Cardiology

Advances in imaging technology are leading to incredible developments in the diagnosis of cardiac artery disease without anesthesia and in a non-invasive way. Here at Weill Cornell Medicine, our physicians use state-of-the-art CT and MRI technology.

Cardiac CT

Cardiac CT technology directly images coronary arteries and identifies arterial blockages that would otherwise only be diagnosed using invasive testing. In addition, cardiac CT imaging is being used to assess patients' future risk of developing cardiovascular disease.

Cardiac CT scans use x-rays and a computer to create high quality images of the heart, its vessels, and other structures in the chest. This safe, painless test is useful for examining the anatomy of the coronary arteries, cardiac chambers, and blood vessels in the chest. The images produced by the CT scan can be used to detect blockages in the coronary arteries, blood clots in the heart's chambers, aortic aneurysms, and cardiac tumors.

Cardiac CT scans can also be used to examine the heart and its vessels for calcium deposits, called calcium scoring. Because calcium deposits occur at sites of atherosclerosis, their presence and their size are indicative of the risk of cardiovascular disease: the more extensive the deposit, the greater the risk. 

Cardiac magnetic resonance imaging (MRI)

Cardiac magnetic resonance imaging (MRI) is a diagnostic procedure that uses a combination of a large magnet, radio frequencies, and a computer to produce detailed still and moving images of the heart. This non-invasive, safe method scans the body to produce information on the anatomy of the heart and its vessels, as well as moving images of the heart as it is beating. This enables the physician to detect abnormalities in the heart's chambers, irregularities in the flow of blood through the heart, and abnormalities of the cardiovascular system, including cardiac tumors, disease of cardiac valves, cardiac hypertrophy (enlarged heart), and others. 

At Weill Cornell Medicine, we offer state-of-the-art cardiac MRI imaging that can reveal areas of heart tissue that have been damaged by myocardial infarction (heart attack) and regions that are not receiving an adequate blood supply.

Cardiac catheterization is a minimally invasive procedure used to detect the presence of heart disease. A catheter is inserted into the groin or wrist and advanced to the heart. Dye is injected to identify any blockages in the heart. (This procedure is called an “angiogram.”) If a blockage is detected, it can be opened through a procedure called “angioplasty” or “stent implantation.”

Cardiac Catheterization Expertise at Weill Cornell Medicine 

The Cardiac Catheterization Laboratory of New York Presbyterian Hospital-Weill Cornell Medical Center is at the cutting edge of interventional cardiology.

Our highly trained interventional cardiologists specialize in catheter-based methods to treat coronary artery disease, peripheral vascular disease, valvular heart disease, and structural heart disease. These highly efficient techniques prevent the need for open-heart surgery, consequently reducing the risks associated with more invasive procedures.

Read our Guide to Cardiac Catheterization, Angioplasty, and Stent Implantation.

Interventional Cardiology Services

Our team of renowned interventional cardiologists offers treatments and procedures for: 

●        Obstructive coronary artery disease: balloon angioplasty, stent placement, rotational atherectomy, directional atherectomy, mechanical thrombectomy, and embolic protection

●        Intravascular Ultrasound and FFR

●        Stenotic valve disease: transcatheter aortic valve replacement (TAVR), balloon valvuloplasty

●        Mitral valve disease: minimally invasive mitral valve repair and mitral valve replacement

●        Hypertrophic cardiomyopathy: alcohol septal ablation

●        Peripheral artery disease, including obstructive carotid artery disease: balloon angioplasty, stent placement, and atherectomy

●        Atrial septal defect and patent foramen ovale: non-surgical closure 

Information for Referring Physicians 

To schedule Catheterization Lab Procedures:
Phone: (212)746-4644
Fax: (212)746-8295

If you are a referring physician and wish to schedule your patient for a Cardiac Catheterization Admission, please complete the CATH Lab Intake Form and fax to (212)746-8295. 

You may also contact our Intake office directly by calling (212)746-4644 and speak to one of our intake staff for more information or assistance.

All studies undergo meticulous assessment of the size and function of the heart and aorta, following standards established by our world-class research and contributions to international guidelines. Our detailed reports provide referring physicians and their patients with a comprehensive assessment of cardiac chamber size and remodeling; valvular and adult congenital heart disease; and systolic and diastolic function.

Our echocardiography laboratory is one of the busiest in the nation performing over 20,000 studies a year, which include over 1,000 transesophageal echocardiograms and over 500 stress echocardiograms. Our faculty members are leading experts in the field and have been involved in numerous clinical research studies. They also teach a structured curriculum for our cardiology fellows, including a series of didactic lectures and intensive "hands-on" training in the performance and interpretation of echocardiograms.

What is the purpose or benefit of an echocardiogram? 

An echocardiogram is a safe, non-invasive diagnostic test that uses high-frequency sound waves (not detectable by the human ear) to produce images of the heart and its vessels. An echocardiogram, a type of ultrasound test, allows doctors to take pictures of your heart and see its chambers as they move and pump blood.

This test is used to assess both the structure and the function of your heart. It can be used to detect many types of heart disease and can also track the effectiveness of various medications and treatments.

Types of echocardiograms:

Transthoracic echocardiogram (TTE)

This is the most common type. Views of the heart are obtained by moving the transducer to different locations on your chest or abdominal wall.

3-Dimensional echocardiograms

This state-of-the-art test employs ultrasound in combination with sophisticated electronics to provide a 3-dimensional view of the heart. This enhanced image is useful in assessing the size of cardiac chambers and the movement of walls within the heart

2-Dimensional echocardiograms

By providing information on the size, shape and movement of the heart, this type of echocardiogram can identify problems with the heart’s valves and the pumping ability of its chambers.  For example, persons with congestive heart failure have thickened ventricular walls and/or weakened heart contractions

Stress echocardiogram

During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine that makes your heart beat harder and faster. A stress echocardiogram is usually done to find out if you might have decreased blood flow to your heart (coronary artery disease, or CAD).

Doppler echocardiogram

This test is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through your heart and blood vessels. Doppler measurements may be displayed in black and white or in color.

Transesophageal echocardiogram (TEE)

For this test, the probe is passed down the esophagus instead of being moved over the outside of the chest wall. TEE shows clearer pictures of your heart, because the probe is located closer to the heart and because the lungs and bones of the chest wall do not block the sound waves produced by the probe. A sedative and an anesthetic applied to the throat are used to make you comfortable during this test.

Dobutamine stress echocardiograms

This type of echocardiogram is designed for patients for whom an exercise stress test is not an option.  In this test, a resting echocardiogram is performed.  Then, dobutamine--a drug that causes the heart rate to increase — is introduced into the circulation, followed by a second echocardiogram.  The results of these two tests are then compared to determine whether any areas of the heart are not pumping normally.

Tissue Doppler Echocardiogram

This echocardiogram is used to define the contraction pattern of the heart, with special attention to the timing of contraction in different heart walls. This technology is useful in identifying patients who would benefit from cardiac resynchronization therapy (biventricular pacing).

Weill Cornell's state-of-the-art Coleman Center for Electrocardiography is located in our newly renovated and easy to find facilities. We perform and provide professional interpretation of a range of inpatient and outpatient electrocardiographic procedures, including routine 12-lead electrocardiograms (ECGs), ambulatory and event monitor recordings, exercise ECGs, signal-averaged ECGs, and transtelephonic pacemaker monitoring.

Our Electrocardiography laboratory is one of the busiest in the nation performing over 110,000 ECG interpretations a year, including over 100,000 12-lead ECGs, over 1,000 exercise stress tests, more than 1,000 ambulatory monitors and over 4,000 transtelephonic pacemaker evaluations.

Our team is led by academic cardiologists with over 30 years of clinical and research experience in electrocardiography and includes Cardiology fellows-in-training and highly-experienced technicians.  We provide a uniquely high-level of clinical service to New York Presbyterian Hospital-Weill Cornell and the surrounding community as well as a rich training environment for our Cardiology fellows.

What is this for?

Considered the first diagnostic tools for evaluation of anatomic changes and arrhythmias, these noninvasive tests use an electrocardiogram (ECG) to assess the electrical activity produced by the heart. In addition to the resting 12-lead ECG, the electrical activity of the heart can be examined over 24 hours, by using portable ambulatory recorders. Event recorders can be used over even longer time periods to detect infrequent rhythm irregularities. The ECG can also be examined during exercise testing..

Types of electrocardiographic procedures:

An electrocardiogram (ECG) is a diagnostic test that is used to detect abnormalities in the heart's rhythm, as well as to provide important information about damage to the electrical system of the heart, heart attacks, structural abnormalities in the heart's walls, and more. Weill Cornell provides the full range of advanced electrocardiography services, including:

• Resting ECG. This test monitors the heart's activity at rest.  It provides information about the heart rhythm, acute and prior heart attacks, and abnormalities of the structure and electrical system of the heart. 

• Stress Test (Exercise ECG). This test monitors the heart's activity under conditions of physical exercise. It is used for the evaluation of exercise capacity, for the detection of coronary disease and the assessment of its severity, for prediction of cardiovascular risk, and for monitoring the response to treatment.

• Signal-averaged ECG. This procedure is performed in the same manner as a resting ECG, except that the heart's electrical activity is recorded over a longer period of time, usually 15 to 20 minutes. A computer processes the information so that slight abnormalities that would not be seen in a standard ECG might be detected. Signal-averaged ECG assesses a patient's risk of developing an arrhythmia. 

• Holter (Ambulatory) Monitoring. The Holter monitor is a portable electrocardiograph machine that allows readings to be made over a 24-hour period, while the individual is performing the usual activities of daily living at home or at work.  This test is useful for detection of intermittent rhythm abnormalities of the heart, to quantify certain abnormalities and to relate patient symptoms to possible rhythm abnormalities.
• Event/loop Recording. Portable event/loop recorders can monitor heart activity for weeks to months, while the device is worn by the individual at home. A permanent record is kept only when the patient activates the recorder during periods when symptoms are felt.  This test supplements the 24-hour Holter monitor and is particularly useful for detection of less frequent symptoms.

Heart Failure Expertise at Weill Cornell Medicine 

Heart Failure, also known as congestive heart failure, occurs when the heart can't pump enough blood to meet the body’s demands. Affecting more than 5 million Americans, heart failure is often a long-term (chronic) condition but may also develop suddenly.

Heart failure is a serious condition that requires expert care. The specialists at the Weill Cornell Medicine Perkin Center for Heart Failure provide patients with comprehensive, effective treatments. 

Heart Failure Risks

The most common risk factors for heart failure are:

• Diabetes
• Hypertension
• Coronary artery disease
• Valvular disease

Other less common causes of “systolic heart failure” include cardiac noncompaction, some forms of cancer treatment, systemic illnesses which may affect the heart including connective tissue and inflammatory diseases (sarcoid, lupus, rheumatoid arthritis, scleroderma spectrum of disease), or fatty infiltration of the heart (ARVD).

In younger patients, heart failure is often caused by myocarditis—an inflammatory response commonly brought about by a viral illness. 

In elderly patients, heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as the most common form of heart failure. 

Heart Failure Symptoms

With heart failure, the heart becomes unable to respond normally to increased demand from activity. The heart is not able to maintain healthy blood pressure and volume levels. This often causes parts of the heart to become enlarged or for the heart to retain fluid. 

Patients with heart failure may experience: 

• Shortness of breath
• Swelling 
• Difficulty exercising
• General fatigue
• Arrhythmia (irregular heartbeat)
• Difficulty performing normal activities, such as dressing or bathing, without assistance
• Sleep-disordered breathing patterns

Types of Heart Failure We Treat

Heart failure is complex and can lead to many different types of heart problems. Other cardiac disorders may have similar symptoms as heart failure, including hypertrophic cardiomyopathy. Therefore, it is important for patients to visit an experienced cardiologist who specializes in heart failure. 

At Weill Cornell Medicine, we treat: 

• Left-sided heart failure including heart failure with reduced ejection fraction (HRrEF), often called “systolic failure” and heart failure with preserved ejection fraction (HFpEF), often called “diastolic failure” or “diastolic dysfunction”
• Right-sided heart failure
• Congestive heart failure 

How We Treat Heart Failure 

At the Weill Cornell Medicine Perkin Center for Heart Failure, our team of world-class cardiologists uses the most advanced diagnostic tools, imaging technology, and therapies to treat and manage heart failure. We work hard to diagnose and treat heart failure as early as possible, as well as provide long-term care that gives our patients the best possible outcomes. 

Our team offers a wide variety of treatments, based on each patient’s specific needs. We may treat heart failure with: 

• Medications
• Minimally invasive (catheter-based) and other cardiac surgery techniques
• Mechanical circulatory support devices
• Heart transplant 

Our team of cardiologists, nurse practitioners, dieticians, physical therapists, and social workers work collaboratively to provide comprehensive care and maximize our patient’s quality of life. 

The nuclear cardiology laboratory performs a variety of non-invasive  cardiovascular imaging studies:  myocardial perfusion imaging (nuclear stress tests) for the detection and management of coronary artery disease, viability studies to assess for the extent of myocardial infarction and radionuclide cineangiograms (RNCA/MUGA studies) to evaluate heart function. Stress modalities routinely performed include: exercise treadmill testing, vasodilator pharmacologic stress and dobutamine stress testing. Our gamma cameras can acquire a complete study in half the time compared to conventional imaging protocols and we can utilize a reduced amount of tracer. Our state-of-the-art facility is accredited by the Intersocietal Accreditation Commission (IAC/Nuclear). Our laboratory provides the highest diagnostic accuracy, while optimizing patient satisfaction, comfort and care.

The nuclear cardiology laboratory performs a variety of non-invasive cardiovascular imaging studies: 

• Myocardial perfusion imaging (nuclear stress tests) for the detection and management of coronary artery disease
• Viability studies to assess for the extent of myocardial infarction 
• Radionuclide cineangiograms (RNCA/MUGA studies) to evaluate heart function

Stress modalities routinely performed include: 

• Exercise treadmill testing
• Vasodilator pharmacologic stress
• Dobutamine stress testing. 

Our gamma cameras can acquire a complete study in half the time compared to conventional imaging protocols and we can utilize a reduced amount of tracer. Our state-of-the-art facility is accredited by the Intersocietal Accreditation Commission (IAC/Nuclear). Our laboratory provides the highest diagnostic accuracy, while optimizing patient satisfaction, comfort and care.

At our state-of-the-art facilities, we perform approximately 3,000 nuclear cardiac imaging studies annually. We also teach a structured curriculum for our cardiology fellows, including a series of didactic lectures and intensive "hands-on" training in the performance and interpretation of nuclear cardiology studies.

What is the purpose or benefit of nuclear imaging testing?

Nuclear imaging evaluates how organs function, unlike other imaging methods that assess how organs appear. Small amounts of a radioactive solution(s) are introduced into the body. A special camera detects the solution in different parts of the body and a computer generates a series of images of the areas of interest.

Nuclear cardiac imaging can help determine if there is adequate blood flow to the heart muscle during stress versus rest. It can also evaluate heart function and the presence of prior heart attacks.

These cardiac images help to identify coronary heart disease, the severity of prior heart attacks, and the risk of future heart attacks. These highly accurate evaluations of cardiac function and amount of heart muscle at risk enable cardiologists to better prescribe medications and select further testing like a coronary angiogram, the need for angioplasty and bypass surgery, or devices to optimize treatment outcomes.

Types of nuclear cardiology imaging:

Cardiac SPECT (single photon emission computed tomography) scans—also called myocardial perfusion imaging—are non-invasive tests that are used to assess the heart’s structure and function. 

SPECT scans use small amounts of radioactive substances that are injected into a vein and special cameras to produce images of the heart. These images allow cardiologists to assess blood flow inside the heart and detect areas of abnormal heart muscle. Information obtained from SPECT scans can be used to:

• identify blockages in the coronary arteries
• determine whether someone has had a heart attack
• try to predict those at high risk for a heart attack
• assess a patient’s condition after bypass surgery or angioplasty

PET (Positron Emission Tomography) is a type of nuclear imaging that can evaluate heart function. Performed in New York-Presbyterian's Division of Nuclear Medicine, PET scans can be used to look for coronary artery disease by examining how blood flows through the heart; it can evaluate damage to heart tissue after a heart attack. Your physician can use this information to determine the best course of treatment for you.

MUGA (Multiple Gated Acquisition) Scan—also called radionuclide angiography (RNA)—is a test that is used to evaluate heart function by measuring how much blood is pumped out of the ventricles of the heart with each heartbeat (ejection fraction). A small amount of a safe radioactive tracer solution is introduced into a vein. This substance attaches to red blood cells, which are visualized by a special camera and computer as they travel through the heart, and the ejection fraction is calculated based on the computer-generated images.

Pulmonary hypertension (often referred to as “PH”) is a type of high blood pressure in the lung vessels. This condition affects the arteries in the lungs and right side of the heart, making it harder for your heart to pump oxygen-rich blood.

The most common symptoms of pulmonary hypertension include: 

• Shortness of breath 
• Difficulty exercising
• Chest pain 
• Near or complete fainting
• Right-sided heart failure symptoms, including swelling in ankles and legs (edema) and fluid in the abdomen (ascites) 

There are several different types of PH. Some are more serious and can become life threatening. For all pulmonary hypertension patients, early diagnosis and treatment by expert cardiologists can significantly help improve symptoms and quality of life, as well as reduce the risk of future cardiovascular problems. 

The cardiologists at Weill Cornell Medicine Pulmonary Hypertension Service at the Perkin Center for Heart failure specialize in diagnosing PH, as well as creating effective treatment plans tailored to each patient’s specific needs. 

Expert Diagnosis and Treatment at Weill Cornell Medicine

Diagnosis: Patients with suspected pulmonary hypertension will receive a variety of tests to correctly diagnose the condition. Our cardiologists use the most advanced imaging and diagnostic technology available. 

Our team specializes in cardiac catheterization—the definitive gold standard for diagnosing this complex disease. 

Treatments: At the Pulmonary Hypertension Service, we create multidisciplinary treatment plans that help each patient achieve their unique needs. Treatment options include: 

• Medications, including diuretics, anticoagulation medication, calcium antagonists, blood vessel dilators, and other medications
• Exercise recommendations
• Diuretics 
• Oxygen when necessary 
• Surgery, including minimally invasive surgery 

Our team also treats any related conditions—such as sleep apnea, interstitial lung disease, and lupus—and collaborates with other specialists at Weill Cornell Medicine as necessary. 

Team approach: The early diagnosis, treatment, and long-term care of patients with pulmonary hypertension require a team approach with physicians, nurse practitioners, dieticians, physical therapists and social workers. This collaborative approach maximizes our patients’ long-term wellbeing. 

Services Offered

The Perkin Center for Heart Failure, Mechanical Circulatory Support, and Pulmonary Vascular Disease at Weill Cornell Cardiology offers:

• Cardiopulmonary exercise testing to identify and follow patients with pulmonary hypertension and heart failure
• Inpatient transfer and outpatient management of patients with pulmonary hypertension
  • This includes intensive nutritional/dietary counseling, as well as telephone follow-up by a nurse practitioner who specializes in pulmonary hypertension
  • Specialty cardiac catheterization to diagnose and gauge response to treatment (done by our catheterization colleagues)
  • Opportunities for participation in multicenter clinical trials as well as ongoing original research
  • End-of-life management and palliative care for patients with unresponsive symptoms and limited life expectancy

Heart valve (valvular) disease occurs when any of the heart’s four valves do not work correctly—making it harder for the heart to pump blood throughout the body.

According to the American Heart Association, about 5 million Americans are diagnosed with heart valve disease each year. With early diagnosis and specialized treatment, valvular heart disease patients can experience fewer and less severe complications. 

Valvular Heart Disease Expertise at Weill Cornell Medicine Acquavella Heart Valve Center

At the Maurice R. and Corinne P. Greenberg Division of Cardiology, an experienced team of experts diagnoses and treats patients with valvular heart disease. Patients are generally first seen at the William Acquavella Heart Valve Center. 

Diagnosis: Weill Cornell Medicine cardiologists use advanced imaging modalities, including new technology in 3D Echocardiography, MRI, and CT Angiography, to evaluate patients with valvular heart disease. 

Collaborative care: We treat patients with all forms of valve disease. Our general cardiologists collaborate with interventional cardiologists, arrhythmia specialists, radiologists, and cardiac surgeons to provide the best care and achieve optimal results for our patients. 

Achievements in research: In addition to the clinical care of patients with valvular heart disease, our physicians have made significant contributions to the understanding of these conditions. They have designed, conducted, and led multicenter studies thathave examined the effects and prognosis of aortic and mitral disease in large populations of patients. 

Physicians at Weill Cornell are well-known for their expertise in mitral valve prolapse and aortic stenosis and have published authoritative articles and book chapters on these subjects. 

To learn more about our valve center, please visit the William Acquavella Heart Valve Center.