Heart & Vascular Clinics

Outpatient Cardiology

TidalHealth Cardiology has locations in Salisbury and Berlin. Our providers are proud to provide the best, most modern heart care to the Delmarva Peninsula. 

Services

Diagnostic Cardiac Catheterization 

• Balloon Angioplasty
• Stenting
• Intracoronary Ultrasound and Doppler

EKG
A diagnostic test that is used to evaluate your heart rate, rhythm, and can be used as a tool to help diagnose other cardiac abnormalities. EKG's are commonly ordered if you are experiencing chest pain, shortness of breath, irregular heartbeat or if monitoring chronic heart conditions. It is also common for a physician to order an EKG prior to surgery. 

An EKG takes about 5 minutes to perform. Ten electrodes, small adhesive patches, are applied to your chest area and a wire is connected to each electrode. Once a good EKG result is obtained, we remove the wires and electrodes. 

If you are coming to the office for an EKG, we ask that you do not use any lotion or powder on your skin prior to your test and avoid wearing hose.

Echocardiography
An echocardiogram is an ultrasound test of the heart. It is used to evaluate the size, thickness, pumping function of the heart and fluid around the heart. With the addition of Doppler and color flow imaging it can also help in the evaluation of murmur and valve problems. The test is non-invasive, which means no needles, catheters or dyes are used and it causes no discomfort.

No special preparation is needed for this test and it will take approximately 40 minutes. The results of the exam are interpreted and a final report is available within 48 hours. Your cardiologist or referring physician will review your results at your next scheduled follow-up appointment.

• Stress Echocardiogram combines a treadmill test with an echocardiogram. It helps determine if there are areas of your heart that do not receive enough blood supply due to possible coronary artery disease. Ultrasound images are captured before and immediately after exercising on the treadmill. During the treadmill testing, you will be continuously monitored for blood pressure, heart rate, and heart rhythm changes. Preparations for this test include not eating or drinking anything two hours prior to your appointment time. Wear walking shoes and loose comfortable clothing. This test will take approximately one hour and a Cardiologist will be present. They will review the test results with you before you leave.
• Trans-thoracic Echocardiography
• Trans-esophageal Echocardiography
• Stress and Dobutamine Echocardiography
• Bubble Studies

Stress and Nuclear Cardiology

• Regular Stress Testing
• Nuclear Stress Test can determine if your heart is getting the blood supply that it needs. This test also evaluates how well your heart is working. To perform this test, a small amount of radioactivity is injected through an IV. A special camera is then able to take pictures of your heart. There are two ways to perform the stress portion of the test. First, an Exercise Tolerance Test is for patients who will be exercising on a treadmill. You exercise until your target heart rate is achieved. Second, is a chemical stress test for those patients that can't exercise on a treadmill. The medication that is used for this causes dilation of the blood vessels.
• Stress Cardiolite
• Lexiscan Cardiolyte
• MUGA Scan evaluates the ejection fraction of the heart. A small amount of radioactivity is given through an IV and pictures are taken by a gamma camera. The pictures allow the doctor to evaluate the amount of blood flow being distributed by the left ventricle of the heart.
• Although radioactivity is used in this test, it is safely cleared from your body naturally. You are exposed to the same amount of radiation as in a simple X-ray or CAT (CT) scan. Millions of nuclear exams are safely performed each year.
• PET Scan (Positron Emission Tomography Testing) is a non-invasive, painless procedure that helps reveal the health of vessels supplying blood to the heart with significantly reduced radiation exposure compared to traditional imaging. PET scans can detect over 95% of patients with significant blockages of coronary arteries. 
• Pacemakers
  • Temporary and Permanent Pacemaker Implantation
  • Resynchronization Pacemakers for Heart Failure
  • Full Device Follow-up Including Remote Internet and Telephone
  • Implantable Defibrillators
• Electrophysiology Studies (EPS) for Diagnostics and Treatment of Heart Rhythm Disorders Including Ablation Procedures To diagnose or treat some heart rhythm abnormalities or physiologic changes in the heart, an invasive procedure may need to be performed at Tidal Health Peninsula Regional. Different types of these procedures include catheter ablation or the implantation of a cardiac device including loop recorders, pacemakers, Implantable Cardioverter Defibrillators (ICD), and cardiac resynchronization pacemakers and ICDs. After the procedure your cardiologist needs to follow your care. In addition to performing in office testing of each patient’s implanted device, we offer remote follow up. Remote services allow patients to have their cardiac devices monitored from home between routine office appointments. 
• Heart Rhythm Monitoring
  • Holter Monitors (24-48 Hours)
  • Event Recorders (Months)
  • Implantable Monitors
  • Mobile Outpatient Telemetry
• Vascular Testing Our vascular lab uses non-invasive diagnostic tools to evaluate a variety of vascular conditions. Most of the exams involve the use of ultrasound to image and evaluate blood flow in specific arteries and veins. Common exams include:
  • Carotid Ultrasound evaluates arteries in the neck for blockages that may restrict flow to the brain and greatly increase the risk of stroke.
  • Lower Extremity Arterial Exam evaluates arterial circulation throughout legs for significant blockages that may cause difficulties while walking. Also useful in the evaluation of circulation in wound care patients for healing potential. Uses ultrasound and blood pressure measurements to determine presence or extent of disease.
  • Upper and Lower Extremity Venous Ultrasound looks at the major arm and leg veins to detect the presence of deep venous thrombosis (DVT), more commonly known as blood clots. Ultrasound is also useful in the evaluation of varicose veins in the legs.
  • Abdominal Ultrasound looks at the aorta (main artery through abdomen) to evaluate for aneurysms, or enlargement of the artery, that can be fatal. It is also used in the evaluation of blood flow to and from the kidneys (renal arteries and veins).

With the exception of the abdominal exam, these studies require no special preparation and do not involve the use of radiation or dyes. We ask that the patients fast overnight for the abdominal exams, as this allows for the best possible study. The abdominal exams are scheduled in the morning.

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Coumadin Clinic

Coumadin is the brand name for Warfarin Sodium, which is a common anticoagulant (blood thinner). Our Coumadin clinics are directed by physicians and managed by staff knowledgeable in anticoagulation therapy. If you are on an anticoagulant, it is important for you to know as much about this medication as possible. In order to be seen in one of our Coumadin clinics a physician referral is needed.

Your physician may prescribe Coumadin therapy for one of the following conditions:

• Deep Vein Thrombosis (DVT) - Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.
• Pulmonary Embolism (PE) - A pulmonary embolism, or PE, is a sudden blockage in a lung artery. The blockage usually is due to a blood clot that traveled to the lung from a vein in the leg.
• Atrial Fibrillation (Afib) - Atrial Fibrillation (also called AF or A Fib) is a common heart rhythm disorder caused by a problem in the conduction of electrical impulses in the upper chambers, or atria, of the heart.
• Artificial Heart Valves - An artificial heart valve is a device implanted in the heart of a patient with heart valvular disease. When one of the four heart valves malfunctions, the medical choice may be to replace the natural valve with an artificial valve. This requires open-heart surgery.
• Cardiomyopathy - Cardiomyopathy is a disease in which the heart muscle becomes inflamed and doesn't work as well as it should. There may be multiple causes including viral infections.
• Clotting Disorders - Clotting disorders is a term used to describe a group of conditions in which there is an increased tendency, often repeated and over an extended period of time, for excessive clotting.

Our Coumadin clinics can be reached by calling our Cardiology offices.

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Vein Care

If you suffer with unsightly or uncomfortable varicose veins, TidalHealth Vein Care can help. Swelling and pain in your legs could be the result of poor or inefficient circulation. More than 40 million Americans needlessly suffer from this condition.

Types of Veins We Treat

• Varicose Veins are a combination of weakened vein walls and faulty valves. In a healthy vein, a small one-way valve opens allowing blood to flow upward toward the heart, then closes to prevent it from flowing backwards. When the valve fails, blood pools and pressure will build up further weakening the valve and damaging the vein causing it to become twisted, enlarged and painful. Varicose veins may or may not be painful. Even if they are not painful, they may be a sign of chronic venous disease or venous insufficiency. Venous insufficiency is most often caused by previous cases of blood clots and varicose veins. Up to 40% of women and 25% of men are affected by this condition. 
• Spider Veins are named for their web-like appearance. They are smaller than varicose veins and appear as red or blue lines. Spider veins are easy to see through the skin.

Causes of Varicose and Spider Veins

• Heredity
• Occupations involving a lot of standing
• Smoking
• Obesity
• Pregnancy
• History of blood clots
• Hormonal changes during menopause or postmenopausal hormonal replacement
• Conditions that increase pressure in the abdomen such as tumors, constipation and externally worn garments such as girdles
• Trauma or injury to the skin or previous vein surgery

Treatment 

TidalHealth Vein Care offers a non-surgical procedure that is safe, virtually painless and requires little-to-no downtime. Using the VenaCureEVLT™ vein laser treatment, a thin fiber is inserted into the damaged vein. Using a beam of light, the treatment closes the vein, sealing it shut. Since varicose veins are close to the surface of the skin and handle less than 5% of your blood flow, closing the vein is safe. The body automatically reroutes the blood through other veins.

After treatment, the appearance of the abnormal vein is instantly improved with minimal to no scarring. There may be some slight swelling around the treatment site. Once the swelling goes down, you will see a significant difference in the appearance of your legs. Many people experience other vein conditions that may need to be treated with additional therapies. Your doctor may recommend additional procedures such as micro-phlebectomy and sclerotherapy.

Your doctor will review with this procedure and other available options for treating varicose veins to determine what is right for you.