Comprehensive Cardiovascular Consultation

This includes a face to face discussion with the doctor, who obtains a detail history including family, social, past, surgical, dietary, physical activity history. It may also include going and interpretation of relevant past and recent testing. It also involves a physical examination and suggestion of necessary testing. It is an opportunity to discuss or diagnosis cardiac problems, or risk of developing cardiac problems, understanding risks and complications, and role of therapies, procedures, medications and adoption of healthy lifestyle to improve and maintain health. It involves a global approach.

Telemedicine Consultations, Visits and 2nd opinions

Telemedicine (also referred to as “telehealth" or “e-health") allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology. All the patient needs is a smart phone, laptop or computer with camera and microphone. This method of communication, has been extremely useful in taking care of patients during this COVID-10 pandemic, when social distancing is being practiced.

Clinical Laboratory Testing (blood, urine & stool for occult blood), & now testing COVID-19 antibodies (IgM & IgG)

Our in-house labs can perform routine tests such as complete blood count, sedimentation rate, basic metabolic panels, liver, kidney and thyroid function tests, certain other hormone assays (menopausal panels, Testosterone, Insulin, Cortisol etc), Vitamins B12 and D hydroxy, PSA, uric acid, magnesium, iron, ferritin etc. We can perform stat troponin and CPK-mb; these tests help detect cardiac muscle injury infarction (heart attack, myocarditis, COVID affecting heart muscle), thus helping to triage a patient immediately; during this current COVID-19 pandemic, we are now able to test for antibodies (IgM recent or current disease) and IgG (past disease).

Electrocardiography (EKG)

An electrocardiogram (abbreviated as EKG or ECG) measures the electrical activity of the heartbeat. It gives two major kinds of information. First, by measuring time intervals on the ECG, one can determine if the electrical activity is normal or slow, fast or irregular (eg. Tachycardia, bradycardia, heart block, atrial fibrillation etc). Second, by measuring the amount of electrical activity passing through the heart muscle, one can determine if the heart is enlarged, overworked, injured or damaged etc). One may have silent or symptomless abnormalities hence ECGs might be quite helpful; See examples of normal and abnormal ECGs below

Ziopatch placement for outpatient rhythm monitoring

The Zio patch is a 2-by-5-inch adhesive single lead ECG monitor, worn much like a bandage, on the upper left side of the chest for up to 14 days. It’s water resistant and can be kept on around the clock while a person sleeps, exercises, or takes a shower. It continuously monitors heart rhythms, storing EKG data for later analysis. It is indicated for use on patients who may be asymptomatic or who may suffer from transient symptoms such as palpitations, shortness of breath, dizziness, lightheadedness, fainting, unexplained fatigue, or anxiety.”

Kardia(AliveCor)/IWatch rhythm Interpretation

KardiaMobile and IWatch both capture a medical-grade EKG in 30 seconds. This information helps detect atrial fibrillation, bradycardia (slow heart rates), tachycardia (rapid heart rates) or confirm normal heart rhythm. The ECGs can be stored on the phone, and emailed to your doctor with the press of a button. These gadgets are now extremely useful to evaluate QTc in COVID-19 patients who are receiving QTc prolonging medication, including Hydroxychloroquine and Azithromycin, both in-hospital or at hom

Stress Testing with ECG, Echo and Nuclear Isotopes

A stress test, also known as an exercise test or treadmill test, is used to find out how well a patient’s heart works during physical activity, or to help advise patients on the best type of physical activity for them. A stress test typically
involves walking on a treadmill or riding a stationary bicycle and the blood pressure, and heart rhythm are monitored. In patients with pacemakers, or who cannot exercise due to a physical limitation or a drug given intravenously may be used
instead.

A stress test is indicated for a patient to assess if he/she has:

• has heart-related symptoms, such as difficulty breathing or chest pain
• is suitable for an exercise program or cardiac rehabilitation program, and if so, how hard they should exercise
• is responding to heart treatment
• needs other tests to detect narrowed arteries, such as a coronary angiogram
• has an irregular heartbeat or abnormal heart rhythm.

Since an ECG stress test may be less sensitive and specific, it may be combined with an imaging modality such as echocardiography or injection of an isotope dye, in which case the images are captured by SPECT (single photon emission computer
tomography or cardiac PET (positron emission tomography). Images are typically taken at pre-exercise and peak exercise, thus assess blood flow or cardiac performance at rest and stress;

Echocardiography

Echocardiography uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart. This technique has become routine in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases. Information on the size and shape of the heart (internal chamber size quantification), pumping capacity, and the location and extent of any tissue damage can be obtained. It also gives us approximates pressures within the cardiac cavities and valve function.

Movie of fluid around the heart

Movie of weakened heart muscle (Cardiomyopathy)

Carotid duplex and carotid intima media thickness studies

A carotid duplex scan combines two types of ultrasound to look for plaque causing narrowing in your carotid arteries, increasing the risk of stroke. The carotid arteries are located along both sides of your neck and supply blood to the brain.
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.

Symptoms of carotid artery disease

• sudden weakness or numbness in the face, arms, or legs (usually on one side of the body)
• trouble speaking (garbled speech) or understanding
• sudden vision problems in one or both eyes
• dizziness
• sudden, severe headache.
• drooping on one side of your face

Carotid IMT (Intima-media thickness)

An increase in the common carotid artery intima-media thickness (CCA-IMT) is generally considered an early marker of atherosclerosis. Early detection may indicate the need for a more aggressive approach to managing the risk factors associated with heart disease and stroke. Aging is a contributing factor to increased carotid intima-media thickness. Other risk factors include high lipoprotein levels, high blood pressure, smoking, diabetes, obesity and a sedentary lifestyle.

Abdominal Aorta Aneurysm screening

Abdominal aortic aneurysms (AAAs) have no or few symptoms until a possible rupture. In rupture, the mortality rate is 65% to 85%. Risk factors for developing an AAA were increasing age, male sex, smoking, high serum total cholesterol, low serum high-density lipoprotein cholesterol, and hypertension.

Bone Density (DEXA) and Body Composition Scans

A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of bones and the chance of a fracture. It estimates the amount of bone in your hip, spine and sometimes other bones.

Our machine also performs the Whole Body Composition, or DEXA scan, providing an accurate, in-depth body composition analysis of your fat, muscle, bone and water mass (modern assessment of health). This can be used to identify health risks and pinpoint problems in the body before they occur. BMI and weight cannot differentiate between muscle and fat.

Digital chest x-rays and total body x-rays read by radiologists

A simple chest x-ray at the office is often very diagnostic (images heart, lungs and bones). Below are a few examples of diagnoses made just based on a chest x-ray.