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:
Also known as cardiac ultrasonography, echocardiography is a valuable, non-invasive tool for imaging the condition of your heart. Using a non-toxic 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 an ultrasound of the heart, both before and after treadmill exercise, to evaluate muscle function, valve function and chamber dimensions and to 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.
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
CT Angiogram in NYC-imageThis 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 and if you 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.
In addition, CT angiograms provide direct visualization of the carotid arteries (which supply blood to the head, neck and brain), renal arteries, other gastrointestinal arteries and arteries of the legs and feet. This comprehensive assessment is used to visualize every artery of the body. For more information, visit www.imagingheart.com.
Dietary Lifestyle And Cholesterol
The dietary lifestyle changes address many diseases, especially in the way the disease is expressed. Cholesterol is a crucial element in the body and is totally necessary for hormone balance and cellular function. There are two types of LDL: Bad, Bad LDL and Bad, Good LDL. The bad, bad LDL are small/dense particles, which stick to the inner arterial wall and cause cardiovascular disease. This is Pattern B LDL. The bad, good LDL are large, fluffy particles that do not stick to the inner arterial wall. This is Pattern A LDL, which is not associated with cardiovascular disease. The good cholesterol (HDL) also has two subtypes. The good, good HDL is the large, most protective particle for the heart (HDL-2) whereas the good, bad HDL is the small, least protective particle for the heart (HDL-3). The best pattern is bad, good LDL and good, good HDL. The brain contains the highest percentage of cholesterol as nerve cells require cholesterol to form connections, which means blocking cholesterol has more side effects than just the elevation in liver enzymes and muscle aches.
- Levels must be drawn after a 12 hour fast.
- Levels will be elevated in those with a under-active thyroid.
- Diuretic use can elevate cholesterol levels.
- HDL (Good) cholesterol can vary by as much as 40% within a individual
- Other factors affecting results include stress, seasonal and illnesses
82% of people who die from heart disease are older than 65. Gender, family history, obesity, poor dietary lifestyle, lack of exercise, smoking and diabetes are important risk factors. This is why the dietary lifestyle is so important in every disease.
These are the drugs that lower cholesterol but if it blocks the enzyme to produce cholesterol, then it is also compromising the other derivative hormones that cholesterol makes. For example, testosterone, the body’s natural steroids, and female hormones will not be made if we are blocking the cholesterol pathway. Also, all clinical trials do not pay attention to this fact and are only concerned that the numbers go down. Two years later, the enhance trial proved there was no change in mortality due to these drugs. A better study showed the effects of statins versus exercise and dietary lifestyle. The statin group did lower cholesterol significantly more than the exercise/diet group. However, there was the same rates of death and heart disease in both groups.
Statins do cause muscle weakness called statin myopathy, where muscles and legs feel weak. This is reversible with the supplement CoEnzyme Q 10, other mitochondial supplements and plant botanical. One must be careful when a doctor prescribes a statin drug with another lipid-lowering drug such as a fibrate. It is good that both of these drugs alter fats in different ways but both can seriously effect the kidneys, which is called rhabdomyolysis.
It has been postulated and shown that statin drugs stimulate the growth of new bloods, which could be a risk of an increase in cancer. Another less known side effect is that statins reduce cognitive function of the brain. A study of 283 individuals were either given placebo or a low dose statin. The statin group was associated with minor changes in memory, performance of testing and overall mental efficacy.