PROCEDURES WE DO
At the Florida Heart Clinic, we perform a wide variety of non-invasive procedures to diagnose and treat cardiology symptoms and conditions. We are affiliated with two hospitals, where we perform our invasive and interventional procedures. Below you will find a partial list of procedures we do.
Once it has been determined that there is a high likelihood of significant blockages in your heart arteries (coronary artery disease), a heart catheterization may be the appropriate next step. This procedure is done in the hospital and may be performed on an outpatient or inpatient basis (that is, some patients will be able to go home in the evening, while others will have to stay overnight in the hospital).
Most catheterizations are done with local anesthesia (numbing medicine) and conscious sedation (patients will feel very sleepy, but they are not unconscious). There should be minimal discomfort. The patient’s arterial system is accessed, usual in the wrist or in the groin, and catheters are advanced into the heart under continuous X-ray guidance. Using special contrast material, pictures of all heart arteries (coronary arteries) are taken. The doctor will measure pressures in the heart, assess how well the heart is working, and obtain all information needed to come up with a plan for effective therapy.
Multiple tools are available to open blocked heart arteries, including small balloon catheters that dilate the blockage, laser catheters that evaporate occlusive material, cutting devices that can tackle hardened and calcified spots, and many others. In most cases, your doctor will then place a small metal sleeve, called a stent. This stent will stabilize the artery and prevent it from collapsing. In many cases, more than one stent will have to be placed.
Following stent placement, it is imperative (it is absolutely necessary) that the patient takes certain medications that will keep the stent from clogging off. Your doctor will determine which medication you need to take, and how long you will have to take it. Always take these medications just as prescribed and just as long as prescribed! Do not let anybody stop you from taking those medications, unless you talk to our doctor first, or to another cardiologist that knows your medical history, or to another healthcare professional that is qualified to judge these issues and fully aware of your medical history and of the medications needed to keep your stent open! You will be given a small stent card the size of a credit card. Always carry this card in your wallet, it contains important information that other doctors may ask you about.
Cardioversion is done in the hospital. The patient is made unconscious for a few minutes. Using an electrical shock (which the patient won’t feel), the patient’s irregular rhythm is interrupted and a normal heart rhythm is restored.
In most cases, the patient will have to take special blood thinning medication before and after the procedure to reduce the risk of clots. Further, some patients may have to take medication to keep their heart rhythm regular in the long run. Finally, excessive consumption of alcoholic beverages is always discouraged, but particularly whenever a patient suffers from irregular heart rhythms.
This is an ultrasound study of the heart that allows your doctor to look at the heart in real time. An ultrasound probe is placed on your chest which emits sound waves that travel into your body. Some of these waves are reflected, and this “echo” is analyzed by the computer inside the ultrasound machine, and subsequently displayed on a screen.
The moving images of the heart give provide important information about the strength of the heart muscle. Areas of prior heart attacks (scar tissue) can be identified. Your heart valves can be examined in detail, and problems can be detected early on in many cases. Ultrasound can even show the flow of blood as it travels between the various chambers of your heart. This non invasive test provides a lot of useful information in less than half an hour.
If there is a chance that you may have blocked heart arteries, your doctor may suggest that you undergo stress testing. Depending on your age, your ability to walk, and on many other factors including your preference, your doctor may suggest that your heart be challenged by way of treadmill exercise (where you walk on a treadmill with continuous monitoring of your heart), or by way of an injection of chemicals that temporarily put your heart under stress – again with your physician at your side and with continuous monitoring. Patients are connected to an EKG (electrocardiogram) machine at all times during this test.
Depending on a variety of factors, your doctor may decide to monitor your heart not only with continuous EKG control, but also with additional imaging techniques at the same time. Both ultrasound and X-ray imaging (nuclear imaging) can be used to provide additional information. Once the test is concluded and all information has been analyzed, your doctor will sit down with you, explain the results, and give you additional recommendations. A stress test is very helpful to identify not only those patients that are in need of additional procedures, but also to give reassurance to elderly patients that wish to start an exercise program and are concerned about a possible heart condition.
Your heart doctor may suggest that your heart be evaluated by way of a nuclear imaging study. At the Florida Heart Clinic, we use Myoview, one of several commercially available agents that are approved for this indication. When used by a cardiologist, nuclear imaging studies are usually (but not always) combined with some form of stress testing. The patient’s heart is challenged either by exercising or by way of an injection that challenges the heart temporarily. A small dose of a radioactive tracer is injected. This substance will travel to the heart and accumulate in the heart muscle. A special X-ray camera will take pictures of the heart and show the presence of the tracer in the heart muscle. A healthy heart will appear in its entirety on the screen. A heart that has sustained previous heart attacks, or a heart that does not receive enough blood flow to all of its areas will result in different images that allow your doctor to identify and locate the problem.
After the test has been concluded and all images have been analyzed, your doctor will go over the test results with you and give you further recommendations. Nuclear imaging provides additional information to stress tests. If you are in need of a stress test, your doctor may suggest nuclear imaging if you have known heart disease, if you are elderly, if you are not able to run on a treadmill, or if your baseline electrocardiogram (EKG) is not normal. At the Florida Heart Clinic, we perform stress testing and nuclear imaging studies not only for our own patients, but also for patients that are referred to us by other doctors such as primary care physicians, surgeons, and others. In that case, your referring doctor will receive a full report of the study, but we will also be glad to sit down with you, explain the test results to you, go over the images with you if you wish, and give you our recommendations.
These are special nuclear imaging studies (MUGA stands for multi-gated-acquisition) that give a very precise assessment of the strength of the heart muscle. A MUGA scan may be needed if ultrasound is not able to give good images in a particular patient. Also, some doctors that treat patients with chemotherapy (for example for breast cancer) need to ensure that this therapy does not damage the heart muscle. These cancer experts will at times refer their patients to a cardiac specialty clinic such as the Florida Heart Clinic so that a MUGA scan can be done to exactly measure the strength of the heart prior or during chemotherapy.
The EKG is probably the most basic heart test. The patient is connected to a series of electrodes which are placed onto the skin over the chest by way of adhesive stickers. The heart has its own electrical system, and the electrical activity can be displayed on a screen, stored, and printed out. EKGs take less than ten minutes to do. EKGs are done in most doctors’ offices and give a quick and rough assessment of the heart. Surgeons and anesthesiologists will at times send their patients to the Florida Heart Clinic to get an EKG with a professional interpretation by our cardiologist as part of their pre-operative risk assessment.
Sometimes patients have symptoms (such as dizziness, heart pounding, or racing heartbeats, but whenever they go to see their doctor all checks out normal. In this case, your doctor may decide to order a Holter test. A Holter exam is, in many ways, similar to an electrocardiogram (EKG). However, whereas an EKG gives an assessment of the electrical activity of the heart over a time span of a few seconds, a Holter study looks at a period of 24 hours. The patients come to the office and electrodes are connected to the chest. These electrodes lead to a small box containing a computer that stores the patient’s electrical heart activity. On the following day, the patient returns to the office, the Holter box is disconnected, and the stored data are analyzed by our doctor.
Importantly, the patient needs to carry a special diary-form and a pen for the duration of the test. If the patient feels any symptoms that might relate to the heart, the patient notes the symptoms on the diary, and the time when they occurred. This permits the doctor to determine whether certain symptoms are caused by heart rhythm abnormalities, or whether other reasons need to be suspected. Of note, patients that carry a Holter monitor for 24 hours can carry on most of their usual activities. Further, the Holter box is very unobtrusive, and most people will not even notice that your heart is undergoing monitoring. Our office staff will give you detailed information on what to do, and what not do, during the monitoring period.
Most people think of the heart when they hear about blocked arteries. However, arteriosclerosis (hardening of arteries) and blockages of arteries can happen pretty much anywhere in the body. The same risk factors that affect the heart (bad diet, smoking, high cholesterol levels, but also a family history of heart disease) affect all arteries in the body.
Some patients have pain when they walk, and blocked arteries in your leg or pelvis can be the reason. Some patients develop blockages in their kidney arteries, which may lead to damage to the kidneys or high blood pressure that resists treatment. Other patients develop blockages in their neck arteries, which puts them at an increased risk for stroke.
In patients that are suspected to have this type of problem, a thorough physical examination is often followed by ultrasound testing. Sometimes special CT imaging will also be ordered. As a next step, a catheter examination may be suggested. This procedure is done in the hospital or in a specially equipped and staffed outpatient X-ray facility. Similar to a heart catheterization, the patient is made comfortable with conscious sedation (medication that makes the patient feel very sleepy and reduces awareness). Using local anesthesia, the patient’s blood vessel system is entered with catheters, and contrast dye is injected. An X-ray camera allows the medical team to look at your arteries in detail, and in many cases the problem can be treated on the spot, using various techniques of vascular intervention (see under the following tab).
Veins (blood vessels that travel towards the heart) can also be diseased, although they are much less often blocked in comparison to arteries (blood vessels that travel away from the heart.) Veins may develop different problems than arteries, but these problems can also be serious. At times a patient’s venous system may need to be studied by catheter techniques, and X-ray imaging will provide valuable information about problems the patient may have.
Patients that suffer from problems inside the arteries or veins outside the heart may need to undergo special catheterization procedures to further identify the issues (see peripheral vascular catheterization tab). If there are blocked arteries (blood vessels that lead away from the heart), they can be opened with balloon catheters, laser catheters, special cutting tools or other devices. Sometimes placement of stents or stent-grafts will be necessary.
Veins (blood vessels that lead towards the heart) can also be diseased. They may need to be un-blocked. Sometimes special protective devices (e.g. Greenfield Filters) have to be placed to protect the heart and lung from blood clots. Patients on dialysis and patients with permanent pacemakers may develop special problems with their venous system that needs to be treated by interventional means. At times, catheter-based techniques are not suited to help the patient, and surgery is needed. Our doctor performs many types of peripheral vascular interventions, but he will also refer patients and coordinate care with other specialists for other procedures.
Similar to heart patients, patients with peripheral vascular disease need to adapt to a lifestyle that aims to protect their blood vessels from damage in the future. Long term medical treatment is also needed in most cases.
For more information about the procedures we perform at the Florida Heart Clinic and at local hospitals, call (954) 534-7769 or use our convenient appointment request form to schedule your appointment.