In practice testing

An echocardiogram is a non-invasive ultrasound of the heart performed to assess the structure and function of your heart chambers and valves.

A stress echocardiogram is a non-invasive exercise test, which involves obtaining ECG recordings and ultrasound images of the heart at baseline and during or immediately after exercise. This test tells whether you have coronary artery disease that is bad enough to limit blood flow to the heart. It is important to increase the heart rate adequately by exercise on the treadmill and then quickly getting the ultrasound images as soon as possible. The exercise and resting images are then compared side-by-side and the effect of exercise on various walls of the left ventricle and its overall function analysed. We also review the ECG and blood pressure measurements made before, during and after the test.

This device records the electrical activity of your heart during normal daily activities and through the night. It can be used to detect electrical abnormalities of the heart that cause intermittent symptoms, such as palpitations, and can also diagnose heart rhythm disorders that you may be unaware of.

This device automatically records blood pressure readings every hour over a 24 hour period and provides a more accurate picture of your blood pressure levels when compared to one-off readings when visiting doctors.

We provide a dedicated Device Clinic on Thursdays to perform in-clinic testing of your implanted pacemaker, ICD and loop recorder. Regular testing is necessary to ensure optimal device function and performance as well as monitoring the battery status.

We also offer you our Device Remote Monitoring Service which is a technology that utilizes telecommunication networks to enable remote monitoring of your device from the comfort of your home. This new standard of care monitor automatically checks your implanted device every day to ensure normal functioning. Should there be an abnormality identified, an alert will be sent to us and appropriate action will be taken.

Outside practice testing/procedures

A CTCA is a non-invasive X-ray dye test, performed in a radiology centre with a specialised cardiac CT scanner, that direct visualises the blood vessels of the heart for any narrowing or blockages. It can also visualise structures within the heart and outside the heart such as the aorta. This test is recommended to investigate chest pain when a functional study such as a stress test is inconclusive or patients cannot exercise appropriately.

You should inform your cardiologist if you have had a contrast (X-ray dye) reaction before so that proper precautions can be taken before scanning. In the radiology practice, you may be given extra cardiac medications to slow down the heart rate. During the scanning, intravenous contrast is injected to allow visualisation of the coronary arteries. In our practice, A/Prof Sanjay Patel and Dr Clare Arnott are accredited CTCA reporters, who will, in most cases, personally review your scans and discuss the results with your cardiologist.

CTCoronaryAngiogramCTCA

Coronaryangiographyandstentin

Coronary angiography is the gold standard method to evaluate narrowings or blockages in the blood vessels supplying the heart (coronary arteries). This procedure is performed under light sedation and local anaesthetic. A tube is placed into a blood vessel either at your wrist or at the top of your leg. A catheter is advanced via this sheath to the coronary arteries under X-ray guidance. Movie clips of the coronary arteries at different angles are then obtained by injecting contrast. You can elect to have this procedure done in a public or private hospital. In our practice, this procedure will be performed and reported by A/Professor Sanjay Patel, who is an experienced Interventional Cardiologist.

If a significant narrowing or blockage is found that appears suitable, you may proceed immediately to angioplasty and stenting. Your cardiologist will discuss this possibility with you prior to the procedure. Using the same sheath used for your angiogram, a tube will be used to engage the relevant artery. A fine wire will then be advanced into the artery across the narrowing. This wire will be used to guide a small balloon to the site of the narrowing. The balloon is expanded to dilate the narrowing. Following this, a stent is almost always placed at the site of the narrowing to keep the vessel open. The balloon is then removed from the body.

Prior to the procedure, you will need to have a blood test. You should fast on the morning of the test. You should inform your cardiologist if you have had a contrast (X-ray dye) reaction before so that proper precautions can be taken. Your cardiologist may instruct you to take certain blood-thinning drugs in preparation for the procedure, and in general, you should continue all your usual pills unless instructed otherwise.

If uncomplicated, a coronary angiogram is a day-stay procedure, and you should expect to spend about 6 hours in the hospital. Patients who undergo angioplasty and stenting are usually required to stay 1 night in hospital.

There are small but significant risks associated with a coronary angiogram and coronary angioplasty. Your cardiologist will discuss the risks and benefits of undergoing this procedure prior to scheduling you.

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Electrophysiology (EP) studies are performed in patients with heart rhythm abnormalities. The purpose of this procedure is to examine the electrical function of your heart’s conduction system and determine whether you are at risk to developing very fast or very slow heart rhythms that may require specific treatment. This procedure is performed in the cardiac catheterization laboratory under a sedation or general anaesthesia depending on the procedure. Small electrical wires are advanced into your heart from peripheral veins to turn on your arrhythmia and localize the “short circuit” or “focal source” within your heart chambers.

Once a diagnosis of your heart rhythm abnormalities has been made, catheter ablation is a widely used procedure for patients who desire a cure of their arrhythmia rather than taking medications. It involves placing the tip of a special ablation catheter next to the targeted heart tissue and delivers high-frequency radio waves energy through the tip of the catheter to burn (“ablate”) the abnormal heart tissue responsible for your arrhythmia. This restores your heart’s normal electrical activity and function. The overall risk of a major complication is approximately 1%. The procedure will usually take 2-4 hours (depending on the complexity of the problem) and requires an overnight stay in the hospital.

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A permanent pacemaker is a small implantable device typically used to treat abnormally slow heart rhythms called “bradyarrhythmias”. Bradyarrhythmias can cause symptoms such as dizziness, dyspnoea, fatigue and faints.
The device is inserted in a pocket of skin and the wound is closed with a waterproof dressing.
Most patients make a quick recovery after a pacemaker.

You will be given oral antibiotics for 1 week. You should not drive for at least 2 weeks, and avoid lifting the arm on the same side as the device above shoulder height for 4 weeks. The battery may last for 8 – 10 years depending on usage. We will test your pacemaker function 1 month after the implantation in the Auburn Cardiology clinic. Then at 3 months followed by 6-9 monthly.

Cardiac-Defibrillator-Implantation

An implantable cardioverter defibrillator (ICD) is a device that is used to prevent your heart from beating too fast due dangerous abnormal heart rhythms known as ventricular tachycardia (VT) or ventricular fibrillation (VF). The ICD can either deliver a rapid burst of impulses to your heart or an internal shock to revert the heart rhythm back to normal. ICD also has the ability to pace your heart to prevent abnormally slow heart rhythms, a function similar to that of a standard pacemaker.

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A Loop Recorder is a small cardiac monitoring device implanted subcutaneously to record heart rate and rhythm for up to a period of 3 years. It is used to confirm or exclude abnormal heart rhythms. It is a minimally invasive procedure performed under local anaesthetic in the cardiac catheterization laboratory. It is MRI compatible and has used wire less one-way telemetry for remote monitoring. You can activate the device to capture a recording of your heart rhythm during symptoms to facilitate diagnosis of your arrhythmia.