Cardiac and Vascular Diagnosis
Many times, cardiac and vascular symptoms are misdiagnosed or thought to point to other health conditions. When this happens, the disease progresses, putting patients at risk. Our cardiovascular experts are specially trained to recognize and treat cardiovascular disease—so you receive the most advanced and effective care you need right away, for a fuller, more active life.
Diagnostic tests like the following help your doctor identify any condition you may have and determine your best course of action and treatment plan:
This test helps detect narrowed or blocked arteries or weakening of the blood vessels. An x-ray contrast, or dye, is injected into your arm or groin while a series of X-rays are taken. Once in the bloodstream, the dye highlights the arteries, allowing the area of blockage to be accurately pinpointed.
Cardiovascular Imaging and Cardiac Catheterization
Cardiac catheterization is a minimally invasive diagnostic and treatment option that involves passing a catheter (a thin, flexible tube) through the vessels supplying blood to the heart and injecting dye through the catheter. Interventional cardiologists use this procedure to tell how well your heart is functioning and to diagnose any possible cardiac disease or blockages.
Cardiac catheterization enables doctors to:
- Determine the pressure and blood flow in the heart's chambers
- Examine the valves and blood vessels of the heart
- Identify heart abnormalities
The procedure is performed in a catheterization laboratory (also called a cath lab). During a cardiac catheterization, the interventional cardiologist uses a number of advanced cardiovascular imaging tests to assess the heart’s functioning:
- Optical Coherence Tomography (OCT) uses fast-traveling light waves (instead of sound waves) to produce detailed pictures of the inside of the heart’s blood vessels.
- Fractional Flow Reserve (FFR) uses a thin wire to measure the blood pressure and blood flow through a specific part of the coronary artery. This test is used to help doctors determine the best course of treatment to help increase a healthy blood flow to the heart.
- Intravascular Ultrasound (IVUS) uses a special catheter that uses sound waves to see the inside of blood vessels and arteries.
Cardiac CT (Computed Tomography Scan)
A CT scan uses computer technology and X-ray imagery to produce high-resolution, three-dimensional images of the heart’s anatomy and circulation. A coronary CT may or may not involve the use of x-ray contrast, or dye, to visualize arteries, chambers, and valves of the heart. Though it offers a patient experience similar to having an X-ray, a cardiac CT scan provides detailed information about the inner workings of the heart. The test can be used in diagnosing abdominal and thoracic aneurysmal disease, as well.
Coronary Calcium Scan (Heart Scan)
A coronary calcium scan uses advanced x-ray technology known as computed tomography, or CT, to detect calcium deposits in the plaque (atherosclerosis) on the walls of the coronary arteries. Having calcium in the arteries that supply blood to the heart may be a sign of coronary artery disease—and may increase your risk of a heart attack.
Calcium scoring is a safe and simple test that takes about 15 minutes and uses only a small amount of radiation (similar to the amount in two or three mammogram tests). Your doctor will receive a detailed report, including your calcium score and a comparison of your score to normal values, and will discuss the results with you, to help lower your risk for heart disease, heart attack, and stroke.
Why should I get a heart scan?
Cardiac MRI (Magnetic Resonance Imaging)
Cardiac MRI is a non-invasive test that creates detailed pictures of the heart and nearby blood vessels using radio waves, magnets and computer technology. Using MRI, doctors are able to create both still and moving pictures of the heart and surrounding vessels, and to assess the heart’s structure and function, without using contrast (dye) or radiation. During an MRI, you will be asked to lie on a padded table, which will move into the donut-shaped MRI machine. You will not feel anything, but will hear a noise as the images are being taken. An intercom allows you to communicate to your care provider during the scan.
A duplex scan uses ultrasound to measure the blood flow through the arteries and veins. It can detect blockages, narrowing, or other abnormalities in the veins and arteries. A special wand that sends out sound waves is moved over the area being tested, while a computer records and measures the sound waves and then converts the sounds into pictures. In addition, the test records the sound of the blood moving through the veins and arteries, to measure the speed and health of the blood flow.
Electrocardiogram (ECG or EKG)
Electrocardiogram (ECG or EKG) records the electrical activity of the heart. The test is used to determine if the heart is beating normally, and can be useful in determining if an implanted heart device is working properly. An EKG can be done as part of a routine health examination, or your doctor may order it if you show symptoms of a heart problem, such as chest pain or breathing problems.
During an EKG, several wires with electrodes that attach to the skin will be placed on your chest, arms and legs as you lie flat. A computer creates a graph of the electrical impulses—or heartbeats—so that your doctor can evaluate the rhythm of your heart during the time of the test.
Electrophysiology Studies (EPS)
An electrophysiology study, or EPS, is a diagnostic test that measures the electrical activity of your heart. It is the most accurate and reliable method of evaluating your heart rhythms and will help your doctor determine the cause of your abnormal heartbeat or arrhythmia. During an EPS, a small, specialized electrode catheter is inserted into a blood vessel leading to your heart. Your electrophysiologist uses this catheter to send electrical signals to your heart and is able to record its activity. He or she uses this information to determine where your arrhythmia is coming from and how it should be treated. Learn more about electrophysiology.
During a heart biopsy, your physician performs a cardiac catheterization to access the heart muscle and remove tissue samples to be sent to a lab for analysis. This test can be useful in determining if you have heart conditions such as cardiomyopathy (a weakening of the heart muscle that can lead to heart failure), myocarditis (inflammation or swelling of the heart muscle) or cardiac carcinoma (cancer), or to ensure that your body is not rejecting a newly transplanted heart.
A Holter monitor is a portable device worn continuously for 1-2 days or so that measures and record heart's activity (ECG) continuously. The small, battery-operated device contains wires with electrodes that attach to the skin with medical adhesive; there is no pain and no risk to the wearer. As it measures your heart rhythms, you will be asked to record your activities in a daily log, so that your doctor can look for patterns or triggers for abnormal heartbeats.
Though Event monitors are similar to Holter monitors, there is one important difference: An Event monitor records your heart rhythms only at certain times as you’re wearing it (wearers are able to activate the Event monitor during a heart episode), while a Holter monitor records your heart’s electrical activity the entire time you’re wearing the device.
Insertable Cardiac Monitor
Sometimes, a patient's arrhythmia may not show up while the EKG is being recorded. In order to help better determine the cause of your irregular heartbeat (arrhythmia) or unexplained fainting spells (syncope), your electrophysiologist may prescribe an insertable loop recorder. This small device is placed underneath the skin close to the heart and continuously records the heart's rhythms over long periods of time. The test results are sent to the cardiologist so he or she can analyze the patterns for cardiac arrhythmias.
Positron Emission Tomography (PET) Scan
A PET scan is an advanced, non-invasive test used to evaluate the blood flow to the heart. During the test, a very small dose of a radioactive chemical, called a radiotracer, is injected into the arm. Patients are asked to lie flat on an exam table that is then placed in the center of PET scanner. The scanner detects and records the activity of the tracer substance, and, using a specialized computer, produces three-dimensional images of the heart. These specialized images help your cardiologist detect heart problems such as coronary artery disease and damage to the heart following a heart attack.
Remote monitoring means that your heart device can be tracked using a special in-home monitor. Once every 24 hours , the data from your device is transmitted to a secure website where your heart care team can review it. Learn more about remote monitoring here.
Stress tests are used to determine the amount of physical activity your heart can safely handle before developing an irregular heartbeat or loss of blood flow. There are several different kinds of stress tests performed by medical professionals that can be used to detect evidence of coronary artery disease, congestive heart failure, and cardiac arrhythmias:
- Chemically Induced, Dobutamine or Adenosine Stress Test
Some patients are unable to endure a level of physical activity needed to get the test results. In these instances, patients are given a medication that has a similar effect on the heart as that of exercise . This allows the cardiologist to safely assess the heart’s response to stress, and no physical activity is required. During this test, you will feel your heart rate increasing.
- Treadmill or Exercise Stress Test
This test involves walking on a treadmill at increasing rates, while your EKG, heart rate, and blood pressure are measured. This test helps evaluate the function of your heart and valves and may help determine your likelihood of having coronary artery disease.
- Nuclear Stress Test
A very small amount of radioactive substance, or tracer, is injected into the patient. A special camera that detects the rays produced by the tracer creates detailed pictures of the heart tissue. These images identify areas of the heart that have decreased blood flow. A nuclear stress test may be prescribed in addition to a treadmill stress test.
- Stress Echocardiogram (Stress Echo)
An echocardiogram, or echo, is an ultrasound image of the heart that details its structure—its size, shape, the motion of the valves and the blood flow. An echocardiogram involves a device called a transducer, which is placed on the chest. The transducer transmits high-frequency sound waves that are measured and captured by a special camera that produces detailed images of the heart. This test involves walking on a treadmill for several turns; in between these periods, the stress echo images are taken. It is a painless test that takes between 15-30 minutes and helps diagnose coronary artery disease, heart valve disorders, and enlargement or thickening of the heart muscle (hypertrophic cardiomyopathy).
Tilt Table Test
During this test, you will lie on a table that is tilted at different angles as your blood pressure, pulse, oxygen levels and the heart’s electrical activity (EKG) are monitored. This test can be used to determine if unexplained fainting spells (syncope) are the result of an irregular heartbeat (arrhythmia) or other heart condition.
A transesophageal echocardiogram, or TEE, is a test that allows doctors to examine the size and shape of your heart, and determine how well your heart chambers and valves are working. TEE uses ultrasound, or high-frequency sound waves, to produce detailed images of your heart, including the muscles, chambers, valves, outer lining (pericardium) and surrounding blood vessels. During the test, a small probe is inserted in your throat and carefully guided into your esophagus. The sound waves produced by the probe create video images of your heart, allowing doctors to detect problems with your heart’s structure or functioning.
TEE is useful for:
- Detecting blood clots and abnormal masses
- Determining the severity of heart valve problems
- Detecting certain heart diseases
- Evaluating patients who have suffered a stroke due to a blood clot
This is a non-invasive test used to discover if a patient has a risk of having ventricular tachyarrhythmias (rapid heartbeat). By reading and analyzing the T-Wave pattern on your EKG, your cardiologist can determine if you are at risk for cardiac arrhythmias, or irregular heartbeat.
This sound-wave test measures blood pressure and blood flow in the arms and legs using ultrasound technology. During an ultrasound, a device called a transducer uses high-frequency sounds to produce detailed images of the part of the body being examined. Doppler ultrasound uses the same technology to bounce sound waves off circulating red blood cells, allowing your doctor to estimate the rate and health of your blood flow. During this test, you will lie flat while the transducer is placed over the area being studied. This painless and non-invasive screening is used to diagnose an arterial blockage, a blood clot inside a blood vessel or bypass graft or an injury to a blood vessel.
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