1500 East Medical Center Drive 3Rd Floor Cardiovascular Center
Ann Arbor MI 48109
Medical School: Other - 2001
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: Yes
Participates In EHR: No
Taxonomy Codes:207R00000X 207RC0000X 207RC0001X
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Awards & Recognitions
Dr. Ramil Goel is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:99223||Description:Initial hospital care||Average Price:$251.25||Average Price Allowed
|HCPCS Code:99215||Description:Office/outpatient visit est||Average Price:$168.90||Average Price Allowed
|HCPCS Code:99214||Description:Office/outpatient visit est||Average Price:$121.42||Average Price Allowed
HCPCS Code Definitions
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
- Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.
Medical Malpractice Cases
Medical Board Sanctions
*These referrals represent the top 10 that Dr. Goel has made to other doctors
Effect of head-up tilt-table testing on left ventricular longitudinal strain in patients with neurocardiogenic syncope. - The American journal of cardiology
Recent studies have shown conflicting data regarding left ventricular (LV) function in patients with neurocardiogenic syncope, with some investigators reporting a marked decrease in LV end-systolic wall stress and stress-corrected fractional shortening. We sought to determine the characteristics of resting LV deformation in patients with neurocardiogenic syncope by selective motion tracking of subendocardial and subepicardial regions using speckle tracking echocardiography. We assessed resting LV function in 82 patients undergoing head-up tilt-table (HUTT) testing. Patients were divided into 3 groups based on a positive HUTT test with associated co-morbid conditions (nÂ = 30), no associated co-morbid conditions (nÂ = 30), or negative HUTT results (nÂ = 22). LV longitudinal, circumferential, and radial strains were obtained by speckle tracking echocardiography of subendocardial and subepicardial regions in each group and compared with resting LV deformation in 20 healthy control subjects. Compared with endocardial longitudinal strain in control subjects, that in patients with positive HUTT results was attenuated, irrespective of co-morbid conditions (p <0.05). Circumferential and radial strains did not differ among groups. On multivariate logistic regression analysis, endocardial longitudinal strain was an independent predictor (odds ratio, 1.16; pÂ = 0.01) of positive HUTT test results. In conclusion, resting LV longitudinal strain is attenuated in patients with positive HUTT test results. Overall, these results may suggest that an increase in resting LV contractility is not a prerequisite for development of neurocardiogenic syncope.Copyright Â© 2013 Elsevier Inc. All rights reserved.
Supraventricular and ventricular arrhythmias. - Primary care
Cardiac arrhythmias comprise of a heterogeneous group of disorders which manifest in a wide range of clinical presentations. They can be associated with underlying cardiac disease and portend a grave prognosis, with some arrhythmias being rapidly fatal. Other arrhythmias, however are relatively benign and can be asymptomatic or may be a mere inconvenience for the patient. All primary care physicians can expect to encounter some forms of arrhythmias during the course of their practice. This review article provides a brief overview of the commonly seen tachyarrhythmias for the general practitioner and provides relevant updates on the recent developments in our understanding of their mechanisms and management.Copyright Â© 2013 Elsevier Inc. All rights reserved.
Newer oral anticoagulant agents: a new era in medicine. - Current cardiology reviews
After a gap of almost 60 years following the development of warfarin, 2 new categories of oral anticoagulant agents have been approved for clinical use - the direct thrombin inhibitors and factor Xa inhibitors. These agents promise to be more convenient to administer with fixed dosing but still have equivalent efficacy and improved bleeding risk compared to warfarin. The clinical community is looking forward to the widespread usage of these agents but there is also some apprehension regarding bleeding risks, non-availability of specific reversal strategies and lack of specific monitoring parameters. This review article will attempt to educate the reader about three representative drugs from these classes: Dabigatran, Rivaroxaban and Apixaban. We will discuss the historical perspective to the development of these drugs, available research data and pharmacology of these agents. The best strategies for monitoring and reversal of these drugs in special situations will also be touched upon.
Pacing polarity and left ventricular mechanical activation sequence in cardiac resynchronization therapy. - Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
The aim of this study is to evaluate the relationship between polarity of left ventricular (LV) pacing and the resultant regional, global, and transmural mechanical sequence of contraction.Cardiac resynchronization therapy (CRT) is widely utilized in patients with drug refractory congestive heart failure with systolic dysfunction (EF <35 %) and intraventricular conduction delay (QRS duration >120 ms). However, little is known about polarity of pacing stimulation and the resultant differences in LV mechanics.The polarity of pacing was altered sequentially in 20 patients (73â€‰Â±â€‰13, 16 males) with preexisting biventricular devices with potential choice of multiple vectors for pacing stimulation. Initial unipolar or extended bipolar configurations were switched to bipolar configuration or vice versa, and echocardiographic images were acquired for off-line analysis. Regional and global LV longitudinal and radial mechanics were assessed selectively from the subendocardial and subepicardial regions with 2D speckle-tracking echocardiography. Left ventricular capture by each vector configuration was confirmed by local lead capture and appropriate QRS alteration.Unipolar pacing resulted in increased dispersion of LV regional endocardial strains with a higher base-to-apex gradients of longitudinal shortening strains (Pâ€‰<â€‰0.05). LV longitudinal shortening strain magnitude was higher at LV base with bipolar stimulation in comparison with unipolar stimulation (-10.5â€‰Â±â€‰10.5 vs. -4.2â€‰Â±â€‰6.3, Pâ€‰=â€‰0.02).There is a difference in the mechanical activation sequence of the LV between unipolar vs. bipolar pacing stimulation. This may have important implications for CRT.
Coronary artery calcification and coronary atherosclerotic disease. - Cardiology clinics
The presence of coronary artery calcium is closely associated with the presence of atherosclerotic lesions in the coronary vasculature. Detection of coronary calcium by imaging techniques has evolved over the last few decades and has become especially more sophisticated with advanced imaging technology. Whereas the status of coronary artery calcium as a marker of increased cardiovascular risk is well established, the indication for testing continues to be a topic of debate.Copyright Â© 2012. Published by Elsevier Inc.
Epicardial fat and its association with cardiovascular risk: a cross-sectional observational study. - Heart views : the official journal of the Gulf Heart Association
The association between visceral obesity and cardiovascular risk has been well described. Some studies show a proportional relationship between the presence of visceral obesity and epicardial fat. Measuring the amount of epicardial adipose tissue (EAT) can be a novel parameter that is inexpensive and easy to obtain and may be helpful in cardiovascular risk stratification. However, the relationship between epicardial fat and cardiac function and that between epicardial fat and cardiac risk factors is less well described.To evaluate the association between echocardiographic epicardial fat and the morphologic and physiologic changes observed at echocardiography and to evaluate the association between epicardial fat and cardiac risk factors. A cross-sectional study of 97 echocardiographic studies (females, n = 42) was conducted. Two groups were identified: epicardial fat â‰¥ 5 mm (group I) and <5 mm (group II).Epicardial fat >5 mm was associated with LA enlargement, with lower ejection fraction, increased left ventricular mass, and abnormal diastolic function. On a multivariable regression analysis, all these parameters also correlated individually with EAT thickness independent of age. Hyperglycemia (DM), systolic hypertension, and lipid parameters for metabolic syndrome showed a trend for positive association, but this was not statistically significant. The association was not significant even for higher cutoff limits of EAT thickness.Epicardial fat >5 mm is associated with cardiac abnormalities on echocardiography. This is a sensitive assessment of body fat distribution, is easily available at echocardiography, and is simple to acquire at no added cost. Further studies looking at the appropriate cut-off thickness of EAT and the sites of measurement to be used are needed. Comparison of this simple and inexpensive measure with other measures of obesity, such as waist-hip ratio, body mass index, Dexa scan of visceral fat, and magnetic resonance imaging of visceral, are needed.
Critical appraisal on the utility of echocardiography in the management of acute pulmonary embolism. - Cardiology in review
Echocardiography can be used for rapid and accurate risk stratification of patients with pulmonary embolism to appropriately direct the therapeutic strategies for those at high risk. Echocardiography is an ideal risk stratification tool in this regard because of its easy portability to the emergency room or to the bed side. It can be performed at a relatively low cost and at no risk to the patient. Furthermore, echocardiography allows repetitive noninvasive assessment of the cardiovascular and hemodynamic status of the patient and the response to the therapeutic interventions. Right ventricular hypokinesis, persistent pulmonary hypertension, a patent foramen ovale, and a free floating right heart thrombus are echocardiographic markers that identify patients at a higher risk for morbidity and mortality. Such patients warrant special consideration for thrombolysis or embolectomy.
Pulmonary thromboembolic disease spectrum: diagnostic and therapeutic strategies. - Expert review of cardiovascular therapy
Pulmonary thromboembolic disease continues to be a challenge in terms of diagnosis and management. This is true for both the acute and chronic forms. Clinical presentation can be nonspecific and manifestations protean, hence a high index of clinical suspicion is warranted so that appropriate tests are performed to help clinch the diagnosis. Acute pulmonary embolus can result in death if untreated, and may progress to chronic thromboembolic pulmonary hypertension if not diagnosed or if it is undertreated. This extensive literature review provides an up-to-date evidence-based approach to the management of acute and chronic pulmonary thromboembolic disease.
The QuantumCor device for treating mitral regurgitation: an animal study. - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
The mitral annular contraction achieved could help reduce mitral regurgitation (MR), and with appropriate modifications, be applied to human subjects providing a potentially effective percutaneous method of valve repair.MR is an important source of morbidity and is an independent predictor of mortality. A variety of percutaneous approaches are being developed to address this issue. We introduce a novel potential method utilizing radiofrequency (RF) energy to heat and shrink the mitral valve annulus in an animal model.In open-heart procedures in 16 healthy sheep (six with naturally occurring MR), we used a malleable probe (QuantumCor, Lake Forest, CA) that conforms to the annular shape to deliver RF energy via a standard generator to replicate a surgical mitral annular ring. Seven sheep were followed chronically and their mitral annulus dimensions measured serially.All sheep underwent intracardiac echocardiography or direct circumferential measurement of the mitral annulus before and after RF therapy. RF therapy was administered in less than 4 min in each case, and the mean anteroposterior (AP) annular distance was reduced by a mean of 23.8% (AP diameter reduction 5.75 +/- 0.86 mm, P < 0.001) acutely. In the six sheep with nonischemic MR, regurgitation was eliminated. Acute histopathology (HP) demonstrated no damage to the leaflets, coronary sinuses, or coronary arteries. At the end of the intended 6-month period of the chronic part of the study, four of the seven animals survived. The four treatment animals showed significant reductions in mitral A-P dimension, with a percent diameter reduction of 26.4% (AP diameter reduction 7 +/- 2.3 mm).The application of RF directly to heat the mitral annulus has resulted in sustained contraction of the annulus in this limited preclinical animal study. With further study and possible modifications, it holds promise for future application in human subjects with MR.Copyright 2009 Wiley-Liss, Inc.
Hypersensitivity Reactions to oxaliplatin: incidence and management. - Oncology (Williston Park, N.Y.)
Oxaliplatin (Eloxatin) is a novel platinum compound that has activity in a wide variety of tumors. Several hypersensitivity reactions distinct from laryngopharyngeal dysesthesia have been described. We retrospectively analyzed 169 consecutive patients who received oxaliplatin for esophageal or colorectal cancer between 1/1/00 and 7/31/02 and reviewed any significant adverse reactions labeled as hypersensitivity reactions. Thirty-two patients (19%) reportedly experienced hypersensitivity. Skin rash was the most common event (22 patients), occurring after a median of three infusions. Fever was seen in five patients after a median of two infusions. Five patients experienced respiratory symptoms at median infusion number 6. Ocular symptoms of lacrimation and blurring of vision were seen in two patients. Five patients experienced more than one type of reaction. Treatments prescribed for hypersensitivity were antihistamines, steroids, and topical emollients. One patient developed grade 4 hypersensitivity during cycle 6, characterized by laryngeal edema, tongue swelling, and labored breathing. This patient underwent a desensitization procedure, adapted from guidelines for carboplatin (Paraplatin) allergy. Subsequently, three cycles were administered over 6 hours and were well tolerated. However, during the fourth infusion postdesensitization, the patient developed recurrent signs of hypersensitivity. In conclusion, hypersensitivity is frequently seen with oxaliplatin, but most reactions are mild.
Map & Directions
1500 East Medical Center Drive 3Rd Floor Cardiovascular Center Ann Arbor, MI 48109
1500 E Medical Ctr Dr 2Nd Floor University Hospital Recp Pathology
1011 N University Ave
1500 E Medical Ctr Dr F6884 Mott, C.S Mott Childrens Hospital,
1500 East Medical Ctr Dr 3Rd Floor Taubman Ctr Recp B
1500 E Medical Ctr Dr 2Nd Floor University Hospital Recp Pathology
1500 East Medical Ctr Drive 1H247 University Hospital