Holter monitoring is a method of recording your heartbeat or electrical activity for a full 24 hour period, in an effort to determine if your heart rhythm has any abnormalities. As with the standard EKG, electrodes are placed on the chest. The electrodes connect to a lightweight unit, which attaches to a belt or shoulder strap. While wearing the monitor you are instructed to keep a diary of activities that you perform and the time of day that the activities occur. This will assist your doctor in determining if any of the irregularities in your EKG are related to physical exertion, emotional stress, etc.

Enhanced External Counterpulsation (EECP) therapy is a noninvasive, outpatient therapy used in the treatment of ischemic cardiovascular diseases, currently used to manage chronic stable angina and heart failure. The therapy increases blood flow and oxygen supply to the heart muscle and other organs and decreases the heart's workload and need for oxygen while also improving function of the endothelium, the inner lining of blood vessels throughout the body, lessening resistance to blood flow. These actions reduce or eliminate symptoms of angina and heart failure, and improve the quality of life for thousands of people worldwide. For details about Kettering's EECP program, call (937) 395-8366.

Space-Age Technology helps angina patients.

A coronary stent is a small metal coil or mesh tube that is placed in a narrowed coronary artery (blood vessel that feeds the heart with blood and oxygen) in an effort to improve blood flow to a region of the heart muscle. The stent is placed in the narrowed blood vessel through a long, thin tube (catheter) and it remains in place to permanently hold the vessel open.

No sooner had the FDA and Medicare approved carotid artery stenting, than Kettering Medical Center did the first procedure in the south Dayton area. M. Niranjan Reddy, MD, and Raja Nazir, MD performed the stenting in June, 2005 on an elderly gentleman who had previous history of carotid surgery which was high risk. "He's doing very well," said Reddy.

Reddy explained the procedure is for patients with severe stenosis and at high risk for carotid surgery. A relatively new endovascular treatment, carotid stenting can be a better option for some patients.

The procedure uses a stent to open partially blocked arteries and to hold the plaque against the artery wall. An embolic protection device is also used to help catch pieces of plaque or debris that can be released during the procedure and lead to a stroke.

The SAPHIRE and ARCHER trials indicated that carotid artery stenting is a safe and equal alternative to carotid endarterectomy. It is done with a catheter-based approach from the groin after the embolic protection device has been placed. The physician maneuvers the stent on a catheter into the vessel and positions the stent across the narrowed area in the carotid artery.

The procedure can be done by interventional cardiologists, interventional radiologists and vascular surgeons who have passed the FDA training program.

Your heart valves are doorways that open and close to direct blood to flow as it is pumped between the upper and lower heart chambers. When heart valve disease occurs, the valve may not open all of the way (stenosis). When this occurs less blood is circulated with each heart beat. Valvular disease can also involve problems with complete valve closure (insufficiency). When this occurs the blood may leak in a backward direction. With either of these abnormalities the heart must work harder to circulate blood and oxygen to the body tissues. Both problems can be corrected with surgery.

During valve repair surgery, stenosis can be repaired by cutting or separating parts of the valve to allow more blood to flow through. Valvular insufficiency can be repaired by strengthening or shortening parts of the valve. If the valve cannot be repaired it can be replaced with a tissue valve taken from a cow, a pig, or another human. Valves can also be replaced with mechanical manmade materials.

Cardiac catheterization is a non-surgical procedure that assists your doctor in diagnosing a heart problem. To perform the procedure, your cardiologist inserts a long, flexible tube called a catheter, into a blood vessel in your arm or groin area. The catheter is gently guided through the blood vessel to your heart. Once the catheter is in place, x-ray pictures and other readings are taken to help your doctor evaluate how well your heart is working.

The information gathered during the cardiac catheterization can help to identify narrowed arteries in the heart, heart valve problems, or abnormalities in the structure of the heart (usually something a person is born with). During the procedure the doctor can view the blood flow through the arteries that feed the heart, the pumping action of the heart muscle, the opening and closing of each heart valve, and various pressure readings inside the heart structure. The data collected during this procedure are used to help the doctor make the best possible treatment recommendations for abnormal heart conditions.

A dobutamine stress test uses the drug (dobutamine) to make your heart beat faster, as if you were exercising. After this drug is injected, an echocardiogram test is performed to image your heart. Viewing the echocardiogram while the heart is under stress helps to determine if certain portions of the heart muscle are not getting enough blood supply. See ECHOCARDIOGRAM for more information about how the sound wave images are produced.

The implantable cardioverter defibrillator (ICD) is a device that is placed in your body to help control your heart rhythm. The ICD is a small, lightweight device that keeps track of your heart rhythm. The ICD generator is surgically implanted under the skin at the left shoulder, below the collar bone, or on the left side of the abdomen at the bottom of the rib cage. Electrode wires are then threaded into the heart to enable the ICD to track and record your heart rhythm. If a life-threatening heart rhythm occurs the ICD will send an electric shock to your heart to return it to a normal rhythm.

KICKSTARTERS

Kickstarters is a support group for patients with an Implantable Cardioverter-Defibrillator (ICD). This group offers an informal meeting with ICD patients, their families, Kettering Medical Center clinical staff, plus one of the electrophysiology doctors. The goals are to provide an opportunity to share personal experiences, answer questions or concerns, and keep you up to date on new developments in ICD therapy.

In 2003, Kettering Medical Center became the first hospital in southwestern Ohio to perform catheter ablation for atrial fibrillation. Since then, electrophysiologist Dr. K. Baig has performed close to 50 of these procedures with a success rate of 75 percent and no complications. Candidates for this procedure, which essentially cauterizes the cells in the heart which are causing the fibrillation, have either exceptionally fast, slow or irregular heart rhythms.

Atrial fibrillation is a fast and irregular heart rhythm. It carries an increased risk of mortality with it. Most patients experience a poor quality of life and functional status. The drug-based treatment has the risk of severe side effects and increase mortality. In the last seven years catheter-based ablation has proven to be effective and safe in bringing the rhythm back to normal. The procedure has also shown it improves the quality and length of life.

The procedure is performed under general anesthesia in the Electro Physiology (EP) lab. The catheters are inserted through the veins in the groin and neck. No surgical incisions are made. At the end of the procedure, the catheters are removed and the patient has simple bandages at the puncture sites. There is a four-hour bed rest following the procedure.

Kettering Medical Center boasts the most experienced nursing team in the EP lab. The procedure also utilizes the most cutting-edge and innovative technology currently available. This includes state-of-art 3-D intracardia and 3-D CT scanning of the heart chambers, intracardiac echocardiography and a variety of ablation catheters.

An echocardiogram is a test that uses harmless sound waves to create an image of your heart. It shows how well your heart muscle and heart valves are working. It also shows the size of your heart. The image of your heart is created via a transducer device that looks like a microphone. The transducer is coated with a cool gel and is moved firmly over the surface of your chest to record sound waves off your heart. A computer then changes these sound waves into images that are seen on a TV screen.

A pacemaker is a small electronic device that helps the electrical system in your heart to send electrical signals at the right speed. Problems with the heart's electrical system can make your heart beat slow or uneven. When this happens you may have dizziness, shortness of breath, fatigue, or fainting spells. These symptoms are most likely to occur when you are doing an activity.

The pacemaker is surgically implanted under the skin at the left shoulder, below the collar bone. Electrode wires are then threaded into the heart to enable the pacemaker to track and record your heart rate. When the heart rate is too slow, the pacemaker generates signals to simulate the heart to beat at the right pace.

Coronary angioplasty is a non-surgical procedure that relieves symptoms of coronary artery disease (commonly known as heart pain or angina) by improving blood flow to a region of your heart that is not getting enough blood and oxygen. During the angioplasty procedure a thin flexible tube (catheter) with a balloon at the tip, is inserted into an artery in your heart where the blood vessel is narrowed. The balloon is then inflated in a effort to widen the blood vessel to allow more blood to flow through.

The electrocardiogram is a test that will record the electrical impulses of the heart's activity through electrodes placed on the chest, shoulders, and legs. These electrical impulses stimulate the heart to pump. If abnormalities in the impulses occur, the heart may beat irregularly or the appearance of the EKG may change shape. The information gathered from this simple test provides much preliminary data for the doctor, that will assist in diagnosing a potential heart problem or in determining what additional testing is needed to make an accurate diagnosis.

Positron emission tomography has the ability to measure chemical changes that occur in the body as a result of many disease processes. The most widely used application of PET in heart patients involves the analysis and location of heart muscle viability. Analysis of the viability of the muscle tissue is very important information when a doctor is in the process of determining the best treatment for a patient with heart muscle damage, after a heart attack. Attempting to increase blood circulation (via angioplasty or bypass surgery) to a portion of the heart muscle that is dead (not viable) is useless. PET therefore provides the information necessary to determine which areas of the heart muscle would benefit from this type of intervention.

Coronary artery bypass surgery creates a new pathway around one or more blockages in the arteries that feed the heart with blood and oxygen, thus allowing oxygen rich blood to again be supplied to areas of heart that were lacking. In most cases, a healthy blood vessel is taken from another part of your body and surgically placed on the heart to create the new pathway. This new pathway is commonly known as a graft. The graft is usually taken from inside the chest wall, the legs or the arms.

Electrophysiology (EP) studies help your doctor to determine the exact type of heart rhythm distrubance (abnormality in the speed or pattern of your heartbeat) you have. During the EP study one or more small flexible tubes (electrode catheters) are inserted in the groin or neck vein and gently threaded into the heart. The electrode catheters record electrical activity in the heart and find where and when these electrical signals begin and how often they are sent.

The electrode catheter can also send electrical signals to stimulate the heart. If these signals cause an abnormal heart rhythm (arrhythmia), medications can given through an IV line to test if they can stop or prevent the arrhythmia from occurring. Arrhythmias can also be stopped by using electrode catheters to regulate (pace) the heartbeat. In some cases an electric shock (defibrillation) is needed to stop the arrhythmia.

The thallium stress test is similar to a regular stress test in that your heartbeat is recorded while you walk on a treadmill or ride a stationary bike, to a maximum exercise level. See EXERCISE STRESS TEST for more information. In addition, this test involves injecting an intravenous (IV) tracer, then stopping the exercise and immediately scanning the heart. Pictures are taken immediately after exercise and then several hours later in order to determine how well the blood flows to each region of the heart muscle.

Coronary atherectomy (also known as rotoblator) is a non-surgical procedure that relieves symptoms of coronary artery disease (commonly known as heart pain or angina) by improving blood flow to a region of your heart that is not getting enough blood and oxygen. During the atherectomy procedure a thin flexible tube (catheter) carrying a special cutting or sanding device gently shaves the inside of the blood vessel at the location of a blockage. The shaved particles are then vacuumed into the catheter and removed.

An exercise stress test records your heartbeat while you walk on a treadmill or ride a stationary bike. The test is often used to evaluate the cause of chest pain. In addition, the test can also evaluate maximum exercise tolerance and/or the effectiveness of medical therapy for a heart condition. During the test electrode pads are placed on your upper body to monitor your heart. The exercise test starts at a low intensity and gradually gets harder until you have reached your maximum tolerance.

Transesophageal Echocardiography is a test that allows your doctor to record images of your heart from inside your esophagus, or food pipe. The esophagus lies just behind the heart, therefore viewing heart images from this position produces clearer pictures of the heart's movement, than does standard echocardiography taken from outside the chest. During TEE, as with standard echo, harmless sound waves bounce off your heart. The images created with these sound waves help your doctor to identify and treat problems such as infection, disease, or defects in your heart's walls or valves.