Consultation
All physicians within the practice provide clinical consultation
at one or both of our offices, and in our participating hospitals.
Cardiac evaluation and assessment of risk for developing heart disease
are an integral part of the exam. A review of the patient’s
history and physical assessment of the body is performed. Usually
an electrocardiogram (ECG) is performed to assist the physician in
determining the condition of the heart. The physician may order additional
tests. A treatment plan is developed and a full report is given to
the referring physician.
*Urgent Care*
We provide urgent care everyday at both offices. Any patient requiring
a same-day appointment can be seen for office consultation. Most diagnostic
tests can be scheduled within 24 hours. Call the office for an appointment.
Nuclear Cardiology
- Stress Myocardial Perfusion Imaging -(SPECT) - This test
is for the detection of coronary artery disease. The patient exercises
and then receives a small injection of an isotope, which provides
evaluation of the blood flow to the heart muscle and evaluates heart
function. Patients unable to walk on a treadmill can receive a medication
as Dipyridamole (Persantine), which simulates exercise and replaces
the treadmill portion of the heart. This test is completed in
one day.
- MUGA - The MUGA scan is done to determine the left ventricular
ejection fraction of your heart. This evaluates how well your heart
is pumping blood throughout your body.
- First Pass Radionuclide Angiography – (FPNA)- for
evaluation of the right and left ventricular function of the heart.
- Stress MUGA- stress equilibrium blood pool imaging with
Dobutamine. This provides evaluation of the heart’s response
to pharmacological stress found to be helpful in determining the
presence of coronary artery disease. (CAD)
- Resting Thallium- Myocardial Perfusion Imaging –
for detection of myocardial viability.
Cardiac Catheterization (Coronary Angiography)
- Cardiac Catheterization - This procedure involves the passage
of a catheter into a blood vessel of the arm or leg; advancing the
catheter into the heart and its arteries. A dye is injected which
enables visualization of the heart, valves and it’s arteries.
Any narrowing of the heart arteries or valve problems can be determined
with this test.
- Cardiac Intervention These are the following procedures
used to treat blocked or partially blocked coronary arteries:
- Percutaneous Transluminal Coronary Angioplasty (PTCA)
This procedure involves advancing a catheter through the heart’s
arteries just as done with a cath. This catheter has a balloon
on the end, which is inflated at the blockage inside of the artery
to push the plaque against the artery wall and allow the blood
to flow normally. This procedure is done in the hospital and the
patient can go home the same day or sometimes stays overnight.
- Stent Implantation A stent is a small stainless steel
tube that is permanently placed inside an artery to keep it open.
Stents are placed inside the coronary arteries in the heart using
the same method of cardiac catheterization. Usually a PTCA is
performed and then the stent is inserted.
- Athrectomy This procedure uses a drill or special catheter
to actually remove the plaque from the artery wall. This procedure
lasts one to three hours.
Echocardiography
This service provides complete evaluation of the heart, valves, and
cardiac function through the use of 2-D and M-mode imaging with Doppler
and color-flow ultrasound.
Complete 2D Echo - This non-invasive exam visualized the heart
chambers, muscle and valves through the use of ultrasound, Doppler
(sound waves) and color flow analysis.
Stress Echo - This exam utilizes both ultrasound and EKG monitoring
with exercise to evaluate the cardiac function during exercise and
at rest. This test can evaluate if there is a lack of blood flow to
the heart muscle during exercise.
Vascular Services
This service provides screening and assessment for peripheral vascular
and cerebral vascular disease. We are able to screen and assess both
for arterial and venous disease of the upper and lower extremities,
including stroke screening.
- Carotid Doppler - complete ultrasound exam of the extracranial
and vertebral arteries. This test is designed to follow cerebral
plaque disease, screen for stroke and TIA, and assess cerebral
blood flow.
- Venous Doppler - complete simple ultrasound exam to
assess for Deep Vein Thrombosis (DVT), superficial Thrombophebitis,
and venous insufficiency.
- Ankle Brachial Index - This is a simple blood pressure
exam to assess peripheral circulation of the legs and screen for
intermittent claudication and arterial occlusive disease.
- Arterial Imaging - a complete ultrasound study of the
upper and lower extremities to evaluate extensive arterial occlusive
disease. We can also evaluate for aneurysm or pseudoaneurysm,
and we can evaluate bypass grafts of the lower extremities.
- Abdominal Aorta Imaging - this is an ultrasound study
of the abdominal aorta to monitor aneurysm and aorta size.
Cardiac Research
Several physicians in the practice participate in pharmaceutical
and device research. These programs offer patients the opportunity
to take cardiology medications not currently on the market. All interested
patients are carefully screened before beginning a research study
and are fully informed about any risks of the study. Participation
in these studies offer the patients free medications and tests that
further evaluate their heart condition. Call the office to see if
there are any studies that may interest you.
Cardiac Device Management
LIVING WITH YOUR DEFIBRILLATOR
You have an Implantable Cardioverter/Defibrillator
often referred to as a Defibrillator or ICD. Here are some points,
which may be helpful in learning about your new device. An ICD detects
when the heart is beating at a dangerously fast rate and delivers
a shock to the heart to restore a more normal heart rhythm. All ICDs
also have a pacemaker component, which can make sure that your hear
rate does not go too slowly.
Take the time to review the company issued defibrillator
booklet given to you at the time of implantation. If this was not
given to you, ask the nurse for the copy or call the implanting physician’s
office to obtain your copy.
You should receive a temporary identification
card before you leave the hospital. The manufacturer will mail a permanent
card to you within 6-8 weeks. You should carry this card with you
at all times along with your list of current medications. Consider
wearing a Medic-Alert bracelet or necklace. Always notify the manufacturer
of any change in address, telephone number, or following physician.
Understand incisional care:
- Check your incision site daily for changes. Notify the implanting
physician of increased redness, swelling, tenderness, or drainage.
- Expect some discomfort at the implant site. After a period of time,
your awareness of the defibrillator will diminish.
- Bathing and showering are permitted unless instructed otherwise
by the implanting physician.
- Cleanse the incision with soap and water, rinse thoroughly, and
pat dry.
- Avoid using lotions, creams, or powders until the incision is completely
healed.
- Steri-stips covering the incision (if used), can be removed in 2
weeks if they have not already fallen off by that time.
The first 4 weeks after surgery DO NOT LIFT THE ARM ON THE IMPLANT
SIDE HIGHER THAN YOUR SHOULDER to avoid dislodging the ICD wire(s).
Do not press on, rub in a circular motion, or manipulate the ICD.
During the postoperative period, notify your
physician of the following should they occur:
Fainting spells
Increased shortness of breath
Fluttering in the chest
Increased chest pain
Persistent dizziness
Sudden weakness or fatigue.
Twitching of the chest or persistent hiccoughs
Increased swelling in the legs or ankles
Increased swelling at the implant site
Lightheadedness
Swelling in the arm on the side of the defibrillator implant
Fever along with redness or drainage at the surgical scar
Increasing swelling at the implant site
Within 24 hours of receiving a single shock
If you have symptoms of a rapid heart rhythm:
- Remain calm and move to where you can lie down or sit comfortably
- Have someone stay with you during the episode if possible
- Call 911 to go to the Emergency Department if you receive 3 or more
shocks closely spaced
- Call 911 to go to the Emergency Department if you receive more than
1 episode of shocks in a single day
- Call 911 to go to the Emergency Department if you have shocks on
2 successive days
- Call 911 to go to the Emergency Department if you faint or pass
out even briefly
- Call 911 to go to the Emergency Department if you continue to have
symptoms or your symptoms worsen
- If you call 911 to go to the Emergency Department, please have the
Emergency Department notify Cardiology Group of WNY
- If you receive one shock only and you feel back to normal in a few
moments, then you do not need to call 911
Driving may or may not be permissible. Be sure
to discuss this with the physician who determined the need for the
ICD. Use of the seat/shoulder belt is always recommended.
Gradually resume activities and exercise. Usual activities like grooming,
combing your hair, and sexual activity, can be resumed within the
first 1-4 weeks and need not be avoided unless your doctor informs
you otherwise.
- Activities requiring arm extension like golfing, bowling, tennis,
and gardening should be avoided for 12 weeks if it requires using
the arm on the same side as the defibrillator.
- Tackle football should be avoided and hunting may need to be modified
or abandoned altogether
- Discuss with your Cardiologist what levels of activity are permissible
for you
Heavy electrical equipment can interfere with
how the defibrillator works. All electrical devices should be in good
repair & properly grounded. Avoid holding or waving small appliances
over the implant site to minimize interference. Keep these appliances
12 inches from your implant site. Avoid using tools or appliances
that could harm you if you receive a shock from your defibrillator
during their use. You can generally use:
- Handheld items like shavers, hairdryers, remote control devices
- Electric blankets, heating pads, blenders, irons, toaster, garage
door openers
- Built-in appliances: washer, dryer, gas & electric stoves &
ovens, microwave, refrigerator
- Vacuum cleaner, sewing machine, treadmill
- TV, AM/FM radio, CD player, VCR/DVD player, legal CB radio
- Computers, copy machines, fax, machines, pagers, printers
Standard wired phones are safe to use. Cellular
transmitting devices, both analog & digital, must be used carefully:
- Examples: cellular phones, portable phones, mobile phones, walkie-talkies
- Cellular devices which transmit at 600-900 milliwatts (data found
in the owner’s manual) - keep the device at least 6 inches away
from your defibrillator
- Cellular devices which transmit at 3 watts or above (data found
in the owner’s manual) - keep the device & its antenna at
least 12 inches away from your defibrillator
- Hold the cellular transmitting device to the ear on the opposite
side from your defibrillator
- Carry the cellular transmitting device on the opposite side from
your defibrillator
- Do not carry the cellular transmitting device in a breast pocket
or on a belt within 6 inches of your defibrillator
NOTE: Some cellular transmitting devices emit signals when
they are turned on but not in use (in the listen or standby modes).
TREAT ALL CELLULAR TRANSMITTING DEVICES AS IF THEY ARE ALWAYS TURNED
ON.
Use with caution: Electrical power tools,
shop equipment, gasoline powered tools such as lawn mowers, snow blowers
& hedge clippers, large running motors or generators, theft protection
devices, electric toothbrushes, and short-wave radios. The defibrillator
can trigger security-screening devices such as in airports. Present
your ICD identification card to security personnel before going through
security check points.
Avoid: Handheld items with an AC motor
such as cordless electric irons & cordless shavers, remote control
with an antenna such as with remote control toys, chain saws electric
arc welding equipment, electric steel furnaces, induction furnaces,
and industrial magnets.
Medical/Dental Procedures: Inform your
present and any new physician, dentist, or therapist that you have
a defibrillator before having any surgeries, tests, or procedures.
Some tests may need to be modified (ex: lithotripsy, TENS therapy,
therapeutic radiation therapy, therapeutic ultrasound, radiofrequency
ablation, diathermy, electrocautery). Some tests cannot be done such
as Magnetic Resonance Imaging (MRI). You may safely have a CAT scan,
diagnostic X-Rays, fluoroscopy, and mammograms.
Defibrillators require regular evaluation to ensure
that the device is set according to your changing needs, monitor the
battery status, and gather the computerized diagnostic data that will
assist the physicians in managing your care. Upon discharge home,
please call our Wehrle office at 716-634-3243, or our Orchard Park
office at 716-677-6800 to arrange your first appointment.
LIVING WITH YOUR PACEMAKER
You have a permanent pacemaker. Here are some points, which may be
helpful in learning about your new device. A pacemaker can make sure
that your heart does not go too slowly, help provide adequate heart
rates during physical activities and exercise, and dual chamber devices
help maintain the timing between the top and bottom chambers of the
heart.
Take the time to review the company issued pacemaker
booklet given to you at the time of implantation. If this was not
given to you, ask the nurse for the copy or call the implanting physician’s
office to obtain your copy.
You should receive a temporary identification
card before you leave the hospital. The manufacturer will mail a permanent
card to you within 6-8 weeks. You should carry this card with you
at all times along with your list of current medications. Consider
wearing a Medic-Alert bracelet or necklace. Always notify the manufacturer
of any change in address, telephone number, or following physician.
Understand incisional care:
- Check your incision site daily for changes. Notify the implanting
physician of increased redness, swelling, tenderness, or drainage.
- Expect some discomfort at the implant site. After a period of time,
your awareness of the pacemaker will diminish.
- Bathing and showering are permitted unless instructed otherwise
by the implanting physician.
- Cleanse the incision with soap and water, rinse thoroughly, and
pat dry.
- Avoid using lotions, creams, or powders until the incision is completely
healed.
- Steri-stips covering the incision (if used), can be removed in 2
weeks if they have not already fallen off by that time.
The first 4 weeks after surgery DO NOT LIFT THE ARM ON THE IMPLANT
SIDE HIGHER THAN YOUR SHOULDER to avoid dislodging the pacemaker
wire(s). Do not press on, rub in a circular motion, or manipulate
the pacemaker.
During the postoperative period, notify your
physician of the following should they occur:
Fainting spells
Increased shortness of breath
Fluttering in the chest
Increased chest pain
Persistent dizziness
Sudden weakness or fatigue.
Lightheadedness
Increased swelling in the legs or ankles
Swelling in the arm on the side of the pacemaker implant
Twitching of the chest or persistent hiccoughs
Fever along with redness or drainage at the surgical scar
Increasing swelling at the implant site
Driving is permissible unless instructed otherwise.
Use of the seat/shoulder belt is always recommended.
Gradually resume activities and exercise. Usual
activities like grooming, combing your hair, and sexual activity,
should gradually be resumed within the first 1week and need not be
avoided unless your doctor informs you otherwise.
- Activities requiring arm extension like golfing, bowling, tennis,
and gardening should be avoided for 10-12 weeks if it requires using
the arm on the same side as the pacemaker.
- Tackle football should be avoided and hunting may need to be modified
or abandoned altogether.
- Discuss with your Cardiologist what levels of activity are permissible
for you.
Strong electromagnetic fields can prevent a pacemaker
from treating you or deliver extra heartbeats. If you experience dizziness,
a rapid heart rate or palpitations caused by interference from equipment,
simply move away from the source of interference and the pacemaker
will return to normal function.
All electrical devices should be in good repair,
and properly grounded. Avoid holding or waving small appliances over
the pacemaker site to minimize interference. Keep these devices 6
inches from your pacemaker. You can generally use:
- Handheld items like shavers, hairdryers, remote control devices
- Electric blankets, heating pads, blenders, irons, toaster, garage
door openers
- Built-in appliances: washer, dryer, gas & electric stoves &
ovens, microwave, refrigerator
- Vacuum cleaner, sewing machine, treadmill
- TV, AM/FM radio, CD player, VCR/DVD player, legal CB radio
- Computers, copy machines, fax, machines, pagers, printers
Standard wired phones are safe to use. Cellular
transmitting devices, both analog & digital, must be used carefully:
- Examples: cellular phones, portable phones, mobile phones, walkie-talkies
- Cellular devices which transmit at 600-900 milliwatts (data found
in the owner’s manual) - keep the device at least 6 inches away
from your pacemaker.
- Cellular devices which transmit at 3 watts or above (data found
in the owner’s manual) - keep the device & its antenna at
least 12 inches away from your pacemaker.
- Hold the cellular transmitting device to the ear on the opposite
side from your pacemaker.
- Carry the cellular transmitting device on the opposite side from
your pacemaker.
- Do not carry the cellular transmitting device in a breast pocket
or on a belt within 6 inches of your pacemaker.
NOTE: Some cellular transmitting devices emit signals when
they are turned on but not in use (in the listen or standby modes).
TREAT ALL CELLULAR TRANSMITTING DEVICES AS IF THEY ARE ALWAYS TURNED
ON.
Use with caution: Arc & resistance
welders, induction furnaces, electrical power tools, shop equipment,
gasoline powered tools such as lawn mowers, snow blowers & hedge
clippers, large running motors or generators, theft protection devices,
electric toothbrushes. The pacemaker can trigger security-screening
devices such as in airports. Present your pacemaker identification
card to security personnel before going through security checkpoints.
Medical/Dental Procedures: Inform your
present and any new physician, dentist, or therapist that you have
a pacemaker before having any surgeries, tests, or procedures. Some
tests may need to be modified (ex: lithotripsy, TENS therapy, therapeutic
radiation therapy, therapeutic ultrasound, radiofrequency ablation,
diathermy, electrocautery). Some tests cannot be done such as Magnetic
Resonance Imaging (MRI). You may safely have a CAT scan, diagnostic
X-Rays, fluoroscopy, and mammograms.
Pacemakers require regular evaluation to ensure
that the device is set according to your changing needs, monitor the
battery status, and gather the computerized diagnostic data that will
assist the physicians in managing your care. Upon discharge home,
please call our Wehrle office at 716-634-3243, or our Orchard Park
office at 716-677-6800 to arrange your first appointment.
LIVING WITH YOUR IMPLANTABLE LOOP RECORDER
You have an Implantable Loop Recorder (ILR). Here
are some points, which may be helpful. An ILR can assist in the diagnosis
of recurrent syncope or fainting, which may result from a heart rhythm
disturbance. It is a small self-contained battery-powered continuous
heart rhythm (EKG) recorder, which is surgically placed just beneath
the chest wall skin. When you have a fainting spell, you will store
the heart rhythm (EKG) in the device upon awakening. Later, the physician
can analyze the stored information to determine whether the faint
was caused by a heart rhythm disturbance. The battery is designed
to last about 14 months.
Take the time to review the company issued booklet
given to you at the time of implantation. If this was not given to
you, ask the nurse for the copy or call the implanting physician’s
office to obtain your copy.
You should receive a temporary identification
card before you leave the hospital. The manufacturer will mail a permanent
card to you within 6-8 weeks. You should carry this card with you
at all times along with your list of current medications. An Activator
will also be given to you at the time of implant. You must always
carry this ith you so you will be able to store the EKG data in the
event of a fainting spell.
Understand incisional care:
- Check your incision site daily for changes. Notify the implanting
physician of increased redness, swelling, tenderness, or drainage.
- Expect some discomfort at the implant site. After a period of time,
your awareness of the Loop Recorder will diminish.
- Bathing and showering are permitted unless instructed otherwise
by the implanting physician.
- Cleanse the incision with soap and water, rinse thoroughly, and
pat dry.
- Avoid using lotions, creams, or powders until the incision is completely
healed.
- Steri-stips covering the incision (if used), can be removed in 2
weeks if they have not already fallen off by that time.
Driving may or may not be permissible. Be sure
to discuss this with the physician who determined the need for the
ILR. Use of the seat/shoulder safety belt is always recommended.
Gradually resume activities and exercise. Usual
activities like grooming, combing your hair, sexual activity should
resume within 1 week and need not be avoided unless your doctor informs
you otherwise.
When you have a syncopal or near-syncopal episode
(faint or near-faint), upon awakening:
- Place the Activator over the implant site, either on your skin or
over your clothing.
- Press the white button on the Activator once
- Immediately remove the Activator and observe the flashing light
1. A flashing green light means the EKG has been stored. You do not
need to press the white button again
2. A flashing yellow light means the ILR did not receive the signal
from the Activator & the EKG is not being stored
3. If you see a flashing yellow light, reposition the Activator over
the ILR implant site and press the white button again. Repeat this
until a flashing green light is seen.
Notify your physician of the following should
they occur:
- Fainting spells or near-fainting spells
- Fever along with redness or drainage at the surgical scar
- Increased swelling at the implant site
- When you use the Activator to store data
The Loop Recorder is designed to receive radiofrequency
signals from your Activator. Devices, which emit radiofrequencies,
such as short-wave radios, have the potential to interfere with the
ILR.
Standard wired phones are safe to use. Cellular
transmitting devices, both analog & digital, must be used carefully:
- Examples: cellular phones, portable phones, mobile phones, walkie-talkies
- Cellular devices which transmit at 600-900 milliwatts (data found
in the owner’s manual) - keep the device at least 6 inches away
from your Loop Recorder.
- Cellular devices which transmit at 3 watts or above (data found
in the owner’s manual) - keep the device & its antenna at
least 12 inches away from your Loop Recorder.
- Hold the cellular transmitting device to the ear on the opposite
side from your Loop Recorder.
- Carry the cellular transmitting device on the opposite side from
your Loop Recorder.
- Do not carry the cellular transmitting device in a breast pocket
or on a belt within 6 inches of your Loop Recorder.
NOTE: Some cellular transmitting devices emit signals when
they are turned on but not in use (in the listen or standby modes).
TREAT ALL CELLULAR TRANSMITTING DEVICES AS IF THEY ARE ALWAYS TURNED
ON.
Use with caution: Avoid prolonged exposure
while passing through electronic detection devices. The ILR can trigger
security-screening devices such as those in airports. Present your
ILR identification card to security personnel before going through
security checkpoints.
You can generally use:
- Household appliances both handheld and built-in
- Electric machine shop tools
- Microwave ovens, stoves, washer/dryers, vacuum cleaners, sewing
machines, treadmills
- Spark-ignited internal combustion engines
- TV, AM/FM radios, CD player, VCR/DVD players
- Computers, copy machines, fax machines, pagers, printers
Inform your present or any new physician that
you have an ILR. With proper precautionary measures, most medical
procedures are unlikely to interfere with the function of your Loop
Recorder.
ILRs will also automatically store heart rhythms
meeting certain requirements, which may be unnoticed by you. Therefore,
ILRs require regular evaluation to obtain the stored data even when
you have had no symptoms. Upon discharge home, please call our Wehrle
office at 716-634-3243, or our Orchard Park office at 716-677-6800
to arrange your first appointment.
Arrhythmia Detection
Holter Monitor & Event Recorders are monitors that can be
worn for 24 hrs or longer that can detect and record any irregular
heart rhythms.
