Cardiac and Vascular Ultrasound
• Echocardiography (Echo) and 2D Echocardiography
• Stress Echocardiography (Stress Echo)
• Transesophegeal Echocardiography (TEE)
• Peripheral Vascular Ultrasound
• Pulse Volume Recordings (PVR)
• Renal Duplex Imaging
• Upper and Lower Arterial Evaluation
Coronary Angioplasty and Stenting
Electrocardiography (ECG or EKG)
• Holter Monitoring
• Stress ECG (Treadmill Testing)
Electrophysiology
• Cardioversion
• Catheter Ablation
Enhanced External Counter Pulsation Therapy
Nuclear Cardiology Imaging
• Myocardial Perfusion
• Pharmacologic-Assisted Myocardial Perfusion Imaging
Pacemaker Implant
• AICD
• Biventricular Pacemakers
• Pacemaker Evaluation and Management
Vascular Imaging
• CT Scan – Angiography
• MRI – Angiography and Cardiac
CPCMG offers a comprehensive array of advanced tests and services in a friendly, relaxing office environment. Our cardiologists will make every effort to interpret your test within two working days. Should any troubling test results be detected, your physician will usually be notified on the day of your test. Otherwise, test results will be provided within two weeks.
Cardiac and Vascular Ultrasound
The same technology that allows you to watch a fetus in the womb can also reveal your heart in motion and the flow of blood through your body. Ultrasound (high-frequency sound) waves are transmitted and their echoes are recorded with a wand-like device called a transducer. A computer uses the information from the transducer to create moving images on a video monitor. By using reflected sound waves, doctors can view your heart and arterial blood flow without ever making an incision.
Echocardiography and 2D Echocardiography
Echocardiography, or “Echo,” uses a transducer to generate high-frequency sound waves that are reflected from the tissues of the heart and uses them to compose images of your heart on a monitor. The test shows how blood flows across the heart’s valve and can help identify heart and valve problems, defects, abnormal motions and fluid around the heart. It can also evaluate the heart’s pumping efficiency. In this procedure, the ultrasound beam is aimed at selected cardiac structures to give a graphic recording of their positions and movements and allow measurement of cardiac dimensions. 2D Echo uses electronic techniques to scan the ultrasound beam rapidly across the heart to produce two-dimensional images of selected cardiac sections. It is usually performed with a Cardiac Doppler to show the speed and direction of blood flow. Sound images of the heart are called echocardiograms. Your doctor may suggest an echocardiogram if he or she suspects problems with the valves or chambers of your heart.
Stress Echocardiography
Some heart problems – particularly those involving the coronary arteries that feed your heart muscle – occur only during exercise. A Stress Echo records ultrasound images of your heart before and immediately following exercise. The exercise may be walking on a treadmill or riding a stationary bicycle. Once the patient has achieved the right level of exercise, he/she is quickly moved to the echocardiography laboratory and, as the patient reclines, sound waves are used to provide images of the heart's function under stress.
Sometimes because of a patient's condition, exercising on the treadmill or a stationary bike is not possible. In such cases, a chemical is injected into your bloodstream to temporarily stress the heart while a physician monitors the patient. Then, either an ECG or echocardiogram is used to gain heart function information and/or images.
Transesophageal Echocardiography (TEE)
If a physical condition, lung disease or obesity makes it difficult to get a clear picture of the heart from outside the body, another option is to take the picture from inside your body. For Transesophageal Echo a flexible tube containing a tiny transducer is inserted into your esophagus. Since the esophagus passes close to your heart, the transducer can often produce better images. A numbing solution is sprayed in the back of your throat to make it easier to swallow the tube. To help you relax, you may receive a sedative intravenously.
Peripheral Vascular Ultrasound
This procedure uses high-frequency sound waves to obtain images and measure the velocity of blood flow in carotids (neck), arms, legs, abdominal aorta and renal (kidney) blood vessels. These images are analyzed to determine whether or not you have blockages in your arteries, blood clots in your veins, or if an abdominal aortic aneurysm is present.
Pulse Volume Recordings (PVR)
A PVR study is a non-invasive vascular test in which blood pressure cuffs and a hand-held ultrasound transducer are used to obtain information about arterial blood flow in the arms and legs. The blood pressure cuffs are used to determine the presence, severity and general location of peripheral occlusive disease. The Ankle Brachial Index (ABI) is a measurement of the blood pressure in the lower leg compared to the blood pressure in the arm. Normally, the blood pressure in your leg and arm should be about equal. If your ankle pressure is notably less than that of your arm, your leg arteries may be narrowed. A Thoracic Outlet Testing is a measurement of the blood pressure in a patient’s upper arms during which a technologist will take the blood pressure measurement while a patient moves his or her arms in various positions.
Renal Duplex Imaging
Duplex imaging of the renal arteries is performed to determine the absence or presence, type, location, extent and severity of stenosis, aneurysm, or other disease of the renal (kidney) arteries. This ultrasound test may be ordered in tandem with an Abdominal Aortic Ultrasound.
Upper and Lower Arterial Evaluation
An upper or lower extremity evaluation uses ultrasound to examine blood flow through the arteries in the arms or legs. If you have atherosclerosis (“hardening of the arteries”), blockages in your arteries, angioplasty-stent placement or bypass grafts of the legs, this test can determine the severity of the blockages or the condition of the stent placement or grafts. An arterial evaluation begins with blood pressure measurements in the arms and ankles. Based on a calculation of two measurements, the technologist may begin the ultrasound scan or may have you walk on a treadmill. The ultrasound transducer is passed over your limbs to evaluate the blood flow of the arteries. The exam may also include evaluation of arteries in your trunk and pelvic region, as they supply blood to the legs.
Coronary Angioplasty and Stenting
Coronary angioplasty is a medical procedure used to open arteries that have narrowed to the point that they impede blood flow to the heart. This procedure widens blocked arteries, which can help prevent complications of atherosclerosis. Angioplasty is usually combined with implantation of a mesh tube called a stent in the clogged artery to help prop it open and decrease the chance of reblockage. The stent looks like a very tiny coil of wire mesh. It remains in the artery permanently to hold it open and improve blood flow to your heart. Stents can be coated with medication that is slowly released to help prevent arteries from reclogging. These coated stents are called drug-eluting stents.
Coronary angioplasty isn't considered surgery because it's less invasive — your body isn't cut open. Rather, angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to dilate the blocked area. Angioplasty is commonly performed through a femoral artery, an artery in your groin.
Electrocardiography (ECG or EKG)
Electrocardiography is a non-invasive test that evaluates the electrical activity generated by the heart at rest and with activity. Each beat of your heart is triggered by an electrical impulse generated from special cells in the right upper chamber of your heart. An electrocardiogram – also called and ECG or an EKG – records these electrical signals as they travel through your heart. Various electrodes (sticky patches applied with a gel) will be attached to your arms, legs and chest to help detect and conduct the electrical currents of your heart. Your doctor may use an ECG to detect irregularities in your heart rhythm, structural abnormalities in your heart, or problems with the supply of blood and oxygen to your heart. An ECG can also confirm if you’re having a heart attack or if you’ve had a heart attack in the past.
Holter Monitoring
If you have a heartbeat irregularity that tends to come and go, it may not be captured during the few minutes a standard ECG records. To work around this problem, your doctor may recommend Holter monitoring, also known as an ambulatory ECG monitor. A Holter monitor records your heart rhythms for an entire 24-hour period. Wires from electrodes on your chest go to a battery-operated recording device carried in your pocket or worn on a belt or shoulder strap. While you’re wearing the monitor, you’ll keep a diary of your activities and symptoms. Your doctor will compare the diary with the electrical recordings to help determine what triggers your symptoms. Holter monitoring is recommended for patients of all ages for the assessment of conditions such as transient symptomatic cardiac arrhythmia, angina and Pacemaker performance.
Stress ECG (Treadmill Testing)
With ECG Stress Testing, electrodes to monitor the heart's activity are applied to the patient with a mild adhesive. The patient walks on the treadmill until the appropriate heart rate is achieved. Then, heart response is measured and recorded.
Electrophysiology
Cardiac Electrophysiology is used to test, diagnose and treat arrhythmias (heart rhythm abnormalities). An Electrophysiology (EP) Study is conducted in order to measure how the electrical impulses flow through your heart during a heartbeat. During this test, small catheters with electrodes at the tips are threaded through the patient’s blood vessels to a variety of spots inside your heart. These electrodes map the spread of electrical impulses through the heart, allowing the doctor to observe the location of an arrhythmia.
Cardioversion
Electrical Cardioversion is a procedure to convert an irregular heart rhythm to a normal heart rhythm by applying high-energy shock. A patient under light anesthesia receives an electrical shock through paddles or patches to the chest, halting the heart’s electrical activity for a split second. When the heart’s electrical activity begins again, it may resume normal rhythm. Common rhythms that require cardioversion include atrial fibrillation and atrial flutter.
Catheter Ablation
Catheter Radiofrequency Ablation (heat) is a procedure used to treat some abnormal heart rhythms. Some people have an electrical short circuit, or “hot spot,” in their heart that can lead to a rapid heart rate. When such rhythm disorders don’t respond well to medication, catheter ablation may be an effective treatment option. In this procedure, a doctor inserts a catheter through a vein in your leg and then into your heart, guided by X-ray. The catheters connect to monitors that record the electrical activity of your heart. This allows the doctor to locate the site of the rhythm disturbance. The doctor then places the catheter in this location and radiofrequency is delivered to electrodes at the tip of the catheter to heat and destroy the heart muscle cells responsible for the arrhythmia.
This procedure usually causes little or no discomfort and can usually be done with only a mild sedative and a local anesthetic. Most people resume normal activities within a few days after the procedure.
Enhanced External Counterpulsation (EECP)
Enhanced External Counterpulsation, or Chronic Angina Therapy, is a non-invasive outpatient therapy that may stimulate the openings or formation of collaterals (small branches of blood vessels) to create a natural bypass around narrowed or blocked arteries. This mode of treatment is used for patients who have persistent anginal symptoms and who have exhausted the standard treatments for revascularization. EECP can also be used for patients who don’t qualify for invasive procedures such as bypass surgery, angioplasty or stenting.
During this procedure, three electrodes are applied to the skin of the chest and connected to an electrocardiograph (ECG) machine. The ECG will display the heart’s rhythms during treatment. A set of cuffs is wrapped around the calves, thighs and buttocks. These cuffs attach to air hoses that connect to valves and inflate and deflate the cuffs, much like a blood pressure machine. Inflation and deflation are electronically synchronized with the heartbeat and blood pressure using the ECG and blood pressure monitors. EECP gently compresses the blood vessels in the lower limbs to increase blood flow to your heart, encouraging blood vessels to open channels that become extra branches. These channels or collaterals may eventually become “natural bypass” vessels to provide blood flow to the heart muscle, contributing to the relief of angina symptoms.
Nuclear Cardiology Imaging
Nuclear imaging is a method of producing images by detecting radiation from different parts of the body after the administration of a radioactive tracer material. In most cases, the tracers are injected into your bloodstream, although in some cases they may be given orally. The amount of radiation a patient receives in a typical nuclear imaging scan is very low, similar to the exposure received in a routine CT scan. During the test or “scan,” a special camera (called a “gamma” camera) takes a series of pictures while a computer connected to the camera detects the radiation from the body organ being examined. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. Inadequate blood flow to any part of your heart will show up as a light spot on the images, because not as much of the radioactive tracer is getting there. It is similar to a routine exercise stress test, but with images in addition to electrocardiograms.
Myocardial Perfusion Scan
Myocardial Perfusion scan is a type of nuclear stress test during which you exercise on a treadmill or stationary bicycle. When you reach your maximum heart rate, you’re given an injection of a radioactive substance. Images are made of your heart shortly after the exercise and also a few hours later. This indicates how well blood flows into the heart muscle and can detect narrowing of the coronary arteries (coronary artery disease). The radioactive substance used is not a “dye” and there should be no serious side effects from its injection.
Pharmacologic-Assisted Myocardial Perfusion
Pharmacologic-Assisted Myocardial Perfusion scan is used for those patients who are unable to exercise to maximal testing level due to some type of physical or mental condition. In this case, you will be injected with a medication that increases blood flow to your heart muscle, simulating exercise.
Myocardial Perfusion imaging is used for the assessment of a variety of known or suspected heart conditions including:
- Coronary artery disease
- Unstable angina
- Myocardial infarction
- Myocarditis and cardiomyopathies
- Congenital heart disease
- Myocarditis and cardiomyopathies
- Post-cardiac transplant
- Valvular heart disease
Pacemaker Implant
If the natural electrical impulses of your heart are disrupted or slowed due to aging, scarring from a heart attack or another reason, it may need assistance from an artificial pacemaker. Some pacemakers also can strengthen a heart weakened by congestive heart failure.
A pacemaker is an electronic medical devise that treats an irregular heart rhythm. The pacemaker is directly implanted in the body, where it supplies the electrical signal needed by the heart to maintain its normal heartbeat. There are three basic parts to a pacemaker: the pulse generator, the lead wire and the electrode. The pulse generator is a small metallic unit containing a battery and electrical circuit. It generates timed electrical pulses or signals. The lead wire is an insulated wire. Electrical signals travel along the lead wire to the electrode. The electrode is a minuscule metal tip at the end of the lead wire. It delivers electrical signals directly to the heart muscle.
In most cases, the lead wire is placed in a vein in the upper chest, then treated along the vein to one of the chambers of the heart. The electrode is left touching the inner wall of the heart chamber. The pulse generator is implanted under the skin in the upper chest with lead wires attached.
Automatic Implantable Cardioverter Defibrillator (AICD)
An AICD (sometimes known as an ICD) continuously monitors your heart for any rapid and/or irregular heart rhythms. It is usually implanted in the upper chest area, next to the left shoulder. Your doctor may order this procedure if you’ve survived a sudden cardiac death (SCD) experience or if a diagnostic test detected a life-threatening arrhythmia. When an AICD detects an arrhythmia, it delivers electrical shock to restore a heart to a normal rhythm, whether to stop the quivering of your heart (defibrillation) or to stop a rapid rhythm (cardioversion). If your heart beats too slowly (bradycardia), an AICD works as a pacemaker, delivering small impulses to pace your heart until it recovers and maintains a normal heart rate.
Biventricular Pacemaker
A Biventricular Pacemaker is designed to treat the delay in heart ventricle contractions. It has been demonstrated to improve symptoms of heart failure such as fatigue, shortness of breath and exercise intolerance. Traditional pacemakers used to treat slow heart rhythms use one or two “leads” (the lead wires that send impulses from the pulse generator to the heart muscle) to keep the right atrium and right ventricle working together. Biventricular pacemakers use a third lead to keep the left ventricle contracting “in synch” with the right atrium and right ventricle. Biventricular pacing keeps the right and left ventricles pumping together by sending small electrical impulses through the leads.
Pacemaker Evaluation and Management
Regular and thorough monitoring of your pacemaker's performance is important. It is especially important if you are a pacemaker-dependent patient, but is also essential for all pacemaker-assisted patients. In both cases, it helps to assure the best performance and provides you with a sense of confidence regarding your pacemaker. Monitoring services are provided as directed by your physician and at intervals in accordance with Medicare coverage guidelines for cardiac pacemakers. During your visit, your special needs will be the focus of our Pacemaker Assessment Team.
Vascular Imaging
In addition to various ultrasound methods, vascular imaging includes a number of radiographic procedures that allows physicians to view the blood vessels and diagnose vascular and arterial diseases. These tests are used to detect the presence, severity and general location of disease or abnormalities.
CT Scan – Angiography
Computed tomography, known as CT or CTA scan, uses X-ray equipment to take multiple images of the body. Using a computer, the information from the scanned images becomes visible as three-dimensional cross sections. Scans of the flow of blood throughout the body, known as computed tomography angiography or CTA, allow physicians to screen individuals for arterial disease.
MRI – Cardiac Angiography
Magnetic Resonance Imaging (MRI) uses a powerful magnet, radiowaves and a computer to view soft tissue or organs hidden from view by bone. MRI – Angiography scans the blood vessels. MRI – Cardiac scans the heart. The computer produces detailed two- or three-dimensional images. MRI does not rely on radiation to produce images. Because MRI scans are so sensitive it may be possible to identify, and therefore treat, abnormal conditions in their early stages.
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