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. Depending on your history, examination and ECG, you may go on to have other tests.

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.

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.

Echocardiography is also referred to as cardiac ultrasound. This test is performed by a specially trained technician. It 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 to increase the conductivity of the ultrasound waves. 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 analyses the information and develops images of your heart. These images 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 - a technique used to view how your heart works under stress. It 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. Transoesophageal echocardiography (TOE) In transoesophageal echocardiography (TOE), the ultrasound transducer is guided through the mouth, down the throat and into the oesophagus. This allows very clear images of the heart to be obtained without the ribs or lungs getting in the way.

This test is performed by a cardiologist in a sterile operating theatre environment. Most people will need to have routine tests before the procedure. These tests may require separate appointments and are usually planned the day before or the day of the procedure. You will be asked not to eat or drink after midnight the evening before the procedure. You are not given a general anaesthetic but may have some medication to relax you if needed. Local anaesthetic is put into an area of skin to the side of your groin or in your arm. A needle and then tube are fed into an artery here and advanced through the blood vessels to the heart. Dye is then injected so that the heart and blood vessels can be seen on X-ray. X-rays and measurements are then taken giving the doctors information about the state of your heart and the exact nature of any narrowed blood vessels. This allows them to plan the best form of treatment to prevent heart attacks and control any symptoms you may have. After the procedure you will have to lay flat for several hours to prevent bleeding.

This refers to narrowing of the arteries that supply blood to the heart muscle. The heart, like all other organs in the body, needs a constant supply of oxygen and energy. Narrowed arteries are unable to keep up with the demand needed to supply the heart muscle with blood. This can cause damage to the heart muscle if prolonged. The most common symptom of this problem is chest pain that occurs when you exert yourself (angina). Typical angina chest pain is a heavy sensation in your chest associated with shortness of breath. It sometimes radiates to your arms and can make you feel like being sick, dizzy or sweaty. Not everybody experiences the same sensation and any one of those symptoms can represent angina. If your GP thinks you may have angina they will refer you for an assessment to plan treatment. Heart Attack (Myocardial Infarction) If an attack of angina lasts for more than 20 minutes then you may be having a heart attack. This is when a piece of the heart muscle has been deprived of oxygen for so long that it can die, resulting in permanent damage to your heart and in some cases death. There are treatments available in hospital that can prevent heart attacks and save lives so if you have chest pain or symptoms of angina that last for more than 20 minutes you should call an ambulance and go to hospital as soon as possible. Am I likely to have cardiovascular disease? There are several risk factors that are scientifically proven to be associated with this disease. However even if you don’t have any of the following it could still happen to you. You are more likely to have cardiovascular disease if you have any of the following: Are or have been a smoker Diabetes High blood pressure High cholesterol A family history of the disease Are older (your risk increases as you get older) Treatment consists of medications to protect the heart and its blood vessels. These include aspirin which makes the blood less sticky and prone to clots, medication to lower your cholesterol (even if it isn’t very high this is still helpful), medication to make your heart go slower and to open the blood vessels. You will be given a nitro lingual spray to carry with you with instructions of what to do if you have angina. You will be given advice on diet changes that can protect the heart as well as stop smoking programs. If you have had a heart attack you will be offered cardiac rehabilitation classes with a trained physiotherapist. Depending on tests you may have procedures offered to surgically correct the narrowed blood vessels. The cardiology department and your GP often share follow-up for this condition.

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 Treatment You are likely to have 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 dietician or given advice about restricting the amount of fluid and salt you take as this can contribute to symptoms. You can also be involved in cardiac rehabilitation programmes run by trained physiotherapists. You will be given reading material to learn more about your disease. The cardiologist and your GP usually share follow-up for this condition.

Your heart rate is controlled by a complex electrical system within the heart muscle which drives it to go faster when you exert yourself and slower when you rest. A number of conditions can affect the heart rate or rhythm. Heart rate simply refers to how fast your heart is beating. Heart rhythm refers to the electrical source that is driving the heart rate and whether or not it is regular or irregular., As some types of arrhythmias can cause you to faint without warning, your doctor may restrict your driving until the condition is controlled., 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 your 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). This trace of the heart's electrical activity gives the diagnosis of the source of the arrhythmia. This is often normal at rest and more extensive testing is needed to try and catch the arrhythmia especially if it is intermittent. an 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., 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 4 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 (see above),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.

There are four major heart valves that control blood flow through the heart. If the valves become narrow (stenosis) so that blood flow through them becomes difficult, or leaky so that some blood flows in the wrong direction, they may need to be repaired or replaced. Valves may be damaged by diseases such as rheumatic fever or bacterial infection, degenerate with age or may not be formed properly at birth. Heart valve surgery involves making a cut through the front of the chest and breastbone (sternotomy) to expose the heart. The heart is then stopped and its function taken over by a heart-lung machine. Part of the heart is then opened and the valve repaired or possibly replaced using a human donor valve, a valve from a pig or cow or an artificial valve. The heart is then restarted, the heart-lung machine disconnected and the breastbone closed with wires. The operation usually takes between three and five hours.

The aortic valve regulates blood flow between the lower left chamber (left ventricle) of the heart and the aorta. Transcatheter aortic valve insertion or TAVI involves the replacement of a damaged aortic valve without the need for open heart surgery. The replacement valve is delivered to the valve site via a catheter in a minimally invasive surgical procedure. Once the new valve is in place it permanently takes over the job of regulating blood flow.

A patent foramen ovale (PFO) occurs after birth when the foramen ovale, a hole in the wall between the left and right atria or upper chambers of the heart, fails to close completely. This occurs in approximately 25% of the population and, in most cases, does not cause any problems. Complications can arise however if blood leaking from the right atrium to the left contains a clot which may cause a stroke or heart attack. Non surgical closure of a PFO is a procedure in which a catheter is inserted into a large vein and moved into the heart to deliver the PFO closure device to the site of the heart wall defect. The device will remain permanently in the heart and will prevent abnormal blood flow between the 2 chambers of the heart.

Percutaneous coronary intervention (PCI), or angioplasty, is a procedure designed to reduce or remove blockages in the coronary arteries (arteries supplying the heart with oxygen). The purpose of a PCI is to restore blood flow to the coronary arteries and ensure the heart is adequately supplied with oxygen. This may reduce or eliminate angina and can restore blood flow in the event of a heart attack. During this procedure, a specially designed catheter with a small balloon tip is guided to the point of narrowing in the artery. Once in place, the balloon is inflated to open the artery and stretch the artery to increase blood flow to the heart. A stent, a small stainless steel mesh tube, can also be inserted at this time to function as scaffolding and give a coronary artery support. A balloon catheter is used to insert the stent into the narrowed coronary artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is then deflated and removed, and the stent stays in place permanently.

A stent is a small stainless steel mesh tube that behaves like scaffolding and gives a narrowed coronary artery support, thus holding it open. A balloon catheter is used to deliver the stent into the narrowed coronary artery then, once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is then deflated and removed, and the stent stays in place permanently.

The left atrial appendage is a small pouch found in the top left chamber of the heart (the left atrium). As the heart contracts with each heartbeat, blood is squeezed out of the left atrium and into the left ventricle (bottom left chamber of the heart). If you have atrial fibrillation, the electrical impulses that control the heartbeat are fast and chaotic and the atria don’t have enough time to squeeze the blood into the ventricles effectively. Blood collects in the left atrial appendage and can form clots, increasing the chances of a stroke. Left atrial appendage closure is a procedure which closes off the opening of the left atrial appendage. A special catheter is gently inserted into a large vein and guided slowly up to the heart. It delivers a device at the opening of the left atrial appendage that becomes a permanent seal that prevents clots from being released.

Balloon Angioplasty: a long thin tube (catheter) with a tiny balloon attached to the tip is inserted through a small incision (cut) made over an artery in your arm or groin. The catheter is guided through the arteries to the site of the blockage where the balloon is inflated to clear the blockage and, in some cases, a metal tube (stent) is inserted into the artery to keep it open.