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Cardiology for the Non-Cardiologist
is designed for Physicians and Allied Health Professionals working with
cardiac patients in their
September 27 - 30, 2018
Rimrock Resort Hotel,
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Appropriate Test by the Appropriate Expert for the Appropriate Patients - Choosing Wisely®
Choosing Wisely® is an educational campaign initially led by the American Board of Internal Medicine and later endorsed and promoted by many subspecialty associations including the Canadian Cardiovascular Society. It aims to promote conversations between physicians and patients by helping patients choose care that is:
Canadian Medical Association and its subsepecialty partners define appropirate use of health care resources as "the right care, provided by the right providers, to the right patient, in the right place, at the right time, resulting in optimal quality care. If all components are followed high quality health care will result "at the right cost" and potential harm to the patient will be minimized.
A major reason for the traditionally long wait times relate to inappropriate application of tests potentially by the wrong providers. Referring the right patient for the right test by the right provider will ensure more Rapid Access to best care. At TotalCardiology we strongly promote the use of APPROPRIATENESS criteria by all referring physicians when ordering these tests. Our carefully designed requisition forms reflect these. These criteria have been developed by the American Heart Association, the American College of Cardiology, the European Society of Cardiology, and the relevant cardiac imaging societies.
The use of such approach affords all of us the following important advantages:
If you require assistance with choosing the right test we recommend a consultation or we are also available by phone - see Telephone consultation
Menu of Tests and Appropriateness Criteria
We have been performing Radionuclide Myocardial Perfusion Imaging (MPI) for over twenty years in our dedicated nuclear cardiology laboratory. We have the largest group of Nuclear Cardiologists in Canada with over 50 years of combined experience with involvement in the training of cardiology residents and subspecialty fellows. A high-quality MPI report maximizes its utility by combining the stress test data with the imaging data in the context of patient’s medical history, prior procedures, and current clinical presentation to provide the most accurate diagnostic (assessment of ischemic heart disease) and prognostic (assessment of risk of cardiovascular events) information for the patient and the referring physician. A detailed and expert knowledge of cardiac physiology and pathophysiology which is the focus of a Cardiolgist's training is essential for this type of high level, clinically relevant reporting.
Newest MPI Technology
Given its established ability to assess the functional status (i.e. blood flow) of the coronary arteries and thus guide treatment strategies, when ordered for the right patient this test is one of the most powerful cardiac risk stratification techniques available with significant supportive follow-up data. We have also implemented a number of initiatives that are promoted by the American Society of Nuclear Cardiology:
When to order an MPI? “Appropriateness criteria”
In general, an MPI has a much higher sensitivity and specificity to diagnose and prognostic a patient for cardiovascular events than a regular stress test. Here are the major APPROPRIATE indications for performing an MPI study:
Types of MPI Stress Tests
Our Cardio-Diagnostic Centre provides:
Our Nuclear Cardiologists also provide hospital based tests such as Dobutamine MPI or 2-day MPI stress testing (for patients > 300 lbs) and MUGA (multigated acquisition) scans for accurate assessment of LV ejection fraction.
A proper stress test must induce a "symptom-limited" level of stress in order for the test to be of good clinical and diagnostic value. While we make every effort to obtain a good level of stress from exercise in every patient towards a symptom-limited end point, we utilize and recommend the use of pharmacologic stress testing in the following very specific cases:
Our Cardiologists can perform a Regular Stress Exercise Test for your patients as you require. Exercise Stress Testing has its place in cardiac assessment and here are the major APPROPRIATE criteria for performing this test:
We have been providing echocardiographic services for over twenty years. We have a dedicated group of Echocardiologists with extensive training in this modality using the latest technologies. Using advanced echocardiography technology, our laboratory provides high quality diagnostic information that will assist in the management and follow up of individuals with suspect or known structural cardiac conditions. All of our technologists are chosen for their specific interest in cardiac imaging. Our physician members are very active not only supervising the laboratory providing echocardiographic services but also the education of medical residents and fellows in the university hospital setting. Our Echocardiologists also provide hospital based services such as Dobutamine Stress Echocardiograms.
The major APPROPRIATE criteria for performing an ECHO are:
We provide Carotid Ultrasound as a new service line to compliment all of our other tests. These are performed by our trained Technologists. In addition to offering echocardiograms our dedicated Echocardiologists have obtained additional training in this modality. They supervise and interpret these tests.
The major APPROPRIATE criteria for performing a Carotid U/S are:
We provide Holter Monitors for your patients as another service line to compliment all of our other tests. These are performed by our Cardiology Technologists and then interpreted rapidly by our Cardiologists.
The major APPROPRIATE criteria for performing a Holter test are: