Diagnostic Testing and Procedures

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Cardiac Catheterization Laboratory

Our Laboratory

Your physician may recommend an examination in our cardiac catheterization laboratory to study how your heart is functioning. We perform a number of minimally invasive procedures that review how your blood is flowing, how the heart valves are working, and what amount of blood pressure is present in your heart chambers.

The Procedure

This general procedure is used to diagnose and treat heart conditions you may have. Some specific procedures that are performed during a catheterization:

  • Left and right heart catheterization—checks the blood flow on both sides of your heart
  • Coronary angiogram—checks for blockages in your heart
  • Balloon valvuloplasty—opens up narrowed heart valves
  • Stent replacement/deployment

Preparation

If you require a cardiac catheterization, talk to your physician about any medications you are using, so you can discuss any you should temporarily stop taking. You will likely be advised not to eat or drink for 8 to 12 hours before the procedure.

Just before the test, a nurse or technologist will check your blood pressure, and you’ll probably be advised to remove dentures if you wear then, as well as any jewelry that could interfere with the images being taken of your heart.

What to Expect

A nurse will remove the hair from the area where the catheter will be inserted, and you’ll be given a shot to make this area numb. During the procedure, you will be awake but sedated. An IV will supply any additional medication you need, and you’ll have electrodes placed on your chest to monitor your heartbeat.

Depending upon the exact procedure you are having, you will have a catheter inserted into an artery at your groin or your wrist. The insertion should not hurt, but you may feel an unusual sensation. You’ll be advised to take deep breaths and relax.

After the test, you may need a several hours to recover, so you’ll be taken to a hospital room. Some patients go home the same day, while others spend a night or two.

Cardiovascular Decision Unit

If you are having cardiac issues but do not yet require hospitalization, our cardiovascular decision unit is there to help monitor and assess you. The unit provides 23-hour observation, which helps physicians determine the next step needed in your treatment.

This unit can accommodate 12 patients, and it provides comfort and privacy as you are evaluated. You and your physicians also have immediate access to other hospital services if you require them.

There are areas for your family members to wait, and they are welcome to visit you when you are not being tested.

Doppler Ultrasound

This noninvasive test is similar to a vascular ultrasound, but it also uses Doppler technology to measure the changes in pitch (or frequency) that your blood cells create when they move through your body. This specialized technology helps check blood pressure in the arteries, as well as look for blood flow problems and blood clots.

Electrophysiology Laboratory

Electrophysiology (EP) is a subspecialty of cardiology and examines the electrical behavior of the heart. Our EP lab is the first of its kind in Osceola County, and it is staffed by experts who are highly trained in diagnosing and treating irregular heartbeats (also known as arrhythmias).

Our hospital is on the cutting edge of cardiovascular care, and it boasts a revolutionary Carto® 3 Navigation System. This incredible technology allows an electrophysiologist to review a map of a patient’s heart and monitor its electrical activity in 3D and in real time. This heart map helps determine the origin of the arrhythmia and assists the physician in guiding a catheter to the right place to treat the problem.

We specialize in the following procedures:

  • Ablation studies
  • Lead management systems
  • Atrial fibrillation management
  • Pacemaker insertion and monitoring
  • Implantable defibrillators
  • Implantable cardioverter defibrillators

What is AFIB?

Atrial fibrillation, or “AFib”, is a common heart rhythm disorder. AFib causes the upper chambers of the heart (atria) to beat rapidly and in an uncontrolled and uncoordinated fashion (fibrillation), impairing blood flow from the heart. The likelihood of developing AFib increases with age. This condition is not usually dangerous by itself, but it is a major risk factor related to stroke.

What are the symptoms?

The most common symptoms during an AFib episode include heart palpitations (irregular or rapid heartbeat), irregular pulse, shortness of breath, weakness, fatigue, dizziness/light-headedness, fainting, and chest pain.

How is it currently treated?

Treatment usually begins with medication; however, some patients do not respond to drug therapy or cannot tolerate the side effects caused by the medications. When patients cannot get relief through medication, doctors are increasingly referring them for a procedure called catheter ablation. This procedure is performed by a doctor called an Electrophysiologist who has had specialist training in the treatment of heart arrhythmias.

What is catheter ablation?

Catheter ablation is a non-surgical, minimally invasive, procedure in which catheters are introduced to the heart via a small incision in a vein in the patient’s leg. The catheter is threaded into the heart where the electrical impulses of the heart can be studied. Once the areas that conduct abnormal electrical activity have been identified, the catheter can treat the arrhythmia by emitting radiofrequency energy in order to disconnect wayward electrical impulses.

Are there special catheters for AFib ablation?

In fact, the NaviStar® ThermoCool® Catheter from Biosense Webster, Inc. is the first and only ablation catheter to be approved for the treatment of AFib* in the United States. A recent groundbreaking clinical study with the catheter showed that ablation was superior to medication in eliminating AFib episodes, reducing symptoms and improving the quality of life of a certain type of AFib patient suffering symptoms despite taking medications.

How does ablation help correct arrhythmias?

Ablation targets the areas of the heart that are generating the wrong kinds of electrical pulses that cause rapid heartbeat.  By neutralizing and blocking these areas, the pulses are controlled and a normal heartbeat returns.

Echocardiogram

This noninvasive test uses sound waves to create images of your heart. During an echocardiogram, your doctor can study how your heart is beating and pumping blood.

  • Transthoracic echocardiogram—There are no special preparations to make before this test. A technician will spread gel on your skin and then press a wand (called a transducer) on your chest. The transducer aims an ultrasound toward your heart and records sound wave echoes from your heart. These echoes are then converted into images that your physician can review.
  • Transesophageal echocardiogram—In some cases, your doctor may not be able to get clear images of your heart with a standard echocardiogram, so a transesophageal echocardiogram may be the solution. Before this procedure, you may be advised not to eat or drink for a few hours. Your throat will be dumbed and you will be given medications that will help you relax. During the exam, your doctor will thread a flexible tube that contains a small transducer down your throat and into your esophagus. From that position, the transducer can record images of your heart.

After a transthoracic echocardiogram, you are free to resume regular activities However, because of the medication needed for a transesophageal echocardiogram, you may need an hour or two to recover and you should have someone else drive you home.

Electrocardiogram

This noninvasive test, also known as an EKG or ECG, measures the electrical activity of the heart. You may need an EKG if you are experiencing chest pain, heart palpitations, shortness of breath, and dizziness. You may also have an EKG as part of a routine physical, during a stress test, or prior to heart surgery.

The test is painless and takes only about five minutes. Several electrical sensing devices, called leads, are placed various places on your body. Usually, they are attached by small adhesive patches or suction cups. The leads transmit information that produce a zigzag pattern on a moving strip of paper. Your cardiologist will review the pattern to determine if you have any heart issues that need to be addressed.

Ejection Fraction

Every time your heart contracts and relaxes, a percentage of blood leaves the heart. An ejection fraction (EF) numerically measures the percentage of blood lost with each heart contraction.

During a heartbeat cycle, the heart contracts and ejects blood from the two pumping chambers, called ventricles. As your heart relaxes, the ventricles fill up again with blood. No matter how forceful a contraction is, there is still blood left in the ventricles, and the ejection fraction number determines the amount of blood that's pumped out with each contraction.

Ejection fraction is usually only measured in the left ventricle—your heart's main pumping chamber. An ejection fraction ranging from 55 to 75 percent is considered normal, and the fraction may increase if you have a weakened heart muscle, have had a heart attack, have high and uncontrolled blood pressure, or have heart valve problems. A high EF might mean you're at risk for certain heart conditions, including hypertrophic cardiomyopathy. A low EF percentage might mean you have a weak heart, or indicate you have an enlarged, thickened or stiffened heart. Low EF is an important indicator of sudden cardiac death as well.

Measuring Ejection Fraction
Ejection fraction is most commonly measured during an echocardiogram, a painless and noninvasive test that uses high-frequency ultrasound waves to produce images of the four heart chambers and valves, as well as images of blood pumping though the heart.

Other imaging techniques used to measure ejection fraction include:

  • Cardiac catheterization, performed by inserting a thin plastic tube, or catheter, into a vein in the leg or arm. The catheter is then internally moved to the heart to capture images of blood pumping.
  • Computerized tomography (CT), a scan that uses special X-ray techniques to capture cross-sectional images of the body part being scanned.
  • Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to capture cross-sectional images of certain parts of the body being scanned.
  • Nuclear medicine scan, during which a small amount of radioactive material, such as thallium, is injected into the bloodstream and detected using special cameras that document blood flow through the heart.

Percutaneous Coronary Intervention (PCI)

A percutaneous coronary intervention (PCI) is also called coronary angioplasty, and the procedure is similar to a cardiac catheterization. The goal of a PCI is to open up a clogged artery by inserting and blowing up a tiny balloon. This helps widen the artery that is affected.

Preparation

Prior to a PCI, discuss any questions you have with your doctor. Be sure you talk about all medications you are using, since you may need to stop taking some of them temporarily.

What to Expect

During at PCI, you will be awake, but you will be sedated. You will receive medications through an IV throughout the procedure, and you will hear everything that is going on.

The incision area will probably be on your leg or arm, and it will be dumbed. Then your doctor will make a small incision and insert a catheter into your artery. Then it will be threaded up to the blockage. This process should not be painful, but you may feel pressure.

A dye will be injected through the catheter, and this will help your doctor as he reviews your x-rays on a nearby monitor. Next, a tiny balloon on the end of the catheter will be inflated and will widen the artery that is blocked. For several minutes the balloon will help widen and stretch the artery. Then it will be deflated and removed. If you have more than one blockage, the balloon will be inflated at each area.

During a PCI, you may also have a stent placed in your blocked artery. A stent looks like a coil of wire mesh and it helps prevent the artery from narrowing again.

After the procedure, you will likely stay in the hospital overnight so your heart can be monitored. It is important when you return home that you drink lots of fluids and avoid lifting heavy objects. After approximately a week, you should be able to return to work or other normal activities. Talk to your doctor about any restrictions that are specific to your daily life.

Make sure you understand all the medications you are to take after a PCI. If you have any questions, don’t hesitate to discuss them with your cardiologist.

Radial STEMI

Transradial Procedure: A Novel Approach for STEMI (Heart Attack) Patients Performed Through the Patient’s Wrist

Dr. Atul MadanCentral Florida Cardiac and Vascular Institute of Osceola Regional Medical Center continues to be the pioneer in cardiovascular care.  On March 10, 2011, Dr. Atul Madan, MD, an interventional cardiologist with the Cardiac Clinic and affiliated with the Cardiac and Vascular Institute, performed the Institute’s first STEMI (ST-Segment Elevation Myocardial Infarction) through the radial artery. 

Transradial procedure or radial approach is a cardiac catheterization procedure performed in select patients through the wrist blood vessel called the radial artery.  This procedure has several advantages over the standard cardiac catheterization procedure which in a majority of cases is performed through the femoral blood vessel (artery) in the groin.

During a STEMI (a type of heart attack), time is of the essence.  A STEMI occurs when a clot interrupts blood flow to the heart.  Central Florida Cardiac and Vascular Institute consistently beats the national standard STEMI Time or “Door-to-Balloon”, the time taken from arrival to the Emergency Department to the opening of the artery. 

STEMIs are treated with balloon angioplasty and stent procedures.  Balloon angioplasty requires the insertion of a catheter into the patient’s artery and threading it through to the heart.  Patients generally receive anticoagulants to dissolve the clot, along with balloon angioplasty. Because of the anticoagulants, it’s important to control patient bleeding. In a Radial approach STEMI, inserting the catheter into the radial artery via the wrist tends to cause less bleeding than groin insertion, an important benefit of the this novel procedure.  Additionally, the procedure offers patients the ability to begin walking sooner (earlier ambulation) and return to daily living activities.

“Research has consistently shown that the Transradial approach significantly reduces complications by 70% compared to the conventional approach,” said Dr. Madan. “This innovative approach for STEMI is a safer alternative to traditional treatment and improves patient outcomes.”

Patients who suffer a STEMI need immediate care in the Emergency Department (ER).  STEMIs are identified in the field by local EMTs or by an ER healthcare team.  Once the “Code STEMI” is activated, a multidisciplinary team is alerted to unblock the blood vessel responsible for the heart attack in less than 90 minutes – the national standard of “Door-to-Balloon” or STEMI Times – saving heart muscle and preventing heart failure and death.

Osceola Regional Medical Center offers state of the art technology and innovative specialized cardiovascular procedures in Central Florida.  “Our goal is to remain at the forefront of cardiovascular care,” said Kathryn Gillette, CEO of Osceola Regional Medical Center. “Providing our community the best in cardiac and vascular care is our top priority.”

Additional Information

For more information on Radial STEMI or to obtain a free physician referral please call 1-800-447-8206.

Stress Testing

In our stress laboratory, we offer a variety of stress tests that help us determine your heart health. The main stress test is sometimes called an exercise stress test. You should wear comfortable clothing and athletic shoes.

As you walk on a treadmill or ride a stationary bike, technicians monitor your breathing, heart rhythm, and blood pressure. Since your heart has to pump harder than usual, the test will reveal problems that you might not notice otherwise.

The stress test can be done in conjunction with an ultrasound, which closely watches your blood flow during the procedure. All this information helps your doctor review your cardiovascular function and proceed with effective treatment as needed.

Vascular Ultrasound

A vascular ultrasound uses high-frequency sound waves to study the inside of your body. It helps your physician examine the blood circulation in your arms and legs. It can help evaluate blood flow in the arteries, blood flow to a newly transplanted organ, and blood flow that indicates narrowed areas of the arteries.

There are no special preparations before the test. You will lie down and a technician will spread gel on the area to be studied. The technician will then press a transducer along your skin, which will send images to a monitor for your physician to study. The procedure is not painful, though you may feel pressure at the site of the transducer. After the test, you can go home and resume regular activities.

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