Procedures

Services Offered by Premier Cardiology

The following are types of testing, procedures, and treatments that can be performed by a Premier Cardiologist either in our offices or at one of Premier Cardiology’s affiliated hospitals.

Electrocardiography (ECG or EKG)

If not done recently, an EKG is usually done. This is a simple test done to check the
rhythm and rate of your heart. It can be done in the office and interpreted within minutes.
It is often the first test done to determine if an individual is having a heart attack or
rhythm disturbance.

Holter and Event Monitoring

Holter monitoring is typically done to check an individual’s heart’s rhythm over a longer
period of time (1-3 days). The Holter monitor is a recording device that can be worn. A
diary of the day’s activities and any symptoms will assist the Cardiologist in determining
if there is a rhythm problem. If the Holter monitor doesn’t reveal anything, the
Cardiologist may recommend an Event Monitor where the patient can indicate and record
specific times when symptoms may be occurring.

For more information, please visit http://www.mayoclinic/health/holter-monitor/MY00577

Echocardiography (Echo, 2D Echo, Color flow Doppler,  Transesophageal echocardiography ( TEE))

One way of looking at the heart, its muscles, chambers and valves, and seeing it pump is
by the interpretation of sound waves or by ultrasound. There are different types of
echocardiograms depending on what part of the heart needs to be examined most closely.
The echocardiogram is also a useful way to check for heart defects.

Doppler echocardiogram (Doppler ultrasound, Doppler): the use of Doppler
signals (the change in pitch that occurs with the movement of sound waves) is
indicated to check blood flow–through the heart’s valves or blood vessels.

Transthoracic echocardiogram (Echo, 2D Echo): the most basic of the
echocardiograms, using a gel on the chest, a Cardiologist can see the heart
chambers and heart valves. Used in conjunction with a Doppler echocardiogram
(click here for more detailed information), blood flow can be checked as it passes
through the heart and its valves.

Transesophageal echocardiogram (TEE): ideal for examining the heart valves
more closely, the TEE requires that a transducer be placed down the patient’s
throat (the procedure is done with sedation) and into their esophagus (the
connection between the mouth and stomach). A TEE may also be recommended
if the traditional 2-Dimensional (2D) Echo is difficult to interpret. Used in
conjunction with a Doppler echocardiogram (click here for more detailed
information), blood flow can be checked as it passes through the heart and its
valves but with greater detail than with the standard Transthoracic
echocardiogram.

For more information on Echocardiograms, go to:
http://www.mayoclinic.com/health/echocardiogram/MY00095.

Carotid Ultrasound (Carotid Duplex): an ultrasound of the neck’s major blood
vessels that supply the brain, the Carotid arteries, it provides a visualization of the
structure of the arteries. When used with the Doppler ultrasound, which shows
the flow of blood in the arteries, it can better detect the existence of a plaque
(which can lead to a stroke or transient ischemic attack (TIA – “Mini stroke”))

For more information on Carotid Ultrasounds, go to
http://www.nhlbi.nih.gov/health/dci/Diseases/cu/cu_whatis.html.

Lower Extremity Ultrasound (Lower Extremity Arterial Duplex): an ultrasound of
the major arteries in the legs, and in conjunction with the Doppler ultrasound, it is
used to detect the presence of Peripheral Artery Disease (PAD) or narrowing of
the arteries in the legs either by plaque formation or hardening of the arteries.

With the exception of the TEE (because the use of sedation is involved), all of these tests
can be performed in the office.

Stress Testing

(Exercise Stress Test, Chemical Stress Test, Nuclear Stress Test,
Cardiolite Stress Test)

One way to test the function of the heart and to see whether there is a chance of
blockages in the coronary arteries (heart disease) is to stress it either with exercise, or a
medication. This type of test is typically done before the more invasive angiogram.

Exercise Stress Test (Treadmill Test): This test may be done with or without the
echocardiogram (see “Stress Echocardiogram”). For those individuals who are
able to walk a fair distance, the patient is hooked up to electrodes for the
electrocardiogram to keep track of any changes that may occur. In addition, the
blood pressure is checked about every two (2) minutes. The treadmill will
continue to incline until the patient is done, or after about 10 minutes, whichever
is sooner. If, however, the patient reports any symptoms or discomfort, the test is
stopped immediately.

Chemical Stress Test (Pharmacologic Stress Test, Dobutamine Stress Test): This
test is usually done in those individuals who are unable to exercise to the level
needed to detect coronary artery disease. It is often done in conjunction with the
echocardiogram (Stress Echocardiogram) or Nuclear Stress Test and a chemical,
like Dobutamine, is injected to stimulate the heart’s rate and force of contraction.
Other medications like Adenosine and Regadenoson (Lexiscan) can be used to
increase blood flow in the coronary arteries. Irregularities in rhythm and function
can then be assessed under stress.

Nuclear Stress Test (Nuclear Scan, Myocardial Perfusion Scan, Cardiolite Stress
Test, Myoview Stress Test, Technetium Stress Test, Thallium Stress Test):
With this type of testing, a scan of the blood flow through the heart muscle is
done usually at rest and with some sort of stress (exercise or chemical–in this
case, adenosine). Much like the other stress tests described, if the individual is
capable of walking, the test will be done with exercise; if not, by medication. A
safe, radioactive substance like Technetium or Thallium is injected followed by
camera images as the blood flows during rest and during stress. By comparing
the images at rest to during stress, the blood flow can be determined to be normal,
or obstructed by blockages. This type of testing is usually done before the more
invasive angiogram and can be done in the office.

Stress echocardiography (Stress Echo): used to examine changes in the heart’s
function or rhythm during some stress (exercise or chemical), this test is often
used before the more invasive coronary angiogram. The Stress echo can
sometimes reveal potential blockages in the arteries that fuel the heart’s muscle,
the coronary arteries.

Coronary Angiography and Stenting

(Cardiac Catheterization, Percutaneous Transluminal Coronary Angioplasty (PTCA), Percutaneous Coronary Intervention (PCI) or stent placement)

These procedures are performed  by inserting a catheter through the femoral artery in the groin, or more recently, through the radial artery in the wrist. A catheter is  advanced to the heart’s coronary arteries where images are taken using an iodine contrast agent (the angiogram), and if blockages are seen,  are opened using a balloon (angioplasty). To reduce the risk of the artery closing down, a  small, metal mesh tube called a stent is frequently placed. To prevent clotting of the  stent, aspirin and an anti-platelet medication will be prescribed.

There are two types of stents:

Bare-Metal Stent: a stent that has no drug coating. Normally, after the stent is
placed, the heart’s normal scar tissue grows over it to restore smooth and normal
blood flow again.

Drug-Eluting Stent: a stent with a medication that releases slowly over time to
prevent overgrowth of the heart’s scar tissue, which can sometimes lead to a new
type of blockage.

At times the angiogram will reveal normal coronary arteries with minimal to no
blockages at which time the procedure is completed without stent placement.

Also, the angiogram may be used to detect other problems involving the heart or aorta,
the major blood vessel that connects the heart to the other arteries in the body. With
Cardiac Catheterization (the actual process of threading the catheter to the heart),
oftentimes heart defects and the opening of tight and narrow heart valves can be done
without requiring open heart surgery.

For more information on Cardiac Catheterization, Angioplasty, and Stents, go to:

http://www.mayoclinic.com/health/cardiac-catheterization/MY00218
http://www.mayoclinic.com/health/angioplasty/MY00352
http://www.mayoclinic.com/health/drug-eluting-stents/HB00090

Electrical Cardioversion

It is important that your heart beat at regular intervals and at an optimal rate for
maximum performance and efficiency. For individuals with an irregularity in their
heart’s rhythm (called an arrhythmia), Cardioversion may be recommended.
Occasionally, Cardioversion may be done pharmacologically with medication; other
times, it is done with a medical procedure that sends electric shocks via electrodes (not
like a defibrillator directly on the chest) to the heart to restore the heart’s normal rhythm.

Because the procedure requires sedation, it is usually done in the hospital, but patients
may be able to go home the same day.

For more information on Cardioversion, go to:
http://www.mayoclinic.com/health/cardioversion/MY00705

Electrophysiology Procedures

Cardiac Arrhythmia Ablations

  • Atrial Fibrillation Ablation
  • Atrial Flutter Ablation
  • Supraventricular Tachycardia Ablation (which can include ablations for AVNRT, Wolf-Parkinson-White syndrome, or Atrial Tachycardia)
  • Ventricular Tachycardia Ablation

An arrhythmia is when the heart’s electrical system goes haywire, resulting in either a heart rate that is too fast (tachycardia) or too slow (bradycardia). During an arrhythmia ablation, we use minimally invasive techniques to introduce a catheter through the leg and thread it to the heart. We are able to get rid of nearly all types of fast arrhythmias with this technique. If you are suffering from an arrhythmia, talk to your cardiologist to see if this method is right for you. You can read more about these types of procedures by clicking here.

Cardiac Rhythm Management Devices

  • Single and Dual Chamber Pacemakers
  • Single and Dual Chamber ICDs
  • Bi-Ventricular Pacemakers and Defibrillators
  • Implantable Loop Recorders

These devices are commonly known as Pacemakers, Defibrillators and Loop Recorders. Pacemakers are primarily implanted when your heart rate goes too low, from a variety of reasons. A Defibrillators is a device that can shock your heart out of a fast, bad rhythm, which can cause you to fall unconscious or even kill you. You can be at risk for this if your ejection fraction (heart function) drops below certain levels, or for a myriad of other reasons. Your cardiologist will let you know if one of these devices is appropriate for you. Loop recorders are primarily implanted if you pass out, and you cardiologist suspects an arrhythmia is the cause – it will constantly watch your heart’s electrical activity and report any arrhythmias that may be present. You can read more about these devices by clicking here.