Services, Procedures, & Conditions
Services & Procedures
Executive Health Services
With Executive HealthServices™ from Heart Group of the Eastern Shore, you are the priority. We schedule staff around your visit to accommodate your healthcare needs in a timely manner. There is no waiting, and what you receive – it’s time well spent.
Executive HealthServices™ evaluates you individually focusing on your health needs. Our goal is provide you comprehensive care in one visit helping you maintain your active lifestyle. We understand time is precious and that’s why we customize your appointment to suit your schedule. Every test is given detailed attention during your one visit – that’s time well spent.
The PLATINUM HealthServices evaluation includes the following tests for patients interested in an executive physical:
· Carotid Doppler
· AAA (aortic) ultrasound
· Peripheral vascular ultrasound
· Stress Testing
· Visit with Exercise Physiologist
· Review of tests and evaluations with Dr. Pursley
The GOLD HealthServices evaluation includes the following tests for patients interested in an executive physical:
· Carotid Doppler
· AAA (aortic) ultrasound
· Peripheral vascular ultrasound
Arrhythmia monitoring refers to tests physicians use to identify the type and the cause of irregular heart rhythms. These tests include electrocardiographic (ECG) testing and electrophysiology (EP) testing.
Cardiac Catheterization and Angiography
Cardiac catheterization involves the insertion of a thin tube called a catheter into an artery. The catheter is threaded through the arterial system to the arteries in the heart, where physicians use it to collect information about the heart’s blood supply or to assess or treat other cardiac problems. The most common test that is performed in conjunction with cardiac catheterization is angiography, also called arteriography. During angiography, a contrast dye used to produce images of the heart’s blood vessels is pumped through the catheter and into the coronary arteries. A physician traces the flow of this dye with an x ray machine to get a ‘road map’ of the heart’s blood vessels. The pictures that result, called angiograms or arteriograms, help doctors pinpoint the location and extent of problems with the heart’s blood supply and decide on treatment.
Congestive Heart Failure Therapy
The goal of heart failure therapy is to lessen the effect of heart failure symptoms and to keep people with the condition out of the hospital. Heart failure caused by valve disease, toxins such as drugs used in chemotherapy, or congenital heart defects is often reversible. People with heart failure caused by permanently damaged or weakened heart muscle, however, require long-term lifestyle modification and medication. Heart failure therapy requires lifestyle changes, such as losing weight, quitting smoking, limiting alcohol consumption, and reducing salt and fluid in the diet. These changes can improve the heart’s ability to function and may help people with weakened hearts feel stronger. Additionally, most people will need to take medications to manage the symptoms of living with a weakened heart for the rest of their lives. Physicians recommend that people take their medications at the same time each day and keep a record that includes the name of the medication, the dosage, the number of times per day the medication is taken, and the symptom or condition the medication is intended to treat.
ECG Stress Testing
An electrocardiogram (ECG) stress test monitors a person’s heartbeat at rest and during exercise, most commonly while a person walks on a treadmill. A physician observes the person, monitors the exercise level, and makes recordings until the person’s heart nears a maximum predicted heart rate. The heart also is monitored during the period of cool-down or recovery that immediately follows exercise. The recordings made before, during, and immediately after an ECG stress test can show subtle changes in the heart’s electrical activity.
Echocardiography is a diagnostic test that uses ultrasound, or high-frequency sound waves, to create images of the heart. A transducer, or modified microphone, turns electrical energy into sound waves, which bounce off tissues in the heart and are recorded onto videotape or computer for later analysis. Echocardiography is primarily used to detect and assess the following: blocked coronary arteries; heart failure or cardiomyopathy (enlargement of the heart); congenital (present at birth) heart defects; damage from hypertension (high blood pressure); heart attack damage or scarring; pericardial disease (the membrane that surrounds the heart); and the function of the heart muscle, blood vessels, and valves.
Duplex ultrasonography is a form of ultrasound that produces images that differentiate between the body’s soft tissues and its fluid-filled structures. Duplex ultrasound can also detect motion, such as the movement of blood cells. Duplex ultrasound is used to detect the presence and severity of numerous conditions, including: thrombosis (blood clots); blockages from atherosclerosis (hardening of the arteries); thrombophlebitis (an inflammation of the blood vessels); trauma to an artery or vein; Raynaud’s phenomenon (a spasm of small blood vessels in the fingers); and increases in the thickness of the blood vessel lining.
One way in which a physician diagnoses coronary heart disease is through nuclear imaging. During nuclear imaging, a small dose of a radioactive isotope is injected into the bloodstream. The radioisotope, or tracer, is carried through the bloodstream and into the myocardium, or heart muscle. Special cameras detect the radiation released from the tracers and record information about the heart muscle and blood flow. This information is then used to produce images of the heart on a computer screen or film.
Pacemaker Implantation and Monitoring
If heart muscle cells are damaged such that electrical rhythms to the heart are interrupted, delayed, or sent down the wrong path, the heartbeat may become irregular, too fast, or too slow. The patient may require a pacemaker, a device to restore a normal heartbeat. Most pacemakers are installed to counteract problems with either failure of cardiac impulse formation or failure of the atrioventricular node (A-V node) conduction. The procedure is performed on an outpatient basis and rarely causes complications. Once the pacemaker is fully adjusted, the person should be able to carry out all the functions of normal daily life, with the pacemaker automatically adapting to various circulation and heartbeat needs.
Nuclear Stress Testing
One way that a physician diagnoses coronary heart disease is through a nuclear stress test. During a nuclear stress test, a small dose of a radioactive isotope is injected into the bloodstream. The radioisotope, or tracer, is carried through the bloodstream and into the myocardium, or heart muscle. Shortly after exercising, a special camera senses the radioactivity of the tracer and constructs an image of the heart. Parts of the heart muscle that receive normal blood flow receive larger amounts of tracer and appear brighter than areas that have inadequate blood flow.
Peripheral Vascular Disease Monitoring and Treatment
Treatment programs are tailored to each individual and take into account the needs of the patient and family. The treatment will depend on factors such as the severity of the symptoms, the degree of arterial narrowing or blockage and the patient’s overall health. Treatment for patients with PVD is provided in three areas: controlling risk factors through lifestyle changes and medication; endovascular therapy or surgery to reopen arteries to the legs or arms; specialized care for patients with PVD who have open wounds or vascular ulcers that won’t heal.
Acute Myocardial Infarction
A myocardial infarction (MI) is damage to the heart muscle or myocardium, that results from a lack of blood flow to the heart. The word acute is used to describe a heart attack because symptoms and damage occur suddenly. People who suffer heart attacks require immediate medical attention. If treatment begins soon after symptoms start, heart attack deaths and heart damage can often be avoided. Each heart attack is different and may have different symptoms. Although different people make different comparisons to express the discomfort they feel, some common symptoms include: chest discomfort that may start out feeling mild and build in intensity; discomfort in other areas of the upper body; shortness of breath; breaking out in a cold sweat; feeling dizzy, light-headed or nauseated; or belching or vomiting.
Angina Pectoris, Stable
In a healthy heart, an increased demand for oxygen because of exercise, for example, results in increased blood flow to the heart. But when coronary arteries are narrowed or blocked by plaque (a condition called atherosclerosis or hardening of the arteries), the heart does not receive enough blood to meet these periods of increased oxygen demands. Stable angina is pain associated with this unmet demand for blood and oxygen in the heart brought on by physical activity or emotional stress. Angina that occurs during or after physical exercise or emotional stress is referred to as stable because of the predictable pattern of heart pain caused by exertion or stress. Stable angina can occur intermittently for weeks, months, or even years.
Angina Pectoris, Unstable
Angina pectoris is chest pain or discomfort. A person may feel pain when insufficient oxygen-rich blood reaches the heart muscle. This reduced blood flow is caused by coronary heart disease (CHD), an accumulation of plaque inside the coronary blood vessels. Angina that occurs unpredictably or during rest is called unstable angina. Sometimes, unstable angina can result from a temporary blood clot that suddenly blocks blood flow to the heart. The pain subsides when the clot dissolves and blood flow resumes. If a person has experienced angina after exertion, called stable angina, and angina symptoms begin to last after exercise or occur at rest, the angina may have become unstable angina. This usually means an artery has narrowed further, often because of a blood clot. If an episode of unstable angina is the first instance of angina a person experiences, it is called new onset unstable angina.
Aortic Valve Disease
The heart has four valves: two on the right side of the heart (the tricuspid and pulmonary valves), and two valves on the left side of the heart (the mitral and aortic valves). Resembling flaps, each valve is made up of segments or leaflets, and each opens and closes so that blood flows through the heart in only one direction. A normal aortic valve has three leaflets that seal tightly together when closed. During contraction, the aortic valve opens to allow blood to flow from the left ventricle into the aorta. When the heart relaxes, the aortic valve closes, preventing blood from re-entering the left ventricle. When aortic valve disease is present, the valve no longer opens or closes properly. Common aortic valve problems are aortic stenosis, or narrowing, and aortic regurgitation, or leakage.
Carotid Artery Disease
Carotid artery disease is the narrowing or blockage of the carotid arteries, which are located in the neck and deliver oxygenated blood to the face, scalp, eyes, and brain. Carotid artery disease is caused by atherosclerosis or the hardening of the arteries. Narrowing or blockage of the carotid arteries can prevent blood from reaching parts of the brain. This lack of blood can cause shortages of oxygen that can result in transient ischemic attacks (TIAs), also called mini-strokes, or strokes. Treatment of carotid artery disease includes lifestyle changes, medications, or surgical procedures.
Aortoiliac disease, also called aortoiliac occlusive disease, refers to disorders of the two major blood vessels that feed the lower half of the body–the aorta and the iliac artery. Aortoiliac disease occurs in one or more of the following locations: the lower abdominal aorta; the iliac arteries; or the point where the aorta divides and becomes the iliac arteries. Impaired circulation in these arteries can result in disorders of the pelvic organs, legs, or the kidneys, which causes a condition called renal artery disease. Additionally, aortoiliac disease can result in an aortic abdominal aneurysm (AAA), a dangerous health condition.
An arrhythmia is a change in the heart’s normal rate or rhythm, normally between 60 and 100 beats per minute. Arrhythmias are classified by their location in the heart and by their speed or rhythm. An atrial arrhythmia is an abnormality that occurs in one of the two upper chambers of the heart, the left or right atrium. Arrhythmias are associated with aging and typically happen more frequently during middle age. At least 10 to 15 percent of people older than 70 years experience arrhythmias.
Congestive Heart Failure
Congestive heart failure means that the heart muscle is weakened. A weakened heart muscle may not be strong enough to pump an adequate amount of blood out of its chambers. To compensate for its diminished pumping capacity, the heart may enlarge. Commonly, the heart’s pumping inefficiency causes a buildup of blood in the lungs, a condition called pulmonary congestion.
Cardiomyopathy is a chronic disorder that occurs when the heart weakens and can no longer pump sufficient amounts of blood. Although there are several types of cardiomyopathy, the most common form is dilated cardiomyopathy, in which the heart enlarges to compensate for its inability to pump blood effectively. By dilating, or enlarging, the heart holds and pumps a higher volume of blood. In addition, the enlarged heart might temporarily increase the force of each heartbeat or elevate the heart rate (number of heartbeats per minute) to continue pumping an increased amount of blood.
Hypertrophic cardiomyopathy is a condition in which the heart muscle becomes excessively thick, making it difficult for blood to flow in and out of the heart. In most cases, the left ventricular muscle becomes abnormally large, although the septum, or wall between the atria and the ventricles, can also become enlarged and obstruct blood flow out of the heart, a condition called hypertrophic obstructive cardiomyopathy. People usually develop hypertrophic cardiomyopathy in their teens to early 20s. Hypertrophic cardiomyopathy can sometimes cause an arrhythmia, a disturbance in the heart’s rate or rhythm. In addition, people with hypertrophic cardiomyopathy are susceptible to endocarditis, an infection of the lining of the heart.
Heart block is a disorder of impulse conduction, meaning that an electrical impulse is impaired from traveling along its normal pathway. Heart block is also called atrioventricular block, because it often occurs in the atrioventricular, or A-V, node, which transmits electrical signals from the atria (the upper chambers of the heart) to the ventricles (the lower chambers of the heart). Depending on its severity, A-V block may be an abnormal delay, a partial interruption, or a complete interruption of the impulse. Delays often have no symptoms, but can cause the heart rate to fall so far below normal that it causes dizziness or fainting. Certain forms of intermittent block may occur in normal people during sleep and cause heart rates of 40 beats per minute and even lower.
Physicians use the terms lipid disorders to describe several conditions in which high concentrations of lipids (fats) exist in the bloodstream. Lipid disorders can be caused by genetics, lifestyle, or a combination of both. Ahterosclerosis, which is the buildup of fat and cholesterol-laden plaque in the walls of the heart’s arteries, can result from lipid disorders.
High cholesterol means that levels of cholesterol in the blood are raised, which can contribute to plaque build-up n artery walls. High cholesterol is a lipid disorder. Physicians use the term lipid disorder to describe several conditions in which high concentrations of lipids (fats) exist in the bloodstream an din part by inherited disorders. Elevated levels of cholesterol in the blood can be caused in part by a diet high in fat and cholesterol-laden foods. Although there is no one standard for high cholesterol, physicians have established ranges of cholesterol levels that are useful in assessing a person’s risk of developing coronary heart disease.
Blood pressure is the outward pressure that blood exerts on the walls of the arteries as it flows through them. This outward pressure is determined by how much blood the heart pumps and the resistance of artery walls to the blood. Blood that enters and flows through arteries easily results in normal blood pressure. When the heart faces resistance and it must work harder to pump blood through the body, high blood pressure results. Hypertension is high blood pressure that persists over time.
Lower Extremity Disease
Lower extremity disease is a condition in which a medium to large artery that supplies oxygen-rich blood to the legs and feet becomes partially or completely blocked. Lower extremity disease can be acute, meaning that it comes on quickly and ends. However, it is usually chronic, meaning it progresses slowly over a long period of time.
Mitral Valve Disease
Mitral valve disease occurs when the mitral valve is unable to open or close properly and includes mitral stenosis, mitral regurgitation, and mitral valve prolapse.
A pulmonary embolism is the blockage or closure of a pulmonary artery or one of its branches by an abnormal object, most frequently a blood clot. The clot typically travels with the flow of blood from a leg vein to the site where it creates a blockage. When a pulmonary artery becomes severely blocked, blood oxygen levels fall, and blood pressure in the lungs and pulmonary arteries can rise so high that the heart may not be able to pump enough blood out of its chambers.
Renal Artery Disease
Renal artery disease is a condition in which an artery leading to one or both of the kidneys becomes blocked. This disease occurs mostly in men between the ages of 50 and 70. Most of the time, the disease affects the arteries leading to one of the kidneys. But in about one-third of the cases, the arteries leading to both kidneys are affected. Left untreated, it can cause permanent kidney damage.
Upper extremity disease
In upper extremity disease, an artery between the chest and the hand becomes partially or completely blocked. Upper extremity disease can be acute, meaning that it comes on quickly. However, it is usually chronic, meaning it progresses slowly over a long period of time. One early symptom is pain when moving the arms. As the disease progresses, pain can occur in the arms at rest. In advanced stages, the disease may cause skin ulcers and cell death from lack of oxygen and nutrients. One of the main causes of upper extremity disease is atherosclerosis, or hardening of the arteries.
Pericardial disease is a disorder that involves the pericardium, the double-layered fibrous membrane surrounding the heart. Major disorders of the pericardium include: Acute pericarditis, inflammation of the pericardium; Cardiac tamponade, a rapid or large accumulation of fluid in the pericardial sac; and Chronic constrictive pericarditis, the persistence of pericarditis. Both chronic and acute pericarditis can be life threatening. If a person experiences any of the symptoms associated with pericardial disease, he or she should seek immediate medical attention.
Venous diseases are problems or conditions with the body’s veins. Problems affecting veins occur because of inflammation, blood clots, obstruction, or stretching. There are four types of venous diseases: deep vein thrombosis (DVT); chronic venous insufficiency; superficial thrombophlebitis (also called phlebitis); and varicose veins.