Testing

Your Consultant Cardiologist may recommend a number of different investigations to help him diagnose and treat your cardiac symptoms/condition. Our Practice Nurse will discuss these in detail with you when booking your appointment and will happily answer any queries that you may have. The investigations that may be recommended include:

Electrocardiogram (ECG)

It is likely that during your initial consultation your Consultant will perform this painless test which takes just a few minutes. It provides an electrical trace of your heart and gives an overview of your heart at rest. This simple test can be an early indicator of problems with your heart rhythm, blood supply and structure. It helps to guide your Consultant as to what further investigations you may require.

Blood tests

Blood tests are a basic but very informative device for our Cardiologists. They help to give an overview of your general health and allow us to assess the function of your key organs (eg liver, kidney and thyroid function). They are also used to identify potential risk factors in the body which may cause problems with your heart in the future (eg cholesterol levels). Blood tests are taken by our experienced and reassuring Practice Nurse who is well aware that you may be nervous about having this done. The sample is sent for analysis to a local laboratory and in most cases the results are normally available within 24 hours.

Echocardiogram (Echo)

An echocardiogram is one of the most informative cardiac investigations that your Cardiologist will request. This detailed ultrasound scan assesses the overall function and effectiveness of your heart and provides a detailed review of its structure including the heart valves, chambers and muscle. This is a painless and safe scan which takes about 20 minutes to complete. It involves you removing your clothes from the waist upwards and having a small probe placed on your chest above your heart so various pictures and measurements can be made. You may hear some sounds as the blood flow across the heart valves is assessed. This is perfectly normal and you should not worry about this! Your echo will be performed by either one of our Consultant Cardiologists or by one of our highly qualified and experienced Cardiac Technicians. Our Practice Nurse will also be in attendance to assist you.

Specialised Echocardiograms

With certain cardiac conditions your Consultant Cardiologist may require more detailed information than can be obtained from a standard echocardiogram. He may then request a more specialised echocardiographic study:

1. Trans-oesophageal echo (TOE)

TOE may be recommended for patients with complex heart valve problems or with recent strokes where more detailed pictures of the heart are needed. Under sedation a narrow flexible tube is passed down your throat and into the gullet (‘oesophagus’). Pictures and measurements can then be taken from the back of the heart without any interference from the lungs and ribs which can obscure some of the views on a standard echo study. This investigation is undertaken as a day case procedure.

Prior to your TOE your Consultant Cardiologist will discuss this procedure at length with you and will then give you an information sheet which should address any questions that you might have. The procedure will be performed personally by your Consultant and is undertaken at a local hospital. Your TOE will be booked on a day convenient to you and you will then be sent detailed instructions by one of our administration team.

2. Stress echo study

Sometimes patients with severe narrowing of the heart arteries have a normal echocardiogram study when the heart is at rest. This scan however can become abnormal in areas where there is a problem with the blood supply when the heart is put under stress, either with exercise or a drug. Stress echo is used to help diagnose and plan the management of patients with coronary artery disease. Following an initial resting echocardiogram study the heart is then made to work harder by either exercise on a treadmill or by an injection into the back of your hand. The echo is then repeated and the pictures compared. This form of investigation may be used if a standard exercise test gives an inconclusive result or if, for whatever reason, you are unable to exercise on a treadmill.

Stress echo studies take approximately 1 hour to complete and currently are undertaken at hospitals in London. You will be contacted directly by these hospitals to arrange a convenient time and full instructions will be given to you at this time. The results will then be forwarded to your Consultant and we will arrange an appointment for you to come and discuss them in detail. In the future we hope to undertake this investigation at West Kent Cardiology Partnership.

Exercise stress test

An exercise test is designed to investigate patients who have cardiac symptoms, especially chest pain, to establish if the symptoms are due to coronary artery disease. It is also as a health screening device to identify asymptomatic patients. The test involves walking on a treadmill (similar to those found in the gym) whilst your heart beat is monitored on a computer screen via electrodes applied to your chest. The treadmill gets progressively faster and steeper every 3 minutes to make your heart beat faster. Patients with angina may well experience this pain as the test progresses and strain on the heart may be reflected by characteristic change of the ECG.

Exercise tests are conducted by one of our trained Cardiology doctors or technicians and a nurse will be in attendance at all times. The investigation will be carefully explained to you both before and during the test. You will be asked to sign a consent form prior to undertaking the investigation. You should wear comfortable shoes and avoid eating a large meal prior to going on the treadmill. Depending on your age and health you would normally expect to be on the treadmill for no more than 9 minutes. We stress to patients that if at any time they experience any chest pain, breathlessness or feel exhausted that they should let the doctor know so that the treadmill can be stopped. In view of the time it takes to set up this test and the need for a period of monitoring after you have finished exercising we normally ask patient to allow 45 minutes for this investigation to be completed. The results will then be reported back to your Consultant who will either discuss the results with you then or at a later stage when other investigations have been completed.

Myocardial perfusion scan (‘Thallium scan’)

This is a more complex scan which is also used to assess the blood flow to the heart during exercise. It is similar to an exercise stress test but gives more detailed information and may be recommended by your Consultant if your exercise test result has been inconclusive and he requires further information, or if (for whatever reason) you are not able to exercise on the standard treadmill. The test involves making your heart work harder and then assessing the blood flow to the heart. This will be done either by walking on a treadmill (as in the standard treadmill test) or by a small injection into your hand. During the test a small amount of radioactive tracer is injected and a scan of the heart is then taken. If there are areas of poor blood supply these will then highlighted on the scan. If this scan is abnormal your Cardiologist will discuss the result with you and may then recommend that you have a cardiac catheter procedure performed.

Myocardial perfusion scans are not performed at our Consulting Rooms due to the specialist equipment and staff that are required. They can be performed in the Nuclear Medicine Department at either the London Bridge Hospital , Brompton Hospital in London or at Maidstone Hospital . You will be contacted by these hospitals directly and given any relevant instructions/information. Myocardial perfusion scans can be arranged promptly if needed and the results will be sent back to us for you to discuss with your Consultant Cardiologist.

Coronary angiogram (‘Cardiac catheter’)

Your Consultant Cardiologist may recommend that you have a coronary angiogram procedure if your initial investigations suggest that there may be obstructions in your coronary arteries. This is the most definitive investigation of your coronary arteries. A coronary angiogram is a special x-ray test. It is performed under a local anaesthetic and involves injecting a special contrast dye into the main arteries supplying your heart via a long thin tube (a ‘catheter’) usually passed via an artery in your leg or occasionally your arm. Pictures are then taken as this ‘dye’ passes through the heart arteries and shows up any narrowing or obstruction in these arteries. This test also offers your Consultant the chance to review the overall pumping function of your heart and its valves. In patients with angina a coronary angiogram will allow your Consultant to identify precisely the artery or arteries causing the problem. These pictures will then enable him to decide on the most effective treatment for your condition. This could include medical therapy (drugs), coronary angioplasty and stenting or coronary artery bypass graft surgery.

Your Cardiologist will have a detailed discussion with you regarding your coronary angiogram prior to the procedure and you will be given an information sheet which describes the procedure in detail and should answer any questions that you may have. This investigation is performed as a day-case procedure at a local or London Hospital . Our Administration team will arrange a date that is convenient to you and then with your medical insurer (if appropriate) to confirm authorisation for the procedure. You will be sent a letter detailing the instructions for the day. Your angiogram will be performed  personally by your Cardiologist. This investigation provides an instant result so he will be able to discuss this with you as soon as the procedure has been completed,

24 hour ECG recording

Patients who are referred to us with palpitations and/or heart rhythm problems are likely to have a 24-hour ECG monitor. As most patients’ symptoms occur only intermittently and it is likely that the heart rhythm disturbance causing your symptom may not captured be on a simple ECG recording. By recording your heart beat over a 24 hour period there is a greater chance of catching any abnormal heart beats or rhythms and give our Consultants a more accurate picture of how often this is occurring. The information provided will help diagnose the cause of your symptoms allowing your Consultant to recommend the most effective treatment for your condition.

The 24-hour monitor is a very small (iPOD sized) device which is clipped on to your trousers or skirt and is linked to 5 ECG electrodes applied to your chest. The device records your heart beat continuously over a 24 hour period. It is a  painless non-intrusive investigation which will not interfere with your day to day activities. During the time you are wearing the monitor you will be unable to have a bath or a shower but you can wash around the device provided you do not get the equipment wet. Our Practice Nurse, who will fit your heart monitor, will give you all the relevant information including how to remove the device once the 24 hour period is completed. You will be issued with a diary sheet and asked to record any periods when you experience symptoms so that your Cardiac Technicians can analyse your heart traces specifically at these times.

7-day cardiac event recorder

If a patient is experiencing palpitations or heart rhythm disturbances on a very infrequent basis, or if a 24-hour heart monitor has failed to pick up any abnormalities, our Cardiologists may suggest an extended period of heart monitoring. This increases the chance of documenting your heart rhythm at a time when you are experiencing symptoms. The monitor continuously records your heart beat over a 7 day period. The event recorder is a small box which you wear around your neck (under your clothes) and is attached to 2 electrodes on your chest. It is a painless and non-intrusive investigation which will not interfere with your day to day activities.

Our Practice Nurse will fit your heart monitor and explain how to remove and refit the device for bathing and showering purposes. She will give you information about the monitor including how you can use the monitor to highlight periods where you experience symptoms to allow our Cardiac Technicians to review the ECG traces specifically at these times. Instructions will be given as to how to remove the recording device once your period of monitoring has been completed. This can then be returned to us for analysis and review by your Consultant.

Tilt testing

This test may be recommended if you have experienced repeated dizziness and fainting and is used to help establish the cause of these symptoms. You will be placed on a special bed and tilted to 60 degrees with your head up. During this time your pulse and blood pressure will be very closely monitored. If your symptoms are due to a common this investigation may provoke similar symptoms. If, however, the test is negative your Consultant may wish to undertake further investigations to establish if your symptoms are due to a cardiac or neurological condition.

This investigation is currently conducted in London at St Mary’s Hospital. You will be contacted directly to arrange your tilt test at a time convenient to you. You will then be given detailed instructions/information regarding this test. The results will be sent to your Cardiologist who will discuss them in detail with you at a review consultation.