Heart and Vascular Care Coordinator
Maria Feo, BSN, RN-BC, CTTS
908-237-5440
We offer a dedicated professional to meet the needs of our heart and vascular patients.
Maria Feo, RNC, CTTS is an expert at cardiovascular preventative health care, as well as risk factor modification.
Maria is able to guide patients to services and resources that can aid them in recovery and beyond.
If you have any questions or need assistance, please contact:

Maria Feo, BSN, RN-BC, CTTS
Heart & Vascular Care Coordinator
908-237-5440
feo.maria@hunterdonhealthcare.org

Heart and Vascular

Interventional Cardiovascular Services

Cardiac catheterization
Carotid artery angioplasty and stenting
Peripheral vascular angiography, angioplasty and stenting
Primary Angioplasty (Emergency coronary artery angioplasty and stenting)
Emergent vascular services
Pacemaker and biventricular pacemaker implantation

 Cardiac Catheterization

What is cardiac catheterization?
What can I expect during a cardiac catheterization?

What are my options if the cardiac catheterization indicates a blockage? 

The Cardiac Catheterization Lab at Hunterdon Medical Center, established in 1997, is a state-of-the-art facility dedicated to meeting the needs of our cardiovascular patient population. A full array of cardiac and vascular diagnostic and interventional procedures are offered and rendered by board-certified interventional cardiologists, specialty trained registered nurses, and certified technologists. Emergency services, such as primary coronary angioplasty and vascular interventions, are available 24/7. In addition, our Cardiac catheterization lab performs essential services such as, cardiac and vascular angiography, pacemaker implantation, carotid angioplasty, and peripheral artery interventions.

Hunterdon Medical Center’s Cardiac Catheterization Laboratory was the first community hospital in New Jersey to perform carotid artery stenting, a minimally invasive breakthrough procedure.

We offer a Same Day Center for patients needing outpatient diagnostic and interventional procedures. The superior staff of the Cardiac Catheterization lab includes:


  • Interventional cardiologists
  • Invasive cardiologists
  • Electrophysiologist
  • Certified registered nurse manager/supervisor
  • Certified registered nurses
  • Registered cardiovascular invasive specialists (RCIS)
  • Radiographic technologist
  • Cardiovascular technologist
  • Unit coordinator

The Cardiac Catheterization Lab team works in conjunction with Hunterdon Cardiovascular Associates to provide our heart and vascular patients the most current diagnostic and treatment options and care.

The services provided by the Cardiac Catheterization lab have grown in importance over the years. They have saved countless lives and offered many people throughout the community a chance at a longer, healthier life. 

What is cardiac catheterization? Cardiac Catheterization is a nonsurgical procedure in which a thin, flexible tube (catheter) containing a special dye, visible only by x-ray, is inserted into an artery and guided to the heart.  Images will provide information on any coronary artery blockages, valvular heart disease and heart muscle function.

What can I expect during a cardiac catheterization?
Cardiac catheterization is a procedure that is performed in a special area of the hospital called the Cardiac Catheterization Lab.

  • X-ray cameras and monitors allow your doctor to visualize your heart and an arteries as the procedure is being done.
  • ECG (electrocardiogram) pads will be placed on your body to check your heart rhythm continuously during the procedure
  • Although you are awake for the procedure, medicine is given to help you relax.
  • The area of insertion will be numbed, and a catheter will be placed into an artery in the wrist, arm, or groin. A recent advancement in cardiac catheterization procedures, is the use of the radial artery located in the wrist. This procedure reduces the risk of bleeding complications, increases patient’s comfort, and shortens the patient’s hospital stay. More than 75 percent of primary angioplasty procedures performed at Hunterdon Medical Center are done through the radial artery.
  • A small amount of x-ray dye is injected through the catheter so pictures can be taken of your heart.
  • As the dye is injected, you may feel a warm sensation for a few seconds.
  • After the procedure, the catheter will be removed and the wrist insertion site will have a small band around it, which acts as a pressure device.
  • Your heart rhythm and blood pressure will continue to be monitored.
  • You will need to lie flat for a few hours to help heal the insertion site.
  • If the catheter was inserted in your groin, it may be sealed with a closure device to allow for a quicker recovery. You will need to keep your leg straight and lie flat if the physician has to use your groin for insertion.
  • Your health care providers will provide special instructions regarding care of the catheter site and activity.

Results of your cardiac catheterization are immediate.  The cardiologist will speak with you and your family following the procedure to discuss your results and treatment plan.

What are my options if the cardiac catheterization indicates a blockage?

  • Medical treatment in the form of medications
  • Cardiopulmonary rehabilitation program
  • Coronary angioplasty and/or stenting
  • Heart surgery, such as coronary bypass

Carotid Artery Angioplasty and Stenting

What is carotid artery disease?

What are the symptoms of carotid artery disease?

What are the risk factors for carotid artery disease?

How is carotid artery disease diagnosed?
What is carotid artery stenting?

What happens during carotid artery stenting?

Why should I choose Hunterdon for my carotid artery stenting procedure? 

What is carotid artery disease?
Your carotid arteries are the vessels that supply your brain with most of the blood it needs to work. You have two carotid arteries, one on each side of your neck. Carotid artery disease is when one or both of the carotid arteries become narrowed or blocked.

Carotid artery disease is caused by atherosclerosis, also called hardening of the arteries. Atherosclerosis is when fatty deposits and other material build up in an artery and form plaque. This plaque buildup is what narrows or blocks the carotid arteries.

Plaque in the arteries increases your chance of having dangerous blood clots. Blood clots can travel to different areas of the body and cause serious problems, such as a stroke.

What are the symptoms of carotid artery disease?
Many people with carotid artery disease do not have any symptoms.  However, some people may experience transient ischemic attacks (TIAs), also called “temporary strokes” or “mini strokes.”  TIA symptoms usually last for a few minutes and go away completely within 24 hours.

Signs of a TIA or stroke include sudden onset of the following symptoms:

  • Numbness or weakness of the face, arm, or leg, especially on one side
  • Confusion or dizziness
  • Trouble speaking or understanding other people
  • Trouble seeing in one or both eyes
  • Trouble walking, loss of balance or coordination
  • Severe headache with no known cause
  • Trouble swallowing

If you experience any of these symptoms it is a medical emergency.  Seek help immediately and call 9-1-1 to activate Emergency Services!

What are the risk factors for carotid artery disease?

  • Age: You are more likely to develop carotid artery disease as you age.
  • Gender: Males have carotid artery disease more often than females.
  • Family history: You are more likely to have problems if atherosclerosis or stroke runs in your family.
  • Heart disease: Atherosclerosis can cause narrowing of the arteries in the heart as well as the carotid arteries.
  • Other health problems: You are more likely to have carotid artery disease if you have high blood pressure, high cholesterol, diabetes, or problems with blood circulation.
  • Smoking: Smoking causes your arteries to narrow and decreases the amount of oxygen in your blood. It also damages the walls of your arteries, which may allow blood clots to form. Smoking increases your risk of having a heart attack, stroke, and other serious health problems.
  • Obesity and lack of exercise: A sedentary lifestyle leads to increased risk of cardiovascular disease and incidence of stroke.

 How is carotid artery disease diagnosed?

  • Carotid bruit: When blood flows through a narrowed carotid artery, it often makes a loud "whooshing" noise. Your healthcare provider may hear this noise, called a bruit, through a stethoscope placed on your neck.
  • Carotid Doppler is a diagnostic study used to determine if there is any plaque or blockage of the carotid arteries. A Carotid Doppler is a noninvasive ultrasound procedure performed by a sonographer with special training in vascular studies. The sonographer scans each side of the neck using an ultrasound probe and gel. Each study averages about 30 minutes. Unlike other ultrasound studies, there are no requirements prior to testing.
  • CT Scan is a diagnostic test that uses X-rays and an injected dye to produce 3-dimensional images of the carotid (neck) arteries.
  • Carotid Angiogram is a nonsurgical procedure in which a thin, flexible tube (catheter) containing a special dye, visible only by x-ray, is inserted into an artery and guided to the carotid artery.  Images will provide information on any carotid or cerebral artery blockages, and blood flow to the brain.
  • Magnetic resonance angiography (MRA) is a diagnostic test that uses a powerful magnet and radio waves to create detailed images of the carotid arteries and surrounding tissues. The test does not require entering the body (it is non-invasive) and does not involve exposure to radiation.

What is carotid artery stenting?
Carotid artery stenting is used for treatment of carotid artery disease. It is a minimally invasive breakthrough procedure to prevent strokes. Carotid artery stenting is generally performed in less than an hour and requires an overnight stay in the hospital. One of the benefits of having carotid artery stenting is that it offers a select group of patients a safer alternative to major surgery.

What happens during carotid artery stenting?

  • Carotid artery stenting is a relatively new procedure, which does not require an incision in the neck or general anesthesia. The procedure is performed in a special area of the hospital called the Cardiac Catheterization Lab.
  • X-ray cameras and monitors allow your doctor to visualize the carotid arteries as the procedure is being done.
  • ECG (electrocardiogram) pads will be placed on your body to check your heart rhythm continuously during the procedure.
  • Although you are awake for the procedure, medicine will be given to help you relax.
  • The area of insertion will be numbed, and a catheter will be placed into an artery in the groin or arm.
  • A small amount of x-ray dye is injected through the catheter so the cardiologist can visualize how easily blood is flowing through the arteries, and assess for any blockages that may be present.
  • As the dye is injected, you may feel a warm sensation for a few seconds.
  • A medical device called a stent is inserted to keep the artery open.
  • A safety feature is utilized during the procedure called an “embolic protection device.”  It is comprised of a small wire with a filter on the end, which prevents any debris released during the procedure from migrating to the brain.   
  • After the procedure, the catheter will be removed and the insertion site may be sealed with a closure device to allow for a quicker recovery.
  • Your heart rhythm and blood pressure will continue to be monitored.
  • You will need to lie flat for a few hours to help heal the insertion site.
  • If the catheter was inserted in your groin, you will need to keep your leg straight.
  • Your health care providers will provide special instructions regarding care of the catheter site and activity.
  • The cardiologist will speak with you and your family immediately following the procedure.

Why should I choose Hunterdon Medical Center for my carotid artery stenting procedure?
Carotid artery stenting is performed by only a small percentage of highly trained interventional physicians in the United States.

  • Hunterdon Medical Center is a leader in carotid artery stenting procedures.  Interventional Cardiologist, Andrey Espinoza MD, FACC, FSCAI, has performed more than 250 carotid artery angioplasty and stenting procedures, since 2004 when it was adapted as a breakthrough procedure.

Peripheral angiogram, angioplasty and stenting

Signs and symptoms of peripheral vascular disease (also called Peripheral Artery Disease or “PAD”)
Am I at risk for PAD?
How is PAD diagnosed?
How do you treat PAD?
What happens during peripheral angiography, angioplasty and stenting?

Vascular disease refers to problems affecting your blood vessels (arteries and veins) outside of the heart.  Vascular disease often occurs due to narrowing of the vessels that carry blood to the legs, arms, kidneys and other vital organs.

Examples of vascular disease are:
Peripheral Artery Disease (PAD)
Carotid Artery Disease
Stroke

Signs and symptoms of peripheral vascular disease (also called Peripheral Artery Disease or “PAD”)
PAD develops slowly over many years. In the early stages, most people with PAD have no symptoms. The most common signs of PAD include one or more of these problems:

  • Cramps, tiredness or pain in your legs, thighs, or buttocks that always happens when you walk but that goes away when you rest. This is called claudication.
  • Foot or toe pain at rest that often disturbs your sleep. Burning pain in your hands, fingers, feet or toes relieved with rest or a warm environment.
  • Tight, shiny, cold skin with uneven hair growth.
  • A change in skin color such as white, red, blue, purple or black that is not normal for you. (This could be the sign of a vascular emergency
  • Wounds or sores on your feet or toes that are slow to heal (or do not heal for 8-12 weeks).
  • Tingling decreased feeling or no feeling in your hands or feet.
  • Weakness in your extremities.

 If you are experiencing any of the symptoms above, be sure to discuss with your healthcare provider since it may be a warning sign of PAD.

Note: When you click on the following resource you will leave the Hunterdon Healthcare System website and be redirected to an outside site. The individuals portrayed on the outside sites are not employees of Hunterdon Healthcare. Hunterdon Healthcare does not endorse any particular products advertised on the websites visited.

 Source: http://www.vdf.org

 Am I at risk for PAD?
The chance of having PAD increases as you get older. People over age 50 have a higher risk for PAD, but the risk is increased if you:

  • Smoke (now or in the past)
  • Have diabetes
  • Have high blood pressure
  • Have high cholesterol
  • Are of African-American ethnicity
  • Have a history of heart disease, heart attack, or stroke

Note: When you click on the following resource you will leave the Hunterdon Healthcare System website and be redirected to an outside site. The individuals portrayed on the outside sites are not employees of Hunterdon Healthcare. Hunterdon Healthcare does not endorse any particular products advertised on the websites visited.

 Source: http://www.vdf.org

 How is PAD diagnosed?

 How do you treat PAD? 

  • Lifestyle changes are your first step towards treating PAD:
    • Quit smoking
    • Know your blood sugar levels and control your diabetes
    • Know your cholesterol levels and control your cholesterol
    • Eat a balanced diet full of fruits, vegetables and whole grains
    • Control your blood pressure and get a yearly physical
    • Be active for at least 30 minutes per day
    • Take medication as prescribed if your doctor orders it
    • In some cases, peripheral angioplasty and stenting or 
      femoropopliteal bypass surgery may be required

What happens during peripheral angiography, angioplasty and stenting?
Specialized procedures to diagnose and treat PAD are performed in our Cardiac Catheterization Lab, by board-certified interventional cardiologists. If an obstructed peripheral artery is inhibiting blood flow to your legs, we have advanced tools to fix the problem. 

  • X-ray cameras and monitors allow your doctor to visualize the peripheral arteries as the procedure is being done.
  • ECG (electrocardiogram) pads will be placed on your body to check your heart rhythm continuously during the procedure.
  • Although you are awake for the procedure, medicine will be given to help you relax.
  • The area of insertion will be numbed, and a catheter will be placed into an artery in the groin or arm.
  • A small amount of x-ray dye is injected through the catheter so the cardiologist can visualize how easily blood is flowing through the arteries, and assess for any blockages that may be present.
  • As the dye is injected, you may feel a warm sensation for a few seconds.
  • A balloon is inserted and inflated to open up the blocked artery, leaving a wider opening for blood flow. Sometimes the interventionalist will use atherectomy devices (devices that remove plaque from the artery) first for better results.
  • A spring-like metal device called a stent may be inserted to keep the artery open.
  • After the procedure, the catheter will be removed and the insertion site may be sealed with a closure device to allow for a quicker recovery.
  • Your heart rhythm and blood pressure will continue to be monitored.
  • You will need to lie flat for a few hours to help heal the insertion site.
  • If the catheter was inserted in your groin, you will need to keep your leg straight.
  • Your healthcare providers will give you special instructions regarding care of the catheter site and activity.
  • The cardiologist will speak with you and your family immediately following the procedure.

Primary Angioplasty
Is primary angioplasty a treatment for heart attack?

How is primary angioplasty performed?

Is Hunterdon MedicalCenter a leader in primary angioplasty?

Is primary angioplasty a treatment for heart attack?
Yes. Primary angioplasty is not only an emergency procedure done in the midst of a heart attack; it is the preferred treatment for heart attacks according to the American College of Cardiology. Emergency angioplasty has been found to reduce the risk of heart attack-related complications – including stroke or a second heart attack – and reduce the likelihood of the development of congestive heart failure due to heart muscle damage. In most cases, emergency angioplasty requires only local anesthesia, reducing the risk of anesthesia-related complications. Primary angioplasty enables our interventional cardiologists to visualize the blocked artery and immediately open it, restoring blood flow to the heart.

How is primary angioplasty performed?
During primary angioplasty a balloon is inserted and inflated to open up the diseased artery causing the heart attack, leaving a wider opening for blood flow, which decreases heart damage. A spring-like metal device called a stent is inserted to keep the artery open.

Is Hunterdon Medical Center a leader in primary angioplasty?
Yes! Hunterdon Medical Center's “door to balloon” time (time from the Emergency Room to emergency angioplasty) is less than 60 minutes!  The national goal is 90 minutes. 

Emergent Vascular Services
Blockages can affect any artery in the body. PAD (Peripheral Artery Disease) occurs when blood vessels become narrowed or blocked by fatty deposits, or plaque. This buildup of plaque, also called atherosclerosis, causes the arteries, which supply blood flow to the legs and feet, to harden and become clogged.

PAD most often occurs in the legs, but can also affect other arteries that carry blood outside the heart. When a piece of plaque or a blood clot breaks off from the lining of the artery, blood flow can be totally obstructed, leading to serious complications. Acute limb ischemia occurs when blood flow to a limb is severely decreased, resulting in lack of oxygen-rich blood flow to the extremity.

Vascular emergencies, such as acute limb ischemia can be limb and life threatening. A cold, blue, or painful extremity should be considered a true medical emergency. A few hours can make the difference between loss of limb, or amputation, or even death. Patients can be evaluated in the emergency room and an on-call team is dispatched if acute limb ischemia is diagnosed. Emergent Vascular services at Hunterdon Healthcare System provides treatment options, which include an angiogram to diagnose the blockage, and interventions such as clot removal, clot-busting medications, angioplasty and stenting of the artery.

Pacemaker and Biventricular Pacemaker Implantation
What is a pacemaker and how do I know if I need one?

How is a pacemaker implanted?

What does a pacemaker feel like?
How many types of pacemakers are there?   

What is a pacemaker and how do I know if I need one?
A pacemaker is a small device, about the size of a wristwatch that helps regulate your heart rate. It is made of thin, flexible wires called leads and a generator. 

Your doctor may recommend a pacemaker if you suffer from, or have had the following:

  • Ventricular tachycardia- when your heart beats too fast
  • Cardiomyopathy -- when your heart is enlarged and can not pump effectively
  • Dizziness, severe fatigue, fainting, or confusion
  • Heart surgery
  • Slow heart rate

How is a pacemaker implanted?
The pacemaker implantation procedure may be done as an in-patient or out-patient procedure, and takes approximately two hours. Although you are awake for the procedure medicine is given to help you relax. A small incision is made in your neck or chest. With the help of a special x-ray, the pacemaker leads are guided into your heart. The leads may be hooked to the outside of your heart. A pocket is made under your skin, usually just below your collarbone, where the generator is placed. The leads are connected to the generator, and the pacemaker is programmed specifically for the needs of your heart.

What does a pacemaker feel like?
Although you will be able to see and touch the outline of the pacemaker, you will not feel it monitoring your heart.

How many types of pacemakers are there?
There are four different types of pacemakers:

  • A permanent, or long-term pacemaker, is one that you will have forever.
  • An external pacemaker, called a transcutaneous pacemaker is used in emergency situations when your heart is beating too slowly. When this happens, your physician needs to speed up your heart rate quickly. Small sticky patches are applied to your chest, and leads are attached to these patches. At the end of the leads is a pacemaker with dials on it. These dials allow your caregiver to immediately adjust the settings of the pacemaker. This type of pacemaker is used for a short time. Afterwards, you may need to get a permanent pacemaker, or you may not need a pacemaker anymore.
  • A transvenous pacemaker is also called a temporary pacemaker. The leads for this type of pacemaker are guided into your heart via a vein in your neck or groin. With a transvenous pacemaker, the generator is worn outside your body in a small pouch. 
  • biventricular pacemaker is surgically placed in your chest.  It has an extra lead to help the left ventricle contract simultaneously with the right ventricle.  Your doctor may recommend this type of pacemaker to help improve moderate to severe heart failure symptoms not relieved with medication.