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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.

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.

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.

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

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.

Congestive heart failure (CHF) is a serious problem, responsible for one of the highest rates of hospitalization in the United States for any medical condition. Starling now operates our own CHF Clinic to resolve issues – quickly and proactively – in order to help patients reduce trips to the hospital or ER, as well as increase patient satisfaction.

About CHF

Heart failure means that the heart’s pumping power is weaker than normal, or the heart muscles are stiff and do not relax and fill properly. With heart failure, blood moves through the heart and body at a slower rate and the heart cannot pump enough oxygen and nutrients to meet the body’s needs. The chambers of the heart respond by stretching to hold more blood to pump through the body. This helps to keep the blood moving for a short while, but then the heart muscle walls weaken and are not able to pump as strongly. The kidneys often respond by causing the body to retain fluid (water) and sodium. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested. Congestive heart failure is the term used to describe this condition.

When Intervention Is Needed

CHF can be made worse by a number of factors. For instance, eating salty foods or a change in diet over the holidays can increase symptoms. It is important to reduce fluid retention before the situation gets more serious. Prescription pill diuretics, sometimes called water pills, can help rid your body of salt (sodium) and water. However, these medications are not as effective as intravenous (IV) diuretics which are delivered directly into a vein. 

That is why Starling is opening a new CHF Clinic to provide patients with a comfortable setting to get prompt treatment to reduce the effects of CHF and provide ongoing education on how to manage the disease.

Partnering For Your Success

Heart failure management is a team effort – making you and your physician the key players on the team. Our staff will work closely with your physicians to keep them updated about your progress.

As a patient referred to our CHF Clinic, you are an active participant in your treatment plan. You will learn how to control CHF through:

• Medication compliance
• Making dietary changes as needed
• Making lifestyle changes, such as monitoring and tracking your weight on a daily basis
• Seeing your doctor regularly

At the Clinic, we will administer intravenous (IV) diuretics to reduce water and salt retention. This important process can prevent CHF from worsening and will hopefully eliminate the need for hospitalization.

What to Expect

Your Starling cardiologist or primary care provider will refer you directly to the CHF Clinic if you show symptoms of congestive heart failure. Symptoms may include swollen ankles, weight gain, shortness of breath especially when lying down at night, fatigue, and rapid/ irregular heartbeat. Your doctor will make sure you are a good candidate for this Clinic, as some of these symptoms could be due to another illness, such as pneumonia.

When you arrive at the Clinic:

• You will have a consultation with a cardiology provider who will educate you about the need to monitor daily weight; lifestyle changes, including low sodium diet; and medication information.
• We will check appropriate labs, weight, and vital signs.
• A nurse will administer an intravenous diuretic and monitor blood pressure.
• An APRN will check in with you after you receive the diuretic to see how you are feeling.
• Within a week, you will be seen by a cardiology provider to see whether you require more IV diuresis.

Our CHF Clinic will provide you with continued follow-up care for as long as it is needed. Our goal is to help you live well with CHF.

 

 

Starling CHF Clinic

 1260 Silas Deane Highway: Suite 109 

Hotline: 860-368-2275 

Starling is proud to have Dr. Shishir Mathur, a Board Certified Interventional Cardiologist, on our team. He offers minimally invasive treatments for varicose veins. Below he shares some of the most common vein conditions and current treatment options.

What are the most common vein issues?

The two most common types include:

• Spider veins: tiny, thin veins that vary in color and that you can see, which is how their name was derived. Spider veins usually appear in leg veins, and sometimes in chest, facial, or hands.
• Varicose veins: enlarged veins that bulge and can be clearly seen above the surface of the skin. They’re found most commonly in the legs. Varicose veins aren’t always just directly under the skin and can occur deeper below the skin’s surface.

What causes vein conditions?

Spider veins are caused by unhealthy valves inside feeder veins, allowing blood to flow backwards instead of upwards toward the heart. Some of this backed-up blood can lead to non-functional, “dead end” veins that appear under the surface of the skin as spider veins.

Varicose veins are caused by unhealthy valves inside the veins that impede the normal flow of blood back to the heart. Blood pools in the veins, enlarging and distorting them.

Are vein conditions painful?

Spider veins may lead to discomfort. Varicose veins can be more problematic, resulting in pain, fatigue, itching, burning, swelling, cramping, restlessness, and throbbing.

What are risk factors for vein conditions?

Some of the most common risk factors include:

• Family history
• Heart disease
• Multiple pregnancies for women
• Obesity
• Prior cases of deep vein thrombosis (DVT)

What is the newest option for treating vein conditions?

The first step in treating varicose veins is usually conservative measures like stockings, but for patients with resistant or severe symptoms, radiofrequency ablation treatment (RFA) is indicated.   

The procedure is performed in the office. Using ultrasound guidance, a thin catheter is inserted into the diseased vein without incisions. The tiny catheter delivers radiofrequency (RF) energy to the vein wall.

As the RF energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close.

Once the diseased vein is closed, blood is re-routed to healthy veins. The circulation actually improves after the vein closure! The procedure takes about 30 minutes and is performed using local anesthesia. There is virtually no post-operative discomfort.

Most people notice an improvement in their symptoms within a few days. The procedure is approved by the FDA and is covered by medical insurance plans and Medicare.

What are the benefits of radiofrequency ablation for varicose veins?

• The procedure can be performed in a doctor’s office in less than an hour.
• The procedure has a 98 percent success rate in the treatment of varicose veins.
• It provides immediate relief of symptoms.
• Patients can return to normal activity immediately with little or no pain.
• The procedure requires no general anesthesia or hospitalization.

What can I expect during my consultation with Dr. Mathur?

Dr. Mathur will review your medical history and conduct a physical exam and venous ultrasound. If your clinical profile and venous ultrasound findings confirm venous reflux problem, Dr. Mathur will discuss different treatment options like conservative measures or RFA procedure for further treatment.

What should be expected after the RFA procedure?

Following the procedure, the leg is wrapped in an Ace bandage for 24 hours. Patients are encouraged to walk but refrain from strenuous activities for several days. Patients who undergo the RFA procedure can resume normal activity the same day. A compression stocking is worn for 3 days. Full activity, including strenuous exercise, can resume after 7 days.

Normal daily activity can be resumed immediately. There may be minor soreness and bruising. Any discomfort can be treated with over-the-counter, non-aspirin pain relievers as necessary.

Are there any risks?

As with any treatment, there are associated risks, though they are minimized in the hands of trained physicians. These include:

• Bruising
• Dyspigmentation
• Scarring
• Skin burns
• Blood clotting

What other treatment options are available?

Occasionally, patients require more than one kind of treatment. Dr. Mathur takes a personalized approach in finding the right therapy or combination of therapies to bring about a positive result.

Additional therapies may include:

Sclerotherapy

Sclerotherapy is a safe, proven medical procedure that treats both the symptoms and the causes of varicose veins and spider veins. Sclerotherapy treatment sessions usually take less than half an hour, with no hospitalization required. Most patients do not find sclerotherapy treatments to be particularly painful, and recovery time is generally very short – most people are back to their regular routines the same day.

For sclerotherapy treatments, a series of microinjections of a solution (“sclerosant”) are administered directly into varicose veins or spider veins.

Phlebectomy

Some patients may have residual veins after RFA procedure. These veins are then removed with phlebectomy. Phlebectomy is an office based procedure where residual veins are removed with very small incisions. This procedure is done under local anaesthesia and lasts about 30 minutes. Patients can go home and resume routine activities the same day.

Non-surgical Options

May include use of compression stockings.

Why should I see a board certified Interventional Cardiologist?

Vein symptoms can represent serious underlying medical conditions. Therefore a comprehensive approach to this problem is needed. To successfully evaluate and treat vein conditions, it is safest to see a board-certified cardiovascular specialist who has in depth training and expertise in both cardiac and vascular diseases. While a number of walk-in day spas and clinics offer these treatments, there are risks of missing serious underlying medical conditions or complications with RFA procedure when it is not clinically warranted. Some treatments delivered by inexperienced staff may result in short-term cosmetic improvements while failing to treat the underlying cause. 

How do I get started?

The first step is to meet with Dr. Mathur who can assess the type of vein issues you face. He will recommend the appropriate treatment and discuss what you can expect.

Vein treatments for medical purposes are usually covered by all insurances. However, not all treatments are covered, especially if the treatment is for cosmetic purposes. It is important to check with your carrier.

Dr. Mathur see patients in New Britain, Wethersfield, and Glastonbury. Call (860) 258-3477.

Heart attack signs are often overlooked. Hear about how Starling Cardiologist, Dr. Shishir Mathur, saved one woman’s life. Watch our recent Better Connecticut segment to learn more about warning signs that should never be ignored>

Congestive heart failure (CHF) is responsible for one of the highest rates of hospitalization in the United States of any medical condition. Cardiologist Dr. Reza Mansoor and Agatha Giliberto, APRN recently participated in a CBS Facebook Live segment about congestive heart failure, symptoms, and the newest treatment and education available at Starling’s CHF Clinic. Watch their recent segment below>

Click here to learn more about CHF, our clinic, and helpful resources.