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Evaluation and Diagnosis

Minimally Invasive Options

• Diagnostic Angiography
  Diagnostic angiography helps quantify the degree of blockage in a blood vessel, which can lead to a heart attack. It's often performed in conjunction with cardiac catheterization. Before the procedure, you'll be given a mild sedative and a local anesthetic. An IV line is inserted into one of the blood vessels in your arm or groin. A catheter is then inserted through the IV and into your blood vessel. The catheter is carefully threaded into the heart guided by an X-ray machine. Once the catheter is in place, contrast material is injected and pictures are taken, allowing doctors to see if the arteries are narrowed or blocked.

  In the imaging laboratories, a quantitative analysis of this procedure can be done to calculate the volume and area of the vessel. This helps physicians diagnose the level of vessel constriction and atherosclerotic plaque, which may be a soft, high-lipid plaque, a hard calcified plaque or a mixture of the two.

• Coronary Intravascular Ultrasound (IVUS)
  Coronary intravascular ultrasound is used to evaluate blockages of the coronary artery. During this procedure, an ultrasound transducer is attached to a catheter and guided through the coronary arteries, where it sends and receives sound waves to create a detailed images of the inside of the vessel. IVUS is used to provide specific information about the coronary artery blockage, including its location, size and shape. This information can help your physician determine the most appropriate treatment and evaluate its success.

• Cardiac Catheterization
  This test can measure the blood pressure within your heart and how much oxygen is in your blood. It's also used to get information about the pumping ability of the heart muscle. You'll be given a mild sedative before the test to help you relax as well as a local anesthetic. Then a slender, flexible tube will be inserted into the groin area, where your thigh meets your abdomen, and directed to the heart. Once the catheter is in place, contrast material is injected and pictures are taken, allowing your physician to see images of the inside of your heart. The procedure is performed in our state-of-the-art digital cardiac catheterization lab.

Non-invasive Options

• Holter Monitoring
  Holter monitoring is a continuous recording of a patient's heart rhythm, usually for 24 hours, during typical daily activities. It is especially useful in diagnosing abnormal heart rhythms called arrhythmia. For this test, small conducting patches called electrodes are placed on your chest and attached to a small digital recording monitor that you can carry in a pocket or in a small pouch worn around your neck. Most current holter monitors and recorders are equipped with an event recorder or marker. When symptoms such as dizziness or palpitations occur, you simply press a button to note the time of the symptoms. This marks the tape so that the symptoms and electrocardiogram ECG recording can be correlated during analysis.

• Echocardiogram
  An echocardiogram uses ultrasound waves to create an image of the heart. It's a safe, non-invasive procedure that helps evaluate the structure and functioning of the heart for diagnosis of cardiac disease, abnormalities and as part of some cardiovascular research studies. During the test, your doctor or sonographer will place a device called a transducer on your chest and aims it at the heart. The transducer sends and receives sound waves that bounce off the heart while a computer takes the returning sound waves, or echoes, and turns them into pictures of the heart.

• Signal-Averaged EKG
  This is a recording of your heart's electrical activity during a standard electrocardiogram (EKG or ECG) test. Before the test, electrodes will be attached to your arms, legs and chest. An EKG is generally performed while you're lying down, although sometimes it's performed while you're exercising or under minimal stress to monitor changes in the heart. This type of EKG is often called a stress test. Your heart's electrical impulses and rhythms are recorded on a strip of moving paper. Normal and abnormal heart rhythms are recorded and averaged to detect arrhythmias, evaluate recurrent symptoms such as palpitations, dizziness or fainting spells, assess the effectiveness of medications and pacemakers, and help determine whether areas of your heart do not receive enough blood supply.

• Cardiac Stress Test
  A stress test, sometimes called a treadmill or exercise test, determines how well your heart can handle work. You'll be connected to an EKG machine and a blood pressure cuff and a sensor may be attached to the finger to measure the level of oxygen in the blood. During the test, the electrical activity of the heart is measured while you walk on a treadmill. The pace of the treadmill will increase and the incline will rise during the course of the exercise.

  The stress test measures the heart's reaction to your body's increased demand for oxygen. The test continues until you reach a target heart rate, unless complications such as chest pain or an exaggerated rise in blood pressure develop with activity. Monitoring continues after exercise for 10 to 15 minutes or until your heart rate returns to baseline. The test shows if there is a lack of blood supply throughout the arteries that go to your heart. Taking a stress test also helps determine if you have heart disease, how severe it is and the kind of exercises that are appropriate for you.

• Nuclear Perfusion Imaging
  A stress test with nuclear medicine imaging is a way to determine if the heart muscle is getting adequate blood supply. The test also helps find out how well your heart is working. To perform the test, a small amount of a radioactive tracer is injected into the blood stream through an IV. A special camera is then used to image the heart. A "rest" image is taken prior to the heart being stressed and a "stress" image is taken following the stress test.

  This stress test is conducted by increasing levels of exercise, combining a slow walk with a medication that dilates the vessels, or by giving you medication while sitting (this is reserved for those who are unable to complete a slow, flat walk for six minutes). The camera is used to view where the radioactive tracer flowed into the heart muscle at rest as compared to stress.

  Although radiation is used, it is safely cleared from the body by natural processes. A patient is exposed to the same amount of radiation as in a simple X-ray or CT scan. Millions of nuclear medicine exams are safely performed each year.

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