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In-Office Cardiac Services
Starting with a comprehensive consultation, we provide many In-Office Cardiac Services. Ultrasound, vein procedures, stress tests compliment our services provided. We invite you to read more about all of our in-office cardiac services below, and contact us with any questions.
Consultation
Every in office service starts with a consultation. It is an initial evaluation and discussion of your cardiovascular health history and current cardiac issues (if applicable.) You will have the opportunity to ask questions and voice any concerns with regard to your cardiac health.
During this visit, you and your provider will discuss the best course of action to ensure optimal management of your cardiovascular health. We provide many services in office, please read more below.
Women Heart Disease Risk Assessment
A woman is exposed to multiple risk factors for cardiac disease from early age. If you are a mother and you suffered from high blood pressure of diabetes during pregnancy your risk to develop cardiovascular diseases is higher. For this and many other specific reason every women should complete an evaluation to understand their risk to develop heart disease and what to do to prevent it.
Stroke Prevention Screening
What do you know about your risk for stroke? You cannot prevent what you cannot control. In this screening you will undergo a series of test and evaluation to asses potential risk factors for stroke or the presence of disease that can increase you risk for it.
Sudden Cardiac Death Screening
You don’t know until you know. There are only a few non preventable causes for SCD. Thru this screening we will be completing a battery of test that are design to identify potential causes for SCD.
Pre-Exercise Screening
This program is designed for those interested in engaging in physical activity. This screening is intended to ensure the safety of your exercise routine, even if you are an athlete interested in engaging in more competitive workouts or if you are planning to get out of the couch and start an exercise routine. With this evaluation the providers will be able to identify high risk markers suggestive of heart disease that might increase your death risk.
Heart Ultrasound
Also known as an echocardiogram, an ultrasound of your heart is ordered to evaluate several different cardiac areas, such as the pumping function of your heart, viewing the different structures of the heart, and checking the health of your heart valves. This is a simple, non-invasive procedure that uses ultrasound technology to obtain advanced imaging of the heart. During the procedure, after changing into a paper shirt, you are comfortably placed on an exam bed. A wand and transmitting gel is then placed on your chest to look at the movements of your heart, and digital images are taken to show your doctor a clear picture. Once all appropriate images are obtained, the procedure is over. The test takes about 15-20 minutes.
Carotid Ultrasound
The carotid arteries are located on either side of your neck and are designed to feed blood to the brain. If your provider suspects there may be abnormalities with either artery, he or she may order a carotid ultrasound. This non-invasive test uses an ultrasound wand to examine the structure and function of the carotid artery. The test can detect blockages within the carotid artery system which can produce symptoms such as lightheadedness or fainting. During the procedure, you are comfortably placed on an exam bed and an ultrasound technologist will use the wand to examine your arteries and capture digital images. If you are wearing an open neck top, disrobing may not be necessary. Once all images have been obtained, the test will be over. The test takes about 15-20 minutes.
Abdominal Ultrasound
An abdominal ultrasound is used to examine the aorta, the main artery leading away from the heart which transports blood to various parts of the body. This non-invasive test uses ultrasound technology to evaluate any abnormalities with the structure and function of the abdominal aorta. Commonly, this test is used to determine if an abdominal aortic aneurysm (AAA) is present. This test is also recommended prior to beginning some therapies such as EECP (see EECP section for more information). During the procedure, you are comfortably placed on an exam table with your shirt lifted. An ultrasound technologist moves a wand over your abdominal region to take digital images of the aorta. Once all pertinent images have been obtained, the exam is over. The exam takes about 15-20 minutes.
Extremity Arterial Ultrasound
An arterial ultrasound, also known as a peripheral ultrasound, is used to examine various arteries within the body. Typically, the arteries of the legs and arms are examined during this procedure to detect any structural abnormalities or blockages within the vessels. Your provider may order an arterial ultrasound if you are experiencing signs of reduced blood flow or pain in your extremities.
During the procedure, you are comfortably placed on an exam table. If the brachial (arms) arteries are being investigated, you will need to remove your shirt, and likewise, if your legs are the subject of the test, you will need to remove your pants. An ultrasound technologist then moves a wand over the different arteries being examined. In some cases, you may be asked to stand to capture images of your legs. Once all pertinent images have been obtained, the exam is over. The test takes about 15-20 minutes.
Venous Ultrasound
A venous ultrasound is used to examine various veins within the body, typically in the legs and arms to detect any structural abnormalities or valve leakages in the vessels. Your provider may order a venous ultrasound if you are experiencing signs of swelling within the extremities. During the procedure, you are comfortably placed on an exam table. If the veins in the arms are being investigated, you will need to remove your shirt, and likewise, if your legs are the subject of the test, you will need to remove your pants. An ultrasound technologist then moves a wand over the different veins being examined. Once all pertinent images have been obtained, the exam is over. The test takes about 15-20 minutes.
Ultrasound
Ultrasound is a non-invasive testing method that uses sonography to can see inside your body to determine organ function, movement, blockages, and other conditions. There are several different ultrasound tests your provider may order to identify or even rule out some cardiac conditions.
Vein Procedures
As we age, our veins can begin to deteriorate, which can manifest as varicose veins, swelling or pain in your legs, and more. Tri-County Heart Institute is pleased to offer advanced treatments to relieve these symptoms. These treatments include endovenous thermal ablation, endovenous chemical ablation, sclerotherapy, and VenaSeal™. In many cases, these procedures can be done in our office or in our outpatient surgical center.
Endovenous Thermal Ablation
Diseased veins that have not responded to more conservative measures may require further intervention. Endovenous thermal ablation therapy uses heat to close the diseased vein. During the invasive procedure, a trained vascular medicine specialist uses an ultrasound-guided catheter to locate and then deliver thermal (heat) treatment to the diseased vein. There is minimal discomfort and few restrictions following the endovenous thermal ablation therapy. The procedure takes about 30-45 minutes to complete, and you will be able to drive to and from your appointment unless otherwise indicated by your provider.
Endovenous Chemical Ablation
Endovenous chemical ablation is very similar to a thermal ablation except it uses medication to close off the diseased vein that is causing your symptoms. During the invasive procedure, a trained vascular medicine specialist uses an ultrasound-guided catheter to locate and then deliver the medication to the diseased vein. There is minimal discomfort and few restrictions following the endovenous chemical ablation therapy. The procedure takes about 30-45 minutes to complete, and you will be able to drive to and from your appointment unless otherwise indicated by your provider.
Sclerotherapy
Sclerotherapy is used to treat unwanted or problem varicose and spider veins. The procedure involves injecting a solution into the vein. The solution irritates the lining of the vessel causing it to shrink and collapse. The results can be aesthetic and can relieve symptoms caused by diseased veins. You can expect mild discomfort from the delivery of the injection, but this usually resolves quickly. The procedure takes about 30-45 minutes to complete. You will be able to drive to and from your appointment unless otherwise indicated by your provider.
VenaSeal™
Diseased veins causing symptoms that have not responded to conservative measures may require further intervention. The VenaSeal procedure uses a medical adhesive to close the diseased vein. During the invasive procedure, a trained vascular medicine specialist uses an ultrasound-guided catheter to locate and then deliver treatment to the diseased vein. There is minimal discomfort and few restrictions following VenaSeal therapy. The procedure takes about 30-45 minutes to complete. You will be able to drive to and from your appointment unless otherwise indicated by your provider.
Exercise Stress Test – Treadmill
Exercise stress testing is a diagnostic test used to determine if there is any exercised-induced damage occurring to your heart. This type of stress testing can detect blockages in your coronary arteries (the arteries that feed blood to your heart) by looking at electrocardiographic monitoring. During this procedure, 12 leads are attached to your chest and abdomen to continuously monitor your heart rhythm throughout the test. A blood pressure cuff is also applied to measure your blood pressure at different stages throughout the exam. You are then asked to walk on a treadmill.
During the stages of the exam, the treadmill will incline and change pace to appropriate speeds to help your provider assess your heart’s response to increasingly strenuous exercise. If you are unable to continue at any time during the procedure and for any reason, the stress test technologist will end the exam. Your cardiologist will interpret the findings to determine an appropriate treatment plan, if necessary. This type of stress test may take up to an hour to complete.
Stress Echocardiogram
This type of treadmill stress test is used in combination with ultrasound technology to examine response to stress from the various regions of the heart. The ultrasound images look at cardiac wall motion abnormalities, if present, as well as abnormalities in the chambers of the heart to determine if there is any damage (called ischemia) happening to the heart muscle. As stress echocardiogram may take up to an hour to complete.
Nuclear Stress Test
Nuclear stress tests utilize radionuclide imaging (a radioactive dye) to further assess the presence or absence of blockages in your coronary system by looking at the way the blood flows through your arteries. There are two types of nuclear stress testing, exercise and chemical, and they both start the same way. You will be asked to sit or lie still while the camera will take a series of digital pictures to establish a baseline of your heart function as the dye moves through your system, illuminating the heart and its function, arteries and other important information.
Exercise Nuclear Stress Test
This type of nuclear stress test uses treadmill exercise to evaluate the heart’s response to exercise. You will be asked to walk on the treadmill until optimum stress levels are reached, and then move to the camera. The imaging obtained helps your provider determine if there is any reversible damage occurring to the heart (presence or absence of blockages). This type of stress test is normally used for those individuals who are able to walk on a treadmill without difficulties.
Chemical Nuclear Stress Test
This version of the nuclear stress test uses a medication (usually adenosine or Lexiscan) to induce the heart to respond as if the heart were exercising. The imaging obtained helps your provider determine if there is any reversible damage occurring to the heart (presence or absence of blockages). This type of stress test is normally used for individuals for whom walking on a treadmill is difficult or not possible.
Stress Tests
Stress testing is a way your provider can determine if there is any concern about blockages in your coronary arteries. There are three main types of stress testing: exercise stress test on treadmill, stress echocardiographic (ultrasound) imaging, and nuclear stress imaging.
Services Provided
In-Office Cardiac Services
Pre-operative Evaluation
If you have an upcoming procedure or surgery, your doctor or surgeon may request that you obtain cardiac clearance prior to the surgery. If a clearance is ordered, the cardiologist will perform a pre-operative evaluation and risk assessment to determine if it is safe for you to undergo the proposed procedure/surgery.
It will be decided at that time if further testing is needed to be cleared. Once cleared for the surgery/procedure, your cardiologist will inform the requesting provider.
Coumadin (INR) Monitoring
Coumadin (generic name Warfarin) is an anticoagulant used to thin the blood. Patients receiving Coumadin must be monitored routinely through a lab test called an INR. This test ensures the medication in your bloodstream is at therapeutic levels to prevent your blood from being too thin or too thick, depending on why Coumadin has been prescribed to you.
Tri-County Heart Institute offers INR monitoring in our office, at a lab and results faxed to our office, or with a home monitoring device which can send the results directly to our office. Your provider will then evaluate the INR results and make recommendations on any Coumadin adjustments that may be needed.
Holter Monitor
A Holter monitor is an external, battery-powered cardiac monitoring device used to evaluate your heart rate and rhythm over an extended period, usually 24 – 48 hours. Your provider may order this monitoring if cardiac arrhythmias or conduction abnormalities are suspected, for therapeutic drug monitoring, or for certain other reasons. We place the monitor while you are in our office using electrode tabs and leads, and the small device is connected to the leads by small wires.
The device is used to store the data gathered during the monitoring period, and you wear it for the entire time, during activities and rest, while not getting it wet (no swimming or bathing with it on). At the end of the monitoring period, you will return the monitor to the provider’s office and the data gathered will be interpreted.
Cardiac Event Recorder
(up to 30 days)
A cardiac event recorder is very similar to a Holter monitor, in that it is an external cardiac monitoring device used to evaluate heart rate and rhythm. An event recorder can be used to diagnose conduction abnormalities and arrythmias within the heart for up to 30 days of monitoring. There are different types of event monitors. When you come to our office to have your monitor placed, our staff will inform you of the different functions and/or restrictions of the device.
Pacemaker/AICD Evaluation and Reprogramming
For patients who have a cardiac pacemaker or AICD, Tri-County Heart Institute provides routine in-office and remote monitoring and surveillance of the device, including monitoring heart rate and rhythm, and battery life. Sometimes it is necessary to reprogram the pacemaker or AICD device for optimal function, and we offer this service in our office. (See Pacemaker Implants for more information about this device).
Loop Recorder Monitoring
For patients who have an implantable cardiac recorder monitor (or Loop), Tri-County Heart Institute provides routine in office and remote monitoring of the device, including monitoring the battery life, and heart rate and rhythm. (See Loop Recorder for more information about the this device).
Kardia Monitoring
Kardia is cardiac monitoring technology that is available for purchase at Tri-County Heart Institute. This device utilizes touch technology to evaluate your heart rate and rhythm. For example, if you are experiencing a certain symptom that may be related to the conduction system in the heart, you will place your fingertips on a touch pad to evaluate your heart rate and rhythm.
The primary difference between a Kardia monitor and the other monitors we offer (30 day event, Loop, and Holter), is that the Kardia monitor requires you to have the touch pad readily available to record your heart rhythm should you experience symptoms (e.g. palpitations, lightheadedness, skipped beat, fluttering, etc.). Around the clock cardiac monitoring is not available with this device.
Ambulatory Blood Pressure Monitoring
For accurate and precise blood pressure measurements, we provide 24-hour monitoring. This information helps your provider better understand your blood pressure measurements throughout during the day and while sleeping. The ambulatory blood pressure monitor is placed at the office. You will wear it home and for the next 24 hours, and return the next business day. Your provider will then analyze the data gathered to formulate a treatment plan based on the results.
Advanced Lipid Management Clinic
Many individuals have received basic cholesterol labs in the past. Tri-County Heart Institute is pleased to offer advanced lipid panel testing in our office. Advanced lipid panel testing is a complete evaluation of cholesterol, inflammation markers, metabolic profile, diet, omega index, and more.
This in-depth lipid analysis can more clearly assess your risk for cardiovascular disease and help your provider develop a treatment plan. If your provider orders this test for you, you will need to have an 8-hour fasting lab draw completed at our Villages location.
Genetic Cardiovascular Disease Evaluation
There are some individuals who may go to extensive lengths to ensure their cardiac health is optimal, but unfortunately still find they suffer from cardiovascular disease. At Tri-County Heart Institute, we can provide an assessment of your genetic predisposition to heart disease. This is done in our office by a simple lab draw. If indicated, your provider will order these labs to determine if you are at a genetic risk for heart disease.
Micronutrient Testing
Nutrients are found in the foods we consume and from our everyday activities (think vitamin D from sunshine). A deficiency in nutrients can lead to unwanted symptoms or side effects. By utilizing micronutrient testing, we can identify these deficiencies to help you live a healthier life. This test is completed in the office by a simple lab test. The labs are then analyzed and presented to you in a follow-up visit to discuss the findings.
Electrocardiogram (EKG or ECG)
An electrocardiogram is used as an initial screening tool to evaluate the rate and rhythm of your heart. This baseline evaluation shows your provider any immediate rhythm abnormalities you may have. This test can also determine if you have any conduction abnormalities or any thickening of the heart muscle surrounding the chambers of your heart. During this procedure, you are asked to lie comfortably on an exam table while 12 tabs with leads are attached to your chest, arms, and legs. A machine records and evaluates the heart’s rate and rhythm. Your provider will then interpret the findings.
Enhanced External Counter Pulsation (EECP) Thereapy
Enhanced External Counter Pulsation (EECP) Therapy is an FDA-approved, non-invasive treatment designed to improve circulation to the heart and decrease inflammation. The therapy uses rhythmic pulses created by gently squeezing the lower body with air pressure to open or create small blood vessels called collaterals. These collaterals create a natural bypass around blocked arteries helping to improve circulation. The therapy is a series of 35 daily treatments, each lasting about an hour. During a session, you lie down on a special bed and oversized blood pressure cuffs are placed around your calves, thighs, and buttocks.
A continuous ECG is also connected to monitor your heartbeat. Air hoses attached to the cuffs rapidly fill and deflate the cuffs with air in time with your heartbeat. The goal is to get your blood pumping in a way that is similar to exercise (though this is not a replacement for exercise), so that stimulation of your blood vessels will help them grow and function to maximum capacity. The therapy is non-invasive, and while it can seem loud, many patients have actually fallen asleep during a session!
