We provide a wide variety of cardiac services that include
ECHOCARDIOGRAPHY
This is a picture of the beating heart that assesses the strength of the muscle, assesses the heart valves for leakage and blockage, and assesses heart structures for problems. It uses sound waves which are harmless. It can be used to evaluate complaints of shortness of breath, palpitations, passing out, fatigue, congenital heart disease, and chest pain.
DOBUTAMINE STRESS ECHOCARDIOGRAPHY
This test is selected for those patients who cannot exercise on a treadmill for stress echocardiography. This test is performed to detect coronary artery disease. Dobutamine (a medicine similar to adrenaline) is given intravenously to mimic the effects of exercise on the heart. Echo pictures are taken at rest and with increasing dobutamine infusion rates.
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
This test is used to provide detailed pictures of the heart valves, heart chambers, and heart structures that may be difficult to image through the chest wall and lungs. It is performed, after proper sedation, by passing the echo probe down the esophagus that lies immediately next to the back of the heart. This test is useful to detect defects in heart valves, heart walls, and assessing cardiac causes of transient ischemic attacks (TIAs) and stroke.
The Raleigh Cardiology echocardiography laboratory is ICAEL (Intersocietal Commission for the Accreditation of Echocardiographic Laboratories) certified. Our echo sonographers are accredited by the American Registry of Diagnostic Medical Sonographers.
ANKLE/BRACHIAL INDEX (ABI)
This test compares blood pressure in the arms with the blood pressure in the ankles. It is ordered to screen for the presence of atherosclerotic blockage in the arteries supplying blood flow to the legs. It is performed at rest and sometimes following exercise.
LOWER EXTREMITY ARTERIAL DOPPLER
This test uses ultrasound and Doppler imaging to define the presence and severity of atherosclerotic blockage in the arteries and grafts supplying blood flow the arms and legs.
CAROTID ARTERY ULTRASOUND
This test screens for atherosclerotic blockage of the carotid arteries supplying blood to the brain. This type of blockage is a major cause of stroke and transient ischemic attacks (TIAs).
ABDOMINAL AORTIC ULTRASOUND
This test screens for bulging of the abdominal aorta which represents a weakness of the aortic wall called an aneurysm. If large enough, aneurysms may rupture.
LOWER EXTREMITY VENOUS STUDY
This test studies the flow of the blood in the veins of the legs. It is used to detect deep vein thrombosis (blood clots) that can be a cause of leg swelling or shortness of breath.
The Raleigh Cardiology peripheral vascular laboratory is accredited by ICAVL (Intersocietal Commission for the Accreditation of Vascular Laboratories). Our sonographers are registered through the American Registry of Diagnostic Medical Sonographers.
CARDIAC CATHETERIZATION
This is a frequently performed test that is the gold standard in the diagnosis of coronary artery disease, valvular heart disease, heart muscle disease, congenital heart disease, and pericardial diseases. A catheter, which is a thin tube (similar to but longer than an I.V.), is passed from a vessel in the arm or leg into the vessels and chambers of the heart to take measurements and pictures. Dye and x-ray radiation are used in the performance of most of these procedures.
CORONARY INTERVENTIONAL PROCEDURES
Balloon angioplasty (percutaneous transluminal coronary angioplasty or PTCA) is a procedure that is performed to enlarge a narrowed segment of a coronary artery. A very small balloon at the end of a catheter is placed inside of the narrowed coronary artery and inflated. This compresses the atherosclerosis into the walls of the coronary artery creating a larger channel for the blood to flow to the heart muscle. In the majority of the interventional procedures, a stent is deployed at the time of PTCA. A stent is a metal mesh tube that has been compressed onto a PCA balloon. The balloon is inflated inside the narrowed segment and expands the stent. The stent serves as scaffolding to support the vessel open. Once the stent has been placed, it cannot move and it becomes covered with cells from the inside of the artery. Stents can be either bare metal or drug coated (drug eluting stent or DES). Large clinical trials have shown both types of stents to be very safe. Drugs such as Plavix will be prescribed for a longer period of time following the placement of drug eluting stents. (DES) than following the placement of bare metal stents (BMS).
In a small minority of interventional procedures, rotablation (percutaneous transluminal rotational atherectomy) will be used to open a narrowed segment of artery. This device uses a catheter that has a diamond chip covered burr that rotates at a very high velocity and grinds the plaque into small particles. The particles are smaller than red blood cells and are cleared from the blood and do not clog flow down-stream.
PERIPHERAL INTERVENTIONAL PROCEDURES
Angiography, balloon angioplasty, stenting, and atherectomy can also be performed in vessels of the body other than the heart. The techniques and descriptions are outlined in the section on coronary interventions. Vessels that can be undergo interventions are the vessels to the legs, the kidneys, the arms and the brain.
NUCLEAR STRESS TESTING
A nuclear stress test (also called myocardial perfusion scan) is a camera image of the heart muscle that is performed to detect problems with the blood flow to the heart muscle due to severe blockages in the blood vessels to the heart muscle. During a nuclear stress test, a small dose of a radioactive isotope is injected into the bloodstream. The radioisotope, or tracer, is carried through the bloodstream and into the myocardium, or heart muscle. Shortly after exercising on a treadmill or in some cases after a chemical (when some cannot walk on a treadmill), a special camera senses the radioactivity of the tracer and constructs an image of the heart. Parts of the heart muscle that receive normal blood flow receive larger amounts of tracer and appear brighter than areas that have inadequate blood flow.
The Raleigh Cardiology Nuclear Cardiology Laboratory is accredited by the ICANL (Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories).
EVENT MONITOR (LOOP RECORDER)
This test is used to diagnose reasons for palpitations (skipped beats), dizzy spells, passing out spells, and fast heart rate spells that arise from abnormal heart rhythms. This test is very effective for symptoms that are somewhat infrequent. The monitor is attached by electrodes and the patient may wear the monitor for weeks.
HOLTER MONITOR
This test is used to record the heart rhythm for a period of one to two days and is used to evaluate palpitations, dizzy spells, passing out spells, and fast heart rate episodes that are more frequent.
TILT TABLE TEST
This test is used to diagnose the cause of dizzy spells or passing our spells
(syncope). Tilt table testing is performed to observe blood pressure, heart
rate, and rhythm response to supine (horizontal) and standing postures.
Medication is often administered during this test to precipitate abnormalities
in heart rate, rhythm, and blood pressure, that might explain the cause of the
spells.
EKG
This is a simple test that records the electrical activity of the heart. The test is generated in seconds by attaching 12 electrodes to the patient. This non-invasive test can detect previous heart attacks, lack of blood flow to the heart, heart enlargement, and abnormalities in heart rhythm.
CORONARY CT SCAN
This test is used to look for abnormalities in the coronary arteries and in coronary artery bypass grafts that supply blood flow to the heart. The pictures are taken in a CT scanner that requires the patient to lay still and hold their breath for a period of time. Intravenous medication may need to be given to slow the heart rate. This test can be used to find the cause of chest pain and to assess the status of bypass grafts.