Orlando Heart & Vascular Institute

Products And Services

• Nuclear Stress Testing

  Nuclear Stress Testing A nuclear cardiology stress test, also known as myocardial perfusion imaging, is used to determine if the heart is receiving an adequate blood supply under both stress and rest conditions. It involves injecting into the bloodstream a small amount of radioactive material that then circulates through the body, helping to evaluate the blood flow and function of the heart. A nuclear cardiology stress test is typically given to those who have symptoms, such as shortness of breath or chest pains, that indicate coronary artery disease. It is also used to determine the risk of a heart attack, and to show if there is limited blood flow to the heart. A nuclear cardiology stress test helps to diagnose coronary artery disease, and determine the best treatment plan for serious heart conditions. Reasons For A Nuclear Cardiology Stress Test If a patient has symptoms that indicate coronary artery disease, or has had a previous electrocardiogram that produced abnormal results, a nuclear cardiology stress test may be recommended. It may also be an option for someone who is unable to exercise, or walk on a treadmill. Patients at high risk, such as those who smoke, or have diabetes or high blood pressure, may also be candidates for nuclear cardiology stress testing. The test is also used to help establish an appropriate treatment plan for a patient who has already been diagnosed with coronary artery disease. The Nuclear Cardiology Stress Test A patient may be asked to refrain from caffeine for 24 hours before taking the test, which begins with the injection of radioactive dye (either thallium or sestamibi) into the bloodstream. Electrodes are placed on different parts of the body to record the electrical signals that trigger heartbeats. Images of the heart are taken when the patient is at rest, and then again when the patient is engaging in physical activity. The images show the areas within the heart that are not receiving enough blood. Both sets of images are reviewed to compare the blood flow through the heart during different stages of rest and activity. If a patient is unable to exercise, a medication that increases blood flow to the heart muscle may be given intravenously. A patient may experience headache, nausea and a racing heart beat during the test, which takes, on average, 3 hours to complete. Recovery From A Nuclear Cardiology Stress Test The radioactive substance used in the test is naturally excreted from the body through urine, and patients are advised to drink plenty of water to help flush it through their systems. Most patients return to their normal activities immediately after testing. Risks Of A Nuclear Cardiology Stress Test Although a nuclear cardiology stress test is generally considered safe, it does have the following risks: Allergic reaction to the radioactive dye Arrhythmia Chest pain Blood-pressure surge Although extremely rare, it is possible for a nuclear cardiology stress test to cause a heart attack.

• Echocardiography

  More information coming soon.

• Stress Echocardiography

  A stress echocardiogram is a diagnostic test used to evaluate the strength of the heart muscle as it pumps blood throughout the body. Using ultrasound imaging, the stress echocardiogram detects and records any decrease in blood flow to the heart caused by narrowing of the coronary arteries. The test, which takes place in a medical center or in the doctor’s office, is administered in two parts: resting and with exercise. In both cases, the patient’s blood pressure and heart rate are measured so that heart functioning at rest and during exercise can be compared. The ultrasound images enable the doctor to see whether any sections of the heart muscle are malfunctioning due to a poor supply of blood or oxygen. Reasons For A Stress Echocardiogram The test is administered to patients whose heart health is in question or to evaluate ongoing cardiac treatment. Patients are candidates for a stress echocardiogram if they have been having chest pains or angina or have recently had a heart attack. They may also have the test as a requirement prior to heart surgery or before beginning an exercise program. The stress echocardiogram measures: How well the heart muscle and valves are working How well the heart handles exercise (stress) Whether the patient is likely to have coronary artery disease Whether the patient’s heart function has improved after treatment Whether chambers of the heart are enlarged Results of the stress echocardiogram are helpful to the cardiologist in determining whether there is a problem with heart muscle strength and what that problem might be. They also help determine an appropriate new course of treatment or evaluate a previous one. Preparing For A Stress Echocardiogram Before undergoing a stress echocardiogram, patients should ask their doctors whether it is necessary to temporarily stop taking certain medications prior to the test, particularly medications prescribed for erectile dysfunction. Patients should refrain from eating or drinking for at least 3 hours before the test and wear comfortable, loose-fitting clothing to the procedure. The Stress Echocardiogram Procedure Before the test begins, electrodes are placed at various locations on the patient’s body, including the chest, arms and legs, to record electrical activity in the heart. The patient will also wear a blood pressure cuff. The resting portion of the procedure is administered while the patient lies on the side with the left arm extended. The doctor moves an ultrasound transducer over the patient’s chest. A special gel is applied to enable the transducer to move smoothly and to transmit sound waves directly to the heart. During the second portion of the test, the patient exercises by walking on a treadmill or peddling on an exercise bicycle. At approximately 3 minute intervals, the patient is asked to speed up activity or to walk up an incline. Depending on the patient’s age and fitness level, the test can take from 5 to 15 minutes. Normally, the test is stopped when the patient’s heart is beating at a targeted rate, or when fatigue, chest pain, or blood pressure changes necessitate cessation. The test results provide the doctor with critical evidence as to whether the heart has more difficulty functioning under stress. Some patients who require the stress echocardiogram may not be strong enough to perform the necessary exercise routine. In such cases, a drug is administered intravenously to make the heart beat faster and more strongly, simulating exercise. Most patients are relatively comfortable during this test, though some become very fatigued and unable to complete it. In rare instances, patients may experience one or more of the following symptoms during the stress echocardiogram procedure, including: Chest discomfort or pain Skipped or extra heartbeats Dizziness Nausea Shortness of breath It is important for patients to report any unusual sensations to the medical professional administering the test. If the test results are completely normal, no further treatment is necessary. If the test shows problems with the heart muscle or with coronary circulation, medications may have to be altered or the patients may require further testing or a surgical procedure. Risks Of A Stress Echocardiogram There is a very low rate of risk associated with a stress echocardiogram since it is mostly non-invasive and the patient is carefully monitored during the entire procedure. Complications occur rarely, but may include heart arrhythmia, syncope (fainting), or heart attack.

• 24 Hour Holter Monitoring

  Holter Monitoring A Holter monitor is a small, portable device that continuously records the heart’s rhythms and records the electrical activity of the heart. A Holter monitor may be used to capture information and check an individual’s heart rhythm if results of other tests, such as an electrocardiogram (EKG), have been inconclusive. The monitor is worn for 24 to 48 hours during normal activity, and it it records the heart’s electrical activity during that time period. Because patients are only hooked up to an EKG machine for a short time, it may not detect any irregularities in the heart rhythm. If symptoms suggest that an individual may be experiencing an irregular heart rhythm, a doctor may recommend wearing a Holter monitor for one to two days. Over that time, the Holter monitor may be able to detect irregularities in the heart rhythm that an electrocardiogram was unable to detect. A Holter monitor may also be used to monitor heart rate after a heart attack or to monitor the effectiveness of new heart medication. How A Holter Monitor Works Electrodes are stuck on the patient’s chest. The electrodes are attached by wires to a small recording monitor. The Holter monitor runs on batteries and is carried in a pocket or pouch worn around the neck or waist. The Holter monitor, worn for 24 to 48 hours and records the heart’s activity throughout that time period. This consistent monitoring may detect arrhythmias that only occur at certain times, such as after physical exertion. While wearing the Holter monitor, individuals are asked to record any symptoms and activities, so the doctor can link them to the results of the Holter monitor. This information is often helpful in identifying the cause of heart rhythm problems After the Holter monitor is removed, the doctor will review the results of the test and compare them with any information that the patient recorded while wearing the monitor. A diagnosis may be determined from the results of this test, however in some cases, additional testing may be necessary. There is no risk involved in using a Holter monitor and the tests is painless.

• Ambulatory Blood Pressure Monitoring

  24-Hour Blood Pressure Monitor An ambulatory blood pressure monitor is a small device worn on a belt, with a blood pressure cuff wrapped around the arm under the clothes for a 24-hour period in order to regularly check blood pressure levels. Reasons For A 24-Hour Blood Pressure Monitor Patients who have uncontrollable high blood pressure may be required to use the monitor. Patients may be asked to wear the monitor if they are: Taking a new medication Pregnant and have high blood pressure Suffering from fainting spells Taking other medications that affect blood pressure The device checks the patient’s blood pressure every 15 to 30 minutes throughout the day in order to thoroughly monitor blood pressure while the patient goes through a normal day’s activities. Patients will be asked to keep a diary of their day so that the doctor can fully analyze any changes in blood pressure. The device will be removed the next day at the doctor’s office, and the monitoring information will be transferred to a computer. Any treatment modifications can be made after the results are reviewed by the doctor and patient.

• Ankle Brachial Index

  The ankle-brachial index (ABI) is a noninvasive diagnostic test used to determine an individual’s risk for peripheral artery disease, or PAD. It can also help determine the severity or progress of the disease if it has already been diagnosed. This test is done by comparing the blood pressure in the ankle with the blood pressure in the arm. Since PAD is a condition that involves a narrowing or blockage of arteries in the leg, a low ankle-brachial index may indicate narrowed arteries in the legs. The ankle-brachial index is an important test since PAD is a dangerous condition which can lead to heart attack or stroke. Candidates For Ankle-Brachial Index Individuals may have risk factors for PAD, making the probability of developing the disease more likely. These risk factors may include: Being age 50 or older Being a current or former smoker Being overweight Having diabetes Having high blood pressure Having high cholesterol Individuals who have poor circulation, experience leg pain and/or have other risk factors for PAD, should have an ankle brachial index test performed. The Ankle-Brachial Index Procedure The ankle-brachial index is a simple, safe and non-invasive procedure with no risks or side effects. Sometimes this test is performed in conjunction with two other procedures that check for blocked or narrow arteries elsewhere in the body: a carotid ultrasound and an abdominal ultrasound. The ankle-brachial index evaluates blood flow in a patient complaining of leg or arm pain, numbness, tingling and fatigue, all of which are symptoms of narrowing, hardening and blockage of the arteries. Doppler technology uses sound waves to detect blood flow, and identify any differences in blood pressure, in the arms and legs. During the arterial Doppler ultrasound, a transducer is used to detect blood flow before and after a blood-pressure cuff is inflated. Patients may experience mild cramping because the cuffs cut off circulation. ABI using Doppler ultrasound usually takes about 45 minutes to perform, and patients can return to their regular activities immediately afterwards.

• Pacer And Defibrillator Interrogation

  Implantable Cardioverter Defibrillator An implantable cardioverter defibrillator (ICD) is an electronic device that is implanted under the skin, and is used to detect an abnormal heartbeat. An ICD is often implanted in individuals with irregular heartbeats or heart arrhythmias. This device uses electrical impulses to control dangerous arrhythmias that may lead to heart attack or sudden cardiac arrest. If an abnormal heartbeat is detected, the ICD will deliver an internal electric shock to the heart, restoring a normal heart beat as needed. An implantable cardioverter defibrillator use electrical pulses or shocks, to treat life-threatening arrhythmias that occur in the ventricles, or lower chambers of the heart. When ventricular arrhythmias occur, the heart cannot properly pump the blood. This may cause a person to lose consciousness within seconds and die within minutes if not treated. To prevent these dangerous results, heart arrhythmias must be treated right away with an electric shock to the heart, a treatment known as defibrillation. Individuals at risk for life-threatening ventricular arrhythmia may include people who have: Congenital heart disease Brugada syndrome Existing ventricular arrhythmia Experienced cardiac arrest Individuals who have had a previous heart attack are at risk for ventricular arrhythmia and may be candidates for an implantable cardioverter defibrillator. How An ICD Works An ICD is a small, battery-operated device that is implanted under the skin, below the left collarbone, to help maintain a regular heartbeat. The ICD sends electronic signals to the heart to help it pump properly when needed. The ICD consists of two flexible parts: the lead and the pulse generator. The lead monitors and treats the heart, while the generator contains a battery and tiny computer. When a very fast or abnormal heart beat is detected, the ICD sends energy to the heart to shock it and help it return to a normal rhythm. The ICD Implantation Procedure A cardioverter defibrillator is surgically implanted and the procedure is performed in a hospital. A small incision is made under the collarbone, and the lead is placed in a vein and led to the heart chamber, while the generator remains attached to it and is placed under the skin of the upper chest. After the ICD is implanted, the doctor programs it to treat the individual’s specific heart rhythm problem. Although rare, complications of an ICD implant may include infection, bleeding, damage to veins or puncture of the heart or lung. Patients should avoid strong electric or magnetic fields after the implantation of the cardioverter defibrillator. An ICD battery lasts an average of 7 to 10 years and should be checked regularly and replaced by a doctor when necessary.

• INR Monitoring

  INR Testing INR (international normalized ratio) testing measures the speed at which blood clots. It is commonly used to measure the clotting time of patients taking blood-thinning medications, such as warfarin (Coumadin) or heparin. The results of this test are given as a ratio. INR testing is performed to evaluate the patient’s blood-clotting process to make sure it is in the normal range, and that the medication in question is preventing serious blood clots without causing dangerous bleeding. Also known as a prothrombin time (PT) test, named after a protein produced by the liver that assists in the blood-clotting process, this test measures how long the clotting process takes and how efficiently it occurs. There are a number of steps to the clotting process; all involve a number of chemicals known as clotting factors. An important step in the process is the one in which prothrombin changes to another protein called thrombin. Measuring the time it takes for this to occur provides essential information about the efficiency and speed of the entire clotting process. When the INR test is administered to evaluate patients taking blood-thinning medications, prothrombin time is presented as a ratio, a formula that adjusts for differences in the chemicals used by different laboratories so that test results can be comparable. The INR Testing Procedure Before undergoing the INR test, patients should always inform their doctors of any prescribed or over-the-counter medications, vitamins, supplements or herbal remedies they are taking, because these products may interfere with the accuracy of test results. During the INR test, the healthcare professional takes a sample of the patient’s blood, which is collected in a sterile vial. Chemicals are then added to the blood sample, and the clotting time of the plasma is precisely measured. Apart from the sting of needle insertion and a small throbbing at the withdrawal site, the INR testing procedure is not uncomfortable. As long as it is performed under sterile conditions, there is no risk involved. INR Test Results Patients taking blood-thinning medications are presented with test results as the international normalized ratio (INR). For those on blood thinners, the effective range is usually 2.0 to 3.0. Patients whose reading is higher have blood that clots too slowly; patients who reading is lower have blood that clots too quickly. An INR range of 2.0 to 3.0 is generally effective for people taking warfarin who need full anti-coagulation, but it may need to be slightly higher in other situations. Although the INR presentation is useful for people on oral blood thinners, there are several reasons for abnormal blood-clotting speeds. For those whose blood-clotting time is too fast or too slow for other reasons, prothrombin time is normally measured in the seconds it takes for blood to clot, rather than as a ratio.

• AAA Screening

  Abdominal Aortic Aneurysm An aneurysm is a localized, balloon-like expansion in a blood vessel caused by weak vessel walls. The aorta is the artery that carries oxygen-rich blood from the heart to the legs. When a bulge occurs in the abdominal section of the aorta, between the diaphragm and the legs, it is called an abdominal aortic aneurysm. Most aortic aneurysms occur in the abdomen, and most abdominal aortic aneurysms occur beneath the kidneys and may continue into the iliac, or leg, arteries. Causes Of Abdominal Aortic Aneurysm Atherosclerosis, the narrowing of arteries due to fatty tissue accumulation, weakens vessel walls and is responsible for about 80 percent of aortic aneurysms. Other causes include: Congenital deformity Blood vessel injury Hypertension Inflammation due to disease Advanced syphilis Fungal infection Men are more likely than women to develop abdominal aortic aneurysms. Being over the age of 60 also increases one’s chances of developing abdominal aortic aneurysms. Symptoms Of Abdominal Aortic Aneurysm Abdominal aortic aneurysms may occur with no warning signs. Possible symptoms include: Deep abdominal or lower back pain Pulsing sensation in the abdomen Pallor, rapid pulse, dry skin or mouth Excessive thirst Anxiety Nausea and vomiting Light-headedness or fainting with upright posture Sweating, clammy skin Fatigue Palpitations or tachycardia Impaired concentration and shock. Abdominal aortic aneurysms may be detected by manual examination by a physician, X-rays, ultrasound, CT scans, MR imaging and aortography. Treatment Of Abdominal Aortic Aneurysm Surgery is recommended for arteries at great risk for rupture: those over six centimeters wide, and those four to six centimeters wide in patients otherwise in good health. Surgery is performed immediately on arteries that threaten imminent rupture or have already ruptured, although success is far less likely once the vessel has burst. While an abdominal aortic aneurysm presents a grave danger, when it is repaired before rupture the prognosis is quite good. Recovery from the surgery, however, may take several months. Traditional surgery involves making an incision to open the abdomen, then removing the aneurysm and replacing the excised vessel piece with a synthetic tube. Minimally invasive laparoscopic techniques require only small incisions, typically made in the femoral artery in the thigh, through which a thin tube with a camera is inserted so the surgeon can see inside the patient’s body without the need for open surgery. Risks Of Abdominal Aortic Aneurysm The weakened, bulging vessel walls are susceptible to rupture, a catastrophic event which causes severe bleeding and pain and is often fatal. Half of all untreated abdominal aortic aneurysms end in rupture and death within 5 years. Leakage rather than rupture may occur, causing blood to flow through the inner lining into the vessel wall, known as aortic dissection. Further, blood clots may form in the aneurysm and travel to other arteries, where they may block blood flow. Other complications are infection and blockage of the aorta.

• Coronary Angiography

  A coronary angioplasty is a procedure performed to improve blood flow in the arteries of the heart, by re-opening or enlarging blocked blood vessels. The blockages usually develop as a result of atherosclerosis. Atherosclerosis occurs when plaque builds up on the inner walls of the arteries and causes them to harden and narrow, often leading to coronary artery disease. A coronary angioplasty involves the insertion of a tiny balloon that is inflated to open and widen the artery. It is often combined with the insertion of a small wire tube called a stent, that helps to keep the artery open, so it will not narrow again in the future. Candidates For A Coronary Angioplasty A coronary angioplasty may be recommended for people with with blockages in the arteries of their heart, especially if they are experiencing chest pain and discomfort. It may also be performed if lifestyle changes and medication have not been an effective form of treatment and after an individual has suffered from a heart attack. The Coronary Angioplasty Procedure Patients are often sedated but remain awake during the procedure. During the angioplasty procedure, an incision is made in the arm or groin, and a catheter is inserted. A contrast dye is injected through the catheter, to highlight the clogged areas during the procedure. A tube with a deflated balloon is inserted through the catheter to the blockage. The balloon is inflated to widen the artery, pushing the plaque aside allow the blood to flow through smoothly. To hold the artery open and prevent it from narrowing again, a wire mesh tube called a stent may be inserted. Some stents are coated with medication that is slowly released into the arteries to help prevent scar tissue from forming and blocking the artery. The coronary angioplasty takes approximately 1 to 2 hours to perform. Recovery From Coronary Angioplasty After the procedure, patients are required to stay in the hospital for a few hours so that their condition can be monitored. Some patients may stay in the hospital overnight for observation. The site where the catheter was inserted is checked for bleeding and patients may experience soreness or tenderness in the area. Medication is prescribed to to help prevent blood clots from forming. Patients are often able to return to work approximately one week after the angioplasty procedure. Cardiac rehabilitation may be recommended after a coronary angioplasty. Patients are encouraged to make certain lifestyle changes after this procedure to lower their risk of coronary artery disease. Life style modifications may include exercise, quitting smoking, losing weight and reducing stress. Risks Of Coronary Angioplasty While a coronary angioplasty is considered a common medical procedure, complications are rare, however they may include: Blood clots Bleeding Abnormal heart rhythms Allergic reaction to contrast dye Heart attack Stroke The risk of complications is higher in people over the age of 65, people with extensive heart disease and blockages in their coronary arteries, and individuals with chronic kidney disease.

• Renal Artery Stenosis

  Renal artery stenosis (RAS) is the narrowing of one or both of the renal arteries, the blood vessels that carry blood to the kidneys from the aorta. RAS often causes high blood pressure and reduced kidney function, however, many times there are no symptoms present until the condition becomes severe. Most cases of RAS are caused by a condition called atherosclerosis, the clogging, narrowing, and hardening of the renal arteries. RAS develops when plaque builds up on the inner wall of the renal arteries and causes the arteries to harden and narrow. RAS may also be caused by fibromuscular dysplasia, an abnormal growth of tissue within the wall of the artery, which causes the blood vessels to narrow. Symptoms Of RAS In addition to hypertension (high blood pressure), people with RAS may also suffer from reduced kidney function which may cause the following symptoms: Edema (swelling) of the hands or feet Increase or decrease in urination Muscle cramps Nausea Vomiting Weight loss Numbness Darkened skin Individuals with RAS may also suffer from symptoms of hypertension which may include headaches, dizziness, and fatigue. High blood pressure caused by renal artery stenosis is commonly referred to as renal vascular hypertension. Diagnosis Of RAS RAS may be diagnosed through a physical examination and a review of symptoms. Blood and urine tests may be performed to check cholesterol and creatinine levels and evaluate kidney function. Additional diagnostic tests may include: Ultrasound Catheter angiogram MRI scan CT scan Magnetic resonance arteriogram (MRA) RAS may be discovered when a person is being tested for other conditions, such as heart problems. RAS may be detected during a coronary angiogram, which is a test that is used to view blood flow through the heart. Treatment Of RAS RAS may initially be treated with conservative methods to improve blood pressure and relieve the narrowing in the renal arteries. These methods may include lifestyle changes such as stopping smoking, eating a healthy diet and exercise. Medication to control blood pressure and cholesterol-lowering medication to prevent plaque from building up in the arteries, may also be prescribed. If conservative methods are not effective, surgical treatment may include: Renal artery bypass Renal angioplasty and stenting Renal endarterectomy Left untreated, RAS may lead to serious conditions including chronic kidney disease,coronary artery disease,peripheral vascular disease and stroke.

• Pacemaker

  A cardiac pacemaker is a device that is implanted under the skin to help control an individual’s heart beat. This device is often used in people who have an arrhythmia, or abnormal heart beat, or in people whose heart beats too fast or too slow. A cardiac pacemaker sends signals to the heart that help it to beat at the correct and healthy pace. A cardiac pacemaker helps to track the heartbeat and maintain an adequate heart beat frequency to allow oxygen and nutrients to flow through the body. Candidates For A Pacemaker The heart pumps blood through the body in a continuous cycle through a steady heartbeat. The heart rate is controlled by signals sent from the body’s natural pacemaker, called the sinoatrial (SA) node. These signals change as the body goes from rest to physical activity or an excited state. When the heart does not beat properly, it can reduce the amount of blood and oxygen that is pumped through the body, and to the brain and other organs, resulting in symptoms that may include lightheadedness, fatigue, fainting, and shortness of breath. An implanted electronic cardiac pacemaker mimics the action of the natural pacemaker within the body. A cardiac pacemaker is a small, battery-operated device that is implanted under the skin, below the left collarbone, to help maintain a regular heartbeat. The pacemaker sends electronic signals to the heart to help it pump properly when needed. Types of cardiac pacemakers include: Single-chamber pacemakers Dual-chamber pacemakers Biventricular pacemakers The Pacemaker Implantation Procedure A cardiac pacemaker is surgically implanted by a doctor. The pacemaker usually has two parts: the pulse generator and the leads. The pulse generator contains the battery and the information to control the heartbeat, and the leads are the wires that connect the heart to the generator and transfer the electrical messages to the heart. Complications Of Pacemaker Implantation Although rare, complications of a cardiac pacemaker implant may include infection, bleeding or puncture of the heart or lung. Results Of Pacemaker Implantation A cardiac pacemaker is an effective device for controlling and regulating heart rate. A pacemaker battery lasts an average of 7 to 10 years and should be checked regularly and replaced by a doctor when necessary.

• IVC Filters

  Inferior Vena Cava Filter An inferior vena cava (IVC) filter , is a vascular filter that is inserted through a small incision into the main vein in the abdomen. This vein in the abdomen is called the inferior vena cava. The filter prevents blood clots from breaking loose in leg veins and lodging in the lung. The IVC filter is typically implanted permanently in those patients with a high risk of pulmonary embolism.

• Cardiac Ablations

  Cardiac Ablations Cardiac ablation is a procedure performed to treat arrhythmia, an abnormal heart rhythm. The cardiac ablation procedure uses small wires called electrodes, that are placed inside the heart to measure electrical activity. Cardiac ablation helps to prevent abnormal electrical signals from traveling through the heart, which can stop an arrhythmia. These electrodes may also be used to scar or destroy tissue in the heart that triggers an abnormal heart rhythm. Cardiac ablation is often used to treat certain heart rhythm problems that have not responded to medication or other forms of treatment. Cardiac Ablation Procedure Before the cardiac ablation procedure begins, an intravenous line with a sedating solution is inserted into the arm. Parts of the groin, arm, or neck will be numbed and a needle will be used to open the skin to reach the blood vessel behind it. A thin tube, known as a sheath, is then placed into this opening. A long, thin flexible tube called an ablation catheter is inserted into the blood vessel in the groin using a guide wire. A special dye is then injected into the catheter to display the inside of the heart on a series of X-rays, known as angiograms. The ablation catheter uses electrodes to detect an arrhythmia, and emits radiofrequency energy to destroy portions of the heart tissue that cause the irregular heart rhythm. Patients are usually asleep during the procedure. If patients remain awake, they may experience slight chest discomfort from the radiofrequency energy and a burning sensation where the catheter is inserted. When the procedure is completes, the ablation catheter, guide wire, and sheath are removed, and the blood vessel is closed up and bandaged. Recovery From Cardiac Ablation Immediately after the cardiac ablation, the patient is moved to a recovery area, where they will be monitored for several hours. While most patients go home the same day as their procedure, in some cases, an overnight hospital stay may be required. Patients may experience soreness or bruising at the site where the catheter was inserted. Regular activities can usually be resumed within a few days. Risks Of Cardiac Ablation While complications are rare, there are certain risks associated with cardiac ablation. Risks include: Blood clots Bleeding Infection where the catheter was inserted Blood vessel damage Kidney damage Puncture of the heart Damage to the heart’s electrical system that requires a pacemaker The risk of complications is higher in patients over the age of 75, as well as in individuals with diabetes or kidney disease. Cardiac ablation is considered an effective form of treatment for heart arrhythmia, however, some patients may need to have the procedure repeated.

• Sclerotherapy

  Sclerotherapy is a minimally invasive medical procedure used to treat varicose and spider veins, most commonly found on the legs, by collapsing them through the use of a solvent. Sclerotherapy has been used on patients since the 1930s with great success, producing increasingly effective medical, as well as cosmetic, results. Reasons For Sclerotherapy Some of the reasons a patient may desire, or a physician may recommend, sclerotherapy may include one or more of the following symptoms: Pain, aching or burning sensations in the legs or feet Swelling or redness at the site Cramping of the legs, especially at night Scaly, dry or discolored skin at the site Discomfort after sitting or standing for long periods Individuals troubled by varicose veins may choose, in consultation with their physician, to undergo sclerotherapy either because they find them unattractive or because the diseased veins are causing unpleasant and/or dangerous symptoms. The Sclerotherapy Procedure During sclerotherapy, a solution of saline and a sclerosant is injected into the damaged veins. This will cause irritation in the affected veins and produce their eventual collapse. During this procedure, the surgeon is guided through the use of ultrasound to ensure precision. When the weakened veins collapse, they will be reabsorbed into the body and other healthier veins will take their place in the circulatory system. Sclerotherapy has proven to be a safe procedure and is performed outpatient in the doctor’s office. Typically, sclerotherapy is performed in less than an hour, although a varying number of injections may be required, depending on the number of veins involved. Patients do not require an anesthetic and usually report little or no discomfort during the procedure, only a mild burning sensation. In some instances, several sclerotherapy treatments may be necessary. Risks Of Sclerotherapy Although sclerotherapy is a safe procedure that has been successfully performed for many years, there are certain risks associated with any medical procedure. Certain minimal, temporary side effects are to be expected, including bruising and discoloration. More serious complications are rare, but may include: Inflammation Swelling, warmth and discomfort around the injection site may indicate the presence of an infection for which the doctor may prescribe antibiotics. Blood Clot A lump of clotted blood may form in a treated vein and require drainage. Rarely, a deeper blood clot may develop, known as a deep vein thrombosis. Since there is danger that such a clot will break off and travel to the chest, resulting in a pulmonary embolism, such a clot requires urgent medical attention. Sudden shortness of breath, chest pain, dizziness or the coughing up of foamy blood are signs of pulmonary embolism and must be addressed immediately. Air Bubbles Tiny air bubbles may rise in the bloodstream. These may not result in any symptoms, but if the patient experiences visual disturbances, headache, coughing or nausea, the physician should be contacted. Nerve Damage Numbness or odd sensations in the affected limb following sclerotherapy should always be investigated. While rare, it’s possible for a patient to have a severe allergic reaction to the sclerosant used in the treatment. Recovery From Sclerotherapy Patients are able to return home shortly after sclerotherapy. Most can return to work and resume normal activities the next day, although exercise and strenuous activities are to be avoided a week or two. Compression bandages usually need to be worn for a week or so after the procedure. While it may take up to a month for the patient to see full results, some improvement is usually visible immediately. In order to promote vascular health and to preserve the positive effects of the sclerotherapy, it is recommended that patients maintain a healthy weight and make exercise part of their daily routine.

• Ambulatory Phlebectomy

  An ambulatory phlebectomy, also called a microphlebectomy or stab phlebectomy, is an outpatient procedure performed to remove spider and varicose veins through small, slit-like incisions in the skin. When varicose veins near the surface of the skin are too large to treat with sclerotherapy and too small to treat with laser ablation, microphlebectomy is the preferred treatment. Since veins are extremely collapsible, even the largest affected veins can often be removed through tiny incisions using the ambulatory phlebectomy procedure. This minimally invasive treatment does not require sutures or general anesthesia and can easily be performed in the doctor’s office with minimal downtime. Ambulatory phlebectomy involves less pain and fewer risks than traditional surgical treatment. Reasons For Ambulatory Phlebectomy Some patients seek treatment for their varicose veins for cosmetic purposes, while others are concerned about the potential risks of their damaged veins. Untreated veins can lead to pain, inflammation and discoloration. They can also affect the flow of oxygen-depleted blood between the lower legs and the heart. Ambulatory phlebectomy treats symptomatic and asymptomatic veins and can relieve both cosmetic and medical concerns in one simple procedure. After damaged veins have been removed, other healthy veins in the leg will absorb the excess blood and reinstate a normal blood flow. Functioning will not be affected by removing the damaged veins, as there are many surrounding veins to take over. Ambulatory Phlebectomy Procedure The ambulatory phlebectomy procedure is performed on an outpatient basis. This procedure takes about 45 to 60 minutes to perform. The doctor will first identify the veins to be treated to ensure precise removal and to help preserve the health of surrounding veins and tissue. Before beginning the surgery, the doctor will inject a local anesthetic into the skin. Patients generally do not experience any discomfort during the procedure. Tiny incisions will be made in the targeted areas, and a surgical hook will be inserted to extract the damaged veins section by section. The incisions are very small and frequently no stitches are required. Veins are very collapsible such that even large veins may be removed through the tiny incisions used in this technique. The patient will be required to wear compression bandages for a week after surgery to help minimize swelling and discomfort. Risks Of Ambulatory Phlebectomy Patients who are allergic to local anesthesia or those who cannot wear compression stockings should not undergo the ambulatory phlebectomy procedure. Any active infections or rashes should be thoroughly treated before this procedure as well.. Although an ambulatory phlebectomy is considered quite safe, there are certain risks associated with any surgical procedure. In a few cases, there may be residual inflammation and irritation resulting from an incomplete removal of damaged veins. Other risks may include: A nerve injury to the skin Adverse reaction to anesthetic or sedative Severe bleeding or swelling Numbness or pain in the feet Post-surgical infection Thrombophlebitis Recovery From Ambulatory Phlebectomy Some bruising, discomfort and swelling are to be expected after an ambulatory phlebectomy. Swelling and pain can be minimized with compression garments and over-the-counter pain medications, and are usually only temporary. Patients will be able to walk and carry on with normal activities immediately after the ambulatory phlebectomy procedure, though they will have to wear compression stockings for the first week. They can usually return to work the next day, although exercise and heavy lifting should be avoided for about two weeks. The incisions from this procedure do not require sutures and are able to heal on their own, and are often barely visible after six to twelve months. Some patients may experience mild skin pigmentation at the site of the varicose vein, but this usually goes away on its own after a short time. Most people see effective results from an ambulatory phlebectomy since damaged veins have been completed removed. Ambulatory phlebectomy offers permanent effective results for most patients, although it is possible for new varicose veins to develop, particularly in patients with a family history of varicose veins. The risk of recurrence can be minimized if the patient maintains a proper weight and an active lifestyle.