Our Procedures



Angioplasty / Stent
Nuclear Imaging
ICD/Implantable Cardioverter Defibrillator
Stress Test
Tilt Table
Carotid Ultrasound
Holter Monitor
Event Monitor
PaceMaker Check
Segmental Pressures



An angiogram is an examination of your blood vessels using x-rays. The doctor will insert a small tube (catheter) into the blood vessel and then he/she will inject x-ray dye (contrast) that makes the vessels visible when the x-ray pictures are being taken. This will then allow the doctor to determine how well the blood moves through the vessels of your brain, lung, abdomen, arms or legs.

You need an angiogram because your doctor suspects there is abnormal blood flow inone or more of your vessels. By injecting contract through a catheter into your vessels and taking x-ray pictures, the radiologist is able to see if there is a problem and help your doctor plan a method of treatment for you.

In the x-ray room you will see lots of special equipment. The staff will position you on the x-ray table and begin to prepare you for the procedure. This includes monitoring your heart and blood pressure. If you don't already have an IV (intravenous line), the nurse will start one so that you can receive fluids and medications during the procedure.


Catheter insertion: The staff will clean your skin with cold soap where the doctor will place the catheter. This is usually at the top of the leg (groin) or the upper arm. You will then be covered with a sterile sheet. Next, the doctor will use a small needle to numb your skin where the catheter will be inserted. The nurse will give you medications in your IV to relieve the pain and allow you to relax. You may feel pressure or brief discomfort as the catheter goes in. The doctor will guide the catheter through the body to the vessel that is to be studied by watching it on a TV-like monitor. You will not feel the catheter moving through your blood vessels.

Taking x-ray pictures: Once the catheter is in the correct vessel, contrast will be injected through the catheter while x-ray pictures are being taken. You may feel hot inside when the contrast is injected, but the sensation only lasts a few seconds. Several series of contrast injections and x-ray pictures may be needed to complete the examination.

Removal of the catheter: When the angiogram is completed, the doctor will remove the catheter from your blood vessel. He/she will apply pressure for 10-15 minutes over the catheter site to prevent bleeding. A band-aid will be placed on the insertion site. The angiogram usually takes one or more hours to complete. The radiology staff will always be nearby to keep you comfortable and answer any questions you may have.

It is important that you do not eat or drink anything after midnight before your exam. You may have a small amount of water or another clear liquid with any medications you need to take. Be sure to ask your doctor if you have any questions about eating or drinking before your exam. If you are allergic to X-ray dye, iodine, or shellfish, it is important to let your doctor know as soon as possible. You will be asked to sign a special form giving the doctor permission to perform the angiogram. Everyone having an angiogram will have blood tests done prior to the procedure. Your groin will also be shaved on one or both sides where the doctor will insert the catheter. You will be asked to put on a hospital gown.

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Percutaneous transluminal coronary angioplasty (PTCA), or angioplasty, is an invasive procedure performed to reduce or eliminate blockages in coronary arteries. The goal of PTCA is to restore blood flow to blood-deprived heart tissue, reduce the need for medication, and eliminate or reduce the number of episodes of angina (chest pain).

Opening a blockage, or a plaque, in a coronary artery typically involves the use of an angioplasty balloon. Often, a stent is implanted after angioplasty to keep the artery open and prevent restenosis (re-growth of plaque).

The arteries are accessed through a needle puncture made in the groin (femoral artery) or arm (brachial artery). Usually the femoral artery is used.

More than one blockage can be treated during a single session, depending on the location of the blockages and the patient's condition. The procedure can take 30 minutes to several hours, depending on the number of blockages being treated.

Angioplasty is recommended for patients with one or more of the following symptoms: 
Blockage (stenosis) of one or more coronary arteries, Angina not well controlled with medications, Angina that disrupts daily activities, occurs at rest (i.e., without exercise or exertion), or recurs after heart attack.

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Thallium and Cardiolite scans (Cardiolite is the trade name for Sestamibi) are tests that show how well blood is flowing to various portions of the heart muscle. These tests, which are varieties of nuclear perform studies, are generally used in conjunction with stress tests to non-invasively diagnose the presence of coronary artery disease.

What is thallium and Cardiolite?
Thallium and Cardiolite are radioactive substances. When injected into the bloodstream, these substances collect in the portions of heart muscle that have good blood flow. If one of the coronary arteries (the arteries that supply blood to the heart muscle) is blocked or partially blocked, not as much thallium (or Cardiolite) accumulates in the muscle supplied by that blocked artery.

How are nuclear perfusion studies performed?
During a stress test, either thallium or Cardiolite is injected into the patient's vein when the maximum level of exercise is reached. The radioactive substance distributes itself throughout the cardiac muscle in proportion to the blood flow received by that muscle. Cardiac muscle receiving normal blood flow accumulates a larger amount of thallium/Cardiolite then cardiac muscle that is supplied by diseased coronary arteries.

An image of the heart is then made by a special camera that can "see" the thallium/Cardiolite. From these pictures, portions of the heart that are not receiving normal blood flow (because of the blockage in the coronary arteries) can be identified.

What are nuclear perfusion studies good for?
Using thallium or Cardiolite perfusion imaging greatly increases the accuracy of the stress test in diagnosing coronary artery disease. A normal thallium/Cardiolite test is an excellent indication that the patient has no significant coronary artery disease. Patients with abnormal perfusion scans are highly likely to have significant coronary artery disease.

What are the risks of nuclear perfusion scans?
These non-invasive studies are very safe. Their only drawback is that radiation is used – but the patient is exposed only to about the same amount of radiation as for a chest x-ray.

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What is it used for?
The ECG is the most commonly performed cardiac test. This is because of the ECG is a useful screening tool for a variety of cardiac abnormalities; ECG machines are readily available in most medical facilities; and the test is simple to perform, risk-free and inexpensive.

How is the ECG performed?
The patient lies on an examination table, and 10 electrodes (or leads) are attached to the patient's arms, legs, and chest. The electrodes detect the electrical impulses generated by the heart, and transmit them to the ECG machine. The ECG machine produces a graph (the ECG tracing) of those cardiac electrical impulses. The electrodes are then removed. The test takes less than 5 minutes to perform.

What information can be gained from the ECG?
From the ECG tracing, the following information can be determined: 
The heart rate, the heart rhythm, whether there are conduction abnormalities, whether there has been a prior heart attack, whether there may be coronary artery disease, whether the heart muscle has become abnormally thickened.

All of these features are potentially important. If the ECG indicates a heart attack or possible coronary artery disease, further testing is often done to completely define the nature of the problem and decide on the optimal therapy. If the heart muscle is thickened, an echocardiogram is often ordered to look for possible valvular heart disease or other structural abnormalities. Conduction abnormalities may be a clue to the diagnosis of syncope (fainting), or may indicate underlying cardiac disease.

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Echocardiogram is an extremely useful test for studying the heart's anatomy. It is non-invasive and entirely safe, and when interpreted by well-trained cardiologists, is very accurate.

How is the echocardiogram performed? 
The patient lies on a bed or examination table, and the echo technician places a transducer (a device that resembles a computer mouse) over the chest wall. The transducer is moved back and forth across the chest wall, collecting several "views" of the heart. The test takes approximately 30 minutes to complete.

How does the echocardiogram work?
The transducer placed on the chest sends sound waves toward the heart. Like the sonar on a submarine, the sound waves bounce off the cardiac structures (that is, they "echo" of the heart). The sound wave "echos" are collected by the transducer. These returning sound waves are computer-processed, and an image of the beating heart is produced on a television screen. By "aiming" the transducer, most of the important cardiac structures can be imaged by the echocardiogram.

What are some of the variations used with the echocardiogram?
Echocardiograms are sometimes used in conjunction with stress tests. An echo test is made at rest, and then with exercise, looking for changes in the function of the heart muscle when exercise is performed. 
Deterioration in muscle function during exercise can indicate coronary artery disease. 
A Doppler microphone can be used during echocardiography to measure the velocity of blood flow in the heart. This information can be useful in assessing heart valve function.

What is the echocardiogram good for?
The echocardiogram reveals important information about the anatomy of the heart. It is especially useful for detecting problems with the heart valves. It is also an extremely useful test for evaluating congenital heart disease. The echocardiogram is also a good way to get a general idea of the overall function of the heart muscle.

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What Should I Do Before Getting a Pacemaker?

Ask your doctor what medications you are allowed to take before getting a pacemaker implanted. Your doctor may ask you to stop taking certain drugs one to five days before the procedure. If you have diabetes, ask your doctor how you should adjust your diabetes medications.

  • Do not eat or drink anything after midnight the evening before the procedure. If you must take medications, take them only with a small sip of water.
  • When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.

How Are Pacemakers Implanted?

Pacemakers are implanted two ways:

Endocardial approach.

            This is the most common technique used.

  • This procedure is performed in a pacemaker or electrophysiology lab.
  • A local anesthetic (pain-relieving medication) is given to numb the area. An incision is made in the chest where the leads and pacemaker are inserted.
  • The lead(s) is inserted through the incision and into a vein, then guided to the heart with the aid of the fluoroscopy machine.
  • The lead tip attaches to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the upper chest.

Epicardial approach. This technique is more commonly used in children.

  • This procedure is performed by a surgeon in a surgical suite. General anesthesia is given to put you to sleep.
  • The surgeon attaches the lead tip to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the abdomen.
  • Although recovery with the epicardial approach is longer than that of the other approach, minimally invasive techniques have enabled shorter hospital stays and quicker recovery times.

The doctor will determine which pacemaker implant method is best for you.

What Happens During Pacemaker Implantation?

The endocardial pacemaker takes about 1-2 hours to implant. Here is an overview of the procedure:

Should I Avoid Certain Electrical Devices if I Have a Pacemaker?

  • You will lie on a bed and the nurse will start an intravenous line (IV) into your arm or hand. This is so you may receive medications and fluids during the procedure. You will be given a medication through your IV to relax you and make you drowsy, but it will not put you to sleep.
  • The nurse will connect you to several monitors. The monitors allow the doctor and nurse to check your heart rhythm, blood pressure, and other measurements during the pacemaker implant.
  • The left or right side of your chest will be shaved and cleansed with a special soap. Sterile drapes are used to cover you from your neck to your feet. A strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.
  • The doctor will numb your skin by injecting a local numbing medication. You will feel a pinching or burning feeling at first. Then, it will become numb. Once this occurs, an incision will be made to insert the pacemaker and leads. You may feel a pulling as the doctor makes a pocket in the tissue under your skin for the pacemaker. You should not feel pain. If you do, tell your nurse.
  • After the pocket is made, the doctor will insert the leads into a vein and guide them into position using the fluoroscopy machine.
  • After the leads are in place, their function is tested to make sure they can increase your heart rate. This is called "pacing" and involves delivering small amounts of energy through the leads into the heart muscle. This causes the heart to contract. When your heart rate increases, you may feel your heart is racing or beating faster. It is very important to tell your doctor or nurse any symptoms you feel. Any pain should be reported immediately.
  • After the leads are tested the doctor will connect them to your pacemaker. Your doctor will determine the rate of your pacemaker and other settings. The final pacemaker settings are done after the implant using a special device called a "programmer."
  • You will be admitted to the hospital overnight for the pacemaker implantation. The nurses will monitor your heart rate and rhythm. The morning after your implant, you will have a chest X-ray to ensure the leads and pacemaker are in the proper position.

    You will be shown how to care for your wound. Keep your wound clean and dry. After five days, you may take a shower. Look at your wound every day to make sure it is healing. Call your doctor if you notice:

  • Increased drainage, bleeding, or oozing from the insertion site
  • Increased opening of the incision
  • Redness around the site
  • Warmth along the site
  • Increased body temperature (fever or chills)

Your pacemaker settings will be checked before you leave the hospital.

You will receive a temporary ID card that tells you:

  • The type of pacemaker and leads you have
  • The date of the pacemaker implant
  • The name of the doctor who implanted the pacemaker

Within three months, you will receive a permanent card from the pacemaker company. CARRY THIS CARD WITH YOU AT ALL TIMES in case you need medical attention at another hospital.

Will I Be Able to Move Around After the Procedure?

  • You may move your arm normally after getting your pacemaker.
  • Do not lift objects that weigh more than 10 pounds.
  • Do not hold your arms above shoulder level for three weeks.
  • Avoid activities that require pushing or pulling heavy objects, such as shoveling the snow or mowing the lawn.
  • Stop any activity before you become overtired.
  • For six weeks after the procedure, avoid golfing, tennis, and swimming.
  • Try to walk as much as possible for exercise.
  • Ask your doctor when you can resume more strenuous activities.
  • Your doctor will tell you when you can go back to work, usually within a week after you go home. If you have the flexibility at your job, ease back to your regular work schedule.
  • Electric blankets, heating pads, and microwave ovens can be used and will not interfere with the function of your pacemaker.
  • A cell phone should be used on the side opposite of where the pacemaker was implanted.
  • Cell phones should not be placed directly against the chest or on the same side as your pacemaker.
  • You will need to avoid strong electric or magnetic fields, such as: some industrial equipment; ham radios; high intensity radio waves (found near large electrical generators, power plants, or radio frequency transmission towers); and arc resistance welders.
  • Do not undergo any tests that require magnetic resonance imaging (MRI).
  • Your doctor or nurse can provide more information about what types of equipment may interfere with your pacemaker.
  • If you have concerns about your job or activities, ask your doctor.

How Long Will My Pacemaker Last?

A pacemaker usually lasts seven to ten years, depending on how often it is used. When the battery becomes low, your pacemaker will need to be changed.

How Often Will I Need to See My Doctor for my Pacemaker?

A complete pacemaker check should be done six weeks after your pacemaker is implanted. Adjustments will be made that will prolong the life of your pacemaker. Then your pacemaker should be checked every three months on the telephone to evaluate battery function. Your nurse will explain how to check your pacemaker using the telephone transmitter. Once or twice a year you will need a more complete exam at a hospital or doctor's office.

If you have a biventricular pacemaker, you may need to visit the doctor's office or hospital every six months to make sure your device is working properly and the settings do not need to be adjusted.


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ICD/Implantable Cardioverter Defibrillator



Exercise Stress Testing for the Heart
Some forms of cardiac disease are easily missed when the patient is at rest, because at rest the patient's physical examination and ECG are often entirely normal. In these cases, cardiac abnormalities may become apparent only when the heart is asked to perform at increased workloads. The stress test is used to evaluate the heart and vascular system during exercise. It helps answer to two general questions: 1) Is there occult underlying heart disease that only becomes apparent when the heart is stressed by exercise? 2) If there is underlying heart disease, how severe is it?

How is a stress test performed?
The patient is attached to an ECG machine, and a blood pressure cuff is placed on one arm. Sometimes a clothespin-like sensor is attached to the finger to measure the amount of oxygen in the blood. After a baseline ECG is obtained, the patient begins to perform a low level of exercise, either by walking on a treadmill, or pedaling a stationary bicycle. The exercise is "graded" – that is, every three minutes, the level of exercise is increased. At each "stage" of exercise, the pulse, blood pressure and ECG are recorded, along with any symptoms the patient may be experiencing. 
With a "maximal" stress test, the level of exercise is gradually increased until the patient cannot keep up any longer because of fatigue, or until symptoms (chest pain, shortness of breath, or lightheadedness) prevent further exercise, or until changes on the ECG indicate a cardiac problem. Maximal stress tests should be performed when the goal is to diagnose the presence or absence of coronary artery disease. With a "submaximal" stress test, the patient exercises only until a pre-determined level of exercise is attained. These tests are used tin patients with known coronary artery disease to measure whether a specific level of exercise can be performed safely. After the test, the patient remains monitored until any symptoms disappear, and until the pulse, blood pressure and ECG return to baseline.

What are the risks of having a stress test?
The stress test has proven to be remarkably safe. It poses about the same level of risk as taking a brisk walk or walking up a hill. While it is possible that the ischemia provoked by such stress can lead to a myocardial infarction (heart attack) or to serious heart rhythm disturbances, in practice this event is rare. Further, when these serious events do occur during a stress test, they occur in the presence of trained medical personnel who can deal with them immediately.

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What is a Transesophageal Echo (TEE)?
A transesophageal echocardiogram (TEE) is a test that doctors use to obtain images of the heart from inside the esophagus (swallowing tube). The esophagus lies immediately behind the heart and with this technology, very clear images of the heart can be obtained. This test is used by doctors to visualize structures of the heart not seen by a standard echocardiogram (from the outside chest wall) as well as clarify structures which may be otherwise poorly seen.

How is the Transesophageal Echo Test Done?
The test is performed by inserting a long flexible probe with an ultrasound transducer at its tip through the mouth and into the esophagus just behind the heart. The transducer send high frequency sound waves into the heart, which return as echoes. These echoes are converted into a real time image of the beating heart and blood flow through the chambers and valves. The images are displayed on a video monitor and are recorded on videotape or disk.

The TEE is a valuable test to detect:

Blood clots within the heart. 
Defects or holes between heart chambers. 
Severity of valve disease. 
Function of prosthetic (artificial) heart valves.

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What is a tilt table test?
Tilt table testing is designed to evaluate how your body regulates blood pressure in response to some very simple stresses. Blood pressure is regulated by a set of nerves which operate continuously and subconsciously and are part of the autonomic nervous system. This set of nerves detects certain bodily needs and they respond by causing the appropriate changes in blood pressure. The purpose of this part of the autonomic nervous system is to insure that there is always enough blood going to the brain, and to distribute blood to other organs according to their needs. For example, during exercise, blood is delivered preferentially to the muscles, whereas during eating blood is delivered preferentially to the intestines. These changes in blood pressure are accomplished by making changes in the way the heart beats and by making changes in the caliber or size of certain blood vessels.

At times, the nerves which control blood pressure may not operate properly and may cause a reaction which paradoxically causes the blood pressure to drop suddenly. This reaction may produce a fainting spell or a number of symptoms including severe lightheadedness. Tilt table testing is designed to determine the likelihood that a patient is susceptible to this type of reaction.

Who needs a tilt table test?
Patients that have symptoms suggestive of a sudden drop in blood pressure may benefit from the evaluation of blood pressure regulation with a tilt table test. The tilt table test was originally designed to evaluate patients with fainting spells because many fainting spell or a number of symptoms include g severe lightheadedness. Tilt table testing is designed to determine the likelihood that a patient is susceptible to this type of reaction.

Who needs a tilt table test?
Patients that have symptoms suggestive of a sudden drop in blood pressure may benefit from the evaluation of blood pressure regulation with a tilt table test. The tilt table test was originally designed to evaluate patients with fainting spells because many fainting spells are caused by a drop in blood pressure. Tilt table patient's with fainting spells because many fainting spells are caused by a drop in blood pressure. Tilt table testing may also be useful for patients who have symptoms of severe lightheadedness or dizziness which don't actually cause them to faint, but force them to sit down or lie down. These symptoms, while not progressing on to an actual fainting spell, may still be indicative of a sudden drop in blood pressure. Many patients suffering from the chronic fatigue syndrome have symptoms of lightheadedness and have been referred for tilt table testing.

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Carotid ultrasound is a test that shows the carotid arteries (vessels in the neck that provide blood flow to the brain), as well as how much blood flows and how fast it travels through them. Ultrasound waves – the same ones used in imaging the fetus in a pregnant woman – are used to make an image of the arteries. This image can be used to find out if there is an abnormality or blockage of the carotid arteries that could lead to stroke.

Why do doctors use carotid ultrasound?
Doctors often use carotid ultrasound on patients who have had a stroke or who might be at high risk for a stroke. Narrowing of the carotid arteries – often caused by cholesterol deposits – and blood clots can be detected using this procedure. These conditions can cause problems with the blood flow to the brain and lead to a stroke. The actual blood flow through the carotid arteries can also be imaged by this test.

What happens during carotid ultrasound?
You will be asked to lie down on an examination table. The technician will place a clear gel on the area of the neck where the carotid artery is located. The gel is simply a lubricant that allows the transducer (a device that both puts out and detects ultrasound signals) to slide around easily on your skin. When the transducer is placed against the skin, an image of the artery is shown on a video screen. To view the arteries from many different angles, your doctor will re-position the transducer several times. Because blood is flowing through the artery, a sound similar to your heartbeat will be heard. The procedure is repeated for the carotid artery on the other side of the neck. A carotid ultrasound usually only takes 15 to 30 minutes to complete.

What are the risks of carotid ultrasound?
Since the procedure is done without entering the body and does not use dyes or x-rays, there is no risk or pain involved in having a carotid ultrasound.

How does carotid ultrasound work?
The transducer emits high frequency, ultrasound waves that pass into the body and bounce off the carotid arteries and the red blood cells moving through them. The transducer detects the different reflections of the sound waves, which are then measured and converted by a computer into live pictures of the arteries and the blood flow.

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What is an electrical cardioversion?
Cardioversion is a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm. Most elective or "non-emergency" cardioversions are performed to treat atrial fibrillation or atrial flutter, benign heart rhythm disturbances originating in the upper chambers (atria) of the heart. Cardioversion is used in emergency situations to correct a rapid abnormal rhythm associated with faintness, low blood pressure, chest pain, difficulty breathing or loss of consciousness.

Why do I need a cardioversion?
Each normal heartbeat starts in an area of the heart known as the sinus node which is located in the upper right chamber of the heart (right atria). The sinus node contains specialized cells that send an organized electrical signal through the heart resulting in a perfectly timed, rhythmic heartbeat. In patients with atrial fibrillation, however, the atria fibrillate (or "quiver") due to chaotic electrical signals that circulate throughout both aria. This typically results in a fast and irregular heartbeat. While some patients have no symptoms, others may experience shortness of breath, lightheadedness and fatigue.

Electrical cardioversion is a procedure whereby a synchronized (perfectly timed) electrical shock is delivered through the chest wall to the heart through special electrodes or paddles that are applied to the skin of the chest and back. The goal of the cardioversion is to disrupt the abnormal electrical circuit(s) in the heart and to restore a normal heartbeat. The shock causes all the heart cells to contract simultaneously, thereby interrupting, thereby interrupting and terminating the abnormal electrical rhythm (typically fibrillation of the atria) without damaging the heart. This split second interruption of the abnormal beat allows the heart's electrical system to regain control and restore a normal heartbeat. 
An electrical cardioversion is performed in a hospital setting. A cardiologist, a nurse and/or an anesthesiologist are present to monitor your breathing, blood pressure and heart rhythm. Special cardioversion pads are placed on your chest and back (or alternatively, both pads can be placed on the front of the chest). The pads are connected to an external defibrillator by a cable. The defibrillator allows the medical team to continuously monitor your heart rhythm and to deliver the electrical shock to restore your heart's rhythm back to normal.

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When the heart is not beating in a nice, smooth rhythm, the irregular beats it produces are called arrhythmias. When the heart is beating more than 100 times per minute, this type of arrhythmia is called tachycardia, a potentially dangerous condition. Ablation is a procedure to destroy very small, carefully selected parts of the heart that are causing tachycardia. As a result, the heart's normal, regular rhythm is restored.

A nonsurgical method of ablation involves inserting a thin tube (catheter) through a blood vessel (in the upper thigh, wrist or arm) and all the way up to the heart. At the tip of the tube is a small wire, which can delivery radiofrequency energy to burn away the abnormal areas of the heart. With a success rate over 90 percent, radiofrequency ablation has become the preferred technique for treating tachycardia.

Depending on the underlying arrhythmia, there still may be a need for antiarrhythmic medications. Patients with atrial fibrillation or ventricular tachycardia, for example, may require continued antiarrhythmics. The type and severity of an arrhythmia may also require more invasive surgery in order to correct the problem.

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What is a Holter Monitor?
Holter monitoring is a continual monitoring of heart rate and rhythm during your usual daily activities over a predetermined length of time, usually a 24-hour period.

Why this test may be performed?
A Holter monitor is used to identify heart rhythm disturbances, which may come and go at various times throughout the day or night. It is often used to correlate any abnormal heart rhythm with a person's symptoms, like dizziness, palpitations, shortness of breath or chest pain.

What this test involves?
Electrodes are placed on the front of the chest and the electrode wires are then attached to a small portable, battery-operated recorder. The recorder is held in place by a belt that can be worn around the wait. The recorder continuously records and stores the heart rhythm for 24 hours. The person is encouraged to continue their usual daily activities. During this time period, the person wearing the device maintains a written log. Symptoms (for example, palpitations, dizziness, and shortness of breath) are written in the log, noting the exact activity and time they occur. Once the monitor has been removed, a physician analyzes the heart rhythm and activity log.

What are the risks/precautions for this test?
A Holter monitor is a non-invasive test. It is painless and not associated with any risks to the patient. It is advisable to shower or bathe before the electrodes are applied to the chest, since you will not be able to do either of these activities while the test is in progress.

What the results may tell you?
A Holter monitor may detect a disturbance in heart rhythm that is not evident on a single, resting electrocardiogram tracing. It allows the physician to correlate specific patient symptoms with the electrical activity of the heart. A Holter monitor can detect rhythm disturbances that are transient or intermittent in nature.

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What is a cardiac event monitor?
A cardiac event monitor is a small recorder that records your heart activity only when you want it to. When you experience symptoms you activate the monitor to make a brief recording of your heart's electrical activity. Patients wear Event Monitors for 30 days .

Why do I need a cardiac event monitor?
Event monitors help your doctor to diagnose problems that don't happen often enough for an EKG or Holter monitor to record. They are very useful to your doctor in diagnosing problems with your heart rhythm (arrhythmias) that happen infrequently.

Using The Cardiac Event Monitor
The electrodes are attached to your chest and connected by wires to the recorder. Worn day and night, the recorder continuously scans your heart's electrical activity. When you experience symptoms, you activate the recorder by pressing a button. The device records and stores several minutes of EKG data before, during and after an event. Then you transmit the stored data over a telephone to a receiving center, who transfers the information to your doctor.

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How often do I need to come to the office for my pacemaker check?
Most cardiologists recommend that your pacemaker be checked in the office every 3 to 6 months.

Why should I come to the office for a pacemaker check?
In the office, we can do a more in-depth analysis of your pacemaker than is possible with telephone monitoring. This type of in-depth check can help prolong the life of your pacemaker battery.

What happens in the clinic when I come to have my pacemaker checked?
Our staff will record the electrical activity of both your heart and your pacemaker. We will then evaluate how your pacemaker is functioning and its battery life. Depending on our findings, we may reprogram your pacemaker to make sure it is meeting your needs or to prolong the life of the battery.

Who does the pacemaker check?
Your pacemaker will be checked or interrogated by an expert technician from the pacemaker company.

How do I set up an appointment for the clinic?
The clinics are scheduled every month on the first Monday of the month. Call our office at (559) 438-8181 and ask to speak with a receptionist to schedule a pacemaker check. If your doctor feels you need to be checked sooner than the next scheduled clinic, he will make arrangement for this to be done as needed.

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What are segmental pressures?
Segmental pressures are a non-invasive measurement of bilateral leg pressures with blood pressure cuffs and a Doppler/PPG prove ultrasound detector. The cuffs and Doppler/PPG probe ultrasound identify and quantify significant obstructive arterial lesions in the legs. In other words, the test assists in identifying the possible location of narrowing and/or blockage of the arterial blood supply in the legs.

What happens during the test?
You will be placed on an exam table and bilateral arm pressures will be taken. Then 4 cuffs will be placed on each leg at the ankle, below the knee, above the knee and high thigh. The cuff will inflate until the pulse signal disappears at which time the cuff will then slowly release the pressure until the pulse returns. Blood pressures are obtained by using a special microphone or Doppler transducer to listen to the pulses at your ankles. The process will continue up the leg until all cuffs have been inflated. The high thigh pressure may cause some discomfort with inflation.

How do I prepare for the test?
There are no special instructions for this test. You will be asked to remove clothing and given a drape. If you are more comfortable you may bring exercise shorts to wear during the procedure.

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