Overview of Services

The Heart Smart Group offers services to manage an entire spectrum of cardiac issues, ranging from preventative medicine and cholesterol management, to hospital-based care for acute and critical patients. Our in-office services include routine stress echocardiogram as well as state of the art nuclear cardiac imaging to detect coronary artery disease. We provide digital echocardiogram, digital Holter and event monitoring. We offer ECP treatment, which provides a noninvasive method of treating refractory heart failure and angina. More information about some of these services is listed in the Common Diagnostic Procedures section below.

We perform a wide spectrum of hospital-based procedures including angioplasty, stenting, arrhythmia, ablation, pacemaker, and defibrillator implantation, as well as cardiac resynchronization therapy.

The following list describes the categories of services offered and specific services or tests under each category. To learn general information about specific heart diseases and conditions, please visit the Patient Education page of this website.

Non-invasive Cardiology

  • Abdominal Aortic Ultrasounds
  • Carotid Ultrasounds
  • Digital 24-hour Holter Monitoring
  • Graded Exercise Testing
  • Echocardiography
  • Stress Echocardiography
  • Transesophageal Echocardiography
  • Pharmacologic Stress Imaging
  • Stress Testing with Nuclear Imaging (Thallium, Adenosine, Lexiscan®)
  • External Counter Pulsation (ECP)
  • CIMT (Carotid Intima-media Thickness Analysis)
  • Stress Testing, including Echo imaging, Nuclear imaging and PET imaging

Invasive Cardiology Services

  • Coronary Angiography
  • Cardiac Catheterization
  • Percutaneous Coronary Angioplasty
  • Coronary Stenting (including Drug Eluting Stent)
  • Radio Frequency Vein Ablation

Clinical Consultation

  • Comprehensive Cardiology Evaluation and Management
  • Preventative Cardiology Services
  • PADNET (Peripheral Vascular Screening)
  • Coumadin Management
  • Lipid (Cholesterol) Management 

Electrophysiology Services

  • Ablation of Arrhythmias, including Atrial Fibrillation
  • Arrhythmia Management
  • Invasive Electrophysiology Studies
  • Pacemaker Implantation and Management
  • Defibrillator Implantation and Management
  • Tilt Table Testing
  • Resynchronization Therapy

Common Diagnostic Procedures (Click on a title to reveal its description)

Cardiac catheterization is a minimally invasive procedure that is performed to examine blood flow to the heart and determine how well the heart is pumping. The exam assesses the heart’s arteries, valves, and contractility, as well as the pressures in the heart and lungs. Cardiac catheterization is most often used to evaluate chest pain. It may also be performed during a heart attack to identify narrowed or blocked coronary arteries. You also may need this procedure if other tests suggest you have coronary artery disease, congestive heart failure, or valvular heart disease.

During the procedure, a catheter is inserted into an artery in the arm or leg. Under x-ray guidance, the catheter is advanced into the chambers of the heart and the coronary arteries. X-ray dye is injected into the coronary arteries to determine whether there is a blockage and usually into the main pumping chamber of the heart to evaluate its function.

Coronary angioplasty, also called percutaneous coronary intervention (PCI), is a procedure used to open clogged heart arteries. Angioplasty involves temporarily inserting and inflating a tiny balloon within a blocked artery to help widen the artery. 

Balloon Angioplasty

Angioplasty is almost always combined with the permanent placement of a stent to help maintain long term patency of the diseased vessel. Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents).

Angioplasty can improve some of the symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty can also be used during a heart attack to quickly open a blocked artery, reduce the amount of damage to your heart and reduce the risk of death in some patients.

Heart scans, also known as coronary calcium scans, provide pictures of your heart’s arteries (coronary arteries). Heart scans are used to look for calcium deposits in the coronary arteries that can narrow your arteries and increase your heart attack risk. The result of this test is often called a coronary calcium score.

A computerized tomography (CT) coronary angiogram is an imaging test to look at the arteries that supply your heart muscle with blood. Additionally, this study can identify problems of the aorta, blood clot in the lungs, and pericardial disease. If you have known coronary artery disease, a traditional coronary angiogram may be a better option, since you can also receive treatment for your artery blockages during a traditional coronary angiogram.

A trans-thoracic echocardiogram (TTE) is a non-invasive exam that utilizes high frequency sound waves to produce two-dimensional images of your heart. This test provides information about the size and function of your heart and how well your heart’s chambers and valves are working. In addition, by using Doppler ultrasound, one can assess how well blood flows through the chambers and valves of your heart and also estimate pressures within the heart. With standard transthoracic echocardiography, it can be difficult to see the aorta, valves and certain other parts of your heart. It may be necessary to get a better look at these areas. In these cases, it may be recommended to perform a transesophageal echocardiography (TEE). This test is performed in a hospital under mild sedation and involves an ultrasound probe being inserted into your esophagus to get a more detailed image of your heart.

An electrocardiogram (EKG) is a non-invasive, painless test that detects and records the electrical activity of the heart. EKGs are used to evaluate signs and symptoms that could indicate heart problems. It takes only a few minutes to perform.

Stress testing provides information about how your heart works during physical stress. During a stress test, you exercise (walk or run on a treadmill). If you cannot exercise, special medications can be given instead. A stress test can reveal problems within your heart that might not be noticeable otherwise.

We offer three types of stress tests in our office:

Treadmill exercise stress test (TMET): An exercise stress test involves walking on a treadmill while your blood pressure, heart rate and rhythm and EKG are being continuously monitored.

Stress echocardiogram: A stress echocardiogram is a more specific test that is used to detect heart disease. The exam consists of three different tests: a resting echo, a stress test on a treadmill, and another echo immediately following exercise.

Stress echocardiogram: A stress echocardiogram is a more specific test that is used to detect heart disease. The exam consists of three different tests: a resting echo, a stress test on a treadmill, and another echo immediately following exercise.

Nuclear stress testing: Nuclear heart scans are used to provide information about the flow of blood throughout the heart muscle, check for damaged heart muscle, and see how well your heart pumps blood to your body. During a nuclear heart scan, a safe, radioactive material called a tracer is injected through a vein into your bloodstream. The tracer then travels to your heart. The tracer releases energy, which special cameras outside of your body detect. Typically, two sets of images of your heart are obtained— one set during an exercise stress test while you are exercising on a treadmill or with medication that stresses your heart, and another set while you are at rest.

You may be given a nuclear stress test to identify coronary artery disease or another heart problem or if an exercise stress test alone wasn’t enough to find the cause of symptoms such as chest pain or shortness of breath. A nuclear stress test may also be recommended in order to guide your treatment if you’ve already been diagnosed with coronary artery disease.

What Is Carotid Ultrasound?

Carotid ultrasound is a painless and harmless test that uses high-frequency sound waves to create pictures of the insides of your carotid arteries. Carotid ultrasound has no risks because the test uses harmless sound waves. They are the same type of sound waves that doctors use to record pictures of fetuses in pregnant women. 

You have two common carotid arteries, one on each side of your neck. They each divide into internal and external carotid arteries. The internal carotid arteries supply oxygen-rich blood to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp, and neck.

How is a Carotid Ultrasound Performed?

Carotid ultrasound usually is done in a doctor’s office or hospital and often doesn’t take more than 30 minutes.

The ultrasound machine includes a computer, a screen, and a transducer. The transducer is a hand-held device that sends and receives ultrasound waves.

You will lie on your back on an exam table for the test. Your technician or doctor will put gel on your neck where your carotid arteries are located. The gel helps the ultrasound waves reach the arteries.

Your technician or doctor will put the transducer against different spots on your neck and move it back and forth. The transducer gives off ultrasound waves and detects their echoes as they bounce off the artery walls and blood cells. Ultrasound waves can’t be heard by the human ear.

The computer uses the echoes to create and record pictures of the insides of the carotid arteries. These pictures usually appear in black and white. The screen displays these live images for your doctor to review. 

What are the Reasons for a Carotid Ultrasound?

Carotid ultrasound shows whether a waxy substance called plaque has built up in your carotid arteries. The buildup of plaque in the carotid arteries is called carotid artery disease.Over time, plaque can harden or rupture. Hardened plaque narrows the carotid arteries and reduces the flow of oxygen-rich blood to the brain. If the plaque ruptures, a blood clot can form on its surface. A clot can mostly or completely block blood flow through a carotid artery, which can cause a stroke. A piece of plaque or a blood clot also can break away from the wall of the carotid artery. The plaque or clot can travel through the bloodstream and get stuck in one of the brain’s smaller arteries. This can block blood flow in the artery and cause a stroke. 

What is a Doppler Ultrasound?

A standard carotid ultrasound shows the structure of your carotid arteries. Your carotid ultrasound test might include a Doppler ultrasound. Doppler ultrasound is a special test that shows the movement of blood through your blood vessels. Your doctor might need results from both types of ultrasound to fully assess whether you have a blood flow problem in your carotid arteries.

When is a Carotid Ultrasound Recommended?

Your doctor may recommend a carotid ultrasound if you:

• Had a stroke or mini-stroke recently. During a mini-stroke, you may have some or all of the symptoms of a stroke. However, the symptoms usually go away on their own within 24 hours.

• Have an abnormal sound called a carotid bruit (pronounced BROO-ee) in one of your carotid arteries. Your doctor can hear a carotid bruit using a stethoscope. A bruit might suggest a partial blockage in your carotid artery, which could lead to a stroke.

Your doctor also may recommend a carotid ultrasound if he or she thinks you have:

• Blood clots in one of your carotid arteries

• A split between the layers of your carotid artery wall. The split can weaken the wall or reduce blood flow to your brain.

A carotid ultrasound also might be done to see whether carotid artery surgery, also called carotid endarterectomy (END-ar-ter-EK-to-me), has restored normal blood flow through a carotid artery.

If you had a procedure called carotid stenting, your doctor might use carotid ultrasound afterward to check the position of the stent in your carotid artery. (The stent, a small mesh tube, supports the inner artery wall.)

Carotid ultrasound sometimes is used as a preventive screening test in people at increased risk of stroke, such as those who have high blood pressure and diabetes.