Cardiology

Congenital heart disease including malformations of the heart or major blood vessels is the most common form of birth defect.  Thanks to modern day advances in the medical and surgical care, most children born with serious congenital heart defects now survive long into adulthood.

In the US, there are now more adults with congenital heart disease than children. While this represents a phenomenal medical success story, many adults with congenital heart disease require lifelong care and follow-up with the goal of living a long and healthy life.

Program Mission

The Cornell Center for Adult Congenital Heart Disease at Weill Cornell Medical College, New York Presbyterian Hospital offers personalized, lifelong care for adult patients with congenital heart disease.  We provide a full range of inpatient and outpatient clinical services and diagnostics including cardiac catheterization and surgical repair. We offer particular expertise in minimally invasive treatment strategies for congenital heart disease. Our mission is to maximize both the cardiac health and social well-being for our congenital heart disease patients

Services Offered

• Consultative - outpatient and inpatient
• Multimodality diagnostic testing
• Comprehensive cardiac and medical management
• Therapeutic interventional cardiac catheterization and electrophysiology therapeutics
• Partnership with surgical specialties with expertise in congenital heart disease and perioperative management
• High risk obstetrics & gynecology consultative services
• Transition clinic for young adults with congenital heart disease (in joint collaboration with Cornell Pediatrics Cardiology)

Team

Our Adult Congenital Heart Disease team includes specialists from multiple disciplines including clinical consultants in adult & pediatric cardiology, heart failure, pulmonary hypertension, high-risk obstetrics, neurology, and pulmonary medicine. We utilize the latest technologies and multimodality imaging to aid in the diagnosis of our patients including 3D-echocardiography, intracardiac echo, cardiac MRI, and cardiac CT.

Specialists in congenital electrophysiology with state-of-the-art arrhythmia mapping systems offer potential curative therapies for life-threatening arrhythmias. The cardiac interventional program offers non-surgical and minimally invasive solutions for repair of congenital cardiac defects. Our cardiothoracic surgeons specializing in adult congenital heart disease and congenital cardiac anatomy are world renown.

Since the Cardiac Electrophysiology Laboratory at Weill Cornell Medical Center first opened its doors in 1987, it has grown into one of the busiest and most experienced laboratories in the country. We offer the full complement of cardiac rhythm management with diagnostic and therapeutic interventions utilizing the most advanced equipment and techniques. Through early detection and treatment, severe arrhythmias (abnormal heart rhythms) can be diagnosed and treated, with the goal of relieving symptoms and preventing the common causes of sudden cardiac death.

For patients with palpitations (fast or abnormal heart beats), electrophysiologic studies performed with temporary electrode catheters placed into the heart through the blood vessels can reveal abnormal electrical circuits within the heart that cause the arrhythmia.  For patients with arrhythmias, catheter ablation can be performed to treat the abnormal tissue within the heart and provide curative therapy.  Patients who are at risk for arrhythmias, such as those with advanced heart disease (hyperlink to CHF webpage) or coronary artery disease (hyperlink to cath webpage), may benefit from implantation of small electronic devices (implantable cardioverter-defibrillator, biventricular devices) into the body to improve the function of the heart and/or protect them from sudden death.

Services Provided Include:

• Diagnostic cardiac electrophysiology studies
• Catheter ablation of arrhythmias (including supraventricular tachycardias, ventricular tachycardias, and atrial fibrillation)
• Pacemaker implantation
• Implantable Cardioverter-defibrillator implantation (ICD)
• Cardiac resynchronization therapy (bi-ventricular pacing)
• Pacemaker and ICD lead removal
• Insertable loop recorder (ILR) implantation
• Electrical cardioversion
• Tilt table testing
• Left atrial appendage occlusion (for stroke prevention in atrial fibrillation patients)
• Pacemaker and ICD follow-up clinic
• Office consultation for evaluation and management of arrhythmias

Request An Appointment

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 Medical College, physicians are using 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, radiofrequencies, 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, 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 disease remains the leading cause of mortality worldwide.  Over the last 2 decades there have been tremendous advancements in the treatment of cardiac disease through minimally invasive techniques.  The Cardiac Catheterization Laboratory of New York Presbyterian Hospital-Weill Cornell Medical Center is at the cutting edge of interventional cardiology participating in major NIH studies and the evaluation of novel clinical approaches. Our highly trained interventional cardiologists are specialized in the area of catheter-based methods to treat coronary artery disease, peripheral vascular disease, valvular heart disease and structural heart disease. Ranked 3rd in the Nation by U.S. News & World Report for 2013-14, the goals of the Cardiac Catheterization/Invasive Cardiology laboratory at Weill Cornell are to render the best quality, cutting-edge, minimally invasive interventional services for patients with cardiac disease. We also evaluate novel pre-clinical and clinical approaches in an effort to improve treatment options for our patients.

For patients with symptoms related to coronary artery disease, our physicians are able to perform both diagnostic and therapeutic procedures via small catheter inserted through a peripheral artery in the groin or wrist area.  For patients with structural heart disease, including valve disorders, our physicians can utilize similar catheter based approaches to insert cardiac structural devices or new heart valves. These highly effective techniques obviate the need for open-heart surgery, consequently reducing the morbidity often associated with more invasive procedures.

Services For The Following Conditions Include:

• 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
• 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

Research Interests Include:

• Novel device evaluation in treatment of obstructive coronary disease, peripheral artery disease, and valvular disease
• Percutaneous treatment of valve disease
• Clinical investigation of novel atrial appendage closure devices
• Clinical investigation of novel access site closure devices
• Clinical investigation of novel, catheter-based approaches for the treatment of refractory hypertension
• Clinical evaluation of various antithrombotic and antiplatelet adjunct pharmacological agents in interventional procedures
• Pre-clinical evaluation of novel interventional devices in treatment of cardiovascular diseases 

Forms 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.

Our state-of-the-art echocardiography laboratory, accredited under strict IAC standards, is located in beautiful patient-friendly facilities. We offer the newest technology for a full spectrum of imaging, Doppler, transesophageal, exercise and dobutamine stress echocardiograms and contrast echocardiograms, with new programs in peripheral arterial imaging and 3-dimensional echocardiographcy. Echo guidance for mitral valvuloplasty and selected electrophysiological procedures, including use of intracardiac ultrasound, is provided as needed. On-line two-way videocables connect the cardiothoracic operating rooms and the echocardiography review room.

The laboratory has particular expertise in a number of areas including: the Marfan syndrome, valvular heart disease, cardiac disease in pregnancy, cardiac disease in stroke, cardiac disease in diabetes and adult congenital heart disease

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.

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.

Heart disease remains the leading cause of death in the United States for both men and women.  At Weill Cornell, our team of expert General Cardiologists, working together closely with their colleagues within the Division and with other Departments, are part of a team of nationally-recognized leaders in the diagnosis, prevention, treatment, and management of heart disease and associated conditions. Some of the more common forms of heart disease we frequently treat include:

• Angina (chest pain)
• Arrhythmias (abnormal heart rhythms)
• Cardiomyopathies
• Coronary artery disease
• Heart attacks
• Heart failure
• High blood pressure
• High cholesterol
• Valve disease

We are dedicated to assessing every patient as an individual, with a commitment to being thorough and comprehensive in our evaluations.  All of our cardiologists are Board Certified in multiple subspecialties and imaging modalities. In addition, we work closely with our colleagues in the Interventional and Electrophysiology labs to assure you that if your treatment requires advanced therapies, you will be able to receive them in an integrated and timely fashion.  We offer longitudinal cardiology care for patients who are in the preventative stage, all the way to those with advanced conditions needing a higher level of care.

Our physicians also oversee and provide the majority of inpatient cardiology services at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, one of the largest teaching medical centers in New York City. Consistently ranked as one of the best hospitals in the country and the #1 Hospital in New York and the New York metro area, our cardiologists are proud to practice at this renowned institution.  Our full time members staff the hospital’s Coronary Care Unit (CCU), Intermediate Care/Telemetry Unit (Stepdown), and provide hospital-wide inpatient consultations for all other medical and surgical services. These combined services treat over 5,000 admissions per year.  Many patients are transferred to our units from more than 50 different hospitals in the metropolitan area and beyond for the specialized services and excellent care that we provide.

We are also proud of our mission of teaching the next generation of leaders in cardiology.  Our faculty is continuously engaged in the education of medical students, residents, and fellows throughout the hospital and clinics and are frequently recognized by awards in teaching excellence at all levels.

Heart failure affects nearly 5 million Americans, with over 400,000 new cases being diagnosed each year. Tremendous advances in medical and surgical therapy for coronary artery disease, congenital heart disease, valvular heart disease and life-threatening arrhythmias have significantly extended the lives of patients with serious cardiac conditions.

In addition to the usual risk factors (diabetes, hypertension, coronary disease), a host of less common but not rare instances of acute and chronic heart failure occur and require special insight into diagnosis and treatment.  When younger patients present with heart failure, it is more commonly a consequence of myocarditis, an inflammatory response often to a common viral illness which may resolve or may go on to significant cardiac sequelae.  Early on in the course it is imperative to assess for different types of inflammation which may require specialty treatment or urgent interventions.  Other less common causes of “systolic heart failure” may include cardiac noncompaction, consequences of cancer treatment, systemic illnesses which may effect the heart including connective tissue and inflammatory diseases (sarcoid, lupus, rheumatoid arthritis, scleroderma spectrum of disease), or fatty infiltration of the heart (ARVD).

Heart Failure with preserved ejection fraction (HFpEF), sometimes referred to as diastolic heart failure, is increasingly recognized as the most common etiology of heart failure among the elderly.  It is likely that this “disease” is a combination of multiple different diseases which may include the sequelae of high blood pressure, stiff and aging systemic and pulmonary vasculature, repetitive and cumulative ischemic insults, concomitant valvular involvement (aortic mitral tricuspid valve disease) and disorders of the upper chamber.  “Left atrial abnormalities” are often a consequence of atrial fibrillation and consequences of renal disease.  Here too, there are some more esoteric diseases such as amyloid, which deposit the abnormal amyloid protein in the heart, which may be due to a hematological abnormality (AL amyloid), an aging protein (wild type abnormal transthyretin) or an inherited abnormality (genetically abnormal transthyretin protein).  Hypertrophic Cardiomyopathy (with or without outflow obstruction, apical variant) may present with heart failure symptoms, chest pain or arrhythmias. Treatment approaches will necessitate appropriate imaging (MRI, echo, CT), hemodynamic and arrhythmia assessments, and appropriate genetic testing in some.  Treatment modalities may include medications and occasionally surgery, with less enthusiasm for alcohol ablation.  Complications of iron overload conditions such as thalassemia and other transfusion-dependent conditions may lead to particular types of heart failure.

Heart Failure symptoms are due to the inability of the heart to respond normally to an increased demand with activity.  The abnormal heart has an altered “pressure-volume” relationship by which either the heart responds with one or another type of enlargement of the cardiac chambers (hypertrophy or dilation).  This often leads to fluid retention, symptoms of shortness of breath, swelling, exercise intolerance, general fatigue and arrhythmias.   In its most extreme form, patients cannot perform the activities of daily living – like dressing and bathing – without assistance.  They also may have cardiac related sleep disordered breathing patterns.

For all, early diagnosis, treatment, and long-term care of patients with heart failure requires a team approach with physicians, nurse practitioners, dieticians, physical therapists, and social workers working together to maximize patients’ functioning, know when it is appropriate to consider high risk surgical or catheter-based techniques, advanced therapies including mechanical circulatory support devices, transplant consideration, how to empower patients and partner with the team to adjust medications and maximize their capabilities.

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

• In-patient treatment. We offer the most advanced care for heart failure. In some cases this includes invasive monitoring procedures to establish the diagnosis, achieve the most effective treatment for heart failure management.  Some patients may have consequences of advanced valvular heart disease.  For those patients who are most critically ill, evaluation for mechanical circulatory support and/or transplant evaluation, and in-patient consultation for complicated heart failure, perioperative management, high risk conventional cardiac surgery, and cardiac obstetrical care.
• Management of ventricular assist device therapy for patients in which the unassisted heart is unable to pump enough blood from advanced heart failure or occasionally following a heart attack or open-heart surgery.
• ECMO support for the “crashing patient.”
• Cardiopulmonary exercise testing to identify those most at risk for advanced heart failure, to identify individuals who would benefit from resynchronization therapy, and to determine whether the cause of a patient's difficulty breathing is heart-based or lung-based.
• Out-patient management of individuals with compensated heart failure. This includes intensive nutritional/dietary counseling, as well as weekly telephone follow-up by a Nurse Practitioner trained in heart failure management.
• Opportunities for participation in multi-center clinical trials as well as ongoing original research.
• End-of-life management and palliative care for patients with unresponsive symptoms and limited life expectancy.

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.

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.

  
Pediatric Cardiovascular Services at Weill Cornell is comprised of the combined programs of Pediatric Cardiology and Pediatric Cardiovascular Surgery. In addition, these divisions represent the Weill Cornell campus of the composite Weill Cornell-Columbia Pediatric Cardiovascular Center, one of the largest and most famous of its type in the world. The program has specialists for every facet of congenital heart disease in infants, children, adolescents and adults.
  
Our Services

Diagnostic imaging, such as echocardiography, non-invasive stress tests, magnetic resonance imaging (MRI), cardiac computed tomography (CT), and cardiac catheterization is available at Weill Cornell, as are interventional cardiology procedures such as balloon angioplasty, coiling, stenting of blood vessels and device closure of heart defects. In conjunction with the Fetal Care Center at Weill Cornell, our physicians provide high-end fetal diagnostic echocardiography and counseling for parents.

Many of these procedures may prevent the need for later heart surgery. However, when necessary, cardiovascular surgery by an outstanding team of heart surgeons is available for the correction of heart defects. 

Our Programs

Cardiac Catheterization Program

Echocardiography Lab

Fetal Echocardiography

Pediatric Cardiothoracic Surgery Program

Non-Invasive Electrophysiology Services 

 
Preparing For Your Child's Visit
  
Thank you for choosing Weill Cornell Pediatrics! To facilitate the check-in process during your child's visit, we have posted important forms and information for you to read, complete and return to the physician's office prior to your arrival. Please download the forms and questionnaires and email to pedscardiotele@med.cornell.edu or fax to 212-746-8373 at least 72 hours before your appointment.
   
      
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Contact Us
Pediatric Cardiovascular Services
Department of Pediatrics
Weill Cornell Medicine
525 East 68th Street, Suite F-677
New York, NY 10065

Telephone/Appointments:
Phone: (212) 746-3561
Fax: (212) 746-8373

Peripheral arterial disease affects almost 10 million patients, yet it remains one of the most underdiagnosed and undertreated conditions. In some patients clogged arteries are not limited just to the heart. Cholesterol plaques can affect the arteries of the neck (carotid arteries), kidneys (renal arteries), aorta, and arteries of the legs and arms. Peripheral arteral disease can result in leg or arm discomfort while exercising, leg ulcers and other serious complications.

Our team of specialists includes experts in both diagnostic imaging and endovascular procedures who are specially trained to detect abnormalities in the vascular/circulation system and who focus specifically on detection and treatment of peripheral arterial disease. These vascular specialists are board certified in vascular or endovascular medicine, cardiovascular disease, and interventional cardiology and are fellowship trained with additional specialization in vascular procedures.

Noninvasive Vascular Imaging

To accurately diagnose abnormalities in the vascular system, our specialists rely on noninvasive tests that use cuffs similar to those used to measure arm blood pressure and ultrasound technology (see Vascular Imaging section). These tests can be conveniently performed at the same location and during a regular office visit and include:

• Ankle-brachial index (ABI)
• Treadmill exercise test
• Pulse volume recording (PVR)
• Arterial and venous (Doppler) ultrasound

Other diagnostic tests and techniques include

• CT angiography (CTA)
• Magnetic resonance angiography (MRA)

A Multidisciplinary Approach To Peripheral Artery Disease

The Endovascular Cardiology Service offers a comprehensive, multispecialty, cutting-edge approach to the evaluation and care of patients with peripheral arterial disease, with an emphasis on a minimally invasive endovascular approach.

We will work closely with the patient and referring physician to coordinate personalized treatment plan for every patient. Our goal is to create an individualized approach to diagnose and treat peripheral arterial disease, improve our patients’ lifestyle and prevent any vascular complications. In addition, we focus on prevention of future vascular problems by providing guidance regarding smoking cessation and life style modifications. All of our vascular specialists are board certified in cardiology and will be able to diagnose and treat associated cardiac conditions if necessary. We use multidisciplinary approach to treating peripheral arterial disease:

Medical therapy:  Medical therapy is an integral part of treatment for all patients with peripheral arterial disease. Medications are used to target leg or arm discomfort that occurs with exertion and due to clogged arteries. Medications are also used to treat diabetes, hypertension and high cholesterol.

Exercise therapy: Exercise therapy can help patients increase the distance and speed with which they can walk without pain.

Smoking cessation: Guidance on smoking cessation and detrimental effects of smoking

Lifestyle changes: These changes are important for prevention of future vascular complications.

Minimally invasive endovascular approach: This approach is used by our experienced interventional cardiologists that specialize in performing percutaneous procedures through a small puncture in the groin or arm, resulting in a short recovery period from the procedure, as opposed to traditional surgical techniques. Clogged arteries can be treated with balloon angioplasty, placement of stents, or atherectomy (plaque excision from the artery).

Areas Of Endovascular Expertise:

Angioplasty and stenting for peripheral arterial disease: The operators use a small balloon-tipped catheter that is threaded through the clogged artery to expand it. A stent may be inserted to relieve the blockage and to keep the artery open. Bare metal stents or novel drug-eluting stents are used to treat clogged arteries.

Chronic total occlusions: Our experienced operators can relieve blockages in the arteries that are completely blocked, particularly blockages that have been present for months and sometimes for years.

Limb ischemia: Treatment of patients with leg or arm discomfort at rest, presence of ulcers or gangrenes.

Atherectomy (plaque excision): A catheter is being used to remove the plaque from the artery. Our specialists use cutting-edge technology, including rotational, excisional, orbital, and laser atherectomy.

Renovascular disease: Clogged renal arteries can lead to hypertension, that is difficult to treat with medications, kidney failure or heart failure. These clogged kidney arteries can be treated with angioplasty and stenting.

Intravascular Ultrasound and Fractional Flow Reserve (FFR): An ultrasound catheter can be threaded through the clogged artery to determine the severity and location of a given blockage. A Fractional Flow Reserve wire is threaded through a blockage and used to measure whether the blockage is detrimental and requires further treatment.

Inferior Vena Cava filter placement and retrieval: Small filter devices are placed in a large vein (vena cava) to prevent clots from traveling to the lungs. These devices can be used for both prevention and treatment of patients with clots formed in deep veins.

Carotid disease and carotid stenting: Carotid artery angiography and stenting (with filter devices in the arteries of the neck that catch plaque particles) can be performed for patients with severe blockages of carotid arteries, particularly in those experiencing strokes or ministrokes.

Active Studies Recruiting Patients:

Novel device evaluation in endovascular treatment of peripheral artery disease.

Clinical evaluation of various antithrombotic and antiplatelet adjunct pharmacological agents in endovascular interventional procedures.

Clinical investigation of novel, catheter-based approaches for the treatment of refractory hypertension (renal denervation).

Clinical evaluation of patients with carotid artery disease

Novel inferior vena cava filter device evaluation.

Pulmonary hypertension (PH) is “high blood pressure” in the lung vessels.  This  often leads to insufficient oxygen delivery and results in an excess load to the heart leading to “right sided heart failure.”  The smaller arterial blood vessels in the lung may be abnormally thick, scarred, inflamed, constricted or have clots.  Normally, the lung vasculature can easily adapt to exercise-induced marked increases in blood flow.  However in pulmonary hypertension, the vascular resistance and the pressure in the lungs is further elevated with activity and leads to decreased flow to the left side of the heart (which pumps to the rest of the body) .  Consequences of this are common symptoms of shortness of breath , exercise intolerance, right sided heart failure symptoms (edema, ascites), chest pain, and/or near or complete fainting (presyncope and syncope).

PH may be idiopathic (unknown cause), genetically or familial related, associated with connective tissue diseases such as lupus and scleroderma, congenital heart disease (VSD, PDA, ASD large shunts), liver disease (WHO Group 1).  In some patients, the pulmonary hypertension is due to left-sided heart disease (WHO 2 PH), lung disease or low oxygenation (WHO 3).  Importantly, a curable form of this disease is that which is caused by chronic blood clots, CTEPH (Group 4), which may be amenable to surgery, and WHO Group 5 which involve a multitude of miscellaneous diseases of a wide spectrum (including sarcoid, end stage renal disease, myeloproliferative disease).  We often see patients who have mixed etiologies, i.e. some left heart disease, some chronic lung disease.

Appropriate testing for patients referred for pulmonary hypertension will often include: special blood tests, ECG, special echos, cardiac MRI, cardiopulmonary stress testing (to distinguish cardiac vs. pulmonary shortness of breath), lung scan to assess for clots (V/Q scan), breathing test (PFTs), high resolution chest CT of the lungs and ultimately the diagnosis needs to made with a cardiac catheterization as the definitive gold standard and the means of differentiating multifactorial disease.

Treatments include: diet and appropriate exercise recommendations, diuretics, oxygen when necessary, often anticoagulation, rarely calcium antagonists, targeted pulmonary vasodilators which can include oral, inhaled, subcutaneous, intravenous medications, research studies, consideration for conventional or special surgical or catheter based interventions (i.e. atrial septostomy, percutaneous or surgical valvular interventions for WHO 2 PH, referral for pulmonary thromboendarectomy, lung transplantation).  Additional treatment for sleep apnea, interstitial lung disease will be addressed by our pulmonary colleagues and additional treatment for active scleroderma, lupus or related diseases by our rheumatology colleagues.

For all, early diagnosis, treatment, and long-term care of patients with pulmonary hypertension requires a team approach with collaborative physicians, nurse practitioners, dieticians, physical therapists and social workers working together to maximize patients’ functioning, know when it is appropriate to consider more advanced interventions, to empower patients to partner with the team to adjust medications and maximize their capabilities, and to know when we have exhausted therapies.

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

• Cardiopulmonary exercise testing to identify and follow patients with PH and heart failure.
• Inpatient transfer and out-patient management of individuals with pulmonary hypertension. This includes intensive nutritional/dietary counseling, as well as telephone follow-up by a Nurse Practitioner trained in management of patients with pulmonary hypertension.
• Specialty cardiac catheterization to diagnose and gauge response to treatment (done by our catheterization colleagues)
• Opportunities for participation in multi-center clinical trials as well as ongoing original research.
• End-of-life management and palliative care for patients with unresponsive symptoms and limited life expectancy.

According to the American Heart Association, about 5 million Americans are diagnosed with heart valve disease each year. Heart valve disease occurs when any of the heart’s four valves do not work the way they should causing the heart to lose its ability to pump blood throughout the body.

NewYork Presbyterian Hospital-Weill Cornell Medical Center is ranked 3rd in the Nation by U.S. News & World Report for 2013-14. Our experts in valvular heart disease use advanced imaging modalities, including new technology in 3D Echocardiography, MRI and CT Angiography/Scan to evaluate patients with valvular heart disease. In collaboration with invasive cardiologists, arrhythmia specialists, and cardiac surgeons, clinical cardiologists in our Division provide care for patients with all forms of valve disease and are recognized experts in mitral and aortic valve disease.

Our state-of-the-art vascular laboratory offers the full spectrum of non-invasive diagnostic modalities for the detection of vascular disease. We perform physiologic testing for peripheral arterial disease (PAD) including measurement of the ankle-brachial index (ABI) with segmental pressures/pulse volume recordings and exercise treadmill testing. In addition, we perform arterial duplex ultrasonography of the carotid arteries, lower and upper extremity arter­ies, the aorta and renal arteries, as well as venous ultrasonography of the upper and lower extremi­ties. Our lab is accredited by the Intersocietal Accreditation Commission for Vascular Testing, which means that the lab meets the highest stan­dards of quality patient care and monitoring.

One of our fastest growing services, our lab performs over 1,800 vascular studies annually.