Cardiologists at Baylor College of Medicine strive to provide the most comprehensive services to provide the best care for our patients. Our doctors have several areas of expertise, including areas of general cardiology, preventive cardiology, interventional cardiology, structural heart disease, heart failure and cardiac transplantation, and electrophysiology (arrhythmias).
A few of the services and diagnostic procedures performed by specialists at Baylor Heart Clinic and Hall-Garcia Cardiology Associates are listed below.
Angioplasty and stenting. Many blockages that are found by angiography can be safely opened by angioplasty. A wire is passed through the blockage, and a small balloon is advanced over the wire so that it can be inflated inside the artery, opening the blockage. However, there is an unacceptably high rate of the artery closing down again if this is the only thing done, so intracoronary stents were developed. These are small expandable metal tubes that hold the artery open. They may be bare metal or they may be coated with a medication that prevents the growth of scar tissue within the stent. Either way, they must be combined with medications to prevent clotting of the stent.
Aortic endovascular aneurysm repair. As part of the process of vascular disease, the wall of the aorta (the large blood vessel that carries blood away from the heart to the rest of the body) can become weak and dilate, and an aneurysm can form, either in the thoracic aorta in the chest or in the abdominal aorta in the belly. When these get large enough to threaten to rupture, a procedure is necessary to repair them, either a surgical procedure or a minimally invasive procedure in which the aorta is reconstructed from within using a device called a stent graft. We have been involved from the very beginning of this developing field. Additional information provided in Abdominal Aortic Aneurysm: Diagnosis and Non-Surgical Options.
Cardiac catheterization and coronary angiography. This common procedure is performed in order to measure pressures inside the heart and take pictures of the coronary arteries – usually in order to look for blockages or atherosclerotic plaques that can cause chest pains and shortness of breath as well as a variety of other symptoms, and when severe can even cause a myocardial infarction (heart attack). Catheters are placed via a sheath (narrow tube) in the artery of the groin or arm, advanced into the heart, and pictures are taken with injectable contrast dye and x-ray.
Cardiac resynchronization. A significant number of patients with symptoms of heart failure such as shortness of breath, fatigue, and fluid retention also have poor heart function and disease of the electrical system of the heart. The electrical component can be significantly improved, in most cases resulting in improved symptoms and improved heart function, by placing a pacing wire through the veins over to the left side of the heart through the coronary veins. The heart is then paced from both sides, with greater efficiency.
Carotid angiography and intervention. Blockages or plaques in the carotid arteries in the neck can cause neurologic symptoms like transient ischemic attacks (TIA or "ministrokes") or strokes. The risk of this is decreased by medication, but in many cases the blockage is already severe enough to make it necessary to open the artery. Traditionally, this has been done via a surgical procedure called carotid endarterectomy, but in recent years it has also become possible to open the artery via minimally invasive stenting, especially in patients who are poor candidates for surgery. For more information see Carotid Artery Disease.
Echocardiography. Our physicians have decades of experience with this common procedure, in which the heart is examined using ultrasound to measure heart function, diagnose disease of the heart valves, and clarify the cause of possibly cardiac symptoms. It is most commonly performed via an ultrasound probe on the chest (transthoracic echocardiography) but in some cases must be performed via a probe inside the throat to look at the heart from behind (transesophageal echocardiography).
Electrocardiograph (EKG) tests. These tests use the electrocardiogram to evaluate the electrical activity generated by the heart at rest and with activity.
Electrophysiologic study and radiofrequency ablation. Electrical or rhythm disorders of the heart can range from the annoying but benign to the life-threatening, and over the last 10 to 15 years, exciting advances have been made in the medical and interventional treatment of these arrhythmias. Small catheters can be placed inside the heart via sheaths in the groin, and the abnormal circuits that cause the arrhythmia mapped out prior to delivering either heat energy (radiofrequency) or freezing energy (cryoablation) to create small scars that break the abnormal circuits. Our physicians have been in the forefront of research and development of these procedures, and we routinely treat all of the arrhythmias that can be ablated, including supraventricular tachycardia (SVT), ventricular tachycardia (VT), and atrial fibrillation. For more information see Cardiac Electrophysiology.
The Stereotaxis Niobe Magnetic Navigation System is one such device. This system enables our physician to perform complex procedures. Stereotaxis is a magnetic system that maps and guides catheters safer more efficient, through out the cardiovascular system. Ablation involves using a catheter to create a line of scar tissue within the heart that will act as a road block to short-circuit an arrhythmia. Traditional ablation methods utilize a harder catheter that is three feet long. The only available access to manipulate the catheter is through the groin. Stereotaxis uses magnets to steer the catheter to the precise area in order to terminate the arrhythmia.
Laboratory tests. Laboratory tests include a number of blood tests used to diagnose and monitor treatment for heart disease.
LARIAT procedure. The LARIAT procedure is used to reduce stroke risk in patients with atrial fibrillation (”a fib” or “AF”) who are unable to take blood thinning medications. Since stroke is the third largest cause of death in atrial fibrillation patients, the new therapy is a potential life saver. Atrial fibrillation affects an estimated three million people. and patients with this condition are five times more likely to have a stroke.
Laser lead extraction. Unfortunately, just like any other man-made device, pacemaker and defibrillator wires can break or get infected, and wire that have been implanted for several years can be difficult to remove because of scar tissue that forms around them. Our physicians are extremely experienced in handling this difficult problem of extracting leads using a variety of tools, most frequently laser-powered or mechanical sheaths to break up the scar tissue and remove the leads.
Non-invasive tests of heart rhythms (Holter monitors, event recorders). These are tests that use small devices that are placed on the patient to record the electrical rhythm of the heart. These tests are used to investigate heart rate abnormalities (arrhythmias) and palpitations. For more information see Non-Invasive Tests.
Nuclear imaging. This method produces images by detecting radiation from different parts of the body after the administration of a radioactive tracer material. The most common type of nuclear test performed is a myocardial perfusion imaging test. It shows how well blood flows to the heart muscle and is usually done along with a stress test.
Pacemakers and defibrillators. Our physicians are experts in the placement of these implantable devices. A pacemaker is placed under the skin (usually at the shoulder) with wires extending through the veins into the heart. Electrical signals from the pacemaker can be used to increase heart rate when the electrical system of the heart fails or is diseased. In addition to being able to act as a pacemaker, an implantable defibrillator senses dangerous, life threatening heart rhythms (ventricular tachycardia and ventricular fibrillation) and shocks the heart back into normal rhythm, which can be life-saving. This may be recommended either after a life-threatening event which the patient has been lucky enough to survive, or more commonly as a preventative measure in patients who are at high risk for future events of "sudden cardiac death."
Peripheral intervention. Blockages can occur in almost any artery of the body – our physicians are expert in the care of diseases of the renal (kidney) arteries, mesenteric (gut) arteries, subclavian (arm) arteries, and the arteries of the leg.
Radiographic tests. These tests use x-ray machines or high tech machines (CT, MRI) to create pictures of the internal structures of the chest and heart.
Stress testing and noninvasive cardiac risk stratification. A stress test may be necessary to diagnose heart disease or to estimate the patient’s risk of a future cardiac event, and in many cases some kind of imaging is necessary to fully evaluate the patient. As an office-based procedure, we perform stress testing both with nuclear imaging, in which a mildly radioactive tracer is injected in order to measure blood flow, and with stress echocardiography, in which the heart is watched with ultrasound during exertion.
Transcatheter aortic valve implantation. This new procedure has shown to significantly reduce mortality compared to standard treatment. High risk patients have shown to remarkable improvement.