24-Hour Holter Monitor
Patients with intermittent heart rhythm problems are often difficult to diagnose. Paris Cardiology Center offers the finest quality ambulatory heart monitoring equipment available. These holter monitors record all of the heart beats of a patient for a period of 24 hours. The rhythms are analyzed by computer and abnormalities are printed out for review by our cardiologists. Many arrhythmias such as atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular tachycardia can be identified in addition to various bradyarrhythmias (slow heart rhythms). Appropriate treatment ranging from medications to pacemakers can be prescribed on the basis of the holter monitor findings. For patients with extremely intermittent rhythm disturbances, event recorders are available which can be carried by a patient for weeks or even months. When symptoms occur, the patient activates the device and the heart rhythm at the time of the symptoms is recorded. TOP
Exercise Stress Test or Treadmill Test
To examine the heart's ability to function under physical stress and exercise. The results help diagnose heart disease, causes of chest pain, rhythm disorders and coronary artery disease. TOP
Echocardiography is a procedure in which the heart is imaged using ultrasound waves. This test is painless, brief and can be accomplished either in the office or in the hospital. The study shows cardiac chamber sizes; heart pumping function including specific areas of heart wall damage; wall thickness; valvular problems; blood clots or masses; and fluid collections around the heart. TOP
This is an echocardiogram that is performed while the person exercises on a treadmill or stationary bicycle. This test can accurately visualize the motion of the heart's walls and pumping action when the heart is stressed; it may reveal a lack of blood flow that isn't always apparent on other heart tests. The echocardiogram is performed just prior and just after the exercise . TOP
Nuclear Cardiac Stress Test
The usual reason for a nuclear cardiac stress test is to tell if your chest pain is caused by partial blockage of one or more arteries of the heart. Patients with this condition are said to have ischemic heart disease.
Many patients will have a history of squeezing chest pain moving (“radiating”) down the left arm during physical stress. Other patients do not have such classic complaints. The idea behind the test is to stress the heart physically through exercise, and then image the response.
If you want to participate in your own care, you will definitely want to speak with your doctor about why you are having this exam. TOP
An arrhythmia (also called dysrhythmia) is an irregular heartbeat. Heart rates can also be irregular. A normal heart rate is 50 to 100 beats per minute. Arrhythmias and abnormal heart rates don't necessarily occur together. arrhythmias can occur with a normal heart rate, or with heart rates that are slow (called bradyarrhythmias -- less than 60 beats per minute). arrhythmias can also occur with rapid heart rates (called tachyarrhythmias -- faster than 100 beats per minute).
What Causes an Arrhythmia?
Arrhythmias may be caused by many different factors, including:
- Coronary artery disease
- Electrolyte imbalances in your blood (such as sodium or potassium).
- Changes in your heart muscle.
- Injury from a heart attack
- Healing process after heart surgery.
Irregular heart rhythms can also occur in "normal, healthy" hearts TOP
A pacemaker system is a two-part electrical system that includes a pulse generator (pacemaker) and one or two leads, or wires, which deliver impulses to the heart. The leads also carry signals back from the heart. By "reading" these signals, the pulse generator is able to monitor the heart?s activity and respond appropriately. A pacemaker helps to pace the heart when the natural rate is too slow (bradycardia) to pump enough blood to the body. TOP
A heart catheterization is a procedure used for both diagnosis and treatment of congenital heart defects. The procedure allows health professionals to see how blood flows through the heart chambers and arteries. This test may also be called angiography (angiogram), cardiac catheterization, or heart cath.
To perform a heart catheterization, a thin flexible tube called a catheter is threaded through a blood vessel in the groin and into the heart. Through the catheter, the doctor can measure pressures, take blood samples, and inject a special dye (contrast material) into the chambers of the heart or the coronary arteries. The doctor watches movement of the dye through the heart's chambers and blood vessels.
A heart catheterization can be used to:
- See whether the anatomy of the heart is normal.
- Measure pressures in the heart chambers and see how the blood is flowing through the heart.
- Collect samples of blood from inside the heart.
- Inject a dye into the heart or arteries to see whether there are abnormal blockages in the blood vessels or abnormalities of the heart chambers (such as defects or holes between chambers).
- View and correct certain heart defects.
A heart catheterization usually takes between 2 and 3 hours to complete. After the test, pressure must be applied over the needle site for 10 to 20 minutes to stop bleeding and bruising. TOP
Angiography is an X-ray test that takes pictures of the blood flow within an artery (such as the aorta) or a vein (such as the vena cava). Angiography is called by different names depending on which blood vessel is being studied. For example, an angiogram of the aorta is called an aortogram; an angiogram of an artery is called arteriogram.
During angiography, a thin, flexible tube called a catheter is placed into the femoral blood vessel in the upper thigh or just above the elbow (brachial vessel) and guided to the area of interest. Then a dye (contrast material) that contains iodine is injected into the vessel being studied to make it more visible on the X-ray pictures.
The angiogram pictures can be produced on regular X-ray films or stored as digital images in a computer. A general angiogram can be used to evaluate the arteries or veins in the arms, legs, chest, or abdomen. Special angiography tests can look at the arteries near the heart (see the medical test Cardiac Catheterization), lungs (see the medical test Angiography of the Lungs), and brain (see the medical test Angiography of the Head and Neck).
An angiogram can detect an aneurysm. It can also detect narrowing or a blockage in a blood vessel that slows or prevents blood flow. TOP
A lipid panel measures lipidsfats and fatlike substances used as a source of fuel in your body; examples include cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Lipids are found in your bloodstream or are stored in tissues; they are an important part of cell structure and other functions in the body. Lipid disorders, such as high cholesterol, may contribute to life-threatening illnesses, such as coronary artery disease (CAD), heart attack, or stroke.
Your health professional may order a lipid panel for routine health screening, to help detect a lipid disorder, or to monitor treatment for a lipid disorder. If your health professional diagnoses a lipid disorder, treatmentwhich may include medication, diet changes, weight loss, and exercisemay be started to help lower your blood lipid levels.
A lipid panel is done on a sample of blood taken from a vein in the arm. You may be asked to fast for 10 to 12 hours before your blood is drawn. This panel measures levels of:
- Total cholesterol.
- High-density lipoprotein (HDL).
- Low-density lipoprotein (LDL). TOP
Bio - Z
The Bioimpedence test is a completely noninvasive test that provides information about the heart's ability to deliver blood to the rest of the body, the force the heart has to pump against with each heartbeat, and the amount of fluid in your chest. The Bioimpedence test measures the mechanical function of the heart, and provides different information than an EKG or electrocardiogram. TOP
Angioplasty, also known as percutaneous transluminal coronary angioplasty (PTCA), has become a common procedure in large medical centers in the United States. The goal of this revascularization procedure is to increase blood flow to the heart muscle tissue. Angioplasty is less invasive and has a shorter recovery time than bypass surgery, which requires open-heart surgery. Most of the time stents are placed during this procedure.
After sedation, a thin flexible tube (catheter) is inserted through an artery in the groin or arm and carefully guided up the aorta into the blocked coronary artery. Cardiac catheterization, also called coronary angiography, is performed first to identify any blockages. TOP
A small, expandable wire tube called a stent is often permanently inserted into the artery during angioplasty. The balloon is placed inside the stent and inflated, which opens the stent and pushes it into place against the artery wall. Because the stent is meshlike, the cells lining the blood vessel grow through and around the stent to help secure it.
- Open up the artery and press the plaque against the artery's walls, thereby improving blood flow.
- Keep the artery open after the balloon is deflated and removed.
- Seal any tears in the artery wall.
- Prevent the artery wall from collapsing or closing off again (restenosis).
- Prevent small pieces of plaque from breaking off, which might cause a heart attack.
Reclosure (restenosis) of the artery is much less likely to occur after stenting than with angioplasty alone. Stent placement is standard during most angioplasty procedures. In addition, newly developed stents, called drug-eluting stents, could become one of the biggest breakthroughs in the treatment of cardiovascular disease, according to the American Heart Association. While conventional stents have proved to be a valuable tool in opening coronary arteries, many times the arteries closed again. Drug-eluting stents are coated with medications that prevent the growth of cells around the stent and thus are more effective than conventional stents in keeping the artery open. TOP
The catheter used in this procedure has a hollow cylinder on the tip with an open window on one side and a balloon on the other. When the catheter is inserted into the narrowed artery, the balloon is inflated, pushing the window against the fatty matter. A blade (cutter) within the cylinder rotates and shaves off any fat that protruded into the window. The shavings are caught in a chamber within the catheter and removed. This process is repeated as needed to allow for better blood flow. Like rotoblation, this procedure is rarely used today. TOP
Placing stents in arteries during angioplasty is very effective at keeping heart blood vessels open. But, even when stents are implanted, arteries narrow again in 15%-25% of people. This re-narrowing is called in-stent restenosis. Most restenosis is due to scar tissue that forms in response to the injury created when the stent was implanted. Some scar tissue is useful; it covers the metal stent and helps prevent blood clots from forming. But, in some people, the process does not stop, and the scar tissue re-closes the artery. When restenosis occurs, doctors can fix the problem by radiating the site of re-narrowing. This is called brachytherapy. TOP
In some heart failure sufferers, problems develop in the ventricles of the heart, causing a delay between the contraction of the right side and the left side. Moreover, the walls of the left ventricle -- the heart's main pumping chamber -- don't contract together. Thus, the heart isn't contracting and moving blood in a unified manner. This is called dysynchrony.
The heart has less time to fill with blood and is not able to pump enough blood out to the body. When this happens, heart failure symptoms worsen.
Biventricular pacing, or cardiac resynchronization therapy, keeps the right and left ventricles pumping together by sending small electrical impulses to the heart muscle coordinating their contractions. This allows the left ventricle and the right ventricle to pump together. The end result? The heart is able to fill and pump blood more effectively. This, along with medical therapy, helps to improve heart failure symptoms.
Studies also show that this treatment can significantly improve quality of life in many heart failure sufferers
What Is a Biventricular Pacemaker?
A biventricular pacemaker device is a specialized pacemaker.
Traditional pacemakers are used to treat slow heart rhythms. The traditional pacemaker can perform two main functions:
- Sense the electrical activity of the heart.
- Send electrical signals to the heart muscle to maintain good heart rate and keep the atria and ventricles working together. This is called AV synchrony.
These tasks are performed by the tiny device (usually implanted under the skin) with leads threaded through the veins into the heart and implanted directly into the heart muscle.
Pacemakers can have one implanted lead, pacing only the ventricles or the atria; others have two leads pacing both the upper chambers (atria) and lower chambers (ventricles) of the heart.
Biventricular pacemakers use a third lead to help the heart beat in a more balanced way, synchronizing the right and left sides of the heart. The leads are placed in the right atrium, the right ventricle, and the left ventricle.
When the biventricular pacemaker senses the heart's rhythm, it causes the atria to contract, and it paces both ventricles to contract at the same time, causing the walls of the left ventricle to contract "in synch" -- thus, the term, cardiac resynchronization therapy. The end result is improved heart function. TOP
Leads are attached in the right atrium, the right ventricle and the left ventricle. This technique helps the heart beat in a more balanced way and is specifically used for patients with heart failure. TOP
Peripheral arterial disease (PAD) is hardening and narrowing of the arteries (atherosclerosis) that supply blood to the arms, legs, and other parts of the body. It results in reduced blood flow to those parts of the body. The arteries in the legs are most often affected. As an artery is narrowed by atherosclerosis, the leg muscles do not get enough blood, especially during increased activity when more blood is required. When the muscle is in a resting state, the blood supply may be adequate.
The main symptom of peripheral arterial disease in the leg is a tight or squeezing pain in the calf, foot, thigh, or buttock that occurs during exercise (such as walking up a hill or a flight of stairs, running, or simply walking a few steps). This pain is called intermittent claudication. It usually occurs after a certain amount of exercise and is relieved by rest. As the condition gets worse, leg pain may occur after only minimal activity or even when at rest.
In addition to the pain of intermittent claudication, other signs of PAD in the legs include:
- Numb, tingling, or cold skin on the feet or legs.
- Loss of hair on the feet or legs.
- Irregular toenail growth.
- The feet turning pale or dusky when they are elevated.
- Skin injuries, especially on the feet, that are slow to heal or that easily become infected TOP
Ambulatory Blood Pressure
Home blood pressure monitoring provides a measurement of a person's blood pressure at different times and in different environments, such as at home and at work, throughout the day. It may be done to:
- Help establish the diagnosis of high blood pressure.
- Monitor the effects of medication taken to lower blood pressure.
- Help people with high blood pressure to see the effects of medications or lifestyle changes on their blood pressure. Home monitoring can help people feel more involved in and more in control of their own health care.
- Help diagnose low blood pressure that may be caused by irregular heart rhythms (arrhythmias), certain medications, or other medical conditions.
- Monitor the blood pressure of people who are taking medications, such as monoamine oxidase inhibitors (MAOIs), that can cause episodes of high pressure.
Blood pressure normally fluctuates from day to day and even from minute to minute depending upon activity, posture, temperature, diet, drugs, and emotional and physical state.
Home blood pressure monitoring is most effective when the person also records his or her daily activities, such as the time when medication is taken or when a stressful event occurs, in a diary. This can help explain an unusual blood pressure reading and help a doctor adjust medication dosages accurately.
Some people experience a significant rise in blood pressure only when they are in a doctor's office. This is called "white-coat hypertension" and probably is caused by anxiety about the doctor visit. By monitoring blood pressure at home, these people can often find out whether their blood pressure readings generally are lower when they are not in the doctor's office. In some cases, ambulatory blood pressure monitoring (ABPM) also may be done to help diagnose white-coat hypertension. TOP
What is a stent and how is one used?
A stent is a wire metal mesh tube used to prop open an artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It's then moved into the area of the blockage. When the balloon is inflated , the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain). Within a few weeks of the time the stent was placed, the inside lining of the artery (the endothelium) grows over the metal surface of the stent. TOP
Implantable cardioverter defibrillator (ICD) implantation surgery generally takes place in an operating room, cardiac catheterization, or electrophysiolgy (EP) laboraratory. The room will be full of equipment and medical personnel. You will be asked to lie on a bed with safety straps placed over your legs. Your arms are secured at your sides, as it is important that the arms remain still during the procedure.
Your chest is then washed again and drapes are placed over the implant area. You will receive one or more shots of numbing medicine in your chest area. Because of the drapes, you won't see the shot. The doctor may touch the area and ask if you are losing sensation in your upper chest.
There are several methods of ICD implantation. The type of surgery you will undergo depends upon many factors, including prior surgeries and type of device. There are four main steps to any ICD implantation procedure. TOP
CT Cornary Angiogram
A new test is available to diagnose coronary artery disease. In the past, noninvasive functional tests of the heart were used, such as treadmill tests and nuclear studies, to indirectly assess if there were blockages in the coronary arteries. The only way to directly look at the coronary arteries was via a cardiac catheterization and coronary angiogram.
CT scans have been used to look at various anatomic regions, but have not been useful for the heart because the heart is continuously in motion, CT is very effective in looking at "static" areas, such as the brain, abdominal cavity, and extremitites. Most early CT scanners take 1-8 pictures (slices) a minute, much slower than the rate of the heart. Just as taking a picture of a moving object with a camera results in a blurry picture, conventional CT scans of the heart are not helpful. A new generation of CT scanners which can take 64 pictures a minute is now available; with the use of a little medication to slow the heart rate to less than 64, CT images of the coronary arteries are now possible. TOP
Silver Hawk Atherectomy
In may 2003, the fda cleared the Silverhawk Plaque excision system (Foxhollow Technologies, Redwood City, CA) for the treatment of peripheral artries. The system is composed of a low profile monorail catheter and palm-sized drive unit with a single on/off switch to control plaque excision. Upon activation, a minute carbide cutting blade located on the catheter tip rotates at 8,000 rpm. The operator places the catheter tip just proximal to the target lesion, activates blade rotation, and advances the cutter through the length of the lesion. With each pass , thin shavings of plaque are exercised and packed into the distal end of the nosecone to maximize the plaque collection capacity. The device can then be removed, the nosecone emptied of plaque, and reinserted to treat additional lesions.
The Silverhawk plaque excision system achieves plaque apposition without the use of a balloon which theoretically may reduce the potential for baratrauma and dissection associated mid and long-term restenosis.
The catheter design facilitates plaque excision from vessels over a wide range of diameters (2-7mm) and particularly from the infrgeniculate vessels which are resistant to stent placement and angioplasty. TOP
Peripheral Arterial Disease (PAD)
What is peripheral arterial disease (PAD)?
PAD is a narrowing or blockage of the arteries supplying your arms and/or legs that cause poor blood flow to these areas. Blockages in the leg arteries are more common and generally cause more problems for patients.
What causes PAD?
The most common cause of PAD is the buildup of plaque on the inside of the artery walls. Plaque is made up of extra cholesterol, calcium, and other material in your body. If the plaque continues to build up, there is less room for blood to flow. When there is less blood flow, the muscles and other tissues in the body are starved of the blood that keeps them functioning properly.
What are symptoms of PAD?
Symptoms of PAD in your legs include tight, aching, or squeezing pain (claudication) in the calf, thigh, or buttock. These pains usually worsen with walking or exercise and improve with rest. Blockages in your arms may cause numbness, tingling, or decreased pulses in your arms.
How is PAD diagnosed?
Your doctor will do a physical exam and look for any signs of PAD. You will also likely need a test called an ankle-brachial index (ABI). This test compares the blood pressure in your arms to that in your legs. Your doctor may also use ultrasound to check the flow in your arteries.
What are risk factors for developing PAD?
Smoking, high cholesterol, high blood pressure, and diabetes are risk factors for PAD. Those most at risk are:
- People age 70 years or older
- People age 50-69 years with a history of smoking or diabetes
- People age 40-49 with diabetes and one other risk factor: claudication, abnormal pulses in your extremities, or known blockages in other places in your body
How is PAD treated?
It is treated with medications, percutaneous intervention, or surgery. Medications are usually the first line of therapy if the disease is mild and your symptoms are not very limitingthis combination is very often unsuccessful. Percutaneous interventiona procedure done through an artery in the groin looks at the vessels in your arms and legsis currently recommended before surgery because it is less invasive and has fewer risks. With percutaneous interventions your doctor can balloon, stent, and/ or clean out the vessel to improve blood flow through the artery. Currently, surgery is recommended only if a patient’s arteries have blockages that cannot be fixed with percutaneous intervention.
What do I do if I already have PAD?
One of the most important things you can do for PAD is to QUIT SMOKING. If you have diabetes, high blood pressure, or cholesterol you will need to make sure that these conditions are well controlled. Your doctor may also have you take medications to thin your blood to help prevent you from forming clots or more blockages.
What can happen if I do not get help for my PAD?
If you have severe PAD, tissues in your leg or foot may die because they do not get enough blood flow. Also, patients with severe PAD are more at risk to develop chronic sores or ulcers if they injure their foot or leg in some way. If this happens and the injury does not heal, part of the foot or leg could have to be removed (amputated).
Does PAD increase my risk of having other blockages?
Yes, the process of plaque buildup usually happens at the same time throughout your body. This means that if you have blockages in your legs or arms your risk of having blockages in your heart or in the arteries that supply your brain is increased. If you have blockages in these areas this increases your risk of heart attack or stroke. TOP
What is carotid stenting?
The carotid arteries are the arteries in your neck that supply the head and brain with blood. Carotid stenting is a procedure in which a physician inserts a slender, expanding tube, called a stent inside your artery to increase blood flow in areas blocked by plaque.
How does blockage in your carotid arteries occur?
This process begins with hardening of your arteries called atherosclerosis. This hardening can cause build up of plaque that can eventually cause decreased blood flow through the arteries. The plaques put you at risk for blood clots or pieces of the plaque to break free and block the arteries in the brain beyond the plaque.
What are symptoms of reduced blood flow through the carotids?
Symptoms of carotid narrowing result because of decreased blood flow or because of clots or plaques breaking free and causing blockages. These symptoms includedizziness, weakness, slurred speech, periodic loss of sight in one or both eyes, and numbness.
How can you treat this condition?
Treatment for this condition depends on your symptoms, the amount of blockage, and any underlying medical problems. Treatments include medications, carotid stenting, or surgery to remove the blockage.
Who qualifies for carotid stenting?
This procedure is currently approved for patients do not qualify for surgery and who have symptomatic carotid artery blockages or have blockages of more than 80%.
How do I prepare?
You will be given specific instructions by your physician regarding things to do before the procedure. These usually include taking a medication that prevents clots 3-5 days before the procedure and may include other studies to find out as much information as possible about the blockage.
Who is not a candidate?
People who are not candidates for carotid stenting include--people with life expectancy less than 2 years, an irregular heart rhythm, allergy to medications used in the procedure, bleeding in your brain in the last 2 months, or complete blockage of the artery.
What can I expect during the procedure?
Carotid stenting is performed in the hospital catheterization lab and usually lasts around 1-2 hours. The physician will first take pictures of your arteries using dye and fluoroscopy (X-ray). After that, he will use either a balloon and/or stent to open the blockage.
What can I expect after carotid stenting?
You will usually stay overnight in the hospital after this procedure. Bruising and mild tenderness at the puncture site is common. After you go home, you will be asked to do light activity for several days. You will be advised to take blood thinning medications to keep clots from forming. Your doctor will also follow you with periodic examinations and carotid ultrasounds to make sure that your stent stays open. Other medications to control blood pressure and cholesterol may also be used to decrease the likelihood of another blockage.
Are there any complications?
While the chances of complications are very small, they can occur. Blockage by a clot or debris in your brain artery is the most serious complication after carotid stenting because this can cause a stroke. A tear along the stent or artery wall called a dissection may also occur. Kidney damage and bleeding from the puncture site are also complications that occasionally occur.
What can I do to prevent carotid blockages or keep them from getting worse?
- Quit smoking
- Exercise more regularly
- Maintain your ideal body weight
- Follow your physician’s recommendations for blood pressure, cholesterol, and blood thinners
Abdominal Endovascular Aneurysm Repair (EVAR)
Is a minimally invasive alternative to major open surgery for the repair of abdominal aortic aneurysms. The AAA Stent Graft is inserted into the aneurysm through a small incisions in the groin and without surgically opening or removing part of the aorta, thereby offering an alternative treatment choice to open surgery.
Most heart patients can have Transradial Catheterization procedure if they pass the Allen Test. In an Allen Test a Cardiologist compresses the ulnar artery for a few minutes and then compares the color of the two hands. Next, the Cardiologist then compresses the radial artery of the patient for a few minutes and compares the two hands again. If the Cardiologist sees that the blood circulates well through the ulnar and radial arteries, the patient is considered clear for the Transradial Cath procedure. Today, only 5% of Cardiologists in the U.S. can perform Cardiac Catheterization procedure (Cath) through the radial artery in the wrist. This procedure is called Transradial Catheterization Procedure.