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Patient Services that
we provide
"Triple Accreditation" for
the Imaging Laboratories of
Berks Cardiologists, Ltd.
Berks Cardiologists, Ltd.,
("BCL"),
provides comprehensive
cardiovascular care,
including state-of-the-art
non-invasive and invasive
diagnostic testing, in both
medical and interventional
therapeutics. BCL's Nuclear
Imaging Center is the first
ICANL Accredited lab in
Berks County and is ICAL
Certified in both Nuclear
Cardiology and Vascular
Imaging.
Policy of Berks
Cardiologists, Ltd.
concerning same-day
interpretation of
Non-Invasive Diagnostic
Testing.
BCL has a policy of same-day
interpretation of all
non-invasive tests (except
Holter monitors that require
additional processing time).
Physicians, need a result
STAT? We can FAX you a copy
of the test results or give
you a telephone report the
same day, on request.
Preparations prior to
testing, see:
Script
Pad Available for Download
Quick
links to different categories of Patient Services:
Echocardiography
 (Cardiac Ultrasound, or simply
"Echo")
A
very safe, non-invasive technique using ultrasound
waves to image the heart and its structural
components in a manner similar to ultrasound
examinations of expectant mothers’ unborn babies in
the womb.
While Echo gives important structural information
about the heart and its components, Doppler
examination using ultrasound waves gives important
information about the function of the heart and
valves.
A
test combining the imaging power of Echo and the
stress component of treadmill exercise to assess the
heart for evidence of blockage in the coronary
arteries.
A
test combining the imaging power of Echo and the
stress on the heart induced by a medication called
dobutamine which is administered intravenously while
the patient is lying down, to simulate the effect of
stress induced on the heart. This test can be used
for patients who cannot exercise but for whom
non-invasive assessment for the presence of blockage
in the coronary arteries is indicated.
A
semi-invasive procedure using an echo probe mounted
on a fiber optic flexible tube. After the patient is
adequately sedated, the tube is advanced into the
patient’s esophagus (food tube connecting the mouth
with the stomach) as it passes directly behind the
heart in the chest for extremely high resolution and
close-up imaging of the heart and its structures
without the patient’s ribs and lungs in the way.
Some patients with weak hearts who have received a
special type of implantable defibrillator—a
pacemaker-like device—can have significant
improvement in their cardiac function by adjusting
the output signals of the device using cardiac
ultrasound as a guide. This process is called
Cardiac Resynchronization Therapy (CRT).
An invasive technique used during cardiac
catheterization to image the insides and the walls
of the arteries of the heart to assess blockages, to
determine optimal therapy.
While Berks Cardiologists primarily treat adult
patients, some of us have had training and extensive
experience in reading cardiac ultrasound
examinations in the pediatric age group—newborn to
age 18—with emphasis on congenital heart disease.
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Stress Testing
Generally safe and painless test that is used to
measure the heart’s tolerance for exercise and
detect various forms of heart disease. This test
combines walking on a treadmill with an
electrocardiogram (EKG) to measure the heart’s
activity both at rest and while working. Your heart
rate and blood pressure are also monitored.
This test helps to determine which parts of the
heart are healthy and function normally and which
are not. A very small and harmless amount of
radioactive substance is injected into the patient.
During this stress test you will have an IV in your
arm so that the nuclear medicine technologist can
inject the imaging drug (Thallium, or Technetium)
into an IV in your arm. Your blood pressure and
heart rate will also be monitored during the test.
While at rest and after exercise, the technician
will use a special camera to identify the rays
emitted from the substance within the body; this
produces clear pictures of the heart tissue on a
monitor that allow the doctor to determine whether
there are blockages in the heart arteries or whether
there has been a prior heart attack.
This test is performed while the patient exercises
in a controlled manner on a treadmill. This test
combines echocardiography with exercise to evaluate
the heart's function at rest and with exertion.
Echocardiography is an imaging procedure that
creates a picture of the heart's movement, valves
and chambers using high-frequency sound waves that
come from a hand held wand placed on your chest.
This test helps your doctor determine the heart
muscles' response to exercise.
This type of stress test is used with patients who
are unable to perform physical activity using a drug
to simulate exercise.
Adenosine Stress Test - uses the drug
(Adenosine or Persantine) to simulate stress to your
heart. Adenosine causes the body to respond as if it
were exercising. It will show the blood flow to the
heart using pictures taken with a special camera.
During this stress test you will have an IV in your
arm so that the nurse and nuclear medicine
technologist can inject the drug Adenosine and the
imaging drug (Thallium, or Technetium) into an IV in
your arm. A nuclear camera will scan your heart.
Your blood pressure and heart rate will also be
monitored during the test.
Dobutamine Stress Echo - a non-invasive test
used to evaluate coronary artery disease in patients
who are unable to exercise on a treadmill.
Dobutamine is a medication that increases heart rate
and blood pressure similar to the effect of
exercise. The test includes an echocardiogram done
at rest and again at peak heart rate. In order to
produce an image of the heart muscle, gel is applied
to the patient's chest area and a transducer (a
wand-like apparatus) is moved over the chest.
Electrodes are placed on the chest to record an
electrocardiogram (EKG) which monitors the heart's
rate and rhythm. An IV line will be started and
Dobutamine will be administered by a technician. The
technician will observe for any symptoms, irregular
heart rhythms, an inappropriate heart rate or blood
pressure responses.
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Cardiac Nuclear Imaging
Exercise Stress Test - test evaluates the
blood flow to the heart at both rest and stress, as
well as helps determine the overall function of the
heart. This test helps to determine which parts of
the heart are healthy and functioning normally and
those that are not. A very small and harmless amount
of radioactive substance is injected into the
patient. During this stress test you will have an IV
in your arm so that the nuclear medicine
technologist can inject the imaging drug (Thallium,
or Technetium) into an IV in your arm. Your blood
pressure and heart rate will also be monitored
during the test. While at rest and after exercise,
the technician will use a special camera to identify
the rays emitted from the substance within the body;
this produces clear pictures of the heart tissue on
a monitor that allow the doctor to determine whether
there are blockages in the heart arteries or whether
there has been a prior heart attack.
Pharmacological Stress Test - test used with
patients who are unable to perform physical activity
on a treadmill or are unable to increase their heart
rate (pulse) enough. Using a drug to simulate
exercise, the same images are obtained as above.
This scan evaluates the blood flow to the heart
demonstrating the regional level of function of the
heart tissue. This test involves the injection of a
radioactive tracer into a vein. A set of pictures
will be taken that determine tracer distribution to
the heart according to blood flow. The pictures are
repeated 3 to 4 hours or even 24 hours after tracer
injection to evaluate the redistribution of the
tracer through the bloodstream over time. This helps
your doctor determine whether the area of heart
muscle is totally scarred or has a significant
amount of healthy muscle.
This test provides the physician with a
comprehensive look at blood flow and the function of
the lower chambers of the heart ventricles. During a
MUGA scan, very small amounts of a radioactive
tracer is injected into the bloodstream through an
I.V. line. As the tracer travels through the heart,
the nuclear camera takes multiple pictures of the
heart, allowing the physician to gain a very
accurate picture of how well the left ventricle
functions. MUGA tests may also be accompanied by
exercise, which will yield information about how the
heart performs under mild physical stress.
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Electrophysiology
A
recording of the heart’s electrical activity as a
graph or series of wave lines on a moving strip of
paper. This test gives the physician important
information about the heart, such as your heart rate
and rhythm and it can also detect a decreased blood
flow, enlargement of the heart or the presence of
either current or past heart attacks.
A
more detailed type of EKG that is used to assess the
electrical conduction system of the heart. During
this test, multiple EKG tracings are averaged over a
period of approximately 20 minutes in order to help
your doctor evaluate your risk for abnormal and
dangerous heart beats.
A
portable electrocardiogram (EKG) that monitors the
electrical activity of a freely moving patient’s
heart, 24 hours a day. Electrodes attached to the
monitor are taped to the patient’s skin and the
patient is sent home to go about their regular daily
activities (except showering/bathing). Patients are
asked to keep a diary of their activities and any
symptoms they may experience.
A
portable monitor that does not record every heart
beat on a tape, but instead uses a circular tape
that stores approximately 30 seconds of a patient’s
heart rhythm. When a patient experiences the symptom
of interest, they press a button that freezes the
recording, which is then transmitted by telephone to
an interpreting center. The major advantage of an
event recorder is that they can be used for up to
30-60 days, until the transient symptom being looked
for occurs.
A
tilt-table test is aptly described by its name. It
involves placing a patient on a table with a
foot-support. The table is then tilted upward. The
tilt-table may start off in a horizontal position
and be tilted by degrees to a vertical position. The
patient’s blood pressure, pulse and symptoms are
recorded with the patient in each position.
Tilt-table testing may be done when heart disease is
not suspected of being responsible for an attack of
fainting (syncope) or near-fainting.
A
test of the heart’s electrical system placing
special pacemaker wires into the heart under x-ray
guidance that allows the doctor to measure the
electrical impulses through the chambers of the
heart. It allows the doctor to recognize abnormal
heart rhythms from a short circuit or a scar, which
allows them to choose the best therapy.
This test checks an implanted pacemaker or automatic
implanted cardioverter/defibrillator (AICD) to make
sure it is working properly. After initial visits
with the cardiologist, subsequent physical
examinations may be alternated with evaluations over
a special telephone system. A special device is
placed on the chest and linked either to the
telephone or to in-office equipment. This device
transmits electronic signals indicating how the
pacemaker and its battery are functioning.
In patients who have had a permanent pacemaker
implanted or had an automatic internal
cardioverter/defibrillator (AICD) implanted, radio
waves are used to communicate with the device to
evaluate the devices’ function, battery life, the
integrity of the leads and many times retrieve any
heart rhythm disturbances that may have occurred.
A
test performed through a pacemaker or a
defibrillator non-invasively similar to an
electrophysiologic study to determine whether a
dangerous heart rhythm is reproducible and whether
the defibrillator will recognize and treat the
abnormal heart rhythm properly.
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Peripheral Vascular Studies
A
quick, simple, non-invasive method of measuring the
effect that arterial disease is having on the blood
pressure in the lower leg. This test is done by
measuring blood pressure at the ankle and in the arm
while a person is at rest. Measurements are then
repeated at both sites after 5 minutes of walking on
a treadmill. This test can diagnose the presence of
peripheral arterial disease and its severity.
Carotid Duplex Scan –A non-invasive test
that uses Doppler color flow ultrasound technology
to provide images of the carotid arteries on both
sides of your neck to visualize the inside of the
carotid artery. The carotid arteries are the main
blood supply to the brain and plaque buildup in
these arteries is the leading cause of stroke A
duplex ultrasound scan of the arteries in the neck
is done looking for blockages that may increase your
risk of stroke.
Renal Duplex Scan - A duplex ultrasound of
the blood vessels in the abdomen is performed.
Blockages of the arteries supplying the kidneys may
be responsible for high blood pressure and kidney
problems. Blockages in arteries supplying the
intestines can cause abdominal pain.
Lower Extremity Arterial Study – Blood
pressures are taken at various levels in the legs. A
Doppler or duplex ultrasound is sometimes used to
look at the arteries and test the velocity of blood
flow. In some case, patients are exercised on a
treadmill and measurements are made after walking.
Venous Duplex Scan – This test uses
ultrasound to examine the veins for clots or
non-functioning vein valves. It helps your doctor
determine the reason for extremity swelling.
An x-ray of the arteries found in your arms and
legs. Because arteries do not normally show up on
ordinary x-rays, arteriograms utilize a “contrast
agent” containing iodine, which is injected into the
arteries. Since x-rays cannot pass through iodine,
the agent shows up on the film. This enables the
physician to see the blood vessels and blood flow in
a specific area.
Percutaneous (through the skin) balloon
angioplasty, or just "angioplasty," is a
technique for enlarging an artery that is blocked or
narrowed without surgery.A diagnostic angiogram is
done first to locate the blockage or narrowing and
determine the severity. A thin plastic tube called a
catheter is inserted into the affected artery
through a needle under local anesthesia. X-ray dye
or contrast is injected, x-ray films are taken and
studied by the doctor. If the obstruction is
significant, especially in a larger more proximal
artery, angioplasty may be reasonable. The
angioplasty catheter has a tiny balloon attached to
the end. The balloon is inflated, pushing aside the
plaque and widening the artery so that it no longer
restricts blood flow. The balloon is then deflated
and removed from the artery. Angioplasty is not a
permanent solution for most people.
Stenting is a technique for arteries that
are very severely blocked or begin to close up again
after angioplasty. Generally, after the stent is
placed, angioplasty is carried out. Stenting and
angioplasty are very useful if the obstructive
lesions are localized and involve a small portion of
the vessel. The majority of peripheral vascular
lesions can be managed by placement of a stent, a
small metal mesh sleeve that is fixed inside the
narrowed artery. The stent holds the artery open.
A renal arteriogram is done to evaluate the
arteries that supply blood to the kidneys. Narrowing
of the renal artery can cause high blood pressure,
renal insufficiency and eventually a non-functioning
kidney. A balloon angioplasty and/or stent will
often correct this problem without having the
patient go through surgery.
Carotid arteriogram is a procedure that
helps diagnose problems in the arteries leading to
your brain. If this examination shows a narrowing in
the vessels that may cause numbness, weakness,
changes in vision, trouble with speech (which may be
warning signs of a stroke) a carotid artery
angioplasty with stenting may be performed.
Carotid artery angioplasty with stenting
is a minimally invasive procedure requiring only a
small incision in the groin. A special catheter
(long hollow tube) is inserted into the carotid
artery to be treated. This catheter has a tiny
balloon at it tip. The balloon is inflated once the
catheter has been placed into the narrowed area of
the carotid artery. The inflation of the balloon
compresses the fatty tissue in the artery and makes
a larger opening inside the artery for improved
blood flow. A stent (a tiny, expandable metal coil)
may be inserted into the newly-opened area of the
artery to help keep the artery from narrowing or
closing again.
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Cardiac
Invasive Studies
Cardiac catheterization (also called cardiac cath
or coronary angiogram) is an invasive imaging
procedure that allows your doctor to “see” how well
your heart is functioning. During the test, a long,
narrow tube, called a catheter, is inserted into a
blood vessel in your arm or leg, and guided to your
heart with the aid of a special x-ray machine.
Contrast dye is injected through the catheter so
that x-ray movies of your valves, coronary arteries
and heart chambers can be created.
This procedure involves the passage of a catheter
into the right side of the heart to obtain
diagnostic information about the heart and to
provide continuous monitoring of heart function in
critically ill patients. This test can be performed
at the bedside in an intensive care unit or in a
special procedure area called a cardiac
catheterization laboratory. In this procedure, the
physician inserts the catheter into the right side
of the heart through a large vein. Typically, a vein
in the right side of the neck is used, however, the
left side of the neck and either side of the groin
can be used. The catheter is threaded through the
chambers and valves of the heart and into the
pulmonary artery. Measurements of the pressures in
the pulmonary artery can be used to indirectly
measure the function of the left ventricle.
Balloon Angioplasty (PTCA: plaque compression
by inflating a small balloon at the site of a
blockage) - A small balloon at the tip of a
specially designed catheter is inflated to compress
the fatty matter into the artery wall and stretch
the artery open to increase blood flow to the heart.
Directional Coronary Atherectomy (DCA: plaque
removal using a cutting device) -
A catheter, with a hollow cylinder on the tip, and
an open window on one side and a balloon on the
other, is inserted into the narrowed artery. The
balloon is inflated, pushing the window against the
fatty matter. A blade (cutter) within the cylinder
rotates and shaves off any fat that protruded into
the window. The shavings are caught in a chamber
within the catheter and removed.
Rotoblation Atherectomy (plaque removal using a
high-speed burr) -
A special catheter, with an acorn-shaped,
diamond-coated tip, is guided to the point of
narrowing in the coronary artery. The tip spins
around at a high speed and grinds away the plaque on
your artery walls. This process is repeated as
needed to improve blood flow. The microscopic
particles are washed safely away in your blood
stream and filtered out by your liver and spleen.
Coronary Stenting (plaque compression by
installing a small stainless steel cylindrical mesh
device at the site of the blockage) - A coronary
stent implant is a therapeutic cardiac procedure
that involves placing a stent, which is a small
mesh-like wire tube in a narrowed artery. This
procedure is similar to angioplasty in many ways.
However, the stent is left permanently in place in
the artery to act as a scaffold to help keep the
artery open.
Brachytherapy (treatment of recurrent blockages
within stents using radiation seeds) – a
procedure used in cardiac care to reopen coronary
arteries that have become blocked after angioplasty
and stenting. A thin flexible tube called a
“catheter” is inserted into the clogged artery,
usually through the groin/upper thigh artery, and
threaded up to the stent. Scar tissue there is
pushed aside with a balloon inserted through the
catheter to create a new opening. Then a radioactive
substance is placed in the catheter and allowed to
sit inside the stent area for a few minutes to kill
scar tissue and clear the artery.
Angiojet and Percusurge clot removal procedures
– a catheter-based procedure used for thrombolysis.
“Thrombus” is a blood clot; “lysis” means to break
apart. So, Angiojet thrombectomy is used to break up
a blood clot that is causing partial or full
obstruction of blood flow in an artery. Angiojet
thrombectomy is often used prior to angioplasty with
or without stent placement, to remove dangerous
blood clots, making the angioplasty procedure safer
and more effective.
The Angiojet is a tiny device attached to a
catheter that is inserted into an artery in the
groin. The catheter (with Angiojet attached) is
advanced to the peripheral artery containing the
blood clot. Once properly positioned, the pump os
the Angiojet is activated, delivering a saline
solution under high pressure out through the pump
jets, into the artery, and directly at the blood
clot. These saline jets create a powerful vacuum
within the artery, breaking up the clot, and
removing clot pieces out through the catheter and
into the pump. The catheter with Angiojet device is
removed, pressure is applied at the insertion site
to stop bleeding, and the patient must rest flat for
several hours.
Intra-Aortic Balloon Pump (IABP) – a simple,
yet effective device to increase coronary perfusion
(blood flow). The IABP is easy to insert and the
most widely used form of mechanical circulatory
support. The IABP is a polyethylene balloon mounted
on a catheter, which is generally inserted into the
aorta through the femoral artery in the leg. The
balloon is guided into the descending aorta, close
to the left subclavian artery. The balloon inflates
and deflates in coordination with the heart’s
diastole (when the heart dilates and fills with
blood) and systole (when the heart contracts and
blood is ejected from the heart) and can increase
the cardiac output by as much as 40 percent.
Cardio-Pulmonary Support (CPS: portable, external
cardiopulmonary bypass) - Patients who have
decompensated (heart failed to maintain adequate
blood circulation) before, during or after a
procedure may be placed on portable CPS. This allows
complete support of both heart and lung function for
a short term until the patient is stabilized. A
cardiopulmonary bypass is a surgical procedure where
the patient's blood is mechanically oxygenated and
pumped through the body while the heart and lungs
are arrested.
Aortic Balloon Valvuloplasty – a procedure
where a thin flexible tube (catheter) is inserted
through an artery in the groin or arm and threaded
into the heart. Once the tube reaches the narrowed
heart valve, a balloon at the end of the tube is
inflated. The balloon presses against the hardened
(calcified) tissue and enlarges the valve opening.
Pericardiocentesis – an invasive procedure in
which the physician removes fluid from the
pericardium (a protective fluid-filled sac
surrounding the heart). The procedure involves the
insertion of a needle into the pericardium to
withdraw fluid. A catheter may also be inserted to
allow further drainage. The pericardium is designed
to hold a small amount of fluid between its tissue
layers, which helps it to cushion, insulate and
protect the heart. However, an inflammation of the
tissue from pericarditis, a prior heart attack, a
rupture or tear in the pericardial wall, or blunt
trauma can lead to an abnormal build-up of fluid.
This build-up places undue pressure on the heart’s
ability to function and often causes sharp chest
pain, especially when a deep breath is taken.
Balloon Pericardiostomy – This procedure uses
a balloon-tipped catheter to create a tear in the
wall of the pericardium. Fluid drains through the
tear and into the pleural cavity, which can
accommodate a considerably larger volume of fluid.
The procedure only require local anesthesia.
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Specialty Clinics, Support Groups, Counseling
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2605 Keiser Blvd.
Wyomissing, PA 19610
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(610) 685-8500