Diagnostic Services

Cardiac Tests

Cardiac Tests

The following cardiac procedures can be preformed at the Wellington Diagnostics and Outpatients Centre:

ECG / Electrocardiogram

This is a simple procedure that involves the application of electrodes to the chest to measure tiny electrical impulses generated by the heart to ensure it contracts and relaxes in an organised manner. It's considered the gold standard for cardiac arrhythmia diagnosis. Applications include a guide for risk stratification for patients with recent myocardial infarctions. The ECG is used as a screening tool for ischaemic heart disease and prior to operative procedures. It may also identify conduction disturbances, electrolyte imbalances, information on the hearts position, chamber sizes, pericardial compliance, lung disease and central nervous system depression. There is no risk associated with the procedure. No preparation by the patient is required.

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Ambulatory Blood Pressure Monitor

This procedure involves the application of a blood pressure cuff to the non-dominant arm with BP recordings made at regular intervals. The monitor will indicate to the patient when it is about to inflate and has an override button if inflation of the cuff becomes uncomfortable. The cuff can also be easily repositioned by the patient if required. A patient dairy is issued to document daily activities for greater understanding of BP trends. The monitor's applications include an early diagnosis of hypertension and to ensure normal BP trends through the day and night. This may be used to prevent a patient progressing towards hypertensive heart disease and associated problems, or to assist better management of medication therapy. There is no risk associated with the procedure. No preparation by the patient is required.

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Ambulatory ECG / Holter Monitor

This involves the application of three ECG electrodes and a monitor to capture every single electrical impulse whilst the device is worn. A patient dairy is issued to document daily activities for greater understanding of heart rate response. Any 'event key' can be pressed by the patient to mark a symptom on the recorded ECG. The monitor has greatest application in identifying arrhythmias as most patients will present with palpitations or syncope (black-outs). Appropriate pacemaker use and atrial fibrillation rate control are other examples of ECG monitor application. Depending on the frequency of the patient's symptoms, monitors can be applied for 24, 48, 72 hrs or a week. There is no risk associated with the procedure. No preparation by the patient is required.

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Echocardiogram / Echo

Involves the application of an ultrasound probe with coupling gel to gather diagnostic information on the heart. Sound waves sent through the probe bounce off the structures within the body and return for the machine to generate a moving image. The applications of echo are vast and include evaluation of murmurs, investigation for congenital heart disease, valvular pathologies, heart failure, peripheral oedema (swelling of ankles), shortness of breath (with or without exertion) and risk stratification of ongoing management of patients with heart disease. Studies can also be tailored to view the effect of pacemakers and determining whether a biventricular pacemaker insertion (a pacemaker with three leads) will improve heart failure. There is no risk associated with the procedure. No preparation by the patient is required.

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Treadmill Stress Tests

This procedure involves the application of electrodes similar to a standard ECG with the added component of physical exercise. This test is used as a screening tool for ischaemic heart disease, exercise induced arrhythmias, determining appropriate behaviour of a pacemaker or heart rate response of a patient with atrial fibrillation. Blood pressure is recorded at regular intervals to assess the response to exertion. The patient is normally required to fast three hours prior to minimise airway hazards.

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Stress Echocardiogram

To further enhance the accuracy of treadmill testing incorporation of echo is applied directly to view the heart after exercise. Set images are taken prior and post exercise and compared, to view heart function. Identification of cardiomoypathies (heart muscle disease) or ischaemia can be made. If a patient experiences shortness of breath on exertion, pulmonary pressures can also be assessed post exercise to exclude a cardiac component. The patient is normally required to fast three hours prior to minimise airway hazards.

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Echo Bubble / Contrast Study

A link has been documented that a 'hole in the heart' can be a potential cause of small strokes or nasty migranes. A patent foramen ovale can be difficult to distinguish by echo alone, but administering of agitated saline solution can easily identify this. If indicated the patient can undergo a simple procedure to close the defect. These tests are non-invasive but involve a needle to administer fluids for the procedure.


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Dobutaimine Stress Echo

If a patient is unable to walk or if viability of heart muscle (after a heart attack) wishes to be determined, this procedure uses the increasing administration of Dobutaimine to mimic the effect of exercise. It is very similar to Adrenaline which is what the body normally produces during exercise to stimulate the heart. The drug is very short acting and side effects are quite rare and mild. These tests are non-invasive but involve a needle to administer fluids for the procedure. The patient is normally required to fast three hours prior as a precautionary measure.

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