Advanced Cardiovascular Studies

The cardiovascular system is your most important yet delicate asset. Name one bodily system that does not use blood to perform its function. Exactly. All bodily functions require blood flow, and the cardiovascular system is the only system that you have for getting adequate blood flow to those areas. Therefore, we analyze the individual intricacies of the system in different ways. Do not be fooled: in-depth cardiovascular testing cannot be performed with one test. It requires multiple tests to assess the different areas. We use multiple tests like pieces of a puzzle in order to determine your cardiovascular system’s overall wellbeing.

  • Heart Pumping Function = Echocardiogram
  • Adequate Blood Flow to the Heart = Exercise Stress Test (CMET) and Stress Echocardiogram
  • Heart Electrical Activity = Electrocardiogram (EKG)
  • Microscopic Blood Flow = Pulse Wave Analysis (Max Pulse)
  • Plaque Build-Up = Carotid Intimal Media Thickness (CIMT)
  • Blood Vessel Stress = Nitric Oxide Testing
  • Heart Pumping Function = Echocardiogram

The heart’s ability to receive and expel blood is evaluated via an Echocardiogram. An ECHO is performed easily and painlessly with an ultrasound machine that visualizes the structures of the heart from a probe that is placed on the skin of your chest. It detects how well the heart is beating by determining the ejection fraction, which is a measurement of how much blood is pushed out of the heart with each heartbeat. If the heart is pumping well, then it will eject 50-70% of its contents. An echocardiogram will also assess your valve status. It will let us know if any of your valves are leaking or narrowed.

Adequate Blood Flow to the Heart = Exercise Stress Test (CMET) and Stress Echocardiogram

Adequate blood flow to the heart is paramount to its viability. The heart is a muscle. Just like overworking a muscle at the gym, it begins to hurt if there is insufficient blood flow. The circulation to the heart is evaluated by exercising and getting your heart to beat as fast as possible. If your heart has adequate blood flow, then it will not show any signs of fatigue on ultrasound or EKG. The exercise stress test is probably the most important information that you can gather. If your heart does not have appropriate blood flow, then it will eventually fail. The heart can fail quickly from multiple heart attacks or slowly from heart failure. Both conditions are terrible and eventually fatal. We want to delay their progress as long as possible. Our cutting edge stress test is performed using a bicycle of increasing resistance to push your heart to its maximal rate. Simultaneously, you will wear a mask that assesses your lung and breathing function in conjunction with heart function. If either is showing signs of fatigue, it will be identified with this form of testing called Cardiopulmonary Metabolic Stress Testing. This is the same stress testing that the Mayo Clinic uses. If you maximize your heart rate and your EKG does not show any electrical abnormalities at maximal heart rate, then your blood flow is considered sufficient.

Heart Electrical Activity = Electrocardiogram (EKG)

The electrical activity of your heart can give clues to the interpreting healthcare provider the condition and health of your heart. It shows old heart attacks that may have been silent and undetected. It can also show diseased electrical branches that may cause symptoms. The electrical activity and conduction is evaluated with an Electrocardiogram (EKG). An EKG is performed quickly and painlessly (unless you are hairy) by placing stickers across your chest, arms, and legs.

Microscopic Blood Flow = Pulse Wave Analysis (Max Pulse)

The health of your microscopic blood vessels is just as important as the large caliber blood vessels in your chest and neck. In fact, we would argue that the billions of microscopic blood vessels found throughout your body are more important. These microscopic blood vessels show signs of disease, aging, and thickening years before the larger blood vessels. Moreover, the microscopic blood vessels can cause disease in larger blood vessels. If the microscopic blood vessels are thickened, it requires the larger blood vessels to get stronger in order to continue delivering blood. However, stronger blood vessels eventually lead to diseased blood vessels and heart failure. Therefore, we consider the Pulse Wave Analysis test essential to optimal health. The test is simple and painless. It involves sitting silently with a device on your finger for several minutes. The device looks very similar to a Pulse Oximeter, which have been used for decades to detect the oxygen content of your blood. However, the Pulse Wave Analysis device is much more sophisticated. It evaluates the microscopic blood vessels in your fingers and determines how well each pulse from the heartbeat is received. A healthy blood vessel expands drastically to receive the blood, and then squeezes down on the blood to keep it moving. If your microscopic blood vessels are not healthy, then your heart will eventually fail under the increased pressure. If you have a poor Pulse Wave Analysis, then your blood vessels are showing signs of aging.

Plaque Build-Up = Carotid Intimal Media Thickness (CIMT)

Plaque build-up can be evaluated with the Carotid Intimal Media Thickness (CIMT) test. This test is performed using an ultrasound to evaluate the large artery in your neck (Carotid Artery) that delivers blood to your brain. Since the carotid artery is relatively close to the skin compared to other blood vessels, we can analyze it very carefully. We can ascertain the thickness of the blood vessel and compare you to others your same age.   This thickness will also tell you how much plaque has accumulated over time. If you are developing plaque or your carotid artery is thicker than others your age, we will be more apt to treat you aggressively.

Blood Vessel Stress = Nitric Oxide Testing

Healthy blood vessels are constantly bathed in a molecule called nitric oxide which tells blood vessels to relax and repair. As time progresses, human blood vessels create less and less nitric oxide causing blood vessels to become more stressed and narrowed. By the time you are 40-50 years old, you make half as much nitric oxide as you did in your younger years. This declining nitric oxide is why many people develop high blood pressure as they get older. Lack of nitric oxide also allows plaque to build at a quicker pace. Nitric oxide has a multitude of other effects. A good book to read is called the Nitric Oxide Solution by Dr. Nathan Bryan. The nitric oxide test is performed on your saliva. Healthy individuals create copious amounts of nitric oxide throughout the day, which causes blood vessels to dilate and relax (good). Without this molecule, blood vessels get thicker and harder over time (bad). Eventually, these blood vessels that are starving for nitric oxide scar and morph into plaque, which is difficult to reverse. By restoring your nitric oxide levels with appropriate supplementation, nutrition, and exercise, your blood vessels can reverse their signs of aging. Nitric oxide boosting is also extremely useful for fitness programs as it allows your muscles to receive more needed blood flow during strenuous exercise. You might notice that after replacing your nitric oxide levels that you are able to push yourself harder.