Areas of Practice
ABDOMINAL AORTA ULTRASOUND
An abdominal aorta ultrasound is a noninvasive, painless examination of the abdominal aorta. This permits detection and follow-up of patients with an aneurysm of the aorta.
AORTIC STENT GRAFT
An aneurysm of the abdominal aorta is an enlargement of this major blood vessel, which leads to weakening of the blood vessel. The weakened vessel could then result in leaking and massive hemorrhage resulting in rapid patient death. Until recently, the only treatment option was open surgical repair. In more recent years, selected patients can be treated by a less invasive aortic stent graft. This is an artificial replacement for the weakened vessel, which is positioned under x-ray guidance via the major leg arteries. Unlike the open surgical repair, recovery after the aortic stent procedure is much quicker with the patient typically spending just one overnight in the hospital.
ARTERIAL DOPPLER
This is a noninvasive ultrasound assessment of flow in peripheral arteries. This test is often combined with an ankle brachial index where, using a cuff, blood pressure is measured both in the arms and legs. This testing provides a detailed assessment of the circulation to the extremity. Doppler can also be used to assess the renal (kidney) arteries. Blockage of these arteries is an important treatable cause of hypertension (high blood pressure).
CARDIAC CATHETERIZATION
(CORONARY ANGIOGRAPHY)
Cardiac catheterization is the most accurate method for assessing a patient’s coronary arteries and heart muscle function. This is usually performed on an outpatient basis in a hospital. Local anesthetic is used to numb the tissue over a blood vessel, catheters are then advanced to the heart and dye is injected to permit visualization of the arteries and pumping chamber utilizing x-rays. The patient is kept in observation for several hours following the procedure in the hospital.
CARDIAC REHABILITATION
Cardiac rehabilitation is recommended in patients who have undergone open-heart surgery, suffered a myocardial infarction (heart attack), or with angina pectoris. Patients who complete a cardiac rehabilitation program have an improvement in functional capacity and well being. Patient’s are engaged in supervised exercise and also receive education on risk factor modification and reducing the risk of further cardiac problems. Outpatient Phase II cardiac rehabilitation is offered at Regional Medical Center Bayonet Point and at Medical Center of Trinity. This can be followed by Phase III cardiac rehab/medical fitness where the patients continue to exercise without requiring monitoring.
CARDIAC SURGERY
Sometimes patients with severe coronary artery disease or valvular disease may require open heart surgery to perform either bypass and/or valve replacement surgery. This is major surgery and involves several days in the hospital. Prior to open heart surgery, the patient is first evaluated by the cardiologist to determine suitability and need and type of surgery. The patient is then referred to a cardiothoracic surgeon who performs the surgery. The cardiologists at Pasco Cardiology work closely with the cardiothoracic surgeons in the patient’s evaluation for surgery and also in the management of any cardiac problems that may arise following the surgery.
CARDIOVERSION
Cardioversion is used to correct an arrhythmia (abnormal heart rhythm) and restore the patient’s heart rhythm to normal. The procedure is performed in the hospital with the patient under anesthesia. A brief electric current is administered to change the patient’s heart rhythm back to the normal rhythm. Following the procedure, the patient may be permitted to go home after a few hours or may be required to stay in the hospital for 2-3 days to start treatment with medications designed to reduce the risk of recurrence of the arrhythmia.
CAROTID ULTRASOUND/DOPPLER
This is a noninvasive ultrasound examination of the arteries that provide blood supply to the brain. The test assesses for stenosis (blockage) and also for thickening, plaque in the arteries.
CHOLESTEROL
This is a noninvasive ultrasound examination of the arteries that provide blood supply to the brain. The test assesses for stenosis (blockage) and also for thickening, plaque in the arteries.
Consultation
All the physicians of Pasco Cardiology provide clinical consultations for patients either in the office setting or in the hospital setting. This involves assessment of the patient’s complaint, history, physical examination; an electrocardiogram (EKG) is usually performed to assist in assessing the patient’s cardiac condition. Additional testing and treatment may be ordered. A report of the evaluation, recommendations for further investigation and treatment are provided to the referring physician.
CORONARY INTERVENTION
(CORONARY STENT/BALLOON ANGIOPLASTY)
These procedures are used to treat blockages in the coronary arteries. This treatment may be an easier method of restoring blood supply to the patient’s heart muscle than if the patient has coronary artery bypass surgery. The procedure is performed via catheters, usually inserted into an artery at the patient’s groin or arm. A balloon is threaded up through the area of obstruction in the coronary artery, the balloon is inflated thus stretching the artery and relieving the obstruction. In the majority of patients a small stainless steel tube called a stent is inserted to hold the artery open and produce a better result. Several other procedures may be utilized as part of this procedure to optimize the results for the individual patient’s artery, including rotational atherectomy (Rotoblator), laser angioplasty, or cutting balloon.
DEFIBRILLATOR (AICD)
A defibrillator is used to correct certain dangerous heart rhythm disturbances. The device is somewhat larger than a pacemaker, it is surgically implanted under anesthesia in the hospital. If the patient’s heart at a later date develops a dangerous heart rhythm disturbance, the device analysis this and delivers a small electric charge to correct the problem. Patients with a defibrillator require regular follow-up testing and monitoring in the office.
ECHOCARDIOGRAPHY WITH COLOR & DOPPLER FLOW
Echocardiography uses ultrasound to non-invasively image the heart muscle, valves and chambers. Doppler and color flow assess the flow of blood through the chambers and valves of the heart. .
ELECTROCARDIOGRAM (EKG)
An electrocardiogram is a noninvasive recording of the heart’s electrical activity performed by briefly placing several electrodes on the patient’s skin. The electrocardiogram may evaluate abnormalities of heart rhythm, conduction or previous heart attack.
ELECTROPHYSIOLOGICAL ABLATION
Sometimes patients with abnormal heart rhythms have an extra electrical connection in their heart that makes them susceptible to heart rhythm disturbances. Catheters are inserted through an extremity blood vessel into the heart, the electrical connection is located and a brief electrical current is applied to create a small burn and interrupt the electrical connection. By interrupting this extra electrical connection, the patient’s heart should no longer have the ability to go into this abnormal rhythm.
ELECTROPHYSIOLOGICAL STUDY
An electrophysiological study is a detailed evaluation of the heart’s electrical system. The test is performed in the hospital under light sedation. One or more pacing catheters are inserted under local anesthesia to different locations in the heart, electrical recordings are made. Additionally, the response of the electrical system to extra stimuli delivered via the pacing catheter is assessed. This provides very valuable information in guiding the further management of the patient’s problem. An electrophysiological study can be performed as an outpatient with the patient being in the hospital for several hours.
EVENT MONITOR
An event monitor is a device that the patient takes home with them for several weeks. When the patient experiences symptoms, that may be due to a heart rhythm disturbance, such as a sensation of rapid irregular heart beating, the patient makes a brief recording using the device. The recording can then be transmitted down the phone lines to the office for evaluation.
EXERCISE/STRESS TEST WITH MYOCARDIAL PERFUSION IMAGING
This test is used for the detection, diagnosis and evaluation of coronary artery disease. The patient receives small injections of an isotope, which provides imaging, to assess the adequacy of blood flow to the heart muscle and permit evaluation of heart function. Two sets of images are performed: one at rest and a second set of images after the patient has exercised by walking on a treadmill. While walking on the treadmill, the patient’s heart rate, blood pressure and EKG are monitored throughout. For patient’s who are unable to exercise on a treadmill, the exercise portion of the test is replaced by a chemical stress test, where the patient lies on a table and receives an intravenous medication over up to several minutes, that takes the place of the exercise. This testing generally takes 2-3 hours to complete.
HOLTER MONITOR
A Holter monitor provides a 24-hour digital recording of all the patient’s heart beats during that 24-hour period. It provides a detailed assessment of any rhythm disturbances or palpitations that have occurred during that 24-hour period.
INTRA-AORTIC BALLOON PUMP
An intra-aortic balloon pump may be inserted to assist the patient’s heart muscle function in cases where the heart muscle is severely weakened. It is inserted into the aorta through a leg artery. The balloon then inflates and deflates, synchronized with the patient’s heart beat and relieves the heart muscle of some of its work. The balloon can stay in position for one or more days. Patients requiring an intra-aortic balloon pump are in a hospital’s intensive care unit setting.
MUGA
(MULTIGATED AQUISITION SCAN)
This test is used to assess the pumping function of the left ventricle of the heart. A small amount of isotope is injected, a scan is performed, and the ejection fraction, (which is a measurement left ventricular pumping function) is calculated.
PACEMAKER
(IMPLANTATION AND FOLLOW-UP)
Patients with heart rhythm problems, where the heart rate may be intermittently or permanently too slow, may require implantation of a permanent pacemaker to correct this rhythm problem. Implantation of a permanent pacemaker is performed in the hospital under general anesthesia and may requires an overnight hospital stay. Following implantation of the pacemaker, the patient must be monitored. This is performed one or more times a year depending on the pacemaker type in the office. Additional monitoring may also be performed via telephone line using special monitoring equipment.
PERIPHERAL ANGIOGRAM
The most accurate test for diagnosing blockages of the arteries to the extremities, kidney or brain is an angiogram. The patient is given a local anesthetic, a catheter is advanced to the relevant vessel and dye is injected. X-ray images are taken providing detailed pictures of the patient’s blood vessels and circulation. The patient is usually observed in the hospital or outpatient laboratory for several hours after the procedure.
PERIPHERAL ANGIOPLASTY/STENT
Peripheral arterial angioplasty/stent is a less invasive method of relieving obstruction in a patient’s blood vessels than an open surgical bypass. The patient receives a local anesthetic and a catheter is advanced to the area of obstruction. Using x-ray dye angiography pictures are taken. A balloon is then advanced through the area of obstruction, the balloon is then inflated to expand and relieve the obstruction. Typically a small stainless steel stent is implanted to hold the artery open and give a better result. This procedure may be performed as an outpatient.
TILT TABLE TEST
A tilt table test can be helpful in diagnosing the cause of symptoms in patients with sudden unexplained loss of consciousness. During this test, the patient is lying down on a special table that can be tilted. EKG and blood pressure are monitored while over a number of minutes the table is tilted from the lying position to a head up position. The test may also involve an intravenous infusion of medication during the test.
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
A transesophageal echocardiogram is an ultrasound evaluation of the heart performed through the esophagus. There are certain conditions where the regular echocardiogram, which is performed through the chest wall, provides visualization that is not of adequate detail and a transesophageal echocardiogram must be performed. This is performed in the hospital, the patient receives a short-acting anesthetic and an echo probe is passed into the esophagus permitting detailed pictures to be obtained from the rear of the heart
VENOUS ABLATION
Patients who have swelling of the legs after prolonged standing, burning/cramping of the legs, restless legs, varicose veins, increasing urinary frequency at night, color changes in the skin of the legs, or leg ulcers, can be evalauted for venous insufficiency. Venous ablation is an in office procedure where these veins are closed with a laser catheter.