Cardiology

Some patients have been started on medication (Coumadin, warfarin or Jantoven) to prevent blood clots from forming. This medication requires frequent blood tests and close monitoring.

Patients schedule an appointment in our Wausau or Rhinelander office with a nurse who specializes in anticoagulation management. Patients will meet with the nurse, have their blood tested using the finger stick method and review the results along with other medications the patient is taking, diet and signs and symptoms of bleeding. The patient will leave their appointment knowing what dose of Coumadin (warfarin or Jantoven) to take and when to return for their next visit.

For those patients that do not live in the greater Wausau or Rhinelander area, they may have their blood drawn at a lab of their choice and have results faxed to Aspirus Cardiology. The nurse will get these results and call the patient with further instructions.

Cardiac PET scanning is a procedure performed to evaluate the blood flow to the muscle of your heart.  Imaging is obtained in a special device called a PET Scanner, which looks similar in appearance to a CT Scanner.  You will receive a series of injections of radioactive material called Rubidium, which is a short lived isotope that represents blood flow.  A stress test is also performed with a medication called Regadenoson which is injected intravenously.  You will be positioned lying flat on your back with arms above your head.  A series of pictures are taken each lasting 5 – 8 minutes.  This procedure takes 1 ¼ hours to complete and requires special prep instructions.

Cardioversion is a way to restore your heart's normal rhythm. When your heartbeat is irregular, medicine is often used first to try to correct the rhythm of your heart. If that doesn't work, cardioversion may be the next step. During this procedure, you are given a small, brief electric shock by a doctor. The shock helps your heartbeat become normal again. Cardioversion is most often done in a hospital. Before scheduling a cardioversion, your physician may ask you to take anticoagulants (blood thinners) for a few weeks. This helps prevent blood clots from forming and will be monitored closely by having frequent blood tests (INR) until the time of the cardioversion.

A carotid duplex is an ultrasound checking for blockages in the carotid arteries located in the neck. An ultrasound technologist performs the non-invasive carotid ultrasound by moving a small device over the arteries in your neck. This device captures ultrasound images of the arteries. The ultrasound is painless and usually lasts 30 minutes. The physician is not present for the exam.

The lab is open for phlebotomy and analytical services Monday through Friday. Blood for almost any assay can be collected by our laboratory when proper orders are presented. We will prcess the specimen(s) and facilitate their transport to the appropriate laboratory if the requested testing is not performed in the CVA laboratory. Appointments are required in most circumstance. Call 715-847-2611 or 800-441-4013 to schedule an appointment.

• General Chemistry – Assays for kidney function, electrolytes and liver and cardiac enzymes are available at Cardiovascular Associates. All other chemistries are available through our relationship with Aspirus Wausau Hospital Regional Lab.
• Lipid Analysis – Routine lipid analysis including total cholesterol, HDL (high density lipoprotein) cholesterol, measured LDL (low density lipoprotein) cholesterol and triglyceride are performed at Aspirus Cardiology. Advanced lipid analysis such as NMR lipoprotein profile (which measures HDL, LDL, particle size, distribution and number), Lp(a), homocysteine, apolipoprotein A1 and apolipoprotein B are available through our relationship with Liposcience, Inc. This advanced testing reveals added information regarding your risk and aids the physician in treating your condition.
• Anticoagulation Clinic – Routine monitoring of oral warfarin (Coumadin) therapy. The protime clinic at Aspirus Cardiology provides instant ProThrombin Time results. Recent updates of instrumentation and the use of highly sensitive reagents yields accurate and precise results. Coumadin/warfarin dose is based on the protime result and American Heart Association recommendations.

A quick, painless test that records the electrical activity of the heart. It may be taken at rest or during exercise. It is used for diagnosing abnormal heart rhythms. Small patches called electrodes are placed on the different parts of the body which then record tracings of the electrical activity of the heart.

Pictures/recording of the heart utilizing ultrasonic (sound) wave directed through the chest wall. Information regarding the position, structure and motion of the heart rate are obtained from this procedure. An ultrasound technologist performs the echocardiogram of your heart by moving a small device on the surface of your chest. This device captures images of your heart in motion. The test usually takes about 30 minutes. The physician is not present for this exam.

Cardiac resynchronization therapy involves the settings of a biventricular pacemaker to improve overall cardiac blood movement. Cardiac resynchronization therapy has been found to improve quality of life, and exercise capacity, as well as, improve patients with impaired left ventricular ( LV ) function, and functional class III/IV heart failure.

This subspecialty of cardiology focuses on the electrical activity of the heart to determine the cause of arrhythmia's (abnormal heartbeats). They will work with you to decide whether you need medicine, a pacemaker, an ICD (implantable cardioverter defibrillator), cardiac ablation or if surgery is needed.

Procedures include: ablations, electrophysiology study, implantation of pacemaker, ICD or loop recorder and device management after implantation.

The purpose of an event monitor is to record your heart rate and rhythm during a symptom “event” over an extended period of time.  Aspirus Cardiology utilizes different monitors based on patient symptoms. Staff will coordinate the most appropriate monitor.  Rhythm strips are recorded and sent automatically to the monitor facility. Patients are also able to trigger the monitor to record during a  symptom. The monitoring period is normally from 14 to 28 days. Cardiology receives any abnormal recordings during the recording period. All recordings will be reviewed for a final result.

The Heart Failure Resource Center is a specialized clinic within Aspirus Cardiology that sees patients with congestive heart failure (CHF) in our Wausau office. The team is made up of a medical assistant, nurses, nurse practitioners, and a physician. Patients can come from anywhere within Aspirus or an outside system based on referral guidelines, medication management guidelines and personnel guidelines that have been set up.

The goal of the clinic is to provide compassionate care and available services to manage heart failure symptoms in the outpatient setting and avoid hospital admissions. In an attempt to optimize outcomes, we have the ability to give IV diuretics (water medication) in the clinic, preventing patients from having to go to the hospital. We provide education on medications, diet, exercise, monitoring of symptoms, and other topics related to heart failure.

We provide close follow-up with clinic visits and phone calls to patients at home to monitor symptoms. We encourage family members to attend visits to allow for more integrated care throughout the system.

The holter monitor is a small portable device that measures and records your heart’s activity (EKG) continuously for 24 hours up to 14 days, depending on the type of monitor used. Abnormal heart rhythms and cardiac symptoms may come and go so you doctor may want to evaluate your heart’s activity over of a period of time while you go about your normal daily activities. The patient will be asked to record symptoms in a diary during the monitoring period. After the monitor is returned the recordings will be reviewed for potential arrhythmias.

This medically supervised, partial meal replacement weight loss protocol targets fat loss while preserving muscle mass. For more information, visit the program's page in the weight loss programs section.

MUGA (multi-gated acquisition) is often ordered when a physician is concerned about how well the heart is actually pumping blood with each beat of the heart. This study involves a radioactive tracer which is used to label the patient's own red blood cells. These labeled red blood cells are reinjected into the patient and EKG and scan are performed. The scanner detects the red blood cells moving through the heart. The result is the calculation of an ejection fraction (or EF). This number is used to determine if the heart is satisfactorily pumping blood. The amount of time consumed for this exam is approximately 1 - 1-1/2 hours.

A nuclear stress test is a two-part test involving resting and stress images.  A radioactive substance (Sestamibi) is used to produce images of the heart at rest and during stress.  The patient is injected with the Sestamibi intravenously.  Thirty minutes after the injection a resting scan of the heart is performed which is followed by a treadmill stress test.  If the patient is not physically able to walk on a treadmill a medication called Regadenoson can be used to increase the heart rate.  Following the stress test, a second scan is performed and the rest and stress images are reviewed by a cardiologist.  The Sestamibi stress test takes approximately three hours and requires special prep instructions.

A two day nuclear stress is sometimes ordered for a certain population of patients.  On the first day a treadmill stress test is performed.  If the patient is not physically able to walk on a treadmill a medication called Regadenoson can be used to increase the heart rate.  During the stress test the patient is injected intravenously with Sestamibi. Following the stress test a scan of the heart is performed. On the second day of this two day procedure the patient returns and is injected again intravenously with Sestimibi.  Approximately 30 minutes after the injection a resting scan of the heart is performed. The rest and stress images are reviewed by a cardiologist.  The test takes approximately 1 ½ hours each day and requires special prep instructions.

If you have a slow and often irregular heartbeat, or if your heartbeat is sometimes normal and sometimes too fast or too slow, blood isn't pumped around your body well. In that case your doctor may recommend an artificial pacemaker. A pacemaker will make your heart beat more regularly. That will help ensure that enough oxygen and nourishment get to your body's cells.

An artificial pacemaker system has two parts: a generator and wires (leads). The pacemaker generator is a small battery-powered unit. It produces the electrical impulses that start your heartbeat. The generator is implanted under your skin through a small incision.

The generator is connected to your heart through tiny wires that are implanted at the same time. The impulses flow through these leads to your heart and are timed to flow at regular intervals just as impulses from your heart's natural pacemaker would.

This test combines the stress test and the echocardiogram into one evaluation.  A limited echocardiogram is performed before and after the stress test.  Electrodes are placed on the chest to monitor the heart rhythm.  The sonographer will obtain echocardiographic images of your heart at rest.   You will then walk on a treadmill to increase your heart rate. If you are unable to walk on a treadmill you will be given a drug to increase your heart rate.  When an acceptable rate has been met the sonographer will take additional echocardiographic images. 
The motion of the heart wall before and after exercise is evaluated.  This can provide an indication of the patient’s risk for a heart attack.

A stress test is also known as a “graded exercise test” or GXT.  This is a controlled exercise session that allows the physician to evaluate the heart’s response to stress/activity.  The patient will have several electrodes placed on their chest to obtain an EKG or recording of their heart’s electrical activity and will be asked to walk on a treadmill to increase their heart rate.

The Aspirus Telehealth program enhances the primary care provider’s role in patient care by bridging the distance between local providers and advanced specialty services. Through advanced secure technology, patients are able to receive high-level diagnostic tests and specialty care close to home. This service is available in Keweenaw and Ontonagon.

Coronary angioplasty, also called "PTCA," is a procedure in which a catheter (flexible plastic tube) with a small balloon dilates, or "opens up," a blocked artery that supplies the heart muscle with blood. In contrast to open-heart surgery, PTCA can be done by making a small puncture in the skin and inserting the catheter into an artery in the leg or arm. Patients are awake during the procedure. Most patients go home within a day or two after the procedure.

Defibrillators are used to monitor your heart rhythm. If it senses an abnormal heart rhythm, it will deliver therapy to your heart. Each defibrillator is programmed for the patient's specific needs. The device is implanted in your chest. One or more leads, which are implanted in your heart, are connected to the device. This device delivers an electrical shock to the heart to restore an extremely rapid and irregular heart rate to normal rhythm.

A cardiac catheterization is a procedure that examines the heart. During this procedure, a physician can measure pressures inside the heart, take pictures of the arteries bringing blood to the heart, and assess how well the heart is pumping. In most cases, patients come to the hospital in the morning, undergo the cardiac catheterization procedure, and leave later in the afternoon. Whether you undergo the procedure as an outpatient or inpatient, you'll first meet with the doctor who'll do the procedure and/or a member of the catheterization team and they will explain why and how the procedure will be done and its risks.

You'll be told not to eat or drink anything the morning of the procedure. Your doctor will want you to take certain medications (such as aspirin and other heart medicines) before your procedure. But he or she may not want you to take other medicines (such as certain diabetes medications, "water pills" or blood-thinning medicines). Make sure you know which medicines to take and avoid before your catheterization.

In directional coronary atherectomy (DCA) a specialized small cutting device is threaded to the blocked area. The DCA device then uses a rotating cutter to "shave off" pieces of the blockage. After part of the blockage has been removed, the artery is usually opened more with balloon angioplasty. A stent is often inserted after that.

A noninvasive therapy for certain patients with chronic chest pain. With the patient lying on a bed, compression cuffs (similar to blood pressure cuffs) are wrapped around the calves, thighs and lower abdomen. Treatment usually lasts an hour per day, five days per week, for seven weeks, which is a total of 35 hours.

If you have a slow and often irregular heartbeat, or if your heartbeat is sometimes normal and sometimes too fast or too slow, blood isn't pumped around your body well. In that case your doctor may recommend an artificial pacemaker. A pacemaker will make your heart beat more regularly. That will help ensure that enough oxygen and nourishment get to your body's cells.

An artificial pacemaker system has two parts: a generator and wires (leads). The pacemaker generator is a small battery-powered unit. It produces the electrical impulses that start your heartbeat. The generator is implanted under your skin through a small incision.

The generator is connected to your heart through tiny wires that are implanted at the same time. The impulses flow through these leads to your heart and are timed to flow at regular intervals just as impulses from your heart's natural pacemaker would.

Stents are now used in most angioplasties. Stents are small, metal, spring-like devices about the size of a spring in an ink pen. The stent is implanted in the coronary artery to reduce the risk that a treated blockage will "grow back."

A tilt table study is done for diagnostic and drug therapy evaluations. A tilt table study is performed with the use of a special table called a "Tilt Table" under controlled conditions. The studies are done in an attempt to induce the symptomatic fainting (syncopal) episode and/or heart rhythm changes (arrhythmia) under controlled conditions for the purpose of diagnosis and therapy evaluations.

TAVR is a less invasive procedure for replacing the aortic valve. This procedure is for patients who have been determined too sick for open-heart surgery and medicine is not helping them feel any better. A surgeon and cardiologist evaluate patients to determine if they are candidates for this procedure.

TAVR is performed while the patient’s heart is still beating. A small incision is made in the patient’s leg where the physician uses a sheath (a small hollow tube) and passes the sheath through the blood vessel to the heart. The procedure takes an average of 4-5 hours. The patient will be in the Cardiac Telemetry Unit (CTU) following the procedure. Average hospital stay is 3-4 days. The patient will be on blood thinning medication for at least 6 months after the procedure and be on aspirin for the rest of their life.

A Transesophageal Echocardiogram or TEE is another type of ultrasound to obtain images of the heart as it pumps. During the TEE, the physician passes a flexible ultrasonic probe into the esophagus. The probe is advanced to various lengths to obtain different images of specific areas of the heart. A TEE is performed when more detailed information is needed to: diagnose heart valve disease, locate blood clots, evaluate the functioning of repaired or replaced heart valves and evaluate heart function. It is performed on an outpatient basis at Aspirus Wausau Hospital, Aspirus Langlade Hospital, Aspirus Riverview Hospital, and Aspirus Ironwood Hospital.

The Valve Clinic has been established to meet the needs of valve disease patients in a one-day visit. Patients will undergo a thorough evaluation that will include a clinical evaluation, diagnostic studies (if necessary) and education about the severity of the patient's valve disease. The assessment will include an evaluation by one of our board-certified cardiologists as well as meeting with one of our board-certified cardiothoracic surgeons to discuss potential surgical options.

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