Procedures

A brief explanation of some of the procedures that Dr Fishman and his staff complete on a regular basis to provide comprehensive care for the patients:

Electrocardiograms (EKG or ECG) – record electrical activity of the heart and provide information about the heart’s function and structure. In an EKG, electrodes are attached to the arms, legs, and front of the chest. The heart’s electrical activity, communicated via the electrodes, is either displayed on a screen or recorded as a trace on paper. EKG’s from a normal, healthy heart, have a characteristic shape. Any irregularity in the heart rhythm or damage to the heart muscle can alter the electrical activity of the heart and will show up on the EKG trace differently from the normal wave form.

Echocardiograms (ECHO) – provide views/moving pictures of the heart that measure chamber size, wall thickness, blood flow, valve function and wall motion. This procedure is completed by placing gel on the skin and holding a transducer against the skin. This allows the sound waves to bounce off the underlying tissue to produce an image on the screen that can be visualized by the physician and technicians.

Stress tests – record the electrical activity of the heart under stress. Regular stress tests require patients to walk on a treadmill. Myoview stress tests use injected isotopes to visualize the coronary arteries. Adenosine and Dobutamine stress tests use medication to make patients’ hearts react as if they were walking.

Exercise stress tests can be performed in our office. When you arrive for the test, you will be asked to undress to the waist. The skin on your chest will be cleaned, and EKG wires applied. You will then be asked to walk on a treadmill until you get too tired to continue, or you experience symptoms such as chest pain or shortness of breath. A cardiologist and a technologist will be present to monitor your blood pressure and electrocardiogram continuously.

Nuclear imaging and “chemical” stress tests are done in the cardiology and radiology departments at the hospital. These can be arranged, when appropriate, by the doctor and his staff.

24-hour Holter monitoring – A non-invasive test in which a patient wears a portable monitor that shows the electrical activity of the heart (ECG) while moving throughout the day and resting at night. The purpose of a Holter Monitor test is to determine the presence and severity of any disturbances in your heart rhythm. The monitor can correlate heart rhythm disturbances with symptoms you may be having, such as dizziness, palpitations, or fainting spells.

Carotid Ultrasound – A non-invasive way to identify patients with arterial or venous occlusive disease. To do this we place some gel on your skin, allowing sound waves to pass into the blood vessels. Some of the sound waves bounce off the blood vessels and return to the ultrasound probe, which projects an image of the flowing blood in your vessels on the screen.

Impedance Cardiography (ICG) – Impedance cardiography is a completely non-invasive test that is performed in the office to provide your physician information about your heart’s ability to deliver blood to the rest of your body, the force your heart has to pump against with each heartbeat, and the amount of fluid in your chest.

Sensors are placed on each side of your neck and chest. A cable from the ICG monitor will then be connected to the sensors. Your ICG measurements will be taken as you lie down on your back and remain still for two to five minutes.

Cardiac catherization – procedures, also known as angiograms, involve placing a catheter and dye into the artery to enable the cardiologist to determine pressures in the heart chambers, conditions of the valves and blockages in the arteries. This procedure is performed in the cath lab at the hospital by the doctor, his assistant and trained technicians.

Balloon angioplasty – is a procedure that involves guiding a small catheter with a balloon tip into a clogged artery and inflating the balloon to push against the plaque to open the artery. The balloon is deflated and the catheter is withdrawn. This procedure may be performed at the time of cardiac catheterization by the doctor.

Tilt Table Test – used to evaluate patients with recurrent dizziness or syncope. This test helps determine how the body responds to changes in position. During the test, the patient lays on a table that can be moved to various positions while the symptoms, heart rate, and blood pressure are monitored by the doctor and the technicians. This procedure is performed in the cardiology department at the hospital and can be arranged by the doctor and his staff, if appropriate.

Arterial duplex/doppler ultrasounds – A non-invasive way to identify patients with peripheral arterial disease or PAD. To do this we place some gel on your skin, allowing sound waves to pass into the blood vessels. Some of the sound waves bounce off the blood vessels and return to the ultrasound probe, which projects an image of the flowing blood in your vessels on the screen. We also take various blood pressures of both legs and arms to determine your Ankle Brachial Index. This number helps to determine if you have PAD.