The anti coagulation clinic helps patients on blood thinners like Coumadin manage their medications. Regular monitoring is very important because when used incorrectly or without regular blood tests, anticoagulants can cause serious side effects. Too much can cause patients to bleed more easily and too little can put patients at risk for forming clots. In the clinic, patients have a finger test (no blood draw required) and get their results immediately and a provider can adjust the dosage if necessary and answer any questions.
An Atrial Septal Defect (ASD) is a hole between the two upper chambers of the heart or atria. In fetal development, the wall between the collecting chambers did not completely close and left a hole. Usually the hole is in the middle of the atria, where the wall is thinnest.
The closure of an ASD is performed using a special closure device attached to a catheter. The catheter is inserted into a vein in the leg and advanced into the heart and through the hole in the atria. The device is slowly pushed out of the catheter (like an umbrella) allowing each side of the device to open up and cover each side of the hole, like a sandwich, closing the hole or defect. When the device is in proper position, it is released from the special catheter. Over time, heart tissue grows over the implant, and it becomes part of the heart. The ASD closure procedure is monitored by X-ray and an ultrasound.
A Patent Foramen Ovale (PFO) is a hole between the two upper chambers of the heart or atria but smaller than an ASD. The procedure to close a PFO is similar to the ASD procedure. The differences are that in the PFO closure the right atrial disk (the device covering the hole on the right side of the heart) is larger and the diameter of the connection between the two disks is smaller than the ASD.
Cardiac ablation is a procedure that can correct abnormal heart rhythms (arrhythmias). An ablation uses catheters (long flexible tubes inserted through a vein in the groin or arm and threaded to the patient’s heart) to scar or destroy abnormal tissue that blocks the electrical signal that travels through the heart to make it beat. By clearing the signal pathway of the abnormal tissue, the patient’s heart can beat normally again.
Cardiac rehabilitation is a comprehensive medically supervised program offering exercise sessions, educational classes and emotional support. It provides many benefits for your overall health. Cardiac rehabilitation is in 3 phases:
- PHASE I: Inpatient
Hospitalized patients to begin medical and exercise therapy as soon as possible. Learning about your cardiac event and beginning to make lifestyle changes.
- PHASE II: Outpatient
Three times a week for monitored exercise sessions and risk reduction modification for a maximum of 36 sessions. Patients will also attend an educational class once a week with their exercise session. Prior to entering the program, the patient will attend an orientation session for a complete cardiovascular evaluation which may include a treadmill test.
- PHASE III: Outpatient
After completing the Phase II program, patients will enter this phase for long term maintenance. This is designed to build upon the progress achieved in Phase II.
Cardioversion is a medical procedure by which an abnormally fast heart rate or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs.
Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart at a specific moment in the cardiac cycle.
Pharmacologic cardioversion, also called chemical cardioversion, uses antiarrhythmic medication instead of an electrical shock. Your doctor will determine which procedure is right for you.
The Carotid Doppler exam uses sound frequency to produce images of the carotid arteries on a viewing screen. The carotid arteries are located in the neck and supply blood to the brain. The ultrasound machine sends out high frequency sound waves and receives the echoes bouncing off the blood vessels to form images. These images help the doctor determine if the arteries have any possible blockages in them.
A Cardiac Catheterization is a heart procedure used to diagnose heart disease. During the procedure, a catheter (or long wire) is inserted into an artery in your arm or leg and guided to your heart. Contrast dye is injected, and X-rays of the coronary arteries, heart chambers, and valves are taken. Once the severity and location of the blockage is found, the doctor will assess if the artery is a good candidate for a balloon angioplasty or stent.
Balloon angioplasty and other interventional procedures are performed to open narrowed coronary arteries and improve blood flow to the heart. The balloon angioplasty involves inserting a collapsed balloon on the end of a catheter to the point of the blockage. The balloon is then inflated pushing the plaque (which forms the blockage) to the sides and opening up the vessel to restore adequate blood flow.
The coronary stent is a stainless steel mesh tube placed in the coronary artery forming a rigid support to keep the vessel open and prevent reclosing, usually following a balloon angioplasty or other interventional procedure.
The diabetes education program is directed at patients with type 1 (Insulin Dependent) and type 2 diabetes. Patients receive a one on one consultation with our registered dietitian and attend weekly classes in order to be educated on how to control their diabetes through nutrition and live long, healthy, lives.
An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent and received through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of the heart. These echoes are turned into moving pictures of the patient’s heart that can be seen on a video screen.
The different types of echocardiograms are:
Doppler echocardiogram: This test is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through the patient’s heart and blood vessels. Doppler measurements may be displayed in black and white or in color. This test is done to assess potential leaks in your valves.
Transthoracic echocardiogram (TTE): This is the most common type. Views of the heart and valves are obtained by moving the transducer to different locations on your chest or abdominal wall.
Transesophageal echocardiogram (TEE): For this test, the probe is passed down the esophagus instead of being moved over the outside of the chest wall. TEE shows clearer pictures of the heart, because the probe is located closer to the heart there is no interference from the lungs and bones of the chest. A sedative and an anesthetic are used on the patient’s esophagus to make them comfortable during this test.
An electrocardiogram (also called EKG or ECG) is a test that records the electrical activity of the patient’s heart through small electrode patches attached to the skin of your chest, arms, and legs. An EKG may be part of a routine physical exam or it may be used as a test for heart disease. An EKG can be used to further investigate symptoms related to heart problems. The EKG assesses your heart rhythm, it can help to diagnose poor blood flow to the heart muscle (ischemia), help diagnose a heart attack, and evaluate certain abnormalities of your heart, such as an enlarged heart.
Electrophysiology (EP) is a test that evaluates the electrical activity within the patient’s heart. This test is used to help the doctor find out the cause of a rhythm disturbance and the best treatment for it. During the test, the doctor may safely reproduce the patient’s abnormal heart rhythm. The doctor can then determine if a medication can control the rhythm or if an invasive procedure (placement of a pacemaker or defibrillator) needs to be performed.
An Event Monitor is small recorder that is attached to electrodes on the patient’s chest. It is worn continuously for 30-days (or longer if the doctor requests). If symptoms are felt the patient presses an event button and the heart's rhythm is recorded and saved in the recorder. The rhythm is transmitted over the phone line which will show up as an EKG for analysis.
A holter monitor is a small recorder that is attached to electrodes which are placed on the patient’s chest. It records the heart's rhythm continuously for 24-48 hours. The patient is asked to do all of their normal daily activities. After the monitor is removed, the patient’s heart activity will be analyzed and allow the doctor to discover any irregular heartbeats, the type of irregular heart beat, how long they last, as well as what may be causing them.
An Implantable Cardioverter Defibrillator (ICD) is a surgically inserted electronic device that constantly monitors the patient’s heart rate and rhythm. When it detects a very fast, abnormal heart rhythm, it delivers electrical energy to the heart muscle to help the heart to beat in a normal rhythm again. ICDs have been very useful in preventing sudden death in patients with known life threatening arrhythmias (abnormal heart beat). Some ICDs also control slow heart rates by pacing the heart into a faster rate.
Once the ICD is implanted it needs to be checked every 3 – 6 months to ensure the device is operational and performing properly. Newly implanted devices will need to be checked more frequently.
Registered dietitians provide dietary counseling, nutritional education and behavior modification techniques for individuals with specific health needs. The consults are directed at educating and helping patients to make their own lifestyle changes that promote good health.
A pacemaker is a small electronic device which is implanted under the patient’s skin and uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart. The primary purpose of a pacemaker is to maintain an adequate heart rate either because the heart's native pacemaker is not fast enough or there is a block in the heart's electrical conduction system. The cardiologist will select the optimum pacing modes for each patient.
Once the pacemaker is implanted, it is periodically checked to ensure the device is operational and performing properly. Routine pacemaker checks are typically done every 6 months. Frequency may vary based on the device and time from device implantation.
A pulse oximetry test is a medical practice that uses a pulse oximeter which indirectly monitors the oxygen saturation of a patient's blood (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume as it is delivered through the patient’s body. The device is attached to the patient’s finger or earlobe and uses infrared lights to determine the concentration of oxygen in a patient’s blood.
A Renal Doppler Ultrasound visualizes the renal arteries that provide blood flow to the kidneys. The ultrasound machine used in this test sends out high frequency sound waves and receives the echoes bouncing off the blood vessels to form images. Physicians use these images to detect narrowing of arteries that may hinder blood flow to the kidneys.
An Exercise Stress Test is used to provide information about how the heart responds to stress. The test involves walking on a treadmill at increasing levels of difficulty until the patient achieves an optimal heart rate. The doctor looks for abnormal changes in the patient’s electrocardiogram, heart rate, and blood pressure which may indicate heart disease. If the patient is not able to exercise to the level necessary, medications may be used to administer the test.
An Exercise Stress Test Echo (Stress Echo) involves obtaining two sets of sound wave images (echocardiograms) of the patient’s heart and valves. One of the images is recorded at rest, and the second is done after the patient has performed an exercise stress test to increase the heart rate to a predetermined level. Both sets of images are obtained by moving the transducer to different locations on your chest or abdominal wall. The doctor will compare the two images to determine the heart’s chamber and valve function at rest and during exercise.
A Nuclear Exercise Stress Test consists of injecting two small doses of a traceable isotope into the patient’s intravenous (IV) line. One dose at rest and then a second during the treadmill stress test (which follows the same protocol as the exercise stress test). The isotope will give the doctor the ability to take images of the patient’s heart at rest and during exercise to determine if and where there is a possible blockage of the coronary arteries.
If, for any reason, the patient is unable to increase their heart rate and to the predetermined level through exercise, their doctor may prescribe a stress medication in place of exercise on the treadmill. This procedure is called a pharmacological stress test and it is used millions of times a year to help produce accurate images.
Lexiscan® is a stress medication that is administered through an intravenous (IV) line and dilates the blood vessels to simulate exercise. A few minutes after the injection of the medication a traceable isotope will also be injected and used to receive images from a special camera. These images will help the doctor determine if and where there is a possible blockage in the coronary arteries.
A Dobutamine Stress test is another pharmacological procedure that involves infusing a medication (dobutamine) through an intravenous (IV) line. This medication stimulates the patient’s heart to increase the rate to a predetermined optimal heart rate for study accuracy. When the patient’s heart achieves the optimum heart rate range, a traceable isotope is injected into the IV line. The isotope gives the doctor the ability to take images of the patient’s heart during stress and determine if and where there is a possible blockage of the coronary arteries.
A Dobutamine Stress Test Echocardiogram (Dobutamine Echo) involves obtaining two sets of sound wave images (echocardiograms) of the patient’s heart. One of the images is recorded at rest, and the second is done after the patient receives a medication (Dobutamine) through the intravenous (IV) line which will increase the heart rate to a predetermined level. Both sets of images are obtained by moving the transducer to different locations on your chest or abdominal wall. The doctor will compare the two images to determine the heart’s chamber and valve function at rest and during stress. This test may be done without or in addition to the nuclear stress test.
A Venous Ultrasound is designed to detect blood clots (thrombosis), narrowing of the vessel (stenosis), or other abnormalities within the veins of the arms or legs. The ultrasound machine sends out high frequency sound waves and receives the echoes bouncing off the blood vessels to form images. These images help the doctor determine the severity and location of any possible blockages or abnormalities.