Tests

A 12-lead electrocardiogram (ECG) is a non-invasive test that records the heart’s electrical activity. ECGs are a valuable tool to detect a multitude of heart conditions such as arrhythmias, evidence of myocardial infarction (heart attack) and other heart conditions.

There is no preparation for an ECG. 12 stickers are placed across the chest and limbs which are connected to an ECG system. The test should take no longer than a couple of minutes to complete and is part of your baseline routine cardiology assessment.

The 24 hour Holter monitor is a non-invasive test that uses a small pager sized device to record heart rate and rhythm continuously for 24 hours. This will allow the cardiologist to correlate symptoms such as dizziness, palpitations or black outs with heart rate and rhythm during the monitoring period.

The device records the data from several stickers that are attached to the chest wall that are connected by leads to the monitor. During the test the patient is encouraged to continue to undertake normal daily activities, including exercise however the device, leads and electrodes cannot be removed or get wet. Thus patients are encouraged to shower just prior to getting the monitor connected, and wear a two piece outfit.

After 24 hours the patient is to return to have the monitor removed and discuss any symptoms that occurred during the monitoring period. The monitor will then be analysed with results to be available for a follow up appointment within 2 business days.

What is Ambulatory Blood Pressure Measurement?

Ambulatory Blood Monitoring uses a small device to measure heart rate and blood pressure at regular intervals over a 24 hour period. The device is attached to a blood pressure cuff on the patients arm via slim tubing, hidden beneath clothing. The cuff is loose fitting when deflated and tightens briefly at regular (30 min daytime, 45 min night time) intervals to record blood pressure. Patients are encouraged to undertake regular daily activities including exercise when wearing the monitor. The monitor is unable to get wet, thus patients are encouraged to shower just prior to getting the monitor attached and wear a two piece outfit.

The device is used to determine the blood pressure load that the heart, organs and vessels are under during a 24 hour period. The monitor can help to determine the need for, or efficacy of current blood pressure management. Ambulatory blood pressure monitors are also useful in the diagnosis of “white coat” hypertension, a condition where blood pressure only appears to be elevated when measured in a clinical setting.

The event monitor is a non-invasive test that uses a small device to record your heart rate and rhythm during symptomatic events over a week long period. This will allow the cardiologist to correlate symptoms such as dizziness, palpitations or black outs with the data recorded on the monitor. This will assist the cardiologist to decide whether the symptoms are heart related. During the test you are encouraged to continue to undertake your normal daily activities, including exercise.

The device records the data from several stickers that are attached to the chest wall that are connected by leads to the monitor. The device, leads and electrodes cannot get wet, however patients will be instructed on how to remove the monitor for showering, and how to re-apply the monitor. Patients must activate a specific button when experiencing an event, otherwise the data will not be collected. A diary sheet will be provided to include all relevant information including symptoms and activity being completed at time of event. It is best that patients wear a two piece outfit.

After 7 days the patient is to return the monitor and discuss any symptoms that occurred during the monitoring period. The monitor will then be analysed with results to be available for a follow up appointment within 2 business days.

1. Echocardiography

Echocardiogram or Echocardiography is the term given to the ultrasound examination of your heart. It is a test in which high frequency sound waves are used to create a moving picture of your heart.

2. How is the test performed?

A trained and accredited sonographer will be performing the test. An instrument (transducer) that transmits and receives high frequency sound waves will be placed in various positions on your chest. These different positions allow the sonographer to examine the entire heart from multiple angles and directions. The transducer picks up the echos of the sound waves and transmits them as electrical impulses. The echocardiography machine then converts these impulses into moving pictures.

3. What should I expect?

You will be required to be bare chested and lie down on an examination table. ECG electrodes will be placed on your chest and then you will be asked to roll onto your side. The transducer probe will be placed on your chest to take the pictures. Usually an ultrasonographic jelly is used to improve contact and imaging quality. The probe may need to be applied firmly against the chest wall and the Sonographer will ask you if this causes discomfort. A number of sites are utilised: the left side adjacent to the sternum (breast bone), the apex which is just under the left breast, and the upper abdomen and sometimes the neck. You may hear loud noises which represent the magnified ultrasonographic signal of blood flowing through the heart chambers and valves and is completely normal. The scanning time will be approximately 40 minutes though may vary depending upon the findings.

1. Patient Preparation

• Nothing to eat 2 hours prior to your test. You may drink water but no caffeine such as coffee, Coke or tea.
• Take your usual medication, unless your cardiologist has advised otherwise.
• Wear comfortable clothing and rubber soled walking or running shoes that are comfortable for exercising. We suggest wearing shorts/pants as clothing from the waist up will need to be removed to gain access to your chest.
• Do not use bath oil, lotion or powder on the morning of your test. You may use deodorant.

2. What is an exercise stress test?

The exercise stress test measures the function of the heart, lungs and blood vessels. It is done to help diagnose blocked arteries in the heart (coronary artery disease), assess abnormal heart beats or to check the function of pacemakers.

Before the test starts, an electrocardiogram (ECG) is taken. This is a paper recording of your heart beat.

Next, your heart is exercised or ‘stressed’. If you can walk easily, you can walk on the treadmill. The speed and slope of the treadmill will increase every three minutes. This makes your heart do more work. The test will be stopped if you have severe chest pain, become very tired or very short of breath (puffed). Your pulse, blood pressure and electrocardiogram are monitored during and after the test. If the doctor is worried about this, the test is stopped.

If you feel unwell you should tell staff at once.

3. What are the risks of this specific investigation?

There are risks and complications with this investigation. They include but are not limited to the following.

Common risks and complications (more than 5%) include:

• Mild angina.
• Shortness of breath.
• Musculoskeletal discomfort.

Common risks and complications (1 – 5%) include:

Low blood pressure.

Rare risks and complications (less than 1%) include:

• Fainting.
• Abnormal heart rhythm that continues for a long time. This may need an electric shock to correct.
• Build up of fluid in the lungs. You may need mehtmldication to treat this.
• Severe chest pain. This is treated with medications.
• Heart Attack
• Death as a result of this procedure is extremely rare.

CT Coronary Angiography (CTCA) is a new way to non-invasively visualize the inside of heart arteries

With the latest advances in high resolution scanning, detailed and accurate images of the heart, lungs, and arteries are created in just seconds.  That means easier, painless diagnosis of the cause of symptoms and earlier detection of developing problems.

Recognised experts in Cardiac CT on the Sunshine Coast

Dr Peter Larsen trained in Cardiac and Cardiovascular CT at the Lahey Clinic in Boston, Massachusetts, after completing Level II competency at the Princeton Longevity Centre in New Jersey, USA.  Peter is the only Interventional Cardiologist on the Sunshine Coast to be accredited in this procedure and who is currently working with a team of CTCA specialists to provide a comprehensive service.

• Registered  Level A CTCA Specialist with the Conjoint Committee RANZCR CSANZ
• Registered with Medicare Australia to be eligible to provide this service.

Dr Mark Johnson trained in Cardiac imaging at St Paul’s Hospital, Vancouver, Canada.

• Registered  Level B CTCA Specialist with the Conjoint Committee RANZCR CSANZ
• Registered with Medicare Australia to be eligible to provide this service.

Drs’ Larsen and Johnson have a special interest in Cardiovascular CT, especially in patients presenting with chest pain to enable:

• Risk stratification – to help target further treatments, eg. stenting of blockages
• Early identification of plaque – to enable early treatment with medications.
• Coronary artery Calcium scoring – to help guide further investigation and therapy.

What is a CT Coronary Angiogram?

A CTCA is a minimally invasive, low radiation CT scan of the beating heart that provides images and information about the coronary arteries, heart muscle, and heart valves.
The coronary arteries supply blood to the heart muscle and it is plaque build up in these vessels that is responsible for most heart attacks.
Hence early detection and treatment with medications and/or stenting is important.
The benefit of a CTCA is its ability to demonstrate the extent, type (hard vs. soft) and distribution of plaque (atherosclerosis) within the coronary arteries.
“At present, this test is mainly used for patients with suspected coronary artery disease who have experienced symptoms (such as chest discomfort) and are considered to be at low to intermediate risk of the disease based on standard risk assessment criteria

What is a CT Calcium Score?

By detecting calcium deposits in the artery walls, the CT scanner can detect the presence of blockages and plaque in your heart arteries that may not yet be severe enough to show up on other tests (eg. a stress test).

A calcium score is generated from a low radiation dose, non contrast, ECG gated CT scan of your heart.

This score is then used in combination with other Cardiovascular risk factors (eg. high blood pressure and cholesterol levels), to help determine what further cardiac tests and or treatments are necessary.

With early detection, Dr Peter Larsen can design an individualized program for you to immediately start to reverse the blockage of your arteries with plaque and lower your risk of future heart attacks.

“This test is most suited for asymptomatic men and women between the ages of 40 to 70 years, who are at low to moderate risk for heart disease (eg. a positive family history for heart disease)”.

What happens during a CTCA?

Preparation

• Your heart rate will be checked using an electrocardiogram (ECG) machine.
• One of the specialist doctors (a CTCA trained Radiologist) will supervise your procedure.
• An intravenous (IV) cannula will  be inserted into one of your veins, usually in a vein on the front of your arm at the elbow . This will enable contrast media to be given (so the CT scanner can “see” your heart arteries).
• The CT scanner takes pictures of your beating (moving) heart. The slower your hear rate, the better the image quality.  Therefore you will be given medication to help slow your heart rate.  This is usually a short-acting “beta-blocker” called metoprolol.

Scanning

You will be helped onto the CT scanner bed for the images to be taken.  The CT scanner is a square machine with a circular hole, sometimes described as looking like a “donut”.  The bed will move into the “donut” while the pictures are being taken.

You will be asked to hold your breath while the pictures are being taken, which takes approximately 10 to 12 seconds. The CTCA scan takes about 20 minuets to be completed.

Reporting

Drs Larsen and Johnson work with a team of CTCA Specialists at Sunshine Coast Radiology. We use a 64 slice Phillips CT scanner and the latest technology to provide a low radiation, accurate scan to provide excellent images of your heart arteries. Each scan is co-reported with an accredited Radiologist.  This is the only service on the Sunshine Coast that provides an integrated and dedicated service with co-reported studies.

After the scan, Drs’ Larsen or Johnson will review you in their office at SCHS to discuss the CTCA results and if necessary design an individualized program for you to immediately start to reverse the blockage of your arteries with plaque and lower your risk of future heart attacks.