Cardiac Catheterization and Angioplasty with or without Stenting (performed at Roy Lester Schneider Hospital):

Cardiac cath (catheterization) is the insertion of a catheter (flexible tube) into the coronary arteries. It is the first step in angiography, a way of looking at blockages in the coronary arteries. Based on these results, the doctor may advise procedures to open the coronary arteries and in some cases, surgery to bypass blockages is needed. Coronary Angiography is when x-ray dye (contrast) is injected through the catheter. This allows coronary arteries to show up on x-rays, called angiograms. You may feel a warm flush as the dye is injected. Several angiograms will be taken, showing where blockages are. If angioplasty or stenting is needed it may be done right away. But, depending on the locations of the blockages, your doctor may advise coronary artery bypass surgery. The next procedures are done in the cath lab and are often done right after angiography. Balloon Angioplasty is when a special balloon-tipped catheter is inserted into the coronary artery. The balloon is then inflated to widen the artery and may be inflated one or more times before being withdrawn. An angiogram follows to confirm improvement of the artery blood flow. Stenting can also be done. The stent provides support for the artery and can help reduce risk of restenosis (renarrowing of the artery in the same place). The stent comes mounted onto a balloon catheter which is delivered to the blockage as with angioplasty. Once in place the balloon is inflated, this pushes plaque against the wall and opens the stent; more than one stent may be used depending on the size of the blockage. Once again an angiogram is taken to confirm improved blood flow in the artery. From Krames.


Electrocardiogram, EKG or ECG (done on initial visit and as follow up based on patient need):

An EKG is an important part of the initial exam of a patient who is suspected to have a heart related problem. Small sticky electrodes are applied to the patient’s chest, arms and legs. Wires are used to connect the patient to an EKG machine. You will be asked to remain very still while a nurse or technician records the EKG. The electrical activity created by the patient’s heart is processed by the machine and then printed on special graph paper. This is interpreted by the physician. The EKG can provide important information about the patient’s heart rhythm, a heart attack, increased thickness of heart muscle, and signs of decreased oxygen delivery to the heart, and problems with conduction of the electrical current from one portion of the heart to another. From Heartsite.com.


Echocardiogram-Transthoracic (performed at both Roy Lester Schneider Hospital and at VI Heart Office):

An Echocardiogram is a test in which ultrasound is used to examine the heart. The Echo allows accurate measurement of the heart chambers; the echo also offers a cross-sectional “slice” of the beating heart, including chambers and major blood vessels that exit from the left and right ventricle. The Doppler portion of the exam evaluates the size, thickness and movement of heart structures, and pumping function of the heart. Sticky patches or electrodes are attached to the chest and shoulders and connected to wires. These help record and EKG during the echo test. A gel is applied to the chest and the echo transducer is placed on top of it. The echo technologist then makes several recordings from different areas of the chest to obtain several heart views. The test is recorded on both photographic paper and video or CD. From Heartsite.com.


Echocardiogram-Transesophageal (TEE) (performed at Roy Lester Schneider Hospital):

A standard echo is obtained by applying a transducer to the front of the chest and the ultrasound beam travels through the chest wall (skin, muscle, bone, and tissue) and lungs to reach the heart. During a TEE the patient will be made to lie on the left side and will be lightly sedated. The echo transducer is much smaller than the standard and is at the end of a long flexible tube. The patient begins to swallow the tube and the procedure begins. The transducer is positioned in the esophagus directly behind the heart and is very useful in detecting clots, masses and tumors that may be located inside the heart. It can also gauge certain valve problems and help detect heart valve infection, congenital defects and tears of the aorta (major artery of the body). From Heartsite.com.


Holter Monitor and Event Monitor (performed at both Roy Lester Schneider hospital and at VI Heart Office):

A Holter Monitor is a continuous tape recording of a patients EKG for 24 hours. It can be worn during the patient’s regular daily activities and can then be correlated with patient symptoms of dizziness, palpitations (fluttering) or syncope (black outs). The monitor is much more likely to detect an abnormal heart rhythm since it is worn for a 24 hour period. Five electrodes will be placed on the chest and a monitor will be attached that is the size of a box of crayons and fits nicely into a holder that fastens along the patients’ waist. An Event Monitor is much like the holter monitor, but is worn for a period of a month and the patient sends information over the phone from the device (about the size of a pager) to a processing company. The event monitor is often used on patients who have persistent symptoms, but which had nothing shown on the 24 hour holter monitor. Two electrodes are used for the event monitor and the device is only the size of a pager which clips to the patients belt. From Heartsite.com.


Stress Testing (Exercise or Pharmacologic) (performed at Roy Lester Schneider hospital and will soon be done at VI heart Office):

The Exercise stress test or treadmill stress test helps to find out how well the heart handles work. The EKG is monitored closely during the test to watch for any changes during the exercise period which may suggest ischemia (an insufficient delivery of oxygen to the working heart muscle). It is tremendously informative in screening for coronary artery disease as well as periodically following known heart disease. It is also scheduled after bypass surgery, angioplasty and heart attack to prepare for cardiac rehabilitation. Often the Stress Test will be combined with Nuclear Imaging (Stress Echo) to improve the accuracy of the results and provide additional information about the structure and strength of the heart. Many patients cannot undergo traditional treadmill stress due to physical limitations such as arthritis, deconditioning, and disease of the leg arteries (peripheral arterial disease). Other patients have changes in their EKG’s caused by pacemakers and heart disease that would likely result in uninformative or erroneous information from a treadmill stress. When a stress test is indicated in such patients, a pharmacologic test will be performed with medicines such as Adenosine and Thallium to simulate the effects of exercise on the heart and to then capture needed EKG. From Heartsite.com.


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Our healthy heart book recommendations.

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