Diagnosis of Cardiovascular Diseases Center in NYC

DIAGNOSIS OF CARDIOVASCULAR DISEASE

Dr. Fratellone will determine which tests are necessary to diagnose coronary artery disease or other cardiovascular conditions. Most of these tests are performed in our offices. Among the non-invasive procedures are:

Echocardiography
Also known as cardiac ultrasonography, echocardiography is a valuable non-invasive tool for imaging the condition of your heart. Using a nontoxic gel applied to your chest with an ultrasound probe. This procedure evaluates muscle function, valve function and chamber dimensions. Echocardiography is used to diagnose:

•   Valve diseases-leaky (regurgitant) or tight (stenotic) valves
•   Pericardial disease-fluid in the sac surrounding the heart
•   Coronary artery disease-blockage of the vessels leading to the heart, impairing wall motion of the anterior, inferior, septal and lateral walls of the heart
•   Cardiomyopathy- enlargement of the heart and weakening of heart muscle function, called the ejection fraction.

We provide two kinds of echocardiography:

•  Transthoracic echocardiogram is a probe on the chest wall performed while you are in a resting state.

•  Stress echocardiography is ultrasound of the heart both before and after treadmill exercise to evaluate muscle function, valve function and chamber dimensions and ascertain the extent of coronary artery disease. By combining treadmill exercise with ultrasound of the heart, we can determine which wall of the heart is not receiving enough oxygen. First you lie on your back while four images of your heart are taken. Then, after you exercise to 85 percent of your maximal heart rate on a treadmill, four more images will be made. Both sets of images are compared to determine if areas of the heart are not receiving enough oxygen. Throughout the test, your heart rate and blood pressure are recorded

Carotid Sonography

Also known as carotid ultrasound, this test is used to evaluate the carotid arteries, which supply blood to the head, neck and brain. Using a non-toxic gel applied to your neck with an ultrasound probe, we can evaluate thickening and blockage of the left and right carotid arteries. By evaluating these structures, we can determine a patient's risk factor for a stroke or a mini-stroke.

	24-Hour Electrocardiographic Monitoring This noninvasive and painless procedure records the electrical signals of the heart over a 24-hour period. The 24-hour electrocardiogram (EKG) is often called a Holter monitor. A set of lead wires is attached to your chest with a miniature electronic tape recorder. There are no restrictions to your physical activity during this time. At the end of the 24-hour period, you return the recording device with the diskette to the office, where the diskette is computer scanned. The results determine: •   Your lowest heart pulse rate; •   Your highest heart pulse rate; •   Your average heart pulse rate; •   Any Arrhythmias
Patient during 24-Hour Electrocardiographic Monitoring

 Electron Beam Computerized Tomography of the Heart

Electron beam computerized tomography (EBCT) is also called ultrafast CT of the heart, the calcium score or the heart scan. Better than a mechanical CAT scan and more accurate than an MRI (magnetic resonance imaging) for heart scans, this noninvasive and painless procedure employs the most advanced technology. It can take images of your moving heart without blurring the image.

The EBCT creates a three-dimensional image of your heart to show the anatomy of the blood flow in the coronary arteries (which supply the heart muscle) and the degree of calcified plaque build-up causing blockage. The information from this procedure, along with other tests such as stress tests, allows us to design a completely individualized treatment plan.

When recommended by Dr. Fratellone, this test is performed at an affiliated imaging center in New York City.

CT Angiogram with Calcium Scores

This non-invasive angiogram is much like any other CT (computerized tomography) scan. A standard intravenous contrast fluid is injected into a vein while the donut-shaped scanner takes cross-sectional pictures of your heart. Unlike invasive angiograms, no catheters are inserted and passed into the coronary arteries.

You will be asked to take two breaths and hold them for 15 seconds each. The entire procedure lasts approximately 15 minutes. No sedation is required; however, if your pulse rate (heart rate) is greater than 90, intravenous medication may be used to lower it. We will ask you if you have any known allergies to shellfish or, iodine or have had previous contrast studies. Also, any patients with diabetes and renal failure will be asked to have a blood test for kidney function (called BUN and creatinine) prior to the exam.

The CT angiogram provides direct visualization of the aorta, pulmonary arteries, coronary arteries and other major vessels. This information provides us with the vessel diameter, an assessment of vessel disease, whether the plaque is hard or soft as well as its shape and the amount of calcium in each coronary artery.  It also can tell us if any stents or bypass grafts are open.