Coastal Cardiology Clinic offers several on site investigations including echocardiograms, stress echocardiograms, dobutamine stress echocardiograms, holter monitoring and stress testing, pacemaker and defibrillator checks.
ELECTROCARDIOGRAPH – ECG
During an ECG, electrodes are placed on the chest and also on the wrists and ankles. A recording is then taken of your heart rate and rhythm. This only takes a couple of minutes.
An echocardiogram, commonly referred to as an echo, involves taking pictures of the heart using an ultrasound machine. This scan only uses soundwaves, and does not use any radiation, and is considered to be a very safe test. The echo will provide the doctor with a lot of information about your heart, such as the size and structure of the heart, the function of the cardiac valves, and how well your heart is pumping at rest.
Sometimes the cardiologist may wish to perform a stress echo. The heart may look normal when it does not have to work very hard, and problems may only become apparent when the heart works hard. It is therefore a common test on patients where there is a suspected problem with their coronary arteries, or when there is a suspected rhythm problem.
During the procedure, the patient is attached to an ECG monitor, and the technician first takes a few pictures of the heart at rest. The next stage involves walking on the treadmill, beginning very slowly, and increasing speed and slope gradually at three minute intervals. The treadmill is used to increase the heart rate, and to see how your heart functions when it has to work hard.
The patient’s heart rate, rhythm and blood pressure are monitored throughout the procedure. The cardiologist will stop the test at the appropriate point, but it is important to try as hard as you can to get your heart rate up, in order for the test to be as accurate as possible. Lastly, the patient returns to the bed very quickly after the treadmill has stopped, in order for the technician to take more pictures whilst the heart is still pumping fast.
The cardiologist then compares the resting images with the post-exercise images, and will discuss the results with you.
DOBUTAMINE STRESS ECHOCARDIOGRAM - DSE
Some of our patients are unable to walk far enough on the treadmill. This test is very similar to a treadmill stress echo, except that the cardiologist uses a drug instead of the treadmill to increase the heart rate, and another drug at the end of the test to bring the heart rate back down.
As some patients feel nauseous from the drug, we ask that they fast for four hours prior to the test, and only drink water. The cardiologist inserts a small cannula into the patient’s arm in order to administer the drugs via an automated drug pump. At the conclusion of the test, which generally takes about twenty minutes, the patients are offered light refreshments, and stay for approximately another twenty minutes after the test, have the cannula removed and then are permitted to go home. A full instruction sheet is available from our staff for each patient who is undergoing this particular test.
This a test for assessing the heart rate and rhythm continuously over a 24 hour period. Five electrodes are placed on the chest, attached to a small recording device. The patient returns to our surgery the following day and the device is taken off. The patient has a completely normal day, with normal activities, with the only exception being that the patient cannot get the device wet. The patient can hit a button on the device should they experience symptoms. This enables the cardiologist to look at the rate and rhythm at the time of the symptoms. The recording is then transferred to a reporting system on the computer, and the cardiologist then looks at the recordings and analyses it.
PACEMAKER AND DEFIBRILLATOR INSERTION
Many of our patients have pacemakers. These are micro computers that are inserted under the muscle in the chest wall. They continuously monitor the heart, and pace the heart, that is, control the heart rate, when required. Patients generally need to get these devices checked every six months, in case any changes are required.
Some patients have defibrillators inserted. This device is capable of delivering a shock to the heart, should the patient develop a life threatening heart rhythm. Both pacemakers and defibrillators are programmed to suit the individual patient’s requirements, in consultation with the cardiologist. Certified cardiac rhythm technicians from all the major pacemaker companies do regular clinics with the doctors at Coastal Cardiology Clinic. This is to check on the device, and alter any settings if required.
CARDIAC CATHETERISATION (CORONARY ANGIOGRAPHY)
The cardiologist may recommend a formal angiogram in hospital. This is performed as an x-ray test and dye is used to enable visualisation of the coronary arteries. A small tube is placed either in the patient’s arm or groin, and passed up towards the heart. Dye is then pumped through the tube to try and detect any blockages or narrowing of the coronary arteries. If any blockages are revealed, the cardiologist will recommend the appropriate treatment. Treatment options include either medication or a stent to open up the blockage. This procedure may be able to be performed on the same day as the angiogram, but often requires another hospital visit.
An angiogram is generally done as a day patient. If the patient requires a stent, the patient will need to stay overnight stay in hospital. The cardiologist will discuss the outcome of the test with the patient following the procedure and the appropriate treatment will be arranged.
DC CARDIOVERSION / TRANSOESOPHAGEAL ECHOCARDIOGRAM
DC cardioversion is a procedure where an electrical current is delivered to the heart to restore normal rhythm. This procedure is done under a short acting general anaesthetic. It can be done on its own or it can be done after the patient has had a transoesophageal echocardiogram. A transoesophageal echocardiogram is a probe, not too dissimilar to an endoscopy camera, placed down the oesophagus in order to look at the heart and exclude any clots prior to the DC cardioversion. This is usually a day only procedure and the patient stays in hospital for a few hours after the procedure. As they are given a general anaesthetic, they are not able to drive for a 24 hour period.
CORONARY ARTERY STENTING
A stent is a small metal tube made of a mesh-like metal material that we use to open up a blocked artery. This procedure is usually done at the time of a coronary angiogram. When an angiogram shows a blockage in the coronary artery, we first balloon the artery and then a stent is inserted to keep the artery open. After the procedure, patients are given additional blood-thinning medication taken in conjunction with Aspirin usually for a twelve month period.