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Cardiology is the specialty that deals with diseases of the heart and vascular system.

At Starling Physicians, our cardiologists can treat your heart conditions, including high blood pressure, peripheral vascular disease, chest pain, abnormal heart rhythms, coronary artery disease, congestive heart failure, aorta problems, and other heart-related issues. Our goal is to assess how effectively your heart functions in order to develop a customized plan to address potentially life-threatening issues.

We provide comprehensive cardiology care and offer a wide range of services:

  • Consultations
  • Stress testing
  • Echocardiography & Stress Echocardiography
  • Pacemaker & defibrillator monitoring
  • Nuclear scans
  • Transesophageal ultrasound
  • Transthoracic echocardiograms
  • Holter and event recorder monitoring
  • Implantable loop monitors
  • Bubble contrast studies with echo
  • Nutritional counseling
  • Anti-coagulation clinic
  • Cardiac catheterization at UCONN
  • Renal ultrasound
  • Cardioversions

Vascular Studies

  • Carotid
  • Leg arterial duplex
  • Arm arterial duplex
  • Leg venous
  • Arm venous
  • ABI with PVR
  • Renal study
  • Aortic study

Our cardiologists are board certified in both Internal Medicine and Cardiology. We have expertise in all aspects of cardiovascular medicine including diagnostic imaging, devices, pacing, electrophysiology, pharmacotherapy, and all modality of modern cardiology care. We believe in not just treating the heart, but treating the whole person.

Learn more about specific cardiology testing and procedures.

  • Muga Scan

    The Muga Scan is a procedure that checks the function and the ejection fraction of your heart. This calculation allows your Starling Physicians team to see how efficiently your heart is functioning.

    • There are no restrictions for this procedure and no preparation is necessary.
    • There are certain chemotherapy treatments that require this exam to be done prior to treatment and during your treatment. The procedure may be repeated every 8-12 weeks depending on the recommendation of your physician.
    • The procedure may also be ordered to assess the ejection fraction of a patient who is not on any treatment or therapy.
    • The procedure requires 2 intravenous injections. The patient receives one injection and then 30 minutes later gets a second injection. The first injection prepares the red blood cells for the second injection, which is a small amount of a radioactive material. This radioactive injection makes it possible for the imaging. The injection yields no side effects and will dissipate from the patient’s system within a day or so with no reaction to the patient.

    The patient will lie on a table for 20 minutes for the imaging. The results are often completed by the time the procedure is complete so that the patient can bring them to their doctor or nurse for immediate availability.

  • Nuclear Stress Tests

    A nuclear stress test is a procedure that allows your team at Starling Physicians to assess the blood flow to your heart. This test is ordered for many reasons; the most common include shortness of breath, chest pain, diabetes, or other positive risk factors that may put you at risk for heart disease. This test is done over one or two days, depending upon your weight. The amount of time will be determined when your appointment is scheduled. If the study is done in one day, the procedure takes 3-4 hours. If the study is done over a two-day period, each session will take approximately 1-2 hours to complete.

     

    You will be asked to prepare for the exam by following these steps:

     

    • Refrain from all caffeine for 24 hours. This includes coffee, teas, decaf products, sodas and chocolate. This is important because having caffeine in your system will invalidate the exam.
    • You will be asked to refrain from eating for 4 hours prior to your stress test. If you need to eat something due to diabetes or hypoglycemia, you may have toast, cereal and juice.
    • You may be asked to stop taking beta blockers for 24 hours prior to your stress test. The following are the meds that may be held: metroprolol (Toprol ®/Lopressor®), isisirbide monitrate (Imdur®), atenolol (Tenormin®), labetalol (Normodyne®), verapamil (Calan®/Verlan®), theophylline, carvedilol (Coreg®), bystolic (Nebivolol®), diltiazem (Cardizem®), digoxin (Lanozin®), propanol (Inderal®).Your cardiologist will inform you if you need to stop taking your beta blocker(s).

     

    It is important to stop these medications so that accurate results from the stress test can be achieved. Beta Blockers will keep your heart rate low; if they are not stopped, we cannot assess the heart’s response to exercise and diagnose coronary ischemia.

     

    • When you come in for your nuclear stress test, you will be greeted by the nuclear technologist and medical assistant. They will explain the procedure and ask you to sign a consent form. The nuclear technologist will place an IV in your vein and and you will be given a radioactive injection for the purpose of imaging. You will then return to the waiting area for 45 minutes to allow the radioactive material time to process. Following this waiting period you will be asked to lie on an imaging table and a series of pictures will be acquired. This imaging takes 20-25 minutes. If you are having a two-day study you will have the stress portion of your study before any images are taken.
    • The medical assistant will prep you for your exercise. Electrode stickers will be placed on your chest and resting ekgs and blood pressures will be taken.
    • The stress portion of the exam will be done using a treadmill. If you have physical limitations, the test can be done using a medication called lexiscan or adenosine. These medications make the heart “feel” like you have exercised. For patients who have physical limitations this medication is used to stimulate the heart chemically without physical exercise. It is helpful if the patient can exercise, you may be asked to walk slowly while this medication is infused through your IV. A radioactive injection will also be administered so that imaging can be done. An APRN or cardiologist monitors the stress test. Your ekg and blood pressure will be monitored during the stress test.
    • If you have no physical limitations, you will be asked to walk on the treadmill to elevate your heart rate to 85% of your maximum heart rate based on your age. Once this heart rate is achieved the technologist will give you a radioactive injection into the IV that was placed earlier for the purpose of imaging.
    • Once this heart rate is achieved, the technologist will give you a radioactive injection into the IV that was placed earlier for the purpose of imaging. You will then return to the waiting area to allow the radioactive injection to process for 45 minutes. During this time you can have something to eat and caffeine is allowed at this point.
    • You will be asked to return after your meal for your imaging.
    • If the study is done over two days, you will leave after this imaging session and return when instructed by the nuclear technologist.
    • On day two of your two-day study, there are no dietary restrictions and you may take all medications as directed.
    • The technologist will give you a radioactive injection. You will then return to the waiting area to allow the radioactive injection to process for 45 minutes.
    • Following this waiting period you will be asked to lie on an imaging table and a series of pictures will be acquired. This imaging takes 20-25 minutes.
    • These two sets of images will be processed and then reviewed by the cardiologist. The report will be sent to your referring physician and to your primary care physician. You will also receive a call from our office with the results within a week of your appointment.
  • Pacemaker/ICD Services

    At Starling Physicians, we are the experts in the programming and follow-up of all devices, including indwelling monitors, pacemakers, implantable cardioverter defibrillators (ICD), and cardiac resynchronization devices for the treatment of congestive heart failure. Our clinics follow patients who are using devices, both in the office and at home, via remote monitoring systems.

    What is an Indwelling Monitor?

    It is a device placed under the skin that can identify rhythm disturbance previously undiagnosed.

    What is a Pacemaker?

    A pacemaker is a battery-powered device about the size of a pocket watch that sends weak electrical impulses to “set a pace” so that the heart is able to maintain a regular heartbeat. There are two basic types of pacemakers; single-chamber and dual-chamber.
1. Single-chamber pacemakers stimulate one chamber of the heart, either an upper (atrium) or, commonly, a lower chamber (ventricle)
2. Dual-chamber pacemakers send electrical impulses to both the atrium and the ventricle and pace both chambers. It synchronizes the rhythm of the atrium and ventricle in a pattern that resembles the natural heartbeat.

    What is an Implantable Cardioverter Defibrillator (ICD)?

    An ICD is a small battery-operated device. It is placed in the chest to monitor the hearts’ rhythm. If the heart begins to beat in a disorganized way, the device provides a shock to restore a normal rhythm. Automatic cardioverter defibrillator implantation is the surgical insertion of an ICD. These days, ICD’s often combine the function of a pacemaker and an external defibrillator.

    What is a Cardiac Resynchronization Device (CRT)?

    This a device that optimizes the performance of a failing heart by resynchronizing the contraction of the left ventricle. In the United States, this device is usually combined with an ICD.

  • Echocardiography/Echocardiograms

    At Starling Physicians, we use different types of echocardiogram to understand how your heart is functioning. Echocardiography is a noninvasive diagnostic method that uses ultrasound to visualize internal cardiac structure.

    All cardiac valves control the flow of blood into, through and out of the heart. The ventricles are the two lower chambers of the heart that, when filled with blood, contract to propel it into the arteries. The right ventricle forces blood into the pulmonary artery and then into the left ventricle after the lungs; the left pumps blood into the aorta to the rest of the body. The left atrium receives oxygenated red blood from the lungs through the pulmonary veins.

    There are several different methods of echocardiography. Two-dimensional sector scanning and continuous-wave, pulse and color-flow Doppler studies are done in our offices; transesophageal echocardiography and exercise stress echocardiography are done in the hospital.

    Two-dimensional sector scanning is used to assess myocardial function, valvular pathology, chamber dimensions and pericardial disease. Two-dimensional sector scanning is indicated for the evaluation of:

    • Left ventricular thickness in patients with hypertension
    • Left ventricular size and function in patients with interstitial pulmonary edema,
    • dyspnea, or findings suggesting congestive heart failure
    • Valvular pathology in patients with murmurs, extertional symptoms, or endocarditis
    • Regional left ventricular function in patients with coronary disease
    • Pericardial pathology

    Continuous-wave, pulsed and color-flow Doppler studies measure the velocity of blood as it passes through cardiac valves and chambers. It is important for the assessment of valvular pathology, congenital heart disease, and ventricular dysfunction. Doppler echocardiography is indicated for the evaluation of:

    • Severity of valvular regurgitation or stenosis
    • Congenital heart disease including atril and ventricular septal defects and patent
    • ductus arteriosis
    • Restrictive cardiac physiology in patients presenting with edema or fatigue

    Tamponade physiology in patients with pericardial effusions

  • Echo Stress Test

    The stress echocardiogram or echo stress test is an ultrasound procedure that shows your cardiologist how your heart is functioning.

    What a stress echocardiogram entails:
First, the echocardiogram technician will perform a resting ultrasound of your heart to get baseline images for how it functions at rest. After adequate resting images are taken, you will be hooked up to a 12-lead ECG monitor in preparation for exercise on the treadmill. At this point, you will exercise on the treadmill (in the Bruce Protocol – as with a treadmill stress test) and a cardiology provider will monitor your heart rate and blood pressure.
Once your heart rate is sufficiently elevated, the treadmill will be stopped. You will immediately be asked to quickly lie back down on the exam table and turn onto your left side for repeat ultrasound images of your heart.
The doctor will compare the images of your heart under stress (when the heart rate is high, from exercise) to the resting images that were previously taken. If there are any changes of concern in the way your heart’s walls squeeze under stress, the doctor will review this with you at the time of the exam.

    How to prepare for a stress echocardiogram:
Do not eat or drink for three hours prior to the procedure. This reduces the likelihood of nausea that may accompany strenuous exercise after a heavy meal. Diabetics, particularly those who use insulin, may have a light snack if they chose shortly before the test. You may need to stop specific heart medications one or two days prior to the test. Individualized instructions are generally provided when the test is scheduled. Wear comfortable clothing and shoes that are suitable for exercise.
We will provide an explanation of the test and ask you to sign a consent form.

    How long the test takes:
 Please allow about 1.5 hours for the test, including preparations, resting ultrasound imaging, and the stress test.

    When to expect the results of the stress echocardiogram: The doctor reading the stress echocardiogram will be in the exam room with you at the time of the test and will review the results with you before you leave that day.

Fax Numbers

All locations except New Britain: (860) 571-2937 or (860) 633-8529

New Britain: (860) 826-4962

 

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