With early detection being such an integral part of helping patients reduce their risk for heart disease and stroke, the importance of the diagnostic procedures CANM’s skilled physicians and staff provide can’t be underestimated. Utilizing the latest in computer-assisted imaging technology, we perform a wide range of both invasive and noninvasive tests that serve to detect problems, determine the severity of a condition, inform the proper course of treatment, even assist in the execution of an interventional procedure.
The precise, proactive diagnosis of the underlying causes of heart disease can drastically improve a patient’s quality of life as well as their longevity. This is especially true in regard to individuals with genetic or inherited risk factors for heart disease, such as high cholesterol, that run in families but often present no outward or physical symptoms.
CANM diagnostic procedures are also employed in the ongoing care of patients either determined to be “at risk” or who have had a heart attack, heart surgery or other heart procedures. As part of a comprehensive program custom designed to expedite recovery and prevent future cardiac emergencies, CANM tests are essential in helping patients with complex heart disease risk factors.
For more information, visit the American Heart Association’s Website.
A quick and painless test that measures the electrical activity of the heart, an electrocardiogram provides your physician with two types of useful information. One being the time it takes for an electrical impulse to pass through the heart. By measuring the impulse intervals on the ECG, your physician may determine if the electrical activity of your heart is fast or slow, normal or irregular. The second type of diagnostic data, gleaned by measuring the amount of electrical activity passing through the heart muscle, enables your physician to determine if parts of your heart are too large or overworked.
An ambulatory electrocardiogram serves much the same purpose as a regular electrocardiogram, providing a graphic record of the heart’s electrical impulses. However, an ambulatory electrocardiogram, also known as Holter monitoring, ambulatory ECG or ambulatory EKG, measures the heart’s electrical activity over longer periods of time.
Since rhythmic disturbances often occur randomly or are provoked by external factors not normally present in a doctor’s office, an ambulatory ECG is valuable in documenting changes in the heart’s normal electrical pattern as the patient goes about their daily routine.
Typically, patients wear a continuous recording device for 24 to 48 hours. Though, in some cases, intermittent recorders may be worn for weeks or months.
To learn more about ambulatory ECGs, visit WebMD.
The American Heart Association also provides information on the Holter Monitor, a small, portable ECG recorder that enables ambulatory electrocardiograms.
The most commonly performed radiographic exam, a chest X-ray is an image of a patient’s thorax. Affording a view of the heart, lungs and bones of the spine and chest, it is regularly used to detect problems with these organs and structures inside the chest. Though a chest X-ray does not provide visual evidence of the interior structures of the heart, it’s quite useful in observing the location, size and shape of the heart, lungs and blood vessels.
To learn more about chest X-rays, visitWebMD.
Also known as a cardiac ultrasound, an echocardiogram is diagnostic sonography of the heart. In other words, it uses sound waves to take “moving pictures” of the heart in order to create a two- or three-dimensional image. It can provide a wealth of helpful information, including the size and shape of the heart, its pumping capacity, and the location and extent of any damage to its tissues
Additionally, an echocardiogram may be used to produce an accurate assessment of the velocity of blood and cardiac tissue at any arbitrary point using pulsed or continuous wave Doppler ultrasound. This is helpful in assessing the function of cardiac valves.
Designed to gauge blood flow to the heart during physical activity, an exercise stress test gives your physician a good idea how well your heart handles work. Also called a cardiac stress test, treadmill test or exercise test, an exercise stress test is often interpreted as a reflection on an individual’s overall physical fitness.
When compared with the blood flow to your heart during periods of rest, an exercise stress test can reveal imbalances or reductions in blood flow to the heart’s left ventricular muscle tissue during periods of physical exertion. It is also useful in determining the type and level of exercise that is appropriate for a patient.
To learn more about exercise stress tests, visit WebMD.
With both interventional and diagnostic purposes, cardiac catheterization (heart cath) is the insertion of a thin plastic tube or catheter into a chamber or vessel of the heart. Normally introduced via an artery or vein in the arm or leg, the catheter is advanced to the heart in order to perform a number of different procedures.
Coronary angioplasty, also called balloon angioplasty or percutaneous coronary intervention, is a common interventional procedure made possible by cardiac catheterization. Using a catheter with a small balloon at the tip, this therapeutic procedure treats the stenotic (narrowed) or obstructed coronary arteries by inflating the balloon once it is in place.
Standard diagnostic procedures aided by cardiac catheterization include coronary angiography or coronary arteriography. Both procedures feature the release of a radio-opaque contrast agent into the blood vessel via the catheter and X-ray based imaging techniques such as fluoroscopy. Other catheter-based diagnostic procedures include measuring blood pressure within the heart and the acquisition of information about the heart’s pumping capability.
To learn more about cardiac catheterization, visit WebMD.
Performed much like an exercise stress test, only a nuclear stress test or thallium stress test involves the injection of a radioactive substance into your bloodstream for imaging purposes. Using a special scanner, myocardial perfusion imaging detects the radioactive material in your heart and identifies areas of the heart where blood flow is inadequate. It’s particularly helpful in determining the extent of coronary artery blockage, prognoses for heart attack survivors, post-op evaluation of interventional procedures and chest pain diagnosis.
A specific type of echocardiogram used to capture pictures of the heart’s valves and chambers for the evaluation of its pumping action, a transesophageal echocardiogram (TEE) differs from a standard echocardiogram in the way ultrasound waves are administered. Rather than externally, the ultrasound transducer is mounted on a long, thin, flexible tube (endoscope) and fed through your mouth into your esophagus. Once in place, it can provide a clear view of your heart, unobstructed by the ribs or lungs. TEE is commonly performed to look for blood clots in individuals with atrial fibrillation.
When utilized in combination with Doppler ultrasound, TEE also enables the study of blood flow across the heart’s valves.
To learn more about transesophageal echocardiograms, visit the American Heart Association’s Website.
Commonly used to diagnose individuals who have experienced periodic loss of consciousness or recurrent fainting spells (syncope), the tilt-table test checks for changes in heart rate and blood pressure when the patient’s body position is changed.
During the test, the patient is strapped to the table and mechanically tilted to an upright position. While in this position for 20 to 30 minutes, the patient’s pulse rate and blood pressure are monitored. An electrocardiogram or tests for blood oxygen saturation may also be performed.
During an upright tilt, a patient’s cardiovascular system is expected to adjust itself in order to prevent blood volume from pooling in the lower extremities. This happens quickly and without a significant drop in blood pressure in normal individuals. If this does not occur, the patient is often diagnosed with one of two varieties of syncope (orthostatic hypotension or vasovagal syncope) and a treatment plan is developed.
To learn more about tilt-tables tests, visit WebMD.
Arrhythmia symptoms can be erratic and fleeting. Often unusual cardiac episodes such as dizziness, shortness of breath, rapid heartbeat or irregular heartbeat happens much too quickly and unpredictably to get to your physician in time for an accurate diagnosis. With that in mind, a transtelephonic monitor, or event recorder, may be used to capture valuable information about an episode for later evaluation by your physician.
When symptoms occur, the small, transient event monitor may be attached with bracelets, finger clips or patches under the arms for the purpose of capturing electrocardiogram (ECG) information during the event.
To learn more about arrhythmia monitoring, visit WebMD.
An angiogram, also known as an arteriogram, is an X-ray image of blood vessels performed to assess vascular conditions, including aneursym, stenosis, and blockages. A renal angiogram focuses specifically on the blood vessels of the kidneys.
For a renal angiogram, a contrast dye is introduced by catheter into the blood vessels of the kidneys and X-rays are taken in an effort to reveal abnormalities affecting the blood supply. A more advanced version of the renal angiogram utilizes fluoroscopy (think of it as an “X-ray movie”) to see more detailed images of the kidneys and associated blood vessels in motion.
An angiogram, also known as an arteriogram, is an X-ray image of blood vessels performed to assess vascular conditions, including aneursym, stenosis, and blockages. A peripheral angiogram focuses specifically on the arteries that supply blood to your legs.
For a peripheral angiogram, a contrast dye is introduced by catheter into the arteries of your leg and X-rays are taken to identify any narrowed or blocked arteries. A more advanced version of the peripheral angiogram utilizes fluoroscopy (think of it as an “X-ray movie”) to see more detailed images of the arteries that supply blood to your legs.
To learn more about peripheral angiograms, visit The American Heart Association's Website.
An angiogram, also known as an arteriogram, is an X-ray image of blood vessels performed to assess vascular conditions, including aneursym, stenosis, and blockages. A carotid angiogram focuses specifically on the arteries that supply blood to your head and neck.
For a carotid angiogram, contrast dye is introduced by catheter into the arteries of your neck that supply blood to your brain and X-rays are taken to show narrowing or blockage. A more advanced version of the carotid angiogram utilizes fluoroscopy (think of it as an “X-ray movie”) to see more detailed images of the carotid arteries.
To learn more about carotid angiograms, visit WebMD.
Duplex ultrasound combines Doppler flow information and conventional imaging information, sometimes called B-mode, to allow physicians to see the structure of your blood vessels. Duplex ultrasound shows how blood is flowing through your vessels and measures the speed of blood flow. It can also be useful to estimate the diameter of a blood vessel as well as the amount of obstruction, if any, in the blood vessel.
Doppler ultrasound measures how sound waves reflect off of moving objects. A wand bounces short bursts of sound waves off of red blood cells and sends the information to a computer. Doppler ultrasound produces two-dimensional color images that reveal if blood flow is affected by problems in the blood vessels, such as cholesterol deposits.
When performing duplex ultrasound, your physician uses the two forms of ultrasound together. The conventional ultrasound shows the structure of your blood vessels and the Doppler ultrasound shows the movement of your red blood cells through the vessels. Duplex ultrasound produces images that can be color coded to show physicians where your blood flow is severely blocked as well as the speed and direction of blood flow.
Your physician may recommend a duplex ultrasound to help diagnose and examine conditions that affect the blood vessels. These conditions include carotid disease, deep venous thrombosis, leg artery disease, and aneuryms in the aorta.
Performed in conjunction with cardiac catheterization, intracoronary ultrasound is an invasive procedure that uses high frequency sound waves (ultrasound) to create images of the heart and coronary arteries internally. This catheter-based diagnostic procedure provides detailed and accurate measurements of lumen and vessel size, plaque area and volume, and the location of key anatomical landmarks.
Intracoronary ultrasound has also proven valuable in the proper placement and optimal expansion of stents, as well as the differentiation among four different varieties of plaque: fibrous, fibro-fatty, necrotic core and dense calcium.
Computed tomography, also known as a CT scan, merges many X-ray images with the assistance of a computer to generate cross-sectional views of the body. Cardiac CT utilizes this technology, with or without intravenous contrast material, to visualize the anatomy of the heart, coronary circulation, and larger blood vessels like the aorta, pulmonary veins and the coronary artery.
This heart-imaging test yields remarkably clear, detailed pictures. During a cardiac CT scan, the X-ray machine will move around your body in a circle and take a picture of each part of your heart. Cardiac CT scans used in the diagnosis of heart disease include: calcium-score screening heart scan and coronary CT angiography (CTA).
Because an X-ray machine is used, cardiac CT scans involve radiation. However, the amount of radiation used is small. This test gives out a radiation dose similar to the amount of radiation you’re naturally exposed to over 3 years.
Positron emission tomography (PET) has been the “silent gold standard” for years in the field of cardiac imaging. Due to limited availability and high equipment costs, it has remained a research tool until recently – but now Cardiology Associates of North Mississippi has the only cardiac PET scanner in north Mississippi. Rubidium-82 is the imaging agent used. It has a half life of 75 seconds, making pharmacologic imaging necessary. The patient lies comfortably, with their head outside of the scanner, for 30 minutes and images obtained before and after lexiscan, the pharmacologic agent of choice at this time. PLEASE LET THE DOCTOR KNOW IF YOU ARE CLAUSTROPHOBIC.
This device is used to detect ischemia and/or scar in patients. PET offers additional benefits in comparison to past forms of nuclear testing. As mentioned, the total procedure takes 30 minutes compared to 3-4 hours for nuclear testing. PET using rubidium-82 has less radiation exposure to the patient and staff. PET also provides better images in obese patients or those with breast implants/large breasts.
CANM, one of the largest single specialty groups in Mississippi, is widely recognized for its excellence in the treatment of coronary artery disease requiring percutaneous intervention. Our experienced medical team is accomplished at performing stenting and angioplasty procedures with superb results. What’s more, our interventional expertise also includes more traditional coronary bypass surgery and device implantation.
Our practice offers an extensive roster of interventional and electrophysiology procedures for the treatment of common and complex forms of coronary artery disease, chronic angina, congenital and valvular heart disorders, and peripheral vascular disease (PVD). The vast majority of interventional procedures we perform are catheter-based and involve the use of small, highly specialized tools mounted on the tip of a catheter. Guided by technologically advanced imaging systems, these procedures often serve to clear blockages, restore blood flow to and from the heart and allow for revascularization. Another common purpose for our catheter-based procedures is the treatment of arrhythmias.
In combination with our advanced diagnostic capabilities, many of CANM’s therapeutic procedures are administered in our comfortable, convenient clinic locations. For more invasive procedures, our physicians enjoy privileges at a pair of nearby affiliated hospitals.
Percutaneous transluminal coronary angioplasty (PCTA), angioplasty for short, is an invasive procedure performed to open narrowed segments or clear blockages in coronary arteries. Its objectives are the restoration of blood flow to blood-deprived heart tissue, the reduction in need for medication, and the elimination or reduction of angina episodes.
The catheter-based procedure typically involves the use of an angioplasty balloon. Guided into the narrowed or blocked segment of artery, the balloon is inflated to open the narrowed artery and flatten the plaque against the artery wall. Once recanalization is achieved, a stent is frequently implanted to keep the artery open and prevent restenosis (regrowth of plaque).
For more information on angioplasty, visit The American Heart Associations Website.
Approved by the FDA in 1994, stenting is a catheter-based interventional procedure in which a small, expandable wire mesh tube (stent) is implated into a diseased artery as a scaffold to hold it open.
A less traumatic alternative to coronary bypass surgery, coronary artery stents are designed to be placed into the coronary arteries that lie on the surface of the heart and supply it with oxygen-fresh blood. Moved into place by a balloon catheter, the stent locks into place when the balloon is inflated and remains in the artery permanently. Coronary artery stenting is almost always performed in conjunction with other catheter-based procedures, such as balloon angioplasty or atherectomy.
For more information on stenting, visit the American Heart Association’s Website.
A catheter-based procedure used to remove plaque from arteries, most frequently the coronary arteries, atherectomy may be performed prior to other catheter-based techniques such as balloon angioplasty and stenting.
For the atherectomy procedure, the physician introduces a long, thin tube (catheter) into the blocked arteries. Equipped with special devices that remove some of the fatty plaque from the inside of the blocked arteries, atherectomy may be accomplished with either a laser catheter that vaporizes the plaque or a rotating shaver catheter that uses a revolving burr to break up the plaque.
Thrombectomy is the removal of an abnormal or dangerous thrombus (blood clot). A percutaneous thrombectomy is perfomed intraluminally (directly in the cavity of the vessel) using a balloon catheter. The clot may either be pressed against the vessel wall in order to restore partial blood flow or the balloon may be inflated past the thrombosis and carefully retracted to draw the clot out of the vessel.
For more information on blood clots, click here.
The most commonly perfomed surgery in the U.S., coronary artery bypass graft surgery (also called CABG or “cabbage”) is a procedure that reroutes and restores blood flow to the heart muscle. “Bypassing” coronary arteries that have become clogged by plaque (a buildup of fat, cholesterol and other substances), a coronary bypass utilizes a substitute blood vessel (or graft) to provide the blood with a new pathway to the heart. The substitute vessel can come from the chest, legs or arms, depending upon the location and size of the blockage and the size of the patient’s coronary arteries.
Coronary bypass surgery can provide immediate relief from chest pain and greatly reduce the risk of heart attack.
Cryotherapy is the use of extreme cold to freeze and destroy diseased tissue. CrypPlasty is a type of cryotherapy specifically targeting peripheral artery disease (PAD). This new and innovative type of vascular therapy gently cools while simultaneously opening arteries clogged with plaque.
CrypPlasty appears to be a promising alternative in combating the stubborn problems of arteries reclogging. Nine months after treatment with CryoPlasty, 85% of treated clogged leg arteries remained open according to interim results of a multicenter study.
A minimally invasive alternative to surgery, embolization is undertaken to prevent blood flow to a specific area of the body. Endovascular coil embolization is a standard treatment for patients who have a brain aneurysm but who are at high risk for complications from the surgical repair of the aneurysm.
In an embolization procedure, a catheter is introduced into a primary artery and advanced to the area where blood supply need to be halted. Curled metal coils are released through the catheter into the abnormal blood vessels, resulting in clotting and the non-surgical closure of these structures. The materials used may depend on the size and type of area to be closed and whether the occlusion is intended to be temporary or permanent.
Atrial septal defect (ASD), often referred to as a hole in the heart, is literally a hole in the septum (wall) that separates the heart’s left and right upper chambers (or atria). The defect is frequently discovered in childhood, but may also be diagnosed later in mature adults. If undetected or untreated, it results in the inefficient pumping of already-oxygenated blood back to the lungs.
To close an atrial septal defect, a catheter is used to guide the placement of an ASD closure device that will seal the hole in the heart wall. Once in the correct location, the ASD closure device is allowed to expand its shape to straddle each side of the hole. The device will remain in the heart permanently to stop the abnormal flow of blood between the two atria chambers of the heart.
For more information on atrial septal defect closure, visit the American Heart Association’s Website.
Arrhythmias (or changes from the normal sequence of electrical impulses, causing abnormal heart rhythms) are often treated and managed using medication. Designed to suppress arrhythmias by treating their underlying cause, preventing conditions that contribute to arrhythmias, and managing arrhythmia symptoms, these medications include a category of drugs referred to as anti-arrhythmic agents, beta-blockers, calcium channel blockers, and digitalis.
Careful dosing of anti-arrhythmic agents is essential, as these medications have a narrow toxic-therapeutic relationship. In other words, a dosage that produces beneficial effects may cause serious complications in slightly higher or lower doses.
For more information on anti-arrhythmic therapy, visit the American Heart Association’s Website.
Angina pectoris (or simply angina) is chest pain or pressure that occurs when the heart is not receiving enough blood and oxygen. The underlying cause is usually coronary artery disease (CAD), resulting from an accumulation of plaque (fatty build-up) inside the coronary blood vessels.
Anti-angina therapy is the pharmacological treatment of the symptoms and underlying cause of angina. Nitroglycerin, a coronary vasodilator, is the most common drug prescribed to relax the blood vessels, improve blood flow to the heart and temporarily relieve the pain and pressure. Beta-blockers and calcium antagonist, that reduce blood pressure and the heart’s need for oxygen, can also provide relief.
Coronary artery disease is treated by medications (anti-platelet, blood pressure, and cholesterol medications) and lifestyle modifications (eating a healthy diet, exercising regularly, avoiding smoking, and maintaining a healthy weight).
For some, reducing and managing cholesterol levels, particularly bad cholesterol (LDL), may be accomplished through improved diet and exercise. However, many individuals also require the additional assistance of medication. Depending on your LDL (bad) cholesterol level and your other risk factors for cardiovascular disease, your physician may prescribe one of a variety of cholesterol lowering drugs on the market today.
Statins (also known as HMG CoA reductase inhibitors), selective cholesterol absorption inhibitors, resins (also known as bile acid sequestrant or bile acid-binding drugs), fibrates (fibric acid derivatives), and Niacin (nicotinic acid) are all viable alternatives.
For more information on lipid reduction therapy, visit the American Heart Association’s Website.
Anti-coagulants (or antiplatelet agents) are sometimes called blood thinners. These medications help prevent existing blood clots from growing larger, and prevent the formation of new blood clots by increasing the amount of time it takes a blood clot to form. Aspirin, warfarin (Coumadin®) and heparin are commonly prescribed examples.
When used as directed, anticoagulants are very safe and effective; however, they can have serious and potentially fatal side effects if not taken properly. It is imperative to follow your physician’s dosage instruction's carefully.
For more information on anti-coagulant therapy, visit the American Heart Association’s Website.
A procedure in which a slender, metal-mesh tube (stent) is expanded inside the carotid artery to increase blood flow in areas blocked by plaque, carotid stenting is accomplished during balloon angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It’s then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain).
Carotid stenting is a less invasive alternative to the surgical removal of plaque, known as carotid endarterectomy.
For more information on carotid stenting, visit the American Heart Association’s Website.
A device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles), a pacemaker is a battery-powered device that sends electrical signals to your heart to help it beat at a proper rate or “pace”. It may be used to treat bradycardia, atrial fibrillation, syncope (fainting spells), congestive heart failure and hypertrophic cardiomyopathy.
Pacemakers may be permanent (implanted) and temporary (external). When implanted, the pacemaker goes under your skin, beneath your collarbone and is connected to your heart by one or more wires (leads). Your physician will determine the minimum rate (lowest heart rate) to set your pacemaker. When your heart rate drops below the set rate, the pacemaker generates (fires) an impulse that passes through the lead to the heart muscle. This causes the heart muscle to contract, creating a heartbeat.
For more information on pacemaker implantation, visit the CardioSmart Website.
A nonsurgical procedure used to treat specific types of rapid heart beat arrhythmia, radiofrequency ablation utilizes a special form of energy that, when delivered through the tip of a special catheter placed inside the heart, results in laser-like precision destruction of abnormal electrical tissues. These tissues are nerve bundles that are responsible for the patient’s irregular heartbeats. The procedure is assisted by real-time, moving X-rays (fluoroscopy) displayed on a video screen.
For more information on radiofrequency ablation, visit the Cleveland Clinic Website.
An electronic device that constantly monitors your heart rate and rhythm, an Implantable Cardioverter Defibrillator (ICD) can detect a fast, abnormal rhythm and deliver a small electric impulse to the heart muscle, causing it to beat in a normal rhythm again.
Comprised of leads and a pulse generator, an ICD is a remarkable computerized device that monitors heart rhythm and determines when a rhythm-restoring shock is necessary. It may be programmed to perform one or more of the following functions: anti-tachycardia pacing (ATP), cardioversion, defibrillation, and bradycardia pacing.
The most frequent implantation technique involves a small incision under the collarbone through which the generator is placed under the skin and the lead is placed into a vein and guided inside the heart chamber.
For more information on implantable cardioverter defibrillators, visit the CardioSmart Website.
The most common irregular heart rhythm in the U.S., atrial fibrillation is an abnormal heart rhythm originating in the atria. Rather than the natural electric impulse traveling through the heart in a orderly fashion, multiple impulses spread randomly through the heart and compete for the opportunity the travel through the AV node. The result—a rapid and disorganized heart beat.
An effective method for treating this type of arrhythmia is atrial fibrillation ablation. A minimally invasive procedure, the physician guides a catheter with an electrode at its tip to the area of heart muscle where the damaged site is located. Then mild, painless radiofrequency energy is transmitted to the site of the pathway. As a result, heart muscle cells in a very small area die and stop conducting the extra impulses that cause rapid heartbeats.
This nonsurgical procedure may also be used in the treatment of other rapid heart beat disorders, such as atrial flutter, atrial tachycardia and supraventricular tachycardia (SVT).
For more information on atrial fibrillation ablation, visit WebMD.
Congestive heart failure (CHF) is an imbalance in pumping function in which the heart fails to adequately maintain the circulation of blood. CHF does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should.
The weakening of the heart's pumping ability can cause blood and fluid to back up in your lungs, edema, tiredness and shortness of breath.
CHF is a serious condition affecting more than five million Americans. Caused by coronary artery disease, high blood pressure and diabetes, CHF treatment includes addressing these underlying causes as well as the use of medications. Common medications used are: ACE inhibitors, diuretics (water pills), vasodilators, digitalis preparations, beta-blockers, blood thinners, angiotensin II receptor blockers, calcium channel blocker, and potassium. Heart transplant is also considered, if all else fails.
For more information on congestive heart failure therapy, visit the U.S. National Library of Medicine's Website.