Comprehensive Cardiology Care

Stress Testing
  • Stress Echocardiography
  • Stress and Adenosine Nuclear Testing
  • Transthoracic Echo
  • Transesophageal Echo
Electrophysiology (Heart Rhythm)
  • Electrocardiogram
  • Cardiac Monitoring
    1. Holter Monitor
    2. Events Recorders
  • Cardioversion
  • Pacemaker and Defibrillator Services
    1. Pacemaker Implant
    2. Defibrillator (ICD) Implant
    3. Generator / Battery Change
    4. Lifevest
    5. Pacemaker Management
    6. Phone Checks
    7. Clinic Visits
  • Electrophysiology Studies
  • Radio Frequency Ablation (including Atrial Fibrillation)
Vascular Lab
  • Carotid Duplex
  • Peripheral Venous
  • Peripheral Arterial
  • Duplex Scan of Aorta
  • Renal Arterial Duplex
  • Renal Vascular Duplex
Enhanced External Counterpulsation Therapy (EECP)

Invasive Cardiology
  • Cardiac Catheterization
  • Percutaneous Transluminal Angioplasty
  • Percutaneous Intracoronory Stent Placement
Cardiac Sports Medicine Clinic

Preventive Cardiology
  • CHF Clinic
  • Blood Pressure Management
  • Dietary Information
  • Cholesterol Management
  • Smoking Cessation
  • Stress Management
  • Coumadin Clinic

Comprehensive Cardiology Care

We provide comprehensive diagnostic and therapeutic treatment for the entire spectrum of adult cardiac diseases. Our staff of specially trained personnel join your cardiologist in providing up to date cardiac care, using current technology and compassion as we listen to your concerns and medical problems.

Our cardiologists are available 24 hours a day for immediate response to cardiac emergencies ranging from chest pain to shortness of breath.

We will see patients as quickly as possible in our office, and consider patients with chest pain and shortness of breath as emergencies that will be dealt with immediately. It is our policy to keep patients and their families informed of their progress on a regular basis.

back to top


Stress Testing

A stress test may be ordered for a variety of reasons. Most commonly, it is done to diagnose the cause of chest pain. Other reasons include evaluation of heart rhythm disturbances and exercise capacity, particularly after an intervention such as bypass surgery or angioplasty. To conduct the test, we carefully place electrocardiographic leads(small patches applied to the skin that are easily removed) on the chest wall. With these we are able to monitor changes in the pattern of the EKG as the patient walks on a stationary treadmill. If the patient develops chest pain due to coronary artery disease, typical changes are seen allowing us to make the correct diagnosis. The entire test typically takes one-half hour, with the patient walking on average about 6-8 minutes.

The test preparation requires that the patient have nothing to eat for at least 4 hours before the scheduled time of the test. Please bring along all pertinent insurance information.


A Stress Echo test utilizes the principle of routine treadmill testing (see section on treadmill testing) and combines it with echocardiography (cardiac ultrasound) to derive a more accurate diagnosis in patients with chest pain. During this test, the patient exercises on a treadmill however before and immediately after the test an echo of the heart is performed. The heart muscle will contract or beat more vigorously after exercise except in areas which receive less blood flow. These areas will show reduced or abnormal contraction. Using this principle we can determine if the arteries supplying the heart muscle are blocked or narrowed. The test is painless but does require the ability to walk on the treadmill. The entire study takes about 30-40 minutes. In special circumstances, patients may need to have the test performed utilizing medication to stimulate the heart instead of a treadmill. Special instructions will be given in that situation.

Preparation for the test requires nothing to eat for at least 4 hours before the scheduled time. Please bring along all pertinent insurance information.


The word nuclear often causes concern among patients. We first want to reassure you that the amount of radiation received by the patient in this type of test is less than that of a standard chest x-ray. There are two types of Nuclear Stress Tests performed in our office.

The first utilizes the principle of exercise on the treadmill coupled with the fact that blood flow to the heart muscle can be assessed by the amount of tracer (nuclear) that is taken up by the heart muscle. We can use this information to determine if blood flow or circulation to the heart muscle is abnormal as is the case with blocked arteries.

The alternative test uses a medication (Persantine) that will simulate exercise to give us similar information. The test takes approximately 1-11/2 hours initially with a brief second imaging session required ( 25 minutes) four hours later. The test requires intravenous access which is skillfully attained by our nuclear technologists and nurses. There are no untoward lasting side effects of the test or the medication.

We will explain the test and the necessary preparation at the time of scheduling. Preparation for the test requires no caffeine products (coffee, chocolate, sodas, etc.) for 24 hours prior to the test. Please wear comfortable clothing. Please bring your insurance information with you.

back to top



Echocardiography utilizes the principles of ultrasound (which can be compared to sonar) to define the size of the heart ,the function of the heart, and the status of the valves that allow blood to pass through the heart.

It is a totally harmless and painless test that does not involve radiation, and can be done safely on everyone including children and expectant mothers. The average study takes less than 30 minutes to complete.

From this test, your cardiologist can accurately assess heart murmurs, the pumping ability of the heart, and other related problems including enlargement of the heart. At times it is necessary to get a closer look at the heart structures, particularly when we need to assess artificial heart valves or when we suspect a clot may be present in the heart. In these cases, we rely on Transesphageal Echo or TEE. This study is done on an outpatient basis and utilizes special equipment. Our staff will provide you with a detailed description of the procedure and will make all the necessary arrangements for your convenience. The test does not require any preparation and patients may eat before the test.

back to top



Definition of Electrophysiology (EP)

Electrophysiology is the study of electrical activity in biological cells and tissues. Cardiac electrophysiology refers to the study of the heartís electrical system and how it affects heart rhythm.

The heart maintains a natural rhythm through its electrical system. The origin of the electrical system is the SA, or sinoatrial, node. This node is known as your natural pacemaker. Arrhythmia is a term used to describe when your heart beats in an irregular rhythm. There are many services used to diagnose and treat arrhythmias.


The electrocardiogram (EKG) is one of the oldest and yet reliable tests in cardiology. Certain patterns on the EKG are diagnostic of heart disease-such as acute myocardial infarction(heart attack). Other patterns, although less specific, help us to diagnose a variety of problems associated with the heart and blood vessels. The test requires no preparation and takes less than 5 minutes. The EKG is often repeated frequently to observe changes that may indicate improvement or worsening of a heart problem. Many EKG tracings that are considered abnormal have no underlying related heart problem. In these situations, our cardiologists and staff will carefully explain this and reassure the patient and their family.

Cardiac Monitoring

Many patients experience irregularities of their heart rhythm, often accompanied by symptoms such as palpitations, lightheadedness, dizziness, or passing out. To properly evaluate these symptoms we provide several types of monitors that can record all or portions of your heart rhythm. This technology has been developed largely from the space program which used this type of monitoring for the astronauts.

The most common type of monitor is a 24 hour recording device (called a Holter Monitor, about the size of a Walkman). With this the patient is able to record the time of their symptoms and we can then correlate that with the findings on the monitor.

We also have event recorders that can be worn for a longer period of time or that can be used at the time the patient experiences symptoms.(King of Hearts Heart card). These are small devices used for symptoms which occur only intermittently.


Occasionally patients develop abnormal heart rhythms which do not respond to traditional medication and require cardioversion. After careful evaluation and thorough consultation we may present this rather effective option to the patient.

The procedure is performed as an outpatient in the setting of controlled gentle sedation. A very light DC charge is passed across the heart-after which the patient is recovered and sent home. The total time involved is less than 3 hours. The procedure is successful in at least 70% of cases.

Pacemaker Implant

A pacemaker is a small device that sends an electrical signal to the heart to help maintain proper heart rhythm. A pacemaker has two parts, the generator and the leads. A generator consists of a small computer and a battery. It is the size of a 50-cent piece and weighs approximately one ounce. The leads are flexible, insulated wires connected from the generator to specific areas of the heart that beat irregularly. A pacemaker monitors the heartís electrical activity, and transmits electrical impulses to increase the heart muscleís contraction and maintain rhythm.

Defibrillator (ICD) Implant

An ICD, or implantable cardioverter defibrillator, is similar to a pacemaker in several aspects. However, if your heart beats too fast, it can cause an abnormal, life-threatening rhythm. An ICD unit monitors your heart beat, and transmits electrical impulses to decrease your heart muscleís contraction and restore rhythm.

Generator / Battery Change

Pacemaker and ICD units have a normal battery life of 5 to 10 years. The battery life is monitored as part of pacemaker management. When the battery starts to lose power, your pacemaker management team will notify your physician and schedule a generator replacement. This is also known as a battery change.


The LifeVest is a trademark name for an externally worn defibrillator. It works identically to an ICD. A LifeVest is generally used as a temporary device until an ICD is surgically implanted.

Electrophysiology Studies

Electrophysiology (EP) Studies are highly-detailed studies of the heartís electrical pattern. Electrical activity and pathways through the heart are monitored and recorded in a hospital EP laboratory. These studies are performed to determine the cause of arrhythmia and to identify areas of the heart that cause electrical interference. Information from these studies may be used to eliminate electrical interference via Radio Frequency Ablation.

Radio Frequency Ablation

Radio Frequency Ablation is a procedure used in conjunction with EP studies. EP studies identify areas of the heart that interfere with electrical flow. Ablation removes obstructions that cause interference and restores electrical pathways. This procedure has a high success rate in treating certain types of arrhythmias, including atrial fibrillation.

back to top


Vascular Lab

Carotid Artery Evaluation

Our vascular lab is able to evaluate blood flow in arteries and veins using ultrasound and doppler(sonor) techniques. We are able to measure the velocity or speed of the blood flow in the carotid arteries that supply blood to the head and brain. This is an important area since a stroke may result from blockage in these arteries. Using the velocity of blood flow coupled with the ultrasound pictures of the arteries we are able to estimate the degree of blockage. The test is painless and harmless and may take 60-70 minutes. There is a very good correlation between the ultrasound findings and the actual amount of blockage. The test is an excellent screening tool in patients who have symptoms suggesting the warning signs of a stroke.

Veinous Doppler

Our expert technical staff evaluates vein blood flow in the legs and arms to determine the presence of clots or inflammation(phlebitis). Using the principle of ultrasound and doppler we localize the area involved which may require treatment. The study is performed frequently in patients demonstrating tender or painful leg swelling or in chronic swelling (edema). The test is painless and takes less than one hour to complete.

Arterial Ultrasound and Physiology Study

We evaluate arterial blood flow in the legs and arms using two complimentary techniques. The first uses the principles of ultrasound which will give us a "picture" of the artery and doppler which will determine blood flow patterns and help to pinpoint areas of blockage that may cause pain in the legs(or arms) with exertion(claudication).

The second technique measures blood pressure in the legs at several levels (upper, mid, calves, and ankles). This information can be "mapped" allowing us to compare one leg against the other and localizes areas of reduced blood flow. The test takes 60-70 minutes to complete and is harmless and painless. We often will walk patients for a brief period of time on a treadmill and measure blood pressures before and afterwards . Walking often brings out symptoms of decreased circulation in the legs.

back to top


Enhanced External Counterpulsation Therapy

Enhanced External CounterPulsation (EECP) is a non-invasive treatment for advanced coronary disease incompletely treated by corrective surgery or percutaneous coronary intervention. The technique involves pressure cuffs placed on the lower extremities and buttocks that sequentially inflate and deflate in relation to the cardiac cycle. This enhances diastolic blood pressure and increases coronary artery perfusion. Other beneficial hemodynamic changes also occur. The result is the encouragement of coronary "collateral" blood vessels to grow and cause functional auto-bypasses to develop.

The treatment is most helpful to those patients with angina that receive limited benefit from medications and procedures to correct the problem. It is performed in the office and requires no needles or "invasive" procedures. An hour per day for 35 treatments is needed to get optimal benefit. All patients are carefully evaluated before and during treatment and the risk of causing any harm is slight.

If this is a treatment option you would like to explore please talk to one of our staff and we will be happy to arrange evaluation.

back to top


Invasive Cardiology

Cardiac Catherterization

As cardiologists we often need to define a patientís specific anatomy of the arteries that provide blood flow to the heart. This is done by way of a cardiac catherterization. The test may is performed on an outpatient basis. Details and careful explanation of the test are given at the time of scheduling. In essence the procedure involves passing a small catheter(less than an 1/8 inch in diameter) by way of a tiny skin puncture to the heart. Pictures of the arteries are taken using a injected contrast(iodine) and then recorded on film. These films are reviewed to determine if blockage is present and if intervention (angioplasty or bypass surgery) is needed. There are minimal risks and inconveniences to the procedure and these are reviewed with the patient and family. The test lasts less than 20 minutes on the average, and patients are usually discharged within four hours.

If bypass or heart valve surgery is required, we refer patients to one of our nearby institutions for the procedure.

back to top


Cardiac Sports Medicine Clinic

Much attention has been given to the area of the athlete and cardiac risk in competitive sports. We established a protocol to evaluate the cardiac status of students who wish to participate in high and college sports. We focus on screening tests that will help us delineate potentially serious heart problems from benign concerns. Our goal is to provide reassurance that it is safe for the student to participate.

back to top


Preventive Cardiology

Blood Pressure Management

Part of our goal in treating high blood pressure is educating the patient with special attention to monitoring their blood pressure readings. To do this effectively we have started a policy of supplying blood pressure cuffs for our patients and teaching them to take home and workplace blood pressure readings. The patients are taught to keep a diary or log of their BPís and review them with their family physician and cardiologist. The devices are loaned to the patients for one month after which we encourage purchase of the equipment at a local supplier. Having the patient as part of the treatment team gives reinforcement and encouragement.

Dietary Information

At Lebanon Cardiology, we strive to offer the best preventive care in the management of heart disease. One of the most important areas is diet planning and counseling. We will assist in planning the appropriate diet for the individual needs of the patient. Examples of this include low salt diets for patients with high blood pressure, low fat diets for patients with arterial blockage due to high cholesterol, and balanced low carbohydrate(sugar) diets for our diabetic patients. We offer diet instruction in the office and often initiate referrals to registered dieticians as needed.


The significance of elevated blood cholesterol levels in the progression of atherosclerosis has been well established . Current information shows a definite link between survival and lower cholesterol levels in patients who have symptoms of athersclerosis such as heart attack or angina. There are four major categories of cholesterol and fat levels we routinely measure;

  • HDL or "Good Cholesterol"
  • LDL or "Bad Cholesterol"
Our goal in treatment is to lower the TOTAL CHOLESTEROL to less than 200 mg% and the LDL CHOLESTEROL to less than 100 mg% . The HDL CHOLESTEROL should be as high as possible, for example greater than 50 mg%. Fortunately diet and medication can significantly alter the TOTAL CHOLESTEROL and the LDL CHOLESTEROL but have little effect on HDL CHOLESTEROL.

If we are unable to achieve our goals by way of diet therapy alone ,we will recommend medication to lower the LDL and TOTAL CHOLESTEROL. A category of drug known as statins have been developed which have shown dramatic ability to lower both LDL and TOTAL CHOLESTEROL and in turn improve survival after a heart attack. Studies have even suggested the medications may lessen the need for an angioplasty. Your cardiologist will review your individual needs and ,if necessary, may suggest the use of these medications in conjunction with a reasonable low fat diet.

TRIGLYCERIDES are also a form of circulating and stored fat. They are important in the diabetic patient and play a limited role in athersclerosis. Usually reduction of sugar, calories, weight, and alcohol in the diet will help to control TRIGLYCERIDES.


Smoking represents a major risk factor in the progression of many types of heart disease. Patients who continue to smoke after a heart attack have a increased risk of dying compared to patients who quit. Regular consumption of tobacco products can lead to progression of blockage in the arteries of the heart, legs and head, leading to heart attack, pain with walking, and stroke. We encourage all our patients to eliminate smoking from their lives ,homes and places of work. Medication and counseling will be made available as needed to assist patients in achieving this goal.

Stress Management

A very important aspect of preventative cardiology is management of stress that surrounds us in everyday life. We cannot avoid it, but certainly can learn to live with it and adjust to it. A variety of relaxation techniques are available to assist in this area. It has been well documented that heart attacks often occur during periods of significant anxiety or depression . Because of this, we will arrange the appropriate counseling or medication needed to help patients deal with stress. We work with the patientís primary physician to coordinate the best care for the individual.

back to top