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Your Heart & Vascular System

Dr. Ghassemi examining a patientThe physicians and staff members of Advanced Cardiology Practice work together with each patient and referring physician to diagnose and treat disorders of the heart. In addition to listening to our patient describe symptoms and discussing our findings with the primary care physician, we use a variety of diagnostic techniques and tools to help determine an accurate diagnosis. Then, with the help of the patient, a treatment plan is developed. Our goal is to treat each patient as an individual, working as a team to help improve the patient's quality of life.

The following are some of the more common treatments that are routinely performed by our cardiologists, either in our offices or in the hospital.

Cardiac Catheterization/Coronary Angiogram
An invasive imaging procedure that involves inserting a catheter into a blood vessel in the arm or leg, and guiding it to your heart with the aid of a special x-ray machine. Contrast dye is injected through the catheter so that x-ray movies of your valves, coronary arteries and heart chambers are taken.

Your doctor uses cardiac catheterization to: Dr-Ghassemi-cath-lab
• evaluate or confirm the presence of heart disease (such as coronary artery disease, valve disease or disease of the aorta)
• evaluate heart muscle function
• determine the need for further treatment (angioplasty or bypass surgery)

The x-ray camera is used to take photographs of the arteries and heart chambers. When all the photos have been taken, the catheter is removed.

The cardiac catheterization procedure only takes about 30 minutes but requires several hours from the preparation through the recovery time.

Interventional Procedures
During the catheterization, if a blockage is identified, or if the cardiologist determines it is necessary, an interventional procedure may be performed to open narrowed coronary arteries to improve blood flow to the heart. Various interventional procedures are available, including:

Types of Angioplasties
A procedure in which a small balloon at the tip of the catheter is inserted near the blocked or narrowed area of the coronary artery. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened to increase blood flow to the heart. There are several types of Angioplasty:

Lower Extremity Angioplasty; Carotid Angioplasty; Renal Angioplasty;
Patients suffering from pain with walking, claudication or nonhealing ulcers may benefit from lower extremity Angioplasty and stent placement to increase the circulation to the legs.

DrGhassemi with PatientIn addition, patients who have had strokes, dizziness or fainting spells may have blockages in the carotid arteries (the arteries that supply the brain). In the past surgery was the only alternative. Now we can offer carotid angioplasty and stent placement without the need of general anesthesia and prolonged hospital days to open these arteries.

Similar angioplasty and stent techniques can be applied to the kidney arteries to treat patients with severe high blood pressure.
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Laser Angioplasty
A laser device is utilized to open blocked arteries in the chest, legs and heart by pulverizing plaue that lines the arterial walls.
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Angioplasty with Stenting

In most cases, balloon angioplasty is performed in combination with the “stenting” procedure. A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter is used to insert the stent into the narrowed artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently. During a period of several weeks, the artery heals around the stent.

Angioplasty with stenting is most commonly recommended for patients who have a blockage in one or two coronary arteries. If there are blockages in more than two coronary arteries, coronary artery bypass graft surgery may be recommended.
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Transesophageal Echocardiogram (TEE)

If a standard echocardiogram is unclear due to an obstruction, it may be necessary to perform a transesophageal echocardiogram. With TEE, the back of the throat is anesthetized and a scope is inserted. On the end of the scope is an ultrasonic device that a cardiologist will guide down to the lower part of the esophagus, where it is used to obtain a clearer, two-dimensional echocardiogram of the heart.
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EECP (Enhanced External Counter Pulsation)

EECP is a therapy program that offers an alternative to surgery, particularly for patients who may not be good candidates for angioplasty or bypass surgery. EECP promotes circulation of blood to the heart to relieve coronary disease, angina and congestive heart failure as effectively as more common surgical procedures.

Patients receive EECP therapy while reclining on a bed with their legs and lower body wrapped in “cuffs” similar to those used for taking blood pressure readings. The cuffs are timed to inflate with air and deflate in coordination with the heart’s pumping rhythm. As the heart relaxes the cuffs inflate, circulating blood into the heart. When the heart pumps, the cuffs deflate, allowing the blood to flow freely through the legs and lower body. Treatments generally last one hour three to five times a week over a seven-week period.
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A cardioversion is a non-surgical procedure that can convert an irregular heartbeat to a normal, regularrhythm. This procedure uses small amounts of electrical current Dr. Biehlgiven through patches or paddles placed on the chest. The electrical current is used to restore the heart to a normal regular rhythm.
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A pacemaker is a small electrical device that is placed inside the body to help the heart maintain a regular beat. A pacemaker may be needed when you heart’s natural pacemaker is not working properly.

Your pacemaker will need to be checked periodically. Your cardiologist will provide all the information you will need for pacemaker care following implantation.
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A defibrilator is a permanent implant similar to a pacemaker, which can prevent life-threatening arrythmias, such as ventricular tachycardias, which can result in sudden death. Defibrilators are recommended for patients with weakened heart muscles and they re-establish the body's natural pacemaker in the heart. For more information, or to see if you are a candidate for a defibrilator, consult with your cardiologist.
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