Cardiac and Vascular Consultants

AORTIC STENOSIS Aortic valve stenosis — or aortic stenosis — occurs when the heart’s aortic valve narrows. This narrowing prevents the valve from opening fully, which reduces or blocks blood flow from your heart into the main artery to your body (aorta) and onward to the rest of your body. When the blood flow through the aortic valve is reduced or blocked, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump, and this can cause symptoms as well as possibly weaken your heart muscle. Your treatment depends on the severity of your condition. You may need surgery to repair or replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems. Types 1. Bicuspid aortic valve Symptoms Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms generally develop when narrowing of the valve is severe. Some people with aortic valve stenosis may not experience symptoms for many years. Signs and symptoms of aortic valve stenosis may include: Abnormal heart sound (heart murmur) heard through a stethoscope Chest pain (angina) or tightness with activity Feeling faint or dizzy or fainting with activity Shortness of breath, especially when you have been active Fatigue, especially during times of increased activity Heart palpitations — sensations of a rapid, fluttering heartbeat Not eating enough (mainly in children with aortic valve stenosis) Not gaining enough weight (mainly in children with aortic valve stenosis) The heart-weakening effects of aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet. When to See a Doctor If you have a heart murmur, your doctor may recommend that you visit a cardiologist. If you develop any symptoms that may suggest aortic valve stenosis, see your doctor. Causes Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, the valves don’t open or close properly, disrupting the blood flow through your heart and potentially impairing the ability to pump blood to your body. In aortic valve stenosis, the aortic valve between the lower left heart chamber (left ventricle) and the main artery that delivers blood from the heart to the body (aorta) is narrowed (stenosis). When the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. This can cause the left ventricle to thicken and enlarge. Eventually the extra work of the heart can weaken the left ventricle and your heart overall, and it can ultimately lead to heart failure and other problems. Aortic valve stenosis can occur due to many causes, including: Congenital heart defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called cusps. Some children are born with an aortic valve that has only two (bicuspid) cusps instead of three. People may also be born with one (unicuspid) or four (quadricuspid) cusps, but these are rare. ABDOMINAL ANEURYSM An abdominal aortic aneurysm is an enlarged area in the lower part of the major vessel that supplies blood to the body (aorta). The aorta runs from your heart through the center of your chest and abdomen. The aorta is the largest blood vessel in the body, so a ruptured abdominal aortic aneurysm can cause life-threatening bleeding. Depending on the size of the aneurysm and how fast it’s growing, treatment varies from watchful waiting to emergency surgery. Symptoms Abdominal aortic aneurysms often grow slowly without symptoms, making them difficult to detect. Some aneurysms never rupture. Many start small and stay small; others expand over time, some quickly. If you have an enlarging abdominal aortic aneurysm, you might notice: Deep, constant pain in your abdomen or on the side of your abdomen Back pain A pulse near your bellybutton https://www.mayoclinic.org/diseases-conditions/abdominal-aortic-aneurysm/symptoms-causes/syc-20350688 Congestive Heart Failure (CHF) Coronary Artery Disease (CAD) Valvular Heart Disease Cardiomyopathy Abnormal Stress Test Lipid (Cholesterol) Management Hypertension (High Blood Pressure) Renovascular Disease Peripheral Arterial Disease (Claudication) Venous Reflux Venous Ulcers May-Thurner Syndrome (Iliofemoral Compression) Deep Vein Thrombosis (DVT) Syncope Carotid Disease

ANTICOAGULATION CHECKS “INR” fingerstick for monitoring drug levels (“walk-in”s) ECHOCARDIOGRAMS Routine Study An echocardiogram (echo) is a test that uses high frequency sound waves (ultrasound) to make pictures of your heart. The test is also called echocardiography or diagnostic cardiac ultrasound. Quick facts An echo uses sound waves to create pictures of your heart’s chambers, valves, walls and the blood vessels (aorta, arteries, veins) attached to your heart. A probe called a transducer is passed over your chest. The probe produces sound waves that bounce off your heart and “echo” back to the probe. These waves are changed into pictures viewed on a video monitor. An echo can’t harm you. Why do people need an echo test? Your doctor may use an echo test to look at your heart’s structure and check how well your heart functions. The test helps your doctor find out: The size and shape of your heart, and the size, thickness and movement of your heart’s walls. How your heart moves. The heart’s pumping strength. If the heart valves are working correctly. If blood is leaking backwards through your heart valves (regurgitation). If the heart valves are too narrow (stenosis). If there is a tumor or infectious growth around your heart valves. The test also will help your doctor find out if there are: Problems with the outer lining of your heart (the pericardium). Problems with the large blood vessels that enter and leave the heart. Blood clots in the chambers of your heart. Abnormal holes between the chambers of the heart. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/echocardiogram-echo EKG AND RELATED STUDIES EKG 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. A normal heartbeat on ECG will show the timing of the top and lower chambers. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/electrocardiogram-ecg-or-ekg Treadmill Stress Test A stress test, sometimes called a treadmill test or exercise test, helps a doctor find out how well your heart handles work. As your body works harder during the test, it requires more oxygen, so the heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart. It also helps doctors know the kind and level of exercise appropriate for a patient. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/exercise-stress-test Holter Monitor A Holter monitor is a battery-operated portable device that measures and records your heart’s activity (ECG) continuously for 24 to 48 hours or longer depending on the type of monitoring used. The device is the size of a small camera. It has wires with silver dollar-sized electrodes that attach to your skin. The Holter monitor and other devices that record your ECG as you go about your daily activities are called ambulatory electrocardiograms. A Holter monitor test is usually performed after a traditional test to check your heart rhythm (electrocardiogram), especially if the electrocardiogram doesn’t give your doctor enough information about your heart’s condition. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/holter-monitor NUCLEAR STUDIES Treadmill (Exercise) Stress Test A nuclear stress test uses radioactive dye and an imaging machine to create pictures showing the blood flow to your heart. The test measures blood flow while you are at rest and are exerting yourself, showing areas with poor blood flow or damage in your heart. The test usually involves injecting radioactive dye, then taking two sets of images of your heart — one while you’re at rest and another after exertion. A nuclear stress test is one of several types of stress tests that may be performed alone or in combination. Compared with an exercise stress test, a nuclear stress test can help better determine your risk of a heart attack or other cardiac event if your doctor knows or suspects that you have coronary artery disease. https://www.mayoclinic.org/tests-procedures/nuclear-stress-test/about/pac-20385231 Vascular Ultrasounds Implantable Loop Recorder Cardiac Catheterization and Coronary Angiography

Endovenous Venous Ablation Vein disease occurs when bad veins in our legs no longer do their job and allows blood to pool in our legs. This can lead to many symptoms and enlarged varicose veins. Venous ablation is an in-office procedure that utilizes radiofrequency energy to cauterize and close bad veins in the legs to alleviate symptoms such as swelling, achiness, fatigue, heaviness of the legs. VenaSeal is an in-office procedure that utilizes a medical adhesive to close bad veins in the legs to alleviate symptoms such as swelling, achiness, fatigue, heaviness of the legs. ClosureFast Procedure Individual results may vary. Images courtesy of Dr. Jonathan Calure. The ClosureFast™ procedure uses radiofrequency energy or heat to close the diseased vein, which redirects blood flow to healthy veins, relieving symptoms. The Traditional Treatment Minimally invasive outpatient procedure Local anesthesia along various points of the leg Less pain and bruising than laser treatment Faster recovery time than laser treatment Compression stockings needed for at least one week after procedure Over 2 million patients have been treated with the ClosureFast procedure in over 100 countries around the world. https://www.medtronic.com/us-en/patients/treatments-therapies/varicose-vein-therapies/our-treatments/closurefast-procedure.html VenaSeal Closure System Individual results may vary. Images courtesy of Dr. Kathleen Gibson. Nonthermal Vein Closure The VenaSeal™ system delivers a small amount of a specially formulated medical adhesive to seal — or close — the diseased vein, rerouting blood to nearby healthy veins, which provides symptom relief. A More Comfortable Experience Simple, outpatient procedure No tumescent anesthesia Less pain and bruising than thermal ablation Faster recovery time than thermal ablation Compression stockings not needed after the procedure More than 100,000 patients have been treated with the VenaSeal closure system around the world. https://www.medtronic.com/us-en/patients/treatments-therapies/varicose-vein-therapies/our-treatments/venaseal-closure-system.html Sclerotherapy Sclerotherapy is a minimally invasive procedure that treats varicose veins and spider veins. It involves injecting chemicals, known as sclerosing agents, into damaged veins. In addition to diminishing the appearance of varicose or spider veins, sclerotherapy can also reduce pain or side effects caused by damaged veins. Varicose veins can cause itching, pain, cramping, and discoloration. Spider veins are smaller and less severe than varicose veins. Varicose veins are more common in women than in men, although anyone can get them. An estimated 20 percent Trusted Source of adults will be affected by varicose veins at some point in their lives. More than 324,000 sclerotherapy procedures were done in the United States in 2017. https://www.healthline.com/health/sclerotherapy Percutaneous Coronary Intervention ( angioplasty/stenting ) Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the insertion of a permanent wire-meshed tube that is either drug eluting (DES) or composed of bare metal (BMS). Peripheral Angiography A peripheral angiogram is a test that uses X-rays and dye to help your doctor find narrowed or blocked areas in one or more of the arteries that supply blood to your legs. The test is also called a peripheral arteriogram. Doctors use a peripheral angiogram if they think blood is not flowing well in the arteries leading to your legs or, in rare cases, to your arms. The angiogram helps you and your doctor decide if a surgical procedure is needed to open the blocked arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is generally placed in the artery after angioplasty to help keep it open. Bypass surgery is another procedure. It re-routes blood around the blocked arteries. https://www.heart.org/en/health-topics/peripheral-artery-disease/symptoms-and-diagnosis-of-pad/peripheral-angiogram Percutaneous Peripheral Revascularization Venous Angiogram And Stenting Implantable Loop Recorder Cardiac Catheterization And Coronary Angiography

CARDIAC CATHETERIZATION AND CORONARY ANGIOGRAPHY A cardiac cath provides information on how well your heart works, identifies problems and allows for procedures to open blocked arteries. For example, during cardiac cath your doctor may: Take X-rays using contrast dye injected through the catheter to look for narrowed or blocked coronary arteries. This is called coronary angiography or coronary arteriography. Perform a percutaneous coronary intervention (PCI) such as coronary angioplasty with stenting to open up narrowed or blocked segments of a coronary artery. Check the pressure in the four chambers of your heart. Take samples of blood to measure the oxygen content in the four chambers of your heart. Evaluate the ability of the pumping chambers to contract. Look for defects in the valves or chambers of your heart. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/cardiac-catheterization PERCUTANEOUS CORONARY INTERVENTION (ANGIOPLASTY/STENTING) Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the insertion of a permanent wire-meshed tube that is either drug eluting (DES) or composed of bare metal (BMS). https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention PERIPHERAL ANGIOGRAPHY A peripheral angiogram is a test that uses X-rays and dye to help your doctor find narrowed or blocked areas in one or more of the arteries that supply blood to your legs. The test is also called a peripheral arteriogram. Doctors use a peripheral angiogram if they think blood is not flowing well in the arteries leading to your legs or, in rare cases, to your arms. The angiogram helps you and your doctor decide if a surgical procedure is needed to open the blocked arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is generally placed in the artery after angioplasty to help keep it open. Bypass surgery is another procedure. It re-routes blood around the blocked arteries. https://www.heart.org/en/health-topics/peripheral-artery-disease/symptoms-and-diagnosis-of-pad/peripheral-angiogram PERCUTANEOUS PERIPHERAL REVASCULARIZATION We utilize a multitude of different devices to open up diseased peripheral arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is spmetimes placed in the artery after angioplasty to help keep it open. We also perform peripheral atherectomy’s utilizing Laser or Orbital atherectomy devices. We use peripheral intravascular ultrasound (IVUS) to determine morphology and size of the vessel. VENOUS ANGIOGRAM AND STENTING Why is an iliac venogram used? A venogram is used to help diagnose abnormalities in your veins, such as deep vein thrombosis. Other uses for a venogram include: Determining the cause of swelling or pain in your legs Tracking down where a blood clot that has traveled to your lungs initially formed If you have a narrowed iliac vein, also known as iliac stenosis, a stent procedure may be used to expand and support the vein. Most people are familiar with coronary/peripheral stents placed in the arteries of the heart/legs to improve blood flow. Venous stents function in the same way. Venous stents are metal mesh tubes that expand against blocked or narrowed vein walls. They act as a scaffold to keep veins open. In most cases, physician place venous stents in larger, central veins, such as those found in the leg and abdomen. Venous stents can help people with chronic leg swelling, venous ulcers, chronic blood clots or other conditions that compress or narrow the veins, limiting blood flow. Below are a few of the conditions that are treatable with venous stenting: Chronic deep vein thrombosis (DVT): DVT is a blood clot in one of the large, deep veins that returns blood from the leg — or less commonly, from the arm — to the heart and lungs. Post-thrombotic syndrome: DVT can damage veins, which can lead to symptoms such as chronic swelling and pain. People may not suffer from symptoms of post-thrombotic syndrome until years after DVT. May-Thurner syndrome: In this condition, the artery that runs from your abdomen to your right leg — called the right iliac artery — presses against the left iliac vein, causing it to narrow and scar, leading to chronic left leg swelling, pain, and sometimes fatigue. Venogram with Intravascular Ultrasound (IVUS) IMPLANTABLE LOOP RECORDER TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE) CARDIOVERSION TILT TABLE TESTING VALVULOPLASTY TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) ENDOVASCULAR ANEURYSM REPAIR (EVAR)