Diagnosis And Treatment

The physicians of the South County Heart Center use the latest and most sophisticated technology available to objectively evaluate and diagnose thepatient's condition. Appropriate to our mission to provide the highest quality medical care, we carefully explain the results of this assessment to the patient, his family and primary physician. Our physicians then formulate a care plan tailored to the individual patient's specific needs. We encourage patient and family participation in all aspects of the diagnostic and treatment program. Our close communication and professional relationship with the primary physician ensures that our efforts are integrated into the overall care of our patients.
Our Services

Cardiac Monitoring

Holter Monitor
A holter monitor is a continuous recording of your heart's electrical activity while you are doing your routine daily activities. You will be wearing a portable tape recorder which is attached to your chest by wires and patches called electrodes. This holter machine records every heart beat, and it is normally worn for 24 hours. The test is usually performed to look for arrhythmias (abnormal heart beats or rhythms), or for a heart beat that is too slow or too fast. It is sometimes used in patients who are having dizzy spells or palpitations (heart fluttering in the chest) to check for irregularities in the heart rhythm.

Cardiac Event Monitor
A cardiac event monitor (sometimes called a loop monitor) is a small recorder that is used to record a person's heart beat. It looks similar to a holter monitor (24 hour monitor), but it is used a little bit differently. As compared to a holter monitor which is worn for only a day, the event monitor is taken home for up to two weeks at a time. Your heart is monitored continuously while you are wearing the machine, but recordings are made only when you activate the machine. We ask you to activate the recorder when you have symptoms, such as dizziness, nausea, weakness, palpitations, or chest pain. The machine can record and store up to five event (or symptoms), and then the recordings must be transmitted over the phone to the receiving station. Your doctor evaluates these recordings to determine whether your symptoms are due to abnormalities of the heart rate and rhythm.

Signal Average ECG
A signal average ECG is performed in a similar way to a routine electrocardiogram, but the electrical activity of the heart is recorded for five to ten minutes instead of only ten to fifteen seconds. By recording many hundreds of heart beats, the ECG machine is able to perform more sophisticated measurements on the heart's electrical waves. This information can be very useful to detect electrical abnormalities that cannot be detected by a routine ECG, or even a holter or cardiac event monitor. It is often used to evaluate the electrical signals for people who experience loss of consciousness or more serious irregular heart beats.

Cardioversion
The heart works most efficiently when it beats in a coordinated way, called normal sinus rhythm. An arrhythmia is a disturbance of the normal rate or rhythm of the heartbeat. These disturbances occur when the heart's own natural pacemaker malfunctions, due either to disease or aging. Some people develop symptoms when their heart beats irregularly, such as dizziness, palpitations (an awareness of an irregular heart beat), lightheaded, or shortness of breath. Cardioversion is the technique to return the heart to a normal beat, and reduce the person's symptoms and return their heart to coordinated function. An electrical cardioversion is the use of electrical energy to convert certain kinds of arrhythmias (irregular heart rhythms) to a normal rhythm. The heart rhythm can also be changed to normal with the use of medication, a procedure called chemical cardioversion. The most common arrhythmia that we convert is called atrial fibrillation. In atrial fibrillation, the atria, or top part of the heart beat very rapidly and irregularly. This causes the pumping chambers of the heart to beat very irregularly, and often too rapidly. Most people with atrial fibrillation need to take medicine to prevent the pumping chamber from beating too fast. Other common arrhythmias that we convert in this way are atrial flutter and supraventricular tachycardia (SVT).

Exercise stress testing

An exercise stress test is a measurement of your heart's health under the stress of physical exercise. Stress testing is most often performed to look for evidence of coronary artery disease (narrowing of the blood vessels that feed the heart). Other reasons to do a stress test include evaluation of palpitations, and evaluation of a person's exercise capacity after intervention (angioplasty or bypass surgery), a heart attack, or before starting cardiac rehabilitation.

The basic concept of a stress test is to exercise the heart. It is usually performed on a treadmill, but can be done on a stationary bicycle. The doctor is present during the procedure. The level of difficulty increases as the exercise progresses. You are not required to exercise for a specific length of time; the time of exercise varies from person to person. In most patients, the basic stress test does not give us all of the information that we need. Therefore, we combine the stress test with some kind of imaging of the heart. This gives your doctor much more information about the blood flow and function of the heart.

Echocardiography-Transthoracic, Transesophageal and Stress-Echocardiography

Transthoracic Echocardiogram
A transthoracic echocardiogram (or TTE) is a test that produces images of the heart muscle contraction and blood flow in the heart itself. Using ultrasound (high frequency sound waves) directed to the heart, the echocardiogram is useful to evaluate the function of the heart muscle and the heart valves. A great deal of information can be obtained for patients who have had previous heart attacks, with heart failure, or with leaking or narrowed heart valves with this technique.

During the test a transducer (a device that produces sound waves) will be lubricated and held in various positions on the chest to fully evaluate all portions of the heart and the blood flow across all of the heart valves. The transducer sends and receives sound waves from the heart and from the blood flowing from the heart, creating a picture on a video screen. The images are also recorded on VCR tape and reviewed by your doctor.

Transesophageal Echocardiogram
A transesophageal echocardiogram (or TEE) is a test using ultrasound waves to take pictures of the heart and its valves. In this procedure, a flexible tube with transducer at the end is introduced in the esophagus (swallowing tube). Since the esophagus is just behind the heart, this transducer can be positioned to take very clear pictures of the heart and its structures. These images are much clearer and more detailed than the pictures from a transthoracic echo. This test is most typically performed when the standard echo does not provide your physician with all of the information about your heart that is needed. A TEE provides the doctor with information about the size of the heart chambers, the functioning of the heart muscle, fine detail about the function of the valves, possible bacterial growth on the heart valves or clots forming in the heart.

Stress Echocardiogram
A stress echocardiogram is a measurement of your heart's health under the stress of physical exercise. Stress echocardiography uses the standard procedure of a transthoracic echo performed with the transducer on the chest. For a stress echo, images are taken of the heart's function both at rest and at peak exercise. A comparison of the heart's function during rest and exercise is made. The exercise is typically performed by walking on a treadmill, but can also be done on a stationary bicycle. This test is most often performed to look for evidence of coronary artery disease (narrowing of the blood vessels that feed the heart).

Occasionally, a patient may not be able to exercise due to orthopedic limitations, weakness, arthritis or other problems. In these individuals, the heart is stressed using a medication called dobutamine, and the test is called a dobutamine stress echo. (Dobutamine is a safe medication often used to help the heart beat more strongly in patients with weak heart muscles) To perform the test, a transthoracic echo is performed at rest. Following this, in place of increasing the difficulty level of the walking exercise, dobutamine is given intravenously in gradually increasing amounts until the heart rate increases sufficiently. When the heart rate is high enough, the echocardiogram is repeated. These pictures are then compared to the echo images obtained before the medication.

Nuclear Cardiology

Nuclear cardiology is the use of certain materials called isotopes that give off very low doses of radiation, to learn more about how the heart muscle functions. The nuclear isotope is injected into a vein using an IV and is absorbed by the heart. After being absorbed by the heart, this isotope permits a sophisticated computer to produce a picture of the heart. The picture allows the doctor to understand a great deal about the blood flow to the heart, the size of a previous heart attack, and how well the heart functions.

In most patients a basic stress test does not give us all of the information we need. Nuclear imaging of the heart is combined with the stress test to learn more about how well blood flows to the heart muscle and how the heart is contracting. The nuclear isotopes most commonly used are Technitium and Thallium. The nuclear test is a combination of two sets of pictures, one set taken when the patient is at rest, the other taken with exercise. To create the rest pictures, the isotope is injected into a vein while the patient is resting, and a picture of the blood flow and heart function is produced. This medication is also injected into the IV near the end of the exercise test and a second set of pictures is obtained. The physician then compares the stress and resting pictures to see if there is evidence of a narrowed blood vessel feeding the heart muscle. With sophisticated computer processing of the pictures, the physician can also watch the heart beating to evaluate its function.

When a patient cannot exercise due to orthopedic limitation, arthritis or weakness, a medicine called adenosine may be used to simulate exercise. Adenosine dilates blood vessels and helps highlight areas of the heart that have decreased blood flow. Adenosine is infused by vein for six minutes, the nuclear material is injected in the middle of this infusion to obtain 'stress' pictures and to determine areas of reduced blood flow to the heart. Stress nuclear imaging, whether done with exercise or with adenosine is much more accurate to detect areas of reduced blood flow than the basic exercise stress test alone

Permanent Pacemaker Implantation

To insure that a sufficient amount blood is pumped to the body, the heart has a natural pacing and electrical system that uses tiny electrical impulses to control its rate and rhythm. In some individuals, the heart beats very slowly. There are many causes, but most people it is due to either disease or aging of the heart's own electrical system. A pacemaker is recommended for individual's who experience symptoms that are caused by a very low heart rate. These symptoms include lightheadedness, dizziness, fainting, or a decrease in energy and stamina.

A pacemaker is an electronic device that is placed inside the body to prompt the heart to beat. It serves as a backup electrical system, providing a safety net when the heart's own beat is insufficient. A pacemaker is actually a two part system. The two parts are the pulse generator (the 'pacemaker' itself), and the leads (or wires). The pulse generator controls the entire pacing system and contains the battery and electronic circuitry that is actually a small computer. The pacing leads are thin, specially insulated wires inserted through a vein and positioned in the heart. The leads are also connected to the pacemaker. They conduct electrical signals from the heart to the pacemaker and carry impulses from the pacemaker to the heart. A small incision is made to allow placement of the generator and leads under the skin in the shoulder area under the collar bone. The incision is closed using several stitches.

There are different kinds of pacemakers, some have one wire while others have two wires. A single chamber pacemaker sends signals to only one chamber of the heart and uses one wire. A dual chamber pacemaker regulates the electrical signals of both the upper and lower heart chambers and helps the heart to beat in a more normal way. This type of pacemaker uses two wires. Some pacemakers can also increase a person's heart rate during exercise and then let the heart beat more slowly during rest.
The pacemaker begins working as soon as the leads are placed in the heart and connected to the pacemaker. Your doctor checks the pacemaker and lead function very carefully during implantation. In the hospital, the heart is monitored to make sure that the pacemaker is working correctly. To insure that you have the very best results from your pacemaker system, we carefully select the model that best suits your needs and monitor pacemaker function in the pacemaker clinic.

Cardiac Catheterization

Cardiac catheterization is an invasive cardiology test that is performed to evaluate the pumping function of the heart muscle, determine the extent of narrowing(s) in the blood vessels that feed the heart, and assess heart valve function. It is done by introducing a plastic catheter into the blood vessels in the leg or arm and advancing them into and near the heart itself. During the catheterization procedure, multiple blood pressure measurements are made in different chambers of the heart and blood vessels that lead to and from the heart. X-ray pictures are taken of the heart muscle and of the blood vessels. This test is very useful to evaluate heart valve function in patients with very leaky or severely narrowed heart valves. At the present time, cardiac catheterization is usually performed to determine the extent and severity of narrowing coronary artery disease. Taking pictures of the blood vessels to the heart is called coronary angiography or arteriography.

Coronary angiography (or arteriography) is an x-ray procedure, part of the heart catheterization, performed to examine the coronary arteries, the arteries that provide the heart muscle with blood. It is done with a special x-ray movie camera. The blood in the heart and blood vessels is not visible to the physician with x-ray alone. To see the blood vessels, a catheter inserted into the leg or arm and is advanced into the aorta (the main artery of the body) to where the coronary arteries originate. Then, a small of amount of dye is injected into the blood vessels. This dye (or contrast) allows the physician to see the blood vessel using the x-ray camera, and then determine whether there is a problem with the arteries. In the cath lab, the contrast allows a moving x-ray picture to be taken of the coronary arteries so that their structure can be seen clearly. Coronary angiography is the most accurate test available at this time to detect the presence of coronary artery disease. It is also the best way to show which parts of the blood vessels are narrowed or completely blocked. The results of the cardiac catheterization are used to determine the best method to treat coronary artery disease. If an angioplasty (PTCA) or bypass operation (CABG) is needed, the pictures obtained during the catheterization are used by the physician performing these next procedures.

Angioplasty & Stent Placement

A stent is a small device that is placed in an artery to help keep it open. It is a permanent implant that remains in the artery. By keeping the artery open, the stent improves the flow of blood and helps relieve symptoms of coronary heart disease.

A stent is usually implanted when there is a concern that the artery may close off after an angioplasty. Other times, a stent may be implanted to help reduce the chance of restenosis. Most patients having angioplasty today also receive a stent.

How Does a Stent Work?
Stents come in several designs. For example, a stent may look like a small metal coil, a slotted tube, or a mesh. A stent is usually less than an inch long, is as narrow as a piece of spaghetti, and weighs as little as a straight pin. A stent acts like a tiny metal scaffold that supports the artery's walls.

Specialty Clinic - Anticoagulation (Coumadin) Clinic

At the current time, many patients receive blood thinners (anticoagulants). These medications are divided into two groups, medicine that is taken by mouth and medicine that is injected. The medicine taken by mouth is called Coumadin (or warfarin). The purpose of taking this medicine is to reduce the chance of forming blood clots that can harm an individual. People take a blood thinner after replacement of a heart valve, with irregular heart rhythms such as atrial fibrillation or atrial flutter, occasionally after a heart attack, or when blood clots develop in the deep veins of the leg.

The anticoagulation clinic is designed to help patients understand why they are taking a blood thinner, ways to minimize the chance of a complication, the signs and symptoms to watch out for that could indicate a problem is occurring, and to make sure that the blood is thinned appropriately. We review the do's and don'ts, and make sure that you understand what vitamins, medicines and foods need to be avoided while taking coumadin.

When starting in the anticoagulation clinic, the patient participates in several educational classes with a specially trained nurse. We provide written material and use multimedia to increase your knowledge of what you can expect. To accurately follow a patient's blood work, we use the best blood test available to determine the level of blood thinning. Using a sophisticated computer system, we track the patient's blood thinning history and make sure that blood tests are done when they are needed. Most importantly, we give you the results of your blood test on the same day it is drawn, either in our office or at your home, and we are available to answer your questions.

Specialty Clinic - Pacemaker Clinic

A permanent pacemaker is implanted to assist the heart's conduction system. It is usually inserted to prevent the symptoms and other effects of a slow or irregular heart beat. In the pacemaker clinic, our goal is to help you to understand the function of your pacemaker, to answer questions you may have, to do periodic checks to make sure that your pacemaker is working properly, and to make any necessary changes to the pacemaker - to 'fine tune' it for your needs.

You will be seen in the pacemaker clinic one week after implantation of the pacemaker, and then every month for the first three months. This is done to check the function of the pacemaker and leads during a time that the electrical connection of the leads to your heart can change dramatically. We insure that there is an adequate safety margin to insure the pacemaker works as it was designed. Adjustments are generally made three months after implantation to extend the life of the pacemaker's battery.

Following the initial three months, your pacemaker will be checked every three to four months. At the time of each appointment your next appointment will be scheduled. For those of you who spend a significant amount of away from Venice, we have telephone transmitters available to check your pacemaker by telephone, or you may establish with a physician who can check the device for you when you are away.
Angioplasty & Stent Placement
A stent is a small device that is placed in an artery to help keep it open. It is a permanent implant that remains in the artery. By keeping the artery open, the stent improves the flow of blood and helps relieve symptoms of coronary heart disease.

A stent is usually implanted when there is a concern that the artery may close off after an angioplasty. Other times, a stent may be implanted to help reduce the chance of restenosis. Most patients having angioplasty today also receive a stent.

How Does a Stent Work?

Stents come in several designs. For example, a stent may look like a small metal coil, a slotted tube, or a mesh. A stent is usually less than an inch long, is as narrow as a piece of spaghetti, and weighs as little as a straight pin. A stent acts like a tiny metal scaffold that supports the artery's walls.
Anticoagulation Clinic

At the current time, many patients receive blood thinners (anticoagulants). These medications are divided into two groups, medicine that is taken by mouth and medicine that is injected. The medicine taken by mouth is called Coumadin (or warfarin). The purpose of taking this medicine is to reduce the chance of forming blood clots that can harm an individual. People take a blood thinner after replacement of a heart valve, with irregular heart rhythms such as atrial fibrillation or atrial flutter, occasionally after a heart attack, or when blood clots develop in the deep veins of the leg.

The anticoagulation clinic is designed to help patients understand why they are taking a blood thinner, ways to minimize the chance of a complication, the signs and symptoms to watch out for that could indicate a problem is occurring, and to make sure that the blood is thinned appropriately. We review the do's and don'ts, and make sure that you understand what vitamins, medicines and foods need to be avoided while taking coumadin.

When starting in the anticoagulation clinic, the patient participates in several educational classes with a specially trained nurse. We provide written material and use multimedia to increase your knowledge of what you can expect. To accurately follow a patient's blood work, we use the best blood test available to determine the level of blood thinning. Using a sophisticated computer system, we track the patient's blood thinning history and make sure that blood tests are done when they are needed. Most importantly, we give you the results of your blood test on the same day it is drawn, either in our office or at your home, and we are available to answer your questions.
Pacemaker Clinic

A permanent pacemaker is implanted to assist the heart's conduction system. It is usually inserted to prevent the symptoms and other effects of a slow or irregular heart beat. In the pacemaker clinic, our goal is to help you to understand the function of your pacemaker, to answer questions you may have, to do periodic checks to make sure that your pacemaker is working properly, and to make any necessary changes to the pacemaker - to 'fine tune' it for your needs.

You will be seen in the pacemaker clinic one week after implantation of the pacemaker, and then every month for the first three months. This is done to check the function of the pacemaker and leads during a time that the electrical connection of the leads to your heart can change dramatically. We insure that there is an adequate safety margin to insure the pacemaker works as it was designed. Adjustments are generally made three months after implantation to extend the life of the pacemaker's battery.

Following the initial three months, your pacemaker will be checked every three to four months. At the time of each appointment your next appointment will be scheduled. For those of you who spend a significant amount of away from Venice, we have telephone transmitters available to check your pacemaker by telephone, or you may establish with a physician who can check the device for you when you are away.
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