WELCOME TO OUR DIAGNOSTIC CENTER

We understand the importance of providing timely services for your patients that require thorough diagnostic studies and testing. We at Advanced Cardiac and Vascular Diagnostic Center combine the most Advanced Imaging Technology with skilled Registered Technologists (RDCS, RVT, RDMS) to provide your patients with efficient Cardiovascular, Peripheral Arterial, and Peripheral Vascular diagnostic testing services. We offer same day appointments for your patients with urgent medical needs.

CERTIFIED TECHNOLOGISTS

All tests are performed by licensed technologists skilled and proficient in the latest technology, and registered with the American Registry of Cardiology Diagnostic Medical Sonographers (ARDMS). Our RVT, RDCS, RDMS, RT, and NCT technologists regularly attend Continuing Medical Education programs and receive special training in the latest advances in technology and techniques, as they become available. This is reflected in the high quality of tests performed at our offices.

WE ARE PROUD TO BE AN ICAEL ACCREDITED DIAGNOSTIC FACILITY. WE ARE CURRENTLY IN PROCESS OF OBTAINING ICANL ACCREDITATION.

Cardiodiagnostic Testing

Cardiac

Non-invasive Cardiology with ICAEL-accredited digital ultrasound for all modalities of adult cardiac testing:

• Echocardiogram - 2D, M-mode, Color Doppler and Flow Doppler Studies

An echocardiogram (also called an echo or trasnthoracic echocardiogram) is a type of ultrasound test that is used to obtain images of the heart. Digital pictures and video clips are stored in a specific order to be interpreted by a cardiologist. The images show the function of the heart muscle, chambers and valves. It also measures chamber sizes, thickness of the heart muscle and assesses pressures in the heart and lungs. The aorta and pulmonary artery are also examined during this test.

The echocardiogram is performed by a sonographer (ultrasound technician) who is specially trained in this type of ultrasound testing. An ultrasound probe called a “transducer” is used to send high-frequency sound waves into the body. These sound waves bounce off of the structure in the heart and send the image back to the ultrasound machine. The transducer is placed in several different locations on the chest, abdomen and the front of the neck. The images seen on the screen may be in black and white or color. The color shows the blood flow in the heart and is similar to what you may have seen on a weather map. It is called Doppler and it tracks the movement of the blood cells. You may also hear the sound of the heartbeat, blood flow and heart valves clicking open and closed. It is normal to hear these sounds during the test.

Below is an animated video from WebMD briefly explaining the different types of echocardiograms:
http://www.webmd.com/heart-disease/video/echocardiogram

• Contrast Echocardiogram and "Bubble Study" for ASD/VSD/PFO
• Exercise Stress Echo - Treadmill

A stress echocardiogram is a test that combines echocardiography (ultrasound imaging of the heart) with stress testing, monitoring your heart while the heart rate is increased either with exercise or medicine.
 
A heart monitor is connected to the chest with sticky patches and wires. An EKG (electrocardiogram) tracing is printed out. The patient will then lie on their left side while a small imaging probe, called a transducer, is held against the chest and pictures are taken. A special gel is used to help the transducer slide over the chest. After the pictures are taken, the patient will start the exercise portion of the test.

Most people will walk on a treadmill. It starts at a slow speed and usually at a small incline. Every few minutes the speed and incline will be adjusted. The patient will continue to walk until he or she becomes too tired to continue, or if the patient has pain or abnormalities in blood pressure or on the EKG that warrant stopping the test.

If the patient is not able to exercise, a medication may be given through an IV (intravenous line) that will make the heart beat faster and harder to simulate exercise. This medicine is given by a Registered Nurse.

Blood pressure, heart rhythm (EKG) and oxygen will be monitored throughout the procedure.

More echocardiogram images will be taken while the heart rate is increasing, or when it reaches its peak with a chemical stress echo. With a treadmill stress echo the second set of  pictures will be taken after the patient stops walking and quickly moves back to the table.
A cardiologist will interpret the images and EKG tracings. Doctors look for any changes that may indicate that part of the heart is not getting enough blood or oxygen due to narrowed or blocked arteries.

Below is a link to a video demonstration of a the different types of echocardiograms, including a Stress Echo fromWebMD.com:
http://www.webmd.com/heart-disease/video/echocardiogram

• Dobutamine Stress Echo
• Multiplane Transesophageal Echocardiogram (TEE), only at 4838 E Baseline Rd location

A transesophageal echo (TEE) test is an ultrasound test of the heart. It is done by passing a special tube down the throat into the esophagus or food pipe. The end of this tube is placed near the heart which allows very clear, detailed pictures of the heart's valves and chambers, without interference from the ribs or lungs. TEE is often used when the results from standard echo tests are not sufficient, or when your doctor wants a closer look at your heart.
 
A local anesthetic is sprayed on the throat to prevent gagging. An IV is also started and IV sedation is given before the tube is passed.
 
The transesophageal echo probe is controlled by a cardiologist (a physician who specializes in the heart). During the test, the patient's heart rate, heart rhythm, breathing, and blood pressure are carefully monitored by a registered nurse and the doctor. The pictures are taken by a sonographer (ultrasound technician) who is specially trained in this type of ultrasound examination. The test takes about 30 minutes.



Below is a link to a video from eMed.com explaining the TEE procedure:
http://www.youtube.com/watch?v=zLB_mY57B8M

• Imaging of the Thoracic Aorta and Great Vessels
• 24-hour Holter Monitoring with 12 Lead EKG
• Tilt Table Testing

Vascular

• Carotid Duplex Scan
• Upper and Lower Extremity Arterial Duplex Scan
• Upper and Lower Extremity Venous Duplex Scan
• Imaging for Vein Reflux Disease
• Deep Venous Thrombosis (DVT) (Same day appointments available)
• Vein Mapping
• Renal Artery Duplex Scan
• Abdominal Aorta Duplex Scan for Aneurysm and lliac artery disease
• Transcranial Doppler imaging
• Screening for Peripheral Vascular Disease ( Vascular Consult; ABIs; Lower Extremity Duplex Scan )

Nuclear Stress Test

 A Nuclear Stress Test is an imaging method that shows how well blood flows into the heart muscle through the coronary arteries, both at rest and during exercise. Nuclear Stress Imaging helps determine whether the coronary arteries have blockages that limit blood flow to heart muscle. It also shows how effectively the heart muscle pumps.

Through an IV, a radioactive tracer is injected into a vein both at rest and during exercise. A special camera is used to scan the heart and create images to show how the tracer has traveled through the blood and into the heart muscle. Most people will walk on a treadmill for the exercise portion of the test. If a patient is not able to exercise, a medication may be given that simulates exercise by increasing the heart rate or dilating the blood vessels.

The images show how the tracer has traveled through the blood and into the heart during exercise (or simulated exercise). By lighting up with color, it shows the areas that have received enough blood to adequately supply the heart muscle. If a portion of the heart muscle does not receive an adequate blood supply through the coronary arteries, these areas do not light up well with color.
 
Below is a video from eMedtv.com showing an animated example of a patient having a Nuclear Stress Test:

http://www.youtube.com/watch?v=wY347r1gFSg

• Nuclear Myocardial Perfusion Scans

64 Slice CT Scanner

• Plain and Contrast-enhanced CT of brain, soft tissues of the neck, heart and blood vessels, lungs, lymph nodes, all organs of the abdomen and pelvis, all bones and spine
• Coronary CT Angiogram (Same day appointments available)

A coronary CT angiogram (CCTA) is a non-invasive imaging test used to look at the arteries that supply the heart muscle with blood. Coronary CT angiograms are sometimes used in place of traditional angiograms to check for coronary artery disease or CAD (narrowed arteries in the heart).

In a CCTA a contrast is injected through an intravenous (IV) line that is placed in the arm. Images are then taken of the heart. The advantage of the CCTA is that if no blockage is found, the patient is not subjected to an invasive procedure and may return to regular activities immediately.

A CCTA may be better than a traditional angiogram for people who have a lower risk of coronary artery disease. If a patient has known coronary artery disease, a traditional angiogram may be recommended by the doctor, since a patient can also receive treatment for artery blockages during a traditional coronary angiogram.

In a traditional coronary angiogram, a catheter is inserted in an artery in the groin and threaded through the blood vessels to the heart. Dye is injected through the catheter and X-ray images of the heart are taken. The doctor can see if there are blockages in the heart's arteries. If blockages are found, the doctor can perform a procedure called angioplasty to open the blockages after a traditional angiogram.



Below is a link to an example of what we can see in a CCTA from mahajanimaging.com:
http://www.youtube.com/watch?v=niXJe3eFCdg

• Coronary Calcium Score as Screening Test for Risk of Heart Disease
• Full CT Angiography Coverage
• Suspected Cases of Aortic Dissection and Pulmonary Embolism (Same day appointments available)

Features and Benefits

• Reduced Radiation Dose
• More Accurate Scanning / Faster Patient Exams
• Voice Instruction for Patient Breathing
• Less Time Needed for Breath-Hold, Less Patient Stress
• Greater Flexibility (e.g., can obtain thicker or thinner slices without rescanning)
• Cross Sectional Displays and 3D Images
• Captures The Heart Images in a Single Breath-Hold

Radiology and General Ultrasound

X-Ray

• Sinus
• Chest
• Abdomen
• Extremities
• Spine

General Ultrasound

• General Abdomen
• Thyroid
• Gall Bladder
• Pancreas and Spleen
• Liver and Kidneys

CT Scanner for Plain and Contrast Studies

• Brain
• Soft tissues of neck
• Lungs
• Lymph nodes
• All organs of abdomen and pelvis
• All Bones and Spine
• CT angiogram of coronary arteries
• CT angiogram for suspected Pulmonary Embolus
• CT angiogram of any and all vessels of the body

Bone DEXA Scan

• Bone Density

Venous Thrombosis Evaluation

Venous Thrombosis EVALUATION: looking for blood clots in veins, same day appointments

Bone Density and DEXA

Bone density scanning, also called dual-energy x-ray absorptiometry (DEXA) or bone densitometry, is an form of x-ray technology that is used to measure bone loss. DXA is today's established standard for measuring bone mineral density (BMD). DXA is most often performed on the lower spine and hips. DEXA is most often used to diagnose osteoporosis, a condition that often affects women after menopause but may also be found in men. Osteoporosis involves a gradual loss of calcium, as well as structural changes, causing the bones to become thinner, more fragile and more likely to break.

In preparation for your DEXA, you will be asked to stop taking any calcium, vitamins, antacids, and any Osteoporosis/Osteopenia medications such as fosomax, actonel and boniva. You will be asked to wear loose clothing free from buttons, zippers, and metal of any kind.

Pulmonary Function Tests

The Pulmonary Function Test (PFT) is a lung function test. The PFT measures how well the lungs take in and exhale air, and how efficiently they transfer oxygen into the blood. Spirometry measures how well the lungs exhale. The information gathered during this test is useful in diagnosing or ruling out certain types of lung disorders, but is primarily used to assess obstructive lung diseases such as asthma.

Cardiac Rehabilitation

Cardiac rehabilitation is a medically supervised program that is focused on lifestyle modification through means of education and exercise, tailored to meet the individuals’ needs.

There are four phases of cardiac rehabilitation; Advanced Cardiac Specialists offers three of the four cardiac rehabilitation phases.

Phase I:

This phase begins while you are in the hospital. Your participation in phase I may include light activity within your room to walking around the hospital.

Phase II:

This phase is a medically supervised outpatient program for people with heart disease who recently had a cardiac event or procedure. A physician refers patients to the rehab program. Phase II cardiac rehab is an insurance based program that incorporates regular exercise along with providing nutritional counseling, stress management, and smoking cessation. Each session lasts about an hour, encompassing warm-ups and cool-downs with about 20-60 minutes of aerobic exercise. The patients are monitored during exercise with ECG telemetry, oximetry and blood pressure. Exercise levels are adjusted regularly by exercise physiologist based on heart rate, rating of perceived exertion, patient’s level of comfort and physicians directions for safe progression.

These are maintenance phases. Phase III begins after graduating from phase II for those who would like to continue with their new active lifestyle. This can take place in a rehab facility where medical supervision can be offered. This is a self-pay program only costing you $2.50 a visit. Phase IV is long-term maintenance which can take place in a medically supervised facility, gym or at home. These phases are designated for continuing to carry out a healthy lifestyle to reduce cardiovascular risk factors.

Why participate in cardiac rehabilitation?

The benefits of cardiac rehab participation are as follows but not limited to:

• Promote a heart healthy lifestyle, including exercise, diet and stress management
• Reduce further complications from heart disease
• Optimize recovery time following an event
• Improve cardiovascular performance and overall heart function in patients with heart disease
• Reduce risk factors by educating each patient of their cardiac risk factors and develop realistic lifestyle modifications
• Restore confidence in patients’ physical and mental capabilities after cardiac events

Who is eligible for cardiac rehabilitation?

Cardiac rehabilitation is for patients who have recently been diagnosed with:

• Coronary artery bypass surgery
• Heart attack
• Percutaneous transluminal coronary angioplasty (PTCA) or stent
• Stable angina
• Heart valve surgery
• Heart transplant
• Congestive heart failure
• Pacemaker implantation

How do I get started?

After treatment for coronary artery disease and being discharged from the hospital phase II cardiac rehab is an option. A referral is needed from your physician to begin. This is a great way to modify your lifestyle to improve health and minimize your risk of future heart events. Ask your physician if you think this type of program is for you. For more information about Advanced Cardiac Specialists cardiac rehab programs, please call 480-892-2800.

EECP

EECP, or Enhanced External Counterpulsation, is a noninvasive treatment for patients with coronary artery disease. Clinical studies over the past several years have shown that 75% of patients treated with a single course of EECP experience a reduction in angina and are able to return to a more active lifestyle.

How it Works

The term External Counter Pulsation (ECP) describes what is happening during the treatment. ECP treatment is 'external' because it happens outside of the body and doesn't require surgery or other invasive procedures. Counter pulsation occurs between heartbeats. The ECP system pumps when the heart is resting (the beginning of diastole) and relieves pressure just before the heart beats (the end of diastole). Counter pulsation increases blood flow to the heart muscle, decreases the heart's workload and creates greater oxygen supply while lowering oxygen demand.

Who qualifies for EECP?

• Inoperable or at high risk of operative complications or post operative failure
• Coronary anatomy is not readily amenable to such procedures.

What a treatment consists of:

Patients lie on a padded table in a treatment room. Electrodes are applied to the chest to record a constant ECG reading. A finger sensor called a plethysmograph, records a tracing that represents blood pressure. Cuffs are wrapped around the calves, thighs and buttocks. The system uses an ECG signal to electronically synchronize inflation and deflation of the cuffs. Patients experience a sensation of strong 'hug' moving upward from calves to thighs to buttocks during inflation followed by the rapid release of pressure on deflation. During ECP treatment, a display shows an ECG signal and a blood pressure tracing. An ECP therapist uses these readings to time Counterpulsation and monitor treatment. The treatment is administered 5 times a week for 7 weeks (35 sessions total) lasting 60 minutes.