Cardiac Care and Pulmonary Rehabilitation

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Phase 2 Cardiac Rehabilitation

Phase 2 Cardiac Rehabilitation is an exercise and education program designed to assist individuals in their recovery from heart ailments such as stable angina, a heart attack, angioplasty, stents, bypass surgery, congestive heart failure or heart valve repair or replacement. Besides the monitored exercise program, we provide patient/family education and counseling on diet, risk factor modification and the importance of change. Change can lead to your feeling better, gaining strength, reducing stress, returning to work or retirement activities faster and, maintaining less risk of a reoccurring incident or future heart problems. Program length varies for each participant (determined by your insurance coverage) but generally is for three days a week for twelve weeks. The exercise classes themselves last for about an hour with additional time slotted for the education portion. We strongly recommend your family and/or friends attend the educational classes along with you in order to help provide the ongoing support you are going to need to make a full recovery. Class hours are 8AM to 3PM , Mondays,Wednesdays, and Fridays. A written referral from your family doctor or cardiologist is required for admission to the program as well as a low level stress test to assure your safety for exercise. Most insurances cover this phase of rehab but we ask that you check with your provider to be sure of the exact coverage. Advanced Cardiac Life Support(ACLS) trained staff are always in attendance during these classes.

During the program your heart rhythm will be continuously monitored to detect any abnormal rhythms. Your blood pressure and pulse will also be monitored. Your well being and safety are always our first priority during this program. Please understand that whatever intervention(s) you previously underwent was not a cure; it just mended the problem and gave you time to make the appropriate lifestyle changes that the Cardiac Rehab program can help you achieve.

Phase 3 Cardiac Rehabilitation

Phase 3 Cardiac Rehabilitation is the maintenance portion of Cardiac Rehabilitation. After completion of the Phase 2 program patients enroll in this phase. Patients attend as long as they wish with many making it a lifelong commitment. It is a self pay program with a modest fee charged per class or per month as the patient wishes. A daily blood pressure is recorded along with a monthly cardiac rhythm strip. Patients maintain their own worksheets and record their own pulses with exercise. Basic Life Support trained staff are always available. Progress reports are sent twice a year to the family physician. Class hours are 7AM to 3PM, Mondays, Wednesdays, and Fridays.

Regular Stress Test | Exercise Treadmill Test (ETT)

The patient walks on the treadmill while their EKG and blood pressure are being continuously monitored. Depending on the protocol chosen by the testing physician, the treadmill speed and incline increase every two-three minutes. The patient walks until a predetermined heart rate is achieved, EKG changes occur, signs or symptoms occur, or the patient fatigues. A regular stress test is heavily dependent upon the interpretation of EKG changes produced by exercise. The reliability drops drastically if there are significant resting changes already present. A report will be forwarded to your physician.

Nuclear Stress Test | Cardiolite Stress Test

The patient walks on the treadmill while their EKG and blood pressure are being continuously monitored. In addition, IV access is obtained prior to the start of the test so that the Cardiolite can be injected as the patient reaches their peak exertion on the treadmill. The Cardiolite is extracted by the heart muscle in proportion to the flow of blood. The amount of tracer uptake helps differentiate normal muscle (which receives more of the Cardiolite) from the reduced uptake found in the muscle that is supplied by a narrowed coronary artery. After completion of the treadmill portion, the patient goes to the nuclear medicine department to be scanned. The patient must return within seven days to the nuclear medicine department to have resting images taken which requires the patient to again be injected with the Cardiolite isotope. Resting images are compared to images taken after the treadmill to determine if a possible blockage exists. A treadmill report along with a nuclear medicine department report will be forwarded to your physician.

Persantine Stress Test | Pharmocologic Stress Test

Instead of walking on the treadmill the patient lies on the stretcher while their EKG and blood pressure are continuously monitored. In addition, IV access is obtained prior to the start of the test so that Persantine, Cardiolite, and Aminophylline can be administered. This test is used for patient’s that are unable to walk on the treadmill adequately due to physical limitations, respiratory status, presence of left bundle branch block pattern, and certain people with pacemakers. IV Persantine is administered over 4 minutes ( the Persantine expands the coronary arteries similar to the effects of exercise) while the EKG and BP are continuously monitored, 2 minutes later the Cardiolite isotope is injected, and 2 minutes later IV Aminophylline is administered to reverse the effects of the Persantine. The patient then goes to the nuclear medicine lab for imaging. The patient must return within seven days to the nuclear medicine department to have resting images taken which requires the patient to again be injected with the Cardiolite isotope. Resting images are compared to images taken after the Persantine was given to determine if a possible blockage exists.

Patients on xanthine medications (examples are aminophylline or theophylline) may have to have medications held for 24-48 hours.

A report will be forwarded to your physician along with a report from the nuclear medicine department.

Echocardiogram (ECHO)

An echocardiogram uses high frequency sound waves called ultrasound to reveal images of your hearts valves and chambers as well as evaluate the pumping action of your heart. The sonographer will place a hand held wand on your chest and record your hearts images for the cardiologist to interpret. A report will be forwarded to your physician.

Electrocardiogram (EKG)

When your doctor writes a prescription for an EKG or Electrocardiogram, you will need to register in the outpatient department and the EKG technician will come to you and take you to a private room for the procedure. It is really a very fast and simple procedure. When we do an EKG we are looking at how your heart is functioning electrically. We put six electrodes across your chest and one on each limb. You are then connected to the EKG machine and the test is run. The entire procedure takes about five minutes. The EKG is then set up for the physician to read and a report is sent to your physician for your office record.

Electroencephalogram (EEG)

When your doctor writes a prescription for an EEG or Electroencephalogram, you will need to register in the outpatient department and the technician will come to you and take you to the EEG room which is located on the second floor. Only the technician and the patient will be allowed in the room for the procedure. When we do an EEG we are looking at the electrical activity of the brain. Depending on the reason for the test or the age of the patient we may request the patient to be sleep deprived for a particular number of hours. We will discuss these issues with you when we schedule your appointment. No caffeine for 24 hours prior to the test. You are allowed to eat breakfast and take your morning medications. We request that you wash and thoroughly dry your hair before coming for the test-DO NOT USE any hair products after washing. The EEG is done for patients who may be possibly have a seizure disorder, a possible stroke, or a syncopal (fainting or near fainting) episode. When the test is performed the technician will put twenty-two electrodes on the scalp and the patient will lie on a bed with their eyes closed for about twenty minutes, while the machine runs the test. The test is then sent to our Neurologist for interpretation. The report is then sent to the ordering physician. The entire exam lasts approximately an hour.

24-Hour Monitoring | Portable ECG

A 24-Hour Holter Monitor is a small, portable ECG recorder that records all your heartbeats during a 24 hour period. Ten small electrodes (sticky patches) are attached to the front of your chest and connected to a small recording device. It is worn continuously, even during sleep. You will return to the clinic the following day to have the electrodes and recorder removed. No bathing or showering is allowed while wearing the monitor as the monitor and electrodes must stay dry and in place for the entire recording. In some cases the monitor may be worn for 48 hours. It is used to diagnose abnormal heart rhythms or heart beats: what kind they are, how long they last, and what may cause them or may be used to correlate your symptoms with your heart rhythm. A report will be forwarded to your physician.

24-Hour Ambulatory Blood Pressure Monitoring

This test is used primarily to prove or disprove the presence of “white coat hypertension” in patients who tend to have high blood pressures whenever they are checked in a hospital or clinic setting or by staff garbed in medical attire. It requires you to wear a blood pressure cuff and monitor that will record your blood pressure every 30 minutes during the day and every hour throughout the night. You will return to the clinic the following day to have it removed. It must stay in place for the 24 hours to detect trends and record accurate blood pressures. A complete report is downloaded from the monitor and sent to your physician for interpretation.

Non-Invasive Hemodynamic Monitoring | Impedance Cardiography (ICG) or (BIO-Z)

This test is used to determine hemodynamic parameters using four dual sensors on your neck and your chest. Hemodynamics is defined as the forces affecting the flow of blood throughout the body. Your physician may use this to determine if your heart is pumping well enough, if you are having a respiratory or cardiac problem, or to see if your medications are working adequately ( especially blood pressure medications or diuretics). The test takes approximately 20 minutes. A report is then sent to your physician.

Symptoms of Stroke

  • Sudden confusion
  • Sudden confusion, trouble speaking or understanding
  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, or loss of balance or coordination
  • Sudden, severe headache with no known cause
  • If you or a loved one experiences any of the above symptoms, call 911.

Syptoms of a Heart Attack

  • Chest Discomfort – may be described as chest pain, chest pressure, chest discomfort, tightness, fullness, or squeezing
  • Upper Body Discomfort – may include pain or discomfort in one or both arms, the back, shoulder blades, neck, jaw, or stomach
  • Shortness of Breath – may occur with or without chest discomfort
  • Other Signs – may include cold sweats, nausea, and/or lightheadedness
  • If you or a loved one experiences any of the above symptoms, call 911

Terms to Know

ACLS (Advanced Cardiac Life Support) – Advanced training that teaches providers how to treat life threatening cardiac events.

Angina – A term for chest pain due to lack of blood flow to the heart. Generally occurs with increased activity or exercise and is relieved with rest and /or Nitroglycerine tablets.

Angioplasty – A procedure in which a catheter with a deflated balloon on its tip is passed into a narrowed artery segment. As the balloon is inflated, the narrowed segment is widened and blood flow through the vessel is restored.

Arrhythmias – An abnormal rhythm of the heart due to a disruption in the electrical impulses that regulate heartbeat, causing a slower or faster beat. Some people may complain of palpitations or a “racing heart”.

Atherosclerosis – Due to deposits of fat and cholesterol in the inner layers of artery walls they become thickened resulting in the restriction of blood flow and oxygen in that artery. Atherosclerosis results in heart disease that may lead to a heart attack if not treated appropriately.

BLS (Basic life Support)– Basic training that teaches providers how to treat respiratory and cardiac emergencies. Training includes CPR ( Cardiopulmonary Resuscitation) , managing foreign body airway obstructions, and use of an AED.

Coronary Artery Bypass Surgery (CABG) – A procedure used to improve the blood supply to the heart. A blood vessel (generally a mammery artery or leg vein) is used to re-route the blood supply of the heart above and below a blockage to restore the blood flow to that area.

Cholesterol – A fat like substance that can build up on artery walls and cause atherosclerosis. It is carried through the bloodstream in two types of lipoproteins-HDL and LDL. High density lipoproteins (HDL’s) are the “good cholesterols”-they carry cholesterol away from the tissues to the liver where it is passed out of the body. Low density lipoproteins (LDL’s) are the “bad cholesterols”- tend to build up on the artery walls , slowing or obstructing the flow of blood and oxygen to the heart.

Electrocardiogram (EKG) – A graphic record of the electrical activity of the heart.

Heart Attack (Also called MI or Myocardial Infarction) – A heart attack occurs when an artery that supplies blood to the heart becomes blocked, depriving the heart muscle of oxygen rich blood and causing it to die. The blockage results when an artery narrows over time due to deposits of fat and cholesterol. A clot then becomes trapped in this narrowed area resulting in a complete occlusion and death to the tissue supplied by that artery. Early treatment with thrombolytics, angioplasty or stents can help salvage the damaged areas.

Hypertension (High Blood Pressure) – A blood pressure reading is the measurement of two forces – the top number (Systolic reading) is the force exerted as the heart pumps blood; the bottom number (Diastolic reading) is the force exerted as the heart rests. These two forces are measured in millimeters of mercury(mmHg). The ideal blood pressure is less than 120/80. Blood pressures above these numbers put strain on the heart and arteries and can contribute to heart attacks, strokes, and kidney failure. Hypertension can be controlled with prescription medications and lifestyle changes such as diet modifications and exercise.

Stents – Metal implants that are used to reopen clogged arteries in heart patients.

Stroke (acute ischemic stroke or “brain attack”) – occurs when a blood vessel leading to or in the brain becomes blocked (ischemic), or ruptures (hemmorhagic), causing brain tissue to die. Stroke symptoms include numbness or weakness on one side of the face or body, difficulty speaking or understanding, blurred vision, sudden, severe or unexplained headaches or loss of balance.

Thrombolytics (clot busters or clot dissolvers) – Medication that dissolves the blood clot formed in an artery in the heart (heart attack) or in the brain (acute ischemic stroke), restoring blood flow to the respective areas. Thrombolytics must be given within hours of symptom onset to be effective.