EVALUATION

Comprehensive cardiovascular clinical evaluation/second opinion/preoperative evaluation

Your physician or nurse practitioner will obtain a detailed medical history, review your past medical/surgical history and other pertinent information, and perform a detailed physical examination as part of diagnosing your cardiac condition. Your doctor will review clinically important available data, as well as ordering appropriate additional testing to complete the evaluation. Once completed, a diagnosis of your cardiovascular condition will be discussed so that you can understand your cardiac condition. A treatment plan as well as a recommendations will be made.



Maintenance/follow-up cardiovascular evaluation

For our established patients, maintenance/follow-up visits are performed for chronic cardiovascular conditions. At these visits your physician or nurse practitioner will obtain an interim history, perform a physical examination, and consider other testing looking for either stability in your cardiovascular condition or changes requiring adjustments in your treatment plan. Additionally, we will continue to evaluate your risk factor profile in order to further reduce your chances for cardiac problems.



Echocardiography

Echocardiograms are an ultrasound evaluation of the structure of the heart, including its muscle, chambers, valves and surrounding tissue. The study is frequently combined with a Doppler interrogation to assess blood flow through the heart to diagnose valve problems (murmurs) as well as to assess the pressures within the heart and lungs. Although it can used to evaluate the result of blocked arteries, echocardiograms do not evaluate the arteries per se. The test is used in the evaluation of chest pain, heart failure, heart murmurs, breathlessness, fainting, palpitations, arrhythmias, as well as a host of other cardiac conditions. The test is easy and quite painless. All of the information is obtained by placing a probe on your chest to take pictures. A complete study averages about 30 minutes. There is no preparation for this test.



Routine stress testing

Routine stress testing involves a walk or run on the treadmill. It begins as a slow walk with a slight incline and progressively gets more intense with increasing speed and incline. While exercising, your heart rate, rhythm, blood pressure and EKG are being constantly monitored. One of the physicians is in attendance throughout the study.This test is used to diagnose coronary artery disease (blocked or narrowed arteries) and in the evaluation of chest pain, arrhythmias, valve problems (heart murmurs) and hypertension. This test may be easy or difficult dependent on your fitness. Our goal is to gather the needed information and end the test, rather than pushing you to the maximum. The exercise will be stopped upon request once we have gathered the needed information. This test is done after a short period of fasting. The prep, test and recovery take 30 – 40 minutes. It is a good idea to wear appropriate clothing. In some instances, cardiac medications should not be taken prior to the test, but only when you are instructed to do so.



Stress echocardiography

A stress echocardiogram is a routine stress test (see routine stress test link) plus an echocardiogram before and after the stress test. This is done for the same reasons as a routine stress test though this is performed when your EKG or other elements of the stress test will not give enough information. A baseline echocardiogram is performed followed by exercise on the treadmill. Immediately upon reaching the endpoint another echocardiogram is performed. We then compare the pre and post stress echo images. It is no more uncomfortable than a stress test or echocardiogram. It is a good idea to wear appropriate clothing. This test is done after a short period of fasting. The prep, test, and recovery take 45 – 60 minutes. In some instances, cardiac medications should not be taken prior to the test, but only when you are instructed to do so.



Nuclear stress test/myocardial perfusion imaging – exercise or pharmacologic

Myocardial perfusion imaging is performed with a low dose radioisotope and requires starting an IV. The radioisotope will be injected into a vein and enters the heart muscle cells. This is combined with stress testing, either on the treadmill (see routine stress testing above) or for patients who cannot exercise vigorously with a light walk on the treadmill in conjunction with an injected stress agent. If you are unable to walk, the injected stress agent will be given while you are comfortably seated without any exercise. Images are taken before and after stress and compared, looking for evidence of narrowed or blocked arteries. This is no more uncomfortable than the other stress tests, though the injected stress agent may make you briefly short of breath. This usually lasts only seconds to minutes. This test is done after a short period of fasting and we ask that you avoid all caffeine (coffee, tea, chocolate, etc) for 24 hours prior to the test. The test takes around 90 minutes. In some instances, cardiac medications should not be taken prior to the test, but only when you are instructed to do so.



MUGA

A MUGA test evaluates heart pumping function very accurately. It requires starting an IV prior to the test. A radioisotope is given through the IV and remains in your bloodstream. Imaging of the heart over a few minutes allows us to accurately calculate your ejection fraction, the strength of your heart contraction. This test is used when an ejection fraction is important in your management and an echocardiogram is inadequate for any number of reasons. There is no preparation for this test. The test takes around 30 minutes.



Noninvasive vascular imaging

Noninvasive vascular imaging may be as simple as obtaining accurate blood pressures and blood pressure waveforms from your extremities or as complex as the combination of duplex imaging, a combination of ultrasound imaging to visualize the arteries or veins in conjunction with Doppler interrogation to assess the flow and velocity of blood. These tests help us diagnose narrowed or blocked arteries (carotid arteries to the brain, upper or lower extremity arteries), dilated arteries such as aneurysms of the abdominal aorta, incompetent (weak) veins, varicose veins or thrombosed (clotted) veins. This test is painless. An ultrasound probe is simply pressed on the exam area for the study. There is no preparation for this test, however for abdominal aortic aneurysm screening we ask that you be fasting for four hours for better imaging. Dependent on the particular test, the study might take as little as 10 minutes or as much as 45 minutes.



Arrhythmia monitoring

Continuous electrocardiographic monitoring of your heart to diagnose arrhythmias is performed utilizing 24 and 48 hour Holter monitoring as well as protracted event monitoring, up to one month in duration. These tests are utilized to diagnose arrhythmias and in the evaluation of a variety of symptoms such as palpitations, near fainting and fainting, shortness of breath, etc. In each of these tests a series of leads (wires) are placed on the chest and attached to the monitoring device. For shorter term monitoring, we ask that you do not remove the leads, though obviously for long-term monitoring the leads will need to be replaced. In rare occasions when more protracted monitoring is required a “computer chip” monitor is available for implantation under the skin (this is a hospital-based procedure). There is no preparation for this test.



Automatic blood pressure monitoring

For patients who require more detailed evaluation of their blood pressure over a 24 hour period we utilize an automatic blood pressure monitor. This is particularly useful to obtain blood pressure values in patients with suspected whitecoat hypertension (patients with normal blood pressure which markedly increases in the presence of a doctor) who cannot monitor their own blood pressure. Additionally, this is used in those patients who require detailed blood pressure values throughout the day and while sleeping for accurate monitoring of their blood pressure, allowing for more accurate control and titration of anti-hypertensive medicine. This is quite simply a blood pressure cuff that inflates and deflates automatically throughout the day. There is no preparation for this test.



Point of service anticoagulation monitoring clinic

We offer a point of service anticoagulation clinic for patients on Coumadin/warfarin for atrial fibrillation, blood clotting disorders, deep vein thrombosis or prosthetic valves. The blood sample is obtained by fingerstick, run through the monitor and an INR is obtained within a minute. Immediate adjustment of your anticoagulation program is made under a physician supervision.



Evaluation of each patient is tailored to their individual history and situation.

A patient's assessment may include a combination of the following:

OUR AREAS OF EXPERTISE

 

Coronary Artery Disease – Hardening of the arteries, asymptomatic coronary atherosclerosis, chest pain, angina, heart attacks

 

Electrical Heart Disease – Arrhythmias, palpitations, skipped heartbeats, extra heartbeats, atrial fibrillation, racing of the heart, diseases requiring pacemaker’s and defibrillators

 

Valvular Heart Disease – Heart murmurs, leaky and stenotic valves, valve replacement

 

Heart Failure – Symptoms of shortness of breath, fatigue, weakness, edema, diagnosis of weakened or enlarged heart

 

Cardiomyopathy – Heart muscle disease, hypertrophic cardiomyopathy, dilated cardiomyopathy

 

Peripheral and Cerebral Vascular Disease – Claudication, painful legs while walking, swollen and heavy legs, stroke symptoms, carotid artery narrowing, abdominal aortic aneurysm screening, evaluation for PAD

 

Hypertension – Evaluation and treatment for hypertension, evaluation for secondary hypertension.

 

Congenital Heart Disease of the Adult – EvaluaEvaluation and follow-up for congenital heart disease, previously diagnosed or not yet detected

 

Risk Factor Evaluation and Management – Detection, diagnosis and management of all cardiovascular risk factors, including emerging risk factors

 

Low Blood Pressure – Evaluation and treatment of low blood pressure conditions, evaluation of fainting and pre-fainting symptoms, syncope, dizziness