INITIAL - An initial appointment is for new patients or returning patients who haven't been seen for some time. If your doctor recommends that you see a cardiologist, they will send us a referral directly.
On arrival the nurse will usually give you an ECG and a treadmill test; then you will have a consultation with your cardiologist.
This appointment takes about 1 hour.
FOLLOW-UP - Follow-up appointments are required when testing has been done and there are results to discuss; or for cardiologists to monitor your progress. This appointment is for approximately 30 minutes.
ELECTROCARDIOGRAM (ECG) is a recording of your heart's electrical activity. Electrode patches are attached to your skin to measure the electrical impulses given off by your heart. The result is a trace (graph) that can be read by a doctor. It can give information of previous heart attacks or problems with the heart rhythm.
EXERCISE ECG or TREADMILL TEST is used because an ECG that is done when you are resting may be normal even when you have cardiovascular disease. This test involves walking on a treadmill to make the heart work harder, while being monitored. If there is any narrowing of the blood vessels resulting in poor blood supply it is more likely to be picked up on the tracing (graph) as your heart goes faster. This test is supervised by an experienced cardiac nurse and interpreted by the specialist.
ECHOCARDIOGRAM or CARDIAC ULTRASOUND is a diagnostic procedure that provides a huge amount of information about the heart's structure and function. This test is performed by a sonographer, a specially trained technician. It uses high frequency sound waves to generate pictures of your heart. Echocardiography can help in the diagnosis of many heart problems including cardiovascular disease, previous heart attacks, valve disorders, weakened heart muscle, holes between heart chambers and fluid around the heart (pericardial effusion). (Click to info sheet)
VASCULAR ULTRASOUND (including Carotid, CIMT, Renal & ABI) is used to image blood vessels and measure blood flow throughout the body. It is used to detect significantly narrowed or blocked arteries such as in the carotid arteries, which may cause a stroke, and the renal (kidney) arteries, which may cause high blood pressure.
It can also be used to detect early signs of cholesterol build up (Carotid Intima Media Thickness scanning, or CIMT) or assess reduced blood flow to the legs (Ankle Brachial Index, ABI).
EXERCISE STRESS ECHOCARDIOGRAM (ESE) assesses your heart's response to increased workload. During the test, an ultrasound of your heart (echocardiogram) is performed at rest and then again immediately following exercise. It shows whether the blood supply to the heart is adequate or whether there is coronary artery narrowing. In addition, the echocardiogram gives a wealth of other information about your heart, how it pumps and how the valves are working. (Click to info sheet)
DOBUTAMINE STRESS ECHOCARDIOGRAM (DSE) is performed if you are unable to walk fast enough on the treadmill to test your heart effectively. During the test Dobutamine is given through a vein in your arm to simulate exercise by increasing the heart rate and workload of your heart. (Click to info sheet)
BLOOD TESTS are another tool used by the doctors, checking for cholesterol levels and checking for evidence of diabetes. You will be referred as necessary and may be asked to have them before your appointment.
COMPUTED TOMOGRAPHIC CORONARY ANGIOGRAM (CTCA) is a CT scan of the heart's arteries. By injecting contrasting dye into a line in your arm the scan can provide high definition, three-dimensional images of your arteries. It is one of the best ways to detect signs of coronary atherosclerosis (narrowing of the arteries due to cholesterol build-up).
CALCIUM SCORE test is a specialised x-ray test using a CT scanner that provides pictures of your heart to enable the detection and measurement of calcium-containing plaque in your coronary arteries. Plaque inside the arteries of your heart can grow and restrict or block the flow of blood to the muscle of the heart. The procedure can identify possible coronary artery disease early, before you have any signs and symptoms.
CARDIAC MAGNETIC RESONANCE IMAGING (CMR or MRI) - This procedure uses magnets and radio waves to capture images inside your body without making a surgical incision. It allows your doctor to see the soft tissues in your body, along with your bones. A heart cardiac MRI looks specifically at your heart and nearby blood vessels.
NUCLEAR SCANNING is a test that examines blood flow to the heart muscle using stress testing and a chemical known as a "tracer", which is a short-lived radioactive agent. This scan is especially useful in determining whether heart artery disease is limiting blood flow, in assessing patients prior to major surgery and in investigating patients with possible angina.
If a problem is found by our experienced cardiologists they may prescribe medication and/or refer you for further tests or procedures. These can include:
CARDIAC ABLATION - a procedure that can correct heart rhythm problems (arrhythmias). It works by scarring or destroying tissue in your heart that triggers or sustains an abnormal heart rhythm. In some cases, cardiac ablation prevents abnormal electrical signals from entering your heart and, thus, stops the arrhythmia.
CORONARY ANGIOGRAM - is a special x-ray examination of the coronary arteries, done under mild sedation, to determine the presence, extent and location of any arteries that may be narrowed due to a slow build-up of fatty plaque.
CORONARY ANGIOPLASTY - coronary arteries with severe narrowings may need an intervention in the form of placement of a metal stent (PCI). This is done in conjunction with an angiogram. The purpose is to restore blood flow to the coronary arteries and ensure the heart is adequately supplied with oxygen which may reduce or eliminate angina. PCI can also restore blood flow in the event of a heart attack.
CORONARY ARTERY BYPASS GRAFT SURGERY (CABG) is an operation that bypasses a narrowed or blocked part of a coronary artery using a graft, which is a section of vein taken from other parts of a patient's
body. This surgery is performed to relieve angina symptoms by improving the blood flow to the heart muscle. This can result in better quality of life, with angina reduced or entirely relieved. It is quite normal to need two, three or four grafts ('double', 'triple', or 'quadruple' bypass surgery).
CARDIOVERSION is done when the patient has either atrial fibrillation or atrial flutter. An electric shock is given while the patient is under general anaesthetic to try and get the heart back into sinus (normal) rhythm.
PACEMAKER IMPLANTATION is for patients whose own heart's electrical system is not functioning correctly. Pacemakers are battery-powered devices that stimulate the heart to contract and thus pump blood throughout the body. Our cardiologists ensure that a pacemaker is programmed and installed correctly. Patients are usually awake for this procedure although likely to be given medication to help them relax. This is normally performed in a hospital and you will be referred by our cardiologists if this is needed.
PERIPHERAL ANGIOPLASTY - an angiogram is carried out to identify any blood vessel narrowing or blocked areas in the arteries supplying your pelvis, legs, knees, ankles and less frequently, your arms. If any blockages are found a special balloon or stent may be used to open the narrowed portion of the artery (an angioplasty).
When we meet with patients it's important to allow for time to answer their questions and discuss concerns.