The cardiology division of the UC Heart & Vascular Center consists of eleven cardiologists. Members of our team have been named among the "Best Doctors in America" and featured as an "Excellent Practitioner" by Good Housekeeping magazine.

Cardiologists use a medical history exam and cardiac tests to determine the presence and severity of diseases of the heart. They also treat heart diseases with medication, with interventions to open blocked arteries, and by using or implanting various devices that effectively treat heart disorders. Members of our team work hand in hand with our researches to provide the most advanced testing and treatment available. Our physicians specialize in cardiac transplantation, heart failure, molecular genetics of the heart, heart disease among women, nuclear cardiology and acute coronary syndrome among others.

Types of Disorders:

• Coronary Artery Disease
• Valve Disease/Adult Congenital Heart Disease
• Cardiac Arrhythmias
• Congestive Heart Failure
• Aorta Disease & Marfan Syndrome
• Hypertrophic Cardiomyopathy

• Non-invasive diagnostics
• Invasive diagnostics

Types of Disorders:

Coronary Artery Disease
Coronary artery disease is caused when there is a build up of plaque in the arteries leading to the heart. Plaque build-up (caused by fatty deposits and high cholesterol) prevents blood and oxygen from getting to the heart muscle. When the heart is deprived of blood and oxygen, a person will usually experience chest pain. If the heart is deprived for several minutes, it can lead to a heart attack and congestive heart failure, both of which are types of cardiovascular disease. Therefore, coronary heart disease is a disease of the coronary arteries and may result in complications such as chest pain (angina) and heart attack. Coronary artery disease can easily be confused with carotid artery disease. Carotid artery disease is the disease of the arteries that affects blood supply to your brain. Carotid artery disease can lead to a stroke.

Valve Disease/Adult Congenital Heart Disease
Heart valves regulate the amount of blood that flows through the heart's four chambers. The heart valves malfunction by either leaking or by not opening properly and thereby affecting the heart's ability to pump blood. A valve can also have both problems. There are several types of valve disease:

• Mitral Regurgitation- Mitral Regurgitation occurs when blood leaks backward into the left atrium increasing blood volume and pressure in the atrium. The increase in blood volume and pressure increases the blood pressure in the veins leading from the lungs to the heart, which can cause fluid to build up in the lungs. In addition to shortness of breath, a person suffering from mitral regurgitation may experience heart palpitations, a stronger heart beat especially when lying on their left side, or a rapid heart beat in an irregular pattern (atrial fibrillation).
• Mitral Valve Prolapse- Mitral Valve Prolapse is a disorder in which the valve bulges into the left atrium when the left ventricle contracts, sometimes allowing blood to leak into the atrium. Most people with mitral valve prolapse don't have symptoms. Others may experience chest pain, palpitations, fatigue and dizziness. Mitral valve prolapse rarely causes' serious heart problems.
• Mitral Stenosis- Mitral Stenosis occurs when the mitral valve narrows causing an increase in blood volume and pressure in the left atrium which causes the left atrium to enlarge. Mitral stenosis usually results from rheumatic fever, a childhood illness that sometimes occurs after untreated strep throat. Rheumatic fever is fairly rare today. Therefore, mitral stenosis is generally found in older adults who were not readily treated with antibiotics during their childhood. Mitral stenosis can also be present at birth.
• Aortic Regurgitation- Aortic Regurgitation is a disease in which the aortic valve leaks each time the left ventricle relaxes. As the left ventricle relaxes to fill with blood from the left atrium, blood leaks backward from the aorta increasing the amount of blood and pressure in the left ventricle. This causes the heart to work harder, which may lead to heart failure. Aortic regurgitation can be caused by rheumatic fever, a hereditary disorder in which the valve gradually becomes floppy, degeneration of the valve due to unknown factors, aortic aneurysms and aortic dissection. Common causes of mild aortic regurgitation are severe high blood pressure and a birth defect in which the aortic valve has two leaflets instead of three.
• Aortic Stenosis- Aortic stenosis occurs when the aortic valve opening narrows decreasing the amount of blood flow from the left ventricle to the aorta. Also, during aortic stenosis, the wall of the left ventricle begins to thicken as it works harder to pump blood through the narrowed aortic valve. In turn, the thickened wall makes the interior of the left ventricle smaller and affects the amount of blood flow reaching the heart muscle. Lack of blood to the heart muscle can lead to heart failure. Aortic Stenosis primarily occurs in people over the age of 60 as a result of scarring and calcium buildup in the valve cusps.
• Tricuspid Regurgitation- Tricuspid Regurgitation occurs when blood leaks backward into the right atrium through the tricuspid valve each time the right ventricle contracts. This causes an increase in blood volume in the right atrium, which causes it to enlarge. Pressure in the veins leading to the right atrium also builds, creating a resistance of blood flow from the body to the heart.
• Tricuspid Stenosis- Tricuspid stenosis rarely occurs. It is the narrowing of the tricuspid valve which causes less blood to flow from the right atrium to the right ventricle. Because the valve narrows, blood volume increases in the right atrium causing it to enlarge and decreases in the right ventricle causing it to shrink.
• Pulmonary Stenosis- Pulmonary stenosis rarely occurs in adults. It is a narrowing of the pulmonary valve which causes a reduction in blood flow from the right ventricle to the pulmonary arteries. It is usually diagnosed in childhood because it produces a loud heart murmur.

Cardiac Arrhythmias
Cardiac arrhythmia is commonly referred to as abnormal heart rhythms. Heart disease can interrupt the normal cycle of the heart and cause abnormally fast or unusually slow heart rates. These conditions make the heart pump less effectively, so not enough blood reaches the brain or other vital organs. When the body's flow is inadequate, a person can faint, suffer chest pain or even die. Today, most arrhythmias are treatable.

Congestive Heart Failure
Congestive Heart Failure (CHF) is the fastest-growing form of cardiovascular disease in the United States. CHF is also one of the most frequently diagnosed disorders in the elderly. It occurs when the left ventricle (one of the four chambers in the heart) weakens and is unable to properly pump blood out of the heart. This is usually caused by a blockage in one of the coronary arteries. Because less blood is being pumped out of the heart and into the rest of the body, the heart cannot keep up with the amount of blood being pumped into the heart. This causes a backup of blood in the body causing a buildup of fluid in the tissue, otherwise called edema. Congestive Heart Failure can also be caused by a heart attack that damages the heart muscle, an infection of the heart muscle that goes unrecognized and eventually weakens the heart muscle or by uncontrolled high blood pressure. You are most at risk of developing CHF if you: have high cholesterol, smoke, have diabetes, are obese, have a family history of CHF, are older, or are not physically active.

Aorta Disease & Marfan Syndrome
Aortic disease causes the aorta to widen and tear. Marfan syndrome is an inherited disorder that changes the connective or elastic tissues in the body, especially in the aorta, eye and skin and may cause an overgrowth of the long bones in the body. Therefore, Marfan patients are tall in stature and have long limbs. The cardiovascular abnormalities are troublesome. Marfan patients may suffer from an enlarged aortic root, aortic regurgitation and prolapse of the mitral valve.

Hypertrophic Cardiomyopathy
Hypertrophic Cardiomyopahy is a rare condition that affects the heart's ability to pump blood. It occurs when the heart muscle abnormally thickens causing the heart wall to stiffen so that it cannot efficiently pump blood. Hypertrophic Cardiomyopathy can be treated in several ways from medication to surgery.

Testing for Heart and Cardiovascular Disease There are several tests Cardiologists use to diagnose heart and cardiovascular disease. The types of tests chosen depend on the patient's risk factors, history of heart problems and current symptoms. The tests used can be divided into two categories:

Non-invasive diagnostics
Non-invasive tests do not involve the insertion of catheters or instruments into the central arteries or veins of the body.

Electrocardiogram (EKG)(ECG)
An electrocardiogram(resting electrocardiogram) is a test that records the electrical activity of the heart. It measures the rate and regularity of heartbeats as well as the size and position of the chambers of the heart. An ECG also can detect damage to the heart and the effects of drugs or devices used to regulate the heart such as a pacemaker. During the test, you are asked to lie down. Electrodes are attached to each arm and leg and to your chest. During the procedure, you are asked to lie still and hold your breath for a short amount of time. Results are recorded on graph paper.

Treadmill Electrocardiogram
A treadmill electrocardiogram also records the electrical activity of the heart and is performed in the same way as an electrocardiogram. However, instead of being at rest, the heart is examined while you are exercising (walking) on a treadmill.

Chest X-ray
A chest X-ray is taken to view the chest, lungs, heart, arteries, ribs and diaphragm. Two x-rays are usually taken: one from the back (posterior-anterior view) and one from the side (lateral view). During the test, you are asked to stand in front of the machine and hold your breath while the X-ray is taken.

Holter monitor (ambulatory electrocardiogram)
A Holter monitor provides a continuous recording of heart rhythm during normal activity. The monitor is worn for either 24 hours or 48 hours to get a complete reading. For a Holter monitor, electrodes are placed on your chest and are attached to a small recording monitor that can be carried in your pocket or worn around your neck. The electrical activity of your heart is recorded during a 24 hour or 48 hour period while you keep a diary of your activities. The recording is then analyzed and a report of the heart's activity is generated. Any irregular heart activity is cross referenced with your activity at the time.

Event Monitor
An event monitor is used to record a heart rate and rhythms over a longer period of time. An event monitor is used to record the heart when symptoms are infrequent. Event monitors are small and portable much like a tape recorder. They are designed to be used only when symptoms occur. The event recorder records the heart rate. Later, the recorded rate and rhythm can be sent by telephone to your physician's office.

Echocardiogram
An echocardiogram uses sound waves to create a moving picture of the heart. The picture is much more detailed than an x-ray image and involves no radiation exposure. During the test, an instrument that transmits high-frequency sound waves is placed on your ribs near the breast bone. It is able to pick up the echoes of the sound waves and transmits them as electrical impulses. The echocardiography machine then converts the impulses into moving pictures of the heart. This test is very useful, because it allows doctors to see the heart beating and to visualize many of the structures of the heart.

Nuclear Stress Test
A nuclear stress test helps measure blood flow to the heart. It is similar to an exercise stress test, however, it can provide more information. During a nuclear stress test the patient is injected with a small amount of a radioactive substance. A nuclear medicine camera detects the radioactive material and then creates images of the heart muscle. If part of the heart is not receiving an adequate blood supply, a light spot will show up on the image.

Exercise Myocardial Perfusion Scan/Dual Isotope Stress Test
A dual isotope stress test is more accurate and provides more information than a standard treadmill stress test. This test examines the blood supply and pumping function of the heart muscle while at rest and while exercising. It helps the physician determine if there are blocked arteries to the heart which require treatment. During the test, the patient is injected with a mildly radioactive isotope (called Thallium) which makes the heart visible under a nuclear medicine camera. Images are then taken of the heart. Electrodes are placed on the patient's chest to monitor their heart rate and rhythm. The patient will be asked to exercise on a treadmill. When the target heart rate is reached, the patient will be injected with a second radioactive isotope. Later, a second set of pictures is taken of the heart. This test will take between two and three hours to complete.

Pharmacological Myocardial Perfusion Scan/Pharmacological Dual Isotope Stress Test
A pharmacological stress test also examines blood flow to the heart. This test is used in place of a dual isotope exercise test if the patient is unable to exercise on a treadmill. Like the dual isotope stress test, the patient is injected with a mildly radioactive isotope which makes the heart visible under a nuclear medicine camera. Pictures are taken of the heart. However, instead of exercising on a treadmill, the patient is injected with a medication that dilates the arteries to the heart much like exercise would. Pictures are again taken of the heart. This test will take between two and three hours to complete.

Cardiopulmonary Exercise Test
A cardiopulmonary test is used to test the effect of exercise on the heart. In short, the test tells how healthy the heart is. During the test, the electrical activity of the heart is measured (by an electrocardiogram) while walking on a treadmill or pedal a stationary bike. Blood pressure readings are also taken. Some patients may be asked to exercise continuously until they reach a target heart rate. Patients are also be monitored after exercise for about 10 to 15 minutes. The exercise stress test measures the heart's reaction to the body's increased demand for oxygen. Radionuclide Ventriculogram (MUGA)
This test is used to examine movement of the walls of the heart and the fraction of blood in the heart that is ejected with each heart beat. Here's how it works: the patient is injected with a short lasting tracer that sticks to the red blood cells. Using an ECG for timing events in the heart and a camera that produces images of the heart from the tracer, a movie of the beating heart is generated.

Invasive diagnostics
Invasive tests involve the insertion of needles, instruments or fluids into the body.

Diagnostic Cardiac Catheterization
Diagnostic cardiac catheterization investigates diseases and disorders of the heart by using a thin tube called a catheter. The catheter is inserted through a vein or artery in the groin or arm and slides inside the vessel to the heart. The catheters are used to, view the inside of the blood vessels, measure blood pressure in major blood vessels and the heart chamber, and reveal how well the heart is pumping blood.

Percutaneous Transluminal Coronary Angioplasty
Percutaneous transluminal coronary angioplasty is also commonly called balloon angioplasty, angioplasty and PTCA. This procedure opens narrowed arteries to increase blood flow. It may be done instead of coronary artery bypass surgery in patients with limited disease. PTCA is non-surgical and is performed under X-ray guidance in the cardiac catheterization lab. Before the procedure the patient is given a mild sedative, but remains awake. A small incision is made and a catheter with a balloon tip is inserted through the artery in either the groin or arm. X-ray is used to guide the catheter up into the heart and into the narrowed artery. The balloon is then inflated and deflated several times to push the plaque deposits against the wall of the artery.

Percutaneous Transluminal Coronary Angioplasty with Stent:
Often after angioplasty is performed, a stent (a wire mesh tube) is placed in the once narrowed artery to prevent it from narrowing again. Stents are placed in the artery with a balloon catheter. The procedure takes between one and two hours to complete. The artery will heal around the stent.

Transesophageal Echocardiogram
A transesophageal echocardiogram is used to evaluate a patient's cardiac condition. It can tell the cardiologist if there are any congenital defects and can detect the presence of heart valve disease or heart muscle disease. A transesophageal echocardiogram can also determine if an artificial valve is functioning properly or if there are any blood clots within the heart. Here's how the test works. A thin flexible tube is inserted down the throat while the patient is sedated. The tip of the tube sends out ultrasound waves that echo within the chest wall cavity. The echoes are picked up and create a picture of the heart that is displayed on a video monitor. This test will likely take between 60 and 90 minutes.