Electrocardiogram (ECG) / Holter monitor
This is a recording of the heart’s electrical activity. It is a useful investigation in all forms of heart disease but is particularly useful when an arrhythmia or abnormal heart rhythm is suspected.Abnormal patterns of electrical activity are also seen in coronary disease, hypertension and cardiomyopathies.
In the investigation of palpitations or dizzy spells, a small portable ECG recorder (Holter monitor) may be worn for 24 hours or longer to help identify intermittent symptoms.
Ambulatory Blood Pressure Monitoring
As blood pressure varies widely throughout the day, it is recognised that a 24-hour recording of blood pressure using a portable monitor is a more accurate measure of identifying true hypertension and defining long-term risk.
A coronary angiogram is an x-ray investigation of the heart and coronary arteries and remains the gold-standard for the diagnosis of coronary heart disease.This is an invasive procedure during which a long, thin tube (catheter) is passed, under local anaesthetic, from an artery in the groin or wrist to the heart and dye is injected to show the heart arteries on x-ray. Although the investigation itself is brief the site at which the catheter is inserted at the groin or wrist is monitored for several hours after the procedure and therefore usually requires a day case inpatient stay.
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This is also known as a stress test and is very useful for assessing patients with chest pain or breathlessness during exercise.Patients undergoing this test have their pulse rate, blood pressure and ECG continuously recorded whilst they are walking on a treadmill. Changes in these parameters can help identify the cause of the symptoms particularly if coronary artery disease is suspected.
An echocardiogram is an ultrasound scan of the heart. The structure and function of the heart can be visualised with the flow of blood through the heart chambers. In patients who are breathless or who have heart murmurs the echocardiogram is used to diagnose disease of the heart valves or a weak or enlarged heart.
Occasionally a very detailed echocardiogram of the internal heart structures is required, performed from a miniature probe passed to the back of the heart, down the oesophagus, under sedation and local anaesthesia (transoesophageal echocardiogram).
CT and MRI Scanning
These scans are useful in a number of heart conditions or when other investigations are not appropriate or possible.
The cardiac MR scans are particularly good at looking at the heart muscle in detail and the heart in relation to it’s major arteries, the pulmonary artery and aorta.
Cardiac CT scans can be helpful in identifying very early coronary disease.