems change the electrical signature of the heart in distinct ways. EKG recordings of this electrical activity can help reveal a number of heart problems, including:

• Heart attack
• Lack of blood flow to the heart muscle
• A heart that is beating irregularly, or too fast or too slow
• A heart that does not pump forcefully enough

ECG recordings can help doctors diagnose a heart attack that is happening now or has happened in the past. This is especially true if doctors can compare a current ECG recording to an older one. ECG recordings can also reveal:

• Heart muscle that is too thick or parts of the heart that are too big
• Birth defects in the heart
• Disease in the heart valves between the different heart chambers

An electrocardiogram (ECG) is done to evaluate signs and symptoms that could indicate heart problems. Some of the signs and symptoms that might be evaluated with an EKG include:

• Chest pain
• Heart pounding, racing, or fluttering, or the sense that your heart is beating unevenly
• Difficulty breathing
• Feeling tired and weak (fatigue)
• Unusual heart sounds when the doctor listens to your heartbeat

When an adult—usually someone who is older than 40 or 50 years of age—has a routine health exam, the doctor may order an ECG to screen for early heart disease that has no symptoms. The doctor is more likely to look for early heart disease if the person has a family history of heart disease in a mother, father, brother, or sister—especially if the heart disease developed early in those family members’ lives.

An electrocardiogram (ECG) is painless and harmless. A technician first attaches 12 soft patches called electrodes to the skin of the chest, arms, and legs. These electrodes are about the size of a quarter. To help an electrode stick to the skin, the technician may have to shave a patch of hair where the electrode will be attached.

After the electrodes are placed on the skin, the patient lies still on a table for a few minutes while the electrodes detect the electrical signals of the heart. A machine then records these signals on graph paper or displays them on a screen.

The entire test takes about 5 minutes. After the test, the electrodes are removed from the skin and discarded.

What is External Counterpulsation?

External Counterpulsation or (ECP) is a non-invasive treatment for patients suffering from advanced Coronary Artery Disease (CAD) and Congested Heat Failure (CHF) and are not candidates for surgical intervention.  ECP therapy is clinically proven to help relive symptoms associated with advanced heart disease.

How do I prepare for the test?

• Do not eat or drink anything for 90 minutes before your procedure.
• Wear loose fitting clothing and a button down shirt.
• You will be given treatment pants to wear during the test
• Wear loose fitting underwear.
• Wear socks to keep your feet warm.
• Examine your skin for irritation or bruising.  If you bruise easily, wear support stocking under the treatment pants.
• It is important to complete seven consecutive weeks of therapy for best results.  Try to avoid any interruption during your planned therapy.
• Drink at least 6-8 glasses of clear liquids after each treatment.

How is the test performed?

A skilled ECP technician administers the ECP therapy.  You will be asked to lie on a comfortable treatment table.  Air pressure cuffs are wrapped snuggly around your lower body on the calves, thighs and buttocks.  These cuffs are similar to blood pressure cuffs. Electrodes will be attached to your chest to monitor your heart rhythm.  A computer then tracks and synchronizes cuff inflation and deflation with your heart rhythm. The cuffs are set to inflate and deflate during diastolic (resting) phase of the cardiac cycle.

How will the test make me feel?

Studies suggest that up to 80% of patients report significant improvement after receiving a full course of ECP Therapy.  Patient often report that they no longer have chest pain, have grater stamina and energy and need less medication.  These results are usually reported after 10 to 14 treatments.

Are there risks associated with the test?

ECP therapy is a low – risk outpatient procedure. Some side effects of this procedure include fatigue, muscle soreness or cramping, headache and skin irritation.  Patient undergoing this procedure are carefully screened.  Your physician will know if you are a likely candidate. 

When will I know results?

Results from this therapy are usually experienced by the patient after several treatments.  Your doctor will monitor your progress and suggest the number of treatments that are right for you.

Hypercholesterolemia Evaluation and Management

What is Hypercholesterolemia?

Hypercholesterolemia is also called high cholesterol, HDL, and hyperlipidemia.

Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. Your body needs some cholesterol to work properly. But if you have too much in your blood, it can stick to the walls of your arteries. This is called plaque. Plaque can narrow your arteries or even block them. High levels of cholesterol in the blood can increase your risk of heart disease and stroke.

Your cholesterol levels tend to rise as you get older. There are usually no signs or symptoms that you have high blood cholesterol, but it can be detected with a blood test. You are likely to have high cholesterol if members of your family have it, if you are overweight or if you eat a lot of fatty foods.

What causes Hypercholesterolemia?

Cholesterol can’t dissolve in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. These two types of lipids, along with triglycerides and Lp(a) cholesterol, make up your total cholesterol count, which can be determined through a blood test.

LDL (Bad) Cholesterol

When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result.

HDL (Good) Cholesterol

About one-fourth to one-third of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as “good” cholesterol, because high levels of HDL seem to protect against heart attack. Low levels of HDL (less than 40 mg/dL) also increase the risk of heart disease. Medical experts think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it’s passed from the body. Some experts believe that HDL removes excess cholesterol from arterial plaque, slowing its buildup.

Triglycerides

Triglyceride is a form of fat made in the body. Elevated triglycerides can be due to overweight/obesity, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates (60 percent of total calories or more). People with high triglycerides often have a high total cholesterol level, including a high LDL (bad) level and a low HDL (good) level. Many people with heart disease and/or diabetes also have high triglyceride levels.

How is Hypercholesterolemia diagnosed?

The American Heart Association endorses the National Cholesterol Education Program (NCEP) guidelines for detection of high cholesterol: All adults age 20 or older should have a fasting lipoprotein profile — which measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides — once every five years.  This test is done after a nine- to 12-hour fast without food, liquids or pills. It gives information about total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides.

Your test report will show your cholesterol levels in milligrams per deciliter of blood (mg/dL). To determine how your cholesterol levels affect your risk of heart disease, your doctor will also take into account other risk factors such as age, family history, smoking and high blood pressure.

How is Hypercholesterolemia treated and managed?

Too much cholesterol in the blood can lead to cardiovascular disease. Cardiovascular disease is the No. 1 cause of death in the United States. 2,200 Americans die of cardiovascular disease each day, an average of one death every 39 seconds. The good news is, you can lower your cholesterol and reduce your risk of heart disease and stroke. Take responsibility for managing your cholesterol levels. Whether you’ve been prescribed medication or advised to make diet and lifestyle changes to help manage your cholesterol, carefully follow your doctor’s recommendations.

Lifestyle Changes
Your diet, weight, physical activity and exposure to tobacco smoke all affect your cholesterol level — and these factors may be controlled by:

• Eating a heart-healthy diet,
• Enjoying regular physical activity, and
• Avoiding tobacco smoke.

Know You Fats
Knowing which fats raise LDL cholesterol and which ones don’t is the first step in lowering your risk of heart disease.

Cooking for Lower Cholesterol
It’s not hard to whip up recipes that fit with the low-saturated-fat, low-cholesterol eating plan recommended by scientists to help you manage your blood cholesterol level and reduce your risk of heart disease and stroke.

Understanding Drug Therapy Options
For some people, lifestyle changes alone aren’t enough to reach healthy cholesterol levels. Your doctor may prescribe medication. Your doctor will prescribe the best medication for you to lower your cholesterol levels.

Hypertension Evaluation and Management

What is Hypertension?

Hypertension is the term used to describe high blood pressure. Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body. Blood pressure readings are usually given as two numbers — for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high. The top number is called the systolic blood pressure, and the bottom number is called the diastolic blood pressure. Normal blood pressure is when your blood pressure is lower than 120/80 mmHg most of the time. High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time. If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension

What causes Hypertension?

Many factors can affect blood pressure, including:

• How much water and salt you have in your body
• The condition of your kidneys, nervous system, or blood vessels
• The levels of different body hormones

You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death.

You have a higher risk of high blood pressure if you:

• Are African American
• Are obese
• Are often stressed or anxious
• Drink too much alcohol (more than one drink per day for women and more than two drinks per day for men)
• Eat too much salt in your diet
• Have a family history of high blood pressure
• Have diabetes
• Smoke

Most of the time, no cause of high blood pressure is found. This is called essential hypertension.

High blood pressure that is caused by another medical condition or medication is called secondary hypertension. Secondary hypertension may be due to:

• Chronic kidney disease
• Disorders of the adrenal gland (pheochromocytoma or Cushing syndrome)
• Pregnancy (see: preeclampsia)
• Medications such as birth control pills, diet pills, some cold medications, and migraine medications
• Narrowed artery that supplies blood to the kidney (renal artery stenosis)
• Hyperparathyroidism

How is Hypertension diagnosed?

Your health care provider will check your blood pressure several times before diagnosing you with high blood pressure. It is normal for your blood pressure to be different depending on the time of day. Blood pressure readings taken at home may be a better measure of your current blood pressure than those taken at your doctor’s office. Make sure you get a good quality, well-fitting home device. It should have the proper sized cuff and a digital readout.

Your doctor will perform a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body.

Tests may be done to look for:

• High cholesterol levels
• Heart disease, such as an echocardiogram or electrocardiogram
• Kidney disease, such as a basic metabolic panel and urinalysis or ultrasound of the kidneys

How is Hypertension treated and managed?

The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you. If you have pre-hypertension, your health care provider will recommend lifestyle changes to bring your blood pressure down to a normal range. Medicines are rarely used for pre-hypertension.

You can do many things to help control your blood pressure, including:

• Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. See: High blood pressure and diet
• Exercise regularly — at least 30 minutes of aerobic exercise a day.
• If you smoke, quit — find a program that will help you stop.
• Limit how much alcohol you drink — one drink a day for women, two a day for men.
• Limit the amount of sodium (salt) you eat — aim for less than 1,500 mg per day.
• Reduce stress — try to avoid things that cause you stress. You can also try meditation or yoga.
• Stay at a healthy body weight — find a weight-loss program to help you, if you need it.

Your health care provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian, who can help you plan a diet that is healthy for you. There are many different medicines that can be used to treat high blood pressure. Your doctor will decide which medication is right for you.

Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication.

Arrhythmia Evaluation

Houston Cardiology Consultants can help you determine if you have arrhythmia.

What is Arrhythmia?
Arrhythmia is an abnormal rhythm of the heart. It may feel like a temporary pause so brief that it doesn’t change the overall heart rate. It may also cause slow or fast heart rate.

There are two basic kinds of arrhythmias:

• Bradycardia (when heart rate is less than 60 beats per minute)
• Tachycardia (when the heart rate is more than 100 beats per minute)

An arrhythmia is a condition caused by a problem with the heart’s electrical system, which produces abnormal rhythms. These abnormal rhythms may make the heart pump less efficiently. Normally, the heartbeat begins in the right atrium when a special group of cells sends an electrical signal. This group of cells is called the sinoatrial node. These cells normally determine the frequency of the beats and the heart’s natural rhythm. The signal is disseminated throughout the atrium and the atrioventricular node, which is the union between the atria and the ventricles. Normally, the atria (the heart’s upper chambers) and the ventricles (the heart’s lower chambers) are separated by an insulating layer of cells that prevents electrical signals from going between them except through the atrioventricular node. The atrioventricular node is connected to a group of fibers that conduct the electrical signal.
The impulse travels through these specialized fibers, known as the His-Purkinje system, to the ventricles.

An Arrhythmia occurs:

• When the heart’s natural pacemaker (the sinoatrial node) adopts an abnormal rate or rhythm.
• When the normal conduction path is interrupted.
• When another part of the heart starts to work as the pacemaker.

Causes of Arrhythmias:
Many arrhythmias do not have a known cause. However various factors that can contribute to arrhythmias include heart disease, high blood pressure, diabetes, smoking, excessive alcohol consumption, and stress. Sometimes substances (certain over-the-counter and prescription medications, nutritional supplements, and herb-based remedies) cause arrhythmias in some people. Some prescription medications can contribute to appearance of arrhythmias.

What are signs of arrhythmia?

• When brief, it may barely be noticed, like a skipped heartbeat
• It may feel like fluttering of the chest or neck
• When it lasts longer, it impacts how well the heart works. If not enough blood is pumped to the body, symptoms can include feeling tired or lightheaded and even passing out.
• Tachycardia can reduce the heart’s ability to pump, which can cause shortness of breath, chest pain, lightheadedness or loss of consciousness. If severe, it can cause heart attack or death.

The heart’s normal rate or pulse
The heart beats when the electrical impulse goes through it. When a person is at rest, the heart beats approximately 60 to 80 times per minute. The atria contract a fraction of a second before the ventricles. This allows the atria to pump blood to the ventricles before they contract.

Pacemaker Implantation & Monitoring

Houston Cardiology Consultants provides Pacemaker Implantation and Monitoring services.

Why would a patient need a Pacemaker?

• Slow heartbeat
• Irregular heartbeat (arrhythmia)
• Block in heart’s electrical pathway

What is a Pacemaker?

A pacemaker is a small device that’s placed in the chest to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate.

Pacemakers are used to treat arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
There are two types of pacemakers, permanent (internal) and temporary (external).

• Pacemakers use batteries to send electrical impulses to the heart and so help it pump properly. An electrode is placed next to the heart wall, and the pacemaker transmits small electrical impulses that reach the electrode through a wire and make the heart contract.
• Most pacemakers have a sensor device that deactivates the pacemaker when the natural heartbeats are over a certain level. It is activated again when the beats are too slow. This is known as a demand pacemaker.

A pacemaker has two parts: a battery-powered generator and wires (leads) that connect it to the heart. If a patient needs a pacemaker for a short time, perhaps after a heart attack, the battery unit can be worn on a belt.

Why are pacemakers important?
Slow heart rhythms may cause symptoms such as lightheadedness, fainting spells, and tiredness.

A pacemaker gives the heart the extra help it needs to relieve symptoms and can help you feel better. Also, having a pacemaker can give you more freedom to do the activities you enjoy.

How does a pacemaker work?
A pacemaker has two main functions. It keeps track of the heart’s natural electrical activity (this is called sensing). It also sends electrical impulses to the heart to make the heart beat (this is called pacing).

For example, if the pacemaker senses that the heart is beating too slowly or pausing for too long, it sends tiny electrical impulses. These impulses are too slight for you to feel, but they stimulate the heart muscle to contract and pump blood.

If the pacemaker senses that the heart is beating at a proper pace, it goes “on demand” and stands by until it is needed. The instant the heart starts beating too slowly or pauses for too long, the pacemaker will begin pacing again.
The pacemaker’s sensing and pacing functions are adjusted, or “programmed,” by your doctor to meet your particular needs.

Pacemaker Implantation
An incision is made in the skin under the collar bone. The wires are threaded through the large vein under the clavicle that goes to the heart and wires are then hooked to the heart. The generator is then placed under the skin, is connected to the wires and held in place with a suture. The implantation procedure requires local anesthesia and takes about an hour.
The generator normally has a useful life of seven to twelve years.
Many people with pacemakers today lead full, active lives.

When can a pacemaker help?

• The decision on whether you need a pacemaker will depend on the type of arrhythmia you have, how severe your symptoms are, and whether you have other problems with your heart.
• Your doctor may recommend a pacemaker if you have one or more the following conditions:
• Bradycardia with significant symptoms, such as dizziness, fainting spells, tiredness, confusion, or shortness of breath
• Bradycardia with a very slow heart rate or long pauses between beats, even without symptoms
• Arrhythmias where the heart alternates between beating too fast and too slowly
• Arrhythmias and other medical conditions that require medications that cause bradycardia
• Recurring syncope (fainting spells) that is caused, at least in part, by significant slowing of the heartbeat
• Severe bradycardia caused by heart surgery or catheter ablation

Caring for your Pacemaker
It is important that you have follow-up visits with your doctor or pacemaker clinic. Your pacemaker may also be checked through telephone monitoring. In some cases, your pacemaker may need to be replaced.

Living with a Pacemaker
Your pacemaker will help you feel better by relieving symptoms caused by a slow heart rhythm. Having a pacemaker may also give you more freedom to do the things you enjoy.
However, there are a few things you need to be aware of, so that your pacemaker works properly.
Your doctor will decide if you need a pacemaker, and if so, he or she will explain the reasons to you.

[i]http://www.webmd.com/heart-disease/abnormal-rhythyms-pacemaker

Microvolt T-Wave Alternans™ Testing

Microvolt T-Wave Alternans (MTWA) test is a non-invasive test to identify patients at risk of life-threatening heart rhythm disturbances that can lead to sudden cardiac death.

Sudden cardiac death claims the lives of over 400,000 people annually in the U.S. Most people who suffer a cardiac arrest episode have an underlying, pre-identifiable, electrical disorder that puts them at risk. MTWA testing identifies those electrical disorders and therefore people at risk for sudden cardiac death

How do I prepare for the test?

• You must not eat, smoke, or drink for 4 hours (or more) before the test.
• Wear comfortable shoes and loose clothing to allow you to exercise.
• Ask your health care provider if you should take any of your regular medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.

How is the test performed?

You will prepare for the MTWA test the same the same way as a stress test. Electrodes will be applied to your chest and you will be connected to an ECG monitor and HearTwave™ equipment. You will be asked walk on a treadmill to raise your heart rate.  The exercise portion of the test will last approximately 8-10 minutes.  Information about your heart will be collected (1) during rest, (2) while you walk on the treadmill and (3) after the exercise.

What is T-Wave Alternans?

T-wave Alternans is a “beat-to-beat” variation in a portion of your electrocardiogram (ECG). When visible on the ECG, these electrical variations are associated with an increased likelihood of life threatening ventricular arrhythmias (abnormal heartbeats). Most of the time, these T-wave variations are not visible on a standard ECG. The Microvolt T-Wave Alternans test permits measurement of the T-waves at a microvolt level (one millionth of a volt), allowing your doctor to evaluate variations of the T-wave that may have been missed without use of the test. If T-wave Alternans are identified, the test is positive.

What are the risks associated with the test?

There are no known risks associated with the T-wave test.

What happens to my results?

Your physician will interpret the test results immediately and may recommend further evaluation.

Exercise Treadmill Testing

An exercise treadmill stress test helps determine how well the heart responds to the increase in workload caused by exercise.

Why is the test performed?

• Diagnose coronary artery disease (obstruction of the blood vessels that supply oxygen to the heart)
• Determine whether symptoms such as chest pain, shortness of breath or nausea are related to a heart problem.
• Evaluate the risk of suffering a heart attack.
• See if there has been an improvement in cardiac function after cardiac procedures.
• Help determine a suitable exercise program.

How is the test performed?

A technologist will place 10 electrodes on your chest, and then connect you to and ECG monitor.  Your blood pressure will be monitor in a resting state (sitting or standing).  You will be asked to walk on a treadmill starting out slowly and with an incline. Every 3 minutes the treadmill will get a little faster and the incline will increase when utilizing a Bruce protocol.  The test will continue until:

• You reach a target heart rate
• You develop chest pain or a change in your blood pressure that worries your doctor
• ECG changes show that your heart muscle is not getting enough oxygen
• You are too tired or have other symptoms, such as leg pain, that keep you from continuing

You will be monitored for 10 – 15 minutes after exercising, or until your heart rate returns to baseline. The total time of the test is around 60 minutes.

How do I prepare for a Treadmill Stress Test?

• You must not eat, smoke, or drink for 4 hours (or more) before the test.
• Wear comfortable shoes and loose clothing to allow you to exercise.
• Ask your health care provider if you should take any of your regular medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.
• Tell your doctor if you are taking sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil (Levitra) and have taken a dose within the past 24 to 48 hours.

• You will need to avoid caffeine for 24 hours before the test. This includes:
  • Tea and coffee
  • All sodas, even ones that are labeled caffeine-free
  • Chocolates
  • Certain pain relievers that contain caffeine

How long does the exam take?

Most people will reach target heart rate in 6-15 minutes on the treadmill. The exam may take a total of 30 minutes that includes preparation for the test and the cool down after the test.

How will the test make me feel?

During the course of exercise on the treadmill you may feel any of the following:

• Chest discomfort
• Dizziness
• Palpitations
• Shortness of breath

Are there risk associated with the test?

Stress tests are generally safe.  Some patient may develop chest pain, faint, or become short of breath.  In very rare cases, a patient may have a heart attack or develop an abnormal rhythm while exercising.

When will I know the results?

In most cases your physician may be able to discuss the results with you immediately following the exam.

Nuclear Stress Test: SPECT

Diagnostic nuclear imaging studies use radioactive tracers, called Cardiolite® (for SPECT). When combined with stress, either through exercise or the use of a pharmacological agent, the nuclear scan helps determine if the heart muscle is getting the blood supply it needs. If you are unable to exercise, your doctor may order a pharmacologic stress test, with either Regadenoson (Lexiscan ®) to simulate exercise and obtain the same information as an exercise stress test.

As coronary artery disease (CAD) progresses, the heart muscle may not receive enough blood when under stress (for example, when exercising). This can result in chest pain called angina pectoris. On the other hand, there may be no outward physical signs of the disease. If CAD is limiting blood flow to part of your heart, the nuclear stress test may be useful in detecting the presence and significance of CAD.

Carotid Ultrasound

Carotid ultrasound can assess the development of plaque in the arteries.

A carotid ultrasound is a non-invasive test using sound waves to assess the size and caliber of the carotid and vertebral arteries that supply blood to the brain. It is a very accurate assessment of plaque development in these arteries but more importantly it will detect serious blockage in the carotid arteries that can put you at risk for a stroke. The carotid ultrasound test checks blood flow in the carotid arteries. It can detect:

• Blood clotting (thrombosis)
• Narrowing in the arteries (stenosis)
• Other causes of blockage in the carotid arteries

Your doctor may order this test if:

• You have had a stroke or transient ischemic attack (TIA)
• You need a follow-up test because: ◦The carotid artery was found to be narrowed in the past
• You have had surgery on your carotid artery
• Your doctor hears an abnormal sound called a bruit over the carotid neck arteries. This may mean the artery is narrowed.

How do I prepare for the test?

There is no preparation necessary for this exam.

How is the test performed?

You will be asked to lie down on an imaging table. A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The sonographer then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.

How will the test make me feel?

There is minimal discomfort when the test is performed as the transducer is pressed over the neck.

Are there any risks associated with the test?

There are no known risks associated with ultrasounds.

When will I know the results?

Your exam will be reviewed by one of our physicians and the results are made available to you or your physician on your next appointment

Abdominal Vascular Ultrasound

An abdominal vascular ultrasound is recommended for patients with a family history of aortic aneurysms, those who have a smoking history or have been diagnosed with coronary artery disease.

Abdominal vascular ultrasound is performed to assess the main aorta and the main arteries including the renal (kidney) arteries that arise from the aorta. The main indication for abdominal vascular ultrasound is to diagnose an abdominal aortic aneurysm, which is an enlargement of the aorta as it runs through the abdominal cavity and branches into the arteries that supply the legs.

How do I prepare for the test?

• No food or drink for 4 hours prior to test
• Wear comfortable clothing

How is the test performed?

You will be asked to lie down on an imaging table. A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The sonographer then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.

This ultrasound examination is usually completed within 30 to 45 minutes. Occasionally, complex examinations may take longer.

How will the test make me feel?

The ultrasound exam is usually painless.  If you have tenderness in your stomach area, you may feel a little discomfort when the transducer is pressed against your skin.

Are there risks associated with the test?

There are no known risks associated with ultrasound.

When will I know the results?

Your exam will be reviewed by one of our physicians and the results are made available to you or your physician on your next appointment.

Upper Extremity Venous Ultrasound

An upper extremity venous study is an ultrasound study of the venous system of the arms. It is usually done to diagnose arm pain, acute or long term arm swelling, vein mapping prior to vascular or cardiac surgery and DVT (deep vein thrombosis). It is done without any discomfort and the results are very accurate, predictable and may be very important in your treatment.

How do I prepare for the test?

Wear comfortable clothing

How is the test performed?

You will be asked to lie down on an imaging table. A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The sonographer then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.

This ultrasound examination is usually completed within 30 to 45 minutes. Occasionally, complex examinations may take longer.

How will the test make me feel?

The ultrasound exam is usually painless.

Are there risks associated with the test?

There are no known risks associated with ultrasound.

When will I know the results?

Your exam will be reviewed by one of our physicians and the results are made available to you or your physician on your next appointment.

Lower Extremity Venous Ultrasound

A peripheral venous study is usually done to diagnose a blood clot in the veins.

A lower extremity venous study is an ultrasound study of the venous system of the legs. It is usually done to diagnose sudden leg pain, sudden or long term leg swelling, DVT (deep vein thrombosis), varicose veins, lower skin discoloration, sores located above the ankle and vein mapping prior to vascular or cardiac surgery. It is done without any discomfort and the results are very accurate, predictable and may be very important in your treatment.

How do I prepare for the test?

Wear comfortable clothing.

How is the performed?

You will be asked to lie down on an imaging table. A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The sonographer then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.

This ultrasound examination is usually completed within 30 to 45 minutes. Occasionally, complex examinations may take longer.

How will the test make me feel?

The ultrasound exam is usually painless

Are there risks associated with the test?

There are no known risks associated with ultrasound

When will I know the results?

Your exam will be reviewed by one of our physicians and the results are made available to you or your physician on your next appointment

Upper and Lower Extremity Arterial Doppler/Ultrasound

Peripheral arterial disease is a common disease associated with atherosclerosis (plaque formation) occurring in any of the arteries in your body. It is often associated with coronary artery disease as well as cerebrovascular disease. It is simply diagnosed by using an ultrasound or by measuring an ankle-brachial index, which is a ratio of the blood pressure measurement in your arms and your legs… If this is noted to be abnormal or if you have symptoms of leg pain while walking, a peripheral arterial study may be indicated. This is an ultrasound study assessing the flow of blood into your legs and is very accurate in assessing the presence of plaque and determining the amount of blood flow to your legs.

How do I prepare for the test?

Wear comfortable clothing

How is the test performed?

You will be asked to lie down on an imaging table.  Multiple blood pressure cuffs are placed on your lower extremities and arms. A paste is applied to the skin over the arteries being examined. Images are created as the transducer is moved over each area. Afterwards, a clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The sonographer then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.

This examination is usually completed within 45 to 60 minutes. Occasionally, complex examinations may take longer.

How will the test make me feel?

The ultrasound exam is usually painless. You may feel some pressure from the blood pressure cuffs.

Are there risks associated with the test?

There are no known risks associated with ultrasound.

When will I know the results?

Your exam will be reviewed by one of our physicians and the results are made available to you or your physician on your next appointment.

Renal Ultrasound

Renal ultrasounds, also called renal sonograms or renal duplex, are most often performed to detect a narrowing in the renal arteries, which provide blood flow to the kidneys.  Uncontrolled hypertension (high blood pressure) and renal insufficiency (decreased kidney function) are common indications for a renal ultrasound.  Patients who have undergone renal stenting may also receive follow-up renal ultrasound exams.

How do I prepare for the test?

• No food or drink for at least 4 hours prior to test
• Wear comfortable clothing

How is the test performed?

You will be asked to lie down on an imaging table. A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The sonographer then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.

This ultrasound examination is usually completed within 30 to 45 minutes. Occasionally, complex examinations may take longer.

How will the test make me feel?

The ultrasound exam is usually painless.

Are there risks associated with the test?

There are no known risks associated with ultrasound.

When will I know the results?

Your exam will be reviewed by one of our physicians and the results are made available to you or your physician on your next appointment.