A coronary angiogram is an X-ray test to enable the cardiologist to look at the coronary arteries and see if there are blockages and determine how to treat them. The cardiologist inserts a long, thin tube (catheter) into a blood vessel in the groin or arm and directs the catheter into the heart. From the catheter, dye is injected into the coronary arteries and X-ray pictures taken. The X-rays will show if the cardiac arteries are narrowed.
The full name for a coronary angioplasty is Percutaneous Coronary Intervention (PCI). This is a non- surgical treatment performed through a small incision in the skin (arm or groin) whereby obstructed arteries are opened up to allow blood flow through the artery. Special balloons are used to open up blocked arteries and small devices known as ‘stents’ (shaped like a small metal cage) are inserted to keep the artery open.
Rotablation represents an addition to the standard coronary angioplasty procedure. While a standard coronary angioplasty is limited to the use of balloons and stents, rotablation also uses a tiny drill, powered by compressed air, to remove calcified deposits. Rotablation is usually followed by balloon angioplasty, and the implantation of one or more stents.
A pacemaker is an electrical device implanted to keep the heart beating at the right speed and rhythm. It is needed when a person’s natural pacemaker either does not work properly or the impulse is not transmitted adequately to the ventricles for the heart to contract. Pacemakers are typically used for hearts that beat too slowly and cause blackouts. Implantation of a pacemaker involves positioning leads (thin, insulated wires) in the heart and placing the device in a pocket of skin, usually in the shoulder area.
To work properly, the pacemaker should be checked periodically to find out how the leads are working and how the battery is doing. The doctor uses a special analyser to monitor the battery to determine when the pacemaker needs to be replaced. The pacemaker rate and rhythm can be modified by external specialised equipment.
An implantable cardioverter defibrillator (ICD) is an electronic device used to shock the heart automatically when a life-threatening ventricular arrhythmia occurs.
The ICD monitors heart rhythm and can detect abnormally fast heart rhythms. When this happens, the ICD uses electrical pulses or shocks to bring the heart rhythm back to normal. The ICD can also stimulate the heart when it detects abnormally slow heart rhythms, in which case it will be acting like a standard pacemaker.
A loop recorder is a small cardiac monitoring device designed to record heart rate and rhythm and is used to confirm or rule out abnormal heart rhythms. The device is inserted just under the skin of the chest and can detect and record the heart rhythm for up to three years with the use of a remote monitor.
Cardiac resynchronisation, or biventricular pacing, is a treatment for heart failure (caused by a poorly contracting heart) that uses a pacemaker implanted in the chest. The pacemaker sends tiny electrical impulses to the heart muscle to coordinate the pumping of the chambers of the heart, improving pumping efficiency and reducing the symptoms of heart failure.
Echocardiography is a diagnostic method in which a handheld device is placed on the chest, and high-frequency sound waves produce images of the heart’s size, structure and motion. An ‘echo’ provides valuable information about the health of the heart muscle and the valves.
3D echocardiography accurately assesses heart chamber size, function and intracardiac masses, e.g., tumours and clots.
Strain or deformation imaging evaluates the function of the heart muscle (myocardium) using cardiac ultrasound. This method is used to identify subtle changes in heart dysfunction. The test may be used to:
Transoesophageal Echocardiography (TOE) uses sound waves to produce images of the heart. Unlike ordinary echocardiography, TOE uses a tube-like device placed in the mouth and passed down the throat into the oesophagus to record images of the heart. This test shows the size, shape and movement of the heart muscle and valves.
An electrocardiogram (ECG) records the electrical activity of the heart, including the timing and duration of each electrical phase in a heartbeat. An ECG is the standard clinical tool for diagnosing arrhythmias (abnormal rhythms) and to check if the heart is getting enough blood or if areas of the heart are abnormally thick.
An exercise stress test is used as a means of assessing how the heart and blood vessels respond to physical exertion. An ECG is recorded at rest, and then while walking on a treadmill. Throughout the test a cardiologist or cardiac technician will monitor and look for indications that the heart is not getting enough oxygen, suggesting obstructed coronary arteries. The ECG, heart rate, blood pressure and symptoms such as chest pain or shortness of breath will be monitored.
Cardioversion is the delivery of an electrical shock to a person’s heart to rapidly restore an abnormal heart rhythm (arrhythmia) back to normal. External cardioversion is performed with a defibrillator, either in an emergency situation or as a scheduled treatment for arrhythmia. Internal cardioversion is delivered by a device similar to a pacemaker, called an implantable cardioverter defibrillator (ICD).
An ambulatory blood pressure monitor is a portable blood pressure machine worn for about 24 hours. A computer activates the blood pressure cuff regularly to take your blood pressure while you are going about your normal daily activities. The computer stores the measurements for later analysis by the cardiac technician.
It is a useful tool to accurately diagnose high blood pressure when an isolated high reading has been detected in a doctor’s office. It is also useful in assessing whether high blood pressure therapy is effective.
Ambulatory ECG monitoring by means of a holter monitor, provides the cardiologist with a recording of the heart’s electrical activity over a prolonged period.
A holter monitor is a battery-operated, portable device that measures and records the heart’s electrical activity continuously, usually for a period of 24 to 48 hours so that any irregular heart activity can be correlated with a person’s symptoms, e.g., dizziness or fainting. The device uses electrodes or small conducting patches placed on the chest and attached to a small recording monitor that is carried in a pocket or in a small pouch worn around the waist. The recorded data is then analysed by a computer.