Coastal Cardiology
 
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Comprehensive Cardiac Care

At Coastal Cardiology, P.C., we offer comprehensive care in a
personal setting. Our services include:


Consultations Hypertension Management
Cardiac and Vascular Ultrasound Cholesterol Management
Cardiac & Peripheral Angiograms Cardiac Arrhythmias
Peripheral Intervention Nuclear Imaging
Pacemaker Implantation and
  Follow-up Analysis

Treadmill Test (Exercise Stress Test)

Exercise testing is a non-invasive procedure that provides diagnostic and prognostic information and evaluates an individual's capacity for exercise. The treadmill test is basically continuous EKG monitoring during physical exertion, with close attention to the blood pressure, O2 saturation and heart rate. Its major use is to detect significant coronary artery disease (Blockages in the coronary arteries). Frequently the test is used to evaluate patients with chest pain, shortness of breath, fatigue, and arrhythmia's (irregular heartbeats). It also provides assessment of the exercise capacity, circulation to the legs, O2 saturation, blood pressure and heart response to exercise. The test is performed according to standard protocols. The most commonly used is the Bruce protocol. It consists of three-minute stages with gradually increasing speed and slope. This allows physicians anywhere in the world to communicate and compare test results. One of the end-points of the exercise test is to achieve at least 85% of the age predicted maximum heart rate. If the patient has a significant narrowing of the coronary arteries, the exercise may elicit chest discomfort (angina pectoris) or changes in the EKG.
 
Echocardiogram

This is a simple office test that uses ultrasound to image the heart. The test provides a detailed analysis of the structure and function of the heart. The information provided includes: size and thickness of the walls of the heart, the strength of the heart muscle as a pump and birth defects of the heart. It assesses heart valves for blockage or leakage, or follows the function of artificial valves. The echo allows the physician to see how your heart is working and determine if it could be causing symptoms. In essence an echocardiogram provides vital information that is necessary in most patients with known heart disease or patients with symptoms that suggest it. Coastal Cardiology has the latest equipment available, as well as caring and skillful technologists who operate it.
 
Stress Echocardiogram

This test combines the treadmill test and the echocardiogram. A resting echocardiogram is done then repeated immediately after the exercise. Both digitized studies are compared side by side. Patients with blocked coronary arteries have transient abnormal motion as part of their heart muscle after exercise, which can be seen with the echocardiogram. If patients cannot exercise a chemical test may be substituted for the treadmill exercise.
 
Cardiac Catheterization (Coronary Angiography)

Cardiac catheterization is an x-ray test that uses radiographic contrast (dye) to visualize the coronary arteries and pinpoint the presence and severity of blockages and, more importantly, to determine the best treatment available. If the test reveals a blockage you will be offered one of the following treatment modalities: medication only, angioplasty, stent, atherectomy, or bypass surgery. The test can be done on an outpatient basis. The patient is mildly sedated but awake during the procedure. A local anesthetic is used to numb the area (usually the right groin). Soft plastic tubes (catheters) are inserted into the artery then advanced under x-ray guidance. The dye is injected into the heart chambers and coronary arteries - pictures are taken from different angles. This is the best test available to find and visualize the blockages.
 
Nuclear Stress Test

A nuclear stress test shows how well blood flows through your heart and arteries while you are resting and during physical exertion. In this test, a small amount of a radioactive substance is injected into your body. This substance allows images of the heart to be recorded so your doctor can see how well the heart is pumping blood, if a part of the heart has been damaged, and if any of the arteries that feed the heart are blocked.

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Coronary Angioplasty

Coronary angioplasty is an invasive procedure used to treat angina and coronary artery disease. These procedures are performed in the cardiac catheterization laboratory. Much like a cardiac catheterization a small tube or catheter is placed in an artery, usually from the leg but occasionally from the arm. An angioplasty is often performed after a cardiac catheterization is done and reveals serious narrowing in the coronary arteries.

Patients are most often referred for angioplasty after presenting with an abnormal stress test, angina pectoris, unstable angina pectoris or a myocardial infarction (MI or heart attack). In general narrowing of the lumen of the coronary artery must be at least 70% before an angioplasty is considered. You will be awake and often sedated and so you will be sleepy. A catheter is placed into the coronary artery and an angiogram is taken. A small wire is chosen and is placed down the artery past the narrowing into the artery. A small balloon is then passed over the wire to the narrowing and inflated to open the balloon and compress the blockage in the artery. You may fell angina or chest pain during this portion of the procedure, this is common and usually resolves within minutes of deflating the balloon. The balloon is inflated for one half a minute to ten minutes. If the artery is opened and blood flow near normal the balloon and wire are removed and a final angiogram is taken. If the results are acceptable the catheters are removed and you will return to your room. After a few hours the blood thinners are allowed to dissipate and a staff member will remove the sheath (tube) in the artery. You will need to lay flat for an additional 4 to 12 hours. The success of angioplasty procedures varies depending on the patient. There are also a number of potential complications and you need to discuss these with your doctor before the procedure.

Angioplasty has an initial success rate of approximately 90%, of the patients with a good initial result about 50 to 60% do well for a long period of time with no chest pain or angina. One third to one half of patients will have angina and require repeat angioplasty or bypass surgery. Angioplasty does not cure the disease of atherosclerosis but rather is a procedure performed to control ischemia and symptoms. You will still need to take some medicine and control your risk factors. Keeping blood pressure, blood sugar and cholesterol under control are all very important. You must stop smoking.
 
Peripheral Angioplasty

Peripheral angioplasty is a procedure that has grown rapidly in the last two decades. The same atherosclerosis that involves the heart arteries can involve any artery in the body. The most common arteries to be involved are those which supply the legs (causing cramps when walking, known as claudication), those to the brain known as the carotid arteries (causing strokes) and the arteries to the kidneys (causing high blood pressure).

The same risk factors for coronary artery disease are associated with peripheral vascular disease. Controlling these factors can help control symptoms.

There are noninvasive tests, which may help your doctor learn if the blood flow through the arteries is blocked and if so may order an angiogram. The procedure of peripheral angioplasty is performed using a catheter and a balloon to expand a narrowed artery. Stents are often used to help keep an artery opened. The procedure is performed under local anesthesia and sedation. You may have your procedure as an outpatient or stay overnight. Light activity may be resumed shortly after the procedure and full activity in about one week.
 

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