|Tests and Procedures performed by Dr. Nilesh Bavishi
Below are some of the most common tests performed by Dr. Bavishi. If other tests are recommended by Dr. Bavishi to diagnose or to treat a condition, more information concerning those procedures will be provided at that time.
Lipid Management (Cholesterol Monitoring)
There are many types of cholesterol found in the body. Three of the most widely known are low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG). Other types include very-low-density lipoprotein (VLDL), lipoprotein (a), small-dense LDL, LDL particle numbers, HDL size, etc. Elevated LDL, elevated small-dense LDL, or low HDL are causes for concern and can increase the risk of heart attack and stroke. Regular screening and monitoring of these different cholesterol levels through blood tests are very important in designing and implementing actions that can reduce the risk of heart disease. Some other tests include C-reactive protein, fasting insulin, serum fibrinogen, etc. Also, genetic tests can be performed to aid in lipid management.
An electrocardiogram (also known as an ECG or EKG) is a 2-D plotting of the heart’s electrical activity a period of time. It is conducted by placing electrodes in key areas of the human body to measure and record electrical activity of the heart. ECG tracings assist with evaluating rate, rhythm, chamber size, wall thickness, ischemia, injury, and electrolyte disturbances. Abnormalities in EKG recordings can help diagnose many heart conditions such as, atrial fibrillation-flutter, atrioventricular blocks, supraventricular contractions (SVC’s), premature ventricular contractions (PVC’s), left ventricular hypertrophy, myocardial ischemia, and injury (i.e. heart attack). It is also used to monitor effect of anti-arrhythmic drugs on electrical conduction and electrolyte abnormalities.
An echocardiogram (also known as an “echo”) is a procedure that captures live 2-D images of the heart by using sound waves. When sound waves are transmitted into the body they come in contact with different structures and bounce back. It is this return of the sound waves which are utilized to generate images of the underlying structures, a process also known as an ultrasound. With an echocardiogram, one can view the heart’s structure along with its muscle, valves, and function. Abnormalities noted include enlarged or reduced chamber size, thickened heart muscle (LV hypertrophy or septal hypertrophy), reduced heart pumping capability (cardiomyopathy), hyperdynamic pumping, valvular narrowing (stenosis), valves not closing completely (regurgitation), parts of heart not moving well (regional wall motion abnormality), and fluid around heart (pericardial effusion).
A stress test is used to determine presence of coronary artery disease. Frequently, patients with heart conditions have no symptoms at rest. When patients experience chest pain/arm pain, weakness or shortness of breath with exercise, or any symptoms that suggest a presence of heart disease, a stress test is usually performed. Exercise can reveal many problems present within the heart that would not be picked up otherwise because exercise requires more blood to pump throughout the body. In such a situation, arteries with blockages will supply less blood than arteries without blockages. These differentials in blood distribution lead to symptoms such as chest pain, shortness of breath, dizziness, and can also lead to abnormal ECG developments. In a stress echo, besides evaluating for symptoms and ECG abnormalities, one also evaluates for RWMA (regional wall motion abnormality) or chamber dilatation right after exercise to examine for a presence of coronary artery disease.
Carotid arteries supply oxygenated blood to the head and neck. They are at a high risk for plaque buildup causing them to narrow, a process known as carotid artery disease. This narrowing also increases the risk for stroke. A carotid ultrasound is used to detect the presence of plaque or narrowing of the carotid artery while a Doppler is utilized to measure the blood flow through the carotid arteries.
Peripheral Arterial Ultrasound/Doppler
Peripheral artery disease (PAD) is narrowing of the arteries of the pelvis and the legs. Similar to carotid artery disease and coronary artery disease, PAD occurs through the buildup of cholesterol deposits/fatty substances in these arteries. Symptoms of PAD can include cramping and pain in the legs when walking or exercising. Tests such as ABI (Ankle Brachial Index) or an arterial ultrasound can help determine the presence of PAD. Also, peripheral arterial disease is associated with increased risk of heart attack and stroke.
A holter monitor is a small, portable gadget that allows for continuous monitoring of the electrical activity of the heart for a determined period of time (usually 24 hours). It is worn while you perform your normal, everyday activities including sleeping. You should keep a diary of any peculiar events that occur during the course of wearing this monitor so that any signs or symptoms that you experience can be linked to abnormalities in your heart’s electrical activity. There is no special preparation required for this test and actually you should not avoid activities that you normally perform as accurate and appropriate monitoring is essential for a diagnosis.
If the 24 hour holter monitor fails to pick up an abnormal rhythm, then an event recorder may be necessary. With an event recorder, the heart rhythm is monitored and the most recent 30 seconds of the rhythm is continuously stored. Whenever an abnormal rhythm or event occurs such as shortness of breath, dizziness, or heart flutters, the patient can push a button on the monitor to store the latest recording on the monitor. Then, the patient can transmit the stored recording, usually by telephone, to an appropriate center for review. The monitor is usually clipped to one’s waist and is worn for periods up to 30 days.
Mobile Cardiac Telemetry
In contrast to an event recorder, a mobile cardiac telemetry device transmits real time ECG recordings while an individual performs daily, routine activities. It differs from an event recorder in that the transmission of the information is immediate compared to an event recorder, which requires the data to be stored and then later transmitted. Similar to an event recorder, this device too can help monitor for changes in heart rhythm and pick up abnormal cardiac events, which may be asymptomatic. This device is worn for periods up to 30 days.
Pacemakers are electrical devices that produce a rhythmic electrical pulse to allow the heart to beat regularly. They are usually implanted in the body when the heart’s own electrical signaling system is ineffective or flawed in some way. If you have a pacemaker or will have one installed, regular pacemaker checks are required after its implantation to correct and adjust the pacemaker for maximum efficiency.