Outpatient Services

Vascular Ultrasound uses the same technology as Echo where sound waves are used to visualize the larger arteries such as the carotids in the neck, the aorta in the abdomen, the arteries leading to the kidneys, and the arteries leading to both legs. With this testing we can look for plaque or narrowing in these arteries and estimate the amount of blockage. This is also a non-invasive test meaning that no needles are involved. These tests are similar to ultrasounds performed on pregnant women to look at babies in utero; but in this case are directed at specific arteries and/or the heart. This is a very safe and painless test.

Over half the people who died suddenly of a heart attack had no prior symptoms. To combat this, you can undergo a coronary artery calcium scoring (CACS) exam to scan the heart and detect calcium deposits along the walls of arteries. The test then produces a calcium score that identifies your level of deposits. Taking into account other factors such as age, family history, and cholesterol level, you doctor uses that score to measure your potential for heart disease. this quick and easy screening takes only 5 minutes and gives immediate results.

It is recommended that people between 20 and 40 undergo a physical examination, including some type of cancer and cholesterol screening, every three years. If you’re over 40, an exam should be done every year. Factors that necessitate more frequent and in-depth screenings
include:

• Family history
• Tobacco use
• Environmental risks (chemical or radiation exposure)
• Lifestyle (nutrition, diet, and exercise)

Certain frequently performed lab tests can be obtained in our office with the convenience of a finger stick. For patients on chronic coumadin therapy, protimes can be measured with this test and results available while the patient waits (less than 5 minutes). This allows for coumadin to be adjusted during one visit rather than waiting for a follow-up phone call. We can also measure cholesterol and liver function tests in this way. These results are immediately available as well. The cholesterol testing must be performed in a fasting state (ie. nothing to eat for 12 hours before the test).

Nuclear medicine provides functional imaging of the heart. It involves injecting medically safe radioisotopes to detect the presence of heart disease. Stress myocardial perfusion imaging adds significant diagnostic and prognostic information predicting long-term outcome in patients with diabetes. Our nuclear medicine services consists of:

• Cardiac PET
• Myocardial perfusion studies (Myoview)
• Perfusion imaging
• Pharmacological stress tests
• Ventricular funtion

Vascular Ultrasound uses the same technology as Echo where sound waves are used to visualize the larger arteries such as the carotids in the neck, the aorta in the abdomen, the arteries leading to the kidneys, and the arteries leading to both legs. With this testing we can look for plaque or narrowing in these arteries and estimate the amount of blockage. This is also a non-invasive test meaning that no needles are involved. These tests are similar to ultrasounds performed on pregnant women to look at babies in utero; but in this case are directed at specific arteries and/or the heart. This is a very safe and painless test.

Certain frequently performed lab tests can be obtained in our office with the convenience of a finger stick. For patients on chronic coumadin therapy, protimes can be measured with this test and results available while the patient waits (less than 5 minutes). This allows for coumadin to be adjusted during one visit rather than waiting for a follow-up phone call. We can also measure cholesterol and liver function tests in this way. These results are immediately available as well. The cholesterol testing must be performed in a fasting state (ie. nothing to eat for 12 hours before the test).

Resting and Stress Echo is an ultrasound of the heart at rest and is then repeated at peak exercise and allows us to see the movement of the walls of the pumping chamber of the heart and compare them at rest and with exercise.

Echocardiography is an ultrasound examination of the heart in great vessels. This is a non-invasive test and normally does not require an IV injection. The ultrasound enables us to accurately measure the heart size, to see the motion of the walls and evaluate the overall heart muscle function, to evaluate blood flow through the valves, and to look for fluid in the sack surrounding the heart. An Echo is a very common diagnostic tool and will usually be one of the first tests ordered if a murmur is present or to evaluate congestive heart failure.

Basic treadmill exercise testing involves EKG monitoring at rest and continuously while walking on a treadmill, which starts at a slow rate and with a mild incline, increases every three minutes until a person has reached their target heart rate or has one of several clinical indications for stopping. An EKG may be normal at rest but with exercise show changes that indicate a likely presence of blockages or narrowing of the coronary arteries. With exercise and increased heart rate, the heart needs more oxygen and therefore more blood flow. If there is a fixed narrowing in one of the coronary arteries, blood flow will be unable to increase in that region and that area of the heart will become ischemic (lacking sufficient oxygen). This is what causes angina, which may be experienced on the treadmill, causes EKG changes, and other defects as discussed below. Sometimes stress tests will be performed with a secondary imaging technique; both to give greater information, greater accuracy and especially if the EKG is abnormal at baseline.

We offer Stress Echo, which is an ultrasound of the heart at rest and is then repeated at peak exercise and allows us to see the movement of the walls of the pumping chamber of the heart and compare them at rest and with exercise. This is in addition to the findings on EKG and generally speaking overrules abnormalities in the EKG. Sometimes Stress Echo will be performed with the injection of a special inert contrast, which allows us to see the heart walls better.

We also offer Nuclear Cardiology. This involves injecting a small amount of radioactive tracer into the vein at rest showing the perfusion or blood flow to the heart at rest. Then after exercise or chemical stress testing, the second injection of tracer is performed and pictures obtained. These two views are then compared to see if an area of the heart fails to get enough blood flow during stress conditions, which implies a narrowing in one of the coronary arteries leading to that part of the heart.

Chemical stress testing can be used in place of treadmill exercise testing for either stress echo or stress nuclear studies. With chemical stress testing, no exercise is performed and a short-acting IV medicine is given which dilates the arteries and/or stimulates the heart to simulate exercise. The decision to use exercise or chemical stress testing will be made by you and your physician based on your ability to perform the exercise test, your underlying EKG, and other clinical factors.