Cardiology Services

Cardiology Consultation

Cardiology consultation is appropriate to address the disorders listed below. Frequently a patient will come to a cardiologist through a referral from a primary care provider. However, it is also appropriate either to choose a cardiologist yourself or to make an appointment on your own if you would like a specialist evaluation of any of the problems listed below.

Exercise Stress Testing

An exercise stress test involves rapid walking on a treadmill, using a standard protocol (the “Bruce” protocol), while connected to an electrocardiogram (EKG) machine. It is used for coronary artery disease screening, evaluation of chest pain and palpitations, screening prior to beginning significant physical exertion (such as joining a gym), for the detection of abnormal heart rhythms (arrhythmias), and to determine the effectiveness of various cardiac medications, such as medication for high blood pressure (hypertension).

Nuclear Stress Testing

Nuclear stress testing of the heart provides a very sensitive noninvasive evaluation of blood flow to the heart through the coronary arteries. Whenever the heart is stressed, such as with exercise, more blood must flow through the coronary arteries to provide the necessary energy for the heart to continue to function. If a blockage exists in one or more coronary arteries (the “plumbing system” of the heart), then the heart will not be supplied with the sufficient amount of blood required to keep up with the physical stress on the body. If this condition is left uncorrected, a heart attack or even death may ensue. The nuclear stress test uses a radioactive tracer to follow the flow of blood through the coronary arteries, and by comparing the flow at rest to the flow after exertion, blockages in the arteries can be detected, prompting the ordering of lifesaving cardiac procedures.

Nuclear Stress testing can be accomplished using a treadmill, or in patients who cannot exercise, with intravenous medication essentially to stimulate exercise while flat on a table. It is appropriate for coronary artery disease screening, for evaluation of chest pain, and for screening or evaluation of abnormal symptoms such as chest pain or shortness of breath after cardiac procedures such as angioplasty, stenting, and bypass surgery. It is also appropriate when an electrocardiogram is uninterpretable for coronary artery disease due to certain baseline abnormalities.

Echocardiography

An echocardiogram is an ultrasound (also known as a “sonogram”) of the heart. It is entirely noninvasive. High quality images of the heart muscle, its strength, and its valves are obtained. Echocardiography is used to evaluate the cause of heart murmurs heard on physical exam, to evaluate and make treatment decisions involving abnormal heart valves, to evaluate chest pain and shortness of breath, to screen for old heart attacks, in the evaluation and treatment of high blood pressure, and for screening in people with a family history of sudden cardiac death.

Evaluation of Heart Valve Disorders

The heart is a muscle surrounding various chambers through which all of the blood in the body must flow to receive oxygen, the source of energy for all organs. Blood flows from the body, through the heart, into the lungs, back into the heart, and then out to the body again in a continuous cycle. As blood flows through the various chambers, it must pass through heart valves (the doorways between the chambers). These valves can become dysfunctional in a variety of ways, resulting in blood leaking backwards through an incompetent valve (“regurgitation”), or resulting in an inability of the blood to pass forward through a very narrowed valve (“stenosis”). These disorders may not produce symptoms and only may be detected by the presence of a heart murmur on physical examination, or they may produce a variety of symptoms including fatigue, shortness of breath, swollen ankles, inability to breathe while flat, palpitations, and occasionally chest pain. Echocardiography (see above) is used to diagnose the specific valve problem, and then appropriate treatments (antibiotics before the dentist, cardiac medications, or valve repair or replacement, to name some examples) can be initiated.

Evaluation of Coronary Artery Disease

The coronary arteries are the tubes through which blood flows to the heart muscle and provides it the energy to pump. When the coronary arteries become diseased or blocked, chest pain, shortness of breath, and a variety of other symptoms may be produced. If left uncorrected, these blockages may result in a heart attack (“myocardial infarction”), which in turn can result in permanent disability or even death. In fact, heart disease is the number one cause of death in men and women. Screening for and treatment of coronary artery disease (with medications and cardiac procedures such as diagnostic angiography, also known as cardiac catheterization, coronary artery angioplasty and stenting to open clogged arteries) is the domain of the cardiologist, and all patients with coronary artery disease should see a cardiologist regularly.

Evaluation of Hypertension (High Blood Pressure)

High blood pressure is one the most common medical disorders, resulting from a combination of genetics, age, and lifestyle (obesity, excessive alcohol intake, lack of exercise, to name a few). It is often called the “silent killer” because if undetected by a physician (or worse, untreated), results in strokes, heart attacks, blindness, and kidney failure, as well as abnormal heart rhythms. High blood pressure is the most common cause of strokes. High blood pressure treatment is often complicated, and sometimes involves screening for uncommon correctable causes of hypertension other than those listed above. High blood pressure is commonly treated by primary care providers, but often they will enlist the help of a cardiologist to assist in the management of high blood pressure.

Evaluation of Chest Pain and Shortness of Breath

Chest pain and shortness of breath are among the most common reasons to see a cardiologist. Although many non-cardiac disorders can cause these symptoms, all patients who experience chest discomfort and/or shortness of breath should have cardiac disease as a consideration of the source of these symptoms. While not all patients with these symptoms will be referred to a cardiologist, the majority will be. This is because failure to detect coronary artery disease, vavular heart disease, or cardiac arrhythmias as a cause of these symptoms can be fatal.

Evaluation of Cardiac Arrhythmias

Cardiac arrhythmias are abnormalities in the pattern of the beating of the heart. They can produce palpitations, fatigue, shortness of breath, fainting, strokes, and even death, depending on the type. There are numerous cardiac monitoring devices available to the cardiologist to detect the type of arrhythmia (the most common of which is the "Holter monitor"), which allows appropriate treatment. While many arrhythmias require no treatment, failure to recognize dangerous heart rhythms can be catastrophic.

Evaluation of Fainting (Syncope)

Fainting, also known by its medical term, syncope, is a common problem, often caused by nonserious conditions. However, because fainting sometimes can result from serious cardiac abnormalities, patients are frequently referred to a cardiologist for the evaluation of fainting and near-fainting.

Evaluation of Fatigue

Fatigue is one of the most frequent patient complaints, and often its cause is unclear or due to noncardiac issues. However, certain cardiac conditions, such as arrhythmias, coronary artery disease, valvular heart disease, and a weak heart muscle (“cardiomyopathy”) can cause fatigue, and a cardiologic evaluation is often performed in patients with fatigue of unknown origin.

Cholesterol Disorders (Dyslipidemia)

Disorders of cholesterol are among the most prevalent medical problems in society today. Each year, more information about the importance of screening for and aggressive treatment of cholesterol disorders becomes available. Disorders of cholesterol are associated with heart attacks and stroke, and depending on the patient, different goals for the level of cholesterol are determined. Often cholesterol disorders can be ameliorated by lifestyle changes, but frequently these changes are not sufficient, and various medications need to be prescribed to reduce the cholesterol to acceptable levels.

Preoperative Screening

Frequently a cardiologist will be asked to assess a patient's risk of cardiac complications related to surgery. This is because undetected heart abnormalities may become symptomatic and troublesome under the stress of anesthesia and surgery, and a heart attack might even ensue. Accordingly, the cardiologist frequently will order a number of tests before concluding that a patient may safely undergo surgery from a cardiac perspective. While these tests are not perfect and do not prevent cardiac complications in all cases, they can significantly reduce the chances of a bad outcome. The most frequently ordered preoperative cardiac tests are stress tests and echocardiograms.

Weight Loss and Nutritional Consulting

Because of the increasing prevalence of obesity in the United States, and the increased awareness of its medical consequences (sleep apnea, pulmonary hypertension, high blood pressure, high cholesterol, and diabetes, to name a few), I offer referrals to a nutritionist, and in appropriate cases, use the OPTIFAST weight loss program. I am a certified provider of the OPTIFAST products (see related link) and these products are only available through certified doctors and clinics, and require medical monitoring while used. The results are often dramatic, and the products have proven efficacy.