Services

The Heart Failure Center at SJHG is dedicated to providing optimal heart failure management. Our goal is to enhance the well-being of our patients through education of patients and their families, promotion of optimal heart function, and reduction in adverse patient symptoms.

We accomplish this through the practice of effective, high-quality care based on guidelines and standards developed by the American Heart Association; we also offer certain promising experimental or research drugs and procedures. Superior service, an outstanding patient experience, and positive outcomes are the goals of all services we provide.

The Heart Failure Program at SJHG is an education and treatment program designed to help manage heart disease. Our Heart Failure Center provides specialized, advanced care and education to people diagnosed with heart failure, helping them to better understand their condition and manage their health.

Heart failure management is a team effort, with the patient, the family, and the physician as the key players.

Cardiac catheterization, also known as Coronary Angiography, is an X-ray test that uses radiographic contrast dye to visualize the coronary arteries, pinpoint the presence and severity of blockages, and determine the best treatment.  If the test reveals blockages, the patient is offered one of three treatments: medications, angioplasty with stent placement, or bypass surgery.

Cardiac catheterization is done on an outpatient basis while the patient is mildly sedated but awake. Local anesthetic is used to numb the area, usually the right groin or wrist, where the catheter (a narrow, soft plastic tube) is inserted into the artery and then advanced to the heart under X-ray guidance. Dye is injected into the heart chambers and coronary arteries, and pictures are taken from different angles. This is the best test available to find and visualize blockages of the coronary arteries.

Bruxelles Heart Group physicians perform cardiac catheterizations at the Washington Township division of the Kennedy Health System, and at the New Jersey Heart Institute at Our Lady of Lourdes Medical Center.

SJHG is a full-service, state-of-the-art cardiology practice that provides complete care for your heart, from diagnostic studies to lifestyle coaching to complex procedures. All services are performed by our board-certified heart doctors, or by our highly-trained technicians under the direct supervision of our heart doctors.

All non-invasive diagnostic studies are performed on an outpatient basis in the comfort of our offices, and all invasive diagnostic studies and interventional procedures are done in the safety of the New Jersey Heart Institute at Our Lady of Lourdes Medical Center.

This test is used to evaluate blood flow in the legs and feet and identify any blockages, and determine the best treatment options. It is similar to cardiac catheterization and often can be done at the same time. It involves injecting dye into the leg arteries and then taking X-rays to show any blockages.

Bruxelles Heart Group physicians perform peripheral and renal angiography as outpatient procedures at the Washington Township division of the Kennedy Health System; at the New Jersey Heart Institute at Our Lady of Lourdes Medical Center; and at Lourdes Medical Center of Burlington County.

Patients with serious disturbances of the heart’s electrical system often require specialized testing called Electrophysiological Studies (EPS), which can determine the mechanism of certain arrhythmias and assess the risk of potentially fatal heart rhythms and sudden death.  The test measures the electrical stability of the heart and tendency to develop potentially dangerous rhythms, all under controlled circumstances. The procedure is done under sedation, similar to a cardiac catheterization procedure. Small electrical cables are passed through the veins of the legs or arms and placed in specific positions on/in the heart under X-ray guidance. Electrical measurements are taken to diagnose the problem and decide the best treatment. Sometimes a short version of the test is repeated after a course of medications to determine if those medications are working as expected.

An Electrocardiogram (ECG) measures the electrical activity of the heart. During this test, electrodes are placed on each arm and leg and at six points on the chest. The ECG can provide important information about the heart rhythm, a previous heart attack, increased wall thickness of the ventricles, signs of insufficient oxygen delivery to the heart muscle or an ongoing heart attack, and problems with conduction of the electrical signals from one part of the heart to another. If the ECG is abnormal, it may indicate one of these or a different heart problem. A normal ECG does not exclude heart disease.

An exercise stress test is a continuous ECG during physical exertion (walking or running on a treadmill) with close monitoring of blood pressure and heart rate.It is mainly used to detect significant coronary artery disease — that is, blockages in the coronary arteries. Frequently, it is used as part of the evaluation of patients with chest pain and palpitations (irregular heartbeats). It also provides assessment of exercise capacity, circulation to the legs, and how blood pressure and heart rate respond to exercise. The test is performed according to standard protocols, most commonly the Bruce protocol, which consists of two- or three-minute stages at increasing speed and slope. One of the endpoints of the exercise test is achieving at least 85% of the age-predicted maximum heart rate. If a patient has a significant narrowing in the coronary arteries, the exercise may elicit chest discomfort (angina pectoris) or changes in the ECG. Although the exercise stress test is extremely useful, it can occasionally miss coronary artery disease. Nuclear imaging or echocardiography (see below), done in conjunction with exercise testing, improves the overall accuracy of the test and provides useful information about the location and severity of the blockages.

This test uses an IV injection of a small amount of a radioactive substance called Cardiolite (or in certain situations, thallium). The Cardiolite or thallium is delivered to the heart muscle through the coronary arteries. A special camera (gamma camera) is used to take pictures of the heart at rest and after stress — sometimes on two different days. Normally, there is uniform uptake of the radioactive substance, but if there is a blockage in one or more of the coronaries, there will be a decrease in the size and degree of uptake, and these changes will indicate the number, location, and severity of the blockages. This study provides more accurate and detailed information than a regular treadmill test. It is frequently used:

• To evaluate patients with chest pain;
• After an angioplasty to detect re-blockage of the dilated artery; or
• After coronary bypass surgery to assess the integrity and function of the bypass grafts.

If the patient cannot exercise, a chemical stress test can be used. Instead of exercise on the treadmill, an IV/intravenous medication that increases blood flow to the heart is used. (These are called coronary vasodilators, and include adenosine, Persantine, and regadenoson). Chemical stress tests are used for patients with severe lung disease, arthritis, leg amputation, stroke, etc.

Echocardiography, also known as Echo-Doppler, is a simple office test that uses ultrasound to form an image by bouncing sound waves off of the heart. It is painless and entirely non-invasive. The electrocardiograph provides a detailed analysis of the structure and function of the heart, including size and thickness of the heart walls; strength of the heart muscle as a pump (extremely important after a heart attack); congenital anomalies of the heart; detailed assessment of the heart valves for narrowing or leakage; and presence of tumors or clots. It allows initial assessment and follow-up of prosthetic heart valves. This study provides vital information necessary for most patients with known heart disease or symptoms that suggest it.

This test combines the treadmill test and the echocardiogram (unlike the “regular” stress test that uses an electrocardiogram). A resting echocardiogram is done before and repeated immediately after the exercise, and then compared side by side. Patients with blocked coronary arteries have transient abnormal motion in part of their heart muscle after exercise, which can be seen with the echocardiogram.

The Holter monitor is a continuous ECG recorded on audiotape over 24 hours. The patients are sent home with an attached monitor to record the heart rhythm, and they are encouraged to perform their usual daily activities while wearing the monitor. A diary is given to the patient to write down any symptoms they experience. The cardiologist then will be able to match the symptoms with abnormal heart rhythms. This test is used to detect any cardiac arrhythmias or simply to determine the patient’s heart rate over a 24-hour period.

This test assesses the flow and velocity of blood in the neck arteries that supply blood to the brain; blockages in these arteries can result in strokes. Ultrasound is used to provide two-dimensional images of the blood vessels and Doppler is used to measure blood flow. This test can tell if circulation is normal, and if not, it can provide vital information about the severity of the blockages and composition of the plaques. Carotid Doppler studies are the technique of choice to detect, quantify, and follow the progression of carotid vascular disease.

This test assesses the flow and velocity of blood in the peripheral/leg arteries that supply blood flow to the lower legs and feet. Ultrasound is used to provide two-dimensional images of the blood vessels and Doppler is used to assess the velocity of blood flow. This study can determine if circulation is normal, and if it isn’t, it can provide information about the severity of the blockages. This study is used to evaluate patients with leg pain usually associated with walking (claudication), and can assist physicians in determining the problem and prescribing appropriate treatment.

This is a blood pressure Doppler test to quickly assess peripheral circulation to the lower legs, ankles, and feet. It is used for smokers, patients with diabetes, and those with an abnormal peripheral artery Doppler.

This test is used to assess circulation in the veins of the leg. Ultrasound is used to provide two-dimensional images of the veins, and Doppler is used to assess blood flow and to identify malfunctioning valves, which can lead to swelling and varicose veins.

This test assesses neural reflexes, which when abnormal, may cause patients to faint from a condition called neurocardiogenic syncope. The test involves the placement of an IV, frequent blood pressure readings, and continuous EKG monitoring, when lying down flat and with the table at 80 degrees (almost standing up). If normal, an IV medication Isuprel or nitroglycerin may be given to induce the abnormal rhythm, and the tilt is repeated.

This a simple calculation that allows a physician to estimate the ten-year risk of a patient having a coronary event. Age, total cholesterol, high density lipoprotein cholesterol (good cholesterol), blood pressure, and smoking history are used in the calculation. This information helps the doctor determine risk and prescribe appropriate treatment based on the National Cholesterol Education Program Adult Treatment Program III Guidelines.

This is the procedure to put a stent in the heart to open a blocked artery, performed routinely or as an emergency treatment for a person having a heart attack. PCI is frequently performed at the same time as an initial catheterization; the preparation for both procedures is similar. For PCI, a thin plastic tube with a balloon at its end is placed at the blockage and inflated to open the artery; then it is deflated and removed. Next, a metal mesh stent is mounted on a balloon and placed in a similar manner. The balloon is inflated to expand the stent, then removed, leaving the stent behind to support the artery. Patients usually go home the same day or the next day. The stented area takes about a year to heal over. Blood thinners, such as aspirin or Plavix, are required during that time to keep clots from forming on the stent. Not every patient or case is appropriate for stenting. A stent cannot be used if the artery is too small or too twisted, if the blockage is too deep in the vessel or involves an important side branch, if the patient has bleeding problems, or for other reasons.

Atherectomy means removing the obstructive plaque, or blockage. There are four techniques available:

1. Directional atherectomy: This procedure uses a catheter which has a side-window on its tip with a cutting blade. The blade is advanced and shaves off the blockage. The little pieces are collected in the nose tip of the catheter and removed. This procedure is appropriate for large arteries with soft blockages, such as in the leg.
2. Rotational atherectomy (Rotablator): An olive-shaped diamond tip that rotates at high speed and literally drills the blockage into microscopic particles that dissolve in the circulating blood. This procedure is appropriate for calcified and hard blockages.
3. Orbital atherectomy: A curved diamond tip on its side. This tool rotates at high speed and shaves the blockage into microscopic particles that dissolve in the circulating blood. This procedure is appropriate for calcified and hard blockages.
4. Laser atherectomy: A laser catheter is passed into the blockage and uses laser energy to vaporize the blockage. This procedure is used for clots or re-narrowed stents.

This procedure is similar to coronary angioplasty stenting , except the balloon or stent is placed at the obstruction in the renal arteries — the arteries that go to the kidneys — to open the blockage.

This procedure is similar to coronary angioplasty stenting, except the balloon or stent is placed at the obstruction in the leg arteries to open the blockage.

This procedure repairs leaking veins in the leg, which most often appear as varicose veins. Performed in the office, an ultrasound is used to find the vein and an ablation catheter is placed. As the catheter is removed, energy is delivered to close the vein that is damaged. The body reroutes the blood through other healthy veins in the leg.

The TAVR procedure is a less invasive way to replace a narrow (stenotic) aortic valve. It is typically done by our cardiac interventionalist in conjunction with a cardiac surgeon in a hybrid-type operating room. The most common approach is through the femoral artery via the groin. The new valve is placed across the narrow valve and begins working immediately. Most patients stay in the hospital for a few days before returning home.

When the heartbeat becomes irregular (atrial fibrillation) or is too fast (tachycardia), the heart may need to be reset electrically. Paddles are placed over the chest and an electric shock is delivered. The patient first receives intravenous sedation and is asleep for a few minutes for the procedure. Although electrical cardioversion may be necessary on an emergency basis if a patient is unstable with low blood pressure, it is usually performed electively as an outpatient. Patients may need to stay in the hospital for one or two days to monitor the heart rhythm if certain antiarrhythmic medications are used.

Certain types of arrhythmias may be treated and cured non-surgically. After the initial electrophysiology study, a special catheter may be used to selectively “burn” by radiofrequency the abnormal tissue causing the arrhythmia.

Ablation can be helpful with many different causes of fast heartbeats, or tachyarrhythmias, and palpitations including:

• Atrial fibrillation
• Atrial flutter
• Ventricular tachycardia
• Premature ventricular contractions
• Atrial tachycardia
• Supraventricular tachycardia

If the heart rate is too slow, a pacemaker may be necessary to electrically stimulate the heart. Placement of a permanent pacemaker requires an overnight hospital stay. Under local anesthetic, a small incision is made in the front chest wall — usually on the left side in right-handed patients — below the clavicle or collarbone. A pocket is made under the skin and one or two tiny wire leads are advanced through a vein into the right-hand heart chambers. The leads are connected to the pacemaker battery and are sutured in place. The pacemaker will only pace the heart when the heart rate is below the pacer set rate. The battery lasts 7 to 12 years. Replacement of the pulse generator battery is easy, requiring only a few hours in the hospital.

Great advances have evolved to miniaturize these sophisticated life-saving devices to a size slightly larger than a regular pacemaker. AICDs continuously monitor the heart rhythm and detect abnormal rhythms. The internal computer decides the best treatment, either pacing the heart or delivering a small electrical shock (like having internal paramedics!). The procedure to implant the AICD is performed in the electrophysiology lab with moderate sedation and typically takes less than one hour.

This recent advance is similar to the permanent pacemaker, but in this procedure, two wires are connected between the pulse generator and the right and left ventricles of the heart. CRT assists the heart to beat more efficiently, and can improve symptoms of heart failure that do not respond to usual medical treatment.

With the use of intracardiac electrode catheters and specialized 3-D electroanatomical mapping systems, a heart rhythm specialist can perform catheter ablation for atrial fibrillation, or AFib. The procedure involves delivery of radiofrequency energy for ablation of each of the left atrial pulmonary veins. Radiofrequency energy employed during the catheter ablation procedure heats the tissue enough to destroy the local heart cell function without physically cutting through the tissue. The goal of the procedure is to electrically isolate the pulmonary veins which trigger and perpetuate atrial fibrillation. Additional areas in the left atrium may be targeted for catheter ablation during the procedure to improve success.

The published success rates for preventing clinical recurrences in the “paroxysmal atrial fibrillation” subgroup — patients who experience occasional AFib — ranges from 70% to 80%. Recurrences can be treated with a second catheter ablation procedure. Success rates are lower for patients with permanent chronic atrial fibrillation.

Not every patient is a candidate for an AFib catheter ablation procedure, and an extensive conversation between physician and patient is important to review the various treatment options.

The Watchman device is a brand-new alternative to long-term treatment with blood thinners for select patients at risk of stroke due to atrial fibrillation. It is a permanent implant that prevents clots from leaving a certain area of the heart (the left atrial appendage) and traveling where they can cause a stroke. This one-time procedure can provide lifelong protection against AFib-related strokes without the use of daily medication. It’s the only device of its kind approved by the U.S. Food and Drug Administration (FDA) for reducing stroke risk in people with AFib not caused by heart valve problems. Bruxelles Heart Group is one of the few centers in the Delaware Valley performing the Watchman procedure.

Up until recently, the only treatment option was long-term oral anticoagulation medications (blood thinners) to prevent the blood from clotting. Unfortunately, not all patients tolerate the effects of blood thinners for various reasons, including bleeding complications. Other challenges include the costs of treatment and the ability to control the effects of blood thinners. The Watchman is a possible treatment alternative that addresses the issues created by blood thinners.