Services
Emergency Services & Chest Pain Center
Chest Pain Center
The Highest Level of Accreditation in Bay Area Means Unparalleled Care for Patients.
Every year, more than 6 million people visit hospitals and emergency rooms with chest pain. That’s why it’s critical to know you are receiving the highest level of care in the most efficient way….because with any type of cardiac event, time matters. And every minute counts toward preserving heart muscle.
We are proud to be a full Cycle III with PCI Accredited Chest Pain Center, a distinction given by the Society of Chest Pain Centers. This is truly a testament to our commitment and resources for providing the highest quality of care for people with chest pain.
Ensuring every cardiac patient receives the most efficient, appropriate care is a collaboration involving a team of caregivers – from pre-hospital providers who make the initial assessments, to the Emergency Department staff, as well as our Cardiac Cath Lab team, our inpatient units and Cardiac Rehabilitation. Our staff works seamlessly to ensure exceptional treatment for our patients. The Cardiac Catheterization Lab is available 24 hours a day, 7 days a week, and our staff works closely with Emergency Department personnel to achieve quick door-to-balloon times. While the national benchmark is 90 minutes, door-to-balloon times in 2010 averaged 63 minutes at The Heart & Vascular Hospital.
Also, when many of the local EMS services recognize a STEMI (a type of heart attack) with a patient out in the field, our team can receive an EKG directly from the ambulance via our Lifenet system. The patient’s information is then fed into our wireless database program, and our Cath Lab team is immediately contacted – all while the patient is being transported. Our team is educated on the patient’s condition and prepared for their treatment. This is critical to the patient’s care, as the least amount of time from the onset of a STEMI to the restoration of blood supply, the greater the chance for survival.
Electrocardiogram (EKG or ECG) and Echocardiogram Services
Using the latest technology, the EKG/Echo Department offers an extensive range of diagnostics and services to patients. An EKG tech responds to all Rapid Responses and “Code Blue” alerts, in the event an EKG is needed. Clear Lake Regional Medical Center is accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories.
Cardiac Imaging Services
Among the latest in cardiac imaging technology, our 64-channel, multi-slice CT scanning equipment provides high-speed imaging with high-resolution quality in a matter of seconds. This revolutionary scanner delivers 64 simultaneous slices of .5 mm, the thinnest available in one rotation. The result is precise isotropic data sets that give a cardiac radiologist detailed images of the coronary arteries and vascular system in a matter of seconds with the assistance of an IV injection of contrast material. This non-invasive procedure provides an impressive diagnostic tool with low-dose exposure and ease of use, yielding a significant evaluation of the coronary arteries.
High-Tech Cardiovascular Operating Areas
The three operating rooms in The Heart & Vascular Hospital have technology unavailable elsewhere in the South Houston region. Sophisticated mounting systems, lighting, operating room tables, equipment, cameras, image-capture systems and information networks are all integrated into one electronic system under the control of the surgical team. Our vascular operating room is a hybrid surgical suite and endovascular room, with a $1 million cutting-edge imaging system. Digital images can be captured, saved and instantly transmitted to another location via our digital imaging system. Our highly skilled Cardiovascular OR staff – which includes specialized RNs, nurse practitioners, physicians’ assistants, surgical technologists and in-house perfusion (who operate the heart-lung machine during cardiac surgery) – is available around the clock and provides support for cardiovascular surgical emergencies.
Procedures
Cardiovascular Surgery
Coronary Artery Bypass Graft (Including Off-Pump)
When circulation is restricted through a blocked or narrowed artery, patients can experience chest pain or suffer a heart attack. Surgeons, however, can simply “bypass” the problem area and restore proper blood flow. Once a patient is under anesthesia, surgeons open the chest and harvest other arteries and veins that can be used to complete the bypass. The graft pieces are then “sewn” into place. This surgery can be performed with the heart stopped or stabilized (off-pump).
Mitral Valve and Aortic Valve Repair/Replacement
Heart valves control the direction of blood flow in and out of the heart, so when these valves fail to function properly, patients can experience chest pain, palpitations, or a heart attack. As either an open heart surgery or minimally invasive procedure, surgeons can repair the malfunctioning valve or replace it altogether with either an artificial implant or a bioprosthesis (made from tissue).
Atrial Fibrillation Surgery (Including Maze Procedure)
Atrial fibrillation is diagnosed when the upper two chambers of the heart are not contracting together. A simple check of the pulse can identify AF, but it is best confirmed with an electrocardiogram. As either an open heart surgery or minimally invasive procedure, surgeons can block abnormal electrical circuits to correct the problem. The Maze procedure gets its name from the pattern of ablations made against the targeted tissue.
Lung Cancer Surgery (Including VATS Procedure)
When a patient has lung cancer, surgeons will often try to remove the affected tissue either through a thoracotomy (entering through the side of the chest) or video-assisted thoracoscopic surgery (VATS). For the latter, a videoscope and other small surgical instruments are inserted into your chest through small incisions between the ribs. VATS is also an effective way to confirm a lung cancer diagnosis, allowing for efficient biopsy. Once the procedure is complete, a chest tube will drain fluid and excess blood from the chest cavity and help refill the lung with air.
Cardiology – Invasive
Diagnostic Cardiac Catherization
When cardiologists need to confirm issues detected by electrocardiograms or echocardiograms, they will rely on diagnostic catheterization. Under local anesthesia, a hollow plastic tube (2-3 mm) is inserted into veins or arteries near the neck, leg, or arm and advanced to the left or right sides of the heart. Once the catheter is positioned, physicians can measure the pressure of the blood in various chambers of the heart, take blood samples, and inject dye for x-ray visualization.
Cardiology – Interventional
Coronary Angioplasty and Stenting
An angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel. Using a guide wire, physicians will pass a deflated balloon into the narrowed location, then inflate it, with the goal of crushing the deposits that are restricting blood flow. If the artery requires additional support to stay open, physicians will insert a stent—basically, a mesh tube placed within the vessel. Some stents are covered with medication that prevents future deposits from forming. Both angioplasty and stenting can reduce chest pain, shortness of breath, improve survival of heart attack, and prevent future heart attack.
Laser Lead Extraction
For those with pacemakers, a lead is a specially designed wire that transfers current from the device to the heart muscle. Sometimes, because of damage to the lead, an accumulation of scar tissue, or an infection at the site, these lead wires must be removed. To free the wire from surrounding tissue, physicians can now use cold, controlled laser energy, allowing for an easier detachment and minimizing possible damage to the heart. The procedure is performed through a catheter, so scarring and recovery time is considerably less than other major heart surgeries.
Rotational Atherectomy
An atherectomy is one approach physicians use to restore blood flow to blocked or narrowed arteries or veins. Whereas an angioplasty or stent push plaque into the vessel wall, an atherectomy removes it altogether. A small, rotating, diamond-tipped blade is inserted through a catheter, which grinds away at the deposited plaque. Once dislodged, the plaque moves through the circulatory system and out of the body.
Peripheral Angiography and Intervention
Angiography refers to an imaging technique that allows physicians to visualize the inside of blood vessels and heart chambers. A radio-opaque contrast agent is injected into the blood vessels (usually via the femoral artery near your groin), and a subsequent fluoroscopy will show blood flow as the dye moves throughout the system. When done peripherally (away from the center of the body), an angiography can identify narrowing or blocked vessels in patients with numbing or cramps in the legs and feet.
Peripheral Laser Atherectomy
An atherectomy is one approach physicians use to restore blood flow to blocked or narrowed arteries or veins. Whereas an angioplasty or stent push plaque into the vessel wall, an atherectomy removes it altogether. A peripheral laser atherectomy focuses on extremities away from the center of the body (the legs especially), using a laser to break apart the deposited plaque. Once dislodged, the plaque moves through the circulatory system and out of the body.
Peripheral Atherectomy
A peripheral atherectomy is one approach physicians use to restore blood flow to blocked or narrowed arteries or veins in the body’s extremities (the legs especially). Whereas an angioplasty or stent push plaque into the vessel wall, an atherectomy removes it altogether. Once dislodged, the plaque moves through the circulatory system and out of the body.
Valvulplasty
Typically, restricted blood flow is the result of narrowed or blocked blood vessels. But the heart valves themselves, gates that control the direction of flow, can also become narrowed. In those instances, a valvulplasty can use a catheter-fed balloon to reopen the obstructed valve, pushing the troublesome plaque into the lining and allowing for proper regulation of flow.
Coronary Ultrasound
A coronary ultrasound uses a miniaturized ultrasound probe attached to a catheter to see inside the blood vessels actually on the heart muscle (myocardium). The proximal end of the catheter remains attached to an ultrasound machine. This technique is especially useful in situations where angiographic imaging (using dye) proves unreliable. Because the coronary arteries are the only source of blood to the myocardium, unrestricted flow through them is critical.
Electrophysiology
Electrophysiology Diagnostic Study
Electrophysiology encompasses a number of diagnostic tests that study, record, and project the electrical properties of your cells. For the heart particularly, an electrocardiogram (ECG or EKG) uses strategically placed electrodes to record the electric activity of the circulatory system. It is a painless, non-invasive procedure. The data is fed from the electrodes to an external machine, allowing physicians to understand what electrical deficiencies or irregularities the heart may be experiencing. The test can aid in the diagnosis of angina, determine risk of heart attack, and check the effectiveness of implanted devices like pacemakers.
Radio Frequency Ablation
Physicians use radio frequency ablation to remove abnormal electrical pathways in heart tissue. Radio current does not stimulate nerve cells like other electrical currents, so neighboring tissue is not unintentionally disrupted. Physicians will first “map” an area to determine abnormal electrical activity. Then, an energy-emitting probe is placed in the heart via a catheter to eliminate the irregular tissue.
Pacemaker Insertion
A pacemaker is a medical device that uses electrical impulses to regulate heartbeat, either because the heart cannot regulate an appropriately timed rhythm, or because the heart's conduction system is malfunctioning. These impulses are delivered by electrodes in direct contact with the heart muscles. Through a relatively routine procedure, the pacemaker is typically inserted just below the collarbone with the lead wires being fed into the heart through a large vein (as guided by a fluoroscope). The first pacemaker was surgically inserted in 1958.
Cardioverter Defibrillator Implantation
An implantable cardioverter-defibrillator (ICD) is a small, battery-powered device that uses electrical impulses to correct arrhythmia within the heart. The surgery is recommended for individuals who are at high risk of death due to cardiac irregularities. During a moment of need, the device will deliver a jolt of electricity to reset the rhythms of the heart. Implanting the device is very similar to how pacemakers are implanted; lead wires run from the device, through a vein, and into the heart chamber. Defibrillators, however, are considered more permanent safeguards compared to pacemakers.
Intracardiac Ultrasound
An intracardiac ultrasound uses a miniaturized ultrasound probe attached to a catheter to see from inside blood vessels out through the surrounding blood column. The proximal end of the catheter remains attached to an ultrasound machine. This technique is especially useful in situations when angiographic imaging (using dye) proves unreliable, like for ostial lesions or overlapping arterial segments. It is also used to assess the effectiveness of earlier vascular intervention.
Laser Lead Extraction
For those with pacemakers, a lead is a specially designed wire that transfers current from the device to the heart muscle. Sometimes, because of damage to the lead, an accumulation of scar tissue, or an infection at the site, these lead wires must be removed. To free the wire from surrounding tissue, physicians can now use cold, controlled laser energy, allowing for an easier detachment and minimizing possible damage to the heart. The procedure is performed through a catheter, so scarring and recovery time is considerably less than other major heart surgeries.
Loop Recorder Monitoring
For patients who have symptoms of an irregular heart rhythm, but only on occasional instances, a loop recorder is a good way to capture the information when you least expect it. It constantly records your heartbeat. You mark the start of symptoms by pressing a button, but data before and after that moment is also captured and preserved for physician review. This feature is especially useful for people who lose consciousness when their heart problems occur and can only press the button only after they wake.
Non-Invasive
Electrocardiogram (ECG or EKG)
An electrocardiogram is a diagnostic test that uses strategically placed electrodes to record the electric activity of the heart. It is a painless, non-invasive procedure. The data is fed from the electrodes to an external machine, allowing physicians to understand what electrical deficiencies or irregularities the heart may be experiencing. The test can aid in the diagnosis of angina, determine risk of heart attack, and check the effectiveness of implanted devices like pacemakers.
Holter Monitoring
A Holter monitor records the electrical signals of the heart through a series of adhesive electrodes attached to the chest. To minimize interference from muscular activity, the patches are usually placed above bone, though their number and exact positioning varies. The device itself can be worn from a belt, hung around the neck, or strapped across the chest. It will keep of log of the heart’s electrical activity throughout the recording period.
Echocardiography (Transthoracic and Transesophageal)
An echocardiogram (sometimes just called an ECHO) is a sonogram of the heart. It can provide a wealth of helpful information, including the size and shape of the heart, its pumping capacity, the efficiency of valves, patterns of blood flow, and more. For a typical transthoracic echocardiogram, an ultrasound probe it simply placed over the chest cavity. As an alternative, a transesophageal echocardiogram places an ultrasound probe down into the patient’s esophagus, usually yielding clearer results.
Nuclear Cardiology
Nuclear cardiology uses non-invasive techniques to assess blood flow, especially along the heart muscle. A small amount of imaging agent is injected into the blood stream, and then, during periods of exercise and periods of rest, physicians can identify areas of the heart muscle that have an inadequate blood supply, as well as the areas of heart muscle that are scarred from a heart attack. Exercise can be in the form of walking on a treadmill or riding a stationary bicycle.
Tilt Table Studies
Physicians use tilt table studies to diagnose dysautonomia (a nervous system disorder) and syncope (repeated fainting) as they relate to a drop in blood pressure and an excessively fast heart rate. Patients are often asked to fast the day before. During the test, you’ll be asked to lie flat on a special table or bed while connected to electrocardiogram and blood pressure monitors. The table will create a change in posture—from lying to standing to lying again. If the test is able to reproduce lightheadedness, dizziness, or fainting, then further investigation might be needed to understand the cause of the problem.
Cardioversion
For an abnormally fast or irregular heart rate, physicians sometimes recommend a cardioversion, where electricity or drugs are used to stabilize the heart’s rhythm. For the former, two electrode pads are applied to the chest and back and supply a determined amount of electric current for a determined amount of milliseconds. For the latter, a physician will prescribe drugs that are effective at normalizing heart rhythm. Often, an electric cardioversion will be followed with a pharmacological cardioversion.
Stress Lab
Exercise Stress Testing
As a test for heart disease, patients will often be asked to undergo an exercise stress test. Electrodes are placed on the chest to record the heart’s activity, and a blood pressure cuff will be placed on your arm. Then, you’ll be asked to walk/run on a treadmill or pedal an exercise bike. The intent of the physical activity is to push the patient to a target heart rate, to induce complications like chest pain or changes in blood pressure, or to show oxygen deprivation within the heart muscles. Monitoring typically continues for 10-15 minutes after exercising ends or until your heart rate returns to its baseline.
Chemical Stress Testing
When patients cannot complete an exercise stress test due to physical limitations—back trouble, joint disease, prior injury, prior stroke, or general unsteadiness—physicians can recommend a chemical stress test instead. It combines intravenous medication with imaging technology. Rather than relying on physical activity to increase heart rate, specially administered medication will, from which point traditional electrocardiogram or echocardiogram technology can be used to study the increased load’s effect on your heart and circulatory system.
Stress Echocardiogram
Stress echocardiograms are very similar to traditional stress testing, except that rather than using electrocardiogram technology (the patches on your chest), ultrasound technology is used to image the heart and circulatory system. The “stress” can be induced either by exercise—treadmill, stationary bike—or pharmacological agents.
Diagnostic Vascular Services
Cardiac Arterial and Venous Imaging
Your arteries and veins are the vessels that carry blood throughout your body. No matter how healthy your heart is, if the blood can’t flow freely, some severe complications can arise. Physicians have several ways to get a look inside your arteries and veins, including external ultrasound, internal ultrasound (like a transesophageal echocardiogram), and diagnostic catherization.
Vascular Interventional/Vascular Surgery
Peripheral Angioplasty (Including Stent Placement and Atherectomy)
A peripheral angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel within the extremities of the body. Using a guide wire, physicians will pass a deflated balloon into the narrowed location, then inflate it, with the goal of crushing the deposits that are restricting blood flow. If the artery requires additional support to stay open, physicians will insert a stent—basically, a mesh tube placed within the vessel. Some stents are covered with medication that prevents future deposits from forming. Another option is to actually dislodge the deposited plaque, freeing it to move through the circulatory system and out of the body. The procedure can reduce chest pain, shortness of breath, improve survival of heart attack, and prevent future heart attack.
Endovascular and Open Abdominal Aortic Aneurysm Repair
Your aorta is the largest artery in the body, running from the heart down to the abdomen. When a weakened lining causes it to swell, or worse, rupture, physicians have two approaches to repair the damage. An open abdominal repair is just as it sounds: surgeons enter through an incision in the abdomen and insert a synthetic tube to reinforce or replace the weakened area. An endovascular repair, comparatively, inserts the stent through the femoral artery (near the groin) for a non-invasive solution that avoids many of the risks associated with open surgery.
Carotid Endarterectomy and Carotid Artery Stenting
A carotid endarterectomy is a surgical procedure aimed at removing plaque that has narrowed or blocked an artery, particularly for the carotid artery along your neck. These deposits are generally caused by lipids (cholesterol and fatty acids) or calcium deposits. Once cleared, if it is determined that the artery needs additional support, a stent (narrow tube) will be inserted.
Vascular Access for Hemodialysis
When kidneys are struggling with renal failure, your body needs another way to remove waste products like creatinine, urea, and free water from the blood stream. To access the blood, there are three main approaches: an intravenous catheter, an arteriovenous fistula (a man-made bypass of capillaries), or a synthetic graft. Once the determined method is in place, a patient’s blood is pumped through and filtered by a dialysis machine. The frequency of dialysis will be determined by your physician and can be done on both an inpatient and outpatient basis.
Peripheral Arterial Bypass
When circulation is restricted through a blocked or narrowed artery, patients can suffer severe pain in the area or even a heart attack. Surgeons, however, can simply “bypass” the problem area and restore proper blood flow. For a bypass in the arms or legs, a vascular surgeon first selects and removes the vein that will serve as the bypass graft for your artery, often the great saphenous vein (GSV) that runs between your foot and groin. Synthetic arteries are also sometimes used. Once the new piece is “sewn” into place, blood flow in the area is checked for improvement, and the incision is closed.
Fetal/Pediatric Cardiology
Fetal Echocardiogram
When a baby is still inside its mother’s womb, a fetal echocardiogram can help identify cardiac defects that will present challenges once the baby is born, allowing neonatologists and pediatricians a chance to plan a course of action for directly after birth. The test is performed much like a traditional ultrasound and able to determine heart arrhythmias, heart muscle defects, nuchal thickness (related to Down syndrome), ductus venosus (regulation of oxygenated blood), and accumulation of fluids.
Pediatric Electrocardiogram/Echocardiogram
Imaging tests, though harmless, can still be scary for kids—all the equipment, flashing lights, and wires—so it’s important to carefully explain what’s happening, why it’s happening, and what they can expect. As they are carried through, an electrocardiogram and an echocardiogram aren’t performed any different on children than they are on adults. The former uses patches to measure electrical activity of the heart; the latter uses ultrasound technology to image activity of the heart. Physicians will account, however, for differences in normal output as it relates to age.
24-Hour Holter Monitoring
A Holter monitor records the electrical signals of the heart through a series of adhesive electrodes attached to the chest. To minimize interference from muscular activity, the patches are usually placed above bone, though their number and exact positioning varies. The device itself can be worn from a belt, hung around the neck, or strapped across the chest. It will keep a 24-hour log of the heart’s electrical activity.
Stress Testing
As a test for heart inefficiencies, children and teens can undergo an exercise stress test. Electrodes are placed on the chest to record the heart’s activity, and a blood pressure cuff will be placed on the arm. Then, they’ll be asked to walk/run on a treadmill or pedal an exercise bike. The intent of the physical activity is to reach a target heart rate, to observe complications like chest pain or changes in blood pressure, or to show oxygen deprivation within the heart muscles. Monitoring typically continues for 10-15 minutes after exercising ends or until the heart rate returns to its baseline.
Targeted Athletic Screening
Athletes participating in UIL-sanctioned athletic events are required to have regular physical screenings, but too few of those screenings can adequately assess heart health. Sadly, it seems every year we hear of student-athletes succumbing to sudden cardiac arrest during practice or game play. A targeted athletic screening can closely measure cardiovascular performance, and if passed, give athletes and their parents the confidence to pursue sports freely.
Cholesterol/Obesity Screening
A high cholesterol level among children can signal possible heart disease when they become adults. A simple blood test can measure cholesterol levels. Obesity is determined through external measurements of the body, like body mass index (BMI), and can be caused by many things: overeating, lack of exercise, thyroid disorders, etc. Once a screening determines you have high cholesterol, obesity, or both, a team of cardiologists, dieticians, and trainers can help create a plan to correct the issues.