Getting a Diagnosis
Dr Sarma will carefully assess your symptoms and past medical problems to understand which cardiac investigations will help understand what is causing your problems. He will explain which tests would be helpful and what to expect.
He works closely with a carefully selected group of specialists so that you can be confident your investigations will be of the highest quality.
The results of blood tests will be available within 24 hours, unless they require specialist laboratory input.
An electrocardiogram (ECG) is a simple test that can be used to check your heart’s rhythm and electrical activity. This is often used alongside other tests to help diagnose and monitor conditions affecting the heart.
Sensors are put on your chest, and sometimes your arms and legs, using sticky patches. These are connected, by wires, to an ECG recording machine. The sensors detect the electrical signals produced by your heart each time it beats. The signals are printed onto paper.
There are 3 main types of ECG:
A resting ECG is carried out while lying down resting and takes about five minutes. This can be carried out during your clinic appointment.
A stress or exercise ECG is carried out while you’re using an exercise bike or treadmill, allowing the heart trace to be recorded during physical activity. The test starts off at a very easy rate and is gradually made harder, but it is not as intensive as an exercise workout. The person carrying out the test will carefully monitor you, your heart rate, and your blood pressure. They will stop the test if you experience any symptoms or feel unwell.
An ambulatory ECG (sometimes called a Holter monitor) connects sensors to a small portable machine worn at your waist so your heart can be monitored at home for one or more days. This test is useful because it can detect abnormal rhythms even if you do not notice symptoms. It may show an abnormally fast or slow heart rhythm or an irregular rhythm that may need treatment. If you experience palpitations, you can record this event, pinpointing possible rhythm disturbances.
If you have symptoms that don’t happen very frequently, standard ECG monitoring may not pick up an abnormal rhythm. Dr Sarma may suggest using a cardiac event recorder to capture your heart’s rate and rhythm over a longer period of time. You can also access Zio heart monitors (link https://irhythmtech.co.uk/the-proven-ambulatory-cardiac-monitoring-service/ ), and AliveCor monitors (link https://clinicians.alivecor.com/our-devices/ ), as well as a device called an implantable loop recorder.
An echocardiogram (echo) uses similar technology to ultrasound scans performed during pregnancy. Some gel is applied to your skin, and a small scanning probe is guided across your chest. It uses sound waves (inaudible to the human ear) to build a detailed picture of your heart. Dr Sarma may require an echocardiogram to assess new symptoms. It may also be used to monitor an existing condition such as heart failure or valve disease.
An echo looks at the structure of your heart. It can image your heart muscle and see how well your heart pumps. It can also provide clear images of your heart valves to assess for narrowing and leaking problems and can be used to look for congenital heart disease (heart conditions people are born with).
Specialist echocardiograms are also available. Sometimes, Dr Sarma may request that an echocardiogram be done while the heart is beating faster – a stress echo – and this is performed while deliberately increasing the heart rate by either exercising on a treadmill or stationary bike or by administering medication through a vein. This test can help to diagnose coronary heart disease as it shows the heart muscle is getting as much oxygen-rich blood as it needs.
If you have suffered a stroke or TIA (transient ischaemic attack), a bubble echo can be used to look for a “hole in the heart”. This involves injecting a small amount of saline that has been shaken. If there is a hidden shunt in the heart, this becomes apparent during the scan.
An echo looks at the structure of your heart. It can image your heart muscle and see how well your heart pumps. It can also provide clear images of your heart valves to assess for narrowing and leaking problems and can be used to look for congenital heart disease (heart conditions people are born with).
A CT scan is a modern, sophisticated type of X-ray. CT technology now offers a chance to assess your coronary arteries in high detail. A calcium score and other data can be analysed to provide more detail about your risk of coronary disease. A CT coronary angiogram visualises your coronary arteries and sometimes prevents the need for a traditional, more invasive coronary angiogram.
During a CT coronary angiogram, some dye is injected into a small vein in your arm. The CT can assess the flow of this dye through your coronary arteries and identify if there are any areas of narrowing.
MRI is a way of creating detailed images of internal organs, such as the heart and blood vessels. A cardiac MRI scan uses an MRI machine to create magnetic and radio waves to show detailed pictures of the inside of the heart.
The MRI machine can produce incredible high-resolution 3D images that can be viewed from different angles. The test is analysed by a Consultant Cardiologist who specialises in Imaging.
However, because the MRI uses powerful magnets, the presence of metal in your body can be a safety hazard or distort the image. Before having an MRI, you’ll likely complete a questionnaire that includes whether you have metal or electronic devices in your body, such as surgical plates or screws or some implants. Unless the device you have is certified as MRI safe, you might not be able to have an MRI.
A myocardial perfusion scan is a highly specialist scan that examines how well your heart is pumping and assesses blood flow to your heart muscle. If you have chest pain, it is important to understand if this is caused by problems with your coronary arteries, which supply your heart muscle with blood. Myocardial perfusion scans use a small amount of radioactive substance to create images which show blood flow to the heart muscle. The test is often also known as a thallium, MIBI, technetium, or nuclear medicine scan.
An angiogram is a diagnostic procedure that uses X-ray images to look for narrowing or blockages in your blood vessels. A coronary angiogram (or cardiac catheterisation) assesses how well the blood circulates in your coronary arteries, which supply blood to your heart muscle.
Dr Sarma worked with the British Heart Foundation to create a video to help explain the angiogram procedure.
Video link: https://www.youtube.com/watch?v=e3fgzcXu7LE&t=4s
This procedure is usually carried out as a day case (without needing an overnight stay in the hospital) with local anaesthetic and sedation. A thin, flexible tube, called a catheter is carefully inserted into the artery via a small incision in the wrist. The procedure takes place in a catheter laboratory (operating theatre) and lasts for around 40 minutes.
During your angiogram, you may need this test to help decide whether you need an angioplasty to one of your coronary arteries. This test is useful if you have a moderate narrowing (stenosis) on your angiogram, where the severity of the disease is unclear. The technique measures blood flow and pressure in an isolated section of the coronary artery. It is a more precise method of determining the significance of a narrowing. A fine guide wire with an electronic sensor is introduced into the relevant artery. Real-time software analysis calculates the relevant changes in blood flow in an arterial narrowing. This helps decide whether further treatment, such as stents or cardiac surgery, is necessary.
Dr Sarma worked with the British Heart Foundation to create a video to help explain the angiogram procedure.
Video link: https://www.youtube.com/watch?v=e3fgzcXu7LE&t=4s
This procedure is usually carried out as a day case (without needing an overnight stay in the hospital) with local anaesthetic and sedation. A thin, flexible tube, called a catheter is carefully inserted into the artery via a small incision in the wrist. The procedure takes place in a catheter laboratory (operating theatre) and lasts for around 40 minutes.
This test uses sound waves to see inside your coronary arteries during your angiogram. It uses a tiny probe mounted on a coronary catheter to generate sound waves. Software processing during the test interprets the signal and produces images. IVUS can show the entire artery wall and provide important information about the amount and type of plaque build-up, providing a clear picture of soft tissues that are not well seen on X-ray images. IVUS also ensures the correct sizing of stents and whether any stents used have been deployed correctly. This is crucial for safety and assuring a stent’s long-term function.
The British Heart Foundation website has more information on many cardiac tests, which is available here: https://www.bhf.org.uk/informationsupport/tests