CT Calcium Score:Fatty deposits called “plaques” can form in the walls of arteries long before there is any meaningful build up inside the vessels. Calcium can deposit inside these “plaques” and they become hardened. These deposits cannot be detected by stress testing or even by “cardiac catheterization”, but they represent the earliest stage of “Coronary Artery Disease”. These calcium deposits can be readily detected by cardiac CT scanning. This test is very simple and painless. The patient simply lays down on a CT machine and the machine whirls around for a few minutes. There is no need to undress, and no IV’s are needed. In ; matter of minutes, you can know if you have any evidence of plaque build up in your heart. Anyone can have this test done, and there is no need for a doctor’s request.

64 Slice Cardiac CT Scans: Until recently, the only way to acquire X-ray pictures of the Heart and its blood vessels was to insert a plastic tube called a catheter inside the circulation and inject X-ray dye or “contrast” into the heart while taking X-ray pictures. This procedure is invasive and requires a day in the hospital. Revolutionary breakthroughs in imaging technology now allow us to accomplish many of the same diagnostic imaging by using a “64 Slice rapid CT scanner”. This test is noninvasive and performed in our office within a matter of minutes. The patient is instructed to hold his or her breath for about 20 seconds while an injection of “contrast” is administered through an “IV” site in their arm. The CT scanner circles the patient for less than a minute and recreates pictures of the heart and blood vessels of the heart. In many cases this completely eliminates the need for further testing or invasive procedures. But, if serious blockages in these vessels are identified, timely intervention with “stents” or surgery can prevent debilitating heart attacks, or medications can be prescribed to reduce and stabilize the blockages and hopefully prevent surgery.

CT Carotid Angiograms: This technique allows us to take “angiograms” (diagnostic X-ray pictures) of the blood vessels that go to the brain. Blockages in these “carotid” vessels are a leading cause of stroke and can be prevented by timely intervention. The patient is instructed to hold his or her breath for about 20 seconds while an injection of “contrast” is administered through an “IV” site in their arm. The CT scanner circles the patient for less than a minute and recreates pictures of the blood vessels which supply the brain. In many cases this completely eliminates the need for further testing or invasive procedures. But, if serious blockages in these vessels are identified, timely intervention with “stents” or surgery can prevent debilitating strokes, or medications can be prescribed to reduce and stabilize the blockages and hopefully prevent surgery.

CT Angiograms of AORTA: This technique allows us to take non-invasive “angiograms” (diagnostic X-ray pictures) of the “Aorta”, which is the largest blood vessel in the body. We can detect “Aneurysms” of the Aorta which are weak spots that can lead to life threatening ruptures. We can also detect blockages of the Aorta which restrict circulation to the legs or the major internal organs as well. Early detection of these problems can be life saving and allow us to prevent the rupture of an aneurysm through close observation and “Endoluminal Stent Grafts” or Surgery when appropriate.

The patient is instructed to hold his or her breath for about 20 seconds while an injection of “contrast” is administered through an “IV” site in their arm. The CT scanner circles the patient for less than a minute and recreates pictures of the Aorta and its branches.

CT Angiogram of Lower Extremities: This technique allows us to take non-invasive “angiograms” (diagnostic X-ray pictures) of the blood vessels which supply the legs and feet. Millions of Americans suffer from “Peripheral Vascular Disease” or “PVD”. This debilitating condition results from blockages in the blood vessels that supply the extremities and can lead to cramping pain in the legs or even loss of extremities due to gangrene. This condition can often be alleviated by stents or surgery.

The patient is instructed to hold his or her breath for about 20 seconds while an injection of “contrast” is administered through an “IV” site in their arm. The CT scanner circles the patient for less than a minute and recreates pictures of the lower extremity vessels.

CT Angiogram of the Renal (Kidney) Arteries: This technique allows us to take non-invasive “angiograms” (diagnostic X-ray pictures) of the blood vessels which supply the kidneys. Blockage of these vessels can lead to severe hypertension (High Blood Pressure) as well as loss of kidney function. These conditions can be treated with placement of “stents” inside the vessels, restoring blood flow to the kidneys.

The patient is instructed to hold his or her breath for about 20 seconds while an injection of “contrast” is administered through an “IV” site in their arm. The CT scanner circles the patient for less than a minute and recreates pictures of the kidney vessels.

Echocardiography: Sonogram images of the heart are taken by placing an ultrasound probe on the chest wall and using sound waves to create two dimensional images of the heart muscle and valves in motion. “Color Flow Doppler” images show the flow of blood throughout the heart and helps identify any problems with the function of the heart valves, or congenital heart defects. Heart muscle strength and performance can be determined.

Carotid Doppler: An ultrasound probe is placed on the neck and sound waves are used to create two dimensional images of the “Carotid Arteries” which supply blood flow to the brain. “Color Flow Doppler” of these vessels can help determine if there is significant blockage of these vessels.

Venous Doppler: An ultrasound probe is placed over the veins of the legs or arms and sound waves are used to create two dimensional images of the veins to look for any evidence of blood clots. Assessment of vein function can be performed to identify causes of swelling in the lower extremities or arms.

Arterial Duplex Doppler: An ultrasound probe is placed over the arteries of the extremities and sound waves are used to create two dimensional images of the blood vessels that supply circulation to the legs or arms.

Aorta Sonograms: An ultrasound probe is placed over the abdomen and sound waves are used to create two dimensional images of the “Aorta” which is the largest blood vessel In the body. This test is used to look for “aneurysms” or weak spots in the vessel which could rupture suddenly with life threatening consequences.

Segmental Pressures: Blood pressures are measured up and down the legs and arms to determine the location of blockage or poor circulation to the extremities. Patients walk on a treadmill to assess the circulation in their legs.

Ankle Brachial Index Test: Screening test to look for evidence of poor circulation to the legs. This is a quick, painless and simple way to screen for the presence of “peripheral vascular disease”.

Treadmill Exercise Stress Test: Patients exercise by walking on a treadmill which has a steady but controlled increase in incline and speed every few minutes until their heart rate gets elevated to their “target heart rate”. ECG monitor leads are placed on the chest and ECG tracings are recorded continuously. Usually this test is combined with “Nuclear Imaging” which consists of a special chemical called an “isotope” being injected into an IV site in the patient’s arm, after which the patient gets pictures of the heart taken by a special camera that detects the distribution of the “isotope” within the patient’s heart.

Pharmacological (Chemical) Stress Test: Patient’s who cannot exercise due to problems with their joints, or inability to walk on a treadmill for any reason are candidates for a “chemical” stress test. Two different types of chemicals called “Adenosine” or “Dobutamine” are available for routine use depending on specific patient characteristics and health conditions. In these cases, the patient lies on a table and an IV is started in their arm. One of these special chemicals is infused through the IV, followed by an injection of a special agent called an “isotope” which is a type of dye that is distributed throughout the heart. This dye is then detected on a special camera.

Nuclear Stress Test Imaging: This technique involves the addition of “nuclear imaging” to any type of stress testing (see above). A special chemical called an “isotope” is injected through an IV which gets distributed throughout the patient’s heart. This “isotope” is then detected by a “nuclear” camera which creates pictures that demonstrate the pattern of blood flow to the patient’s heart. Using this technique, your doctors can determine if there is adequate circulation to the heart.

MUGA Scan: This technique involves the injection of a special chemical called an “isotope” which is distributed inside the patient’s pumping chamber of their heart. The patient then lies on a table or sits in a chair, while a “nuclear camera” takes pictures of the patient’s heart pumping. This test is used to measure the patient’s “ejection fraction” which is a measure of how strong the heart muscle is and how well the pumping chamber is squeezing. This test is routinely used to follow the progress of patients with “congestive heart failure” or conditions that weaken the heart.

Pacemaker Interrogation: An electromagnetic device is positioned over the site of the pacemaker and the program settings of the pacemaker can be determined. These settings can then be adjusted easily and painlessly. This allows our doctors to make certain that our patient’s pacemaker devices are working correctly and are optimized for the battery to last as long as possible.

Transtelephonic Pacemaker Monitoring: Patient’s with pacemakers can perform a simple test in their own home on a monthly basis. By placing a special electromagnetic wand over their pacemaker site the status and functionality of their pacemaker can be quickly assessed. This information is then transmitted over phone lines to our central monitoring agent which tells us the status of their pacemaker function.

Transtelephonic Cardiometric Monitoring: Patients with specialized pacemakers called “defibrillators” can perform self testing from home to determine whether or not they have too much fluid in their bodies causing them to go into “congestive heart failure”. This revolutionary technique allows us to obtain information about the patient’s heart function remotely, and adjust their medications by phone to help avoid unwanted trips to the hospital.

Advanced Lipid Testing: Standard “cholesterol tests” do not always detect those who are at risk for developing build up of fatty deposits called “plaques” inside the blood vessel walls. More sophisticated techniques are available to help determine those at risk for heart disease. Our doctors can offer the latest technology with regards to testing for all cardiovascular risk factors.

Cholesterol and Lipid Management: Our cardiovascular specialists work in conjunction with your primary doctor to help regulate your cholesterol, LDL, HDL, and Triglycerides. Our goal is to optimize your health and prevent progression of atherosclerotic disease whenever possible.

Management of Coumadin and Warfarin: Many patients require the use of “Coumadin”, or “Warfarin”, which are strong blood thinners that necessitate close monitoring and frequent lab tests. Our doctors and nurses manage thousands of patients who are taking these medicines. We can monitor and adjust your anticoagulant level as needed through our clinic. Blood samples can be obtained in our office, or at an outside lab, whichever is most convenient for the patient.

24 Hour Holter Monitor: This device is worn by the patient for 24 hours. Three separate leads are attached and the recorder device is carried in a sling around the patient’s neck and shoulder. The patient’s heart rhythm is recorded and the patient keeps a diary of all their symptoms during the recording phase. The rhythm strips are then analyzed and correlated with the patient’s symptoms in order to identify the cause of the patient’s palpitations or other symptoms.

Event Monitors: This device is much smaller than a “Holter” device (see above). It is meant to be worn for one month at a time, but it is designed to be light weight, small and convenient to attach and wear underneath clothing so it is not noticeable. Each time the patient feels a palpitation or other symptom of concern, the patient pushes a button on the device and the rhythm is recorded. The patient removes the device when bathing or as desired. This device allows us to have up to one month to “capture” the patient’s rhythm during their symptoms.

Continuous Outpatient Telemetry: This device is small and light weight, and is attached to a portable telephone device that sends information continuously to a monitoring service. This is similar to being on “telemetry” in the hospital, but is done as an outpatient. This device allows us to monitor for rhythm disorders that the patient may not be aware of.

Implantable Loop Recorders: Some patients have rhythm conditions that are very infrequent and difficult to capture using the standard techniques discussed above. In these cases we can implant a small device underneath the skin, similar to a pacemaker, which the patient can wear for up to eighteen months at a time in order to capture the rhythm disturbance and document the problem.

Cardiac Catheterization: A small thin plastic tube (called a “catheter”) is inserted inside the major artery in the thigh. This is taken up to the heart and the tube is positioned inside the arteries that feed the heart. X-Ray dye is injected inside the tube and into the heart arteries and then X-Ray pictures of the heart and its arteries are taken. This is called an “angiogram”.

Abdominal Aortogram: A small thin plastic tube (called a “catheter”) is inserted inside the major artery in the thigh. This is taken up to the major artery in the body called the “aorta”. X-Ray dye is injected inside the tube and into the “aorta” and then X-Ray pictures of the “aorta” and its branches are taken, including the blood vessels that supply the internal organs and kidneys.

Peripheral Runoff: A small thin plastic tube (called a “catheter”) is inserted inside the major artery in the thigh. X-Ray dye is injected inside the tube and into the blood vessels that supply the legs. X-Ray pictures of the leg arteries are taken.

Renal Angiogram: A small thin plastic tube (called a “catheter”) is inserted inside the major artery in the thigh. The catheter is placed inside the arteries that supply the kidneys. X-Ray dye is injected inside the tube and then X-Ray pictures of the kidney arteries are taken.

Carotid Angiogram: A small thin plastic tube (called a “catheter”) is inserted inside the major artery in the thigh. The catheter is placed inside the arteries that supply the brain called the “carotid arteries”. X-Ray dye is injected inside the tube and then X-Ray pictures of the “carotid” arteries are taken.

PTCA and Coronary Stenting: A small thin plastic tube (called a “catheter”) is inserted inside the major artery in the thigh. This is taken up to the heart and the tube is positioned inside the arteries that feed the heart. X-Ray dye is injected inside the tube and into the heart arteries and then X-Ray pictures of the heart and its arteries are taken. A thin wire is passed inside the blood vessel and a tiny balloon is passed over the wire inside the vessels to a point where the artery is narrowed. The balloon is inflated and the blood vessel is stretched. A small metal coil is then expanded inside the artery which props the artery open and restores blood flow down the artery.

Balloon Angioplasty of Peripheral Vessels: A small thin plastic tube (called a “catheter”) is inserted inside the major artery in the thigh and taken to a blood vessel that has build up of blockage. A thin wire is passed inside the blood vessel and a tiny balloon is passed over the wire inside the vessels to a point where the artery is narrowed. The balloon is inflated and the blood vessel is stretched. A small metal coil is then expanded inside the artery which props the artery open and restores blood flow down the artery. This can improve the flow of blood to vessels all over the body.

Renal Stenting: A small thin plastic tube (called a “catheter”) is inserted inside the major artery in the thigh and taken to the artery that supplies the kidney. A thin wire is passed inside the blood vessel and a tiny balloon is passed over the wire inside the vessel to a point where the artery is narrowed. The balloon is inflated and the blood vessel is stretched. A small metal coil is then expanded inside the artery which props the artery open and restores blood flow down the artery. This improves the flow of blood to the kidney.

Carotid Stenting: A small thin plastic tube (called a “catheter”) is inserted inside the major artery in the thigh and taken to the artery that supplies the brain called the “carotid artery”. A thin wire is passed inside the blood vessel and a tiny balloon is passed over the wire inside the vessel to a point where the artery is narrowed. The balloon is inflated and the blood vessel is stretched. A small metal coil is then expanded inside the artery which props the artery open and restores blood flow down the artery. This improves the flow of blood to the brain and prevents strokes.

Directional Atherectomy: A special catheter is used to shave away plaque from the inside walls of blood vessels and remove it from the body. This restores the flow of blood in that vessel.

Laser Atherectomy: A special catheter with a laser is used to burn and evaporate away plaque inside of blood vessels and remove it from the body. This restores the flow of blood in that vessel.

Permanent Pacemaker Implantation: An electronic pacemaker device is implanted underneath the collar bone. Pacemaker wires are implanted inside the heart. This device restores the rhythm of the heart.

Defibrillator Implantation: An electronic device is implanted underneath the collar bone which contains a pacemaker, but also contains a special wire that provides a shock in the event that the heart rhythm stops. This device restores the rhythm of the heart and reduces the risk of “sudden death” due to the heart rhythm stopping.

Implantable Loop Recorder: An electronic device is implanted underneath the collar bone which has a recording device. This allows us to monitor the rhythm of the heart for long periods of time in order to capture and record abnormal rhythms that are difficult to capture.

Trans-esophageal Echo: A narrow tube is inserted inside the stomach and sonogram images of the heart are obtained from within the body at very close proximity to the heart. By doing this we can obtain very high definition quality images of the interior of the heart.

Ablation Procedures: Many abnormal heart rhythms can now be cured by passing a small tube called a “catheter” inside the heart and positioning the catheter next to the focus of abnormal electrical activity inside the heart. Electrical energy is applied to that focus which burns that tissue and eliminates the rhythm disorder.

Direct Current Cardioversion: Patients are sedated under anesthesia. Then electrical paddles are applied to the chest and an electric shock is applied in order to convert the heart rhythm back to normal.

Cardiac and Vascular Surgical Procedures: Our doctors try everything possible to avoid sending our patients for invasive surgical procedures. However, when open heart surgery is necessary, or bypass surgery on the major blood vessels of the body is necessary, our doctors have access to a network of top-rated surgical specialists throughout the Dallas/Fort Worth Metroplex and throughout North Texas.