Services

Leading Cardiology Services in Port Arthur, TX

At Gulf Coast Cardiology Group, we offer an array of cutting-edge cardiology services. Our services include EKGs, 24-hour Holter monitoring, echocardiograms (ultrasounds of the heart), carotid ultrasounds (ultrasounds of the neck arteries going to the brain), exercise treadmill stress tests, PVRs (vascular studies for upper and lower extremities), as well as nuclear stress tests. There is adequate room for expansion of testing facilities, so that if the need arises, we may expand our services to offer outpatient cardiac catheterizations.
Learn about Heart Conditions

AngioJet

The AngioJet is a safe and minimally invasive procedure that is cost-effective and efficient at eliminating clots that can lead to heart attacks and stroke and is an invaluable new technology that can prevent the need for surgery. This cost-effective procedure removes clots that can lead to heart attacks and stroke and is far less invasive than surgery. Patients only require local anesthesia to numb the area where the catheter is inserted, and are awake through the entire procedure. The AngioJet removes the clot entirely rather than dissolving it, eliminating the possibility that tiny pieces could move downstream and cause additional complications. It breaks through plaque buildup in the heart’s arteries by delivering high-speed jets of saline solution through tiny openings in the top of a surgical instrument called a catheter. The AngioJet offers the 7 million people who suffer from coronary artery disease each year an invaluable new technology that can prevent the need for surgery.
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Cardiac Catherization

This is a procedure to examine blood flow to the heart and test how well the heart is pumping. A doctor inserts a catheter into an artery or vein in the arm or leg. From there, it can be advanced into the chambers of the heart or into the coronary arteries. This test can measure blood pressure within the heart and how much oxygen is in the blood. It’s also used to get information about the heart muscle’s pumping ability. Catheters are also used to inject dye into the coronary arteries. This is called coronary angiography or coronary arteriography. Catheters with a balloon on the tip are used in the procedure called coronary angioplasty (commonly referred to as percutaneous coronary intervention). Catheterization of the heart may also be done on infants and children to examine for congenital heart defects.
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Cardiovascular Consultation

Consult any of our four Board-certified cardiologists about any heart-related conditions.
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Cardiac Rhythm Management Procedures

Cardiac rhythm management procedures include cardioversion, Single and Dual chamber permanent pacemaker implants, Biventricular pacemaker implants, Single and Dual Chamber ICD implants, Insertion and removal of implantable vent recorder, PPM and ICD replacements, and Lead revisions. Electrical cardioversion is a procedure in which electric current is used to reset the heart’s rhythm back to a regular pattern. Pacemaker insertion is a small device that is implanted in the chest to help regulate electrical problems with the heart. Implantable Cardioverter Defibrillator is a small, battery-powered electrical impulse.
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Coronary Interventions

Coronary interventions include Percutaneous Transluminal Angioplasty, Percutaneous Transluminal Angioplasty with Stent, and Percutaneous Transluminal Angioplasty with Drug-Eluding Stent. Percutaneous Coronary Intervention is a nonsurgical method used to open narrowed arteries that supply the heart muscle. A stent may also be used.
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Coronary Procedures

Coronary procedures include left heart catherization with coronaries with and without LV, right heart catherization, as well as right and left heart catherization combined study. Cardiac Catherization is a diagnostic procedure that does a comprehensive exam of how the heart and blood vessels function.
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Critical Care and ICU

The intensive care unit (ICU) is a specially equipped hospital unit that provides highly specialized care to patients who suffer from a serious injury or illness. A multidisciplinary team (physicians, nurses, respiratory therapists, pharmacists) trained in the care of critically ill or injured patients provides continuous observation and monitoring, as well as specialized care. 

Patients are admitted to the ICU from an emergency room, an operating room, or another care area within the same hospital, or after being transferred from another hospital. Admission is based on a physician finding that close observation or specialized monitoring and/or therapy is necessary. Once close observation and monitoring or specialized therapies are no longer required, the patient is discharged from the ICU to either a regular hospital room or a concentrated care (step-down) unit where modified observation or therapy can be administered.

Because the level of care required by critically ill patients does not diminish during the night, critical care units are busy 24 hours a day. Many alarms on the monitoring equipment sound at all hours, often making rest difficult. As patients improve, one of their first complaints is the lack of sleep they receive. This is usually a good sign they have improved enough to move from the ICU.
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Echocardiography

Echocardiography is a diagnostic test that uses ultrasound waves to create an image of the heart muscle. Ultrasound waves that rebound or echo off the heart can show the size, shape, and movement of the heart’s valves and chambers, as well as the flow of blood through the heart. Echocardiography may show such abnormalities as poorly functioning heart valves or damage to the heart tissue from a past heart attack.

Purpose
Echocardiography is one of the most widely used diagnostic tests for heart disease. It can provide a wealth of helpful information, including the size and shape of the heart, its pumping capacity, and the location and extent of any damage to its tissues. It is especially useful for assessing diseases of the heart valves. It not only allows doctors to evaluate the heart valves, but can detect abnormalities in the pattern of blood flow, such as the backward flow of blood through partly closed heart valves, known as regurgitation. By assessing the motion of the heart wall, echocardiography can help detect the presence and assess the severity of coronary artery disease, as well as help determine whether any chest pain is related to heart disease. Echocardiography can also help detect hypertrophic cardiomyopathy, in which the walls of the heart thicken in an attempt to compensate for heart muscle weakness. The biggest advantage to echocardiography is that it is noninvasive (doesn’t involve breaking the skin or entering body cavities) and has no known risks or side effects.

Aftercare
No special measures need to be taken following echocardiography.

Risks
There are no known risks associated with the use of echocardiography.

Normal Results
A normal echocardiogram shows a normal heart structure and the normal flow of blood through the heart chambers and heart valves. However, a normal echocardiogram does not rule out the possibility of heart disease.

Abnormal Results
An echocardiogram may show a number of abnormalities in the structure and function of the heart, such as:
  • thickening of the wall of the heart muscle (especially the left ventricle)
  • abnormal motion of the heart muscle
  • blood leaking backward through the heart valves (regurgitation)
  • decreased blood flow through a heart valve (stenosis)
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Inferior Vena Cava Filter

IVC stands for inferior vena cava, a major blood vessel that returns blood from the lower body to the heart. An IVC filter is a small piece of metal that can be put into the inferior vena cava to prevent blood clots in the legs from traveling the lungs. A blood clot in the leg is called a deep vein thrombosis (DVT). If the clot goes to the lung, it’s called a pulmonary embolus (PE). A large PE can be lethal.

Why does an IVC filter need to be placed?
If you have a DVT, you’ll probably need to take blood-thinning medication to prevent the clot from moving. Some people are unable to take blood thinners because of bleeding problems; others may have tried blood thinners, but the medicine may not have worked properly. These people may need a temporary or permanent IVC filter to prevent blood clots from moving into the lungs. Several types of IVC filters are used today, with the Greenfield filter one of the most familiar names. Some of these filters are permanent; others are temporary and can be removed easily.

How is an IVC filter placed?
An IVC filter is placed by a doctor, known as an interventional radiologist, in a minor surgical procedure. Since patients are sedated for the operation, they usually don’t remember anything. A needle goes into a vein in your neck or groin to put a catheter into your blood vessel. The catheter is carefully positioned so the IVC filter can be inserted. By using an X-ray, the doctor can see the filter and move it to the right place.

How long does the procedure take?
The procedure usually takes less than an hour. Most people go home within a day or two if there aren’'t any major problems.

What are the risks?
The procedure is considered low risk, so major problems are rare. Bleeding and infection are possible at the incision; the risk of injury to other organs is very small. Other risks, including death, are very rare.

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Interventional Cardiology

Interventional Cardiology refers to diagnostics and nonsurgical treatments of the heart. Cardiac interventions are used to diagnosis and treat coronary artery disease, valvular heart disease, and congenital heart disease. A large number of procedures can be performed on the heart by catheterization. This most commonly involves the insertion of a sheath into the femoral artery (but, in practice, any large peripheral artery or vein) and cannulating the heart under X-ray visualization (most commonly fluoroscopy, a real-time X-ray).

Procedures performed by specialists in interventional cardiology include:
  • Angioplasty (PTCA, Percutaneous Transluminal Coronary Angioplasty) – for coronary atherosclerosis
  • Valvuloplasty – dilation of narrowed cardiac valves (usually mitral, aortic, or pulmonary)
  • Procedures for congenital heart disease – insertion of occluders for ventricular or atrial septal defects, occlusion of patent ductus arteriosus, angioplasty of great vessels
  • Emergency angioplasty and stenting of occluded coronary vessels in the setting of acute myocardial infarction
  • Coronary thrombectomy – a procedure performed to remove thrombus (blood clot) from blood vessels

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Invasive Cardiology

Invasive cardiology is a special aspect of cardiology that uses invasive procedures to treat heart disease. These procedures generally require insertion of instruments through the skin and into the body to treat a problem, thus the term “invasive.” Many of the procedures done in this exciting field can be lifesaving.

At the center of invasive cardiology is a procedure known as cardiac catheterization. This involves inserting a special thin tube called a catheter into or near the heart. In this procedure, the skin is first anesthetized with local anesthetic or “numbing” medicine. The catheter is inserted through the skin and into one of the blood vessels under the skin, usually in the groin area. Once the catheter is inside the blood vessel, it can be threaded or advanced through the vessel and into or near the heart. The catheter is usually watched with a special X-ray machine as it’s being advanced toward the heart. The wonder of cardiac catheterization is what can be done once the catheter is in its place, in or near the heart.

The most common use for cardiac catheterization is when a blockage has occurred or is suspected in the arteries that supply blood and oxygen to the heart. A blocked artery, supplying blood to the heart, is the cause of heart attacks and angina. Angina is a chest pain or shortness of breath that occurs with lesser degrees of arterial blockage, which have not yet become severe enough to cause a complete heart attack. Long-term blockage in the heart arteries, also called the coronary arteries, can also weaken the heart and cause a condition called congestive heart failure. Heart failure is when the heart is too weak to pump enough blood to meet the body's needs.

During cardiac catheterization, contrast material or a “dye,” can be squirted through the catheter and into the heart arteries. X-ray pictures of the dye can be taken as it passes through the heart arteries, allowing for any blockages in these arteries to be seen. In many cases, if a blockage is seen, it can be fixed right away.

Fixing a blockage in a heart artery during cardiac catheterization involves what is called angioplasty. In most cases, a special tiny deflated balloon is placed into the blocked artery using a catheter. The balloon is placed into the center of the blockage and then inflated, which then opens up the blockage and restores blood flow and oxygen to the heart.

In many cases, this procedure is done as an emergency, when someone has or is suspected of having a heart attack. The procedure may also be used during a severe case of angina that won’t go away, which is called unstable angina. Cardiac catheterization and angioplasty may prevent or lessen the permanent heart damage, or even death, which can occur in these two conditions. 

Invasive cardiology can also be used for several other conditions. In many cases, special instruments or tools are introduced through the catheter during cardiac catheterization to perform certain functions. 

For example: 
  • Radio-frequency ablation — This is a procedure used for certain types of irregular heartbeats, also called arrhythmias. Arrhythmias occur when the electrical system inside the heart is not working properly. In some cases, small areas of abnormal electrical activity in the heart can be destroyed using radio waves. This can stop or “cure” the irregular heartbeats.
  • Management of heart defects present at birth — This may involve taking pictures of the inside of the heart cavities and arteries. In addition, tools may be used to fix abnormal heart valves or create special openings in the heart to reduce symptoms and prevent further heart damage.
  • Management of heart valve abnormalities in adults — In some cases, the valves inside the heart can become narrow or stiff, which prevents normal blood flow through the heart. Tiny tools can be inserted through the catheter and used to open up the valves. Though the field of invasive cardiology can save and improve lives, it does involve some risk. Anyone who is a candidate for one of the procedures mentioned above would have these risks explained to him or her well before the procedure. This branch of medicine is constantly evolving and improving, and may one day save you or someone you love. Of course, the best treatment for heart disease is still good old-fashioned prevention.
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Non-Invasive Cardiology

Various non-invasive tests can be used to diagnose heart disease and conditions such as angina (chest pain). Cardiac MRI, a relatively new imaging system, can be used to evaluate coronary artery disease, heart failure, and congenital heart disease.

Echocardiogram
This non-invasive test translates sound waves from your chest into pictures of your heart. It provides information about how the heart is pumping, how blood flows in the heart and blood vessels, how large the heart is, and how the valves are working.

Electrocardiogram
The electrocardiogram (ECG or EKG) records the heart’s electrical activity. Small patches called electrodes are placed on your chest, arms, and legs, and are connected by wires to the ECG machine.

Stress/Exercise Electrocardiogram
Stress tests are conducted to see how the heart performs under physical stress. The heart can be stressed with exercise on a treadmill or, in a few instances, a bicycle.

Stress Thallium Test
Stress thallium tests have two components: a treadmill stress test and heart scan after injection of a radionuclide material, such as thallium, which allows doctors to see the coronary arteries and the shape and function of the heart. It has been used in this manner safely for many years to demonstrate the amount of blood the heart is getting under various conditions: rest and stress.

Cardiac MRI
Cardiac MRI uses a powerful, high-strength magnet to help diagnose heart problems and guide treatment. With this advanced technology, physicians can now obtain amazingly detailed, three-dimensional images of the heart never seen before. With the images produced by cardiac MRI, physicians can assess how well the heart muscle is contracting, as well as any areas of damaged tissue. This radiation-free technique is especially useful for evaluating such conditions as coronary artery disease, heart failure, and congenital heart disease.

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Nuclear Cardiology

Nuclear cardiology uses small amounts of radioactive material to obtain information about the heart. With this technology, developed in the 1960s and 1970s, the nuclear cardiologist may assess the heart muscle. Nuclear cardiology procedures are performed by cardiologists in hospitals, clinics, and private offices. Such facilities must have a license from the government, which is only issued after a thorough evaluation of the facility and the physicians’ training.
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Pacemaker Implantation and Services

Cardiologists use pacemakers to control the speed at which the heart pumps in patients prone to abnormally slow heart rates. Modern pacemakers are about two-thirds the size of the average cellular phone and contain a battery, a timing mechanism, and wires, which electrically stimulate the heart muscle to contract.

Our cardiologists place very sophisticated pacemakers quickly in patients under intravenous sedation. The cardiologist will access the heart through the vein under the collar bone (subclavian vein). The cardiologist then threads two wires through the vein, placing them in the appropriate position, and then implants the timing mechanism and battery just underneath the skin near the shoulder.

After pacemaker placement, patients return to our office on a periodic basis to have the battery and timing mechanisms checked. If your battery needs to be changed or your pacemaker does not function properly, we can detect it before a serious problem develops.
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Percutaneous Transluminal Coronary Angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) is performed to open blocked coronary arteries caused by coronary artery disease (CAD), and to restore arterial blood flow to the heart tissue without open-heart surgery. A special catheter (long, hollow tube) is inserted into the coronary artery to be treated.

This catheter has a tiny balloon at its tip, which is inflated once the catheter has been placed into the narrowed area of the coronary artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow.

The use of fluoroscopy (a special type of X-ray, similar to an X-ray “movie”) assists the physician in locating blockages in the coronary arteries as the contrast dye moves through the arteries. A small sample of heart tissue (a biopsy) may be obtained during the procedure to be examined later under the microscope for abnormalities.

Intravascular ultrasound (IVUS), a technique that uses a computer and a transducer that sends out ultrasonic sound waves to create images of the blood vessels, may be used during PTCA.

The use of IVUS provides direct visualization and measurement of the inside of the blood vessels and may assist the physician in selecting the appropriate size of balloons and/or stents to ensure that, if used, a stent is properly opened, or to evaluate the use of other angioplasty instruments.

The physician may determine another type of procedure is necessary. This may include the use of atherectomy (removal of plaque) at the site of the narrowing of the artery. In atherectomy, there may be tiny blades on a balloon or a rotating tip at the end of the catheter.

When the catheter reaches the narrowed spot in the artery, the plaque is broken up or cut away to open the artery. Atherectomy is used when the plaque is calcified or hardened, or if the vessel is completely closed. Another type of atherectomy procedure uses a laser, which opens the artery by “vaporizing” the plaque.

Reasons for the Procedure
PTCA is performed to restore coronary artery blood flow when the narrowed artery is in a location that can be reached in this manner. Not all coronary artery disease can be treated with PTCA.

Your physician will decide the best treatment of your CAD based on your individual circumstances. There may be other reasons for your physician to recommend a PTCA.

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Peripheral Interventions

Peripheral interventions iinclude Peripheral Balloon angioplasty, Peripheral Stent placement, IVC filter insertions/removal, and atherectomy. Peripheral Interventions include Illiac Stent, Renal Stent, and Atherectomy. Atherectomy is a procedure that utilizes a catheter to remove plaque from a blood vessel; it is generally used to treat peripheral artery disease of the lower extremities.
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Peripheral Procedures

Peripheral procedures include abdominal peripheral runoff, abdominal angiogram, Upper and Lower Extremity angiogram, Renal angiogram, carotid angiogram, peripheral angiogram, and viscereal angiogram. Peripheral Procedures are angiograms that study the blood supply to the carotids, brain, abdomen, renals, viscereal arteries, and extremities.
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Preventive Cardiology

Preventive Cardiology is steps that should be taken to prevent cardiac and other related conditions. All of the following cardiac and vascular conditions are preventable: first heart attack, recurrent heart attack, angina, stroke, atherosclerosis or hardening of the arteries, congestive heart failure due to heart muscle disease, congestive heart failure due to valvular heart disease, most arrhythmias, syncope or fainting, and sudden death. Although some are more easily prevented than others, a preventive strategy is available for treatment of each.

Everyone would like to prevent illness for as long as we can. Cardiac disease is a common cause of serious illness in the United States and the most frequent cause of death for both men and women. Preventing such health problems takes two forms.

Secondary Prevention
Secondary prevention represents efforts to prevent the recurrence, progression, or complications of a cardiac problem that has already developed. This can mean using various strategies to prevent recurrence of atherosclerotic heart disease, such as another heart attack or stroke. Progression of cardiac muscle dysfunction needs to be halted before heart failure sets in. We always wish to prevent complications requiring emergency room visits, hospitalization, or cardiac surgery.

Primary Prevention
This is prevention of a cardiac disease in someone likely to get it in the future. Evaluation and treatment are useful only for people who have conditions, or risk factors, known to make a cardiac illness much more likely. A prime example is genetic predisposition because of a family history of early heart attack. Other examples are elevated cholesterol, smoking, high blood pressure, and diabetes.

A Plan for Prevention
Prevention is a long-term process. After an accurate diagnosis, your treatment plan involves the following: 
  • Providing information and education about your cardiac condition so you can understand how best to deal with it yourself.
  • Agreeing on the treatment strategy.
  • Setting goals for changes in lifestyle, diet, exercise, weight reduction, and use of medications, if necessary. 
  • Re-evaluating your progress periodically. 
  • Reviewing new information with you regularly. Cardiology is still progressing rapidly and new treatment strategies emerge every year.
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Rotablator IVUS

A rotablator, which was first introduced in 1993, is a miniature drill capped with an abrasive, diamond-studded burr. The rotablator is used in a type of catheter-based procedure called rotational atherectomy. Rotational atherectomy is a minimally invasive treatment sometimes used to pulverize hardened plaque within a coronary artery. During rotational atherectomy, the rotablator is guided to the blockage via a catheter: a thin, flexible, hollow plastic tube small enough to be threaded through a blood vessel.

Rotablator Procedure (RP)
Your doctor may believe the particular plaque formation closing off one of your arteries can be managed better using a rotablator procedure (RP). This procedure is used when:
  • The plaque is felt to be too difficult to flatten against the artery wall with just a PCTA.
  • The plaque appears to have a large amount of calcium present in it and won’t move easily.
  • The plaque is too long or starts where the artery begins.
  • The artery has too much plaque, which needs to be removed before doing another procedure.
  • The artery is felt to be too small for other procedures.
  • A PCTA and/or stent has been done before and the lesion has reclosed.
During this procedure, a very small device called a rotablator is used. It is the shape of a tiny football and comes in many sizes to suit various arteries. It is threaded over a guidewire through the catheter used to inject dye at the blockage site.

The tip of the rotablator is coated with very tiny pieces of diamond crystals. Air pressure (turbine) is used to power and rotate the tip against the plaque at very high speeds. When the tip is rotated, it sounds much like the tools a dentist might use. Short bursts of power will be used to rotate the tip up to 190,000 rpm, which will grind or break the plaque down into very small particles. These particles are the size of sand dust, which is smaller than a red blood cell. The dust is flushed downstream in the blood with IV fluids to be cleaned up and removed by the body’s natural defenses.

The diamond crystal tip will only grind the plaque because it is firmer and more rigid than the soft, flexible tissue of the artery itself. This is much like shaving brittle hair off soft skin. You may experience some angina during the procedure because the artery is blocked. Be sure to let your doctor know if this occurs. It is common to feel a little sore or bruised inside your chest after an RP.; this will go away in a day or two.

The rest of your hospital stay after an RP is usually one night and is much like recovering from a regular cardiac catheterization. When you are discharged, follow the general PTCA guidelines for going home. Your doctor, nurse, or cardiac educator will review with you any special activity guidelines you may have, along with your medications. It is important that you take cardiac drugs as directed, and keep your doctor’s appointments.
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Stent Placement

The advent of coronary stents has greatly reduced the rate of recurrent blockage at the site of previous angioplasty. A stent is a thin stainless steel mesh that is mounted on the angioplasty balloon and embedded into the wall of the artery at the time of angioplasty. Prior to the advent of stents, the rate of recurrent blockage at the site of angioplasty was 40%. After the discovery and routine use of stents, the rate of recurrent blockage has been reduced to 15%. The most recent stents, called drug-eluting stents, are specially coated with medications that prevent blood clots from forming in the coronary artery, and further reduce the rate of recurrent blockage at the site of stent placement to about 5%.
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Stress Testing and Stress Echocardiography

Cardiologists commonly use stress tests to distinguish chest pain related to heart problems from chest pain caused by other ailments, such as acid indigestion and inflammation of the chest wall. Depending on the degree of suspicion for heart disease, your ability to exercise, and your other related medical problems, the cardiologist may recommend one of several alternative types of stress tests.

Treadmill Exercise Stress Testing
The treadmill test is the oldest of the different modalities. For this test, patients walk on a treadmill while a trained technician monitors the blood pressure, pulse rate, and a continuous electrocardiogram. The technician also questions the patient at set time intervals regarding symptoms such as chest pain, difficulty breathing, and lightheadedness.

The major advantage of treadmill exercise testing over chemical stress tests is the additional information the cardiologists gain by monitoring your response to exercise. Scientific data show patients who can exercise more strenuously are less likely to suffer life-threatening heart attacks.

Treadmill stress testing is not 100% accurate. Even experienced cardiologists cannot detect every single patient with coronary artery disease from a treadmill stress test alone. Additional testing may be required, and cardiologists will often combine the treadmill test with pictures of the heart obtained through nuclear imaging.

Chemical Stress Testing
Many patients cannot exercise on a treadmill due to back problems, leg pain, lung disease, or other comorbid medical problems. If you fall into this category, we often use medications to speed up the heart rate and simulate exercise. We use an injected medicine called adenosine for performing our nuclear stress tests, and an infusion called dobutamine for performing stress echocardiograms.

Nuclear Stress Testing
The term nuclear stress test refers to the modality used to obtain pictures of your heart. We obtain these pictures before and after exercise, or before and after an injection of adenosine to speed up the heart rate. Our trained technologists will place an intravenous line prior to the test and will administer a small dose of a radioactive isotope agent. The radioactive isotope travels with your blood to different regions of the heart muscle, and our gamma camera takes pictures of the heart to determine which areas of the heart muscle receive adequate amounts of blood. Areas scarred from prior heart attacks will not receive blood and subsequently will not absorb the isotope.

Next, we take a second set of pictures after administering a medication called adenosine or performing a treadmill exercise test. As the heart pumps harder with exercise or medication, more blood will flow to the muscle of the heart. Those areas of heart muscle connected to blocked arteries will not receive increased blood flow and subsequently will not absorb the radioactive isotope. Through this method, our cardiologists can detect the presence of blocked arteries and how severe the obstructions are.

Stress Echocardiogram
In some cases, our cardiologists may recommend using sound waves in the form of ultrasound to visualize the heart. When performing stress echocardiography, our technicians will image the heart at rest, and then image the heart again after exercise or administration of an infusion called dobutamine. The heart muscle beats more forcefully with exercise or dobutamine administration, and those areas of the heart receiving inadequate blood flow from blocked arteries will not pump as vigorously as normal areas of the heart.
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Tilt Table Testing

The tilt table test is a test in which a patient is positioned in a supine position and brought to a predetermined angle or angles from the horizontal position. Such positioning helps to identify the cause of any decrease in oxygen to the brain. Different types of drugs may also used in the testing process. The purpose of the tilt table test is to help determine appropriate therapy for individuals with fainting (syncope) and presyncope of unexplained origin.

Precautions
Precautions are few with the tilt table test. However, when any drug is used with this test, the appropriate precautions for that particular drug should be observed. For example, when isoproterenol or similiar drugs are used during the tilt table test, the taking of non-prescription drugs for asthma, cough, cold, or allergy; appetite suppressants; sleeping pills; or drugs containing caffeine should be made known to the physician prior to the test. Likewise, the physician should be informed of allergies to any sympathomimetic drugs, including several of the diet pills on the market. The physician should also be told about any serious heart rhythm disorders.

Description
Syncope is described as a pathological brief loss of consciousness caused by a temporary deficiency of oxygen in the brain. Previous studies have shown the effectiveness of tilt table testing in establishing the diagnosis of neurocardiogenic syncope, and in dictating therapy in patients with syncope of unknown origin. Despite its usefulness, small numbers of patients and brief followup reports have limited the majority of studies. Sensitivity-enhancing techniques, such as the administration of isoproterenol, are applied in specific cases to children and young adults to compensate for the otherwise low sensitivity (20-30%) observed in that population.

Preparation
For a patient to make informed decisions about any diagnostic test or procedure, there are important questions that need to be asked prior to the procedure. The information gained will be helpful for that patient in determining benefits, risks, and cost of the procedure, as well as alternatives. The patient should understand the purpose of the tilt table test, and the diagnosis that the physician is trying to confirm or rule out. If the tilt table test is positive, the patient should ask questions about the frequency of false-positive results for that particular tilt table procedure, and should inquire about the next step in treatment.

Aftercare
After the procedure, the patient is asked to transfer from the supine position to a sitting position, and is observed for a short period of time. During this time and after several minutes in the sitting position, any symptoms of dizziness and vertigo are noted. When ready, the individual transfers from the sitting position to standing. After additional observation and taking of vital signs, the individual is allowed to go home.

Risks
Risks of the tilt table test are low, but do include significant changes in blood pressure while in the supine position, and any adverse reactions to any drugs administered during the tilt table test.

Normal results
Normal results of the tilt table test should help the physician in assessing what may or may not be the cause of the syncope.

Abnormal results
Abnormal results include any pathologic reactions to the position changes or sensitivity-enhancing techniques, such as the administration of isoproterenol or other related drugs.
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Transesophageal Echocardiography (TEE)

Transesophageal echocardiography (TEE) is a diagnostic test using an ultrasound device that is passed into the esophagus of the patient to create a clear image of the heart muscle and other parts of the heart. A tube with a device called a transducer is passed down into the patient’s throat and into the esophagus (the food tube that connects the mouth to the stomach). The transducer directs ultrasound waves into the heart, and the reflected sound waves picked up by the transducer are translated into an image of the heart.

Purpose
Since the esophagus is right next to the heart, transesophageal echocardiography gives a very clear picture of the heart. It can provide information on the size of the heart, its pumping strength, and the location and extent of any damage to its tissues. It can detect abnormal tissue growth around the heart valves. It is also good at detecting abnormalities in the pattern of blood flow, such as the backward flow of blood through partly closed heart valves, known as regurgitation or insufficiency. It is especially useful in cases in which conventional echocardiography (a test in which the transducer is kept on the patient’s chest) cannot provide a good image, such as when the patient is obese or has a thick chest wall. It is useful for monitoring heart function during cardiac surgery and detecting blood clots in the left atrium of the heart.

Precautions
Patients should avoid consuming alcohol for a day or so before the procedure, since alcohol may amplify the effects of the sedative used with the procedure.

Description
Echocardiography creates an image of the heart using ultra high-frequency sound waves — sound waves that are much too high in frequency to be heard by the human ear. The technique is very similar to ultrasound scanning commonly used to visualize the fetus during pregnancy.

A transesophageal echocardiography examination generally lasts 30 to 60 minutes. The patient is given a mild sedative and the back of the throat is sprayed with a local anesthetic to suppress the gag reflex. Next, a special viewing tube called an endoscope, containing a tiny transducer, is passed through the mouth and into the esophagus. It is carefully moved until it is positioned directly next to the heart. Essentially a modified microphone, the transducer directs ultrasound waves into the heart, some of which get reflected (or “echoed”) back to the transducer. Different tissues and blood all reflect ultrasound waves differently. These sound waves can be translated into a meaningful image of the heart, which is displayed on a monitor or recorded on paper or tape. The transducer may be moved several times during the test to help doctors get a better view of the heart.

Preparation
The patient may be given a mild sedative before the procedure, and an anesthetic is sprayed into the back of the throat to suppress the gag reflex.

Aftercare
After the test, it is important to refrain from eating or drinking until the gag reflex has returned; otherwise, the patient may accidentally inhale some of the food or beverage. If a sedative has been given, patients should not drive or operate heavy machinery for at least 10 to 12 hours. They should avoid consuming alcohol for a day or so, since alcohol may amplify the effect of the sedative.

Risks
Transesophageal echocardiography may cause gagging and discomfort when the transducer is passed down into the throat. Patients may also experience a sore throat for a few days after the test. In rare cases, the procedure may cause bleeding or perforation of the esophagus, or an inflammatory condition known as infective endocarditis. The patient may have an adverse reaction to the sedative or local anesthetic.

Normal results
A normal transesophageal echocardiogram shows a normal heart structure and the normal flow of blood through the heart chambers and heart valves.

Abnormal results
A transesophageal echocardiogram may show a number of abnormalities in the structure and function of the heart, such as thickening of the wall of the heart muscle (especially the left ventricle). Other abnormalities can include blood leaking backward through the heart valves (regurgitation) or blood clots in the left atrium of the heart.

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24-hour Holter Monitoring

Holter monitoring (also called continuous ambulatory electrocardiographic monitoring) is a continuous monitoring of heart rate and rhythm during your usual daily activities, usually for a 24-hour period. A Holter monitor is used to identify heart rhythm disturbances, which may come and go at various times throughout the day or night. It is often used to correlate any abnormal heart rhythm with a person’s symptoms, such as dizziness, palpitations, shortness of breath, or chest pain. The Holter monitor also can evaluate if an artificial pacemaker is functioning properly.

What this test involves
A Holter monitor is applied in a doctor's office, cardiology suite, or at the hospital bedside. Electrodes are placed on the front of the chest and the electrode wires are then attached to a small, portable, battery-operated recorder. The recorder is held in place by a shoulder strap or belt that can be worn around the waist. The recorder continuously records and stores the heart rhythm, usually for 24 hours. The individual is encouraged to continue daily activities. During this time, the person wearing the device keeps a log. Activities such as eating, walking, and driving and symptoms such as palpitations, dizziness, and shortness of breath should be recorded in the log, noting when they occur. Once the monitor has been removed, a physician analyzes the heart rhythm and activity log.

Risks and precautions
A Holter monitor is a noninvasive test. It is painless and not associated with any risks to the patient. Shower or bathe before the electrodes are applied to the chest, since you won’t be able to perform these activities while the test is in progress.

Results
A Holter monitor may detect a disturbance in heart rhythm that is not evident on a single, resting electrocardiogram tracing. It allows the doctor to correlate specific patient symptoms with the electrical activity of the heart. A Holter monitor can detect rhythm disturbances that are transient or intermittent in nature. Malfunctions in artificial pacemakers can also be detected.
Heart logomark

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