Echocardiography is a very basic tesing modality in cardiology that utilizes ultrasound to record a very high resolution image of the heart thru the chest wall. This test provides the ability to see all of the four chambers of the heart, including all of the valves.  The great vessels of the heart, including the pulmonary artery and aorta, both extending from the aortic root, ascending aorta and the thoracic aorta can also be seen.  The sac around the heart, called the pericardium can also be viewed to assess for the presence of any fluid collection around the heart.  Transesophageal echocardiography is a bit more invasive and is done in the hospital setting.  This imaging is performed utilizing a probe within the esophagus immediately behind the heart.  This test is a very important diagnostic tool as it gives us extremely high resolution images of the intracardiac structures.  Echocardiography in general is a very basic tool in our fight against heart disease.

Some nuclear imaging modalities are used to assess only myocardial function but other modalities are utilized in conjunction with stress testing to assess for abnormal flow patterns in the blood vessels which might imply that there is a blockage present.  Stress testing protocols include exercise and non-exercise methods depending on the patients ability to walk.  The two most commonly used nuclear imaging materials are thallium and cardiolite.  Usually intravenous access is obtained so that medications can be infused.  The patients test will be performed in two phases to allow circulation of the nuclear tracing material at rest and with exercise.  This gives the “before and after” exercise images that are so important in compairing the regional blood flow in the heart.  During the stress portion of the test, the patient is monitored closely by ekg.  A nuclear stress test may require up to two hours because of the delay in imaging.  Patients must fast overnight and abstain from coffee use prior to the test as this may interfere with the image recording.  Radiation exposure is minimum, usually equivilent of a single chest x-ray. 

The test is usually performed in response to a patients complaint of certain symptoms that might indicate angina or coronary ischemia.  A treadmill is the most common method of exercise in patients who can walk, however for individuals who are orthapedically impaired, we utilize other medications that mimic exercise to the heart but do not require actual exercise.  Exercise stress testing may be utilized as a primary modality but may also be utilized in conjunction with nuclear imaging to assess the flow patterns of the coronary arteries.  Most patients who have non-exercise stress testing must utilize nuclear imaging to obtain adequate information about coronary blood flow.  During exercise stress testing, the patients blood pressure and heart rhythm is closely monitored.  In general, this is an extremely useful test with very low risk in our attempt to assess for a patient who may have coronary blockages.  A routine stress test takes approximately 30 minutes.

The carotid arteries are the large arteries in the front of your neck that bring blood to your brain.  Just as blockages may occur in other arteries in your body, the carotids may develop disease which may result in stroke.  If the carotid artery developes a blockage, this may lead to a reduction in flow that can actually be measured by the ultrasound velocity of the blood flow through the artery.  If the carotid doppler study reveals a high degree of blockage, the doctor may order a test called a ct angiogram which directly measures the degree of blockage.  Medical management of minor blockages are usually treated with aspirin therapy, however high grade blockages may require surgery or a stent.  Feel free to ask your doctor for more information should this test become necessary.

These symptoms may be as simple as palpitations or the feeling of skipped beats but may be as dangerous as racing of the heart or even loss of consciousness.  Frequent arrhythmias may be easy to document with short term testing; however, some of these problems may not occur frequently and may require long term monitoring.  Holter monitoring is usually used for 24 to 48 hour intervals.  There are other forms of monitoring that include event monitoring which may be an external device that is worn up to several weeks at a time.  For particularly difficult problems there are implantable loop recorders which are small devices placed under the skin on the left of the chest wall which can assess for rhythm abnormalities for as much as 3 years at a time.  Please ask your doctor for more information should this type of testing become necessary.

Defibrilltors on the other hand are devices that are implanted in patients who have life threatening risk of certain arrhythmias that may result in sudden death.  Once these devices are implanted, they require long term monitoring for the life of the device within the patient.  Routine pacemaker followup monitoring is utilized to assess lead function and lead continuity and to assess whether the patient may be having asymptomatic arrhythmias.  Once the acute installation process is done, pacemaker followup is usually done every 3 months utilizing a transtelephonic monitoring system.  The patient is usually seen in the office at lease once per year to do a manual interrogation to make sure the device is functioning normally and the patient is medically stable.  Defibrillator followup is done in a similar fashion; however, post implant monitoring is much more complex and requires the expertise of a cardiac electrphysiologist.  Once the device has been implanted, a transtelephonic monitor will be mailed to you directly and you will be instructed on its use at your first office visit.  Please ask your doctor for more information if you require one of these devices.

Blood pressures are measured at each segment of the artery from your thigh to below your knee to down below your ankles.  If there is an abnormal drop off in the blood pressure, this usually implies that there is blockage above the previously measured location.  If this outpatient test is abnormal, it is usually followed up by a more invasive test such as an angiogram or a ct angiogram which utilizes intravenous contrast to directly visualize the site of the blockage.  This may respond to medical therapy but it may also require stenting and angioplasty for further management.  Please ask your doctor for more information should this test be required.

With an electrocardiogram, we can assess if your heart rhythm is normal or if there are any delays in parts of your electrical system.  There may actually be information that implies prior damage to the heart or even ongoing heart damage should the test be required in an emergency situation.  The test requires 12 leads.  The leads being on each shoulder, each extremity, and six leads that cross the chest from the left side of your breast bone to the side of your chest.  The test usually measures somewhere between six and ten seconds of your heart rhythm and is printed out on special paper.  The reading physician has had special training in the performance and interpretation of this test.  Please do not hesitate to ask your physician for more information should this test be required.

During the test, the patient has heart rate and blood pressure monitoring in the supine position and is then tilted to the standing position to assess for changes in heart rate and blood pressure related to changes in posture.  The aim of the test is to reproduce the patients clinical symptoms of syncope and dizziness in an effort to assess their blood pressure and heart rate response to define the pathology involved in the patients problem.  The test usually requires approximately 30 minutes to complete.  In rare situations, repeat tilt table testing may be required to assess the efficiency of medical therapy that has been prescribed.  Please ask your electrophysiologist for further information should you require this test.

Venus reflux disease is a progressive medical condition and if left untreated, may worsen over time and develop into a more serious form of venous disease called chronic venous insufficiency. 
Venous reflux disease develops when the valves that keep the blood flowing out of the legs and back to the heart no longer function, causing the blood to pool in the legs, and leading to these signs and symptoms:
Varicose veins   
Leg or ankle 
Leg heaviness
Leg pain, aching or cramping
Burning or itching of the skin
Restless legs
Skin changes or rashes
Ulcers, open wounds, or sores

Using an ultrasound, your physician will position the catheter into the diseased vein through a small opening in the skin. The small catheter delivers heat to the vein wall, causing it to shrink and the vein to seal closed. Once the diseased vein is closed, blood will reroute itself to other healthy veins. 
Following the procedure, a simple bandage is placed over the insertion site, and additional compression may be provided to aid healing. Your doctor may encourage you to walk and to refrain from extended standing and strenuous activities for a period of time. The average patient typically resumes normal activities within a few days.