Comprehensive Diagnostics

Lipid Tests: These tests are routinely performed on plasma, which is the liquid part of blood without the blood cells. The purpose of blood lipid testing is to determine whether abnormally high or low concentrations of a specific lipid are present. Low levels of cholesterol are associated with liver failure and inherited disorders of cholesterol production. Low levels of triglyceride are seen in persons with malnutrition or malabsorption. Increased levels are associated with diabetes mellitus, hypothyroidism, pancreatitis, glycogen storage diseases, and estrogens.

Tapp Medical Clinic currently outsources the testing to two outstanding laboratories to assure the best possible accuracy regarding our patients test results.

 LipoScience, Inc. providing Lipid Test Services

LipoScience is a medical technology company dedicated to developing and marketing clinical diagnostic applications of nuclear magnetic resonance, or NMR spectorscopy. The NMR LipoProfile test is a superior diagnostic tool that is changing the way heart disease is assessed and managed. There is no other diagnostic test commercially available that can quantify the number of lipoproteins in a person’s blood.

The NMR LipoProfile test is an advanced cardiovascular diagnostic test that uses nuclear magnetic resonance (NMR) spectroscopy to uniquely provide rapid, simultaneous and direct measurement of LDL particle number and size of LDL particles, as well as direct measurement of HDL and VLDL subclasses. This detailed lipoprotein particle information allows clinicians to make more effective individualized treatment decisions than previously possible based on standard lipid panel testing. The atherosclerotic culprit is LDL particle number, not LDL cholesterol.

The clinical value of the NMR LipoProfile test is based on data demonstrating stronger CVD associations compared to the traditional cholesterol-based lipid panel. Data from several clinical trials show significantly stronger associations of NMR LipoProfile test values. LipoScience is based in Raleigh, North Carolina and began operations in 1997. In May 2002 the company changed its name from LipoMed to LipoScience.

 Berkeley HeartLab, Inc. providing Lipid Test Services

Unlike other lipid testing companies that are focused on the primary screening market for CVD, Berkeley HeartLab's proprietary testing technology and facilitating esoteric testing capability allow for the ongoing monitoring of a patient’s disease and precise determination of the most appropriate degree of aggressiveness in establishing a personalized treatment plan. Berkeley HeartLab (BHL) provides proprietary LDL and HDL tests, as well as 20 other tests associated with cardiovascular disease. These test results, combined with BHL's disease management tools, enable development of a comprehensive baseline of patient risk for cardiovascular disease.

BHL has pioneered lipoprotein subfractionation, the process by which lipoproteins are divided into diameter-based subclasses to assess degree and characterization of cardiovascular disease risk. The core of their offering is an exclusive license to SGGE™ lipoprotein subfractionation technology developed at the Lawrence Berkeley National Laboratory. BHL has used this technology to develop the only peer-reviewed lipoprotein analysis test method that correlates to analytic ultracentrifugation. This technology allows BHL to differentiate the 7 subclasses of LDL and 5 subclasses of HDL, and more importantly the most atherogenic particles, LDL IIIa, IIIb, and IVb and also the most helpful HDL particle, HDL2b.

Berkeley HeartLab provides a third-generation technology and complete suite of tests designed to help clinics develop a comprehensive baseline of patient risk to determine who to treat, how aggressively, and to monitor the therapy. Their technology is the most advanced commercially available and reduces “false negatives” by 27% to 41% compared to alternative technologies. Because Berkeley's technology reveals that risk and disease profiles can be very different between seemingly similar patients, their array of test offerings allows them to create specific treatment profiles for each patient that are recommend to physicians. In some cases, their treatment profiles enable doctors to consider prescribing lower doses of a drug or to substitute one drug class for another

  Carotid Intima-Media Thickness (CIMT) to screen for Heart Disease

Staying intune with latest medical techniques and protocols, Tapps Medical Clinic now offers the CIMT innovative testing. CIMT is a new noninvasive ultrasound test that is being recommended by the American Heart Association and the American College of Cardiology to screen for heart disease in appearently healthy individuals ages 45 or greater. CIMT stands for Carotid Intima-Media Thickness. This is a noninvasive test which is performed with a high-resolution B-mode ultrasound transducer. The test is safe, painless and takes about twenty minutes. After applying conducting jelly to the skin over your neck, a small hand-held transducer is applied to image the carotid arteries. The sonographer measures the combined thicknesses of the intimal and medial layers of the carotid artery walls.

The carotid arteries in the neck provides a “window” to the coronary arteries. Not only do they have similar risk factors – more importantly, the relationship between the atherosclerotic burden in a carotid artery and a coronary artery is the same as between any two coronary arteries. Thus carotic aterosclerosis provides a window to the degree of coronary atherosclerosis in an individual. CIMT is an independent predictor of future cardiovascular events, including heart attacks, cardiac death, and stroke.

  Ankle-Brachial Index to test for Peripheral Artery Disease

The ankle-brachial index (ABI) is a simple, reliable means for diagnosing P.A.D. P.A.D. is short for Peripheral Arterial Disease. People have P.A.D. when the arteries in their legs become narrowed or clogged with fatty deposits, or plaque. The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. Some people call this poor circulation.

Blood pressure measurements are taken at the arms and ankles using a pencil shaped ultrasound device called a Doppler. A Doppler instrument produces sound waves (not x-rays) and is considered noninvasive because it does not require the use of needles or catheters. The ABI test is simple enough to be performed in any doctor's office or vascular laboratory. Not only is the ABI one of the most reliable tests for PAD, it is also the least expensive. The ABI test is used to document the presence or absence of PAD, and can be performed every year to quickly assess whether PAD is getting worse.

The ABI can also predict how severe an individual's atherosclerosis is and the risk of future leg problems (such as development of future leg rest pain, poor healing of foot wounds, need for leg bypass surgery, or amputation). It can also predict the risk of future problems from atherosclerosis in other parts of the body (such as heart attack and stroke). Lower ABI values are associated with a higher risk. In fact, the ABI value can be an accurate predictor for patients with coronary heart disease (such as the blood cholesterol value, coronary calcium score, and C-reactive protein value).

  Automated Impedance Cardiography (ICG)

Impedance cardiography (ICG), also known as thoracic electrical bioimpedance (TEB), is a technology that converts changes in thoracic impedance to changes in volume over time. In this manner, it is used to track volumetric changes such as those occurring during the cardiac cycle. These measurements, which are gathered continuously, have become more sophisticated and more accurate with the development of data signal processing and improved mathematical algorithms.

Impedance cardiography is a safe, non-invasive method to measure a patient’s hemodynamic status. The ICG waveform is generated by thoracic electrical bioimpedance (TEB) technology, which measures the level of change in impedance in the thoracic fluid. Four small sensors send and receive a low amplitude electrical current through the thorax to detect the level of change in resistance in the thoracic fluid. With each cardiac cycle, fluid levels change, which affects the impedance to the electrical signal transmitted by the sensors.

This technology, orginally used by NASA in the 1960’s, has benefited from the advent of the microprocessor and the better understanding of the cardiac cycle, thanks to technology such as echocardiography and magnetic resonance imaging. Today, noninvasive methods of measuring of cardiac output are coming into clinical use on a larger scale than ever before and are compared with other methods such as thermodilution and the direct and indirect Fick methods.

  Electrocardiogram (EKG)

An electrocardiogram is a test that measures the electrical activity of the heartbeat. With each beat, an electrical impulse (or “wave”) travels through the heart. This wave causes the muscle to squeeze and pump blood from the heart. A normal heartbeat on ECG will show the timing of the top and lower chambers.

The right and left atria or upper chambers make the first wave called a “P wave" — following a flat line when the electrical impulse goes to the bottom chambers. The right and left bottom chambers or ventricles make the next wave called a “QRS complex." The final wave or “T wave” represents electrical recovery or return to a resting state for the ventricles.

An ECG gives two major kinds of information. First, by measuring time intervals on the ECG, a doctor can determine how long the electrical wave takes to pass through the heart. Finding out how long a wave takes to travel from one part of the heart to the next shows if the electrical activity is normal or slow, fast or irregular. Second, by measuring the amount of electrical activity passing through the heart muscle, a cardiologist may be able to find out if parts of the heart are too large or are overworked.

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