Invasive and interventional testing and procedures are performed off-site under our physicians’ orders. The tests are used to view and interpret heart structure, heart function, and blockages in blood vessels. The procedures are used to reduce or eliminate the blockages, widen stiff or narrowed heart valves and treat some types of rapid heart beating. The most common testing and procedures that we prescribe are:
- Hi-Speed 64 Slice CT Cardiac Scanning
- Catheterization & Angiography
- CT Angiography
- Cardiac MRI & MRA
- Cardiac PET Scan
- Coronary and Peripheral Angioplasty
- Stent Placement
- Peripheral and Coronary Atherectomy
- Laser Angioplasty
- Electrophysiology Studies
- Radio-Frequency Ablation
- Pacemaker and AICD Insertion
During cardiac catheterization, a physician inserts a long, thin tube into a blood vessel in your groin or arm. The tube is gently directed to the heart and to the origin of the coronary arteries. Dye is then injected into the coronary artery while x-ray pictures (angiograms) are taken. The dye in the coronary arteries is seen by the x-ray as a black line. A disruption of the black line may signify an area of plaque build-up inside the wall of the artery. Dye is also injected into the heart’s pumping chambers in order to see how well the heart muscle is contracting and how well the valves are working. Pressure measurements are taken and are interpreted by a computer.
In most cases, cardiac catheterization is recommended when a partial or complete arterial blockage is suspected. It is used to evaluate how well the heart is functioning and to obtain information about blockages.
CT (computed tomography) angiography is an examination that uses x-rays to visualize blood flow in the arteries and veins throughout the body. CT combines the use of x-rays with computerized analysis of the images. Beams of x-rays are passed from a rotating device through the area of interest in the patient’s body from several different angles to create cross-sectional images, which then are assembled by computer into a three-dimensional picture of the area being studied. Dye is injected into a small peripheral vein by using a small needle or catheter. This type of exam is used to screen for arterial disease.
With the introduction of the revolutionary high-speed, 64 slice CT scanner, CT scanning now employs the latest and fastest technology to create clear, detailed images of the body that help doctors make the best diagnosis and prescribe the best treatment.
MRI (magnetic resonance imaging) and MRA (magnetic resonance angiography) use radiofrequency waves and a strong magnetic field rather than x-rays to provide clear and detailed pictures of internal organs and tissues.
Magnetic resonance is becoming very important in the initial diagnosis and subsequent management of coronary heart disease. MRI/MRA can help physicians to look closely at the structures and function of the heart and major vessels quickly and thoroughly, without the risks associated with traditional, more invasive procedures. Using MRI/MRA, physicians can examine the size and thickness of the chambers of the heart, and determine the extent of damage caused by a heart attack or progressive heart disease. MRI/MRA can also detect the buildup of plaque and blockages in the blood vessels
These tests do not require injection of a dye or exposure to X-ray. Thus, they cause less discomfort and risk for the patient.
Cardiac PET (Positron Emission Tomography) is a noninvasive method of studying the heart that makes use of drugs that emit positrons. Positrons are electrical particles with a positive charge.
During PET, a radioactive tracer that emits positrons is injected into the arm. The blood stream carries the positrons to the heart muscle. A special PET camera detects the emitted positrons and constructs a picture of the heart.
PET scans reveal the health of the vessels supplying blood to the heart, heart muscle and surrounding tissue. The most common use of PET imaging in cardiology is to identify heart muscle weakened but not irreversibly damaged by blocked arteries.
Angioplasty is an invasive procedure performed to reduce or eliminate blockages in coronary arteries. The goal of angioplasty is to restore blood flow to blood-deprived heart tissue, reduce the need for medication, and eliminate or reduce the number of episodes of angina (chest pain).
Opening a blockage in a coronary artery typically involves the use of an angioplasty balloon. When the blockage is calcified or so dense that a balloon cannot be placed, other devices are used. Plaque can be cut out, ablated with a laser, or bored out using a surgical drill bit. Often, a stent is implanted after angioplasty to keep the artery open and prevent restenosis (regrowth of plaque).
The arteries are accessed through a needle puncture made in the groin or arm.
If an artery that has been opened through an atherectomy or angioplasty should happen to close or narrow during the procedure, a stent may be inserted to hold the vessel open. A stent is a small, expandable, metal tube that mounts onto a deflated balloon. A catheter positions the stent at the blockage site, the balloon is inflated, and the stent expands. The balloon and chatheter are then removed, leaving the stent in place to keep the artery open.
Atherectomy is the removal of arterial plaque. An atherectomy catheter has a small rotating cutter at its tip that shaves and removes plaque from the artery. Once the plaque is removed, the artery is sufficiently open to restore blood flow.
Laser angioplasty is a technique that opens coronary arteries blocked by plaque. In this technique, a thin, flexible plastic tube called a catheter with a laser at its tip is inserted into an artery. It is then advanced to the blockage in the coronary artery. When the laser is in position, it emits pulsating beams of light. The laser beam vaporizes plaque without damaging the surrounding tissue.
Valvuloplasty is a procedure used to widen a stiff or narrowed heart valve as an alternative to open heart surgery.
A catheter with a small deflated balloon is inserted through the skin in the groin area, guided to the heart, and positioned through the diseased heart valve. The balloon is then inflated, enlarging the opening through the valve and improving blood flow through the heart and to the rest of the body. This allows the heart to pump more effectively, reducing pressure in the heart and lungs, and easing
Normally, electricity flows throughout the heart in a regular, measured pattern. This electrical system brings about heart muscle contractions. A problem anywhere along the electrical pathway causes an arrhythmia, or heart rhythm disturbance. By accurately diagnosing the precise cause of an arrhythmia, it is possible to select the best possible treatment.
An EP study is a test that records the electrical activity and measures the electrical pathways of your heart. This test is used to determine the cause of your heart rhythm disturbance and the best treatment for you. During the test, your doctor will safely reproduce your abnormal heart rhythm and then give you different medications to see which one controls it best.
EP studies help your physician decide the best treatment for an abnormal heart rhythm. They also help monitor the effectiveness of antiarrhythmic treatment.
Radiofrequency ablation is a nonsurgical procedure used to treat some types of accelerated heart rates. It’s most often used to treat supraventricular tachyarrhythmias, which are rapid, uncoordinated heartbeats that start in the heart’s upper chambers or middle region.
A physician guides a catheter with an electrode at its tip to the area of heart muscle where there’s an extra pathway. The catheter is guided with real-time, moving x-rays displayed on a video screen. The procedure helps the doctor place the catheter at the exact site inside the heart where cells give off the electrical signals that stimulate the abnormal heart rhythm. Then, a mild, painless, radiofrequency energy is transmitted to the pathway, destroying carefully selected heart muscle cells in a very small area (about 1/5 of an inch), which then stops the area from conducting the extra impulses that caused the rapid heartbeats.