Cardiovascular diseases still rank as the predominant cause of death and morbidity in the United States. There are many factors contributing to this high rate of disease, such as poor diet, lack of aerobic exercise, genetics and stress. The most important factor in treating cardiovascular diseases is prevention of cardiovascular diseases and early detection. The DiGiovanna Family Health and Wellness Center is involved in all aspects of cardiovascular disease and treatment, the most important of which is prevention. Through our Annual Wellness Examinations, we utilize a variety of screening tools to identify those patients at risk for cardiovascular disease. We analyze a a patient's diet, exercise patterns, family history, occupational history, exposure to stress and other risk factors to make a recommendation for a particular level of Annual Wellness screening. Through the targeted Annual Wellness examination, we recommend and perform the appropriate screening tests, including diagnostic imaging, stress testing, laboratory testing, genetic testing and advanced cardiac diagnostics to identify those patients that are at risk or may already have early cardiovascular disease.
The DiGiovanna Family Health and Wellness Center's Department of Cardiovascular Diseases is lead and directed by Salvatore Trazzera, M.D., a board-certified Cardiologist affiliated with St. Francis Hospital, The Heart Center in Roslyn, NY. Dr. Trazzera personally examines all cardiovascular patients, recommends an appropriate regimen of cardiovascular testing and refers those patients who require a higher level of care to renowned Cardiovascular Subspecialists affiliated with St. Francis Hospital. Some of the tests that may be performed on-site at the DiGiovanna Family Health and Wellness Center are:
Utilizing the Modified Bruce Protocol, patients are hooked up to a continuous EKG machine and their heart rate, blood pressure and EKG readings are constantly monitored while the patient walks on a treadmill at increasing speed and elevation. The purpose of this test is to put aerobic stress on a patient's heart, in a carefully monitored environment, to assess whether there is any indication of dysfunction in the patient's cardiac rhythm, which may indicate underlying cardiovascular disease.
Utilizing an ultrasound machine with a transducer specifically designed to best image the heart, echocardiography is utilized to image the patient's heart. Images can be captured in real-time to assess how the heart is beating, to detect any abnormalities in the motion of any of the walls, to detect any abnormalities in the functioning of any of the four cardiac valves, to assess the thickness of the heart muscle which can infer underlying cardiovascular disease, and to estimate cardiac functioning and ability by measuring blood flow using a doppler technology, which can also estimate pressures within the heart.
The same doppler technology and sonography can be utilized to assess blood flow and pathology in arteries and veins. Looking for abnormalities in blood flow in these vessels may be used to detect blockages, blood clots or early peripheral vascular disease. Cardiovascular imaging that can be performed on-site at the DiGiovanna Family Health & Wellness Center include:
Carotid Dopplers - Ultrasonography and doppler technology are used to image the large, high-pressure arteries in the neck. These arteries feed blood to the brain. Blockages in these arteries can lead to strokes.
Extremity Dopplers - Ultrasonography and doppler technology are used to image the arteries in the arms and legs, the sites of Peripheral Artery Disease. These arteries feed blood down to the hands and feet. Blockages in these arteries can lead to pain, cramping with exertion, poor healing of wounds, loss of hair in the extremities, alterations of the color of the extremities, lack of pulses in the extremities and swelling of the hands and feet.
Aorta Doppler - Ultrasonography and doppler technology are used to image the aorta, the biggest and highest pressure artery in the body. It is often an early location for arteriosclerotic arterial disease (hardening of the arteries). Arteriosclerotic disease of the aorta may lead to aneurysms. Aneurysms which rupture are very often fatal, so early detection and treatment are paramount to prevent death by ruptured abdominal aortic aneurysm.
Venous Dopplers: Ultrasonography and doppler technology are used to image veins. Veins are found everywhere in the body, but inflammation of these veins lead to a condition called phlebitis and may slow blood flow which can lead to clots forming within the veins. These may lead to pain in the extremities, swelling of the extremities, change in color of the extremities and tenderness to the touch in the extremities. If untreated, these clots may break loss, travel through the larger veins and lodge in the lungs, leading to a pulmonary embolism, a clot in the lung which may be fatal or cause significant impairment. Early detection is imperative to prevent worsening of the condition.
Transcranial Dopplers: Ultrasonography and doppler technology are used to image blood flow through the arteries at the base of the brain. Blockages in these arteries can lead to strokes, headaches, numbness and tingling, and pain lower in the body. Early detection of these blockages is important in stroke prevention. Spasms of these arteries can also lead to migraine headaches, so this imaging technique can be used to work up a patient with suspected migraines.
The PADNET test is an easy way to screen for peripheral arterial disease, blockages in the arteries of the legs, The PADNET test is a computerized ankle/brachial index (ABI) wherein a blood pressure cuff is placed on an arm, and blood pressure cuffs are placed in different locations loving down the legs. The computer checks the blood pressure in the arm, and serially checks the blood pressures down the legs and compares the different readings. A significant drop in blood pressures moving down the leg may indicate peripheral arterial disease.
ELECTROCARDIOGRAPHY, HOLTER MONITORING AND CARDIAC EVENT MONITORING
Electrocardiography (EKG) technology is used to measure the electrical activity of a patient's heart by attaching 10 electrical leads to the patient's extremities and chest. Looking at the heart's electrical activity from different angles can help to assess electrical conductance problems, electrical blockages in the conduction system of the heart and changes in the electrical pattern can signal underlying cardiovascular disease. A limitation of the EKG are that it is performed at rest. Checking the EKG while exercising the patient can better detect underlying coronary artery blockages (see Treadmill Exercise Stress Testing above). Another limitation of the EKG is that it is only performed for a few minutes, so it is often difficult to detect cardiac arrhythmias, where the heart beats abnormally. Monitoring the electrical activity of the heart for a longer period of time increases the ability to detect these abnormalities of rhythm. Holter monitoring can be performed by the DiGiovanna Family Health and Wellness Center on-site by hooking the patient up to a small tape recorder through 3-5 cardiac electrical leads on the chest, which can be worn and taken home generally for a 24 hour period of time. If the cardiac arryhthmia is still not detected but suspected, a cardiac event monitor can also be used. This is a very small digital tape recorder that can be placed directly on the chest to record the patient's cardiac rhythm whenever the patient is having symptoms. This cardiac event monitor is sent directly to a central monitoring site and the patient can be monitored 24 hours per day, 7 days per week for up to several months at a time.
Lead by Dr. Trazzera, advanced cardiac testing may be performed off-site. The DiGiovanna Family Health and Wellness Center has referral connections to obtain a variety of advanced cardiac tests. Depending on the patient's symptoms and the results of initial cardiovascular testing, the following tests may be performed:
Nuclear Stress Testing - The patient is hooked up similar to the Treadmill Exercise Stress test, as above, but once the patient achieves a certain level of exercise, the patient is injected with a radioactive isotope. This isotope is taken up into blood cells and carried into the heart muscle. The patient is then placed under a special camera that can detect the distribution of the isotope. The pattern of distribution can infer whether or not there may be blockages in the patient's coronary arteries. This test is performed in Dr. Trazzera's cardiac lab in his Farmingdale facility, only minutes from the DiGiovanna Family Health and Wellness Center.
Cardiac CT Scan - a minimally invasive procedure where a patient is injected with a contrast agent and placed inside a CT scan machine which is equipped with special software. This software allows the physicians to create a 3-dimensional image of the patient's coronary arteries which can then help to determine whether intervention is necessary, such as medical intensification, coronary artery stenting or surgery. This test is performed under the guidance of Dr. Trazzera at St. Joseph's Hospital in Bethpage, just minutes from the DiGiovanna Family Health and Wellness Center.
Electrophysiological Studies (EPS) - if a significant cardiac arryhthmia is detected or highly suspected, the patient will be referred to St. Francis Hospital, under the guidance of Dr. Trazzera, to the EPS Lab. There, invasive testing can be performed to detect and even treat these significant cardiac arrhythmias.
Coronary Angiography and Coronary Artery Stenting - depending on the results of previous cardiac testing, a high index of suspicion for coronary artery disease will often lead to definitive testing and treatment. Coronary angiography where a catheter is placed, usually in the groin, and fed into the heart, where a contrast agent is injected selectively into the heart and arteries so they may be seen on a special x-ray screen. If significant blockages are found, they may be opened up with a balloon in the catheter and a stent placed in the area of narrowing to hold the artery open. These procedures are performed through a referral network established by the DiGiovanna Family Health and Wellness Center at St. Francis Hospital, The Heart Center in Roslyn, NY.
Equally as important as early detection of cardiovascular diseases, is the prevention of cardiovascular disease. By performing a targeted Annual Wellness Examination, risk factors for cardiovascular disease can be identified. While not perfect, identification of these risk factors and aggressive risk factor modification can lessen the risk of developing cardiovascular disease. Some of the programs that the DiGiovanna Family Health and Wellness Center has developed to helped modify these risks are:
At its core, weight loss is one of the most important risk factors most at-risk patient should modify. The DiGiovanna Family Health and Wellness Center has developed a time-tested program that has assisted many patients lose the weight they need to make them healthier. To learn more, please click below.
Genetics play a major role in determining who is at risk for cardiovascular disease. At the DiGiovanna Family Health and Wellness Center, we perform targeted genetic screenings to try and identify those at risk patients. Although genetics cannot be altered, those patients identified can undergo more aggressive cardiovascular risk reduction and lifestyle modifications, and a more targeted approach to cardiovascular monitoring and interventions can be designed. To learn more about our genetic screening program, please click below.
The DiGiovanna Family Health & Wellness Center fully recognizes the paramount importance that the role of nutrition plays in our state of health, well-being and disease. More than ever, people are coming to realize that the statement "You are what you eat" is true at many different levels. If we are going to assist our patients in seeking disease prevention and mitigation, we need to be able to provide the best nutritional and complementary medicine advice based on sound medical principles and the latest research knowledge. The DiGiovanna Family Health & Wellness Center has worked hard to create such a department. Led by Peter Roth, with his 25 years of experience in the field of Functional Nutrition and Complementary Medicine, our nutritional services department is something we can be very proud of. To learn more about these services, please click below.
Diabetes mellitus is in epidemic proportions today, and relates to our poor dietary habits and obesity. Diabetes mellitus is a major risk factor for the development of cardiovascular diseases. Without proper management, diabetic patients are at great risk of complications of both macrovascular diseases, such as heart attacks, peripheral arterial disease and strokes, and microvascular diseases, such as toe amputations, chronic kidney disease and blindness. By participating in the latest clinical research trials and working with the major pharmaceutical companies, the DiGiovanna Family Health and Wellness Center has been able to bring the latest advances and protocols for diabetes treatment to our patients. Our Diabetes Management Department incorporates these advances into the everyday treatment and recommendations for our diabetic patients. Through collaborations with several major universities, the DiGiovanna Family Health and Wellness Center is also participating in very advanced research to try to find a cure for diabetes. To learn more about our Diabetes Management services, please click below.