The Pinehurst Medical Clinic’s Cardiology unit performs many procedures on-site. Among these are:
- External counter pulsation (ECP). This noninvasive treatment for patients with angina (heart pain) increases blood flow to the heart. The patient’s legs are wrapped in compression cuffs, which are inflated in sequence. The treatment consists of a one-hour visit five days a week for seven weeks.
- Echocardiography (echo). This noninvasive procedure visualizes the heart to assess heart function and size.
- Stress echo. This test examines how your heart functions during stress. You will walk on a treadmill first and immediately afterwards have an echo performed.
- Electrocardiograms (ECG or EKG). This test records the electrical activity of the heart to check the rate and regularity of heartbeats. Measuring devices called leads are attached to the chest to measure this activity.
- Holter monitoring (portable heart monitoring). This is a test that records the heartbeat continuously. Leads are placed on the patient’s chest and are attached to a portable recording device worn on a belt. The patient keeps a diary of activities and symptoms during the time this device is worn. After 24 hours the patient returns the device. A cardiac technician scans the recordings and a physician reviews the data.
- Lipid clinic. This is a special clinic run by a nurse practitioner and overseen by a physician for patients who have elevated cholesterol and triglycerides. Treatment includes medication and diet.
- Nuclear cardiology. This procedure measures wall motion and function of the heart. The patient is given an intravenous injection of a radioactive substance and is then placed under a scanning device designed to visualize the heart. A patient usually walks on a treadmill before the injection.
- Pacemaker analysis. This clinic for patients who have had pacemakers inserted is run by a pacemaker technician and overseen by a physician. Pacemaker checks can be done remotely by transmitting the heart rhythm over the phone for the tech and physician to review.
- Exercise stress test (treadmill test). This test helps evaluate how well the heart works under stress. The patient walks on a treadmill while hooked up to equipment that monitors the heart rate, heart rhythm, breathing, and blood pressure. The speed and incline of the treadmill are gradually increased.
- Cardiac CT imaging. Cardiac CT imaging (also called coronary computed tomography angiography, or coronary CTA) is a noninvasive diagnostic procedure that uses X-rays to scan the coronary arteries. The X-ray beam moves in a circle around the body, allowing many different views and providing much greater detail than a standard X-ray. In a matter of minutes, the cardiologist is able to visualize the arteries of the heart remarkably well with this noninvasive test. Coronary CTA is used to evaluate chest pain and shortness of breath and to stratify cardiac risk in patients with suspected coronary artery disease.
- Cardiac event monitoring. Cardiac event monitoring is a test similar to Holter monitoring that is used to evaluate abnormal heart rhythms or cardiac symptoms that occur infrequently. The device used for cardiac event monitoring is smaller than a Holter monitor and is worn or carried for more than one day. The monitor is activated by the wearer when symptoms occur.
- Three-dimensional echocardiography (3D echo). This enhanced imaging technique allows visualization of the length, width, and depth of the heart, including the valves and ventricles. Three-D echo is used to evaluate and monitor a variety of cardiovascular conditions, including cardiomyopathy, valve problems, and congenital heart disease.
The Pinehurst Medical Clinic cardiologists also perform off-site (hospital) procedures to diagnose and treat cardiovascular disease, including the following:
- Cardiac catheterization. This is a non-surgical procedure in which a thin flexible tube is passed through a blood vessel and threaded into the heart with the aid of an X-ray machine. A dye is injected so that pictures can be taken of the heart and blood vessels. Cardiac catheterization is used to evaluate heart valves, heart function, and blood supply and to determine the need for heart surgery.
- Angioplasty. This is a medical procedure in which a balloon is inserted through a catheter to open narrowed or blocked blood vessels to the heart. Angioplasty may be performed to treat persistent chest pain (angina), to widen an artery that has been narrowed by plaque, or to open an artery that has been blocked during or after a heart attack.
- Stent. A stent is a coil of wire mesh that is placed in an artery after angioplasty to help prevent the artery from re-narrowing. The stent remains in the artery permanently. Stents may be coated with medication that is released slowly to help prevent the artery from closing up again.
- Electrophysiology studies. These tests are performed to help locate the specific areas of heart tissue that are causing an arrhythmia and to evaluate the effectiveness of drugs to regulate the heart rhythm. Electrophysiology studies are done in a hospital under local anesthesia and mild sedation.
- Radiofrequency ablation. This is a non-surgical procedure to treat a rapid heartbeat. A catheter is inserted through a blood vessel and guided to the heart. At the end of the catheter is a small wire that delivers energy to selectively destroy abnormal tissue that is responsible for the arrhythmia.
- Implantable cardioverter/defibrillator (ICD) placement. An ICD is an electronic device that continually monitors the heart rate and rhythm and delivers energy to the heart to restore a normal rhythm when the heart is beating abnormally. Having an ICD implanted is a surgical procedure that is performed in the hospital with deep sedation.
- Pacemaker implantation. A pacemaker is a small battery-operated device that helps the heart beat in a regular rhythm. Having a pacemaker implanted is a minor surgical procedure that is performed with mild sedation and a local anesthetic.
- Transesophageal echocardiography (TEE). This is a variation of an echo test. The back of the patient’s throat is anesthetized and a scope is inserted down the throat and into the lower part of the esophagus. An ultrasound device on the end of the scope provides pictures of the heart.
- Atherectomy. This procedure is similar to angioplasty, except that it uses a cutting device (a laser or a tiny rotating knife) to remove plaque buildup from the wall of the coronary arteries. As in angioplasty, a catheter is inserted into the body through a blood vessel and advanced to the area of narrowing in the coronary artery. Once the catheter is in place, the fatty deposit is gently shaved off the wall of the artery. The shavings are collected in the catheter and removed when it is withdrawn from the body.
- Intracoronary ultrasound. This is an imaging technique that provides a cross-sectional view of the coronary arteries from inside the arteries. Intracoronary ultrasound is performed by threading a tiny ultrasound device into the artery from inside a catheter. As the catheter is moved along the length of the artery, the ultrasound waves bounce off the arterial walls to register an image that shows changes in the walls’ thickness. This enables the cardiologist to determine the extent of a blockage and to evaluate the success of angioplasty or stent placement in restoring healthy blood flow.
- Tilt table test. This test is used to evaluate a person’s susceptibility to sudden drops in blood pressure that can cause fainting spells, severe lightheadedness, or dizziness. The test involves lying quietly on a bed that is tilted to 60 degrees while machines monitor blood pressure and heart rhythm. In some cases, a drug that stimulates the heart is given via IV to see if this stress causes a drop in blood pressure when the table is tilted.
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