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3650 W. Wheatland Rd. Suite C, Dallas, TX 75237
Phone: 214-774-9771
Fax: 214-774-9762
Russell M. Canham
, MD, MCS
Testing and Studies
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ANKLE-BRACHIAL INDEX (ABI)
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The ankle-brachial index or ABI test is a quick, noninvasive way to check for peripheral artery disease (PAD). The disease occurs when narrowed arteries reduce the blood flow to your limbs. PAD can cause leg pain when walking and increases the risk of heart attack and stroke.
The ankle-brachial index test compares the blood pressure measured at your ankle with the blood pressure measured at your arm. A low ankle-brachial index number can indicate narrowing or blockage of the arteries in your legs.
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ADVANCED LIPID and LAB TESTING
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Standard lipid testing, represented by total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglycerides, is a well-established platform for cardiovascular disease (CVD) risk prediction and management. Despite the proven clinical utility of standard lipid testing for risk management, a significant burden of CVD events remains unaddressed in primary and secondary prevention populations.
Standard lipids are carried within lipoprotein particles that vary in size, density, charge, core lipid composition, specific apolipoproteins, and function. These advanced lipoprotein tests have been proposed for improving assessment of CVD risk and guiding lipid modifying therapies. Some of these tests include apolipoprotein B (apoB), small density LDL (sdLDL), and lipoprotein(a). Our advanced labs also include new cardiac biomarkers and lab tests for inflammation to help guide your therapy. These more advanced labs are still be studied and evaluated for improving clinical management and patient outcomes.
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CORONARY CALCIUM SCORE
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A coronary calcium scan for the heart, is a specialized X-ray test that provides pictures of your heart that can help your doctor detect and measure calcium-containing plaque in the arteries.
Plaque inside the arteries of your heart can grow and restrict blood flow to the muscles of the heart. Measuring calcified plaque with a heart scan may allow your doctor to identify possible coronary artery disease before you have signs and symptoms.
Your doctor will use your test results to determine if you may need medication or lifestyle changes to reduce the risk of heart attack or other heart problems.
Plaque is made up of fats, cholesterol, calcium and other substances in the blood. It develops gradually over time, long before there are any signs or symptoms of disease. These deposits can restrict the flow of oxygen-rich blood to the muscles of the heart. Plaque also may burst, triggering a blood clot that can cause a heart attack.
Coronary Artery Calcium (CAC) scoring is calculated based on the amount of plaque observed in the CT scan. It may be converted to a percentile rank based on your age and gender. Your likelihood of having heart disease or a heart attack correlates with your calcium scoring. As with all testing, it has limitations and can miss soft non-calcified plaque.
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CARDIAC CT AND MRI​
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A computerized tomography (CT) coronary angiogram is an imaging test that looks at the arteries that supply blood to your heart. It might be done to diagnose the cause of chest pain or other symptoms.
A CT coronary angiogram produces images of your heart and its blood vessels. The procedure is noninvasive. CT coronary angiograms are used to diagnose a variety of heart conditions. High resolution scanners can produce very good images and even calculate a rough estimate fractional flow reserve (FFR) or coronary pressures across a lesion.
A coronary CT angiogram is different from a standard coronary angiogram as it is non-invasive, but it does use a moderate dose of contrast dye. A coronary CT angiogram is mainly used to check for narrowed or blocked arteries in your heart (coronary artery disease). A good study is dependent on slow and stable heart rates and winding or torturous vessels can mistakenly be reported as a blockage.
Magnetic resonance imaging (MRI) is a test that uses a large magnet, radio signals, and a computer to make very good images of the heart. It creates a strong magnetic field around the body.
MRI of the heart may be done to assess and better define a cardiomyopathy or heart failure or potential reasons for an arrhythmia. This happens when the heart muscle becomes thick and weakened. It is useful for congenital heart disease, or defects in the heart that happen before birth. It is also useful for cardiac tumors.
The test can help doctors study the structure and function of heart muscle, find the cause of a patient's heart failure or identify tissue damage due to a heart attack.
Some cardiac MRI patients will receive an injection of a contrast medium or dye through a vein before the scan to improve the ability of the MRI machine to capture more detailed images of tissues that can affect the kidneys.
Cardiac MRI also is used to predict how the heart will respond to treatments for coronary artery disease, such as coronary artery bypass surgery or angioplasty.
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CAROTID ULTRASOUND
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Carotid ultrasound is a procedure that uses sound waves to examine the blood flow through the carotid arteries. Your two carotid arteries are located on each side of your neck. They deliver blood from your heart to your brain.
Carotid ultrasound tests for blocked or narrowed carotid arteries which can increase the risk of stroke. The results can help your doctor determine a treatment to lower your stroke risk.
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ECHOCARDIOGRAM
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An echocardiogram (echo) is an easy quick test that uses high frequency sound waves (ultrasound) to make pictures of your heart. This can be done conveniently in our office.
An echo uses sound waves to create pictures of your heart’s chambers, valves, walls and the blood vessels (aorta, arteries, veins) attached to your heart. A probe called a transducer is passed over your chest.
It is great for assessing the size, shape and thickness of your heart, the movement of your heart’s walls, the heart’s pumping strength and if heart failure is present. It is also very good to assess if the heart valves are working correctly or leaking with doppler imaging. If blood is leaking backwards through your heart valves (regurgitation) or if the heart valves are too narrow (stenosis) and not allowing enough blood through. It can also see if there is a tumor or infectious growth around your heart valves. An echo will help find out if there are problems with the outer lining of your heart (the pericardium), problems with the large blood vessels that enter and leave the heart, blood clots in the chambers of your heart or abnormal holes between the chambers of the heart.
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ELECTROCARDIOGRAM (EKG or ECG)
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An electrocardiogram (EKG or ECG), is a test that measures the electrical activity of the heartbeat. With each beat, an electrical impulse travels through the heart. This wave causes the muscle to squeeze and pump blood from the heart.
A normal heartbeat on ECG will show the timing of the top and lower chambers. It can help identify old heart attacks, arrhythmias, conduction disease, and thickness in the heart muscle, chamber sizes and even about the pericardium or sack around the heart. It is useful to identify those at risk coronary disease or ischemia and can even identify rare genetic cardiac syndromes.
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EXERCISE TREADMILL STRESS TESTING
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A stress test, sometimes called a treadmill test or exercise test helps assess for abnormal changes on the ECG with exercise that can occur with narrowing in the heart vessels that can cause heart attack. It can diagnose coronary artery disease that can cause symptoms such as chest pain, shortness of breath or lightheadedness. It can help determine a safe level of exercise and check the effectiveness of procedures done to improve coronary artery circulation in patients with coronary artery disease.
As your body works harder during the test on the treadmill, it requires more oxygen and the heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart. It also helps doctors know the kind and level of exercise appropriate for a patient.
During the study, a person is hooked up to equipment to monitor the heart and the speed is increased for a faster pace and the treadmill is slowly inclined to produce the effect of going up a small hill. Heart rate, breathing, blood pressure, electrocardiogram (ECG or EKG), and how tired you feel are monitored during the test.
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LOWER EXTREMITY ARTERIAL DOPPLER
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An arterial ultrasound of the upper or lower extremities provides pictures of the arteries and the blood flow to the legs. It is a safe noninvasive study used to examine the blood circulation of the lower extremities.
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A Doppler or duplex ultrasound study is a technique during the study that evaluates blood flow through a blood vessel. Doppler ultrasound evaluates the speed and direction of blood as it flows through an artery or vein of the arm or leg.
It is helpful at diagnosing peripheral arterial disease and is performed after an abnormal ankle-brachial index or ABI or for patients with known or are at high risk of peripheral arterial disease.
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NUCLEAR STRESS TEST
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A nuclear stress test or Myocardial Perfusion Scan (MPS) is a very accurate and safe study that uses radioactive dye and an imaging machine to create pictures showing the blood flow or perfusion to your heart. It is one of the best tests available to diagnose coronary artery disease and find out if a heart attack has occurred. It is used to show how well blood is flowing to the heart and how well the heart is working. There are 2 main techniques for a MPS, a single photon emission computed tomography (SPECT) and a positron emission tomography (PET).
Both SPECT and PET MPS scans use very safe radioactive material called tracers. The tracers mix with your blood and are taken up by living heart muscle. The tracer’s signals are converted into images by a computer. The pictures will help your doctor see if your heart is getting enough blood or if blood flow is reduced because of narrowed arteries. It can be used to examine blood flow in your heart at rest and during exercise. If you can’t exercise, you’ll get a medicine to increase the blood flow in your heart as if you were exercising called a chemical or pharmacologic stress. These nuclear stress test scans can also give information about how well your heart is pumping.
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They help diagnose coronary artery disease (CAD) and damage due to a heart attack. MPS scans can show healthy and damaged heart muscle that is scarred from a prior heart attack, or may have ischemia and develop a future one. It can help find out if you will benefit with viable tissue from a percutaneous coronary intervention (PCI) such as angioplasty and stenting, coronary artery bypass surgery (CABG) or another procedure.
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STRESS ECHOCARDIOGRAM
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A stress echocardiography, also called an echocardiography stress test or stress echo, is a very helpful procedure that determines how well your heart and blood vessels are working.
During a stress echocardiography, you will exercise on a treadmill while you are monitored with your blood pressure and heart rhythm on ECG. When your heart rate reaches peak levels, your doctor will take ultrasound images of your heart to determine whether your heart muscles are getting enough blood and oxygen while you exercise.
A stress echocardiography test can be ordered if you have chest pain that is thought to be due to coronary artery disease or a myocardial infarction, which is a heart attack. This test also determines how much exercise you can safely tolerate if you’re in cardiac rehabilitation. If positive, a left heart catheterization may be ordered to further evaluate your coronary vessels for significant blockages.
The test can also tell your doctor how well treatments such as bypass grafting, angioplasty, and anti-anginal or antiarrhythmic medications are working.
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TELEMETRY MONITORING OR HOLTER OR MCOT
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Ambulatory Rhythm Monitoring includes several types of wearable heart monitors. Holter monitors, cardiac event or telemetry monitors, and mobile cardiac telemetry (MCOT) all provide ways to monitor a patient’s electrocardiogram for an extended period of time. Their main purpose of them all, is to determine the cause of a brief event by recording a patient’s heart rate and rhythm during normal activity. They involve wearing a patch that attaches to your chest for a period of times ranging from 24 hours to 30 days. Although similar, all these monitor devices have distinctive differences and meet different needs, which impacts the physician’s choice of monitoring method.
Holter monitors are often worn around 24 to 48 hours during which the Holter is monitoring the patient’s heart rhythm. A cardiac event or telemetry monitor is another typically worn for 14 to 30 days, it is prescribed for patients whose symptoms occur infrequently. The patient can manually presses a button to record the preceding moment following several minutes of the event in addition to an auto-capture recording feature. Both of these monitors store the recorded data, which is eventually transmitted either to a physician’s office or to a central recording station to be uploaded for review. MCOT automatically send data and provide even more information such as arrhythmias burden. The data is transmitted to a 24-hour manned monitoring center. In contrast to the cardiac event monitor, MCT provides real-time monitoring and analysis.
You may be prescribed one of these for symptoms like palpitations, dizziness, syncope, or concern for abnormal rhythms. Longer monitoring can be done with a very small and safe implantable loop recorder (ILR), which can last up to 2-3 years. This can also be placed in the office setting.
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