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Cardiology Clinic Services

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Cardiac Risk Assessment and Management

Your risk of heart disease, particular coronary artery disease or "blocked heart arteries," is related to multiple well-known risk factors. These risk factors include advancing age, male sex, family history of coronary artery disease, diabetes, high blood pressure, high cholesterol, smoking, lack of physical activity and obesity.

A person's risk of having coronary artery disease and future risk of heart attacks and other heart problems can be estimated from the above risk factors. Our cardiologists are experts in identifying and assessing these risk factors and your risk for heart disease. We also recommend steps that can reduce these risks, including drug therapy to reduce blood pressure and high cholesterol levels, individualized diet and exercise programs to promote weight loss and physical fitness, and steps to help with smoking cessation.  

We also determine if further tests would be indicated to help better determine your risk of coronary artery disease. These tests include
non-invasive stress tests, coronary artery calcium scoring or non-invasive CT scan coronary angiograms. Please see the other sections of the website for details on these tests.

Coronary Angiography and Angioplasty

Cardiac catherization involves passing a catheter (a thin flexible tube) into the right or left side of the heart. In general, this procedure is
performed to obtain diagnostic information about the heart or its blood vessels or to provide treatment in certain types of heart conditions.

Cardiac catheterization can be used to determine pressure and blood flow in the heart chambers, collect blood samples from the heart, and
examine the arteries of the heart.

How is the procedure done?
You will be given a mild sedative prior to the test to help you relax. An intravenous (IV) line is inserted into one of the blood vessels in your arm, neck, or groin after the site has been cleansed and numbed with a local anesthetic.

A catheter is then inserted through the IV and into your blood vessel. The catheter is carefully threaded into the heart using an X-ray machine that produces real-time pictures (fluoroscopy). Once the
catheter is in place, contrast material is injected and pictures are taken.

Test Preparation
Food and fluid are restricted 6 to 8 hours before the test. The procedure takes place in the hospital and you will be asked to wear a hospital gown. Sometimes, admission the night before the test is required. Otherwise, you will be admitted as an outpatient or an inpatient the morning of the procedure. Your healthcare provider should explain the procedure and its risks. Tell your doctor about all your medicines and allergies.

Let your doctor know if you are allergic to shellfish or if you have had a bad reaction to contrast material in the past. Notify your doctor if you are taking Viagra, Cialis or Levitra, or if you might be pregnant.

The Procedure
The study is carried out in a laboratory by a trained cardiologist. You will be awake and able to follow instructions during the catheterization. A mild sedative is usually given before the procedure to help you relax. The procedure generally lasts one hour. Local anesthesia will be used to numb the IV site, so the only sensation should be one of pressure at the site.

After the test, the catheter is removed. You might feel a firm pressure at the insertion site, used to prevent bleeding. If the IV is placed in your groin, you will usually be asked to lie flat on your back for a few hours after the test to avoid bleeding. This may cause some mild back discomfort.

Information obtained from the procedure Cardiac catheterization is usually performed to evaluate heart valves, heart function and blood supply.

Therapeutic catheterization may be used to repair certain types of heart defects, open a stenotic heart valve, and open blocked arteries or grafts in the heart.

Abnormal Results
The procedure can identify heart defects or disease, such as coronary artery disease, valve problems, ventricular aneurysms, or heart enlargement. The procedure also may be performed for the following: heart valve abnormalities, heart artery abnormalities and heart function abnormalities.

Risks of the procedure
Cardiac catheterization carries a slightly increased risk when compared with other heart tests. However, the test is very safe when performed by an experienced team. Generally, the risk of serious complications ranges from 1 in 1,000 to 1 in 500. The risks include the following: stroke, heart attack, vascular injury and death.

Considerations associated with any type of catheterization include the following: In general, there is a risk of bleeding, infection, and pain at the IV site. There is always a very small risk that the soft plastic catheters could actually damage the blood vessels. Blood clots could form on the catheters and later block blood vessels elsewhere in the body. The contrast material could damage the kidneys (particularly in patients with diabetes).

Peripheral Vascular Disease

Peripheral vascular disease (PVD) refers to blockages of the arteries outside of the heart composed of cholesterol plaques. As the condition progresses, patients frequently experience intolerance to walking because of discomfort or weakness in the legs. Worsening of the disease may result in pain at rest or sores in the legs. Ultimately, a person might require amputation of the affected limb.

PVD is more common with increasing age, in smokers, and in diabetic patients. Simple, painless and inexpensive non-invasive tests can be
performed in the office to detect the condition. Further evaluation may require advanced (CT or MRA) imaging. Catheter-based angiography may also be necessary to define the extent and severity of the disease.

PVD is typically first treated with risk factor modification: smoking cessation, cholesterol lowering therapy, aspirin and possible other medications. A search for other organs affected by cholesterol plaques may be indicated. Rehabilitation is recommended for PVD patients, and may be the only form of treatment needed.

Medications may help alleviate symptoms related to PVD. Patients who have inadequate relief with conservative management or who are at risk for sores or limb loss are frequently evaluated with the
goal of aggressively improving blood flow.

Surgery was once the only therapy available to achieve this goal. Now, minimally invasive therapy, including balloon angioplasty and stent implantation, has great success for many patients. This is typically an outpatient procedure that offers immediate relief for many patients.

Carotid Vascular Disease

Stroke is the third-leading cause of death and the leading cause of disability in the U.S. A stroke is an obstruction of blood flow to a part of the brain that results in that part of the brain dying. Symptoms of a stroke include weakness, loss of control, or numbness in an extremity, visual disturbances, or difficultly with speech. Stroke symptoms that resolve within one day are called "transient ischemic attacks," or TIAs (frequently also referred to as "mini-strokes").

Following a TIA, there is a very high risk of a completed stroke within the next year. Strokes most frequently, however, occur suddenly with no warning symptoms.

About one in four strokes are the result of significant cholesterol plaque buildup (atherosclerosis) in the carotid arteries. Patients with other atherosclerotic disease are frequently screened for carotid artery disease.

Often, physical examination findings suggest the presence of carotid artery disease. Screening for carotid artery disease is quite simple and painless. An ultrasound examination of the carotid arteries takes
about 20 minutes and can usually be completed at the time of an office visit.

Treatment of carotid artery disease begins with risk factor management including smoking cessation, blood pressure control, treatment of diabetes, and cholesterol lowering. Medical therapy most often involves blood thinners.

Carotid surgery may be performed to remove the cholesterol plaque. More recently, a less invasive option has become available in the form of carotid stents. This procedure has been shown to have similar results to surgery in selected patients.

Electrophysiology and Arrhythmia

Electrophysiology is a specialized area of cardiology, focusing on the treatment of heart rhythm abnormalities. We provide evaluation and
treatment of people with known heart rhythm abnormalities, as well as syncope (fainting), and other symptoms that may suggest the presence of electrical problems in the heart. We also provide surgical implantation of devices that prevent sudden death from heart rhythm problems (defibrillators), and treat slow heart beating (pacemakers).

We provide:

  • diagnostic studies to determine the presence and nature of the heart rhythm abnormality
  • complex mapping and ablation (location of the abnormality and application of treatment)
  • implantation of a full range of pacemakers and internal defibrillators, including bi-ventricular devices used to treat patients with cardiomyopathy and congestive heart failure
  • tilt table testing and other neurophysiologic studies for individuals with syncope
  • implantation of internal recorders used to help detect difficult, intermittent symptoms likely related to heart rhythm abnormalities
  • non-invasive techniques for the evaluation of heart rhythm abnormalities include placement and interpretation of continuous Holter monitors
  • patient-activated event monitors

Long-term follow-up is available through our many convenient outreach sites.

Pulmonary Hypertension

Pulmonary hypertension is high pressure in the blood vessels that carry blood into the lungs. This strains the lungs and heart and can lead to serious problems.

Systemic hypertension means the pressure is too high in blood vessels throughout the body. A person with pulmonary hypertension may also have systemic hypertension.

Causes of Pulmonary Hypertension

The cause of pulmonary hypertension is sometimes unknown, but it is most often caused by another health problem. In many cases, controlling this health problem can help prevent or control pulmonary hypertension. Some of the most common causes of pulmonary hypertension are:

In Adults

  • Lung conditions, such as chronic obstructive pulmonary disease (COPD), advanced bronchitis, cystic fibrosis, or pulmonary fibrosis
  • Blood clots in the lungs
  • Left-sided heart failure
  • HIV infection
  • Sleep apnea
  • Other conditions, such as scleroderma, lupus, or sickle cell disease

In Children

  • Severe lung problems in a newborn
  • Lung conditions, such as cystic fibrosis or interstitial lung disease
  • Heart disease
  • Congenital heart defects
  • HIV infection
  • Other conditions, such as scleroderma, lupus, or sickle cell disease

Symptoms of Pulmonary Hypertension

Symptoms may come on suddenly. Or, they may come on slowly over time. Symptoms can include:

  • Shortness of breath
  • Blue lips or fingernails (signs that the body is having trouble getting oxygen)
  • Tiring quickly, especially when active
  • Fast heartbeat
  • Bloating
  • Swelling in the legs or ankles
  • Chest pain or pressure
  • Fainting or dizzy spells

Diagnosing Pulmonary Hypertension

The doctor will examine you and listen to your heart and lungs. Your blood pressure will also be measured. Tests may be done as well. These may include:

  • Blood tests. These measure certain body functions. They also check for problems such as infection.
  • A chest X-ray. This takes a picture of the inside of the chest. It can show certain heart and lung problems.
  • An electrocardiogram (ECG or EKG). This test records the heart’s electrical activity.
  • An echocardiogram. This test uses sound waves to create a moving picture of the heart.
  • Pulmonary function tests. These tests measure breathing and lung capacity.
  • Cardiac catheterization. This procedure gives detailed information about the heart’s structures. A thin tube (catheter) is put into a blood vessel and guided into the heart. Certain blood pressure tests are then done.

Treating Pulmonary Hypertension

Treatment depends on your age, health and severity of your symptoms. Any underlying health problems you have will be treated. Treatment may also include:

  • Oxygen
  • Medication to lower the pressure in the lung blood vessels
  • Medication to help the body lose excess water
  • Medication to prevent blood clots

Long-Term Concerns

Most people do well after treatment. In rare cases, a lung transplant may be needed. Your doctor can tell you more about this if needed.
Call your doctor right away if you have any of the following:

  • Persistent blueness of lips or fingernails
  • Shortness of breath
  • Fever of 100.4°F or higher
  • Fainting spells

Mercy Anticoagulation Center (MAC)

Mercy’s Anticoagulation Center (MAC) manages patients who are currently taking anticoagulants. Care is individualized and tailored to the patient’s specific needs to the right anticoagulant, including monitoring and proper dosing to ensure patient safety.

The MAC Program Includes:

Education:

  • Diet
  • Review of medications you are currently taking
  • Drug and food interactions
  • Support services and resources that are available

Physical Assessment:

  • Vital signs

Individualized Care Plan:

  • Provide you with access to a team of specialists if needed
  • Discuss strategies and a treatment plan to assist in decreasing the risk for bleeding events

Discharge Care includes:

  • Patient update sent to referring family doctor and/or cardiologist
  • Ongoing monitoring of lab values and dosing as needed
  • Patients receive an educational guide focused on living with anticoagulation therapies

Mercy’s Anticoagulation Center hours are 8 a.m. to 5 p.m. Monday through Friday,. Physician referral required.

For more information, contact Mercy Cardiology Clinic at (319) 832-2328.

Heart Failure Center

Mercy’s Heart Failure Center is a comprehensive program which includes a team of doctors, nurses, dietitians, social workers, counselors, financial planners and pharmacists that assists patients with managing a heart condition and improving quality of life.

Heart Failure Center Program Includes:

Symptom Management, such as:

  • Monitoring your weight
  • Reducing the swelling in your legs and/or stomach
  • Improving shortness of breath

Education:

  • Diet
  • Medications you are currently taking
  • Activity
  • Support services and resources that are available

Physical Assessment:

  • Vital signs
  • Assessing for and reviewing with you the signs and symptoms of a flare-up
  • Heart and lung sounds

Individualized Care Plan:

  • Provide you with access to a team of specialists to assist with improving your quality of life
  • Discuss strategies and a treatment plan to assist you in decreasing hospital and emergency room visits

Discharge Care includes:

  • Patient update sent to referring family doctor and/or cardiologist
  • Schedule a follow-up clinic appointment in the Heart Failure Center
  • Schedule a home visit within a week of discharge if desired

Heart Failure Center hours are 8 a.m. to 5 p.m. Monday through Friday. Physician referral required.

For more information, contact Mercy Cardiology Clinic at (319) 832-2328.

Women's Heart Health

Cardiovascular disease has usually been thought of as a "male" disease, but it is the leading cause of death for women in the United States. In 2007, cardiovascular disease claimed the lives of more than 500,000 American women according to the American Heart Association (AHA). In fact, two out of every five female deaths in the United States are caused by cardiovascular disease and it claims more than 10 times as many lives as breast cancer annually and more than eight times as many lives as lung cancer. It is responsible for more deaths annually among women than all other causes combined.

Researchers say that women experience cardiovascular disease differently than men, especially coronary heart disease. It may have different symptoms, and onset tends to occur later in life. Because of these differences, women are often less likely to be referred for testing for heart disease. Women must therefore be more assertive in seeking appropriate care.

Women also have different target goals than men when it comes to controlling risk factors such as cholesterol levels and triglycerides.
It is very important that all women understand the dangers posed by cardiovascular disease and take appropriate steps to prevent it.

Non-Invasive Stress Testing

This test helps detect heart disease by providing your cardiologist with information about how your heart tolerates exercise stress. A technician will attach electrodes to your chest to monitor your heart's electrical activity (ECG) during and after exercise. You will be asked to exercise on a treadmill until you feel that you need to stop due to fatigue, shortness of breath or chest discomfort. Depending on your medical history and exercise capabilities, a medication may be substituted for physical exercise.

You will be asked to rate your level of exertion periodically. A technician and cardiologist/nurse clinician will be in the exercise room the entire time to monitor and evaluate the test. Exercise may be stopped due to changes in the ECG recording or blood pressure criteria. After you have exercised to your peak intensity, you will be monitored for several minutes. 

There is low risk associated with treadmill stress testing and it is minimized by the completion of a thorough examination beforehand and by careful monitoring during the test. After the procedure your cardiologist will review the results with you. 

It may be necessary to image the heart at rest and after stress with echocardiogram (heart ultrasound) or nuclear cardiology techniques.

Nuclear Cardiology

Nuclear Cardiology has played an important role in diagnosing the presence and extent of heart disease. It also aids in predicting coronary artery disease outcomes.

Nuclear cardiology studies use noninvasive techniques to assess blood flow to the heart muscle, to evaluate the pumping function of the heart, and to visualize the size and location of a heart attack.

During a nuclear stress test, a small amount of a safe chemical is injected into the blood stream during rest and also during exercise or
chemical stress. A scanning device is used to measure absorption of the chemical by the heart. If there is significant blockage of a coronary artery, the heart muscle may not get enough blood supply during exercise or chemical stress. This decrease in blood flow will be detected by the images shown on the nuclear camera.

A nuclear study can also be used to assess heart function (the pumping function of the heart). A small dose of a chemical is injected into the blood stream and pictures of the four chambers of the heart are taken using the camera. These techniques can also provide information about the function of the valves of the heart, the integrity of all the cardiac chambers, and the effects of different drugs on the heart.

The evaluation of cardiac function using a nuclear camera is accurate and continues to play a critical role in predicting outcomes in patients
with heart disease.

CT Coronary Angiography

Ultrafast computed tomography (CTA) is a non-invasive imaging technique used to create three-dimensional pictures of your beating heart. The electron-beam CT uses a scanning electron beam that can take very rapid pictures of the heart, timed to coordinate with your heart beat. This speed allows the cardiologist to actually see the working heart, and to measure the size and volume of the right and left ventricles, the muscle mass in the left ventricle, and the status of the coronary arteries.

Coronary CTA is used to detect the earliest of heart artery narrowings, before symptoms occur. The scan is sensitive enough to identify the early stages of coronary plaque formation.

Ultrafast CT scans are also being used to rapidly diagnose other cardiac related conditions, including aortic dissection, pulmonary embolism, restenosis after angioplasty, and the effectiveness of heart surgery or medical therapy. Additionally, ultrafast CT scanning is valuable in an emergency room setting because of its speed.

Studies have shown that these tests may be of some value in predicting future risk for heart attack, especially when combined with other markers of cardiac risk such as the Framingham coronary risk profile. Evidence for early coronary plaque might lead a physician to recommend additional testing, such as a nuclear stress test, coronary angiography, or exercise stress test.

Because the test involves radiation exposure, women who are or may be pregnant should not have the test done.

Preventive Cardiology

If you have a family history of heart disease; are concerned about high cholesterol, high blood pressure, diabetes, smoking and other
cardiovascular risks; or if you are recovering from a heart attack or surgery, you can benefit from a cardiac risk assessment with a cardiologist.

We specialize in the prevention, early detection and treatment of cardiac problems, with an emphasis on early risk factor identification. Using state-of-the-art technology, we provide you with a comprehensive cardiovascular risk assessment and an individual plan on how to improve your heart health.

Diseases such hypertension, high cholesterol and diabetes are targets for prevention. Our staff looks at the entire scope of the vascular
system. We screen patients for all types cardiovascular diseases, including blockages and clotting of the legs, neck, heart and kidneys. We have the technology and experience to perform screenings of the carotid arteries, coronary arteries, testing for peripheral arterial disease (PAD/PVD), and renal artery stenosis.