You are likely to have blood tests done before coming to clinic to check your cholesterol level and looking for evidence of diabetes. These blood tests are done "fasting" which means you have the blood taken in the morning on an empty stomach before breakfast.

An 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 that can be read by a doctor. It can give information of previous heart attacks or problems with the heart rhythm.

Ambulatory ECG - this can be performed with a Holter monitor which monitors your heart for rhythm abnormalities during normal activity for an uninterrupted 24-hour period. During the test, electrodes attached to your chest are connected to a portable recorder - about the size of a paperback book - that's attached to your belt or hung from a shoulder strap.

Another form of ambulatory ECG test is an Event recorder which covers 1-2 weeks. You wear a monitor (much smaller than a Holter monitor) and if you have any symptoms, such as dizziness, you press a button on a recording device which saves the recording of your heart rhythm made in the minutes leading up to and during your symptoms. Because you can wear this for a longer period of time it has a higher rate of catching your abnormal rhythm.

An ECG done when you are resting may be normal even when you have cardiovascular disease. During an exercise ECG the heart is made to work harder so that 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 as your heart goes faster. For this test you have to work harder which involves walking on a treadmill while your heart is monitored. The treadmill gets faster with time but you can stop at anytime. This test is supervised and interpreted by a doctor as you go. This test is used to see if you have any evidence of cardiovascular disease and can give the doctor some idea as to how severe it might be so as to direct further tests and possible treatment.

Echocardiography (or cardiac ultrasound) is a test that uses high frequency sound waves to generate pictures of your heart. During the test, you generally lie on your back, gel is applied to your skin and a technician then moves the small, plastic transducer over your chest. The test is painless and can take from 10 minutes to an hour.

The machine then develops images of your heart which are seen on a monitor. This is referred to as an echocardiogram.

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, fluid around the heart (pericardial effusion).

If doctors are looking for evidence of coronary artery disease, they may perform variations of this test which include:

• Exercise echocardiography - compares how your heart works when stressed by exercise versus when it is at rest. The ultrasound is conducted before you exercise and immediately after you stop. Either a stationary bicycle or standard treadmill is used.
• Dobutamine stress echocardiography - if you’re unable to exercise for the above test, you might be given medication to simulate the effects of exercise. During this test, an echocardiogram initially is performed when you’re at rest. Then dobutamine is given to you via a needle into a vein in your arm. Its effect is to make your heart work harder and faster just like with exercise. After it has taken effect, the echocardiogram is repeated. The effect wears off very quickly.

Service types: Echocardiogram.

What is stress echocardiography?

A stress echocardiography, also called an echocardiography stress test or stress echo, is a procedure that determines how well your heart and blood vessels are working.

During a stress echocardiography, you’ll exercise on a treadmill while your doctor monitors your blood pressure and heart rhythm.

When your heart rate reaches peak levels, your doctor will take ultrasound images of your heart to determine whether your heart muscles are getting enough blood and oxygen while you exercise.

Your doctor may order a stress echocardiography test if you have chest pain that they think is due to coronary artery disease or a myocardial infarction, which is a heart attack. This test also determines how much exercise you can safely tolerate if you’re in cardiac rehabilitation.

The test can also tell your doctor how well treatments such as bypass grafting, angioplasty, and anti-anginal or anti-arrhythmic medications are working.

What are the risks associated with a stress echocardiography?

This test is safe and non-invasive. Complications are rare, but can include:

• an abnormal heart rhythm
• dizziness or fainting
• heart attack

This is a special type of CT (computed tomography) scan that takes detailed 3D pictures of the coronary arteries — the blood vessels that supply the heart. It shows whether they are narrowed or blocked.

In the procedure, a contrast dye is injected into a vein to make the arteries visible. You then lie on a table that slides into the CT scanner, which takes rapid X-ray images of your heart.

Service types: Coronary artery calcium scoring.

What is coronary artery calcium scoring?

Coronary Artery Calcium Scoring (CACS) is a method to image the coronary arteries to look for signs of Coronary Artery Disease (CAD) due to the build-up of calcium in fatty deposits (or artherosclerosis, also called plaques) in the coronary arteries.

This technique involves the use of a ECG gated CT scanner and won't require any medicines or x-ray dyes.

With a few breath holds, images of the coronary arteries are taken. Using sofisticated software, the amount of calcium in your coronary arteries from the images is measured, and a score (CAC Score) is calculated from the amount of calcium present. The calcium score is then compared to a reference range for the population of your age and gender, and gives a relative risk of developing symptoms of coronary artery disease compared to that of the rest of the population.

CACS doesn’t replace coronary angiography. It only risk stratifies and helps in managing risk factors but most the definite answers regarding blockages and severity of blockages can be obtained by doing CT coronary angiography.

Service types: Computer tomography (CT) Coronary angiography (CTCA).

A computerised tomography (CT) coronary angiogram is an imaging test that looks at the arteries that supply your heart with blood. In a traditional coronary angiogram, catheters are passed via blood vessels in the wrist or groin to the heart and after injecting dye (contrast) and using X-rays the flow of contrast is seen to check for blockages in blood vessels. Post procedure, patients need to stay in hospital for few hours or overnight sometimes.

The CT coronary angiogram procedure uses a powerful X-ray machine that produces images of your heart and its blood vessels. The procedure is minimally-invasive with the need for an injection only. It yields the same results as that of invasive coronary angiography.

In Northland DHB a 256 slice GE Revolution CT scanner is used which enables rapid scanning and minimal radiation dose. Image quality is excellent.

Why do I need this procedure?

A coronary CT angiogram (CTCA) is performed to check for obstruction of arteries in your heart (coronary artery disease) which increases the risk of heart attack.

In a CT angiogram procedure, an intravenous (IV) line is placed in your arm and dye injected via the IV line. X-ray images are taken of your heart. To get good images, ideally the heart rate is required be 60 beats per minutes or less and to achieve that might need medications (e.g. Metoprolol or Diltiazem or Ivabridine) to slow the heart.

For this procedure you can take your usual medication except the ones that affect blood pressure or kidney functions (our cardiac nurse will be in touch to discuss and advise regarding those medications). Avoid drinking alcohol or caffeine based drinks (coffee, tea, soft drinks). You are also asked to refrain from taking Cialis, Viagra or Levitra for 2 days before your procedure.

Please come to Whangārei Hospital Radiology Department and report to main reception. Our friendly cardiac nurse will take you into another private room and after obtaining consent for a CT scan and for contrast, will check your blood pressure and heart rate and potentially take an ECG reading.

You will be asked to change to a hospital gown. When ready, you will be taken to the CT Suite, placed on the table, have the ECG dots placed on your chest and given GTN spray under the tongue which helps the bloods vessels to open up so that injected dye is circulated well and makes the imaging of blood vessels better.

If the heart rate is still fast then IV beta blockers might be given to lower the heart rate, and blood pressure is monitored closely to make sure the procedure is done safely. If blood pressure is low and heart rate is fast then the procedure might be abandoned. Also if there is any contraindication to beta blockers, the procedure might be abandoned but the cardiac nurse will review all this information and discuss with the cardiologist before booking the appointment.

A CT technician will do the CT scan and will be in constant contact with you during the procedure. It is important to keep as still as possible. You will be asked to hold your breath. Any movement can blur the X-ray images.

After your CT angiogram is completed, the cardiologist will be able to discuss the formal report with you and the final report will be sent to you within 2-7 days once a radiologist reviews other aspects of the CT images like your lungs, gastrointestinal tract and skeletal system. After the procedure you can return to your normal daily activities. You should be able to drive yourself to work or home.

Cardiovascular disease is a general term for any condition that affects the heart or blood vessels.

Common types of cardiovascular disease include:

• Coronary artery disease – narrowing or blockage of the arteries that supply the heart, which can lead to chest pain or heart attack.
• Heart failure – when the heart can’t pump blood effectively.
• Arrhythmias – abnormal heart rhythms.
• Stroke – damage to the brain caused by blocked or burst blood vessels.
• Peripheral artery disease – narrowing of arteries in the legs or arms.
• Heart valve problems – issues with valves that control blood flow through the heart.

Risk factors:

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Obesity
• Family history of heart disease
• Are older (your risk increases as you get older)

Heart failure refers to the heart failing to pump efficiently. There are many diseases that cause this including cardiovascular disease, high blood pressure, viral infections, alcohol, and diseases affecting the valves of the heart. When the heart is inefficient a number of symptoms occur depending on the cause and severity of the condition. The main symptoms are tiredness, breathlessness on exertion or lying flat, and ankle swelling. Doctors often refer to oedema, which means fluid retention usually in your feet or lungs as a result of the heart not pumping efficiently.

Tests looking for possible causes of heart failure include: Chest x-ray, Electrocardiogram (ECG), Echocardiogram (Cardiac ultrasound), Angiogram.

You are likely to be given several medications over time, started and monitored by your cardiologist and GP. These include medication to control the amount of fluid that builds up (diuretics), medication to protect your heart and slow it down as well as to thin your blood. You will often be referred to a dietitian or given advice about restricting the amount of fluid and salt you take as this can contribute to symptoms.

Heart rhythm refers to the electrical source that is driving the heart rate and whether or not it is regular or irregular. Heart rhythm can be affected by a number of conditions.

Some common terms

• Sinus rhythm is the normal rhythm
• Arrhythmia means abnormal rhythm
• Fibrillation means irregular rhythm or quivering of one part of the heart
• Bradycardia means slow heart rate
• Tachycardia means fast heart rate
• Paroxysmal means the arrhythmia comes and goes

Tachycardia

The most common form of this is atrial fibrillation. This is where the heart rhythm is irregular and often too fast. Symptoms include fatigue, palpitations (where you are aware of your heart racing or

pounding), dizziness and breathlessness.

Other tachycardias include supraventricular tachycardia (SVT) or ventricular tachycardia (VT). These have similar symptoms as atrial fibrillation but can also cause you to lose consciousness (faint).

Bradycardia

The most common form of this is called heart block. This is because messages from the electrical generator of the heart don't get through efficiently to the rest of the heart and hence it goes very slowly or can pause. Symptoms of the heart going too slowly include feeling tired, breathless or fainting.

Tests

Tests to diagnose what sort of arrhythmia you have include an electrocardiogram (ECG) and an ambulatory ECG (Holter monitor or Event recorder).

Treatment

Most treatments for tachycardias consist of medication to stop the abnormal rhythm or make it slower if and when it occurs. Atrial fibrillation, if you have other problems, can increase your risk of stroke so blood-thinning medication is often used as well.

If you have bradycardia, you may be referred to the surgeons for a pacemaker. This is a small operation where a battery powered device is placed under the skin with wires that lead to your heart and provide it with electrical stimulation to prevent it from going too slowly. You can't feel it doing this but will be aware of a small flat lump under your skin just below your collar bone.

Your heart consists of four chambers that receive and send blood to the lungs and body.

Disorders affecting valves can either cause stenosis (a narrowing) or regurgitation (leakage after the valve has closed). Depending on what valve is involved and how severe the damage is it may result in symptoms of heart failure, as it makes the heart pump inefficiently.

Suspicion of a heart valve problem is usually picked up by your doctor when they listen to your heart and hear a murmur. A murmur is heard with the stethoscope and is turbulence of blood flow that occurs through a narrowed or leaky valve. Not all heart murmurs mean serious problems but are best investigated further.

The echocardiogram is the main test to diagnose what valve is involved and how severe it is.

Treatment depends on the type and severity of the valve lesion. You may simply be monitored over years to see if anything changes. Some conditions require medication to thin the blood or treat any complicating heart problems. You may be referred to a heart surgeon for consideration of a valve replacement or dilatation of a narrowed valve.