The Division of Cardiovascular Medicine has an active clinical
practice at the LAC+USC Medical Center. The clinical services
offered by Cardiovascular Medicine include a 12-bed CCU, a
six-bed Step-Down Unit, and an 18-bed ward with telemetry
capabilities. The Division has an active cardiology and electrophysiology
consultation service, as well as providing 24-hour consultation.
The Cardiac Catheterization and Electrophysiology Laboratories
are under the supervision of Cardiovascular Medicine with
a busy catheterization, interventional and invasive electrophysiology
program. The noninvasive laboratory provides TTE, TEE, and
stress echos, while the exercise laboratory provides stress
testing and thallium and sestimibi rest and stress imaging.
The Division’s ECG service provides interpretation of
all ECG’s done at LAC+USC Medical Center and also has
a 24-hour holter monitoring service. The Cardiovascular Medicine
faculty oversees one outpatient cardiology clinic, one interventional
cardiology clinic, one anticoagulation clinic, and one high-risk
pregnancy clinic at LAC+USC Medical Center. Cardiovascular
Medicine also runs an outpatient clinic at Roybal Comprehensive
Health Center in East Los Angeles.
The Division provides 24-hour consultative services to USC
University and USC/Norris Hospitals and is actively involved
in the direct care of inpatients at USC University Hospital.
Many diagnostic and therapeutic services are offered by Cardiovascular
Medicine at USC University Hospital, including cardiac catheterization,
invasive cardiology, and pacing and electrophysiology studies.
The Cardiovascular Medicine Noninvasive Service provides TTE,
TEE, stress echo and thallium and sestimibi rest and stress
imaging. The Division provides interpretation of all ECG’s
done at University and Norris Hospitals. The Division’s
outpatient private practice office is located at Healthcare
Consultation Center on the Health Sciences Campus.
Under the direction of Dr. Leslie A. Saxon, the USC Cardiac
Electrophysiology Service offers specialized treatment to
patients who are diagnosed with arrhythmias and/or heart failure.
Our understanding of the processes that lead to heart failure
enables us to take effective steps to change the course of
the disease. The Cardiac Electrophysiology Service is dedicated
to treating a patient as a whole person and to delivering
the highest level of comprehensive care. We integrate the
efforts of various USC physicians and nurse specialists who
treat heart failure. Our mission is to provide patients with
treatments that slow disease progression, prolong survival,
and improve quality of life.
Cardiovascular Magnetic Resonance Imaging
The USC Division of Cardiovascular Medicine is particularly
proud of its pioneering program in high-field cardiovascular
magnetic resonance (CMR) imaging. While most cardiac centers
use lower-field imaging devices, our division has invested
in devices capable of high-field diagnostic studies. With
this novel technology, the heart can be captured in three
dimensions with amazing clarity. Our two new 3T MRI systems
produce optimal-resolution images of the heart muscle, the
structure of the heart (for congenital and valvular heart
disease detection), and the coronary arteries. They also
allow us to observe scarred heart muscle, blood flow through
the muscle of the heart, and heart muscle metabolism to
detect and study inadequate blood flow to the heart. CMR
additionally allows for clinical visualization of the peripheral
and renal arterial systems as well as the carotid arteries.
With CMR, conditions such as aortic aneurysms and aortic
dissections can be detected at their earliest phases, and
the presence and extent of pulmonary hypertension can be
reliably determined.
USC cardiovascular medicine faculty are involved in several
research projects that employ CMR imaging. Using CMR’s
ability to accurately evaluate left ventricular size, shape,
and function, USC acts as a core laboratory for the international
NIH (NHLBI)-supported Surgical Treatment for Ischemic Heart
Failure (STICH) trial, which examines surgical treatment
for heart failure after heart attack. The STICH trial compares
medical, bypass surgical, and surgical ventricular restoration.
In a second NIH (NHLBI)-supported, CMR-based program, our
researchers study the heart muscle in patients with type
I diabetes. Using phosphorus CMR to assess ATP and phosphocreatine
levels in the heart muscle at rest and during stress, the
study aims to determine the biochemical basis for the abnormal
heart function commonly found in diabetics. Finally, a third
NIH (NHLBI)-supported program—the Women’s Ischemia
Syndrome Evaluation (WISE)—uses phosphorus CMR at
rest and with stress to determine the basis for chest pain
in women who show no evidence of coronary artery obstruction.
Many women suffer from this syndrome, sometimes called “Cardiac
Syndrome X.”
CMR imaging is non-invasive and allows for the evaluation
of heart and vascular function using a single modality and
without the risks associated with ionizing radiation or
X-ray dye. High-field CMR imaging can be described as a
“one-stop shop” for the comprehensive analysis,
including severity and prognosis, of virtually any form
of cardiovascular disease.
Echocardiography
Echocardiography is now considered as important to office
cardiology evaluations as electrocardiography has been for
the past three decades. The USC Division of Cardiovascular
Medicine has very active, state-of-the-art echocardiography
laboratories both at USC University Hospital and the LAC+USC
Medical Center. Many referring community physicians rely
on the sophisticated echocardiogram assessments our cardiology
experts provide.
Transthoracic echocardiogram (TTE): A transthoracic echocardiogram
is essentially an ultrasound of the heart. During a TTE,
a transducer wand is moved over the skin of the chest, taking
images of the heart through the chest wall. This allows
for the comprehensive evaluation of heart condition and
function and for assessment of tumors, ischemia (inadequate
blood flow), and viability. The stress echocardiogram, which
combines a treadmill stress test and a transthoracic echocardiogram,
is an indispensable tool for ischemia analysis.
Transesophageal echocardiogram (TEE): In some cases, a
patient’s build or a pre-existing condition may limit
ultrasound transmission, so that a transthoracic echocardiogram
cannot be used. For these patients, a transesophageal echocardiogram
can be used to evaluate the basic function of the heart.
During a TEE, a transducer is attached to the tip of a thin,
flexible tube and inserted down the throat and into the
esophagus. TEE plays a major role in the comprehensive assessment
of aortic disorders, systemic emboli, and the heart valves,
especially for patients with mitral regurgitation, mitral
stenosis, aortic stenosis, or tricuspid stenosis. TEE is
also a very valuable tool in evaluating the function and
pathology of prosthetic valves as well as assessing left
atrial thrombi (blood clots). In select cases, a dobutamine
TEE can be performed to evaluate for ischemia. Injecting
a patient with dobutamine increases heart rate and blood
pressure so that the heart can be studied under stress conditions.
The echocardiography program includes the following services:
• Comprehensive assessment of valvular and nonvalvular
hemodynamics
• Contrast echocardiography
• Dobutamine stress echocardiography
• Dobutamine transesophageal echocardiography
• Exercise stress echocardiography
• Intraoperative echocardiography
• Myocardial dysynchrony imaging
• Three-dimensional echocardiography
• Tissue Doppler imaging
• Transesophageal echocardiography
• Transthoracic echocardiography
Nuclear Cardiology
Another non-invasive diagnostic tool, nuclear cardiology
studies use small doses of radioactive material to assess
myocardial blood flow, metabolism, and viability. The Nuclear
Cardiology Program at USC is noted for its expertise in
the statistical methods that demonstrate the efficacy of
this approach. Using single photon emission computed tomography
(SPECT), our program provides state-of–the-art diagnoses
for patients with coronary artery disease. Among the most
important applications of nuclear cardiology is the evaluation
of risk for patients with chest pain and those about to
undergo major surgical intervention.
Preventive Cardiology and Atherosclerosis
The preventive cardiology and atherosclerosis program is
integrated with the world-class Lipid Clinic at USC, where
patients with hyperlipidemia (high cholesterol levels) and
other lipid disorders are treated. The program provides
primary screenings for patients without known heart disease
to determine if significant risk factors for atherosclerosis
are present. Patients are offered the opportunity to enter
into a continual monitoring program that involves lipid
lowering, control of hypertension, cigarette smoking cessation,
exercise training, and counseling. The center uses a unique
atherosclerosis measurement developed by the USC Atherosclerosis
Research Unit. This non-invasive technique involves measuring
the thickness of the carotid artery with B-mode ultrasound
and has been found to be very sensitive to changes in the
degree of atherosclerosis. Using this method, along with
careful dietary monitoring, significant regression has been
documented in USC research studies.
Congenital Heart Disease in Adults
An adult congenital heart disease program was recently
established at USC. The program provides ambulatory and
inpatient services to this growing group of patients with
specialized needs.
In collaboration with pediatric cardiologists from Childrens
Hospital Los Angeles, the Division of Cardiovascular Medicine
holds bimonthly conferences on adult patients with congenital
heart disease. With specialists in pediatric and adult cardiology
as well as cardiothoracic surgery, the group discusses patient
cases before and after diagnosis to determine treatment
that will optimize care for this complex patient group.
Heart Failure
Treating heart failure is one of the most common challenges
facing contemporary cardiovascular medicine. It is associated
with many cardiac disease states, including coronary artery
disease, valvular heart disease, and cardiomyopathy, and
is even associated with pregnancy. A clinical program has
been established at USC for the diagnosis, evaluation, and
management of heart failure. Clinical care can include outpatient
treatment, at-home infusion therapy, and device therapy
as well as evaluation for surgical ventricular restoration,
potential valve repairs, heart transplantation, and participation
in the STICH trial. With its complement of advanced diagnostic
techniques and instrumentation, the Division of Cardiovascular
Medicine provides heart failure patients with expert diagnoses,
treatment, and follow-up.
High Risk Pregnancy Clinic
Having pre-existing heart disease or developing cardiomyopathy
during pregnancy can increase the risk of complications
for both mother and fetus. USC cardiologists are experienced
in peripartum cardiomyopathy and the management of valvular
heart diseases and prosthetic valves during pregnancy.
Marfan Syndrome
Marfan syndrome is a disorder of the fibrillin gene. The
condition is named after a French pediatrician, Antoine
Marfan, who in 1896 described a 5-year-old girl whose arms,
legs, fingers and toes were disproportionately long and
thin, whose muscle development was poor, and whose spine
curved abnormally. This syndrome involves multiple organ
systems including the heart, aorta, skeletal system, eye
and structures enveloping the brain. It is characterized
by valve prolapse, dilatation of the aorta with a high risk
of rupture, dislocated lens, retinal tear, tall stature,
and kyphoscoliosis. Early diagnosis and management is important
to prevent complications such as aortic rupture. Pregnancy
imposes special risk. Beta blocker therapy; genetic counseling
and appropriate surgery are important components of the
disease management.
The Marfan Center is a comprehensive multidisciplinary
disease management program composed of a clinical cardiologist,
a cardiologist specialized in advanced cardiac imaging,
a surgeon with a special interest in aortic and valve repair,
an orthopedic surgeon specialized in spine disorders, an
ophthalmologist (with expertise on lens diseases) and a
geneticist. Members of this multidisciplinary team include
Padmini Varadarajan, MD (Director and advanced cardiac imager),
Vaughn Starnes, MD (Chairman of cardiothoracic surgery),Ramdas
G.Pai, MD (cardiologist and advanced cardiac imager), Gerald
M. Pohost, MD ( cardiologist and advanced cardiac imager),
John Irving MD (ophthalmology), Mark Spoonamore MD (spine
surgery) and Sharte Ricker (geneticist).
USC Marfan Center Provides:
• Initial evaluation of suspected patients and screening
of family members of known Marfan patients
• Echocardiography and Cardiac Magnetic Resonance
Imaging (MRI)
• Medical management and monitoring
• Genetic counseling
• Surgical management of multisystem complications
such as aortic dilatation, cardiac valve disorders and orthopedic
problems such as kyphoscoliosis, corneal lens dislocation
and retinal tears.
Appointments may be obtained by calling 323-442-5100, and
asking to be seen in the Marfan Center.
Valvular Heart Disease
This center offers comprehensive evaluation of all types
of valvular disorders and timing and delivery of appropriate
management in a multidisciplinary set-up. The types of valvular
diseases include rheumatic, degenerative, drug induced,
valve problems associated with cardiomyopathy, mitral valve
prolapse etc. The members of the team include Ramdas G.Pai,
MD (medical director and cardiologist with special interest
in valves and advanced cardiac imaging), Vaughn Starnes,
MD (surgical director and Chairman of Cardiothoracic Surgery),
Padmini Varadarajan, MD (cardiologist with special interest
in valves and advanced cardiac imaging), Anil Mehra, MD
(percutaneous valve therapies), and Alex Durairaj, MD (percutaneous
valve therapies). Dr Starnes is a pioneer in the field of
valve repairs, minimally invasive valve surgery, robotically
assisted valve repairs and the Ross procedure. Dr.Pai is
expert in echocardiographic assessment of valvular lesions
including mechanisms of failure, using both transthoracic
and transesophageal echocardiography.
USC Heart Valve Center Provides:
• Assessment of known or suspected valve problems
• Follow up of patients with valve problems
• Transesophageal echocardiography for evaluation
of valves
• Follow up of patients after valve repair or replacement
• Evaluation of patients for percutaneous valvuloplasty
• Evaluation of patients by Dr Starnes for minimally
invasive valve repairs
• Evaluation of patients by Dr Starnes robotically
assisted valve repairs
• Complex mitral valve repairs and Ross procedure
by Dr Starnes
Appointments may be obtained by calling 323-442-5100 and
asking to be seen in the Heart Valve Center.
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