Patient Care Services

Diagnostic Testing
Many cardiac diagnostic procedures, some highly sophisticated and some relatively simple, are employed at Greenwich Hospital, including the following:

24-Hour Blood Pressure Monitoring: A portable apparatus makes possible 24-hour studies in which the patient's blood pressure is recorded at regular intervals while the patient goes about normal activities.

64-slice Volume CT Scan: A technology that enables non-invasive cardiovascular imaging. Read more.

Cardiac Catheterization: See Hemodynamic Monitoring and Cardiac Electrophysiology information below.

Cardiac Electrophysiology: Electrophysiologists are cardiologists with additional training in the diagnosis and treatment of heart rhythm disorders – the electrical misfiring of the heart, which is also known as arrhythmia. Electrophysiology tests enable physicians to precisely pinpoint the location and cause of the problem and determine the appropriate treatment option.

During a diagnostic electrophysiology study, a thin catheter is inserted into a vein or artery in the groin and guided to the heart to measure the heart's electrical activity and pathways.

The test findings can lead to further treatment with antiarrhythmic medications or the implantation of a pacemaker or implantable cardiverter defibrillator. In some cases, the physician may perform a catheter ablation, a procedure that uses radiofrequency to destroy selected abnormal areas of the heart's conduction system, restoring the heart's normal electrical activity.

At Greenwich Hospital, all diagnostic electrophysiology procedures are performed by Alexander DelVecchio, MD, a board-certified electrophysiologist. Catheter ablations are performed at Yale New Haven Hospital.

Echocardiography: Ultrasound waves are bounced off the heart and converted to images on a screen, giving detailed information about the heart, its valves and chambers. Two-Dimensional Echo, a variation, shows the actual shape and motion of the various heart structures. Doppler Echo allows doctors to evaluate the flow of blood through the heart.

Exercise Echocardiography: This test combines an ultrasound study of the heart with exercise to show how the heart functions when working hard. It is particularly helpful in showing blockages in arteries around the heart.

Hemodynamic Monitoring: Measuring the status of a critically ill patient by observing changes in blood flow and pressure in the large vessels and major chambers of the heart, this test employs a small, special tube known as the "Swan-Ganz" catheter.

Holter Monitors: This special tape recorder, worn on a strap over the shoulder or around the waist, provides a continuous EKG over a period of time, typically 24 hours. It is helpful when people have occasional abnormal heart rhythms that might not show up in a standard EKG.

Metabolic Syndrome Screening: Metabolic syndrome is characterized by a group of metabolic risk factors in one person. People with metabolic syndrome are at an increased risk of coronary artery disease, other diseases related to plaque buildups in the artery walls and type 2 diabetes. According to the American Heart Association, metabolic syndrome is identified by the presence of at least three of the following risk factors:

• Abdominal obesity (excessive fat tissue in and around the abdomen)
• Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls)
• Elevated blood pressure
• Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
• Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)
• Proinflammatory state (e.g., elevated C-reactive protein in the blood)

Peripheral Vascular Studies: Peripheral Vascular Disease (PVD) is the name for damage or blockage in arteries or veins far from the heart. It may be diagnosed with various tests such as arteriography, in which a dye is injected into the bloodstream to show the location and severity of a blockage.

Stress Testing: This is the popular name for exercise EKGs, which allow doctors to see how well the heart functions during physical exertion.

Thallium Scan: This test helps determine whether certain areas of the heart are receiving enough blood. It uses a radioactive substance known as a tracer and usually is performed after patients walk on a treadmill or ride a stationary bike. For those unable to perform such tasks, certain drugs may be given to mimic the effects of exercise on the heart.

Tilt Table: People who experience certain symptoms, such as fainting, may need medication or a pacemaker. During this test, as the examination table is tilted to simulate the effects of standing up, blood pressure and other vital signs are monitored.

Transesophageal Echocardiography (TEE): This test allows the physician to record images of the heart from inside the esophagus or "food pipe," which lies just behind the heart. A slim, flexible tube is inserted into the esophagus, where it produces sound waves that are bounced off the heart.