A transthoracic echocardiogram is an ultrasound of the heart and is often called an ‘echo’ or ‘TTE’. Ultrasound uses high frequency sound waves to produce images of different structures within the body. A specially qualified technician will perform the test.

Echocardiogram can provide valuable information on the size of the chambers of the heart, as well as the strength of the muscle within each chamber.

It is also used to assess function of each of the valves and uses a technique called ‘colour doppler’ to detect any abnormal blood flow that may suggest a disease of the valves.

A transducer – a small probe – covered in gel is used to send the sound waves into the heart to create the images. You cannot feel the sound waves, however you may feel that the gel is cold on your skin.

Like an ECG, a 24-hour Holter monitor uses electrodes and leads connected to a smaller device to continuously monitor the rhythm and rate of the heart.

Applying a Holter monitor takes around 15 minutes. You usually do not have to do any preparation for this test.

A trained health professional will apply a total of 5 ‘sticky dots’ on your torso. They will connect the dots to the device via special leads. You will be given a small pouch to hang around your neck to hold the device close to your body. Despite often being called a 24-hr Holter monitor, you may be required to wear the device anywhere between 12 and 48 hours. You should continue your normal activity during this time; however, you will be unable to swim or take a shower while wearing the device. Upon return of the device an experienced cardiologist will report on the findings.

A 24-hour Blood pressure monitor is an important diagnostic tool for diagnosing high blood pressure (hypertension) and to measure any fluctuations in your blood pressure.

Applying a blood pressure monitor usually takes 15 minutes, and you do not need to do any preparation for this test.

A trained health professional will apply a blood pressure cuff to one of your arms. The cuff is also connected to a recording device, which can hang around your neck in a pouch.

The blood pressure cuff will automatically inflate at fixed intervals. It is important when you feel the cuff beginning to inflate that you keep your arm straight and try not to move too much while the cuff is inflated. This will help to get an accurate recording of your blood pressure.

An electrocardiogram (ECG) is a simple diagnostic tool that allows Cardiologists and other health professionals use to look for various heart conditions. An ECG usually only takes fifteen minutes. You often do not need to do any preparation for an ECG.

Electrodes, commonly referred to as ‘sticky dots’, send the electrical signal of the heart to the ECG machine via leads that are attached to the electrodes.

A trained professional will place a total of ten ‘sticky dots’ onto your person. Six will be placed on your chest and one on each arm and leg. You will be required to remove clothing from the upper half of your body for this procedure. It may also be necessary to remove excess hair from the chest to allow good contact with the dots.

The dots connect to ten leads that are attached to the ECG machine. You will need to lie still while the ECG is printing – this should only take a minute or two.

During a stress echocardiogram or stress ECG, you will undergo the same process as if you were having a transthoracic echocardiogram or ECG.

The difference with a stress echo or stress ECG is that you will be required to walk on a treadmill while connected to the monitoring equipment. This kind of test allows your Cardiologist to see how well your heart performs under physical stress. There are changes to your hearts rhythm and contractions that can be detected on the ECG or TTE that let your Cardiologist know there might be a blockage in your heart’s arteries.

The test will be performed with a cardiac technician and a cardiologist. They will provide you with instruction on when to start and when to stop walking. They might also increase the speed of the treadmill during the test. It is important that you inform them of any chest pain you experience during the test.

Some people require a stress test but are not physically capable of walking on a treadmill. In this case a medication can be given that mimics the effects of physical activity on the heart. This is called a Dobutamine Stress Test (DSE). For a DSE you will lay in a bed while connected to the monitoring equipment and the doctor or nurse will inject the medication via a cannula they insert into your arm. You may feel flushed and notice your heart beating fast while the medication is being injected. These feelings will stop almost as soon as the medication is ceased. After the test, the cannula will be removed from your arm and a small dressing place over the site.

Sometimes the test can indicate quite strongly that there is a blockage in your heart. In this situation your cardiologist might arrange for further testing on the same or following day. Most commonly, the next test you would be required to undergo is a coronary angiogram.

Sometimes further investigations are required to detect various heart conditions, and these can be performed by our team of cardiologists including:

• A bubble study is a test that can help to identify if there are any ‘holes’ in the heart. Such holes are known as Patent Foramen Ovale (PFO) or Atrial Septal Defect (ASD).

• A transoesophageal echocardiogram is often called a ‘TOE’. It is performed by a Cardiologist, and like a transthoracic echocardiogram it uses ultrasound to capture pictures of the heart. However, instead of the transducer being placed onto your chest, a thin flexible probe is placed down your oesophagus. A TOE can get close-up images of your heart and provides your Cardiologist with more in-depth detail on valvular disease. A TOE can also check for clots in your heart and is used during certain procedures.

• A coronary angiogram is a procedure that uses x-ray and a special dye known as contrast to take pictures of your coronary arteries. It is sometimes called ‘cardiac catheterisation’. Most often when you have a coronary angiogram it is because your doctor wants to rule out or assess any coronary artery disease. A coronary angiogram is performed by an Interventional Cardiologist and always take place in a hospital.

• Left ventriculography is often performed at the end of a coronary angiogram to assess how well the muscle in that region of the heart is working. A catheter is inserted into the left ventricle and contrast is injected. The contrast mixes with the blood and becomes visible under x-ray. It is then possible to see if any part of the ventricle isn’t moving as it should be. The catheter that is inserted into the ventricle is attached to an external device that can measure the pressure in the ventricle, which can provide further information regarding how well the heart muscle is functioning.

• Right heart catheterisation can also be performed during a coronary angiogram. The process is very similar to that of an angiogram. The Cardiologist will insert a small tube into your groin or arm. This tube will sit in a vein, unlike in angiogram where the tube sits in an artery. By entering a vein, the catheter can enter right side of your heart, compared to an angiogram where the catheter enters the left side of the heart. The catheter can be fed to your lungs and pressure measurements are taken at various places. These pressure measurements can be used to assess heart failure and valve disease.