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Heart Health
Glossary
Noninvasive cardiovascular tests
Invasive tests and procedures
Interventional procedures
Surgical Services
Noninvasive cardiovascular tests
ECG: Or electrocardiogram, is the oldest available heart test and is an electrical recording of your heart beat. It gives valuable information about heart rhythm, heart enlargement, and whether or not you have had a heart attack. An ECG is invaluable in helping us evaluate chest pain.
Chest X-ray: This is simply an X-ray of your heart and lungs which gives your doctor information about heart size and whether or not your lungs might contain excess fluid.
Holter Monitor: This is a small tape recorder sized device which records every heart beat you have in 24 hours (normally, about 100,000!). It is useful in matching your symptoms with potential heart rhythm disturbances.
Cardiac event recorder: A small device which can record around a minute's worth of your EKG and then be decoded later. It is especially useful in patients who have rhythm disturbances only once in awhile. Patients generally keep this device for a month.
Treadmill test: An exercise test which takes place on a moving belt or a bicycle while your EKG , pulse, blood pressure, and heart rhythm are continuously monitored. These tests are very useful in determining if your symptoms of chest discomfort or pain are related to blockages in the heart arteries. The test is also very useful in determining fitness levels and to allow your cardiologist to write an accurate exercise prescription for you. The test and its interpretation take about an hour.
Sestamibi (Cardiolite) stress test: A treadmill test coupled with the injection of a weakly radioactive tracer called sestamibi which is taken up by heart muscle cells. The heart is then scanned under a gamma camera and a picture of the blood flow to your heart muscle is created by a computer. Your cardiologist is then able to determine if you have heart artery blockages. Be prepared to stay in the office about 4 hours for this test, so bring something to read!
Dipyridamole (or Persantine) sestamibi stress test: Similar to the above but a medication called dipyridamole is injected into a vein to study the heart's blood flow and you do not have to walk on the treadmill. It is especially useful for people with orthopedic problems or those who we do not think it safe for them to walk on the treadmill machine.
Echo-Doppler test: Also known as an echocardiogram. A specialized machine is used to send a harmless ultrasound beam into your heart. A life-like picture of your heart chambers and valves is created and recorded on a video tape for your doctor to review. Valuable information about your heart size, heart pump function, birth defects, and valve problems is learned from an echo-Doppler. The Doppler portion of the test gives us accurate information about leaky or restricted heart valves. The entire test takes about one hour.
Stress echo test: A stress test coupled with an echocardiogram before and after exercise. Your doctor will be able to tell if you have blocked or narrowed heart arteries by viewing how your heart muscle contracts in response to exercise. This test takes about an hour to complete.
Transesophageal echocardiogram (TEE): A scope with an ultrasound probe mounted on its tip is passed through the mouth into the esophagus just behind the heart. This allows the cardiologist performing the test to obtain very clear pictures of your heart and the aorta (the main artery in the chest). This test is often used when clear pictures of the heart cannot be obtained from the outside of the chest during an echo-Doppler. You will receive light sedation for this test to assure that you are comfortable.
Carotid Doppler study: This is a painless ultrasound study of the four arteries in the neck which carry blood to the brain. It is used to learn about plaque blockages in these arteries in people who have TIAs, or stroke-like symptoms. The test takes less than an hour.
Venous Doppler study: An ultrasound machine is used to examine the veins in your legs or arms to see if they contain blood clots (phlebitis).
Lower extremety arterial study: The blood pressures are measured at various levels in your arms or legs to see if you have evidence of plaque blockages in your arteries. An ultrasound picture is often made of the artery suspected to contain a plaque blockage.
Abdominal aortic ultrasound: An ultrasound picture of the largest artery in the abdominal cavity, the aorta. This test is most often ordered to see if someone has enlargement (an aneurysm) of the aorta in the abdominal cavity.
Invasive tests and procedures
This set of tests require that a small tube, or catheter be inserted into a vein or artery through a tiny nick in the skin. They are all performed with local anesthetic and sedation to assure your comfort. All of these tests are performed in the hospital but an overnight stay is not always needed.
Cardiac catheterization: This test is also called an angiogram, heart cath, or a coronary arteriogram. Small catheters are inserted into a vein and/or artery of the leg or arm and then passed back to the heart under X-ray guidance. The blood pressures in your heart chambers and the amount of blood flow leaving your heart is measured through the catheters. X-ray dye (contrast) is injected through the catheters to make pictures of your heart arteries and into the left ventricle to make a picture of your heart beating.
Electrophysiology (EP) study: A test used to learn where rhythm disturbances, or arrhythmia, come from in the heart. The test also teaches us how fast and dangerous the arrhythmia might be to you and whether or not medicines prescribed to stop the arrhythmia are working. In this test small pacemaker catheters are passed through an artery or vein into the heart.
Lower extremity arteriogram: A catheter is inserted into an artery then used to inject X-ray dye into the leg arteries to determine if plaque blockages are present.
Interventional procedures
These are highly specialized procedures where tools mounted on small catheters are used to clear blockages or cure arrhythmia in order to help relieve symptoms. These procedures generally require a one or two night stay in the hospital.
Coronary angioplasty: Small balloon catheters are passed over a thin guidewire to a site of plaque blockage within a heart artery. Inflation of the balloon compresses the plaque and stretches the artery thereby opening the inner channel of the artery. Relief of the blockage allows more blood to pass downstream through the artery. A successful procedure almost always relives symptoms of angina (chest discomfort arising from the heart).
Coronary atherectomy: A tool containing a high speed spinning wheel shaves the plaque away from the artery wall and collects it in a housing. This technique is useful for removing bulky plaques.
Rotablator: A diamond-tipped burr drill is moved through a blockage disintegrating plaque deposits as it advances. It is often useful in long blockages which contain calcium deposits.
Laser: Plaques are vaporized by high intensity laser energy delivered in a controlled manner from the end of a catheter.
Stents: These are small, thin stainless steel mesh cylinders which are mounted on a balloon and delivered to the site of blockage in a heart artery. The balloon is then inflated thereby stretching the stent and delivering it to the wall of the artery. Stents act as scaffolds within the heart arteries.
The New Mexico Heart Institute also has a Peripheral Vascular Program. Many of the interventional tools used in the heart (coronary) arteries can also be used to clear plaque blockages in the leg arteries.
Ablation: This technique was introduced in the early 1990's and has made it possible for many patients to be cured of tachycardia, or a rapid heart rhythm disturbance. Prior to the introduction of ablation therapy, patients either faced open heart surgery or a lifetime of taking heart rhythm medicines to avoid having tachycardia. An electrophysiologic study is needed first to discover where the tachycardia arises within the heart. Once the tachycardia circuit is located, high energy radio waves are delivered through the tip of an ablation catheter causing a small, controlled burn of the heart tissue involved in the arrhythmia, thereby cutting the circuit. Ablation therapy is not needed or helpful in all types of arrhythmia. Your cardiologist or cardiac surgeon will discuss ablation with you if it would be helpful to you. A patient receiving an ablation usually needs to spend one night in the hospital.
Surgical Services
Pacemaker: A sophisticated electrical device which is sometimes needed for the treatment of slow heart rhythms (bradycardia). One or two wires are passed into the right heart chambers through a vein under the collarbone and connected to the pacemaker. The pacemaker contains a battery and the circuitry needed to allow the device to interact with your own heart rhythm. It is tucked into a small pouch beneath the skin after it is connected to the wires placed in your heart.The pacemaker is about the size of a small cookie and can last from 5 to 10 years, depending on how much your heart relies on it. The procedure lasts an hour or two and is performed with sedation and a local anesthetic.
Defibrillator: Also known as an AICD or PCD, this device is usually inserted like a pacemaker in patients with runaway heart rhythm disturbances which may cause blackouts or be life-threatening. These remarkable devices can terminate some runaway heart rhythm disturbances by acting as a pacemaker but also can do so by applying a gentle shock to the inside of the heart (defibrillation) to restore normal heart rhythm within precious seconds.
Coronary artery bypass surgery (CABG): Bypass surgery is sometimes needed when interventional therapy is too risky, medications have failed to control symptoms of angina, or when surgery is felt to be the best treatment for assuring long term survival in patients with heart artery blockages, or coronary artery disease. Veins from the leg or the internal mammary artery from the inside of the chest are used as conduits to carry oxygen rich blood to points downstream beyond blockages or narrowings within heart arteries.
Valve replacement surgery: Leaky or narrowed heart valves sometimes reach a point where they need to be replaced to prevent further enlargement or weakening of the heart muscle and to reduce or eliminate symptoms. There are many types of heart valves available: prosthetic valves made of manmade materials, valves from pigs, which closely resemble human valves, valves from human cadavers, and man made valves constructed from animal tissues. Sometimes the surgeon is able to repair and not replace your heart valve. In rare situations our surgeons can transplant a healthy valve from one part of the heart and insert it where the diseased valve is removed. An artificial valve is then placed where the transplanted valve was removed from. Your surgeon and cardiologist will discuss your particular options for heart valve surgery with you and your family.
Aneurysm repair: Surgery is sometimes needed to repair or remove aneurysms involving the major arteries of the body. The diseased segments of the involved artery are usually replaced with a synthetic graft made out of materials such as Gortex or Dacron.
Peripheral bypass surgery: Surgery is sometimes needed to improve threatened or inadequate blood supply to limbs or vital organs like the kidneys. The bypasses are made out of manmade materials or veins "borrowed" from other parts of the body where they are not vital.
Carotid endarterectomy: Plaque narrowings in the carotid arteries of the neck can sometimes cause serious nervous system symptoms such as a stroke or a TIA. A TIA stands for a transient ischemic attack, a temporary interruption in the blood flow to the brain causing transient nervous system symptoms. The plaque is removed from the inside of the artery during this surgery.
Thoracoscopy: Sometimes chest surgery can be accomplished through a small scope introduced into the chest cavity during general anesthesia. The smaller incisions speed the patient's recovery and shorten hospital stays. Our surgeons are trained in this technique.
Cardiac transplantation: Where a very diseased heart is surgically removed and replaced by the heart of a donor. Transplantation is reserved for patients who have exhausted all options with heart medications or corrective types of heart surgery such as bypass or valve replacement surgery. Candidates for transplantation are carefully screened and taught a great deal about the transplant surgery and aftercare during their wait before the transplantation.
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