OFFICE SERVICES
Cardiology Consultation
Our office provides prompt evaluation and consultation, with the goal of timely and efficient treatment and communication.
Our normal office hours are Monday through Friday from 7:30 AM - 5 PM and appointments can be scheduled by calling 818-994-0616 from 8:00 AM- 5 PM.
Routine Office Procedures
We perform EKGs,Holter monitoring, Exercise Stress testing with or without nuclear imaging, Muga scanning, Adenosine and Lexiscan nuclear (Cardiolite) testing, Dobutamine nuclear (Cardiolite) stress testing, Exercise and Dobutamine stress echocardiography, Impedence cardiography, M-mode/2D/Doppler and color doppler echocardiography, Carotid and Peripheral Arterial / Venous Duplex scanning. We also offer EECP (external counter pulsation), Pacemaker and AICD followup and programming, coumadin clinic, lipid clinic (cholesterol management), participation in clinical research trials, as well as other routine office procedures.
Our office staff are available every day to answer patient inquiries by phone.
Staff and physicians are dedicated to providing the best service possible to all of our patients. TOP
New Patient Form
Nuclear Cardiology
Nuclear stress tests are given at our office location with the utmost attention to quality and detail by our dedicated staff.
Our schedulers provide patients with thorough instructions. Patients will receive written and verbal instructions with reminders to assist in understanding and compliance with preparation. The instructions are also available on this web site. TOP
Test Procedure
Instructions for Nuclear Stress Test
SPECT and PET Imaging
Echocardiography
Echocardiography is a non-invasive diagnostic modality used to assess heart function that continues to be one of the most effective tools to aid in diagnosis and follow-up care. All echocardiography studies are read on site by our board certified cardiologists. It remains our goal to provide the highest level of service and care to patients and physicians.
Fit Heart M.D. offers full service. The labs function under the guidance of our Medical Director, Dr.Ramesh Arora and the studies are performed under the supervision of a Registered Diagnostic Medical Sonographer (RDMS) using all digital equipment.
Sonographers routinely perform trans thoracic echoes, exercise treadmill stress echoes and dobutamine stress echos.. When a physician requests an echo as part of diagnosis, the sonographer performing the study places a transducer or probe on the chest. The probe emits a painless high frequency sound wave to identify heart structures within the chest wall. Blood flow through the chambers and valves of the heart are imaged and recorded to enable the physician to review and identify any findings that would aid in diagnosis and treatment. Measurements of chamber size, wall thickness and the function of the heart muscle are assessed. TOP
Vascular Services
Our non-invasive vascular laboratory takes pride in providing a high level of patient care and quality testing for the diagnosis of vascular disease.
Tests Scheduled in the Vascular Department include:
- Carotid Artery and Vertebral Ultrasound
- Lower & Upper Extremity Arterial Duplex
- Lower & Upper Extremity Venous Duplex
- Abdominal Aortic Ultrasound
- Intimal Medial Thickness (IMT)
Patient care and comfort are of the utmost importance. A thorough explanation of the examination is given to the patient before the test. TOP
HOSPITAL SERVICES
Vascular Interventional Services:
Cardiac Catheterization
The procedure involves a needle hole entry in the femoral artery, and the insertion of a catheter through the artery to the heart. A dye is infused, and the arteries around the heart are visualized by fluoroscopy. Blockages found may be cleared with angioplasty, and a stent may be placed to secure the open pathway through the artery. TOP
A doctor inserts a thin plastic tube (catheter about 2mm in diameter) into an artery or vein in the arm or leg. From there it can be advanced into the chambers of the heart or into the coronary arteries. This test can measure blood pressure within the heart and how much oxygen is in the blood. It is also used to get information about the pumping ability of the heart muscle. Catheters are also used to inject dye into the coronary arteries. This is called coronary angiography or coronary arteriography. Catheters with a balloon on the tip are used in the procedure called percutaneous transluminal coronary angioplasty. TOP
Stent Procedure
A stent is a wire mesh tube used to keep open an artery after angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It is then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle, and relieves symptoms (usually chest pain).
Stents are used depending on certain features of the artery blockage. This includes the size of the artery and where the blockage is. Stenting is a common procedure; in fact, it now represents 70-90 percent of procedures.
Stents are known to reduce the renarrowing that occurs after balloon angioplasty or other procedures that use catheters. Stents also help restore normal blood flow and keep an artery open if it has been torn or injured by the balloon catheter. Reclosure (restenosis) is also a problem with the stent procedure (though less frequent than balloon angioplasty). In recent years, doctors have used new types of stents called drug-eluting stents. These are coated with drugs that are slowly released and help keep the blood vessel from reoccluding. These newer drug eluting stents have shown promise for improving the long-term success of this procedure.
Patients who have had a stent procedure must take one or more blood-thinning agents. Examples are aspirin and clopidogrel. Aspirin is used indefinitely; clopidogrel is used for a few months (depending on the type of stent) after the procedure. If you are taking this medication, it is important that you do not stop taking it without consulting your cardiologist. For the next four weeks, a magnetic resonance imaging (MRI) scan should not be done without a cardiologist's approval. However, metal detectors do not affect the stent. To date there is no evidence of long-term complications from having a permanent stent. TOP
Percutaneous Coronary Interventions
Percutaneous coronary intervention (PCI) encompasses a variety of procedures used to treat patients with diseased arteries of the heart. These include:
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Balloon angioplasty
- Coronary Stent including drug eluding stent
Typically, PCI is performed by threading a slender balloon-tipped tube - a catheter - from an artery in the groin to a trouble spot in an artery of the heart (this is referred to as percutaneous transluminal coronary angioplasty - also known as PTCA, coronary artery balloon dilation or balloon angioplasty). The balloon is then inflated, compressing the plaque and dilating (widening) the narrowed coronary artery so that blood can flow more easily. This is often accompanied by inserting an expandable metal stent. Stents are wire mesh tubes used to prop open arteries after PTCA. TOP
Intravascular ultrasound (IVUS)
Intravascular ultrasound (IVUS) is a catheter-based technique, which provides real-time high-resolution images allowing precise tomographic assessment of lumen area, plaque size, and composition of a coronary segment, and therefore provides new insights into the diagnosis of and therapy for coronary disease. The arteries of the heart (the coronary arteries) have been the most frequent imaging target. IVUS is used in the coronary arteries to determine the amount of disease at any particular point in one of the coronary arteries regardless the presence or absence of any stenosis. Additionally, IVUS is also a useful and accurate measure of the expansion of the stenosis. TOP
Fractual Slow Reserve (FFR)
An FFR wire is used to meausre pressures within the coronary arteries at different levels to access the hemodynamic significance of a stenosis.
Electrical Cardioversion
An electrical cardioversion procedure used to convert an irregular heart rhythm to a normal heart rhythm by applying high-energy shock. Your doctor uses cardioversion to convert an irregular or fast heart rhythm back to a normal rhythm. Common rhythms that require cardioversion include atrial fibrillation and atrial flutter. Your blood needs to be adequately monitored prior to a cardioversion to make sure it is properly thinned, in order to avoid a stroke during or after the procedure. It is an outpatient procedure using intravenous short acting anesthesia. The patient generally does not feel or remember anything about the procedure which takes just an instant to perform. TOP
PACEMAKERS:
What is a pacemaker?
o A pacemaker is prescribed for people whose hearts are beating too slowly or irregularly (bradycardia). A pacemaker sends tiny electrical impulses to the heart muscle. The electrical impulses are precisely timed and cause the heart to beat, very similarly to a naturally occurring heart rhythm. When people refer to a pacemaker, they are really discussing a pacing system: a pacemaker and pacing lead(s). Two parts of a pacing system are placed inside the body:
- The pacemaker is a small metal case that contains electronics and battery. The pacemaker sends a tiny electrical pulse at a specific time.
- A pacing lead is an insulated wire that carries the tiny electrical pulse to the heart. It can also relay information about the heart's activity back to the pacemaker.
- The two parts of a pacing system work together to make the heart beat at a more normal rate. By restoring the heart rate, the symptoms of bradycardia are often eliminated. This often means patients have more energy and less shortness of breath.
How a Pacing System Works
- A pacing system restores one of the most essential rhythms of life--the rhythm of the human heart. The two parts of the pacing system inside the body, the pacemaker and the pacing lead, work together to perform two main functions: pacing and sensing.
- Pacing is when a pacemaker sends tiny electrical signals to the heart through a pacing lead. Each tiny electrical signal is called a pacing pulse (pacing impulse, pace) and it is this pacing pulse that starts a heartbeat. The pacemaker paces (sends a pacing pulse to) the heart when the heart's own rhythm is interrupted, irregular, or too slow.
- A pacemaker may also sense (monitor) the heart's natural electrical activity. If a pacemaker senses a natural heartbeat, it will not deliver a pacing pulse to the heart.
How pacing starts a heartbeat:
- The pacemaker sends a tiny electrical signal, a pacing impulse.
- This impulse travels through the insulated wires of a pacing lead until it reaches the metal electrode at the tip of the lead.
- The electrode, which is in direct contact with the heart, delivers the electrical impulse to the heart.
- The electrical impulse causes the heart tissue to begin a heartbeat.
How a pacemaker knows when to send a pacing impulse:
- The pacing pulses are timed so that the heart beats in a manner very similar to a naturally occurring heart rhythm.
- For some pacemakers, this timing is exactly the same for each heartbeat.
- In other pacemakers, the timing is based on when the heart beats on its own. For these pacemakers, information about the heart's own electrical activity is sent back to the pacemaker through an electrode on the lead. (This is called sensing.)
- If the pacemaker circuitry determines that the heart is beating too slowly, a pacing pulse is sent to start a heartbeat.
- If the pacemaker circuitry determines that the heart is beating at a proper rate, the pacing pulse is withheld.
- In rate responsive pacemakers, a special sensor detects changes in the body such as movement of arms and legs or how often a person breathes. The pacemaker's circuitry interprets these changes and increases the pacing rate (the number of times per minute that a pacing pulse is sent) by either a little or a lot - depending upon the body's need for oxygen.
How the doctor or nurse know what a pacemaker is doing:
During a follow-up visit at a clinic or hospital, a programmer is used by a doctor or nurse to monitor the pacemaker and adjust the pacing and sensing.
Surgery
Pacemaker surgery is often done using a local anesthetic and the person usually returns home the same day. Occasionally, a patient who requires other surgery, such as a coronary bypass, will have the pacemaker implanted at the same time as the other surgery. The cardiologists have specialized training in the diagnosis and treatment of heart rhythm disorders. TOP
The surgical procedure includes these steps:
- An incision is made for the pacemaker. (This may be on either side of the chest wall or in the abdominal wall. )
- The leads are inserted into a vein and guided to the heart.
- The leads are connected to the pacemaker.
- The pacemaker and leads are tested.
- The incision is closed.
Women's Cardiac Health
Since 1984, more women than men have died from cardiovascular disease each year. For every woman dying from breast cancer, twelve women die from cardiovascular disease. Only 8% of women know that cardiovascular disease is their greatest risk. It is the #1 killer of women, regardless of race or ethnicity. It also strikes at younger ages than most people think, and the risk increases in middle age. About two thirds of women who have heart attacks never fully recover.
The best tool to manage cardiovascular disease is knowledge, and Fit Heart M.D. is determined to increase public awareness by educating men and women on risks and lifestyles affecting heart health. TOP |
