Heart Monitoring Services (Return to Top of Page)
| Monitoring of the electrocardiogram can be done over the phone, or on a continuous tape recording, or intermittently as needed to evaluate pacemakers, palpitations, dizziness, fainting, or abnormal heart rhythms. The services provided by Mid Carolina Cardiology include: | ||
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Permanent Pacemaker Telephone Monitoring Holter Monitoring: A portable ECG (electocardiogram) monitor worn will record the heart rhythm continuously for 24 hours. A record of all the patient's activities/symptoms is also kept. The heart record and activity records are then compared. It helps the physician correlate symptoms of palpitations, dizziness or fainting/blackouts with the patient's heart rhythm. |
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Heart Catheterization Services (Return to Top of Page)
| Cardiac Catheterization: Is a common, relatively painless, non-surgical procedure used to diagnose a heart problem or treat a heart disease. A long flexible tube called a catheter is inserted into a blood vessel and gently guided towards the heart. A special camera is used to record x-ray images of the heart, which can be watched on a video screen. During angiography (taking pictures of blood vessels) and ventriculography (taking pictures of the heart itself) tests, x-ray contrast fluid is injected and circulated throughout the heart while x-ray picture (angiogram) and precise measurements of blood flow are taken. Angiograms can record pictures of clogged blood vessels, problems with heart muscle function. This procedure is the most direct and precise way for the doctor to study the heart and the blood supply going to and leaving the heart. |   |
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Interventional
Balloon
Angioplasty (Percutaneous Transluminal Coronary Angioplasty): PTCA
is a non-surgical procedure that relieves narrowing and obstruction of
arteries to the muscles of the heart. A balloon-tipped catheter is inserted
into the artery in the groin or arm, and advanced to the
narrowing in the coronary (heart) artery. The balloon is then inflated
to compress the plaque, and enlarge the narrowing in the artery. When
successful, PTCA can relieve chest pain of angina and minimize or stop
a heart attack without the patient having to undergo an open heart coronary
bypass graft (CABG) surgery.
Intracoronary
Stents: A catheter holding a stent (a
small stainless steel spring-like device mounted on a balloon) is inserted
to the point of blockage and the balloon on the catheter is then
inflated
pressing the sides of the stent against the walls of the vessel. This
secures the stent in place. The catheter is then removed leaving the stent
in place to support the vessel. The stent acting as a scaffold, holds
the artery open, increasing blood flow to the heart muscle and helps reduce
the rate of restenosis or renarrowing of the artery.
Atherectomy
PTCRA-Percutaneous
Transluminal Coronary Rotational Atherectomy:
A special atherectomy catheter is threaded through the guiding catheter
and over the guided wire, and positioned at the narrow spot in the coronary
artery. It uses a diamond burr near the tip of the catheter
to grind the plaque into small particles that float harmlessly away in
the blood stream. The burr spins at speeds between 160,000 and 200,000
revolutions per minute (RPM) as it sands the plaque. (Return
to Top of Page)
Cardiac
Imaging Services (Return
to Top of Page)
At Mid Carolina Cardiology, we possess a range
of testing methods, which, when combined with "stress" or exercise, can
be used specifically to evaluate coronary artery disease and overall heart
function. For those patients who keep other options are available.
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Nuclear Cardiac Imaging: This test is often called a heart scan. If the arteries to the heart are blocked due to accumulation of fatty materials, the heart may not receive enough blood under stress (exercise). This may cause angina or chest pain. The narrowing of the heart is called CAD (coronary artery disease). Sometimes there may be no physical signs of the disease. If CAD is limiting blood flow to a part of the heart, the stress exam with radioactive tracers may detect the presence, and significance of CAD. Thallium and Cardiolite are radio tracers, we use to visualize the blood flow pattern of the heart. The patient is given an injection of a low level radiotracer, through an intravenous line, both at rest, and during the last stages of an exercise bout on a treadmill. A special nuclear camera takes pictures of the heart both at rest and after exercising. This is called imaging. Imaging allows the physician to compare the amount of blood flowing through the heart muscle during stress (exercise) and at rest. |
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Gated
Blood Pooling Imaging: This is a scanning
test performed to evaluate the efficiency and sizes of the pumping chambers
of the heart.This test calculates an important measurement of heart function
known as the EF. The ejection function of the heart refers to the amount
of blood pumped out of the heart with each beat.
Ultrasound Procedures
Echocardiography:
(Echo) - Sound waves are used to make
an image of the heart. An echocardiogram takes a video picture of the
heart. A special probe held over the chest bounces harmless sound waves
off the heart, and the returning signals are converted into a moving image
on a video screen. It is similar to the sonogram used with pregnant mothers
to view the baby in the womb. The test is painless and allows the doctor
to visualize the heart without the use of x-rays. An echocardiography
shows the structure and movement of the heart muscle. This test is to
determine if there is a problem with the heart muscle or the heart valves.
The test shows whether the heart is enlarged, demonstrates the thickness
of the hearts walls, evaluates problems with the valves, and determines
how efficiently the heart pumps. Measurements can be taken at rest, and
again after walking exercise on a treadmill. An image taken after exercise
is called Stress Echocardiography. For patients unable to exercise for
whatever reason, drugs to stimulate the heart rate and blood flow are
given during the test. Sometimes a drug might be used instead of walking
on the treadmill.
Transesophageal Echocardiography: On occasion, more information that can be proved by a routine TEE is needed. In these circumstances, a TEE is often helpful. A small flexible tube with an ultrasound probe on its tip is passed through the mouth, down the food pipe (esophagus) and positioned in the stomach. The closer proximity of the probe in the stomach to the heart gives the highest clarity of ultrasound pictures to more precisely define valve problems and cardiac structures. (Return to Top of Page)
Electrophysiology Services (Return to Top of Page)
Electrophysiological Studies (EPS): The study actually attempts to induce an arrhythmia by means of electrical stimulation. Under local numbing medicine, temporary pacemaker catheters, (long thin tubes), are threaded through the veins into the heart and the heart is then electrically stimulated in an attempt to produce an arrhythmia. If an arrhythmia is induced electrically, it can usually be terminated with pacing. In some cases a shock to the chest is required. This is used only as a last resort if the arrhythmia is very serious. If the arrhythmia is well tolerated, your doctor may perform "mapping" to locate the source of the problem.
| Permanent Pacemaker Implantation: A pacemaker is a small electronic device that is placed inside the body (implantation). It is useful in treating dangerously slow heart rates. It could be implanted near the right or left shoulder with leads or electrode catheters, thin flexible coated wires, extended from the pacemaker to the heart. The pacemaker keeps track of the heartbeat, and when necessary, generates electrical signals similar to the heart's natural signals. It ensures that the heart is beating at the right pace. A pacemaker may be inserted inside the heart (endocardial) or outside the heart (epicardial). |
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Catheter
Ablation (CA): Catheter ablation destroys
(ablates) an abnormal electrical pathway or group of electrical cells
that may be causing an arrhythmia. The procedure is often done during
or after an Electrophysiological Studies (EPS). During the procedure,
an ablating electrode catheter is placed in the heart. Radio frequency
waves are then sent through the catheter to destroy the abnormal pathway
or cells.
Implantable Cardioverter/Defribrillator (ICD): An ICD is used to terminate life threatening excessively rapid heart rhythms. It is a small electronic device that is implanted either pectorally (under the skin) or in the abdomen. Ventricular tachycardia or ventricular fibrillation are two such dangerous rhythms. Like a pacemaker, the ICD continuously monitors your heart rhythm. If it senses your heart beating too fast, the ICD can pace the heart to slow down the heart rhythm. If necessary, the ICD can also send out one or more electric shocks to return the heart to its normal rhythm. Lifelong monitoring is necessary to be sure that your ICD continues working correctly and to check for any further changes in your heart rhythm. (Return to Top of Page)
Vascular Imaging (Return to Top of Page)
| Doppler Ultrasound: Pain or fatigue in the buttock, calf or arms may be due to peripheral artery disease. If there is reduced blood flow to the arms or legs, these muscles can cramp during activity. Walking can become painful, which is also relieved upon rest. |
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| Angioplasty: PTA (Percutaneous Transluminal Angioplasty): Angioplasty is a non-surgical procedure that utilizes a balloon to compress plaque, thereby relieving narrowing and obstruction of arteries to the muscles of the arms and legs | ||
T-Wave Alternans (Return to Top of Page)
T-Wave Alternans
Early identification is the key to reducing the number of people who suffer
from sudden cardiac death. The measurement of Microvolt T-Wave alternans
is a non-invasive tool for identifying patients at potential risk of ventricular
tachyarrhythmia or sudden cardiac death.
Microvolt T-Wave alternans testing is performed similarly to the well-known stress test. It requires the patient to walk on a treadmill with electrodes strapped to their chest. The test will measure changes from one heartbeat to the next that occur at the level of a microvolt. These changes are so small, they do not show up on an electrocardiogram.
This testing has been approved for patients with prior myocardial infarction, patients with left ventricular dysfunction, patients with history associated with increased risk of sustained ventricular arrhythmias, and patients undergoing electrophysiology study.
The testing of Microvolt T-Wave alternans, essentially, will identify
patients that would benefit from standard electrophysiologic study.
EECP info for Internet
Enhanced External Counterpulsation also known as EECP is a non-invasive treatment option for patients suffering from angina or experiencing similar symptoms. EECP may serve as an alternative to bypass surgery, balloon angioplasty and drug treatments. However, EECP is generally performed when the other procedures are not considered an option. It is important to discuss with your physician which option is best for you.
An EECP course consists of 35 one-hour treatments that are given one hour a day, five days a week for seven weeks. During this process, cuffs are placed on the lower limbs of the body. These cuffs will inflate sequentially from the lower to the upper leg increasing blood flow toward the heart. These compressions will lower the resistance of blood vessels in the legs therefore, allowing the heart to pump blood more easily. The EECP system is timed with the rhythm of the heart and will pump blood while the heart is in between beats. The pumping of the blood while the heart is at rest will help decrease the amount of work normally required of the heart muscle.
Symptoms of angina may be your body's way of letting you know your heart muscle is not receiving a sufficient supply of blood and oxygen. The EECP treatments may help to open and stimulate natural pathways around the blocked or narrowed areas of the heart to supply it with the amounts of blood and oxygen needed.