'interventional work'

An electrocardiogram — abbreviated as EKG or ECG — is a test that measures the electrical activity of the heartbeat. With each beat, an electrical impulse (or “wave”) travels through the heart. This wave causes the muscle to squeeze and pump blood from the heart. A normal heartbeat on ECG will show the timing of the top and lower chambers. The right and left atria or upper chambers make the first wave called a “P wave” — following a flat line when the electrical impulse goes to the bottom chambers. The right and left bottom chambers or ventricles make the next wave called a “QRS complex.” The final wave or “T wave” represents electrical recovery or return to a resting state for the ventricles. Why is it done? An ECG gives two major kinds of information. First, by measuring time intervals on the ECG, a doctor can determine how long the electrical wave takes to pass through the heart. Finding out how long a wave takes to travel from one part of the heart to the next shows if the electrical activity is normal or slow, fast or irregular. Second, by measuring the amount of electrical activity passing through the heart muscle, a cardiologist may be able to find out if parts of the heart are too large or are overworked. Why would I have this test? An ECG is one of the most common heart tests. It is the only way of uncovering certain problems with the heart’s electrical impulses. There are a number of reasons why someone may have an ECG, including an irregular heartbeat, shortness of breath when they exert themselves, significantly high blood pressure, palpitations or a suspected heart valve problem. It can also be a useful way of ruling out problems. If your doctor recommends an ECG, think of it as a basic investigation. What does the test involve? The ECG is a simple test, with 10 electrodes used to record 12 different views of your heart’s electrical activity. You don’t need to do anything to prepare for it. An electrode is attached to each ankle and wrist with sticky pads and six more are attached to the chest. The patient lies almost flat with the head and chest raised a little. Relaxing for a few minutes before the recording is made is important, as this allows the electrode connections to stabilise and means the ECG will be more reliable. During this time, your details can be recorded on the ECG machine. Will it hurt? No. There’s no pain or risk associated with having an electrocardiogram. When the ECG stickers are removed, there may be some minor discomfort. Are there any after effects? Very rarely someone may have a slight skin reaction to the electrodes, but normally there are no after effects. What will it tell my doctor? An abnormal ECG can tell your doctor if you have any of these issues: irregular heartbeat (an arrhythmia) problems with the spread of electrical activity within the heart an enlarged heart areas of the heart with reduced blood supply a ‘silent’ heart attack (an interruption to blood flow in the coronary arteries without usual heart attack symptoms). In an acute emergency, the ECG can help your doctor treat you. For example, the electrical source of a high heart rate may be located, which will determine appropriate treatment.

What are electrophysiology studies? Electrophysiology studies (EPS) are tests that help doctors understand the nature of abnormal heart rhythms (arrhythmias). Quick facts Electrophysiology studies test the electrical activity of your heart to find where an arrhythmia (abnormal heartbeat) is coming from. These results can help you and your doctor decide whether you need medicine, a pacemaker, an implantable cardioverter defibrillator (ICD), cardiac ablation or surgery. These studies take place in a special room called an electrophysiology (EP) lab or catheterization (cath) lab while you are mildly sedated. Why do people have electrophysiology studies? When someone’s heart doesn’t beat normally, doctors use EPS to find out why. Electrical signals usually travel through the heart in a regular pattern. Heart attacks, aging and high blood pressure may cause scarring of the heart. This may cause the heart to beat in an irregular (uneven) pattern. Extra abnormal electrical pathways found in certain congenital heart defects can also cause arrhythmias. During EPS, doctors insert a thin tube called a catheter into a blood vessel that leads to your heart. A specialized electrode catheter designed for EP studies lets them send electrical signals to your heart and record its electrical activity. Doctors use EPS to see: Where an arrhythmia is coming from. How well certain medicines work to treat your arrhythmia. If they should treat a problem by destroying the place inside your heart that is causing the abnormal electrical signal. This procedure is called catheter ablation. If a pacemaker or implantable cardioverter defibrillator (ICD) might help you. If you are at risk for heart problems such as fainting or sudden cardiac death due to cardiac arrest (when your heart stops beating). During an EPS, about 3 to 5 electrically sensitive catheters are placed inside the heart to record electrical activity. What are the risks of EPS? Risks may include: Arrhythmia. During EPS you may have abnormal heart rhythms that make you dizzy. If this happens, your doctor may give your heart an electric shock to bring back a regular heartbeat. Blood clots sometimes can form at the tip of the catheter, break off and block a blood vessel. Your doctor may give you medicine to prevent blood clots. Infection, bleeding and bruising at the site where the catheter went in (groin, arm or neck). Your doctor or nurse will help you avoid these problems. How do I prepare for EPS? Don’t eat or drink anything for 6 to 8 hours before the test. Tell your doctor about any medicines you take, including over-the-counter medicines, herbs and vitamins. He or she may ask you not to take them before EPS. Don’t stop taking your medicine until your doctor tells you to. Have someone drive you to your appointment and take you home. If you usually wear a hearing aid, wear it during your procedure. If you wear glasses, bring them to your appointment. What happens during EPS? At a hospital or clinic, doctors and nurses do EPS in a room that has special equipment for the tests. You may hear this room called the electrophysiology laboratory, or EP lab. Some call it the catheterization laboratory (cath lab). During the test: A nurse will put an IV (intravenous line) in your arm. You’ll get medicine (a sedative) that will help you relax. But you’ll be awake and able to follow instructions during the test. Your nurse will clean and shave the part of your body where the doctor will be working. This is usually in the groin but may be the arm or neck. You’ll be given a shot – a local anesthetic will be given — to make the area numb. Your doctor will make a needle puncture through your skin and into your blood vessel. A small straw-sized tube called a sheath will be inserted into your artery or vein. The doctor will gently guide several specialized EP catheters into your blood vessel through the sheath and advance them to your heart. A video screen will show the position of the catheters. You may feel some pressure in the area where the sheath was inserted, but you shouldn’t feel any pain. Your doctor will send small electric pulses through the catheters to make your heart beat at different speeds. You may feel your heart beat stronger or faster. Electrical signals produced by your heart will be picked up by the special catheters and recorded. This is called cardiac mapping and allows the doctor to locate where arrhythmias are coming from, Your doctor will remove the catheters and the IV line. Your nurse will put pressure on the puncture site to stop any bleeding. EPS usually last 1 to 4 hours. If the type and location of the arrhythmia is identified and an appropriate therapy decided, cardiac ablation or insertion of a pacemaker or ICD may be performed during or immediately after the EPS. “I could feel my heart speeding up, which was weird. But it didn’t hurt. It was more like hiking up and down hills really fast.” Esmerelda, age 38 What happens after EPS? You’ll be moved to a recovery room where you should rest quietly for 1 to 3 hours. During this time: Stay still as long as your nurse tells you to. Be sure to keep the arm or leg used for the test straight. Your nurse will check on you often to see if there is bleeding or swelling at the puncture site. After the sedative wears off, your doctor will talk to you about your test results. Before you leave, you’ll be told what to do at home. What happens after I get home? Follow the instructions your nurse or doctor gave you, including taking any new medicines that were prescribed. Most people can start eating food and taking their medicines within 4 to 6 hours after the test. Most can do their usual daily activities the day after the test. Don’t drive for at least 24 hours. The puncture site may be sore for several days. A small bruise at the puncture site is normal. If the site starts to bleed, lie flat and press firmly on top of it. Have someone call the doctor or EP lab. What should I watch for? Call 9-1-1 if you notice: A sudden increase in swelling around the puncture site. Bleeding doesn’t slow down when you press hard on the site. Call your doctor right away if you notice: Your arm or leg that was used for the sheath feels numb or tingles. Your hand or foot feels very cold or changes color. The puncture site looks more and more bruised. The puncture site begins to swell or fluids begin to come from it. How do I learn the results of my EPS? Most of the time, doctors will ask you to make an appointment to discuss the results of your test. You’ll discuss your treatment at that appointment. How can I learn more about EPS? Talk with your doctor. Here are some good questions to ask: Are there medicines that I can use to control my abnormal heartbeats? Will I need a pacemaker or implantable cardioverter defibrillator (ICD) now or in the future? What caused my irregular heartbeat? Am I at risk of serious heart rhythm problems in the future?

Who Needs a Pacemaker? Doctors recommend pacemakers for many reasons. The most common reasons are bradycardia and heart block. Bradycardia is a heartbeat that is slower than normal. Heart block is a disorder that occurs if an electrical signal is slowed or disrupted as it moves through the heart. Heart block can happen as a result of aging, damage to the heart from a heart attack, or other conditions that disrupt the heart’s electrical activity. Some nerve and muscle disorders also can cause heart block, including muscular dystrophy. Your doctor also may recommend a pacemaker if: Aging or heart disease damages your sinus node’s ability to set the correct pace for your heartbeat. Such damage can cause slower than normal heartbeats or long pauses between heartbeats. The damage also can cause your heart to switch between slow and fast rhythms. This condition is called sick sinus syndrome. You’ve had a medical procedure to treat an arrhythmia called atrial fibrillation. A pacemaker can help regulate your heartbeat after the procedure. You need to take certain heart medicines, such as beta blockers. These medicines can slow your heartbeat too much. You faint or have other symptoms of a slow heartbeat. For example, this may happen if the main artery in your neck that supplies your brain with blood is sensitive to pressure. Just quickly turning your neck can cause your heart to beat slower than normal. As a result, your brain might not get enough blood flow, causing you to feel faint or collapse. You have heart muscle problems that cause electrical signals to travel too slowly through your heart muscle. Your pacemaker may provide cardiac resynchronization therapy (CRT) for this problem. CRT devices coordinate electrical signaling between the heart’s lower chambers. You have long QT syndrome, which puts you at risk for dangerous arrhythmias. Doctors also may recommend pacemakers for people who have certain types of congenital heart disease or for people who have had heart transplants. Children, teens, and adults can use pacemakers. Before recommending a pacemaker, your doctor will consider any arrhythmia symptoms you have, such as dizziness, unexplained fainting, or shortness of breath. He or she also will consider whether you have a history of heart disease, what medicines you’re currently taking, and the results of heart tests. Diagnostic Tests Many tests are used to detect arrhythmias. You may have one or more of the following tests. EKG (Electrocardiogram) An EKG is a simple, painless test that detects and records the heart’s electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart. The test can help diagnose bradycardia and heart block (the most common reasons for needing a pacemaker). A standard EKG only records the heartbeat for a few seconds. It won’t detect arrhythmias that don’t happen during the test. To diagnose heart rhythm problems that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors. Holter and Event Monitors A Holter monitor records the heart’s electrical activity for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG. An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart’s electrical activity at certain times while you’re wearing it. For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms. You can wear an event monitor for weeks or until symptoms occur. Echocardiography Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves are working. Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren’t contracting normally, and injury to the heart muscle caused by poor blood flow. Electrophysiology Study For this test, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records the heart’s electrical signals. Your doctor uses the wire to electrically stimulate your heart. This allows him or her to see how your heart’s electrical system responds. This test helps pinpoint where the heart’s electrical system is damaged. Stress Test Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests, such as an EKG or echo, are done. If you can’t exercise, you may be given medicine to raise your heart rate.

Holter and Event Monitors Also known as ambulatory EKG; continuous EKG; EKG event monitors. Holter and event monitors are small, portable electrocardiogram devices that record your heart’s electrical activity for long periods of time while you do your normal activities. These monitors can record how fast your heart is beating, whether the rhythm of your heartbeats is steady or irregular, and the strength and timing of the electrical impulses passing through each part of your heart. Information from these recordings helps doctors diagnose an arrhythmia, or irregular heartbeat, and check whether treatments for the irregular heartbeat are working. There are many types of monitors, such as episodic monitors, autodetect recorders, 30-day event recorders, and transtelephonic event monitors. Your doctor will decide which monitor is best for you. Most monitors have electrodes with sticky adhesive patches that attach to the skin on your chest. Some monitors and electrodes used for long-term recording may be implanted under your skin to make it easier for you to bathe and perform your daily activities. Your doctor will explain how to wear and use the monitor and tell you whether you need to adjust your activity during the testing period. You should avoid magnets, metal detectors, microwave ovens, electric blankets, electric toothbrushes, and electric razors while using your monitor. Usually, you will be instructed to keep electronic devices such as cell phones, MP3 players, and tablets away from the monitor. After you are finished using the monitor, you will return it to your doctor’s office or the place where you picked it up. If you were using an implantable recorder, your doctor will remove it from your chest. There is a small risk that the sticky patches that attach the electrodes to your chest can irritate your skin. You may have an allergic reaction to the electrode adhesive, but the reaction will go away once the electrodes are removed. If you are using an implantable recorder, you may get an infection or have pain where the device was placed under your skin. Your doctor can prescribe medicine to treat these problems.

Varicose Veins usually announce themselves as bulging, bluish cords running just beneath the surface of your skin . They almost always affect legs and feet. Visible swollen and twisted veins — sometimes surrounded by patches of flooded capillaries known as spider veins — are considered superficial varicose veins . Although they can be painful and disfiguring, they are usually harmless. When inflamed, they become tender to the touch and can hinder circulation to the point of causing swollen ankles,itchy skin and aching in the affected limb. During a coronary angiogram, a type of dye that’s visible by an X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels. If necessary, your doctor can perform procedures such as an angioplasty during your coronary angiogram. What Causes Varicose Veins ? To help circulate oxygen-rich blood from the lungs to all parts of the body, your arteries have thick layers of muscle or elastic tissue. To push blood back to your heart, your veins rely mainly on surrounding muscles and a network of one-way valves. As blood flows through a vein, the cup-like valves alternately open to allow blood through, then close to prevent backflow. In varicose veins, the valves do not work properly — allowing blood to pool in the vein and making it difficult for the muscles to push the blood “uphill.” Instead of flowing from one valve to the next, the blood continues to pool in the vein, increasing venous pressure and the likelihood of congestion while causing the vein to bulge and twist. Because superficial veins have less muscle support than deep veins, they are more likely to become varicose. Most people feel fine a day or so after having the procedure, Any condition that puts excessive pressure on the legs or abdomen can lead to varicose veins. The most common pressur inducers are pregnancy, obesity and standing for long periods. Chronic Constipation and — in rare cases, tumors — also can cause varicose veins. Being sedentary also may contribute to varicosity, because muscles that are out of condition offer poor blood-pumping action.although you may feel a bit tired afterwards and the wound site is likely to be tender for up to a week. Any bruising may last for several weeks.

What Does Cardiac Rehab Involve? Cardiac rehab doesn’t change your past, but it can help you improve your heart’s future. It’s a medically supervised program designed to help improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery. Think of cardiac rehab as three equally important parts: Exercise counseling and training: Exercise gets your heart pumping and your entire cardiovascular system working. You’ll learn how to get your body moving in ways that promote heart health. Education for heart-healthy living: Managing your risk factors, choosing good nutrition, quitting smoking…education about heart-healthy living is a key element of cardiac rehab. Counseling to reduce stress: Stress hurts your heart. This part of rehab helps you identify and tackle everyday sources of stress. Cardiac Rehab is a Team Effort You don’t need to face heart disease alone. Cardiac rehab is a team effort. It’s a medically-supervised program in which you partner with your doctors, nurses, pharmacists — plus family and friends — to take charge of the choices, lifestyle and habits that affect your heart. What’s Next? You’re in the driver’s seat…but here’s what we suggest to get started: Ask your doctor if you are eligible for cardiac rehab. If you are eligible for cardiac rehab, register for a program. In consultation with your medical team, set some heart-health goals and create a cardiac rehab plan. Take an active role in your care to achieve your goals. Keep taking your medicines correctly.

Peripheral Vascular Disease

What is Cardiac Rehabilitation? What Does Cardiac Rehab Involve? Cardiac rehab doesn’t change your past, but it can help you improve your heart’s future. It’s a medically supervised program designed to help improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery. Think of cardiac rehab as three equally important parts: Exercise counseling and training: Exercise gets your heart pumping and your entire cardiovascular system working. You’ll learn how to get your body moving in ways that promote heart health. Education for heart-healthy living: Managing your risk factors, choosing good nutrition, quitting smoking…education about heart-healthy living is a key element of cardiac rehab. Counseling to reduce stress: Stress hurts your heart. This part of rehab helps you identify and tackle everyday sources of stress. Cardiac Rehab is a Team Effort You don’t need to face heart disease alone. Cardiac rehab is a team effort. It’s a medically-supervised program in which you partner with your doctors, nurses, pharmacists — plus family and friends — to take charge of the choices, lifestyle and habits that affect your heart. What’s Next? You’re in the driver’s seat…but here’s what we suggest to get started: Ask your doctor if you are eligible for cardiac rehab. If you are eligible for cardiac rehab, register for a program. In consultation with your medical team, set some heart-health goals and create a cardiac rehab plan. Take an active role in your care to achieve your goals. Keep taking your medicines correctly. Call 911 if you experience new or worsening symptoms.

What is Angiography ? A Coronary Angiogram is a procedure that uses X-ray imaging to see your heart’s blood vessels. Coronary angiograms are part of a general group of procedures known as heart catheterization.Heart catheterization procedures can both diagnose and treat heart and blood vessel conditions. A coronary angiogram, which can help diagnose heart conditions, is the most common type of heart catheterization procedure. During a coronary angiogram, a type of dye that’s visible by an X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels. If necessary, your doctor can perform procedures such as an angioplasty during your coronary angiogram. What happens during Coronary Angiography? During the procedure, a long, thin and flexible tube called a catheter is inserted into a blood vessel in your groin or arm. Using X-ray images as a guide, the tip of the catheter is passed up to the heart and coronary arteries.A special type of dye called contrast medium is injected into the catheter and X-ray images (angiograms) are taken.The contrast medium is visible on the angiograms, showing the blood vessels that the fluid travels through. This clearly highlights any blood vessels that are narrowed or blocked.The procedure is usually carried out under local anaesthetic, so you will be awake while the procedure is carried out, but the area where the catheter is inserted will be numbed. After Coronary Angiography ? You will usually be able to leave hospital on the same day you have a coronary angiography after a period of rest and observation. Most people feel fine a day or so after having the procedure, although you may feel a bit tired afterwards and the wound site is likely to be tender for up to a week. Any bruising may last for several weeks. You will usually be advised to avoid certain activities, such as bathing, driving and lifting heavy objects, for a day or two after the procedure.While you are recovering, it’s important to look out for signs of any problems. You should seek immediate medical attention if swelling at the site of your wound gets worse, or if you experience excessive bleeding or circulation problems in your limbs.