Central Coast Cardiology specializes in diagnosing and treating heart problems. We offer a full range of integrated cardiac services. We consult in the cardiac care units of the hospital as well as other nursing units. As a recognized leader in cardiology services for the community, we offer a full range of diagnostic testing procedures, many of which are performed right here in our office. We also conduct diagnostic tests and procedures at Salinas Valley Memorial Hospital or
Community Hospital of the Monterey Peninsula.
Cardiac Catheterization
A cardiac catheterization, or cardiac cath, as it is often referred to, is an outpatient procedure done in the hospital. A thin, flexible tube, or catheter, is guided into the coronary arteries and chambers of the heart from a blood vessel. This allows pictures to be taken of the arteries to determine whether blood vessels supplying the heart muscle are narrowed or blocked, whether the heart is pumping properly, and to rule out heart problems. This procedure is used to diagnose and provide the doctor with information needed to formulate a treatment plan. During the procedure you will be awake and a sedative will be given to help you relax.
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Cardiac and Vascular MRI
MRI uses a powerful magnetic field and radio waves to produce images of different parts of the body. The latest generation MRI machines now have the capability to image fast enough to take moving pictures of the heart and blood vessels. In addition to being non-invasive (not requiring an incision), and radiation free (unlike CT scans and X-ray) MRI can image the heart and blood vessels with much higher resolution than other tests. High resolution imaging allows MRI to show abnormalities in cardiac chamber contraction, evaluate heart valves, and identify areas of the muscle that have become damaged as a result of infarction (heart attack). The unique capabilities of MRI make in an important new diagnostic imaging tool for evaluation your heart and blood vessels, and is a technology that we are proud to be able to offer to our patients at Central Coast Cardiology.
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Coronary Angiography/Angioplasty
Coronary Angiography is a procedure which allows taking x-ray pictures of the arteries of the heart to locate blockages and narrowings. An x-ray dye is injected into the arteries via the catheter which allows them to show up on the x-ray. Once these areas are identified, your doctor can recommend a procedure to increase blood flow to the heart.
Balloon angioplasty can be performed right after the angiography. A small balloon is inserted into the artery through the catheter. It is inflated to open the artery. Often this procedure is followed by a stent placement.
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Stent Implantation
A stent is a wire mesh tube inserted into the
artery to hold the artery open. The stent remains permanently in the artery. A drug-eluting stent, which releases medication over time, may be used to prevent scar tissue from forming in the artery thus preventing restenosis, or a new blockage.
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Peripheral Angiography
Peripheral angiography is an outpatient procedure that helps find blood vessel problems in your lower body and legs. A small incision is made near an artery in your groin. A thin catheter in inserted through the site and slid into an artery. Contrast dye is injected into the catheter which allows the doctor to observe blood flow on a video monitor. This can identify blockages which can then be treated.
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Carotid Angiography
Carotid angiography is an outpatient procedure that helps find problems in blood vessels leading to your brain. These vessels include the carotid arteries, which supply your brain with blood. A small incision is made near an artery in your groin. A
thin catheter in inserted through the site and slid into an artery. Contrast dye in injected into the catheter which allows the doctor to observe blood flow on a video monitor. This can identify blockages which can then be treated.
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Catheter Ablation 
Catheter ablation is a newer therapy which treats the cause of atrial fibrillation. It is sometimes referred to as pulmonary vein isolation. This procedure is performed by a cardiac electrophysiologist using radiofrequency energy to destroy carefully selected groups of tissues in the left atrium, pulmonary veins and superior vena cava, that start atrial fibrillation. This procedure, done in the hospital, can take 3+ hours to perform.
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Echocardiography
The echocardiogram (echo) is an ultrasound of the heart. Using standard ultrasound techniques, two-dimensional slices of the heart can be imaged. During an echo, harmless and painless sound waves are bounced off the heart, and the returning signals are converted into a moving image on a video screen.
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Exercise Stress Echocardiography
A transthoracic echo is performed, providing an image of how the heart functions at rest. A second echo is taken after a period of exercise, providing an image of how the heart functions with an increased workload.
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Dobutamine Stress Echocardiogram
Providing the same effect as an exercise stress echo, a dobutamine stress echocardiogram uses a medication, instead of exercise, to determine the effect of how the heart functions with an increased workload. This is particularly beneficial for people with physical limitations.
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Transesophageal Echocardiogram (TEE)
During a transesophageal echo, a small transducer is placed down the throat, through the esophagus, which lies directly behind the heart. Sound waves are emitted from the transducer, providing images of the heart and aorta.
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Electrocardiogram (EKG or ECG)
An electrocardiogram (ECG) is a test that records the electrical activity of the heart. It is used to measure the rate and regularity of heartbeats as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart.
An ECG is painless and it is useful in determining whether a person has heart disease. If a person has chest pain or palpitations, an ECG is helpful in determining if the heart is beating normally.
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Holter Monitor
A holter monitor is a machine that continuously records the heart's rhythm. The monitor is painless and is worn for 24 hours during normal activity. Electrodes, or small conducting patches, are stuck onto your chest and attached to a small recording monitor. You carry the holter monitor in a pocket or in a small pouch worn around your neck or waist. The monitor is battery operated.
While you wear the monitor, it records your heart's electrical activity. You record symptoms in a diary. After 24 hours, the doctor will look at your records and see if there have been any irregular heart rhythms causing your symptoms.
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Implantable Cardioverter Defibrillators (ICD's)
An implantable cardioverter defibrillator, or ICD, is a device that will protect your heart if your heart rhythm becomes too fast. A very fast heart rhythm is serious and dangerous. An ICD can reduce the risks associated with this condition. An ICD is a small electronic device which is placed permanently inside your body. Like a pacemaker with some additional features, an ICD monitors your heart rhythm. If the rhythm becomes too fast or too slow, the ICD will provide impulses to slow it down or speed it up to return
your heart rhythm back to normal. The ICD will either send electrical impulses to override a fast rhythm or interrupt a fast rhythm by briefly shocking the heart. This shock usually
returns a fast rhythm back to normal.
During implantation, an ICD is placed in your body. This is done in an electrophysiology lab in the hospital. In most cases this procedure takes from 1 to 3 hours. The ICD is usually implanted on the left side of your chest. A small pocket is created just below the collarbone to hold the ICD. A lead is threaded through the incision into a vein in the upper chest. X-ray monitors help guide the lead into on of the heart's chambers. The leads are attached to the heart muscle to remain in place. The ICD generator is placed in its pocket under the skin. The device is tested and the incision is closed.
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Magnetic Resonance Imaging (MRI)
An MRI uses a powerful magnetic field and radio waves to produce a highly accurate view of the inside of the heart. It is a painless and extremely safe procedure because no radiation
is used. 
Nuclear Cardiology
Nuclear cardiology studies use noninvasive techniques to assess myocardial blood flow, to evaluate the pumping function of the heart as well as to visualize the size and location of a heart attack. Among the techniques of nuclear cardiology, myocardial perfusion imaging is the most widely used.
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Myocardial Perfusion Imaging
Myocardial perfusion images, combined with exercise, assesses the blood flow to the heart muscle. Exercise can be in the form of walking on a treadmill. A "chemical" stress test uses the drug adenosine which can be substituted for patients who are not able to exercise maximally, providing similar information about the heart's blood flow.
A small amount of an imaging agent (thallium or sestamibi (Cardiolite) or tetrofosmin (Myoview)), is injected into the blood stream during rest and during exercise or chemical stress. A scanning device (gamma camera) is used to measure the uptake of the heart of the imaging material during exercise or chemical stress and at rest. If there is significant blockage of a coronary artery, the heart muscle may not get enough of a blood supply in the setting of exercise or during chemical stress. This decrease in blood flow will be detected by the images.
Myocardial perfusion studies 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.
Stress MPI Instructions
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Pacemakers
A pacemaker is a small, battery-powered device that is implanted inside the chest to help regulate the heart rhythm by producing electrical signals to start your heartbeat. The pacemaker is about two inches in diameter and weighs about one ounce. Pacemakers are designed to sense whether or not the heart is producing electrical signals naturally within a specified time. If natural beating activity does not occur within a specified time it will automatically "pace" or send an electrical signal to the heart, causing it to beat.
The pacemaker is implanted in your chest just under your skin through a small incision. Pacing leads - the wires that connect to your heart through which the signals flow - are connected at the same time. More than 100,000 pacemakers are permanently implanted in patients each year in the United States.
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