Central Maine Healthcare

Where You are the Center

Cardiovascular Services

Anticoagulation Management

When it comes to heart medication, there’s good news and bad news. The good news is that providers now have more medications than ever before to manage various types of heart and vascular diseases and conditions. The bad news is that because these are strong drugs with occasional side-effects, patients may need expert care in managing their heart drugs and calibrating their dosages, especially if they take multiple medications.

Central Maine Healthcare’s Anticoagulation Management Clinic  in Lewiston is here to help. We work with people who require medical management of heart risks and conditions. Our nurse practitioners monitor medications and their side effects so that you can feel your best and optimize your heart health. If a certain medication is causing uncomfortable side effects, we can work with you to find a medication strategy that works better for you.

To learn more about our Anticoagulation Management Clinic, call 800-760-6622.

Medications for Your Heart

When your provider prescribes heart medications, you may have to take them for the rest of your life, so it’s important to find dosages and types of drugs that maximize health benefits while minimizing side-effects.

Sometimes, switching from one type of a drug to another within a class of drugs can eliminate side-effects. For example, if warfarin (Coumadin) doesn’t work for you, heparin, another type of anticoagulant, may be a better choice. The nurse practitioners at in our Anticoagulation Management Clinic can help with that. We assist patients manage some of the following common heart medications:

Anticoagulants:
These medications are known as blood thinners, although they don’t actually make your blood thinner. Instead, they lower your blood’s ability to clot, which can help prevent blood clots from forming. Your provider may prescribe anticoagulants if you are at risk of stroke or to treat certain types of heart, blood vessel or lung conditions. Some common anticoagulants include warfarin (Coumadin) and heparin.

Antiplatelet drugs:
These medications help prevent blood clots from forming by stopping platelets from sticking together. (Platelets are tiny disc-shaped substances in the blood that help form clots.) Antiplatelet drugs may be recommended (aspirin) or prescribed for people with who have angina or who have had a heart attack or stroke or who have had a stent implanted in the coronary artery or coronary artery bypass graft surgery (CABG). Some common antiplatelet drugs include aspirin, clopidogrel (Plavix) and dipyridamole.

ACE inhibitors:
These drugs help expand your blood vessels to allow blood to flow more easily. They are prescribed for people with high blood pressure or heart failure. Some common ACE inhibitors include benazepril (Lotensin), captopril (Capoten) and enalapril (Vasotec).

Beta blockers:
These drugs help lower your heart rate, which helps your heart beat more slowly and less forcefully. They are prescribed for people with high blood pressure, abnormal heart rhythms (arrhythmia), angina and previous heart attacks. Some common beta blockers include acebutolol (Sectral), atenolol (Tenormin) and bisoprolol (Zebeta).

Calcium channel blockers:
These medications interrupt the flow of calcium into your heart and blood vessels, resulting in a reduction of the strength of your heartbeat and a relaxation of your blood vessels. They are prescribed for people with high blood pressure, angina and certain types of arrhythmia. Some common calcium channel blockers include amlodipine (Norvasc, Lotrel), diltiazem (Cardizem, Tiazac) and felodipine (Plendil).

Cholesterol-lowering medications:
These drugs lower the amount of cholesterol in your blood, especially LDL (“bad” cholesterol). Some common cholesterol-lowering medications include statins such as atorvastatin (Lipitor) and rosuvastatin (Crestor), nicotinic acids such as lovastatin (Advicor) and cholesterol absorption inhibitors: such as ezetimibe/simvastatin (Vytorin).

Digitalis preparations:
These medications help your heart beat more forcefully. They are prescribed for heart failure and some types of arrhythmias, such as atrial fibrillation. A common digitalis preparation is lanoxin.

Diuretics:
These drugs help remove water and sodium from your blood, which relieves pressure on your heart and helps reduce swelling in your ankles and legs. They’re prescribed for people with high blood pressure and edema (swelling). Some common diuretics are chlorthalidone (Hygroton) and furosemide (Lasix).

Vasodilators:
These medications, which are also known as nitrates or nitroglycerine, help relax your blood vessels while increasing blood flow to your heart. They are prescribed for angina. Some common vasodilators include isosorbide dinitrate (Isordil) and nesiritide (Natrecor).

Chest Pain Center

Chest pain should never be ignored. Remember: when in doubt, get checked out.

The Chest Pain Center at the Emergency Department at Central Maine Medical Center provides a faster, higher level of care to patients with heart attack symptoms. Our physicians are trained to deliver specialized care during the early stages of a cardiac event — when treatment is critical to saving lives and preserving heart muscle. We’re also able to monitor patients when it is not certain that they are having a heart attack, ensuring that they’re not sent home too quickly or needlessly admitted to the hospital.

Our proven process includes:

Step 1: Intake

When a patient enters the Chest Pain Center, our emergency physicians treat them as potential cardiac patients until a proper diagnosis is made.

Step 2: Assessment

The patient is set up on a cardiac monitor, with oxygen administered as a precaution. Intravenous lines may be started so life-saving drugs can be administered quickly if needed.

Step 3: Testing

Diagnostic testing helps our specialists reduce the time needed to determine the cause of the patient’s chest pain.

Step 4: Making a Treatment Plan

Once the patient’s condition is stable, the emergency physician may consult with one or more of our board-certified cardiologists for possible follow-up.

For more information, call the Chest Pain Center at (207) 795-2200.

Diagnostic Tests

Angioplasty

Angioplasty, also known as percutaneous coronary intervention, or PCI, is a minimally invasive procedure performed to restore blood flow to the heart muscle when the coronary arteries are partially or entirely blocked. During an angioplasty, a catheter with either a balloon or laser tip is routed to the site of the blockage to clear the artery.

Why Do You Need Angioplasty? The coronary arteries are responsible for carrying blood and oxygen to the heart muscle. When those arteries become blocked, either partially or entirely, by plaque or a blood clot, blood flow is disrupted and your heart doesn’t get the enriched oxygen it needs to pump effectively. In some cases, blocked arteries are discovered as part of routine diagnostic testing, but in other cases, a blockage may be discovered when a patient experiences chest pain and is in an emergency setting.

Getting Ready for Angioplasty: Angioplasty can be performed as an elective (scheduled) procedure when noninvasive testing reveals probable heart disease, or it can be done on an emergency basis to clear blockages during a heart attack. Prior to elective angioplasty, your provider will give you specific instructions about when you’ll need to stop eating or drinking before arriving at the hospital. You may have a blood test that provides information about how fast your blood clots, and you may also get a sedative to help you relax before the procedure.

When angioplasty is performed on an emergency basis, hospitals try to perform the procedure within a 90-minute window after a patient arrives at a hospital with chest pain and other symptoms. Because of this, there really aren’t any steps to take to prepare for emergency angioplasty.

What to Expect During Angioplasty: During angioplasty, the arteries in your heart will be reopened. You will be awake but sedated during the procedure, which is performed in a cardiac catheterization lab. To begin the procedure, your provider will insert a catheter into an artery and then guide the catheter up and into the blocked coronary artery. The provider uses an X-ray and dye to properly visualize the arteries and safely guide the catheter into place.

Once the blockage is reached, your provider will use one of two primary methods to remove the blockage. In one method, a balloon will be inflated at the tip of the catheter, which pushes the plaque causing the blockage to the side, while in the other method, a laser is used to dissolve the plaque. If the blockage in your coronary artery is severe — typically when at least 70% of the artery is blocked — your provider will also likely place a stent in the artery during the angioplasty. A stent, which is made of mesh, holds the artery open and ensures that it does not become blocked again.

Recovering From Angioplasty: Following angioplasty, you will need to remain in the hospital for observation at least overnight. In cases where a stent is placed, you may require a longer hospital stay. Most people are able to return to work and normal activities within a week or so, but your provider will provide individualized guidance about when it’s safe for you to resume normal daily activities. Your post-angioplasty care will also include education and guidance related to heart-healthy habits. Practicing healthy lifestyle habits, including regular exercise and a diet low in saturated fat, will help limit the risk of additional blockages in the future.

Ankle-brachial Index (ABI)

The ankle-brachial index is a simple, noninvasive test to check for peripheral artery disease (PAD). It’s a quick outpatient test that measures the blood pressure at your ankle compared with the blood pressure at your arm. The results are determined by dividing the blood pressure in an artery of the ankle by the blood pressure in an artery of the arm. A low ankle-brachial ratio or index number can be an indication of PAD.

Why Do You Need an Ankle-Brachial Index? Your provider may order an ankle-brachial index if you have leg pain while walking or have any of the following risk factors for PAD:

  • Being older than age 70, or being younger than 50 with diabetes and one additional risk factor
  • Diabetes
  • High blood pressure or cholesterol
  • Smoking

The test can also be done to check the severity of PAD if you’ve already been diagnosed. It may be something your provider orders annually.

Getting Ready for an Ankle-Brachial Index: Minimal preparation is needed for this test. You may want to wear loose clothing so the technician can easily place the blood pressure cuffs on your arm and ankle. When you schedule your appointment, ask if there are any additional instructions you may need to follow before your test.

What to Expect During an Ankle-Brachial Index: You’ll need to rest for at least 15 to 30 minutes before the procedure. During the test, you will lie on the table while a technician measures your blood pressure in both arms and both ankles. Testing generally lasts 10–20 minutes, depending on how many times your blood pressure is taken. The technician will calculate the results by dividing the blood pressure in your ankle by the blood pressure in your arm. A low ratio indicates potential PAD. These results will be shared with your provider, who will share them with you. Depending on your provider’s schedule, you may or may not receive the results that day.

Cardiac Catheterization Lab

If you have problems with the muscle, valves or arteries in your heart, Central Maine Heart and Vascular Institute (CMHVI) Cardiac Catheterization Lab is here to provide you with the care you need. At our Cardiac Catheterization Laboratory, also known as the Cath Lab, cardiologists and a team of specialty nurses and radiologic technicians use a procedure known as cardiac catheterization to diagnose, assess and treat heart problems such as coronary artery disease and angina.

State-of-the-Art Catheterization Technology: CMHVI’s Cath Lab uses the latest technology to assess and treat heart problems, including a multi-view camera that rotates around the patient and provides multiple views. This advanced camera emits less radiation than traditional imaging technology, requires less contrast dye and greatly enhances image quality. We also use a cutting-edge hemodynamic system that monitors your blood pressure, the electrical activity in your heart, your pulse and blood oxygen levels during catheterization procedures.

Cardiac Catheterization From Diagnosis to Treatment: Providers use catheterization to perform a variety of procedures, including a type of X-ray called a coronary angiogram that can detect blockages in the arteries. During catheterization, a cardiologist inserts a catheter (thin plastic tube) through an artery in your groin or arm and guides it into your heart. Contrast dye injected through the catheter allows blood vessels to show on a monitor. This part of the procedure is called an angiogram. The test also measures blood pressure and blood oxygen levels. Images from the test detect blockages that may need to be repaired. If an angiogram shows that your arteries are narrowed, you may be a candidate for treatment called percutaneous coronary angioplasty (balloon angioplasty) to reopen them and improve blood flow to your heart. Balloon angioplasty is also used in emergencies to treat patients who have suffered heart attacks because an artery has developed a total or near-total blockage.

Percutaneous Coronary Angioplasty (Balloon Angioplasty): To re-open narrowed or blocked coronary arteries in someone with coronary artery disease or heart attack (myocardial infarction), an interventional cardiologist guides a catheter to the site where a waxy substance made of cholesterol and other substances called plaque has formed a blockage. The tip of a catheter used in this procedure is equipped with a tiny deflated balloon. Once the catheter is in place, the surgeon inflates the balloon. As the balloon expands it pushes aside the plaque, widening the flow space inside the artery. Once the artery is open, the surgeon slowly withdraws the catheter.

Coronary Artery Stent Placement: Once a narrowed or blocked artery has been re-opened, the danger isn’t necessarily over. Arteries that have been unclogged often narrow or close again later. To reduce the risk for this problem, providers often choose to insert a device called a stent in the segment of an artery that was reopened. A stent is a tiny mesh tube that providers implant in an artery to prevent plaque from blocking the blood vessel. Stents are implanted in arteries in the heart (coronary arteries), neck (carotid arteries) or liver. Drug-eluting stents are coated with medication that is released over time to help prevent the artery from becoming blocked again. A coronary artery stent implant may lower the risk of heart attack and stroke.

Other Cath Lab Procedures available at CMHVI Cath Lab:

  • Intravascular ultrasound
  • Intra-aortic balloon pump
  • Pacemaker placement
  • Procedural education
  • Diagnostic peripheral arterial catheterization
  • Percutaneous peripheral arterial intervention (stent placement, angioplasty, limb salvage)
  • Diagnostic and intervention peripheral arterial procedures

Cardiac MRI

Cardiovascular Magnetic Resonance Imaging: Cardiovascular magnetic resonance imaging, or Cardiac MRI is a state-of-the-art technique for taking pictures of the heart. It is an imaging modality that can be used to supplement other imaging modalities such as echocardiography and Cardiac CT, but with better accuracy and more detail.

The study is done by asking a patient to lie flat in a strong magnet. One of the more significant patient benefits is that no radiation is used in the study. The magnet emits radio frequency pulses. Based upon the interaction of the impulses, the molecules in the heart and the magnetic field, images are acquired of the heart and displayed on a computer. Using special software, those images are manipulated to provide information about the patient’s heart. Most patients are given a contrast agent through an IV which enhances the image quality and helps increase diagnostic yield. Tissue characteristics of Cardiac MRI are excellent and, as a result, the heart muscle can be closely evaluated for abnormal thickness or cardiac anatomy. Cardiac MRI can also be used to measure the extent of damage, or scar, within the heart muscle that may result from a heart attack. Inflammation of the heart muscle such as myocarditis or pericarditis can be seen in Cardiac MRI as well.

Doppler Ultrasound

A Doppler ultrasound is an imaging test used to evaluate the way blood moves through the blood vessels. It is the only imaging test able to show blood flow and helps providers diagnose vascular disease or determine the success of treatments for arteries and veins. There are different types of Doppler ultrasound, but all use the Doppler effect (an increase or decrease in wavelength) to measure sound waves that reflect off of moving blood cells to create an image.

Why Do You Need a Doppler Ultrasound? Doppler ultrasounds help your provider find out if your blood flow is blocked or reduced. These imaging tests can help diagnose conditions such as:

  • Arteriosclerosis
  • Carotid arterial stenosis
  • Deep vein thrombosis
  • Peripheral artery disease
  • Venous insufficiency

Getting Ready for a Doppler Ultrasound: Depending on the type of Doppler ultrasound your provider orders, you may not be able to eat or drink for several hours before. If you smoke, avoid cigarettes or other nicotine products at least two hours before your test. Nicotine causes your blood vessels to narrow, which may affect your test results.

What to Expect During a Doppler Ultrasound: First, a radiologist or ultrasound technologist will put a gel on the skin of the area being tested. This gel helps sound waves travel between a transducer, which sends sound waves into your body, and your skin. As the transducer travels over your skin, moving blood cells will cause the pitch of the sound waves to change. The sound waves are recorded on a computer and made into graphs or pictures, depending on the type of Doppler ultrasound performed. The test usually takes 30 minutes to an hour to complete. After your test, the radiologist or technologist will send your results to a provider. The provider will review your results and, if necessary, alert you of any next steps.

Echocardiogram

An echocardiogram is a type of ultrasound imaging that uses high-frequency sound waves to make a detailed picture of your heart on a video monitor. Echocardiograms look at your heart’s blood vessels, chambers, valves and walls. They allow your provider to see the size and shape of your heart, how your heart moves and pumps blood, and whether your heart valves are working correctly.

Why Do You Need an Echocardiogram? Your provider may recommend an echocardiogram to check your heart’s function or to see how your heart looks. An echocardiogram can be used to detect many heart problems, such as:

  • Abnormal heart valves
  • Damage after a heart attack
  • Heart failure
  • Heart murmurs
  • Infection or tumors in the heart
  • Pulmonary hypertension
  • Stenosis

Getting Ready for an Echocardiogram: No at-home preparation is necessary for an echocardiogram, and you can eat or drink as you normally do on the days before.
On the day of your echocardiogram, you may find it helpful to wear a shirt or blouse you can easily remove.

What to Expect During an Echocardiogram: During your test, the technician will put a gel on your chest to help the sound waves reach your heart through your skin. A device called a transducer will be placed and moved around on your chest. The transducer transmits ultrasound waves into your chest. The waves will bounce off your heart and “echo” back to the transducer, which will help create the pictures of your heart. The test usually takes less than an hour to complete.
After your echocardiogram, the technician will send the pictures to a cardiologist. The cardiologist will review the pictures and tell you about any next steps you may need to take.

Holter Monitors

A Holter monitor is a device that continuously records your heart’s activity for a short period of time, usually 24 to 48 hours. It works as a portable electrocardiogram (EKG) that measures your heart’s electrical activity. Unlike a traditional EKG that takes only a few seconds worth of data, a Holter monitor gives your provider more detailed information about your heart during normal activity. As you wear the monitor, it measures the speed and regularity of your heartbeat and the strength and timing of your heart’s electrical impulses.

Why Do You Need a Holter Monitor? Holter monitors help providers diagnose arrhythmia (irregular heartbeat) and determine the success of treatments. You may be asked to wear a Holter monitor if you:

  1. Become faint or dizzy regularly
  2. Experience irregular heartbeat
  3. Need to determine whether your heart is getting enough oxygen
  4. Recently had a heart attack
  5. Take medications intended to treat a cardiac condition

Getting Ready for a Holter Monitor: Holter monitors generally have small electrodes that attach directly to your chest with adhesive. Wires connect these electrodes to a monitor that you keep in a pocket, hang over your shoulder or wear around your waist. Very little preparation is needed before you wear one. However, you cannot get the electrodes or monitor wet, so you should bathe or shower prior to receiving the device. Men who have hair on their chests may need to shave the area where the electrodes will be placed.
Electricity and magnets can affect the Holter monitor’s readings, so you will need to take some precautionary steps:

  • Avoid electric blankets, electric razors, electric toothbrushes, magnets, metal detectors and microwave ovens while wearing the device.
  • Do not have any X-rays while wearing your monitor.
  • Keep cellphones and other electronic devices, such as MP3 players and tablets, away from the monitor.

What to Expect During a Holter Monitor Test: Wearing a Holter monitor is painless, and you will be free to go about your usual activities. However, you will need to track any symptoms, such as dizziness or unusual heartbeat, in a diary. Note the time and what you were doing when the symptoms occurred. When your test period is complete, you will return your Holter monitor to your healthcare provider. They will then process your test results, which should be ready for you within one to two weeks.

Stress Test

Otherwise known as an exercise test or treadmill test, a stress test demonstrates how well your heart performs under pressure. During physical activity, your body needs more oxygen than it does when it is at rest. In response, your heart needs to pump more blood. The stress test illustrates if an adequate amount of blood has been pumped to the arteries that supply your heart. This test will also help you and your provider understand what kind of exercise is safe for your body.

Why Do You Need a Stress Test? If you have symptoms of a heart complication, including chest pain, dizziness, irregular heartbeat or shortness of breath, your provider may recommend a stress test. This test may help determine if you have a heart condition, such as:

  • Heart failure
  • Heart valve disease
  • Ischemic heart disease

Getting Ready for a Stress Test: Prior to your test,

  • Ask your provider if there are any medications you should stop taking.
  • Do not drink beverages that contain caffeine, such as soda, coffee or tea, on the day of your test.
  • Wear comfortable clothing.

What to Expect During a Stress Test: When you arrive for your stress test, a healthcare provider will inject a radioactive substance into one of your veins. This substance will help your provider see how well blood is flowing into your heart. For about 15 to 45 minutes, you will recline and relax while the substance travels to your heart. The provider will then put electrodes on your chest, a blood pressure cuff on your arm and a pulse monitor on your finger to monitor your blood pressure and heart activity while your body is at rest and as you start to move.

During the actual test, you will walk on a treadmill or pedal an exercise bike with increasing speed and intensity. You may also breathe into a tube for a few minutes as you exercise. Once the test is complete, you will rest while your results are evaluated. Your provider will evaluate several results, including your blood pressure, breathing, heart rate and your level of fatigue.

Vascular Lab Diagnoses Circulatory System Issues

The Central Maine Heart and Vascular Institute’s Vascular Lab uses non-invasive vascular measures to diagnose conditions and abnormalities of the circulatory system, including blood vessel blockages and aneurysms. The Vascular Lab is accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories. The lab’s sonographers are nationally certified.

24-hour Blood Pressure Monitoring

Recording someone’s blood pressure over a 24-hour period may be done to help diagnose patients experiencing borderline high blood pressure, uncontrollable blood pressure, blood pressure problems caused by medications, pregnancy accompanied by high blood pressure, or fainting spells.

A 24-hour blood pressure monitor is a small digital device that records blood pressure readings while an individual is at home, work or participating in day-to-day activities. This information shows how environmental factors impact an individual’s cardiovascular system, including “white-coat hypertension” experienced by those who only have high blood pressure at the provider’s office. Patients are asked to keep a diary of their activities, so the provider will know when patients were active and when they were resting.

Abdominal Ultrasound

An abdominal ultrasound is a painless test that provides information about internal organs and blood vessels within the abdomen. Sound waves are used to produce images. The ultrasound may be prescribed for patients with kidney, liver, gallbladder, appendix, pancreatic, spleen or arterial issues. The exam may take up to an hour. Patients recline while the technician uses a wand and gel to transmit soundwaves, which are then recorded as images.

Ankle Brachial Indexes (ABIs)

Ankle-brachial index (ABI) testing measures blood pressure in the arms and legs for comparative analysis. The ratio of the two measurements can indicate if there is a blood flow problem in the legs. ABI testing is a non-invasive flow study (NIFS) used to diagnose claudication, experienced as pain while walking, may be caused by peripheral arterial disease (PAD). PAD, a form of atherosclerosis, causes arteries to narrow and leg muscles to receive less blood, and therefore less oxygen.

Diagnosing this condition is important, as it may precede cardiovascular issues, including heart attack or stroke. The test takes 45 minutes to an hour. No special preparation is needed.

Arterial Duplex Ultrasound

An arterial duplex ultrasound is used to evaluate issues involving arteries and/or veins of the arms and/or legs. This painless, non-invasive procedure uses sound waves to gather information. Blood flow is measured and images of the blood vessels are taken. The technician transmits sound waves with the use of a wand that is gently passed over the areas being studied. The procedure takes about an hour.

Carotid Duplex Ultrasound

Carotid duplex ultrasound is a simple and painless procedure that allows providers to evaluate the carotid arteries in the neck. These major arteries supply blood to the brain. When blood flow to the brain is insufficient, a stroke and/or death are possible. The ultrasound may reveal blood clots (thrombosis), narrowing of the arteries (stenosis), or other blockages. The ultrasound uses sound waves to produce images of the blood vessels so blood flow can be evaluated.

Segmental Pressures

Segmental pressure testing is similar to ankle-brachial index (ABI) testing but involves two or three additional blood pressure cuffs. These are placed just below the knee, just above the knee, and at the upper thigh. Blood pressure at each point is recorded. Significant drops between body segments may suggest blockages or narrowing in the arteries.

Segmental pressure testing is a non-invasive flow study (NIFS) used to diagnose claudication, experienced as pain while walking, may be caused by peripheral arterial disease (PAD). PAD, a form of atherosclerosis, causes arteries to narrow and leg muscles to receive less blood, and therefore less oxygen. Diagnosing this condition is important, as it may precede cardiovascular issues, including heart attack or stroke. The test takes 45 minutes to an hour. No special preparation is needed.

Venous Ultrasound Imaging

Venous Ultrasound Imaging captures real-time images of the inside of the body. Venous ultrasound, in particular, looks at blood flow through veins in the arms or legs. Ultrasound is easy-to-use, less expensive than other imaging methods, and does not emit any ionizing radiation. For standard diagnostic ultrasound there are no known harmful effects on humans.

Venous ultrasound studies are used to evaluate varicose veins; assist in the placement of a needle or catheter into a vein; evaluate veins in the leg or arm for potential use for bypassing a narrowed or blocked blood vessel (graft); and examine a blood vessel graft. Venous ultrasound is used to search for blood clots, especially in leg veins. Often called deep vein thrombosis, or DVT, these clots can cause a dangerous condition called pulmonary embolism if they move to the lungs. However, if a blood clot in the leg is detected early enough, proper treatment can prevent it from passing to the lung.

A provider specifically trained to supervise and interpret imaging examinations (radiologist) analyzes the ultrasound results and sends a report to the patient’s primary care provider and/or to the provider who referred the patient for the exam.

Ralph’s story

Ralph and his wife were driving home on a January day when he began sweating profusely and felt sick to his stomach. Ralph sped up and crossed into the opposite lane. “Debbie started to holler for me to slow down and that was the last thing I heard before passing out,” Ralph says. “When I came to, the car had gone off the road and slammed into a ditch.” Ralph had suffered a massive heart attack.

While Debbie wasn’t badly hurt, Ralph was rushed to CMMC where he received the diagnosis and began treatment. Ralph now spends three days a week at the Central Maine Heart and Vascular Institute (CMHVI) for rehabilitation. It’s a lot of time and effort, but he feels he’s lucky to be there. His provider said if he hadn’t been in the accident, it’s likely he would have died in his sleep that night.

“So here I am, and I’m doing really well,” Ralph says. “I work with the Cardiovascular Rehabilitation team three times a week and they’ve been great. Debbie and I are eating a lot healthier and exercising. I’m doing seven or eight miles between the treadmill and the stationary bike, which is great, considering that three months ago I couldn’t even take two steps.”

Vein Disorders

Although you may think of varicose veins only as a cosmetic problem—and sometimes, that’s all they are—they can sometimes lead to serious issues such as leg pain, leg swelling and the development of serious blood clots.

At the CMHVI, we offer a full range of vein treatments for people whose vein disorders are a health risk. Most insurance plans cover varicose vein treatment if self-help management has failed to alleviate symptoms.

Varicose Veins Can Be More than a Visual Concern

Your arteries carry blood from your heart to the rest of the body and your veins deliver blood back to the heart. In healthy veins, valves help prevent blood from flowing backwards. In patients with a condition known as venous insufficiency, the valves are damaged and no longer work properly. Venous insufficiency causes leg veins to enlarge, twist and appear blue or purple, a condition called varicose veins.

Varicose veins are not necessarily a serious health risk, but they can be painful and cause leg ulcers that are resistant to healing. In addition to swelling, they can raise your risk for serious blood clots known as deep vein thrombosis (DVT).

Get a Non-invasive Diagnosis

CMHVI’s Vascular Lab uses non-invasive ultrasound to diagnose conditions and abnormalities of the circulatory system, including vein disorders. The Vascular Lab is accredited by the Intersocietal Accreditation Commission, which accredits vascular laboratories. Our sonographers are nationally certified. Some of the diagnostic testing we use for vein disorders includes:

  • Arterial Duplex Ultrasound: This test is used to evaluate issues involving arteries and/or veins of the arms and/or legs. It is a painless, non-invasive procedure that uses sound waves to measure blood flow and measure blood vessel size. 
  • Venous Ultrasound Imaging: This test uses sound waves to capture real-time images of the flow of blood through veins in the arms and legs. It is used to evaluate varicose veins and to search for DVT blood clots, especially in leg veins. These clots can cause a dangerous condition called pulmonary embolism if they move to the lungs. However, if a blood clot in the leg is detected early enough, proper treatment can prevent it from passing to the lung.

Receive Treatments Specific to Your Disorder

Our vascular and endovascular surgeons can treat varicose veins and other vascular conditions using some of the following procedures:

  • Microphlebectomy: A diseased vein is removed through a series of very small incisions. Recovery is fast, but the procedure doesn’t fix the underlying problem of leaky valves.
  • Sclerotherapy: Using a small needle, a provider injects spider veins and small varicose veins with a solution that seals the veins. The treated veins fade after a few weeks, but the same veins may require more than one treatment. This treatment may not be covered by your health insurance.
  • Stripping and Ligation: Along section of vein is tied off, usually at the groin, then removed along the length of the thigh. This conventional treatment for varicose veins has been largely replaced by minimally invasive venous ablation.
  • Venous Ablation: The provider inserts a catheter into the enlarged vein and uses ultrasound imaging to guide the catheter to the saphenous vein, a major blood vessel in the thigh. The catheter emits radiofrequency energy that closes the vein. This sealing of the saphenous vein typically causes decompression of downstream varicose veins resulting in symptomatic relief and improved appearance. Blood is naturally rerouted into healthy veins and is carried back to the heart more efficiently. This procedure causes less post-operative pain and bruising than vein stripping and promotes faster recovery.

Valve Disease

Structural heart disease is any type of abnormality of the heart’s muscle, valves, arteries or other supporting structures. The most common type of structural heart disease is aortic stenosis, which affects about 1.5 million Americans.

In the past, open heart surgery offered the only option for repairing structural heart conditions. But now, minimally invasive surgery offers you or your loved one a far less complex way to correct some structural heart and valve problems. Our heart providers have expertise in all types of heart valve surgeries, including minimally invasive aortic valve and mitral valve surgery. We offer valve repair as well as both aortic valve replacement (AVR) and transcatheter aortic valve replacement (TAVR)] a revolutionary, minimally invasive alternative to open heart surgery.

What is Structural Heart and Valve Disease?

Aortic stenosis is a condition that affects the aorta, which is the main artery through which blood flows from the heart to the rest of your body. The aortic valve must open fully to allow blood to flow and then close to prevent blood from flowing back into the heart. When your aortic valve doesn’t function properly, blood flow from the heart is decreased and the heart must work harder to pump blood, which can cause thickening of the heart as well as chest pain. Over time, blood can back up into your lungs.

Although aortic stenosis can develop before birth (congenital aortic stenosis), it is more likely to occur later in life, because of a buildup of calcium deposits on the aortic valve. Aortic stenosis afflicts about 2 percent of people over age 65. It’s important to diagnose and replace faulty heart valves, because if you have severe aortic stenosis and don’t have the valve replaced, the chance of dying in two to three years increases by roughly 50 percent.

Another common type of structural heart disease is mitral valve stenosis. The mitral valve is located between the left atrium and the left ventricle of the heart and controls blood to flow from the left atrium into the left ventricle. Problems with this valve can make it harder for your heart to pump blood properly.

Recognize Valve Disorder Symptoms

Valve disorders can cause the following symptoms:

  • Chest pain or discomfort that may worsen with activity
  • A feeling of pressure or squeezing in the chest that can extend into the arm, jaw or neck
  • Cough, sometimes bloody
  • Trouble breathing during activity
  • Fatigue
  • Heart palpitations
  • Fainting
  • Weakness, lightheadedness or dizziness, particularly with activity
  • Swelling of the feet or legs

How Do You Determine Structural Heart Disease?

To diagnose structural heart disease, your cardiologist starts by giving you a physical exam and talking with you about your symptoms and health history. You may also receive one or more of the following diagnostic tests:

  • Electrocardiogram (ECG): This test uses small sensors (electrodes) attached to your chest and arms to record electrical signals as they travel through your heart. 
  • Echocardiogram: In this noninvasive test, sound waves are used to produce a video image of your heart in motion. 
  • Chest X-ray: This test can show whether your heart is enlarged and whether you have enlarged blood vessels or calcium buildup in your heart. 
  • Cardiac stress test (also known as a treadmill test or exercise EKG or ECG): This test measures how your heart performs in response to exercise or stress by monitoring blood flow and oxygen levels as your heart beats faster and works harder.
  • Cardiac computerized tomography (CT) scan. This test uses a series of X-rays to look at the size and condition of your heart and heart valves.
  • Catheterization and angiogram: During this test, a cardiologist guides a catheter (a thin plastic tube) through an artery in the arm or leg into coronary arteries. Dye is injected through the catheter, to make images that can be captured in an X-ray. This test allows your providers to look at your heart and heart valves. 
  • Cardiac MRI: This test uses magnets and radio waves to create images of your heart as it beats. It can give your providers a better idea of whether your heart or valves are damaged. 

Treatment and Specialties


CMHVI heart and vascular experts offer a full spectrum of services and programs. We offer comprehensive cardiovascular care, from medical management of heart and vascular conditions and lifestyle guidance to diagnostic testing. We also perform procedures such as heart catheterizations, angioplasty or implanting a pacemaker as part of your personalized treatment plan. If necessary, our cardiac and vascular surgeons will provide advanced surgical treatment of your condition.

Our expert team of providers, nurses, technicians and therapists works together to improve heart and vascular health. From early prevention to advanced care and rehabilitation, you’ll find innovative technology and procedures, and a team who is there for you where and when you need us.

Peripheral Artery Disease

Just as the arteries in your heart can become narrowed and blocked by atherosclerosis, so too can the arteries that bring blood to your legs, stomach, head and arms. When these arteries in the outer regions of the body become blocked, the resulting condition is known as peripheral artery disease (PAD). PAD can cause severe pain; without intervention, PAD can cause gangrene that can require amputation.

Luckily, treatment can help. If you have PAD, you can trust the board-certified vascular and endovascular surgeons at CMHVI to provide you with the care you need.

PAD: Learn When It’s More than Leg Pain

PAD is caused by a build-up of plaque in the arteries (most often, of the legs) that restricts blood flow. If you have PAD, you may suffer muscle pain while walking, a condition known as claudication. In severe cases, PAD can cause severe foot pain or gangrene.

Symptoms of PAD may include:

  • Leg pain while exercising that does not go away when you stop moving
  • Foot or toe wounds that do not heal or that heal slowly
  • Coldness in your lower leg or foot 
  • Reduced growth of toenails or leg hair
  • Erectile dysfunction, particularly in men with diabetes

Get a Thorough Diagnosis with a Range of Diagnostic Tests

Our vascular specialists have a range of diagnostic tests they can use to determine whether you have PAD. They include:

  • Ankle Brachial Indexes:  This test measures blood pressure in your arms and legs for comparative analysis. The ratio of the two measurements can indicate if there is a blood flow problem in the legs.
  • Segmental Pressures Test: Like ankle-brachial index testing, this uses two or three additional blood pressure cuffs placed just below the knee, just above the knee and at the upper thigh. Significant drops between body segments may suggest blockages or narrowing in the arteries. 
  • Arterial Duplex Ultrasound:  This painless, non-invasive procedure uses sound waves to gather information and evaluate issues involving the arteries and/or veins of the arms and/or legs. 
  • Computed Tomographic Angiography (CT): This non-invasive test creates images of the arteries in your legs, abdomen or pelvis.  
  • Magnetic Resonance Angiography (MRA): This non-invasive test is like a CT but creates images without the use of X-Rays. 
  • Peripheral angiogram: This is a test that uses dye X-rays to determine whether arteries that bring blood to your legs are narrowed or blocked.

What Are Your Options for Treatment?

Depending on how serious it is, your PAD may be treated in the following ways:

  • Diet modification: Many people with PAD have unhealthy cholesterol levels. Your provider may suggest eating a diet low in saturated fat and trans fats to help lower your cholesterol levels. If you’re overweight, your provider may recommend weight loss. 
  • Exercise: Regular activity can be a very effective treatment for PAD and its symptoms. Your provider may recommend that you participate in our Cardiopulmonary Rehabilitation Program. Cardiac rehabilitation is a medically supervised program to help heart failure patients recover by following an individualized plan that provides evaluation and instruction on physical activity, nutrition, stress management and other health-related areas as needed. Other activities that may benefit you include walking outdoors, treadmill walking and leg exercises designed specifically for people with PAD. 
  • Smoking Cessation: If you smoke, your provider can help you find a program to help you quit. Smoking makes PAD worse. 
  • Managing diabetes: Because diabetes raises the risk of PAD, taking steps to keep your blood sugar under control can help manage PAD. 
  • Medication: Various medications can help people with PAD. For example, your provider may prescribe medication for cholesterol, blood pressure or to prevent the formation of blood clots.  
  • Balloon angioplasty with a stent: A stent is a tiny mesh tube that our providers implant in an artery to prevent plaque from blocking the blood vessel. After clearing a blockage in an artery with a balloon angioplasty, your provider uses a catheter to place the stent in the newly opened artery. The stent helps hold the artery open and reduces the chance that plaque will block the artery again. 
  • Bypass surgery: This procedure uses an implanted blood vessel from elsewhere in your body to create a new path for blood flow around a blocked artery. 

Diagnosis: Cardiovascular Services

Cardiac Stress Test

A cardiac stress test measures how the heart performs in response to exercise or stress. The test monitors blood flow and oxygen levels as the heart beats faster and works harder. Stress tests are often performed to help determine the cause of chest pain or shortness-of-breath. A stress test can help diagnose coronary artery disease (CAD – narrowing of the heart’s blood vessels), which can cause chest pain and increases a patient’s risk for a heart attack. The test can also reveal irregular heart rhythms and determine if medical treatments have been effective.

Prior to the Treadmill Test, (also known as as an exercise stress test or an exercise ECG) patients are given an electrocardiograph (EKG or ECG) and an echocardiogram. The EKG measures heart rate, while the echocardiogram gives images of the heart’s structures. It assesses heart and valve health and blood flow. Both tests are painless and the patient’s heart rate, blood pressure and cardiac electrical system are monitored.

For the exercise test, electrodes are placed on the chest, arms and legs. A blood pressure cuff is worn on the arm and an oxygen monitor is placed on the finger. The patient exercises by walking on a treadmill or pedaling a bicycle until they develop symptoms or feels tired. The patient is given an EKG and echocardiogram afterward.

Metabolic stress testing – This test measures the performance of the heart and lungs while under physical stress. It is similar to an exercise stress test but includes an analysis of the patient’s respiratory system.

Pharmacological (medication-induced) stress echocardiogram – A stress echocardiogram integrates ultrasound imaging and exercise stress testing to measure how the heart functions while the patient walks on a treadmill or rides a stationary bicycle. Medication is be used to stimulate exercise for patients who are unable to exercise safely.

Nuclear stress test — Your provider may order a Nuclear Stress Test to assess the blood flow to your heart. This is done by taking two sets of pictures of your heart; one set of pictures shows the blood flow to your heart at rest, and the other set of pictures shows the blood flow to your heart at stress. Each set of pictures requires an intravenous injection of a radioactive material, which will not make you feel any different in any way. Your test may be scheduled with one set of pictures on different days, or it may be a one-day test. The stress test may be done on a treadmill, with medications, or a combination of both. For the pictures, you must lay very still on a table while a camera passes over your chest for about 15 minutes. While Nuclear Stress Testing is extremely safe, a provider will be at your side during stress testing.

Echocardiogram

A conventional or Transthoracic Echocardiogram (TTE) can be done in a resting state or during exercise (stress echo), the ultrasound source is outside the body, on top of the chest. A technician obtains views of the heart by moving a small instrument called a transducer to different locations on the chest or abdominal wall. A transducer, which resembles a microphone, sends sound waves into the chest and picks up echoes bouncing off the heart. A standard echo usually provides highly detailed images of the heart walls and chambers which can be analyzed by a cardiologist. There are no side effects from a TTE or recovery time needed.

Holter Monitor Applications and Interpretation

One tool that providers use to diagnose arrhythmia (an abnormal heart rhythm) is the Holter monitor. The Holter monitor, worn for one or two days, is a small appliance that can be attached to a belt or a shoulder strap. Several electrodes placed on the chest connect to the monitor. The monitor records heart rhythms. Patients may also be asked to keep a record of cardiac symptoms experienced while wearing the monitor. Symptoms include chest pain, heart flutters, faintness or dizziness. It is also helpful for the patient to record when he/she takes medications, exercises or experiences emotional events. The Holter monitor will not interfere with most activities, other than bathing or water-based activities, as it must remain dry.

Transesophageal Echocardiogram

Echocardiograms use sound waves bounced off the structures of the heart to generate images of the heart in motion. In some cases, most often when patients have serious lung disease, or are immobile or overweight, ultrasound images of the heart are not clear. In these cases, cardiologists may request a transesophageal echocardiography (TEE)

Unlike the standard echocardiogram, in which the transducer is placed over the chest wall, in TEE the transducer is passed into the esophagus (the swallowing tube) and sometimes into the stomach. The esophagus, in particular, provides an ideal viewing of the heart, aorta and other great vessels and produces high-quality images of these structures.

TEE examinations are useful in helping providers diagnose and evaluate patients with embolisms (clots), valvular heart disease, bacterial infections, lesions, aortic abnormalities and injuries, and congenital heart disease. TEE is also used to evaluate critically ill patients and potential heart surgery candidates. A TEE carries more risk than the standard echocardiogram procedure (which is essentially risk-free) but is still very safe and under the right circumstances can be extremely useful.

Contact Information

CMHVI Diagnostic Testing Center 
60 High Street, Y1
Lewiston, Maine 04240
(207) 795-8200

Services:

  • Cardiac Catheterization Lab
  • Cardiac Diagnostic
  • Cardiac MRI
  • Cardiopulmonary Rehab
  • Electrophysiology (EP) Lab
  • Vascular Lab
  • Vein Center
  • Wound Center – 795-8260

_________________________________

Lipid Clinic 
60 High Street, ground floor
Central Maine Heart Associates
(207) 753-3900

_________________________________

Single-Stay Unit (SSU) 
60 High Street, Y3
Lewiston, Maine 04240
(207) 753-3907

Read more about Diagnostic Tests

Arrhythmia/Atrial Fibrillation

A healthy heart beats smoothly, with a steady rhythm. If your heart beats too quickly, too slowly or irregularly, you may be experiencing arrhythmia. In that case, it’s important to be diagnosed and treated to reduce your chances of more serious problems such as stroke. In fact, your risk of stroke is about five times higher if you have atrial fibrillation (AFib), the most common form of arrhythmia.

Trust the board-certified cardiologists at CMHVI to provide you with the arrhythmia care you need. Our cardiac electrophysiology heart specialist will use the resources available in our Electrophysiology Lab to diagnose and treat any condition affecting your heart’s electrical system. We offer a range of treatments that can help you feel better and help prevent the health problems that can result from this condition.

When Your Beat is Off: About Arrhythmia

Arrhythmias affect millions of Americans, including about nine percent of people over the age of 65. They are related to the complex system in your heart that manages your heartbeat. Certain cells in your heart create electrical signals that cause your heart to beat and pump blood. When you have AFib or other type of arrhythmia, the electrical impulses that control your heartbeats occur unevenly, rather than at a steady, measured pace. People with AFib sometimes describe it as making their heart feel as if it’s quivering like a bowl of gelatin.

In addition to AFib, there are several kinds of arrhythmias, including:

  • Bradycardia (slow heart rate)
  • Tachycardia (very fast heart rate)
  • Conduction disorders (abnormal heartbeat)
  • Premature contraction (early heartbeat)

It’s important to diagnose and treat AFib and other heart rhythm disorders as early as possible, because they can interfere with normal blood flow. Over time, this can damage your lungs, brain and other organs. They may even lead to stroke or heart failure.

Know the Symptoms of Arrhythmia

If you experience any of the following symptoms, you may have AFib or some other heart rhythm abnormality.

  • A fast, slow or irregular heartbeat
  • A feeling that your heart is skipping beats
  • Lightheadedness or dizziness
  • Chest pain
  • Shortness of breath 
  • Sweating 
  • Getting tired more easily when you exercise
  • Fainting
  • Chronic fatigue

How Will You Be Diagnosed?

When you visit our state-of-the-art Electrophysiology Lab, our cardiac electrophysiology heart specialists will take your medical history and perform a physical exam. They’ll also perform one or more of the following diagnostic tests to learn more about your heartbeat.

  • Electrocardiogram (ECG): This test uses small sensors (electrodes) attached to your chest and arms to record electrical signals as they travel through your heart. 
  • Echocardiogram: In this noninvasive test, sound waves are used to produce a video image of your heart in motion.
  • Holter monitor: This portable ECG device is carried in your pocket or worn on a belt or shoulder strap. It records your heart’s rhythms for 24 hours or longer, giving your provider a prolonged look at any problems.
  • Transtelephonic monitor: For infrequent arrhythmias or arrhythmias that come and go, this monitor attaches to your arms, wrists or fingers for a month or two. It records and stores information about your heart’s electrical system, which can be transmitted to your provider. 
  • Treadmill testing: Also known as a stress test or exercise test, a treadmill test can check for arrhythmias that occur with activity. 
  • Blood tests: These help your provider rule out thyroid problems or other substances in your blood that may lead to AFib.
  • Chest X-ray: These images help your provider see the condition of your lungs and heart and may help diagnose conditions other than AFib that may explain your signs and symptoms.

Understand Your Treatment Options

If our tests show that you have AFib or another form of arrhythmia, you and your provider discuss the best approach to managing your symptoms and reducing your risk of complications. Your provider may recommend one or more of the following treatments for arrhythmia:

  • Medication: Drugs used to treat arrhythmias include anti-arrhythmia drugs, drugs that control heart rate and blood thinners.
  • Pacemaker and Implantable Cardioverter-Defibrillator (ICD): An ICD is a tiny device implanted through a small incision under the collarbone during a minimally invasive surgery. The system includes a palm-sized device with electrical leads that connects to your heart to restore a normal rhythm. Recovery is quick, though some patients may stay overnight. 
  • Cardioversion: Cardioversion is a medical procedure for treating an abnormally fast or irregular heartbeat. Most commonly used for AFib, atrial flutter or ventricular tachycardia, cardioversion sends an electrical impulse to your heart muscle, restoring normal heart rhythm. Cardioversion is usually performed as a scheduled treatment and may be repeated if the arrhythmia returns. 
  • Radiofrequency Ablation: During an ablation procedure, small areas of your heart muscle are purposely destroyed to create scars (called lesions) that improve your heart’s function by correcting a faulty electrical process. 
  • Catheter Ablation: This procedure uses intense cold or high-frequency electrical energy to disrupt an abnormal heart rhythm. Ablation is performed surgically or with a thin, flexible tube (catheter) that is inserted into a blood vessel in the groin or neck and guided into the heart. Your provider uses the catheter for the ablation, which is done either with intense cold (cryo-ablation) or with high-frequency energy (radio-frequency ablation). Some patients require a pacemaker after an ablation is performed. 
  • This procedure can be done with cryo-ablation, radio-frequency ablation, microwave ablation, ultrasound energy or laser energy. There are two types of surgical ablation, minimally invasive via small chest incisions or during open-heart surgery.