24 Hour blood pressure recording
High blood pressure (hypertension) is one of the major causes or risk factors for of heart disease and stroke. It is normal for blood pressure readings to vary throughout the day but it is well known that some patients have very high readings when they are taken in a medical setting (white coat effect) but overall their ‘true’ blood pressure is satisfactory. If this situation is suspected we may recommend you wear a special machine which records your blood pressure throughout the day and night. The monitor takes blood pressures every 20 minutes (less frequently over night).This gives us a feel for your true blood pressure. The test may also be used to check that satisfactory control is being achieved in patients taking tablets for high blood pressure.
24/48 Hour ECG Recording (‘Holter’ recording)
Palpitations or awareness of the heartbeat are extremely common but usually only occur intermittently. A simple resting ECG will often not ‘catch’ the rhythm of the heart whilst the patient has symptoms. In this situation, we will often suggest the fitting of a 24/48 hour ECG recorder. The small recorder (about the size of a small iPod) is called a Holter monitor and as you go about normal daily life the monitor makes a graphic record of the heart’s electrical currents and provides valuable information about the basic rhythm of the heart as well as the rhythm at the time of symptoms.
Sometimes palpitation symptoms are very elusive and may not be recorded during the 24/48 hours of recording. In this situation, a longer period of recording using a small device you carry with you and activate at the time of symptoms (‘event recorder’) may be recommended.
Caridomemo and event recorder
These are more sophisticated versions of the basic Holter. Whenever you have an attack of symptoms, you can activate the device to record your heart’s rhythm.
The advantage of the cardiomemo is that it doesn’t have any leads, so you can just place it on your chest when you get symptoms, without having to put any leads in position.
Blood testing is an essential way of checking for disease and establishing the chances or risk of developing a heart problem in the future. We have access to the full range of blood tests including lipid biomarkers and the results will be available promptly – sometimes even on the day that they are taken.
Coronary angiogram (cardiac catheterisation)
A coronary angiogram is a special x-ray test designed to take pictures of the arteries of the heart. It is a safe test and is performed under local anaesthetic. It’s done to find out if your coronary arteries are clogged, where and by how much. An angiogram helps your cardiologist to see if you need treatment such as angioplasty, coronary artery bypass surgery or medical therapy.
Before the procedure, you may be given medicine to relax you, but you will stay awake. You go to the catheterisation laboratory (“cath lab”) and lie on a table near a camera and other equipment. Your cardiologist numbs a spot on your groin or arm and inserts a thin tube (catheter) into an artery and up to the heart. Most people do not find this particularly uncomfortable. A special fluid is injected through the catheter to show up the coronary arteries on an x-ray. Many x-rays are taken as the fluid goes through the artery. The test gives us a roadmap of the arteries and shows up any blockages or narrowings. The valves, pumping function and oxygen levels in the heart can also be assessed.If you wish, you can see the x-ray pictures on the screen during or after the test.
After the test, the catheter will be taken out. A nurse or doctor will apply direct pressure for 15 minutes or longer where the catheter was inserted to make sure there is no internal bleeding. You will be asked to lie quietly on your back for several hours. You won’t have to lie on your back if the catheterisation was performed from an artery in your arm. The patient will be brought back to their hospital room or Cardiac Care Unit (CCU). It is possible that the patient may feel sore where the catheter was inserted or from lying on your back. Generally, we recommend that you take a few days off work after the procedure and do not drive for a couple of days.
Coronary CT scanning and EBCT (Electron-beam CT scan)
This is a scan to look for calcium buildup in the arteries of the heart (coronary calcification) which is a very early sign of furred and narrowed arteries. This usually occurs long before any symptoms of a heart problem develop and is therefore used as a screening test in people who may be at risk of heart disease.
The very latest scanners are now able to actually take angiogram-like pictures of the arteries without the need to place tubes in the heart, although the use of x-rays is still required and the results are not as reliable as those provided by conventional angiography.
Echocardiogram (‘echo’ or ultrasound)
An echocardiogram is a test that uses high-frequency sound waves (ultrasound) to create an image of the heart. The test uses sound waves to measure the speed and direction of blood flow. By combining these tests, a cardiologist receives useful information about the heart’s anatomy and function. It allows us to assess all aspects of heart function including size and thickness of the walls and chambers of the heart, the heart’s pumping function and the function of the heart valves. Echocardiography is the most common test used to diagnose or rule out heart disease and also to follow-up on patients who have already been diagnosed with a heart problem.
Echo is a completely safe and painless test and takes up to 30 minutes to perform and revolutionised the assessment of cardiac disease when it was developed in the 1970s.
This simple, painless test takes a few minutes to perform. It records the normal electrical activity of the heart into a tracing and this can reveal a number of different cardiac conditions. An ECG gives two major kinds of information. Firstly, it can demonstrate abnormalities of the cardiac rhythm. Secondly, it can show possible abnormalities of the heart structure. As it is only a single brief snapshot of the heartbeat at rest a normal ECG does not necessarily exclude important disease of the heart. There’s no pain or risk associated with having an electrocardiogram. When the ECG stickers are removed, there may be some minor discomfort.
Exercise Tolerance Test
This is a key test to assess angina but is often also used to ‘screen’ patients without symptoms for early signs of coronary heart disease.
An exercise tolerance test is sometimes called an exercise test, stress test or a treadmill test, exercise test or stress ECG. It helps a doctor find out how well your heart handles work. As your body works harder during the test, it requires more oxygen, so the heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart. It also helps doctors know the kind and level of exercise appropriate for a patient.
A continuous ECG is taken whilst you undergo graded standardised exercise on a treadmill. The test starts at a leisurely pace and gradually the speed and gradient increase every three minutes. The technician can stop the test at any time if needed. Blood pressure is also checked every three minutes. Afterwards, the patient will sit or lie down to have their heart and blood pressure checked during recovery.
Heart rate, breathing, blood pressure, electrocardiogram and your symptoms are monitored during the test. Healthy people who take the test are at very little risk. It’s about the same as if they walk fast or jog up a big hill. Medical professionals will be on standby in case something unusual happens during the test.
Patients with a coronary disease may experience symptoms and this is often associated with characteristic changes in the shape of the ECG.
Depending on the results of the exercise stress test, the doctor may recommend more tests such as a stress echo, thallium scan or cardiac catheterisation (coronary angiogram).
Echocardiogram and ultrasound technology has developed very rapidly and in certain situations, even more, specialist forms of echo scanning of the heart are required.
Trans-Oesophageal Echo (T.O.E.)
Usually, a standard echocardiogram is detailed enough to give all the information about the heart we require. Sometimes, however, particularly in patients with a problem with the heart valves, we need to get really detailed pictures of the heart and this can be done by passing a narrow flexible tube down your throat into the oesophagus (the feeding tube between your mouth and stomach). It is very similar to the scope used for upper endoscopy by gastroenterologists. The tube has a tiny echo sensor built into the tip and this generates extremely detailed pictures of the heart with no interference from the lungs and ribs. The procedure is carried out under sedation and usually takes 20 to 40 minutes, but the total time with sedation is usually 60 to 90 minutes. This test is extremely safe and you will usually only need to spend a few hours in the hospital and go home on the same day.
Even in patients with severe narrowing of the hearts arteries (coronary artery disease) the echocardiogram at rest may be completely normal. In this situation, however, under the stress of exercise, the function of the heart can become abnormal in areas of the heart where there is a problem with blood flow. Stress echo uses this fact to help us diagnose coronary artery disease and may be used as an alternative to an exercise test or perfusion (MIBI/thallium) scan. Following a detailed resting echocardiogram, the heart is ‘stressed’ either by exercising you or with a special medicine injected into a small vein. The echocardiogram is then repeated and the images compared.
This test is extremely safe and you will usually only need to spend an hour or two in the hospital and go home on the same day.
Thallium Scan (Perfusion scan)
This is a specialised scan to assess the blood flow to the heart. The heart is usually stressed with a medication given into a vein and a, a tiny amount of a special radioactive substance is injected. A scan of the heart taken using a gamma camera. Occasionally a second test without stress is required at a later stage Areas of the heart with poor blood supply are highlighted on the scan.
If this test is not normal your cardiologist may well suggest you have an angiogram.
This test is used to investigate dizziness and fainting. The patient is placed on a specially designed bed which is then tilted to 60 degrees with the head up. The patient’s pulse and blood pressure are closely monitored. It has been found that, depending on the cause, this test will provoke a typical episode of fainting and thereby allow us to see the cause of the problem and plan treatment.