Congestive Heart Failure Clinic

During a visit of a patient with congestive heart failure, the following will be assessed:

• Vitals

Congestive heart failure requires a comprehensive approach looking at various aspects of therapeutic intervention. An immediate echocardiography and blood tests enable the provider to make immediate therapeutic changes.
Patients with congestive heart failure can make an immediate appointment in our walk in clinic.

Immediate access to a congestive heart failure clinic of this kind avoids hospital admission and possible death. In some instances establishing an I.V. and giving I.V. therapy in office can provide substantial treatment.

The immediate availability of x-ray and labs enables continuous heart monitoring. This is performed on an out patient basis.

Besides medications, congestive heart failure is often treated with implantable cardioverter defibrillators (ICDs) and biventricular pacemakers. This allows us to provide multiple modalities to improve congestive heart failure.

Any comprehensive program for congestive heart failure also involves weight management and dietary restrictions. Patients are guided accordingly and encouraged to weigh themselves daily and to report any weight gain of more than 2lbs.

A comprehensive congestive heart failure clinic such as ours allows patients to return to a normal lifestyle and improves prognosis.

 

For further information check out our Educational Resource Center http://orlandocvi.com/erc.html

 

CVI Generic Drug Program

Here at Cardiovascular Interventions, we dispense a variety of generic drugs.

Our generic drugs include:

 

We offer most of the same generic drugs you can get at a retail pharmacy with benefits.

This helps in increasing patient compliance, accuracy, and documentation.

Avoid the delay and access the medications you need at a low cost.

Holter Monitor

Arrhythmia detection is an integral part of a cardiac workup. Arrhythmias may cause syncope, loss of consciousnees, palpitations, congestive heart failure, or even death.  These symptoms can not distinguish between benign and malignant (life-threatening) arrhythmias.  Therefore, accurate arrhythmia detection is of vital importance.

In a patient who is having dizziness, light headedness, palpitations, or frank loss of consciousness, we encourage them to come to our clinic immediately for evaluation.

An immediate electrocardiogram (EKG) during symptoms is extremely beneficial.

A Holter monitor is applied for 24 hours to a patient who is having frequent symptoms.

An Event recorder is a valuable test to detect intermittent arrhythmias which are unlikely to be detected within 24 hours. An event recorder is temporarily kept by a patient for 2-4 weeks. This will automatically transmit arrhythmias to our office 24 hours a day. Further, a patient initiated transmission can correlate symptoms to objective arrhythmias.

An Implanted Loop recorder is a small heart rhythm recording device that is placed under the skin on the left side of the chest with the use of local anestheic. This stores any abnormal rhythms for up to 2 years.

A loop recorder is most useful in patients who are having  rare, but severe symptoms such as black outs. This is useful in detecting arrhythmias  that are missed by other methods.

The T Wave Alternans  test (TWA): is an expanded electrocardiogram performed with a heart rate of 110. This is beneficial in detecting susceptibility to ventricular tachycardia/ ventricular fibrillation.  These arrhythmias cause sudden death. Its detection is often elusive and causes death. The t-wave alternans  study is done in our exercise stress laboratory an only takes 20 minutes to perform.

Pacemaker clinic: The interrogation of pacemakers and implantable cardioversion devices can reveal stored arrhythmias and is useful in making further therapetic changes.

 

For further information check out our Educational Resource Center http://orlandocvi.com/erc.html

Nuclear Stress Test

By injecting a nuclear tracer into a vein, blood flow to various parts of the heart muscle can be seen. If a coronary artery is narrowed or blocked there will be decreased radioactive uptake in that portion of the heart muscle during stress.

Heart attacks result in scars within the heart muscle which can also be detected by nuclear imagining. The hearts overall contraction strength is quantified during this test. Therefore, this test is of most value in detecting the presence of blocked arteries (atherosclerosis), showing previous heart attacks, and the overall strength or weakness of the heart muscle.

A narrowed artery is often detected by angiography (cardiac catheterization). This may not necessarily reveal poor circulation to the heart muscle,not the need of  revascularization (stents/coronary bypass) therapy. A nuclear stress test can demonstrate areas of poor circulation due to obstruction and is used to evaluate chest pain or results of intervention.

The nuclear stress test can be performed on the treadmill for those who have a good exercise capacity. In all others, the test is performed pharmacologically with the use of an intravenous injection of a coronary vasodilator called LEXISCAN. This versitility allows us to accurately evaluate coronary circulation and risk of coronary disease in almost everyone with little risk from the procedure.

Our nuclear laboratory is state certified and has a state of the art dual head camera.

In urgent cases, we provide the results of the test on the same day within the same visit.  This type of versitility allows us to avoid hospitalization.
MUGA scan is a test to evaluate the ejection fraction (strength of contraction of the heart) which is also done in our lab.

 

For further information check out our Educational Resource Center http://orlandocvi.com/erc.html

Pacemaker/ Defibrillator Clinic

Patients who have pacemakers and defibrillators require special care of their devices. These devices include pacemakers and implantable cardioverter defibrillators which can be interrogated in our office and even from home in some cases.

 

Interrogation gives us vital information about the normal functioning of the device, arrhythmias, and battery life.

The reprogramming of devices has to be done here in the clinic. Reprogramming is often needed according to the needs of the patient.

Our clinic allows for evaluation at any time between 8:30am- 5pm Monday to Friday. Such immediate access decreases unnecessary hospitalization.

An increasing number of cardiac conditions are being treated with implantable devices such as pacemakers, implantable cardioverter defibrillators (ICDs), biventricular pacemakers and biventricular ICDs. A typical interrogation takes about 15 minutes and gives the physicians access to the report immediately.

For some devices a home monitoring system is set up. An automatic wireless interrogation of the device may be done from a home setting at a predetermined interval, usually every month. This convenient way of following devices is better suited for stable patients or patients living far from our clinic.

Our clinic is capable of interrogating and reprogramming the maker of any device whether is be a Medtronic, St. Jude, Boston Scientific, or Biotronik device on site.

For further information check out our Educational Resource Center http://orlandocvi.com/erc.html

Nutrition and Exercise Counseling

CVI offers a wealth of information about the importanc of eating healthy an maintaining an active lifestyle. CVI provides heart healthy recipes and guidelines for exercising, as part of a prevention plan to lower your risk of heart disease.

CVI also utilizes the MedGem as seen on The Biggest Loser. This machine gives you the amount of calories your body needs at rest (resting metabolic rate). Using this number, our nutrition counselors can give you a diet plan catered to your needs and your body to promote the most efficient weight loss possible! The test takes 45 minutes which includes a one-on-one with our nutrional counselors!

Enhanced External Counterpulsation (EECP)

EECP is a non-invasive, FDA approved, outpatient therapy for patients having coronary artery disease with persistent symptoms of angina or heart failure who have already had the standard treatments for revascularization or those who are not eligible for surgical intervention.

EECP quickly stimulates the formation of collaterals to help create a natural bypass around narrowed or blocked arteries to improve coronary perfusion. This increases the amount of oxygen rich blood to the heart and reduces the symptoms of chest pain, shortness of breath, and fatigue.

This therapy can be completed in less than 2 months.

About 80% of patients usually notice improvement of symptoms with this therapy.

The benefits of EECP include:

• Decreases the requirement of medications.

• Decreases the onset and frequency of chest pain.

• Enhance the quality of life and the ability to return to daily activities.

 

How it works:

EECP affects the dynamics of cardiovascular blood flow. A series of inflatable cuffs sequenced from the calves, thighs, and hips rapidly inflate and deflate.

The timing of the inflation will be during the exact resting phase of each of your heartbeats.

This timed compression in the lower extremities pushes the arterial blood backwards into the aorta and increases the coronary perfusion pressure causing stress in the coronary arteries facilitating the development of collaterals.

 

Dr. Jamnadas has been performing EECP on patients since 1994 and has the largest EECP experience in Central Florida.

EECP is FDA-approved and covered by most insurance companies.

For further information check out our Educational Resource Center http://orlandocvi.com/erc.html

 

 

Whole Life Health

Vascular Laboratory

 

Arterial Doppler Study

 

An arterial Doppler study is a noninvasive, painless study used to assess the blood flow and pressure within the arteries using high frequency sound waves.

This study is carried out in our office daily and can take up to 1 hour to perform.

An arterial Doppler may be used to diagnose a variety of conditions including:

 

 

Venous Doppler Study

 

A venous Doppler study is a noninvasive study used to measure the direction of blood flow through a vein using high frequency waves.

This study is useful in detecting any abnormalities which may present in a vein. This study is performed in our office and only takes 30 minutes.

A venous Doppler study is useful in diagnosing the following:

 

 

Venous Reflux Study:

 

A venous reflux study is a noninvasive study used to assess venous insufficiency.

Often patients present with symptoms of venous insufficiency which include:

If you have any of these symptoms, please call our office to set an appointment for a venous reflux study.

 

 

Carotid Artery Doppler Study

 

Carotid artery Doppler study is a noninvasive procedure carried out in our office which is used to asses blocked or reduced blood flow of the arteries of the neck that could cause stroke.

This test is also used to evaluate symptoms of dizziness, vision changes, and loss of balance that may be caused by impeded or restricted blood flow through these vessels.

 

 

Abdominal Ultrasound Study

 

Abdominal ultrasound study is a simple, non-invasive office procedure that uses high frequency waves to view images of the abdomen.

This study is done in our office daily.

An abdominal study is used to evaluate the kidneys, liver, gallbladder, pancreas, spleen, and abdominal aorta.

This study is useful in the diagnosis of:

 

Lipid Clinic

Our comprehensive lipid clinic offers state of the art management of the most important risk factors for cardiac and vascular disease.

Aggressive management of hyperlipidemia has clearly been shown to reduce heart attacks, strokes, vascular diseases, and even death.

Laboratory test results are available in a matter of minutes which allow immediate medication changes that may be necessary.  

Advanced lipid panel is a test which is sent out to a reference laboratory which allows a further break down of the lipid panel to assess particle size, atherosclerotic markers like Lipoprotein –A, and other genetic markers. With this, the physician is able to go beyond the standard care to reduce patient morbidity and mortality.

The lipid clinic carefully monitors any rare potential side effects and symptoms. Most patients who do not tolerate one drug will find an alternative drug without side effects. A side effect from one drug does not necessarily predict the intolerance of other necessary drugs.

No lipid clinic is complete without dietary education which is provided here.
Most of the medications prescribed are available here in out generic drug pharmacy.

 

For further information check out our Educational Resource Center http://orlandocvi.com/erc.html

Coumadin® Clinic

Coumadin® Clinics eliminate the need for painful blood draws and instead provides a finger-stick method of blood analysis.

Maintenance of anticoagulation effects of Coumadin is important to avoid bleeding and ensure efficacy.

We monitor, track, and adjust the doses of Coumadin needed using a simple finger prick.

The frequency of testing and adjustment of medications depends on your personal diet, health, lifestyle, and other medications.

We ensure accurate results which are available within two minutes.

Echocardiography

 

What is it?

An echocardiogram (ECHO) is a simple diagnostic study used to assess the condition and function of the heart using high frequency waves. This study is performed here in our office.

 

 

 

When is it used?

 

An ECHO may show signs of:

 

You will lie on a table while a trained ultrasound technician applies a clear jelly over the desired area. A probe is used to glide over this jelly which helps in transmission of sound waves through the skin.

The probe is pressed firmly over the chest to view the heart. Sound waves produced by the heart, create an echo that can be formed into an image. These images are recorded on to a monitor to be interpreted.

Sound waves given off the blood help to assess the direction of blood flow and blood pressures in the arteries of the heart. This also detects any abnormal sounds that may be produced by the heart.

The study only lasts about 30 minutes.

This is useful in planning for your treatment and also helps in determining whether further testing is needed.

 

An ECHO may reveal:

 

For further information check out our Educational Resource Center http://orlandocvi.com/erc.html

 

Genetic Testing

 

Genetic testing is used to predict cardiovascular risks (i.e. myocardial infarction, death, strokes) and can also be used to predict the response and risks of commonly used drugs.

Incorporating genetic testing in selected patients allows for safer medication usage, better choice of medications, and other preventive treatments.

We are currently testing for the following:

• Plavix metabolism (CYP450 2C19)

• Beta Blockers (CYP450 2D6)

• Coumadin (Warfarin)

• Apo E

• Factor II Mutation

• Factor V Leiden

• Hereditary Hemochromatosis

• Hypertrophic Cardiomyopathy

 

The test involves a simple buccal swab (i.e. No blood test necessary)

 

 

 

 

Peripheral Vascular Diagnostic Center

 

Peripheral Vascular Disease

 

Peripheral vascular disease is a disease of the arteries of the circulatory system due to atherosclerosis. Atherosclerosis is a gradual build up of fat in the arterial walls depriving the limbs of the oxygenated blood flow it needs.

Atherosclerosis is not confined to one artery, but may involve other areas as well. Most commonly peripheral vascular disease is seen in the legs and is noticed by intermittent pain while walking.

Often patients present with symptoms of arterial insufficiency which include:

 

Peripheral vascular disease is often diagnosed by blood tests and arterial Doppler study.

 

Arterial Doppler Study

An arterial Doppler study is a noninvasive, painless study used to assess the blood flow and pressure within the arteries using high frequency sound waves.

This study is carried out in our office daily and can take up to 1 hour to perform.

 

 

 

Venous Insufficiency

 

Venous insufficiency is a condition which affects the veins of the legs. When the valves within the veins are damaged or not working properly, blood flows backwards resulting in a pooling of blood in the legs.

Pooling of blood in the legs increases the pressure in the veins leading to venous hypertension. This increase in pressure can cause mild symptoms of leg heaviness and aching or in chronic cases may progress to severe symptoms.

Symptoms of venous insufficiency include:

 

A venous Doppler and venous reflux study are used to assess the diagnosis and management of venous insufficiency.

 

 Venous Doppler Study

 

A venous Doppler study is a noninvasive study used to measure the direction of blood flow through a vein using high frequency waves. This study is useful in detecting any abnormalities which may present in a vein.

This study is performed in our office and only takes 30 minutes.

 

 

Venous Reflux Study:

 

A venous reflux study is a noninvasive study used to assess venous insufficiency.

This study is performed in our office.

 

 

For further information check out our Educational Resource Center http://orlandocvi.com/erc.html