

Elliot Physicians Network
Elliot Cardiovascular Consultants

A Department Of Elliot Hospital
1 Elliot Way, Suite 100, Manchester, NH 03103


In Office:
Any and all services performed in our practice by our Doctors and or technicians. This includes consultations with a Doctor or any of the services on this list.


-Exercise Tolerance Test
-MIBI Stress Test
-Adenosine MIBI Stress Test
-Exercise Stress Echocardiogram
-Dobutamine Stress Echocardiogram
-Transesophageal Echocardiogram (TEE)
-Pacemaker/Defibrillator (ICD) Interrogation

-Electrocardiogram (EKG)
-Holter Monitor
-Carotid Ultrasound
-Percutaneous Vascular Intervention
-Upright Tilt Test (Tilt Test)
-Ambulatory Blood Pressure Measurement
-Coumadin Monitoring


Hospital Cardiology Services:
All procedures performed by our Doctors in the hospital setting.


-Cardiac Catheterization
-Percutaneous Coronary Intervention (PCI)
-Paclitaxel Drug-eluting Stents
-Peripheral Artery Disease
-Pacemaker Insertion

-Biventricular Pacemaker Insertion
-Implantable Cardiac Defibrillator (ICD)
-A.I.C.D. Support Group
-Electrophysiology Study (EPS)

In Office Services(Detailed):

A common test to evaluate how the heart performs during exercise. This test is often done to diagnose the presence of coronary artery disease, or to administer adequate medical therapy. You may also hear exercise tolerance test called exercise stress test, stress tests, exercise EKG's or treadmill tests.


A MIBI Stress Test is a study that combines exercise tolerance testing and nuclear imaging to evaluate blood flow to your heart muscle. MIBI is a low level isotope used to highlight the heart muscle and evaluate its blood supply. This test is used to diagnose the presence of coronary artery disease. It is usually performed when patients have angina, unexplained chest pain, shortness of breath, or known coronary artery disease.


An Adenosine Mibi Stress Test is a study that combines exercise tolerance testing and nuclear imaging of the heart to evaluate coronary blood flow. Adenosine is a medication used to dilate coronary arteries and simulate the effect of exercise on the heart. This medication is ordered if the patient cannot exercise to a high enough level to obtain an adequate stress result. The test can be done with or without walking on a treadmill.


A test that combines an ultrasound study of the heart (echocardiogram) and an exercise tolerance test . This test helps to identify areas of decreased blood flow to the heart muscle or blockages in the coronary arteries.


A Dobutamine Stress Echocardiogram is a test that combines an ultrasound study of your heart ( echocardiogram ) with a medically induced stress test. Dobutamine is a medication to make the heart beat faster and more forcefully. This simulates the effect of exercise in those who are unable to walk on a treadmill. This test helps to identify areas of abnormal blood flow to the heart muscle, caused by blockages in the coronary arteries.


An Echocardiogram is a noninvasive procedure that uses sound waves (ultrasound) to evaluate how well the heart is working. This test will help the doctor to evaluate the size, pumping strength and function of the heart muscle and valves.


A transesophageal echocardiogram (TEE) is a test that doctors use to obtain images of the heart from inside the esophagus (swallowing tube). The esophagus lies immediately behind the heart and with this technology; very clear images of the heart can be obtained. This test is used by doctors to visualize structures of the heart not seen by a standard echocardiogram (from the outside chest wall) as well as clarify structures that may be otherwise poorly seen.


An Electrocardiogram (ECG or EKG) is a noninvasive test that records the electrical activity of the heart. EKG is used to measure the rate and regularity of heartbeats as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart (such as a pacemaker).


Holter monitoring provides a continuous recording of heart rhythm during normal activity. The monitor is usually worn for 24 hours to obtain a recording of a complete day. This test will help the doctor evaluate the type and amount of irregular heartbeats during regular activities, exercise and sleep.


An Upright Tilt Table Test (Tilt Test) is used to assess symptoms such as dizziness, lightheadedness and/or syncope (fainting, passing or "falling" out). It is performed to try to reproduce the symptoms while being monitored. Lightheadedness or syncope can result from a rapid fall in blood pressure, which can occur when moving from a supine (flat) or sitting position to a standing position. It sometimes involves reflex receptors in the heart, which may prevent the heart from beating quickly or forcefully enough to provide sufficient blood flow to the brain. This can result in the symptoms described above. The tilt table test is a procedure that involves monitoring your heart rate and blood pressure in both the supine and upright positions in an effort to uncover this abnormal reflex.


A Cardioversion (electrical Cardioversion) converts certain types of abnormal heart rhythms (arrhythmias) to normal ones. It accomplishes this with a well-controlled and perfectly timed electrical shock to the chest wall.


Carotid Ultrasound:
This is a non-invasive test that measures the blood flow through the arteries in the neck to the brain. Blockages in these arteries can cause mini strokes and strokes. In a relaxed position, the echo technologist uses an ultrasound probe to follow the blood vessels in your neck, checking both sides for any evidence of blockage. The speed that the blood travels through the arteries correlates with the amount of blockage, and can be followed over time to check for progression. The test is completely painless, and patients often fall asleep during testing.


Pacemaker/Defibrillator (ICD) interrogation and follow up:
If you've had a pacemaker or ICD implanted by one of our Doctors, we will periodically check the function of your device. This is done by placing a magnet on the battery area of the device. The computer does the rest. An amazing amount of information is stored on the pacemaker about how your heart is functioning and this can help to tailor your treatment plan. Other practices do this over the phone, but we have found that the phone technique can occasionally give incorrect information and that much more complete evaluation of the device can be done in the office by our specially trained nurses. You are also able to ask questions directly to the nurses and doctors regarding your cardiovascular care while here.


Coumadin Monitoring:
You may have been placed on a blood thinner known as coumadin or warfarin by your Doctor for any number of conditions, like atrial fibrillation, or heart valve surgery. The coumadin is important to prevent blood clots from forming and leading to stroke. Coumadin interacts with the proteins in your blood and the dose must be adjusted to keep your blood at an appropriate level to avoid clots, while also avoiding any bleeding. The monitoring and dose adjustment traditionally uses venipuncture in the arm for blood samples. We are able to offer many patients coumadin level monitoring (or INR) with only a drop of blood from a tiny finger stick. Adjustments are typically made with you still here in the office, and follow up scheduled at the same time.


Ambulatory Blood Pressure Measurement:
Many people with high blood pressure, also known as hypertension, believe that their pressure is high only in the doctor's office because they have often rushed to get to their appointment or are anxious about their visit. The term for this is "white-coat hypertension". Unfortunately, though, many people do have high blood pressure when outside of the office too, and this can lead to serious consequences. Ambulatory BP monitoring is done with a regular cuff that automatically inflates about every thirty minutes while awake and every 60 minutes while asleep. A small computer, about the size of a walkman, is worn at the waist. This tool gives your Doctor a much better insight into the pattern of your blood pressure to be better able to tailor your medications to suit your specific needs.


Percutaneous Vascular Intervention:
If there are blockages in the arteries in your body that are causing symptoms ranging from arm or leg pain, high blood pressure or stroke, traditionally this was fixed with a surgical procedure. Now, many of these problems can be repaired with only a minor procedure performed through a tube thinner than a drinking straw, which require no overnight stay and virtually no recovery time. Also, general anesthesia is not needed and only mild sedation used to keep you relaxed and lightly napping through the procedure. Arteries are typically opened with tiny balloons and small metal tubes called stents are sometimes used to prop open the blocked vessels. Patients typically leave the same afternoon and are immediately pain free. The risks associated with this type of approach are far less than those of surgical arterial repair.

Hospital Cardiology Services(Detailed):

Cardiac Catheterization
Cardiac catheterization (also called cardiac cath or coronary angiogram) is a procedure that allows your doctor to "see" how well your heart is functioning. The test involves inserting a long, narrow tube called a catheter into a blood vessel in your arm or leg, and guiding it to your heart with the aid of a special X-ray machine. Contrast dye is injected through the catheter so that X-ray movies of your valves, coronary arteries and heart chambers can be created.


Implantable Cardiac (ICD) Defibrillator
An Implantable Cardioverter Defibrillator (ICD) is a small electronic device placed permanently inside your body. You may be given an ICD if you have had a cardiac arrest or if you have a fast heart rhythm problem that could lead to cardiac arrest. The ICD continuously monitors your heart rhythm (the speed and pattern of your heartbeat) and if the ICD senses a dangerous heart rhythm, it can send out one or more electrical shocks to return the heart to its normal rhythm. Lifelong monitoring is necessary to be sure that your ICD continues working correctly and to check for any further changes in your heart rhythm.
Click here to learn more about the AICD Support Group

A new AICD and an old AICD (circa 1987)


Electrophysiology Study (EPS)


Percutaneous Coronary Intervention (PCI)
Percutaneous Coronary Intervention (PCI) is a procedure used to open blocked coronary arteries using angioplasty and stent implantation during a heart attack. The procedure is performed in the cardiac catheterization laboratory on an emergency basis. Once a blocked coronary artery has been located after a cardiac catheterization, a small wire is advanced into the artery and past the blockage. Then, over this wire, a balloon catheter is advanced and the balloon is inflated. By inflating the balloon, the blockage is opened.

A stent is a small metal mesh tube that is secured to a balloon at the end of a delivery catheter. This may also be implanted if your cardiologist determines that it is needed. Once the stent is placed exactly over the blockage, the balloon is inflated, expanding the stent into the wall of the artery. When the balloon is deflated, the stent remains in place permanently. Over time, the lining of the artery wall will grow around the stent as the stent continues to support the vessel.

Elliot Hospital has established relationships with area ambulance services to allow for transmission of electrocardiograms from the ambulance prior to arrival in the Emergency Department. This allows for early activation of the cardiac cath lab team, resulting in quicker transport to the cath lab for this procedure.

After discharge from the hospital, you may need assistance with changes in lifestyle (i.e. smoking cessation, increasing physical activity and improving diet). You will most likely need to take Plavix® for a few months after discharge if a stent has been implanted to prevent artery closure. You may also be prescribed aspirin, cholesterol lowering agents and other medications as determined by your cardiologist. You will require follow-up with the cardiologist to check medication and lifestyle changes.


Paclitaxel Drug-eluting Stents
When a stent is implanted in an artery, the body reacts naturally to heal itself. To accomplish this, the vessel produces a layer of new cells, which will eventually cover the stent. While this covering of the stent is a natural healing response, the layer can become too thick. This leads to a narrowing of the vessel, and reduced blood flow.

To prevent this, Cardiologists at Elliot use a TAXUS™ Express²™ Paclitaxel-Eluting Coronary Stent System. Paclitaxel is a drug that interferes with the ability of the vessel cells to divide and multiply, therefore reducing re-blockage and repeat procedures.

The procedure for implanting a drug-eluting stent is much like the procedure for implanting a conventional stent. In both cases, the physician will insert an introducer sheath into the groin, arm, or wrist to gain access to the artery. A balloon-tipped catheter will be threaded through the sheath, into the patient's bloodstream, and to the affected portion of the coronary artery. The balloon is inflated to compress the plaque against the wall of the artery. After the artery has been widened, a second catheter is then inserted with a stent wrapped around the balloon. When the balloon inflates, the stent expands and is imbedded in your arterial wall. The artery will heal around the stent, holding it firmly in place. The special polymer coating on the stent will release an anti-restenosis medication directly into the artery in small, controlled quantities.

The procedure is performed under local anesthetic, so that patients can respond to their physician's directions and notify him or her of any pain they experience during the procedure. While undergoing the procedure, some patients may experience tightness or discomfort in their chest while the catheter is being guided to the lesion and the balloon is expanded. The procedure should take less than two hours. Following the procedure, the doctor will prescribe one or more medications to prevent the formation of blood clots. On average, a patient's hospital stay may last one to three days.

More information on the TAXUS™ Express²™ Paclitaxel-Eluting Coronary Stent System can be found at


Pacemaker Insertion
A pacemaker is a small, lightweight electronic device that's placed permanently inside your body to treat a slow heart rhythm. A pacemaker keeps track of your heartbeat, and when necessary generates electrical signals similar to the heart's natural signals to keep your heart beating at the right speed. Lifelong, regular checkups help make sure that your pacemaker continues to run smoothly.


Biventricular Pacemaker Insertion
A biventricular pacemaker is one specific kind of pacemaker that can help heart failure patients feel a lot better. It is called a "biventricular pacemaker" because it "paces" both of the heart's ventricles (pumping chambers) at the same time. Many heart failure patients' hearts don't have all chambers firing at just the right time to beat effectively. Re-timing the beat of some chambers can make your heart function better, which makes you feel better.

Peripheral Artery Disease

A common cause of chronic leg pain is poor circulation. The medical name for this condition is peripheral artery disease, or PAD. PAD can seriously impair a person's ability to walk and function independently.

Patients with this may experience pain in their legs, hip or buttocks when walking a certain distance. Resting usually relieves the pain but it returns when walking that same distance again. These symptoms are known as intermittent claudication. A person experiencing these symptoms should call their doctor.

Common Risk Factors For PAD include:
• Family history of heart or vascular disease
• History of smoking
• High blood pressure
• Diabetes
• High cholesterol
• Obesity

Your doctor can diagnose PAD using different tests including ultrasound, CT scanning or MRA. Additionally, the diagnosis can be made using a test called an arteriogram. An arteriogram is a special x-ray of the arteries. If treatment is needed, here at the Elliot Health System, we can provide a number of non- surgical options, such as angioplasty and vascular stent placement.

Stent implantation is an exciting option for patients with PAD; this is a major improvement in the way that vascular disease is being treated. With a stent, patients can get back on their feet right away, without leg pain and return to a more active and independent life almost immediately, with virtually no post-procedural recovery time.

Dr Carl Fier is offering his services for both cardiac and vascular intervention at the Elliot Health System.


Here at the Elliot Health System, Dr. Paul LeLorier from Boston Medical center is offering his services for patients in the Manchester area who have heart arrhythmias. Over the last decade, ablation techniques have revolutionized the treatment of many heart arrhythmias and it is now considered the primary therapy for heart arrhythmias.

Ablation is a nonsurgical procedure that is done to cure many SVT's or A flutters using radio frequency waves that heat the tip of a cather. Energy is delivered though a cather, which reaches a certain temperature. This will results in searing of tissues at the site, which will no longer conduct electrical impulses. An ablation is usually done following a diagnostic study to confirm arrhythmia called an EP.

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