HEART HEALTH

Devoted to Your Optimum
Cardiac Care

Welcome to Lakeshore Cardiology

A fully accredited comprehensive cardiac facility

The team at Lakeshore cardiology specializes in consultative non-invasive diagnostic cardiology. Our goal is to make your healthcare experience a very positive and comfortable one. We strive to provide the highest quality of patient care. Our doctors and staff are determined to combine innovative state-of-the-art diagnostic equipment with a caring compassionate manner. Meeting all your health care expectations is of the utmost importance to us.

Our Royal College of physicians and surgeons of Canada certified specialists and registered cardiovascular technicians cardiac sonographers and nurses are all determined to meet your health care needs. Purpose of the clinic is to optimize medical care in a timely manner using comprehensive noninvasive techniques to improve patient outcomes your quality of life and hopefully reduce your stress and fear related to your health issues.

We understand patients living with a heart condition often require frequent monitoring adjustment to their medication and potentially tertiary care referral. We work with your family doctor or other primary healthcare provider to coordinate your care.

We Are a Team of Dedicated Cardiac Healthcare Professionals

Dr. Emilio Raimondo, MD FRCPC

Cardiologist

Dr. Antonio Rocca, MD Phd FRCPC

Cardiologist

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Physician Assistant

Nurse

Nurse Practitioner

Sonographers

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Medical Receptionist

Areas of Practice

Electrocardiogram

An electrocardiogram, also known as an ECG or EKG, is a non-invasive diagnostic test that detects electrical activity in the heart. It is usually part of a routine physical exam and is commonly performed after patients have experienced heart attack symptoms including chest pain, shortness of breath and heart palpitations. An ECG produces a record of waves that relate to the electrical impulses that occur during each beat of a patient’s heart.

This test is performed by attaching electrical wires, called electrodes, to the arms, legs and chest. The ECG will begin recording your heart’s electrical activity, showing how quickly and regularly your heart beats, as well as any structural abnormalities in the chambers and thickness of the heart. It is important for patients to remain still during this test, as muscle movement may interfere with results. Abnormal results from an ECG may indicate signs of a heart condition, which should be further investigated.

Echocardiography

Echocardiography uses an echocardiogram (ultrasound of the heart) to assess the functioning and health of the the heart by creating images out of sound waves. In addition to detecting many other heart problems, echocardiograms can diagnose specific heart conditions; determine if heart abnormalities exist; and evaluate the effectiveness of procedures that have been performed on the heart.

The most common type of echocardiogram is transthoracic (TTE), which is painless and non-invasive. A transducer that emits high-frequency sound waves is placed on the patient’s chest; when the sound waves bounce back to the transducer, they are interpreted by a computer and the results are shown on a monitor.

Indications:

heart murmurs
Native Valvular Stenosis
Native Valvular regurgitation
Known or Suspected Mitral Valve Prolapse
Congenital or inherited Cardiac Structural Disease
Prosthetic Heart Valves
Infective Endocarditis
Pericardial Disease
Cardiac Masses
Interventional Procedures
Pulmonary Diseases
Chest Pain and Coronary Disease
Dyspnea, Edema, and Cardiomyopathy
Hypertension
Thoracic Aortic Disease
Neurologic or Other Possible Embolic Events
Arrhythmias Syncope and Palpitations
Before Cardioversion
Suspected Structural Heart Disease

Stress Echocardiogram

A stress echocardiogram is a diagnostic test used to evaluate the strength of the heart muscle as it pumps blood throughout the body. Using ultrasound imaging, the stress echocardiogram detects and records any decrease in blood flow to the heart caused by narrowing of the coronary arteries. The test, which takes place in a medical center or in the doctor’s office, is administered in two parts: resting and with exercise. In both cases, the patient’s blood pressure and heart rate are measured so that heart functioning at rest and during exercise can be compared. The ultrasound images enable the doctor to see whether any sections of the heart muscle are malfunctioning due to a poor supply of blood or oxygen.

Indications:

Typical or atypical chest pain or ischemic equivalent syndrome.
Possible acute coronary syndrome (ACS) with non-diagnostic ECG changes and negative or borderline significant troponin levels.
History of Congestive Heart Failure.
Known LV systolic dysfunction of unclear etiology.
Significant ventricular arrhythmia.
Syncope of unclear etiology.
Borderline or high troponin levels in a setting other than ACS. 70
Significant cerebrovascular or peripheral atherosclerosis.
Re-evaluation (≥1 yr.) in patients with significant cerebrovascular or peripheral atherosclerosis.
Equivocal or non-diagnostic results from other stress modalities.
Initial evaluation of patients at intermediate or high global coronary artery disease (CAD) risk.
Periodic (≥2 yrs.) re-evaluation of patients with intermediate or high global
CAD Risk.
New or worsening chest pain or ischemic equivalent.
Post MI or ACS for risk stratification (within 3 months).
Viability in patients with known significant LV dysfunction post re-vascularization.
Periodic (≥1 yr.) re-evaluation of stable patients with known CAD (previous coronary angiography, Computed Tomographic Angiography (CTA)/Electron Beam Computed Tomography (EBCT), myocardial infarction (MI), ACS, or abnormal stress imaging).
Physiologic assessment and/or symptom correlation in patients with moderate or severe Aortic Stenosis, Mitral Stenosis, Mitral Regurgitation, Aortic Regurgitation, Hypertrophic Cardiomyopathy.
Assessment of established or latent pulmonary hypertension.

Dobutamine Stress Echocardiogram

Dobutamine stress echocardiography imaging, also known as a dobutamine stress test, is a diagnostic test performed to determine if the heart is receiving adequate blood supply under both stress and rest conditions. The test is done with the injection of a small amount of dobutamine material into the bloodstream, which will circulate throughout the body and help to evaluate the blood flow and function of the heart. This procedure is performed to determine the risk of a heart attack and to show if there is a limited blood flow to the heart and determine the best treatment plan for serious heart conditions.

During the stress test, an amount of dobutamine material is injected into the bloodstream once during the exercise portion of the test and again when the patient is at rest. Images of the heart will be taken shortly after each injection to show any areas of the heart that are not receiving enough blood. Both sets of images will be interpreted by a board-certified cardiologist before providing the patient with the results.

Holter Monitoring

Heart arrhythmias occur when the electrical impulses that coordinate your heartbeats don’t function properly, resulting in your heart beating irregularly, too quickly or too slowly. To diagnose a heart arrhythmia, your doctor will review your symptoms and perform cardiac tests that specifically monitor arrhythmias. These tests include:

Electrocardiogram
Holter Monitor: a small, wearable device that keeps track of your heart rhythm for 24, 48, 72, hours or up to 14 days while you go about your daily activities.

Exercise Stress Test

An exercise stress test is used to evaluate how well your heart functions during physical activity. This non-invasive cardiac test can reveal problems with your heart that can go undetected because exercise makes your heart pump harder and faster than it otherwise normally would. Your doctor will ask you to exercise on a treadmill while they monitor your blood pressure, heart rhythm and ECG tracing.

Ambulatory Blood Pressure Monitor

An ambulatory blood pressure monitor is a portable blood pressure recording device. This test monitors your blood pressure at regular intervals over 24 hours and readings are recorded. These readings are then analyzed by sophisticated equipment and the results are interpreted by one of our Cardiologists.

The equipment consists of a small recorder and a blood pressure cuff, which is applied to the arm. The cuff is worn continuously for the duration of the test. The cuff will inflate automatically at regular intervals to record the blood pressure.

If you have had any medical concerns that would affect the wearing of the blood pressure cuff, you should inform the technician; this will influence the positioning of the arm cuff. Usual activities should be performed except bathing.

Nuclear Perfusion Imaging:

Nuclear stress myocardial perfusion imaging (MPI) is a nuclear cardiology test that determines how well blood flows to the muscle of the heart (myocardium). This test is used to diagnose the presence or absence of coronary artery disease. Other names for this test are Nuclear SPECT, Exercise Cardiolite and Persantine Cardiolite studies.

During this test a radioactive tracer (called Cardiolite) is injected into the bloodstream and is taken up by the heart tissue. A specialized camera detects the radiation released by the tracer to produce images of the heart. Two sets of images are taken, one after an injection at rest and another after an injection during a stress test – either exercise stress on a treadmill/bike or drug-induced stress with Persantine (dipyridamole) medication, which simulates exercise.

CT Angio

Coronary computed tomography angiography (CCTA) uses an injection of iodine-containing contrast material and CT scanning to examine the arteries that supply blood to the heart and determine whether they have been narrowed. The images generated during a CT scan can be reformatted to create three-dimensional (3D) images that may be viewed on a monitor, printed on film or by a 3D printer, or transferred to electronic media.

Patient Preparation

Preparations For Testing

Please wear running shoes and comfortable exercise clothes. Do not consume anything containing caffeine for 24 hours prior to the test. This includes coffee (including decaffeinated coffee), tea (including decaffeinated tea and herbal tea), soft drinks, chocolate (including chocolate flavourings and cocoa), Tylenol with codeine. Do not consume alcohol for 24 hours prior to your test. You will need to fast for 4 hours prior to your test. Since this test uses radiation you should notify the staff if you are planning to travel out of the country within days following the test. (We will provide you with a letter for Border Services.)

Reasons for a Stress Echocardiogram

The test is administered to patients whose heart health is in question or to evaluate ongoing cardiac treatment. Patients are candidates for a stress echocardiogram if they have been having chest pains or angina or have recently had a heart attack. They may also have the test as a requirement prior to heart surgery or before beginning an exercise program. The stress echocardiogram measures:

How well the heart muscle and valves are working
How well the heart handles exercise (stress)
Whether the patient is likely to have coronary artery disease
Whether the patient’s heart function has improved after treatment
Whether chambers of the heart are enlarged

Results of the stress echocardiogram are helpful to the cardiologist in determining whether there is a problem with heart muscle strength and what that problem might be. They also help determine an appropriate new course of treatment or evaluate a previous one.

Preparing for a Stress Echocardiogram

Before undergoing a stress echocardiogram, patients should ask their doctors whether it is necessary to temporarily stop taking a certain medication prior to the test.

Patients should refrain from:

NO eating, smoking, vaping, drinking, 2 hours before the test.
NO Caffeine or Alcohol 4 hours before. Wear comfortable shoes, lose fit clothing to the procedure.

The Stress Echocardiogram Procedure

Before the test begins, the patient will have electrodes placed at various locations on the chest, arms and legs to record electrical activity in the heart, and will be wearing a blood pressure cuff. The resting portion of the procedure is administered while the patient lies on the side with the left arm extended. An ultrasound transducer moves over the patient’s chest. A special gel has been applied to enable the transducer to move smoothly and to transmit sound waves directly to the heart.

During the second portion of the test, the patient exercises by peddling on a recumbent bike or walking on a treadmill. At approximately 3 minute intervals, the patient will be asked to speed up activity or to walk up an incline. Depending on the patient’s age and fitness level, the test can take from 5 to 15 minutes. Normally, the test is stopped when the patient’s heart is beating at a targeted rate, or when fatigue, chest pain, or blood pressure changes necessitate cessation. The test results provide the doctor with critical evidence as to whether the heart has more difficulty functioning under stress.

Preparing for a Dobutamine Stress Echocardiogram

Before undergoing a stress echocardiogram, patients should ask their doctors whether it is necessary to temporarily stop taking a certain medication prior to the test.

Patients should refrain from:

NO eating, smoking, vaping, drinking, 2 hours before the test.
NO Caffeine or Alcohol 24 hours before. Wear comfortable shoes, lose fit clothing to the procedure.

Preparing for an Exercise Stress Test

Before undergoing an exercise stress test, patients should ask their doctors whether it is necessary to temporarily stop taking a certain medication prior to the test.

Patients should refrain from:

No eating, smoking, vaping or drinking alcohol 2 hours before the test.
NO Caffeine or Alcohol 4 hours before.
Wear comfortable shoes, lose fit clothing to the procedure.

Preparing for Ambulatory Blood Pressure Monitor

On the day of the test, you can eat or drink as usual and should take all prescribed medications.

No special preparation is needed. Please wear loose fitting clothing when coming to the clinic for this test.

Preparing for CT Angio

Tell your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you’re taking, and allergies. You will be instructed not to eat or drink anything several hours beforehand and to avoid caffeinated products, Viagra or similar medication. If you have a known allergy to contrast material, your doctor may prescribe medications to reduce the risk of an allergic reaction. These medications must be taken at multiple intervals beginning 13 hours prior to your exam. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown. If you are breastfeeding, talk to your doctor about how to proceed.