Central Maine Healthcare

Where You are the Center

Cardiovascular Services

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.

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. 

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. 

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. 

Heart Failure

Your heart has a big job: To pump enough blood to every part of your body. A healthy heart has no trouble doing this, but in people with heart failure, which is also known as congestive heart failure, the heart can’t pump enough blood to meet the body’s needs. The name “heart failure” is a little misleading. If you have heart failure your heart is still working; it simply isn’t working as well as it should.

Our cardiac specialists can provide you with the full range of care you need for heart failure. Our team of cardiologists, specially trained nurses and other care providers work closely with you to create a fully personalized treatment plan to treat your condition.

Although there is no cure for heart failure, medications, treatments and smart lifestyle choices can help you feel more comfortable and live a longer, more active life.

Give Your Heart a Break: Learn about Heart Failure

If you are one of the 5.7 million Americans living with heart failure, you understand that how hard your heart works. And if you suffer with diabetes, lung disease, coronary artery disease , arrhythmia, high blood pressure and other heart conditions, the impact is even greater.

If your heart weakens, it can cause fluid buildup in the lungs and other parts of the body. This fluid buildup can contribute to the most common signs and symptoms of heart failure, which include:

  • Shortness of breath
  • Trouble breathing
  • Fatigue 
  • Swelling in the ankles, feet, legs or abdomen
  • Swelling in the veins of the neck

What to Expect During Diagnosis

There is no single test used to diagnose heart failure. In addition to giving you a physical exam and talking with you about your medical history, your provider may administer 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. 
  • 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.
  • Holter monitor:  Worn for one or two days, the Holter monitor 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, which records heart rhythms. 
  • Chest X-ray: This test can show whether your heart is enlarged and whether you have fluid in your lungs. 
  • BNP blood test:This test measures the amount of a hormone in your blood known as BNP, which increases in people with heart failure.
  • Doppler ultrasound: This is a test that uses sound waves to learn more about how your blood is flowing through your heart and to your lungs. 
  • Nuclear heart scan: During this test, you receive an injection of a safe radioactive substance known as a tracer. Using special scanners, your provider can see images of your heart and learn more about how well blood is flowing through your heart. 
  • 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 can measure blood pressure and blood oxygen levels and detects blockages that may have to be repaired.
  • Cardiac MRI: This test uses magnets and radio waves to create images of your heart as it beats. It can show damage whether heart failure has caused damage to your heart. 

Work with a Specialist to Find the Right Treatment

Your treatment options for heart failure depend on the type and severity of heart failure you have and how early heart failure is diagnosed. Treatment strategies include:

  • Diagnosing and treating the causes of heart failure: For example, if your heart failure is caused by coronary artery disease, arrhythmia or high blood pressure, you’ll receive treatment or medication for those conditions. 
  • Improving symptoms: Treating symptoms such as excessive swelling can help you feel better. For example, medications can help lower your blood volume and make it easier for your heart to move blood throughout your body and diuretics can reduce fluid buildup in your lungs and swelling in your legs, ankles and feet. 
  • Making healthy lifestyle changes: Quitting smoking, improving your diet, being more active and losing weight may help relieve symptoms of heart failure and improve your outcome. 
  • Pacemaker:This small device, which is implanted near your heart, sends signals to your heart to help it beat at the correct pace. 
  • Implantable cardioverter defibrillator: This device, which is implanted near your heart, produces electrical pulses that can correct irregular heart rhythm and reduce the risk of sudden cardiac arrest. 
  • Mechanical heart pump: This device, which is surgically implanted in your chest, helps your heart pump blood. 
  • Heart transplant: This surgery, which is reserved for end-stage heart failure as a life-saving intervention, replaces your heart with a healthy heart from a deceased donor. 

Improve Quality of Life with Cardiac Rehabilitation

If you have heart failure or any other heart conditions, CMHVI offers cardiac rehabilitation as part of its Cardiopulmonary Rehabilitation Program. Our cardiac rehabilitation is a medically supervised program that helps heart patients recover with an individualized plan that provides evaluation and instruction on physical activity, nutrition, stress management and other health-related areas as needed. Cardiac rehabilitation can make a significant difference in the lives of heart patients.

  • Coronary artery disease
  • Angina
  • Coronary artery angioplasty or stents
  • Open heart surgery such as coronary bypass or valve surgery
  • Heart failure
  • Heart transplantation

We also invite you to join Mended Hearts™, a patient-run support group affiliated with the American Heart Association that offers support and encouragement through its visiting program, monthly meetings and educational forums. To learn more, call 207-795-8230.

Heart Attack

If you think you or a loved one is experiencing a heart attack, call 911 immediately. Do not attempt to drive to the hospital.

Each year, about 800,000 Americans have a heart attack, which happens when the blood supply to your heart is cut off. Having a heart attack is a frightening experience, but the good news is about 85 percent of people survive if treated quickly.

The best cure is prevention: as part of our commitment to cardiac and vascular health, we sponsor wellness and prevention programs throughout the region.

Around 85 percent of heart damage occurs within the first two hours of a heart attack, so be sure to call 911 right away if you or someone you’re with shows symptoms of a heart attack.

Certified for Rapid Response: CMMC’s Chest Pain Center

We are proud of the fact that our CMMC Chest Pain Center, which is part of our Emergency Department in Lewiston, is certified for its rapid-response care. If you come in with chest pain, the emergency professionals in our Chest Pain Center provide the immediate care you need. We treat all patients with chest pain as potential cardiac patients until we determine a definite diagnosis.

If you arrive at our Emergency Department with chest pain or other heart attack symptoms, you will be immediately connected to a cardiac monitor, receive oxygen and started on intravenous lines so that life-saving drugs can be administered quickly if needed. Our experienced emergency professionals conduct diagnostic testing to determine what’s causing your symptoms and once your condition is stable, we connect you with one or more cardiologists for possible follow-up care.

Know the Warning Signs of Heart Attack

It’s important to be aware of the signs of heart attack so that if you or someone you’re with is having a heart attack, you can get emergency care as rapidly as possible. Warning signs include:

  • Chest pain or discomfort that occurs in the center or left side of the chest; it may last for a few minutes or more or it may come and go
  • Pressure or a feeling of squeezing or fullness in the chest
  • Pain or discomfort in one or both arms or your back, neck, stomach or jaw
  • Shortness of breath
  • Cold sweat
  • Nausea (with or without vomiting)
  • Light-headedness or fainting

The signs of heart attack may look different in men than in women. Although men and women may both feel chest pain or pressure, women often don’t have chest pain with a heart attack. Instead, they may have other symptoms, such as shortness of breath or dizziness, that are less commonly associated with heart attack.

Keep in mind that your chance of having a heart attack goes up if you have risk factors such as high blood pressure, high cholesterol or diabetes or if you smoke or have had a previous heart attack or stroke.

Learn How We Provide Diagnosis

To determine whether you’re having a heart attack, our chest pain specialists may conduct one or more of the following tests:

  • Blood tests: These tests measure certain enzymes in your blood. For example, high levels of an enzyme known as troponin in the blood can indicate a heart attack has taken place.
  • Electrocardiogram (ECG or EKG): A test that measures heart rate, monitors the heart’s electrical system and provides images of the heart’s structures, assessing heart and valve health and blood flow.
  • Chest X-ray: X-rays may show whether the heart muscle has been damaged.
  • Echocardiogram: An ultrasound test that uses sound waves and the echoes they produce to obtain highly detailed images of the walls and chambers of the heart.
  • Cardiac stress test (also known as a treadmill test or exercise EKG or ECG): A test that measures how your heart performs in response to exercise or stress. This test monitors blood flow and oxygen levels as your heart beats faster and works harder.
  • Nuclear stress test: A test that assesses the blood flow to your heart by taking two sets of pictures of your heart: one set while you’re at rest and the second while your heart is being stressed by exercise, medication or a combination of both. Radioactive material is injected into your vein to highlight healthy and damaged tissue in the pictures.

Get Access to a Range of Treatments

Heart attack treatment varies based on several factors, including the type and severity of the attack and other health considerations. After we determine that you’re having a heart attack, we may provide one or more of the following treatments:

  • Medications: Depending on the type and extent of your heart attack, as well as any other health conditions you have, your provider may prescribe drugs such as anticoagulants, ACE inhibitors, beta blockers, calcium channel blockers, cholesterol-lowering medications, diuretics or vasodilators.
  • Thrombolysis: A procedure in which a clot-dissolving agent is injected to restore blood flow in a coronary artery.
  • Catheterization and balloon angioplasty: A test in which an inflatable balloon-type tool is used to compress plaque against artery walls, allowing increased blood flow. Balloon angioplasty is performed during a catheterization.
  • Percutaneous Coronary Intervention (PCI): Also known as angioplasty and stent treatment, PCI implants a tiny mesh tube in an artery to prevent plaque from blocking the blood vessel. After clearing blockage in an artery, 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.
  • Coronary artery bypass grafts (CABG): Also known as heart bypass surgery, this procedure is open-heart surgery requiring general anesthesia. During bypass surgery the surgeon removes a piece of a healthy blood vessel from your leg, arm or chest wall to use as a graft to create a new path for blood flow around a blocked artery. One end of the healthy graft is sewn to the blood vessel just below the blocked artery. The other end of the graft is sewn above the blocked artery. Blood can then flow around the blocked area. After bypass surgery, blood moves more freely through the coronary arteries, lowering the risk of heart attack.

Recover with Cardiac Rehabilitation

If you have a heart attack or any other heart conditions, we offer cardiac rehabilitation as part of our Cardiopulmonary Rehabilitation Program. Our cardiac rehabilitation is a medically supervised program that helps you recover with an individualized plan that provides evaluation and instruction on physical activity, nutrition, stress management and other health-related areas as needed. Cardiac rehabilitation can make a significant difference in your quality of life after a heart attack.

  • Coronary artery disease
  • Angina
  • Coronary artery angioplasty or stents
  • Open heart surgery such as coronary bypass or valve surgery
  • Heart failure
  • Heart transplantation

As a heart attack survivor, you will also be invited to join Mended Hearts™, a patient-run support group affiliated with the American Heart Association that offers support and encouragement through its visiting program, monthly meetings and educational forums. To learn more, call: (207) 795-8230.

Conditions We Treat: Cardiovascular Services

Find the Beat Again with Arrhythmia Care

If your heart beats too quickly, too slowly or irregularly, you may be experiencing an arrhythmia. Our heart rhythm specialists (electrophysiologists, or EPs), diagnose and treat arrhythmias such as atrial fibrillation and other problems with the heart’s electrical system. Treatments include implanting medical devices to regulate your heart and minimally invasive procedures that use either heat (radiofrequency) or cold energy (cryoablation) to modify abnormal heart tissue and restore a healthy rhythm.

Clear Up Coronary Artery Disease

Being diagnosed with coronary artery disease (CAD) means the arteries that bring blood to your heart have hardened and narrowed by a buildup of plaque on their inner walls, reducing the flow of oxygenated blood to the heart. Our board-certified cardiologists offer answers through a full range of state-of-the-art CAD care. In our cardiac catheterization lab, we provide diagnostic and interventional cardiac procedures, including heart catheterization, angioplasty, trans-catheter aortic valve replacement (TAVR) and stent placement.

Nationally Recognized Heart Attack Care

Heart attacks strike 800,000 Americans each year. You’re most likely to survive a heart attack if you receive emergency treatment as quickly as possible. Our nationally certified Chest Pain Center, part of our Emergency Department in Lewiston, is ready around the clock to provide rapid-response care. If you or a loved one report chest pain, we will treat you as a potential cardiac patient until we determine a definite diagnosis. If you suffer a heart attack, we also offer personalized rehabilitation to help restore your quality of life and reduce your chances of having another episode.

Get Your Life Back after Heart Failure

When you suffer heart failure, your heart can’t pump enough blood to meet your body’s needs. Our cardiac specialists can provide you with the full range of care you need for heart failure. You’ll also have access to our comprehensive cardiac rehabilitation program to help regain the highest possible quality of life.

Relieve Pain from 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 elsewhere in your body, such as your legs, causing severe pain and other potential problems. This condition is known asperipheral artery disease (PAD). Our board-certified vascular/endovascular providers can provide you with the care you need to feel better and to prevent future problems, such as medication and information about lifestyle interventions.

Find the Right Solution for Structural Heart Disease

If you are one of the millions of Americans who suffer with structural heart diseases such as aortic stenosis, the heart surgeons at CMHVI can help. We offer expertise in all types of structural heart procedures, including valve repair and replacement. In addition to open heart surgery, we offer aortic valve replacement (AVR) and transcatheter aortic valve replacement (TAVR)—a revolutionary, minimally invasive alternative to open heart surgery.

Get Relief from Vein Disorders

If you experience leg pain or leg swelling, you may suffer from vein disorders that can result in serious, potentially life-threatening blood clots. CMH Heart & Vascular Care offers a full range of vein treatments to help repair or manage your vein disorders, reducing associated health risks.