Cardiac & Vascular Services Offered in The Villages, FL

At CVC each patient is treated as an individual.

At Cardiac and Vascular Consultants, our physicians and staff have years of experience treating simple heart conditions to complex disease states associated with cardiovascular health.

By working together with our patients, we focus on innovative solutions for high blood pressure, high cholesterol, diseases of the heart, Peripheral arterial and venous diseases, and more.

If your cardiologist determines that you need a test or procedure, these can be performed at our office, Outpatient Cathlab or if necessary, at one the local hospitals we are associated with. Below, you will find a list of the many cardiovascular conditions we treat and the imaging services that we offer at Cardiac and Vascular Consultants.

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Our Board Certified Cardiologists specialize in providing excellent quality patient-centered care.

Cardiovascular Conditions

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Abdominal Aneurysm

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An abdominal aortic aneurysm is an enlarged area in the lower part of the major vessel that supplies blood to the body (aorta). The aorta runs from your heart through the center of your chest and abdomen.

The aorta is the largest blood vessel in the body, so a ruptured abdominal aortic aneurysm can cause life-threatening bleeding.

Depending on the size of the aneurysm and how fast it’s growing, treatment varies from watchful waiting to emergency surgery.

Symptoms
Abdominal aortic aneurysms often grow slowly without symptoms, making them difficult to detect. Some aneurysms never rupture. Many start small and stay small; others expand over time, some quickly.

If you have an enlarging abdominal aortic aneurysm, you might notice:

  • Deep, constant pain in your abdomen or on the side of your abdomen
  • Back pain
  • A pulse near your bellybutton

https://www.mayoclinic.org/diseases-conditions/abdominal-aortic-aneurysm/symptoms-causes/syc-20350688

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Aortic Stenosis

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Aortic valve stenosis — or aortic stenosis — occurs when the heart’s aortic valve narrows. This narrowing prevents the valve from opening fully, which reduces or blocks blood flow from your heart into the main artery to your body (aorta) and onward to the rest of your body.

When the blood flow through the aortic valve is reduced or blocked, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump, and this can cause symptoms as well as possibly weaken your heart muscle.

Your treatment depends on the severity of your condition. You may need surgery to repair or replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.

Types
1. Bicuspid aortic valve

Symptoms
Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms generally develop when narrowing of the valve is severe. Some people with aortic valve stenosis may not experience symptoms for many years. Signs and symptoms of aortic valve stenosis may include:

  • Abnormal heart sound (heart murmur) heard through a stethoscope
  • Chest pain (angina) or tightness with activity
  • Feeling faint or dizzy or fainting with activity
  • Shortness of breath, especially when you have been active
  • Fatigue, especially during times of increased activity
  • Heart palpitations — sensations of a rapid, fluttering heartbeat
  • Not eating enough (mainly in children with aortic valve stenosis)
  • Not gaining enough weight (mainly in children with aortic valve stenosis)

The heart-weakening effects of aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet.

When to See a Doctor
If you have a heart murmur, your doctor may recommend that you visit a cardiologist. If you develop any symptoms that may suggest aortic valve stenosis, see your doctor.

Causes
Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, the valves don’t open or close properly, disrupting the blood flow through your heart and potentially impairing the ability to pump blood to your body.

In aortic valve stenosis, the aortic valve between the lower left heart chamber (left ventricle) and the main artery that delivers blood from the heart to the body (aorta) is narrowed (stenosis).

When the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. This can cause the left ventricle to thicken and enlarge. Eventually the extra work of the heart can weaken the left ventricle and your heart overall, and it can ultimately lead to heart failure and other problems.

Aortic valve stenosis can occur due to many causes, including:

  • Congenital heart defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called cusps. Some children are born with an aortic valve that has only two (bicuspid) cusps instead of three. People may also be born with one (unicuspid) or four (quadricuspid) cusps, but these are rare.
    This defect may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced.
    Having a congenitally abnormal aortic valve requires regular evaluation by a doctor to watch for signs of valve problems. In most cases, doctors don’t know why a heart valve fails to develop properly, so it isn’t something you could have prevented.
  • Calcium buildup on the valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can build up on the valve’s cusps. These calcium deposits aren’t linked to taking calcium tablets or drinking calcium-fortified drinks.
    These deposits may never cause any problems. However, in some people — particularly those with a congenitally abnormal aortic valve, such as a bicuspid aortic valve — calcium deposits result in stiffening of the cusps of the valve. This stiffening narrows the aortic valve and can occur at a younger age.
    However, aortic valve stenosis that is related to increasing age and the buildup of calcium deposits on the aortic valve is most common in older people. It usually doesn’t cause symptoms until ages 70 or 80.
  • Rheumatic fever. A complication of strep throat infection, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve stenosis later in life.
    Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close fully — or both. While rheumatic fever is rare in the United States, some older adults had rheumatic fever as children.

Risk Factors
Risk factors of aortic valve stenosis include:

  • Older age
  • Certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve
  • History of infections that can affect the heart
  • Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure
  • Chronic kidney disease
  • History of radiation therapy to the chest

https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139

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Congestive Heart Failure (CHF)

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The term “heart failure” makes it sound like the heart is no longer working at all and there’s nothing that can be done. Actually, heart failure means that the heart isn’t pumping as well as it should be. Congestive heart failure is a type of heart failure that requires seeking timely medical attention, although sometimes the two terms are used interchangeably.

Your body depends on the heart’s pumping action to deliver oxygen- and nutrient-rich blood to the body’s cells. When the cells are nourished properly, the body can function normally. With heart failure, the weakened heart can’t supply the cells with enough blood. This results in fatigue and shortness of breath and some people have coughing. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen. Basically, the heart can’t keep up with its workload.

At first the heart tries to make up for this by:

  • Enlarging. The heart stretches to contract more strongly and keep up with the demand to pump more blood. Over time this causes the heart to become enlarged.
  • Developing more muscle mass. The increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly, at least initially.
  • Pumping faster. This helps increase the heart’s output.

The body also tries to compensate in other ways:

  • The blood vessels narrow to keep blood pressure up, trying to make up for the heart’s loss of power.
  • The body diverts blood away from less important tissues and organs (like the kidneys), the heart and brain.

These temporary measures mask the problem of heart failure, but they don’t solve it. Heart failure continues and worsens until these compensating processes no longer work.

Eventually the heart and body just can’t keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.

Heart failure is a term used to describe a heart that cannot keep up with its workload. The body may not get the oxygen it needs.
Heart failure is a serious condition, and usually there’s no cure. But many people with heart failure lead a full, enjoyable life when the condition is managed with heart failure medications and healthy lifestyle changes. It’s also helpful to have the support of family and friends who understand your condition.

https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure

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Coronary Artery Disease (CAD)

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Coronary heart disease is a common term for the buildup of plaque in the heart’s arteries that could lead to heart attack. But what about coronary artery disease? Is there a difference?

The short answer is often no — health professionals frequently use the terms interchangeably.

With coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. This is also called ischemia. It may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. Or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot.

The traditional risk factors for coronary artery disease are high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to Fisher. Obesity may also be a risk factor.

Living a healthy lifestyle that incorporates good nutrition, weight management and getting plenty of physical activity can play a big role in avoiding CAD.

https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/coronary-artery-disease

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Valvular Heart Disease

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In heart valve disease, one or more of the valves in your heart doesn’t work properly.

Your heart has four valves that keep blood flowing in the correct direction. In some cases, one or more of the valves don’t open or close properly. This can cause the blood flow through your heart to your body to be disrupted.

Your heart valve disease treatment depends on the heart valve affected and the type and severity of the valve disease. Sometimes heart valve disease requires surgery to repair or replace the heart valve.

Symptoms
Some people with heart valve disease might not experience symptoms for many years. Signs and symptoms of heart valve disease may include:

  • Abnormal sound (heart murmur) when a doctor is listening to the heart beating with a stethoscope
  • Chest pain
  • Abdominal swelling (more common with advanced tricuspid regurgitation)
  • Fatigue
  • Shortness of breath, particularly when you have been very active or when you lie down
  • Swelling of your ankles and feet
  • Dizziness
  • Fainting
  • Irregular heartbeat

Causes
Your heart has four valves that keep blood flowing in the correct direction. These valves include th

e mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (leaflets or cusps) that open and close once during each heartbeat

. Sometimes, the valves don’t open or close properly, disrupting the blood flow through your heart to your body.

Heart valve disease may be present at birth (congenital). It can also occur in adults due to many causes and conditions, such as infections and other heart conditions.
Heart valve problems may include:

  • Regurgitation. In this condition, the valve flaps don’t close properly, causing blood to leak backward in your heart. This commonly occurs due to valve flaps bulging back, a condition called prolapse.
  • Stenosis. In valve stenosis, the valve flaps become thick or stiff, and they may fuse together. This results in a narrowed valve opening and reduced blood flow through the valve.
  • Atresia. In this condition, the valve isn’t formed, and a solid sheet of tissue blocks the blood flow between the heart chambers

https://www.mayoclinic.org/diseases-conditions/heart-valve-disease/symptoms-causes/syc-20353727

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CARDIOMYOPATHY

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Cardiomyopathy refers to diseases of the heart muscle. These diseases have many causes, signs and symptoms as well as treatments. In most cases, cardiomyopathy causes the heart muscle to become enlarged, thick or rigid. In rare instances, diseased heart muscle tissue is replaced with scar tissue.

As cardiomyopathy worsens, the heart becomes weaker. The heart becomes less able to pump blood throughout the body and incapable of maintaining a normal electrical rhythm. The result can be heart failure or irregular heartbeats called arrhythmias. A weakened heart also can cause other complications, such as heart valve problems.

Overview
The main types of cardiomyopathy are:

  • Dilated cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy
  • Arrhythmogenic right ventricular dysplasia
  • Transthyretin amyloid cardiomyopathy (ATTR-CM)

Some cases of cardiomyopathy have no signs or symptoms, and need no treatment. But in other cases, cardiomyopathy develops quickly with severe symptoms, and serious complications occur. Treatment is required in these instances.

Treatments include lifestyle changes, medications, surgery, implanted devices to correct arrhythmias and other nonsurgical procedures. These treatments can control symptoms, reduce complications and prevent the disease from worsening

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ABNORMAL STRESS TEST

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Ischemia does not occur at normal heart rates in most patients because at rest, with a normal heart rate, the heart muscle’s need for blood is comparatively small, and the amount of obstruction of the coronary arteries is not great enough to reduce the flow of blood to the heart muscle. During stress, however, when the heart rate speeds up, and the heart has to work harder, the heart muscle requires a great deal of extra blood to generate the energy needed to perform the extra work. Now, the obstruction to the coronary arteries may be great enough, to prevent the blood flow from increasing, and the heart muscle will become ischemic. Think of a 4 lane freeway with one or two blocked lanes. When traffic is light there will be no slowing of traffic. During rush hour, however, marked slowing of traffic will take place.

Ischemia produces distinctive changes in an electrocardiogram, in a nuclear perfusion study, and in the contraction of the heart muscle that can be seen on an echocardiogram. When these tests are abnormal, most cardiologists immediately assume that one or more coronary arteries are severely obstructed, and that coronary angiography will be necessary to evaluate the Coronary arteries in more detail.

http://www.heartprotect.com/stress-tests.shtml

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Lipid (Cholesterol) Management

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When it comes to cholesterol, there are two terms worth knowing. Hyperlipidemia means your blood has too many lipids (or fats), such as cholesterol and triglycerides. One type of hyperlipidemia , hypercholesterolemia, means there’s too much LDL (bad) cholesterol in your blood. This condition increases fatty deposits in arteries and the risk of blockages.

Another way your cholesterol numbers can be out of balance? Your levels of HDL (good) cholesterol can also be too low. With less HDL to remove cholesterol from your arteries, your risk of atherosclerotic plaque and blockages increases.

If you’re diagnosed with hyperlipidemia, your overall health and known risks (such as smoking or high blood pressure) will help guide treatment. These factors can combine with high LDL cholesterol or low HDL cholesterol levels to affect your cardiovascular health. Your doctor may use the National Institutes of Health’s Estimate of 10-Year Risk for Coronary Heart Disease Framingham Point Score to assess your risk of a coronary event in the next 10 years.

The good news is, high cholesterol can be lowered, reducing the risk of heart disease and stroke. If you’re an adult 20 or older, have your cholesterol tested and work with your doctor to adjust your cholesterol levels as necessary.

Often, changing behaviors will go a long way toward bringing your numbers into line. (If lifestyle changes alone don’t improve your cholesterol levels, medication may be prescribed.) Lifestyle changes you may be asked to make are:

Eating a Heart-healthy Diet

From a dietary standpoint, the best way to lower your cholesterol is reduce saturated fat and trans fat. The American Heart Association recommends limiting saturated fat to 5 to 6 percent of daily calories and minimizing the amount of trans fat you eat.

Reducing these fats means limiting your intake of red meat and dairy products made with whole milk. (Choosing skim milk, low-fat or fat-free dairy products instead.) It also means limiting fried food and cooking with healthy oils, such as vegetable oil.

A heart-healthy diet emphasizes fruits, vegetables, whole grains, poultry, fish and nuts, while curbing sugary foods and beverages. Eating this way may also help to increase your fiber intake, which is beneficial. A diet high in fiber can help lower cholesterol levels by as much as 10 percent.

Many diets fit this general description. For example, the DASH (Dietary Approaches to Stop Hypertension) eating plan promoted by the National Heart, Lung, and Blood Institute as well as diets suggested by the U.S. Department of Agriculture and the American Heart Association are all heart-healthy approaches. Such diets can be adapted based on your cultural and food preferences.

To be smarter about what you eat, you’ll may need to pay more attention to food labels. As a starting point:

  • Know your fats. Knowing which fats raise LDL (bad) cholesterol and which ones don’t is key to lowering your risk of heart disease.
  • Cooking for lower cholesterol. A heart-healthy eating plan can help you manage your blood cholesterol level.

Becoming More Physically Active

A sedentary lifestyle lowers HDL (good) cholesterol. Less HDL means there’s less good cholesterol to remove LDL (bad) cholesterol from your arteries.

Physical activity is important. Just 150 minutes of moderate-intensity aerobic exercise a week is enough to lower both cholesterol and high blood pressure. And there are lots of options: brisk walking, swimming, bicycling or even a dance class can fit the bill.

Quitting Smoking

Smoking lowers HDL (good) cholesterol.

Worse still, when a person with unhealthy cholesterol levels also smokes, his or her risk of coronary heart disease increases more than it otherwise would. Smoking also compounds the risk presented by other risk factors for heart disease, such as high blood pressure and diabetes.

By quitting, smokers can lower their cholesterol levels and help protect their arteries. Nonsmokers should avoid exposure to secondhand smoke.

Losing Weight

Being overweight or obese tends to raise LDL (bad) cholesterol and lower HDL (good) cholesterol.

Losing excess weight can improve your cholesterol levels. A weight loss of as little as 10 percent can help to improve your high cholesterol numbers.

https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia

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Hypertension (high blood pressure)

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High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Symptoms
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

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Renovascular Disease

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Renovascular disease is a progressive condition that causes narrowing or blockage of the renal arteries or veins. These are the blood vessels that take blood to and from the kidneys. It’s the general term used for three disorders: renal artery occlusion, renal vein thrombosis, and renal atheroembolism.

The term is most often used to describe diseases affecting the renal arteries since blockage of the renal vein is not very common. Renovascular disease usually affects the elderly. However, young women in their teens to late 30s are at risk of a certain type of renovascular disease called fibromuscular dysplasia, a disorder of the muscular lining of the renal arteries that can cause severe high blood pressure.

Renal artery occlusion happens when one or both of the renal arteries are blocked. The arteries carry blood to the kidneys, where waste material is filtered out of the blood.

Renal vein thrombosis occurs when the veins leaving the kidneys (the renal veins) become blocked. The renal veins carry the filtered blood away from the kidneys to the rest of the body.

Renal atheroembolism results from a buildup of fatty material that blocks the renal arterioles (the smallest section of blood vessels leading to the capillaries). Cholesterol and lipids (fats) may also build up on the lining of the blood vessels, causing them to narrow.

Causes

People who are at risk for other vascular diseases (blood vessel problems) are also more likely to develop renovascular disease (e.g., seniors). For some people on high blood pressure medications, such as ACE (angiotensin-converting enzyme) inhibitors, the problem may be discovered if side effects such as kidney failure or other severe kidney problems appear. As well, smokers and people with diabetes seem to be more likely to develop renovascular disease, as are people with high blood pressure.

Renal artery occlusion occurs when the renal arteries become closed off, either partially or totally, by an embolism (a blood clot or foreign substance that blocks a blood vessel) or hardening of the arteries. Hardening of the arteries occurs when cholesterol, calcium, and other substances line the arteries. Embolisms can be caused by heart disease, surgery, trauma, or tumors.

Renal vein thrombosis is fairly uncommon, but if there’s been a trauma to the back or abdomen, a blood clot may form and get stuck in the renal veins. Sometimes it’s a result of other kidney-related conditions (e.g., nephrotic syndrome, kidney cancer). Occasionally, a test or procedure might also trigger an embolism.

https://www.medbroadcast.com/condition/getcondition/renovascular-disease

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Peripheral Arterial Disease (Claudication)

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Claudication is pain caused by too little blood flow to muscles during exercise. Most often this pain occurs in the legs after walking at a certain pace and for a certain amount of time — depending on the severity of the condition.

The condition is also called intermittent claudication because the pain usually isn’t constant. It begins during exercise and ends with rest. As claudication worsens, however, the pain may occur during rest.

Claudication is technically a symptom of disease, most often peripheral artery disease, a narrowing of arteries in the limbs that restricts blood flow.

Treatments focus on lowering the risks of vascular disease, reducing pain, increasing mobility and preventing damage to tissues.

Symptoms
Claudication refers to muscle pain due to lack of oxygen that’s triggered by activity and relieved by rest. Symptoms include the following:

  • Pain, ache, discomfort or fatigue in muscles every time you use those muscles
  • Pain in the calves, thighs, buttocks, hips or feet
  • Less often, pain in shoulders, biceps and forearms
  • Pain that gets better soon after resting

The pain may become more severe over time. You may even start to have pain at rest.

Signs or symptoms of peripheral artery disease, usually in more-advanced stages, include:

  • Cool skin
  • Severe, constant pain that progresses to numbness
  • Skin discoloration
  • Wounds that don’t heal

When to See a Doctor
Talk to your doctor if you have pain in your legs or arms when you exercise. Claudication can lead to a cycle that results in worsening cardiovascular health. Pain may make exercise intolerable, and a lack of exercise results in poorer health.

Peripheral artery disease is a sign of poor cardiovascular health and an increased risk of heart attack and stroke.

Claudication is generally considered a warning of significant atherosclerosis in the circulatory system, indicating an increased risk of heart attack or stroke. Additional complications of peripheral artery disease due to atherosclerosis include:

  • Skin lesions that don’t heal
  • Death of muscle and skin tissues (gangrene)
  • Amputation of a limb

The best way to prevent claudication is to maintain a healthy lifestyle and control certain medical conditions. That means:

  • Quit smoking if you’re a smoker
  • Exercise regularly
  • Eat a healthy, well-balanced diet
  • Maintain a healthy weight
  • If you have diabetes, keep your blood sugar in good control
  • Keep cholesterol and blood pressure within normal values

https://www.mayoclinic.org/diseases-conditions/claudication/symptoms-causes/syc-20370952

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Venous Reflux

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Venous reflux refers to the abnormal backing up of blood in the veins. When blood flows backward in the veins, a person is then known to have venous insufficiency (also called chronic venous insufficiency or CVI for those for whom reflux is an ongoing concern). Venous insufficiency is a common medical condition that underlies most of the clinical presentations of venous diseases, such as varicose veins, swollen and achy legs, and venous ulcers.

In healthy human circulation, the heart pumps blood carrying oxygen down through the body through the arteries; oxygen-depleted blood moves back up to the heart through the veins. Aided by the contraction of the calf muscle, blood in the veins moves against gravity.

Vein valves, which are small flaps attached to the inside of the vein walls, allow blood to flow upwards, and are key to vein health.

In healthy veins, valves are one way, meaning they allow the blood to move upward and then close so blood continues to move in the right direction. When veins are unhealthy, the valves become weak, and instead of closing, their laxity allows for two way blood flow. This causes venous insufficiency or CVI. See the illustration below.

 

Symptoms of Venous Insufficiency
CVI causes several symptoms ranging from mild to severe.

Pain often accompanies the symptoms of venous reflux. Sometimes legs can feel itchy, sore, or heavy. In severe cases, you may develop a venous ulcer (a wound by your ankles).

How do Doctors Diagnose Venous Insufficiency?
Your doctor will take a complete medical history and physical exam, taking special note of any changes in your skin temperature, color, and texture. Your doctor will also check the pulses in various places throughout your circulatory system.

After a physical exam, if your doctor suspects you have venous disease, you will then have a venous reflux exam. In this simple test, also called a duplex venous ultrasound, a sonographer or your doctor uses a handheld transducer to evaluate vein function, check for venous reflux and ensure there are no blood clots, blockages or other conditions.

Treatment
Treatment usually begins with conservative measures: compression stockings, leg elevation, weight loss. If conservative measures don’t help, your doctor will decide how to proceed based on your individual venous anatomy as well as your unique medical history and priorities.

Non-surgical methods:

  • Endovenous thermal ablations: Endovenous ablation uses hеаt рrоduсеd by a laser or hіgh-frеquеnсу sound waves to heat uр affected veins and seal them closed, re-routing blood flow to healthier veins. There is no down-time associated with endovenous ablation; it is safe, effective and convenient.
  • Sclerotherapy: Sclerotherapy is the injection оf a medication directly іntо аffесtеd vеіnѕ. Delivered in liquid or foam form, the medication irritates the walls of the veins and causes them to seal closed. Over time, the veins are reabsorbed by the body.
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Venous Ulcers

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A venous ulcer is a sore on your leg that heals very slowly, often due to weak blood circulation in the leg. They can last anywhere from a few weeks to years.

Venous ulcers occur when there’s a break in the skin on your leg, often around the ankle. The veins in the leg, which should send blood back to the heart, instead allow backflow.

This backflow of blood can mean swelling and increased pressure in the leg. When that happens, it can weaken the skin and make it harder for a cut or scrape to heal.

Do I Have a Venous Ulcer?
About 1% to 3% of Americans have venous ulcers. They’re more common in older people, especially women.

Symptoms may include:

  • Itching or burning skin
  • Swollen area around the sore
  • A rash or dry skin
  • Brownish discoloration
  • A foul-smelling fluid oozing from the sore

An ulcer is vulnerable to infection. If it becomes infected, you may experience:

  • A fever
  • Worsening pain
  • A redness or swelling of the surrounding skin
  • Pus

Risk factors include:

  • Varicose veins
  • Have previous leg injuries
  • Have had blood clots or phlebitis
  • Smoking
  • Obesity
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May-Thurner Syndrome (Iliofemoral Compression)

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May-Thurner syndrome is a rare vascular condition that affects a vein in your pelvis.
It occurs when a nearby artery compresses the left iliac vein. This vein brings blood from your pelvis and legs back up to your heart.

The compression prevents blood from flowing properly, leading to narrowing and scarring.

In some cases, an artery can compress the right iliac vein, or both veins.

May-Thurner Syndrome Complications
Some people with May-Thurner syndrome have no symptoms, but over time, this condition can lead to:

  • Leg swelling.
  • Chronic venous insufficiency, in which blood pools in your veins. This causes swelling, pressure, skin changes, and venous ulcers or sores that don’t heal.
  • Deep vein thrombosis (DVT), a blood clot in a vein deep below your skin.

If a blood clot breaks free and travels to your lungs, heart, or brain, it can lead to serious, even life-threatening issues like:

  • Pulmonary embolism, a blood clot in your lung
  • Heart attack
  • Stroke

https://www.upmc.com/services/heart-vascular/conditions-treatments/may-thurner-syndrome

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Deep Vein Thrombosis (DVT)

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Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but also can occur with no symptoms.

Deep vein thrombosis can develop if you have certain medical conditions that affect how your blood clots. It can also happen if you don’t move for a long time, such as after surgery or an accident, or when you’re confined to bed.

Deep vein thrombosis can be very serious because blood clots in your veins can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism).

Symptoms
Deep vein thrombosis signs and symptoms can include:

  • Swelling in the affected leg. Rarely, there’s swelling in both legs.
  • Pain in your leg. The pain often starts in your calf and can feel like cramping or soreness.
  • Red or discolored skin on the leg.
  • A feeling of warmth in the affected leg.

Deep vein thrombosis can occur without noticeable symptoms.

When to See a Doctor
If you develop signs or symptoms of deep vein thrombosis, contact your doctor.
If you develop signs or symptoms of a pulmonary embolism — a life-threatening complication of deep vein thrombosis — seek immediate medical attention.

The warning signs and symptoms of a pulmonary embolism include:

  • Sudden shortness of breath
  • Chest pain or discomfort that worsens when you take a deep breath or when you cough
  • Feeling lightheaded or dizzy, or fainting
  • Rapid pulse
  • Coughing up blood

https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557

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Syncope

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Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the brain. It’s also called fainting or “passing out.”

It most often occurs when blood pressure is too low (hypotension) and the heart doesn’t pump enough oxygen to the brain. It can be benign or a symptom of an underlying medical condition.

Syncope is a symptom that can be due to several causes, ranging from benign to life-threatening conditions. Many non life-threatening factors, such as overheating, dehydration, heavy sweating, exhaustion or the pooling of blood in the legs due to sudden changes in body position, can trigger syncope. It’s important to determine the cause of syncope and any underlying conditions.

However, several serious heart conditions, such as bradycardia, tachycardia or blood flow obstruction, can also cause syncope.

https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting

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Carotid Disease

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Carotid artery disease is the narrowing of the carotid arteries, the main arteries located on the sides of your neck. These arteries supply blood flow directly to the brain.

A blockage consisting of an atherosclerotic plaque can develop in the artery. This blockage can narrow the channel for blood to flow through and also cause turbulence and small clots to form on the plaque surface.

These small clots and bits of plaque can “break off” into the bloodstream and be carried away – up to the brain and cause a stroke or mini-stroke. A stroke is a sudden change in neurological functioning that results in paralysis, weakness, blindness, numbness or difficulty with speech.

Do I Have Carotid Artery Disease?
Symptoms of carotid artery disease consist of stroke or mini-stroke symptoms. Due to the sudden blockage of blood flow to an artery in the brain, the nerve cells in the brain stop working properly.

Symptoms can include:

  • Paralysis of an arm or leg (usually on one side of the body)
  • Weakness of an arm or leg
  • Numbness
  • Blindness in one eye
  • One-sided facial droop
  • Slurring of speech or difficulty speaking

A mini-stroke, or transient ischemic attack (TIA), consists of the same symptoms above but, unlike a stroke, usually passes within a few minutes. Both a stroke and mini-stroke are medical emergencies and should be dealt with by calling 911 or your local EMS for immediate transport to a hospital.

Most of the time patients may not have any symptoms of carotid artery disease at all. However, during a physical exam, we may hear a “bruit,” an abnormal whooshing sound, through the stethoscope when listening to your neck.

Other conditions such as dizziness, fainting spells, or vertigo are not usually directly associated with carotid artery disease but may lead to tests that discover its presence.

Common Risk Factors

  • Age
  • Smoking
  • Coronary artery disease (history of heart attacks)
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Obesity
  • Kidney failure
  • History of radiation to the neck (i.e. treatment of neck cancer)

Cardiovascular Services

IN OFFICE TESTS

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Anticoagulation checks

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“INR” fingerstick for monitoring drug levels (“walk-in”s)

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Echocardiograms

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Routine Study

An echocardiogram (echo) is a test that uses high frequency sound waves (ultrasound) to make pictures of your heart. The test is also called echocardiography or diagnostic cardiac ultrasound.

Quick facts

  • An echo uses sound waves to create pictures of your heart’s chambers, valves, walls and the blood vessels (aorta, arteries, veins) attached to your heart.
  • A probe called a transducer is passed over your chest. The probe produces sound waves that bounce off your heart and “echo” back to the probe. These waves are changed into pictures viewed on a video monitor.
  • An echo can’t harm you.

Why do people need an echo test?
Your doctor may use an echo test to look at your heart’s structure and check how well your heart functions. The test helps your doctor find out:

  • The size and shape of your heart, and the size, thickness and movement of your heart’s walls.
  • How your heart moves.
  • The heart’s pumping strength.
  • If the heart valves are working correctly.
  • If blood is leaking backwards through your heart valves (regurgitation).
  • If the heart valves are too narrow (stenosis).
  • If there is a tumor or infectious growth around your heart valves.

The test also will help your doctor find out if there are:

  • Problems with the outer lining of your heart (the pericardium).
  • Problems with the large blood vessels that enter and leave the heart.
  • Blood clots in the chambers of your heart.
  • Abnormal holes between the chambers of the heart.

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/echocardiogram-echo


Stress Echocardiography

A stress echo is a more dynamic test that examines the heart in action. It combines an ultrasound of the heart with a stress test. A stress test, often called a treadmill test, measures how your heart works when experiencing added workload or “stress” of exercise.

A stress echo test has 3 phases. First, the patient lies on the exam table and the technician performs an echocardiogram as a baseline reading of the LV (left ventricular) function at rest. Step two the patient undergoes a standard treadmill test, where the speed and grade of the treadmill are increased every three minutes. At each interval, the technician checks the patient for a change in symptoms, usually pain or shortness of breath. The patient remains on the treadmill until they become symptomatic or they reach their target heart rate. Step three, the patient quickly returns to the exam table and receives another echocardiogram for the tech to assess LV function for changes.

The stress echo test might be ordered if coronary artery disease is suspected, or if abnormalities are found during a baseline electrocardiogram or echocardiogram and require further examination.

Preparing for a Stress Echo

The exam requires NPO status – patients are asked to refrain from eating or drinking anything but water for 3-4 hours prior to the test. Patients on beta-blockers (a treatment for hypertension and coronary artery disease) are asked to not take their medication the day of the procedure. Beta-blockers often diminish the heart rate response. A person taking this medication will have a slower at rest heart rate, and may have a hard time reaching ideal heart rate during the treadmill portion of the exam. Finally, the patient should wear comfortable clothing and shoes, appropriate for exercise. The stress echo typically takes 90 minutes.

https://www.vacardio.com/echocardiogram-vs-stress…


Enhanced External Counter Pulsation (EECP)

Enhanced external counter pulsation (known as EECP) may be an option to relieve
your angina when all other treatments have failed or aren’t right for you. It can help
your blood vessels make a natural bypass around narrowed or blocked arteries that
cause your chest pain.

EECP treatment uses several blood pressure cuffs on both legs to gently, but
firmly, compress the blood vessels there to boost blood flow to your heart. Each
wave is timed to your heartbeat. So more blood goes there when it’s relaxing.
When your heart pumps again, pressure is released right away. This lets blood be
pumped more easily.

EECP may help some small blood vessels in your heart open. They may give
more blood flow to your heart muscle. This helps ease your chest pain.

www.webmd.com/heart-disease/guide/treating-chronic-angina-eecp

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EKG and related studies

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EKG

An electrocardiogram — abbreviated as EKG or ECG — is a test that measures the electrical activity of the heartbeat.

With each beat, an electrical impulse (or “wave”) travels through the heart.

This wave causes the muscle to squeeze and pump blood from the heart. A normal heartbeat on ECG will show the timing of the top and lower chambers.

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/electrocardiogram-ecg-or-ekg


Treadmill Stress Test

A stress test, sometimes called a treadmill test or exercise test, helps a doctor find out how well your heart handles work.

As your body works harder during the test, it requires more oxygen, so the heart must pump more blood.

The test can show if the blood supply is reduced in the arteries that supply the heart. It also helps doctors know the kind and level of exercise appropriate for a patient.

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/exercise-stress-test


Holter Monitor

A Holter monitor is a battery-operated portable device that measures and records your heart’s activity (ECG) continuously for 24 to 48 hours or longer depending on the type of monitoring used.

The device is the size of a small camera. It has wires with silver dollar-sized electrodes that attach to your skin. The Holter monitor and other devices that record your ECG as you go about your daily activities are called ambulatory electrocardiograms.

A Holter monitor test is usually performed after a traditional test to check your heart rhythm (electrocardiogram), especially if the electrocardiogram doesn’t give your doctor enough information about your heart’s condition.

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/holter-monitor

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Nuclear Studies

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Treadmill (Exercise) Stress Test

A nuclear stress test uses radioactive dye and an imaging machine to create pictures showing the blood flow to your heart. The test measures blood flow while you are at rest and are exerting yourself, showing areas with poor blood flow or damage in your heart.

The test usually involves injecting radioactive dye, then taking two sets of images of your heart — one while you’re at rest and another after exertion.

A nuclear stress test is one of several types of stress tests that may be performed alone or in combination. Compared with an exercise stress test, a nuclear stress test can help better determine your risk of a heart attack or other cardiac event if your doctor knows or suspects that you have coronary artery disease.

https://www.mayoclinic.org/tests-procedures/nuclear-stress-test/about/pac-20385231


Chemical Stress Test

A chemical or pharmacological stress test combines an intravenous medication) with an imaging technique (isotope imaging or echocardiography) to evaluate the LV. In these cases, the medication serves the purpose of increasing the heart load instead of using exercise. Stress causes normal coronary arteries to dilate, while the blood flow in a blocked coronary artery is reduced. This reduced blood flow may decrease the movement of the affected wall (as seen by echo), or have reduced isotope uptake in a nuclear scan. Agents that are commonly used in pharmacologic stress testing include dipyridamole, dobutamine and Adenosine (Trade name).

http://www.heartsite.com/html/chemical_stress.html


MUGA Scan

A MUGA scan is a test using a radioactive tracer (called a radionuclide) and a special camera to take pictures of your heart as it pumps blood. The test measures how well your heart pumps with every heartbeat. The test is called “multi-gated” because a gamma camera takes pictures at specific times during each heartbeat.

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/radionuclide-ventriculography-or-radionuclide-angiography-muga-scan

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Pacemaker/Defibrillators

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In-office “check” and remote monitoring, device adjustments

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Vascular Ultrasounds

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Duplex Ultrasound

A duplex ultrasound is a test to see how blood moves through your arteries and veins.

How the Test is Performed
A duplex ultrasound combines:

  • Traditional ultrasound: This uses sound waves that bounce off blood vessels to create pictures.
  • Doppler ultrasound: This records sound waves reflecting off moving objects, such as blood, to measure their speed and other aspects of how they flow.

There are different types of duplex ultrasound exams. Some include:

  • Arterial and venous duplex ultrasound of the abdomen. This test examines blood vessels and blood flow in the abdominal and lower extremities.
  • Carotid duplex ultrasound looks at the carotid artery in the neck.
  • Duplex ultrasound of the extremities looks at the arms or legs.
  • Renal duplex ultrasound examines the kidneys and their blood vessels.

You may need to wear a medical gown. You will lie down on a table, and the ultrasound technician will spread a gel over the area being tested. The gel helps the sound waves get into your tissues.

A wand, called a transducer, is moved over the area being tested. This wand sends out the sound waves. A computer measures how the sound waves reflect back, and changes the sound waves into pictures. The Doppler creates a “swishing” sound, which is the sound of your blood moving through the arteries and veins.

You need to stay still during the exam. You may be asked to lie in different body positions, or to take a deep breath and hold it.

Sometimes during a duplex ultrasound of the legs, the health care provider may calculate an ankle-brachial index (ABI). You will need to wear blood pressure cuffs on your arms and legs for this test.

The ABI number is obtained by dividing the blood pressure in the ankle by the blood pressure in the arm. A value of 0.9 or greater is normal.

https://medlineplus.gov/ency/article/003433.htm

PROCEDURES AVAILABLE AT OUR OUTPATIENT CATHLAB

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Endovenous venous ablation

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Vein disease occurs when bad veins in our legs no longer do their job and allows blood to pool in our legs. This can lead to many symptoms and enlarged varicose veins.

Venous ablation is an in-office procedure that utilizes radiofrequency energy to cauterize and close bad veins in the legs to alleviate symptoms such as swelling, achiness, fatigue, heaviness of the legs.

VenaSeal is an in-office procedure that utilizes a medical adhesive to close bad veins in the legs to alleviate symptoms such as swelling, achiness, fatigue, heaviness of the legs.


ClosureFast Procedure

Individual results may vary.

Images courtesy of Dr. Jonathan Calure.

The ClosureFast™ procedure uses radiofrequency energy or heat to close the diseased vein, which redirects blood flow to healthy veins, relieving symptoms.

The Traditional Treatment

  • Minimally invasive outpatient procedure
  • Local anesthesia along various points of the leg
  • Less pain and bruising than laser treatment
  • Faster recovery time than laser treatment
  • Compression stockings needed for at least one week after procedure

Over 2 million patients have been treated with the ClosureFast procedure in over 100 countries around the world.

 

https://www.medtronic.com/us-en/patients/treatments-therapies/varicose-vein-therapies/our-treatments/closurefast-procedure.html


VenaSeal Closure System

Individual results may vary.

Images courtesy of Dr. Kathleen Gibson.

Nonthermal Vein Closure

The VenaSeal™ system delivers a small amount of a specially formulated medical adhesive to seal — or close — the diseased vein, rerouting blood to nearby healthy veins, which provides symptom relief.

A More Comfortable Experience

  • Simple, outpatient procedure
  • No tumescent anesthesia
  • Less pain and bruising than thermal ablation
  • Faster recovery time than thermal ablation
  • Compression stockings not needed after the procedure

More than 100,000 patients have been treated with the VenaSeal closure system around the world.

 

https://www.medtronic.com/us-en/patients/treatments-therapies/varicose-vein-therapies/our-treatments/venaseal-closure-system.html


 

Sclerotherapy

Sclerotherapy is a minimally invasive procedure that treats varicose veins and spider veins. It involves injecting chemicals, known as sclerosing agents, into damaged veins.

In addition to diminishing the appearance of varicose or spider veins, sclerotherapy can also reduce pain or side effects caused by damaged veins.

Varicose veins can cause itching, pain, cramping, and discoloration. Spider veins are smaller and less severe than varicose veins. Varicose veins are more common in women than in men, although anyone can get them.

An estimated 20 percent Trusted Source of adults will be affected by varicose veins at some point in their lives. More than 324,000 sclerotherapy procedures were done in the United States in 2017.

https://www.healthline.com/health/sclerotherapy

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Cardiac catheterization and coronary angiography

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A cardiac cath provides information on how well your heart works, identifies problems and allows for procedures to open blocked arteries. For example, during cardiac cath your doctor may:

  • Take X-rays using contrast dye injected through the catheter to look for narrowed or blocked coronary arteries. This is called coronary angiography or coronary arteriography.
  • Perform a percutaneous coronary intervention (PCI) such as coronary angioplasty with stenting to open up narrowed or blocked segments of a coronary artery.
  • Check the pressure in the four chambers of your heart.
  • Take samples of blood to measure the oxygen content in the four chambers of your heart.
  • Evaluate the ability of the pumping chambers to contract.
  • Look for defects in the valves or chambers of your heart.

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/cardiac-catheterization

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Percutaneous coronary intervention (angioplasty/stenting)

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Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the insertion of a permanent wire-meshed tube that is either drug eluting (DES) or composed of bare metal (BMS).

https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention

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Peripheral angiography

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A peripheral angiogram is a test that uses X-rays and dye to help your doctor find narrowed or blocked areas in one or more of the arteries that supply blood to your legs. The test is also called a peripheral arteriogram.

Doctors use a peripheral angiogram if they think blood is not flowing well in the arteries leading to your legs or, in rare cases, to your arms. The angiogram helps you and your doctor decide if a surgical procedure is needed to open the blocked arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is generally placed in the artery after angioplasty to help keep it open. Bypass surgery is another procedure. It re-routes blood around the blocked arteries.

https://www.heart.org/en/health-topics/peripheral-artery-disease/symptoms-and-diagnosis-of-pad/peripheral-angiogram

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Percutaneous peripheral revascularization

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We utilize a multitude of different devices to open up diseased peripheral arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is spmetimes placed in the artery after angioplasty to help keep it open. We also perform peripheral atherectomy’s utilizing Laser or Orbital atherectomy devices. We use peripheral intravascular ultrasound (IVUS) to determine morphology and size of the vessel.

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Venous angiogram and Stenting

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Why is an iliac venogram used?
A venogram is used to help diagnose abnormalities in your veins, such as deep vein thrombosis. Other uses for a venogram include:

  • Determining the cause of swelling or pain in your legs
  • Tracking down where a blood clot that has traveled to your lungs initially formed

If you have a narrowed iliac vein, also known as iliac stenosis, a stent procedure may be used to expand and support the vein.

Most people are familiar with coronary/peripheral stents placed in the arteries of the heart/legs to improve blood flow. Venous stents function in the same way.

Venous stents are metal mesh tubes that expand against blocked or narrowed vein walls. They act as a scaffold to keep veins open. In most cases, physician place venous stents in larger, central veins, such as those found in the leg and abdomen.

Venous stents can help people with chronic leg swelling, venous ulcers, chronic blood clots or other conditions that compress or narrow the veins, limiting blood flow.

Below are a few of the conditions that are treatable with venous stenting:

  • Chronic deep vein thrombosis (DVT): DVT is a blood clot in one of the large, deep veins that returns blood from the leg — or less commonly, from the arm — to the heart and lungs.
  • Post-thrombotic syndrome: DVT can damage veins, which can lead to symptoms such as chronic swelling and pain. People may not suffer from symptoms of post-thrombotic syndrome until years after DVT.
  • May-Thurner syndrome: In this condition, the artery that runs from your abdomen to your right leg — called the right iliac artery — presses against the left iliac vein, causing it to narrow and scar, leading to chronic left leg swelling, pain, and sometimes fatigue.

Venogram with Intravascular Ultrasound (IVUS)
A venogram is an x-ray that allows your doctor to see the anatomy of your veins.

After inserting a catheter (thin, flexible tube) into a vein — most often in the leg — your doctor injects a contrast dye into the catheter, which allows your veins to be seen on the x-ray. We also perform an (IVUS) intravascular ultrasound which allows us to see the vein from the inside to evaluate for compression or thrombosis.

Your physician can use the venogram and IVUS to diagnose and treat your condition by performing venous angioplasty and stent placement at the same time if indicated.

What to Expect During Venous Stenting?
Your physician can place most venous stents on an outpatient basis, under moderate sedation.

During venous angioplasty, your physician will:

  • Insert a needle into a vein in your groin or behind your knee, depending on which vein needs stenting.
  • Insert a guide wire and pass a catheter sheath over it, followed by a guide catheter through the sheath.
  • Use x-ray guidance (fluoroscopy) to steer the catheter to the site of the narrowing.
  • Use (IVUS) Intravascular Ultrasound to assess the vessel and determine the % compression or thrombosis
  • Advance a balloon-tipped catheter to the site of the narrowing.
  • Inflate and deflate the balloon several times to widen the narrow vein.

To place a venous stent, your physician will:

  • Remove the angioplasty balloon and insert a catheter with a closed stent on it.
  • Place the stent in the vein. The stent pushes against the walls of the vein, serving as a support to keep it open.
  • Remove the catheters and apply pressure to the insertion point to close the wound.

In most cases, people who undergo venous stenting go home the same day.

To prevent blood clots from developing, most people must take clopidogrel (Plavix) for a few months.

https://www.upmc.com/services/heart-vascular/services/tests-procedures/venous-stents

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Implantable Loop Recorder

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A cardiac event recorder is a battery-powered portable device that you control to tape-record your heart’s electrical activity (ECG) when you have symptoms. There are two types of event recorders: a loop memory monitor and a symptom event monitor.

Cardiac event recorders and other devices that record your ECG as you go about your daily activities are also called ambulatory electrocardiographic monitors.

Quick facts:

  • A cardiac event recorder makes a record of your electrocardiogram (ECG or EKG) when you have fast or slow heartbeats, or feel dizzy or like you want to faint. It can also be used to see how you respond to medicines.
  • Some cardiac event recorders store your ECG in memory in the monitor. Your ECG can be sent by telephone to a receiving center or to your doctor.
  • There are no risks when using a cardiac event recorder.

https://www.heart.org/en/health-topics/arrhythmia/prevention–treatment-of-arrhythmia/cardiac-event-recorder

HOSPITAL PROCEDURES

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Cardiac catheterization and coronary angiography

Your Subtitle Goes Here
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A cardiac cath provides information on how well your heart works, identifies problems and allows for procedures to open blocked arteries. For example, during cardiac cath your doctor may:

  • Take X-rays using contrast dye injected through the catheter to look for narrowed or blocked coronary arteries. This is called coronary angiography or coronary arteriography.
  • Perform a percutaneous coronary intervention (PCI) such as coronary angioplasty with stenting to open up narrowed or blocked segments of a coronary artery.
  • Check the pressure in the four chambers of your heart.
  • Take samples of blood to measure the oxygen content in the four chambers of your heart.
  • Evaluate the ability of the pumping chambers to contract.
  • Look for defects in the valves or chambers of your heart.

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/cardiac-catheterization

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Percutaneous coronary intervention (angioplasty/stenting)

Your Subtitle Goes Here
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Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the insertion of a permanent wire-meshed tube that is either drug eluting (DES) or composed of bare metal (BMS).

https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention

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Peripheral angiography

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A peripheral angiogram is a test that uses X-rays and dye to help your doctor find narrowed or blocked areas in one or more of the arteries that supply blood to your legs. The test is also called a peripheral arteriogram.

Doctors use a peripheral angiogram if they think blood is not flowing well in the arteries leading to your legs or, in rare cases, to your arms. The angiogram helps you and your doctor decide if a surgical procedure is needed to open the blocked arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is generally placed in the artery after angioplasty to help keep it open. Bypass surgery is another procedure. It re-routes blood around the blocked arteries.

https://www.heart.org/en/health-topics/peripheral-artery-disease/symptoms-and-diagnosis-of-pad/peripheral-angiogram

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Percutaneous peripheral revascularization

Your Subtitle Goes Here
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We utilize a multitude of different devices to open up diseased peripheral arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is spmetimes placed in the artery after angioplasty to help keep it open. We also perform peripheral atherectomy’s utilizing Laser or Orbital atherectomy devices. We use peripheral intravascular ultrasound (IVUS) to determine morphology and size of the vessel.
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Venous angiogram and Stenting

Your Subtitle Goes Here
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Why is an iliac venogram used?
A venogram is used to help diagnose abnormalities in your veins, such as deep vein thrombosis. Other uses for a venogram include:

  • Determining the cause of swelling or pain in your legs
  • Tracking down where a blood clot that has traveled to your lungs initially formed

If you have a narrowed iliac vein, also known as iliac stenosis, a stent procedure may be used to expand and support the vein.

Most people are familiar with coronary/peripheral stents placed in the arteries of the heart/legs to improve blood flow. Venous stents function in the same way.

Venous stents are metal mesh tubes that expand against blocked or narrowed vein walls. They act as a scaffold to keep veins open. In most cases, physician place venous stents in larger, central veins, such as those found in the leg and abdomen.

Venous stents can help people with chronic leg swelling, venous ulcers, chronic blood clots or other conditions that compress or narrow the veins, limiting blood flow.

Below are a few of the conditions that are treatable with venous stenting:

  • Chronic deep vein thrombosis (DVT): DVT is a blood clot in one of the large, deep veins that returns blood from the leg — or less commonly, from the arm — to the heart and lungs.
  • Post-thrombotic syndrome: DVT can damage veins, which can lead to symptoms such as chronic swelling and pain. People may not suffer from symptoms of post-thrombotic syndrome until years after DVT.
  • May-Thurner syndrome: In this condition, the artery that runs from your abdomen to your right leg — called the right iliac artery — presses against the left iliac vein, causing it to narrow and scar, leading to chronic left leg swelling, pain, and sometimes fatigue.

Venogram with Intravascular Ultrasound (IVUS)
A venogram is an x-ray that allows your doctor to see the anatomy of your veins.

After inserting a catheter (thin, flexible tube) into a vein — most often in the leg — your doctor injects a contrast dye into the catheter, which allows your veins to be seen on the x-ray. We also perform an (IVUS) intravascular ultrasound which allows us to see the vein from the inside to evaluate for compression or thrombosis.

Your physician can use the venogram and IVUS to diagnose and treat your condition by performing venous angioplasty and stent placement at the same time if indicated.

What to Expect During Venous Stenting?
Your physician can place most venous stents on an outpatient basis, under moderate sedation.

During venous angioplasty, your physician will:

  • Insert a needle into a vein in your groin or behind your knee, depending on which vein needs stenting.
  • Insert a guide wire and pass a catheter sheath over it, followed by a guide catheter through the sheath.
  • Use x-ray guidance (fluoroscopy) to steer the catheter to the site of the narrowing.
  • Use (IVUS) Intravascular Ultrasound to assess the vessel and determine the % compression or thrombosis
  • Advance a balloon-tipped catheter to the site of the narrowing.
  • Inflate and deflate the balloon several times to widen the narrow vein.

To place a venous stent, your physician will:

  • Remove the angioplasty balloon and insert a catheter with a closed stent on it.
  • Place the stent in the vein. The stent pushes against the walls of the vein, serving as a support to keep it open.
  • Remove the catheters and apply pressure to the insertion point to close the wound.

In most cases, people who undergo venous stenting go home the same day.

To prevent blood clots from developing, most people must take clopidogrel (Plavix) for a few months.

https://www.upmc.com/services/heart-vascular/services/tests-procedures/venous-stents

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Implantable Loop Recorder

Your Subtitle Goes Here
3

A cardiac event recorder is a battery-powered portable device that you control to tape-record your heart’s electrical activity (ECG) when you have symptoms. There are two types of event recorders: a loop memory monitor and a symptom event monitor.

Cardiac event recorders and other devices that record your ECG as you go about your daily activities are also called ambulatory electrocardiographic monitors.

Quick facts:

  • A cardiac event recorder makes a record of your electrocardiogram (ECG or EKG) when you have fast or slow heartbeats, or feel dizzy or like you want to faint. It can also be used to see how you respond to medicines.
  • Some cardiac event recorders store your ECG in memory in the monitor. Your ECG can be sent by telephone to a receiving center or to your doctor.
  • There are no risks when using a cardiac event recorder.

https://www.heart.org/en/health-topics/arrhythmia/prevention–treatment-of-arrhythmia/cardiac-event-recorder

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Transesophageal echocardiogram (TEE)

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Transesophageal echocardiography (TEE) is a test that produces pictures of your heart. TEE uses high-frequency sound waves (ultrasound) to make detailed pictures of your heart and the arteries that lead to and from it. Unlike a standard echocardiogram, the echo transducer that produces the sound waves for TEE is attached to a thin tube that passes through your mouth, down your throat and into your esophagus. Because the esophagus is so close to the upper chambers of the heart, very clear images of those heart structures and valves can be obtained.

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/transesophageal-echocardiography-tee

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Cardioversion

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Cardioversion is a procedure that uses medicine or electric shocks to correct arrhythmias. An arrhythmia is a heartbeat that is too slow, too fast, or irregular. It may prevent your body from getting the blood and oxygen it needs. Your heart has 4 chambers, called the atria and ventricles. The atria are at the top of your heart, and the ventricles are at the bottom of your heart. Most arrhythmias that need cardioversion start in the atria.

https://www.heart.org/en/health-topics/arrhythmia/prevention–treatment-of-arrhythmia/cardioversion

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Tilt Table testing

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If you often feel faint or lightheaded, your doctor may use a tilt-table test to find out why. During the test, you lie on a table that is slowly tilted upward. The test measures how your blood pressure and heart rate respond to the force of gravity. A nurse or technician keeps track of your blood pressure and your heart rate (pulse) to see how they change during the test.

Quick Facts

  • Doctors use tilt-table tests to find out why people feel faint or lightheaded or actually completely pass out.
  • Tilt-table tests can be used to see if fainting is due to abnormal control of heart rate or blood pressure. A very slow heart rate (bradycardia) can cause fainting.
  • During the test, you lie on a special table that can have your head raised so that it is elevated to 60 to 80 degrees above the rest of your body while a nurse or doctor monitors your blood pressure and heart rate. You may have an IV inserted to give medicine or draw blood.

Doctors use this test to trigger your symptoms while watching you. They measure your blood pressure and heart rate during the test to find out what’s causing your symptoms. The test is normal if your average blood pressure stays stable as the table tilts upward and your heart rate increases by a normal amount.

If your blood pressure drops and stays low during the test, you may faint or feel lightheaded. This can happen either with an abnormally slow heart rate or with a fast heart rate. That’s because your brain isn’t getting enough blood for the moment. (This is corrected as soon as you are tilted back to the flat position.) Your heart rate may not be adapting as the table tilts upward, or your blood vessels may not be squeezing hard enough to support your blood pressure.

Feeling lightheaded or fainting may be caused by taking certain medicines, severe dehydration, abnormal heart rhythms (arrhythmias), hypoglycemia (low blood sugar), prolonged bed rest and certain nervous system disorders that cause low blood pressure.

https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/tilt-table-test

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Valvuloplasty

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A valvuloplasty, also known as balloon valvuloplasty or balloon valvotomy, is a procedure to repair a heart valve that has a narrowed opening.

In a narrowed heart valve, the valve flaps (leaflets) may become thick or stiff and fuse together (stenosis). This reduces blood flow through the valve.

A valvuloplasty may improve blood flow through the heart valve and improve your symptoms.

Doctors will examine you and determine if valvuloplasty or another treatment is right for your valve condition.

Your doctor may recommend valvuloplasty if:

  • You have severe valve narrowing and are having symptoms
  • You have narrowing of the mitral valve (mitral valve stenosis), even if you don’t have symptoms
  • You have a narrowed tricuspid or pulmonary valve
  • You or your child has a narrowed aortic valve (aortic valve stenosis)

However, the aortic valve tends to narrow again in adults who’ve had a valvuloplasty, so the procedure is usually done if you are too sick for surgery or are waiting for a valve replacement.

In a valvuloplasty, a doctor inserts a long, thin tube (catheter) with a balloon on the tip into an artery in your arm or groin. X-rays are used to help guide the catheter to the narrowed valve in your heart. The doctor then inflates the balloon, which widens the opening of the valve and separates the valve flaps. The balloon is then deflated, and the catheter and balloon are removed.

You’ll be awake but sedated during the procedure. After the procedure, you’ll usually stay in the hospital overnight.

Valvuloplasty may improve blood flow through your heart and reduce your symptoms. However, the valve may narrow again. You may need to have another valvuloplasty or other heart procedure, such as valve repair or replacement, in the future.

https://www.mayoclinic.org/tests-procedures/valvuloplasty/pyc-20384961

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Transcatheter Aortic Valve Replacement (TAVR)

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This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter.

Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.
This procedure is fairly new and is FDA approved for people with symptomatic aortic stenosis as an alternative to standard valve replacement surgery. The differences in the two procedures are significant.

Watch an animation of TAVR here.

Usually valve replacement requires an open-heart procedure with a “sternotomy.”, in which the chest is surgically separated (open) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place.

A TAVR procedure is not without risks, but it provides beneficial treatment options to people who may not have been candidates for them a few years ago while also providing the added bonus of a faster recovery in most cases. A patient’s experience with a TAVR procedure may be comparable to a balloon treatment or even an angiogram in terms of down time and recovery, and will likely require a shorter hospital stay (average 3-5 days).

The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:

  • Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest, or
  • Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/what-is-tavr

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Endovascular aneurysm repair (EVAR)

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Abdominal aortic aneurysms can weaken the aorta, your body’s largest blood vessel. This can develop into a potentially serious health problem that can be fatal if the aneurysm bursts, causing massive internal bleeding.

Endovascular stent grafting, or endovascular aneurysm repair (EVAR), is a newer form of treatment for abdominal aortic aneurysm that is less invasive than open surgery. Endovascular stent grafting uses an endovascular stent graft to reinforce the wall of the aorta and to help keep the damaged area from rupturing.

The word endovascular refers to the area inside of a blood vessel such as the aorta. With endovascular stent graft therapy an endovascular stent graft is placed inside of your abdominal aorta to help protect the aneurysm from rupturing.

The stent graft is placed inside of the aortic aneurysm with the help of a long, very thin, soft, plastic tube called a delivery catheter. The delivery catheter contains the compressed stent graft.

Here is how the endovascular stent graft is placed in the aortic aneurysm:

  1. The catheter is inserted into an artery in the leg near the groin.
    Delivery catheter is inserted through the vessel into the aneurysm to guide the stent into place.
  2. Using advanced imaging methods, the surgeon guides the delivery catheter carrying the stent graft to the area of the abdominal aortic aneurysm.
  3. Once the stent graft is in position, the surgeon fastens it into place and removes the delivery catheter.
  4. The endovascular stent graft is placed inside the abdominal aorta to help keep the aneurysm from bursting.

Endovascular stent grafting and open surgery grafting are both done to prevent an abdominal aortic aneurysm from rupturing. The difference is that the endovascular stent graft is put into place inside the aneurysm without removing any tissue from your aorta, and it does not require open-chest or open-abdominal surgery.

Because it is less invasive than open surgery, the recovery time for endovascular stent grafting may be faster. Usually, the patient can return home within a week and return to normal activities in 4 to 6 weeks.

https://www.medtronic.com/us-en/patients/treatments-therapies/stent-graft-aaa/what-is-it.html

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