Cardiology Services

Echocardiography

An Echocardiogram, often referred to as a cardiac echo or simply an echo, is a sonogram of the heart. Echocardiography uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart.

 

Echocardiography has become routinely used in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases. It is one of the most widely used diagnostic tests in cardiology. It can provide a wealth of helpful information, including the size and shape of the heart (internal chamber size, quantification), pumping capacity, and the location and extent of any tissue damage.

Contrast Echocardiography

Contrast Echocardiography refers to the injection into the bloodstream of an agent that results in increased echogenicity of the blood or myocardium on ultrasound imaging, producing opacification of the cardiac chambers or an increase in echo density of the myocardium. Ultrasound “contrast” is generated by the presence of microbubbles in the ultrasound field. At low ultrasound power outputs, microbubbles scatter ultrasound at the gas-liquid interface, resulting in the detection of a strong signal by the transducer. Fundamental ultrasound imaging is based on detection of this signal reflected from the gas-liquid interface..

Contrast Agents

There are two types of echo-contrast agents, those that opacify the:

▪   Right heart

▪   Left heart & Myocardium The most widely used agent for contrast of the right heart is agitated saline. Commercially available contrast agents for the left heart consist of air or low solubility fluorocarbon gas in stabilized microbubbles encapsulated with denatured albumin, monosaccharides, or other formulations.

 

Applications

Contrast echocardiography has four proposed diagnostic applications:

▪   Detection of intracardiac shunts

▪   Enhancement of Doppler signals

▪   LV opacification

▪   Myocardial perfusion

Stress Test

A cardiac Stress Test is a treadmilll test that measures a heart's ability to respond to external stress in a controlled clinical environment. The stress response is induced by exercise or by drug stimulation.

 

Cardiac Stress Tests allow us to assess a patient's  coronary circulation during maximum physical exertion, lookiing for evidence of any impaired blood flow to the myocardium (heart muscle tissue). This test can be used to diagnose coronary artery disease (also known as ischemic heart disease) and assess patient prognosis after a myocardial infarction (heart attack).

Stress Echo

A Stress Echocardiogram is a procedure that determines how well your heart and blood vessels are working.

It combines certain features of an ultrasound of the heart with those of a stress test. 

 

A Stress Echo test has 3 phases.

  1. Step one: the patient lies on the exam table and the technician performs an echocardiogram as a baseline reading of the LV (left ventricular) function at rest.

  2. Step two; the patient undergoes a standard treadmill test, where the speed and grade of the treadmill are increased every three minutes. At each interval, the technician and doctor check the patient for a change in symptoms [usually pain or shortness of breath], while monitoring his/her vitals and watching for ECG changes. The patient remains on the treadmill until he/she become symptomatic or they reach their target heart rate. 

  3. Step three: the patient quickly returns to the exam table and receives a post-exercise echocardiogram so that we can determine if there has been any change in the heart function [chambers, valves and pulmonary pressures]

 

Your doctor may order a stress echocardiography test if you have chest pain which they think might be due to coronary artery disease.The test can also tell your doctor how effectively your treatments are working; treatments such as bypass grafting, angioplasty, anti-anginal or antiarrhythmic medications.

Event Loop Recorder 

A cardiac Event Loop Recorder (ELR) is a battery-powered portable device that you control , so that you may tape-record your heart’s electrical activity (ECG) whenever you have symptoms and trigger it. It is constantly digitally recording the heart rhythm, and will only save information when you activate it or when it gets 'auto-activated' by an unusually fast or sloe rhythm 

So, an ELR can make a record of your heart rhythm whenever you have fast or slow heartbeats, or feel dizzy or to faint. The recording that you trigger will include heart beats both before and after the specific event, and the doctor can then decide if the rhythm uncovered merits any specific treatment.

Holter Monitor

A Holter Monitor is a battery-operated portable device that measures and records your heart’s activity (ECG) continuously for 24, 48, 72 hours or longer depending on the type of monitoring used. The device is the size of a very small camera. It is attached to your chest by wires with electrode pads.

You may be asked to wear a Holter monitor to see if you have a slow, fast or irregular (uneven) heartbeat.

Your doctor may use it to see how well your medicine is working to treat these problems.

If you have a pacemaker and feel dizzy, your doctor may use a Holter monitor to determine  if your pacemaker is working properly.

This monitor has no risks and wearing it isn’t painful.

The results of wearing a Holter monitor will help you and your doctor determine if you need more tests or medication to manage your arrhythmia, or whether or not you might need a pacemaker or cardioversion procedure to restore a regular heart rhythm.

Electrocardiogram

 

An Electrocardiogram — abbreviated as EKG or ECG — is a test that measures the electrical activity of the heartbeat. With each beat, an electrical impulse (or “wave”) travels through the heart. This wave causes the muscle to squeeze and pump blood from the heart. 

 

ECGs are quick, safe, and painless. With this test, your doctor may be able to:

  • Check your heart rhythm;

  • See if you have poor blood flow to your heart muscle (this is called ischemia);

  • Diagnose a heart attack;

  • Assess for structural heart disease 

Ambulatory Blood Pressure Monitor

 

An Ambulatory Blood Pressure Monitor (ABP) is a portable blood pressure recording device. It is used to record blood pressure readings at specified times during a 24-hour period. The monitor consists of an arm cuff attached by a flexible rubber tube to a light-weight monitor. The monitor sits in a pouch held by a waist belt or shoulder strap. This test is usually ordered if a diagnosis of high blood pressure (hypertension) is suspected.

One of the advantages of using an ambulatory BP monitor compared with a home BP monitor, is that we may obtain blood pressure readings during the hours when the patient is asleep. This can be very helpful in certain patients who may only have elevated blood pressure while they are asleep, which we  often see with those who have sleep apnea.