Testing

Ablation

Radiofrequency ablation is where one or more flexible, thin tubes (catheters) are guided via x-ray through the blood vessels to abnormal heart muscle tissue. Once there, a burst of radiofrequency energy destroys very small areas of the tissue, which give rise to abnormal electrical signals causing rhythm disturbances.

Abdominal Aortic Aneurysm (AAA) Ultrasound to measure the major blood vessel in the abdomen

Advanced Carotid Artery Ultrasound to identify existing plaque or narrowing of the arteries supplying blood flow to the neck and brain

Angiography

The arteries that supply blood to the heart muscle are called coronary arteries. In healthy hearts, blood flows freely to and from the heart and throughout the body. Sometimes these arteries are narrowed or blocked prohibiting proper blood flow. A Coronary Angiogram is a procedure that uses X-ray imaging to look at your heart’s blood vessels. For your Angiogram, you will be taken to our onsite Cardiac Catheterization Lab where a small catheter will be inserted into your heart through an artery or a vein. Dye is injected to allow the doctor to see the blood flow in your heart and coronary arteries, and X-rays pictures will be taken. The results of your Angiogram will assist your cardiologist in diagnosis and prevention of a number of concerns.

Angioplasty & Stenting

If a blockage is identified by cardiac catheterization, the doctor may open the blocked artery or vein with angioplasty or a stent. During angioplasty, a small balloon-tipped catheter is guided into the blocked blood vessel. The balloon is inflated to open the vessel. Once the blood vessel is opened, the balloon is deflated and removed. A stent may also be inserted through the catheter. A stent is a tiny expandable coil that is placed in a blocked blood vessel to prevent it from becoming blocked again. The stent holds open the blood vessel to improve circulation and allow greater blood flow.

https://www.youtube.com/watch?v=SrUlaztdQCM&index=3&list=PLFCC5143DFE5D9F66

Advanced Lipid Profile

There are a number of risk factors involved when evaluating your overall heart health. Some of these factors can be managed or controlled, and others cannot. An Advanced Lipid Profile test is used as part of an overall assessment to help determine your likelihood of developing cardiovascular disease. The results of the lipid profile are considered along with other known risk factors of heart disease to develop a plan of treatment and follow-up. By making lifestyle adjustments, such as healthy dietary choices, quitting smoking, and exercising regularly, you can reduce your overall risk for heart disease. For some patients, your cardiologist may recommend lipid-lowering medications such as statins.

Blood & Cholesterol Tests

Specific blood tests can be performed to see if there is a problem with your heart or blood vessels, including cholesterol profile to measure levels of HDL (good cholesterol), LDL (bad cholesterol) and triglycerides; cardiac enzyme tests; blood clotting tests and more.

Cardiac Catheterization

Heart Catheterization procedures can both diagnose and treat heart and blood vessel conditions. The most common type of heart caths, a Coronary Angiogram, helps your cardiologist diagnose an array of cardiovascular conditions. The results provide very clear images of the heart, making them an invaluable diagnostic tool. For this test, an ultrasound device is inserted down the patient’s throat. Your doctor may decide to use this test depending on what part of the heart needs to be viewed.

https://www.youtube.com/watch?v=O9-gNv_-k48&list=PLFCC5143DFE5D9F66&index=2

Echocardiography (Echo) – An echocardiogram is an ultrasound (sonogram) of your heart for the assessment of chamber size and function, valve function, physiological information (blood flow velocities, gradients and pressures) and other important disorders such as congenital defects. It will show how well your heart muscle is working, if it is enlarged or thickened, if any of the valves are leaking or have calcium build up and if there is fluid around the heart. This test is not able to evaluate whether you have ‘blocked arteries’. It is not in any way invasive – it is identical to the test done on pregnant women to check the fetus in the womb. There is no preparation for the test. You should wear a two-piece out-fit as you will have to undress from the waist up. You may eat and take all your medications.

The echocardiogram will be performed in our office by a technician and takes about 30 minutes. A transducer coated with cool gel will be moved over your chest; this device creates sound waves that make images of your heart. The images are digitally recorded and reviewed by the cardiologist.

Electrocardiogram (ECG or EKG) is one of the simplest and fastest procedures used to evaluate the heart. An EKG records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.The heart operates by receiving electrical impulses which regulate its rhythm. If your doctor suspects an irregularity with your heart’s rhythm or beat, he might order an electrocardiogram (EKG). An electrocardiogram is a test that measures that electrical activity. The results are displayed as a wave on either a strip of paper or a video screen. By examining the wave pattern, your doctor can see the timing and type of the electrical impulses and use it to see the rhythm and heart rate. Underlying problems with the heart can also be noticed with an electrocardiogram. The results from your first EKG will be used by your doctor to compare future electrocardiogram readings to see if any changes took place which might indicate a problem.

Event Monitoring – A patient-activated Event Recorder is used for an extended period of time and helpful in the evaluation of sporadic cardiac symptoms or events. The heart uses electrical impulses to tell the chambers when to contract to pump blood throughout your body, by measuring these impulses, your doctor can determine if your heart is functioning properly. Sometimes, an in office electrocardiogram (EKG) might be taken, but this only gives a brief snapshot of your heart’s health. For a clearer picture of how your heart’s rhythm changes throughout the day, your cardiologist could ask for continuous monitoring for several days or up to a month using an event recorder. These record your heart patterns throughout your daily activities. Event recorders are portable EKGs, and like EKGs are painless.

Heart Rhythm / Electrophysiology

The heart is a beautifully designed pump that relies on its own electrical system to beat and circulate blood throughout the body. Sometimes there is a problem with the heart’s electrical system – or electrophysiology – resulting in a heart rhythm disorder whereby the heart beats too fast, too slow or irregularly, which can lead to a number of complications, including stroke and even sudden death.

There are a number of advanced technologies and techniques for diagnosis and management:

Evaluation and treatment of atrial fibrillation, ventricular

Tachycardia and other arrhythmias

Evaluation and treatment of syncope

Management of antiarrhythmic medications

Electrophysiology studies

Ablations

Holter monitors, event monitors and implantable loop recorders

Implantation and management of pacemakers

Implantation and management of implanted cardioverter

Defibrillators (ICDs)

Cardiac re-synchronization therapy and biventricular devices

Intracardiac echocardiograms

Holter Monitoring – The heart uses electrical impulses to tell the chambers when to contract to pump blood throughout your body, by measuring these impulses, your doctor can determine if your heart is functioning properly. Sometimes, an in office electrocardiogram (EKG) might be taken, but this only gives a brief snapshot of your heart’s health. For a clearer picture of how your heart’s rhythm changes throughout the day, your doctor could ask for continuous monitoring for a day or two using a Holter monitor. This test is simply a 24- hour electrocardiogram of your heart. This test in not in any way invasive. It is designed to pick up certain rhythm irregularities in your heart, as well as periods of “angina” that could happen during that period. This information would give your cardiologist a better understanding of your problem and help diagnose and treat you.

The Holter monitor will be put on in our office by a medical assistant and you will be given a sheet of paper headed “Diary”, to indicate time and date of any particular symptoms that happen during the 24-hour monitoring. While you wear the monitor, you are free to perform your regular activities, except showering. You will have to return to our office 24 hours later to have the monitor removed. A technician will scan the Holter monitor tape and the doctor will interpret the results. You will be advised by your cardiologist of the results, diagnosis, and treatment.

ICD Implantation

Implanted cardioverter defibrillators (ICDs) are 99 percent effective in stopping life-threatening arrhythmias and are the most successful therapy to treat ventricular fibrillation, a major cause of sudden cardiac death. An ICD is implanted under the skin near the heart and constantly monitors a patient’s heart rhythm. If it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle causing it to beat in a normal rhythm.

Nuclear Medicine – Cardiology

Our state-of-the-art nuclear laboratory performs several types of cardiovascular diagnostic tests. With the use of hi-tech computers, we can analyze relative blood flow and global function of the heart muscle. A nuclear stress test is similar to an exercise stress test, but it is more accurate since it uses SPECT or PET scans in addition to a traditional exercise stress test. It allows your cardiologist to look at your heart’s reaction to stress, either through exercise or with medications. A clearer picture of heart health is given, but the use of radioactive substances during the test prevent cardiologists from using this as a replacement to exercise stress tests. A radioactive substance, known as an isotope, is injected into the blood, where it travels to the heart. By using a special monitor, your cardiologist can create a picture of your heart. This test is especially useful if you have suffered a heart attack, have a blood clot, or have symptoms of coronary artery disease.

You may have a light breakfast prior to the stress test. For twelve hours prior to the stress test you should not have any caffeinated foods or drinks including coffee, tea, decaffeinated coffee or tea, chocolate in any form and all colas/fountain drinks/sodas.

You will be asked by one of the office staff to hold certain medications prior to the test. Therefore, please BRING THE PILLS WITH YOU THAT YOU DID NOT TAKE SO YOU CAN TAKE THEM AFTER THE TEST. This is particularly important if you are on diabetic or heart medications. If you have asthma, emphysema, chronic bronchitis or chronic obstructive lung disease you must inform your doctor several days before the test because you may not be a suitable candidate for this test.

If you are pregnant or breastfeeding, please check with your doctor.

Pacemaker & ICD Clinic

There are several tests that can be performed to evaluate your pacemaker or ICD. Many of the routine pacer and ICD checks are done via telephone transmission from the patient’s home. Periodically, the patient may need to come to the office for a more formal interrogation or for computerized reprogramming of the device.

Pacemaker Implantation

Pacemakers are miniature devices that can be implanted underneath the skin to monitor and provide control of a patient’s heart rhythm. Pacemakers are particularly helpful in patients who suffer from heart rhythms which are abnormally slow. Typically, the pacemaker is placed under the skin of the front wall of the heart below the collarbone. Monitoring of the pacemaker is usually done remotely at home with periodic visits to our office.

Peripheral Artery Disease Screening

Screening for peripheral artery disease (PAD) includes a review of your medical history and risk factors for peripheral artery disease, as well as blood tests, Doppler ultrasound and ankle-brachial blood pressure measurements. Ankle-brachial index (ABI) is done by measuring blood pressure at the ankle and in the arm while a person is at rest. Measurements are usually repeated at both sites after five (5) minutes of walking on a treadmill. Additional imaging tests, such as intravascular ultrasound or magnetic resonance angiography may be recommended, if necessary.

Stents

A small, expandable tube called a stent is often permanently inserted into the artery during angioplasty. A very then guide wire is inside the catheter. The guide wire is used to move a balloon and the stent into the coronary artery. A balloon is placed inside the stent and inflated, which opens the stent and pushes it into place against the artery wall. The balloon is then deflated and removed, leaving the stent in place. Because the stent is mesh-like, the cells lining the blood vessel grow through and around the stent to help secure it.

Stenting should:

  • Open up the artery and press the plaque against the artery 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.

Stent placement is standard during most angioplasty procedures.

Your cardiologist may use a bare metal stent or a drug-eluting stent. Drug-eluting stents are coated with medicine that helps keep the artery open after angioplasty.

Vascular Studies – These noninvasive tests are beneficial in the assessment of peripheral vascular disease or circulation disorders. Using various ultrasound and pressure recording techniques, the arteries and veins of the extremities can be studied. In addition, these exams can identify abnormalities in the carotid arteries of the neck and also abdominal aorta.


Charles A. Shoultz, Jr., M.D., F.A.C.C.   •   Charles A. Shoultz, III, M.D., F.A.C.C.   •   Rodney A. Brown, M.D., F.A.C.C.
William R. Pitts, M.D., F.A.C.C.   •   Donald S. (Buck) Cross, M.D., F.A.C.C. • Andrew K. Day, M.D., F.A.C.C.
Sherwin F. Attai, M.D., F.A.C.C.   •   Shawn J. Skeen, M.D. F.A.C.C.   •   Harvey R. Chen, M.D. F.A.C.C.
Adam M. Falcone, M.D., F.A.C.C.   •   Brian C. Barnett, M.D., F.A.C.C.

Diplomates, American Board of Internal Medicine,
Cardiovascular Disease, Interventional Cardiology, Clinical Cardiac Electrophysiology