Holy Cross Hospital is pleased to offer inpatients and emergency care cardiology services. The services are provided by Board Certified physicians Geilan Ismail, MD and Louis Constantine, MD.
Why travel to Santa Fe or Albuquerque for the procedures you can get in Taos? Our caring, skilled and experienced cardiologists are committed to the treatment and prevention of cardiovascular disease through leading and innovative therapies as well as clinical best practices. They openly discuss conditions, treatment options and procedure details with patients and their families. They listen to their concerns and encourage questions. When more intervention is needed beyond what they can provide here they will refer patients to the most appropriate location.
Our team of experts works together to achieve superior views of the heart to enable an accurate diagnosis.—from ECG’s to three-dimensional technology that allows cardiologists to obtain the clearest picture of cardiac arteries available today.
A Comprehensive Range of Cardiology Services:
The echocardiograph, or echo, is a noninvasive test that provides cardiologists with a survey of the heart using ultrasound technology similar to that used for pregnant women. The echo allows cardiologists to examine the size of a patient's heart and the condition of the patient's valves to determine how efficiently the heart contracts. Echos also reveal common congenital problems and possible causes for murmurs, palpitations, chest pain and shortness of breath.
A technician called a sonographer, who spreads a gel over the chest to make sure that the ultrasound transducer maintains good contact with the skin, performs the echo. During the exam, the sonographer will take moving pictures of the heart, record images of the heart beating, and examine the direction of blood flow. Based on the results of this 45-60-minute test, cardiologists determine if you will need more invasive tests.
During a transthoracic echocardiogram (TTE), a technician obtains views of the heart by moving a small instrument called a transducer to different locations on the chest or abdominal wall. A transducer, which resembles a microphone, sends sound waves into the chest and picks up echos that reflect off different parts of the heart.
During a TTE, you will lie on your back or on your left side on a bed or table.
- Small patches (electrodes) will be taped to your arms and legs to record your heart rate during the test.
- A small amount of gel will be rubbed on the left side of your chest to help pick up the sound waves.
- The transducer is pressed firmly against your chest and moved slowly back and forth.
- The echos from the transducer are sent to a video monitor that records pictures of your heart for later viewing and evaluation.
- The room is usually darkened to help the technician see the pictures on the monitor.
- At times you will be asked to hold very still, breathe in and out very slowly, hold your breath, or lie on your left side.
- The technician will move the transducer to different areas on your chest that provide specific views of your heart.
- The test usually takes from 45 to 60 minutes.
Unlike a transthoracic echo, which is done from outside the body, transesophageal echocardiography (TEE) is performed with a probe inserted into the esophagus. The picture available through the esophagus is much clearer than a traditional echo because there is less distance between the transducer and the heart imaging from the esophagus For example, the Cardiologist can't view as much of the aorta on a traditional echo, they with TEE. The heart vavles can also be seen in much better detail with a treansesophageal echocardiogram.
While the regular echo gives the cardiologist a picture of the heart at rest, the stress echo gives the cardiologist a picture of the heart before and after the patient has been exercising on a treadmill. By comparing a stress echo to the at-rest echo, the cardiologist may catch problems that surface only when the heart is under strain. Roughly 95 percent of stress echos are done to look for evidence of blocked arteries in patients who are experiencing chest pain, shortness of breath or palpitations.
For patients who are unable to walk on the treadmill due to disability or lung problems, the stress echo can be done with Dobutamine, a drug that that increases the heart rate without exercise.
Nuclear Stress Test
The nuclear stress test and the stress echo both test the condition of the heart under strain. A nuclear stress test can use treadmill testing or regadenoson (instead of Dobutamine). In some cases, the nuclear stress test offers a clearer image. However, the procedure takes longer than a traditional stress test, and results are often not immediately available until a technician processes them for the cardiologist to review.
Multi-slice Computed Tomography Angiography
Computed tomography (CT) is a test that gives doctors a truly three-dimensional picture of how a patient's coronary arteries run along the surface of the heart relatively noninvasively. This test is the latest advance in the effort to map blockages in coronary arteries.
With a stress echo, a cardiologist is able to demonstrate the likelihood of a blocked artery based on how the heart responds to exercise. CT angiography can give cardiologists a clearer picture of the actual blockage through 3 dimensional reconstructions of the arteries. Eventually, this cutting-edge improvement may reduce the number of patients who need invasive testing, such as an angiogram.
Calcified plaque in the heart arteries is a result of years of fatty deposits which have subsequently calcified and can be a marker of the amount of plaque that is present.
A procedure called calcium scoring is a non-invasive, painless medical test that takes pictures of your heart in thin sections and tracks the location and extent of calcified plaque in your coronary arteries.
Calcium scoring is one of the screening tools we have in Cardiology to detect the presence of coronary artery disease in people who do not have symptoms of chest pain or shortness of breath. Several risk factors may prompt your doctor to consider a calcium score test:
- family or personal history of coronary artery disease
- male over 45 years of age; female over 55 years of age
- past or present smoker
- history of high cholesterol, diabetes, or high blood pressure
- inactive lifestyle.
Cardioversion (light shock)
What is cardioversion?
If your heart has an irregular (uneven) beat or is beating too fast (arrhythmia), cardioversion is a way to restore a regular rhythm. Doctors restore regular rhythms by electrical cardioversion applying an electrical shock to the heart.
- Doctors use cardioversion to treat a fast, irregular heart rhythm called atrial fibrillation or flutter.
- If you have electrical cardioversion, you’ll get medicine to put you to sleep so you don’t feel the shock.
Why do people have cardioversion?
People have non-emergency or elective cardioversion to treat persistent arrhythmias. The electrical signals that control your heartbeat start in the upper right chamber of your heart (atrium). In atrial fibrillation, very fast, irregular electrical signals move through both of the upper chambers of your heart. This can make your heartbeat fast and irregular. Some people who have atrial fibrillation don’t notice any changes in the way they feel. But others feel:
- A very fast heartbeat
- Short of breath
- Very tired
Cardioversion also treats other kinds of abnormal heartbeats, including atrial flutter, atrial tachycardia and ventricular tachycardia.
Implantble Cardioverter- defibrillation (ICD)
An implantable cardioverter-defibrillator (ICD) is a specialized device designed to directly treat certain types of cardiac tachydysrhythmia. ICDs have revolutionized the treatment of patients at risk for sudden cardiac death due to ventricular tachyarrhythmias.
Internal defibrillators are used in emergency situations for people who suffer sudden life threatening arrhythmias.
A variety of common cardiac conditions can lead to an electrical malfunction and the resulting need for an ICD. Some of these conditions are:
- Ventricular fibrillation – a life-threatening condition in which the ventricles contract in a rapid, chaotic rhythm and cannot pump blood to the body
- Ventricular tachycardia – a serious condition in which the ventricles cause a fast heartbeat
- Heart failure – a condition in which the heart is unable to pump blood effectively to meet the body's metabolic needs
- Predisposition – being at risk for sudden cardiac arrest due to family history or other known conditions
The device is programmed to manage heartbeat speed and has a number of life-saving functions that can be programmed by a physician based on the patient's needs for restoring a normal heart rhythm.
The ICD can also be programmed to function as a basic pacemaker as needed. Sometimes, after a shock is delivered, the heart may beat too slowly. The ICD has a "backup" pacemaker, which can stimulate the heart to beat faster until the normal heart rhythm returns. Additionally, an ICD can act as a pacemaker not only after a shock is delivered, but also any time the heart rate drops below a pre-programmed rate.
An ICD can also record and store information about your heart rhythm and therapies delivered by the ICD for your physician to review. As with a pacemaker, regular appointments are necessary in order for a physician to adjust the settings when needed, thus ensuring you maintain a healthy heart rhythm.
A permanent pacemaker is an implanted device that provides electrical stimuli, thereby causing cardiac contraction when intrinsic myocardial electrical activity is inappropriately slow or absent. It can also be used when medications required to prevent the heart from beating too fast then make the heart too slow.