What is an Electrocardiograph E.C.G?
An Electrocardiograph (E.C.G.) is the most common cardiac test carried out on cardiac patients. The E.C.G. takes a recording of the electrical activity of the heart (heart beat) onto paper.
How is an E.C.G. performed?
You will be brought into a cubicle in the diagnostic department by a Cardiac physiologist. They will ask you to remove all your top clothes. If you are wearing knee length stockings or tights you will need to remove them. When you are undressed you will be asked to lie flat on the examination couch. The physiologist will apply small stickers called "electrodes" to your wrists, ankles and your chest, generally 10 electrodes in all.
The physiologist will then attach the electrodes to the E.C.G. machine via small cables.
Once all the electrodes are in place you will be asked to try and relax and stay still for approximately one to two minutes. This may be extended if more information is required. The physiologist may ask you to take a deep breath in and to hold your breath for a few seconds. Once the E.C.G. is completed the E.C.G. machine prints out a graph of your heart rhythm. The physiologist will remove the electrodes. The test generally takes about five minutes.
What information can be obtained from the E.C.G?
The E.C.G. gives the doctor information about your heart rate, heart rhythm and may or may not show evidence of heart disease. The physiologist cannot give you any results or discuss the E.C.G. findings at the time as the reading has to reported on by a Doctor.
What happens after the E.C.G. is done?
If you are going back to the out-patient clinic, you will bring the printout with you. If you are not going back to the out-patient clinic the tracing is sent to the medical filing room for filing in your chart.
If you are a patient in a ward in the hospital the physiologist who has performed the E.C.G. will put it into your chart. If as an in-patient you are sent to the cardiology department for your E.C.G. the physiologist will give you the E.C.G. to take back to the nurse who is looking after you.
If your GP requested the E.C.G., the tracing is put aside for the cardiac doctor to report. When the E.C.G. is reported the results are sent to you doctor by post.
What is a 24 hour Ambulatory E.C.G. (Holter Monitor)/Event Monitor?
This test is performed in order to find the cause of chest pain, shortness of breath, palpitations, collapse or dizzy spells. There are two types of monitors, the Holter Monitor and an Event Monitor.
A 24 hour ambulatory E.C.G. monitor or Holter Monitor is used to record cardiac symptoms, which occur occasionally. "Ambulatory" this refers to the fact that you can walk around and perform all your normal activities during the day.
The monitor is like a mini E.C.G. machine. The standard E.C.G. machine only takes a snapshot of your heart rhythm whereas the Holter can record your heartbeat for 24 hours or longer if necessary.
If the physiologist puts on an event monitor you generally wear this for one week. The cardiac physiologist will explain how to put on new electrodes if you need to.
Similar to the E.C.G., electrodes (stickers) are applied to the skin. These electrodes are attached to the monitor by cables. You can go home and continue with your normal daily activities.
You should record the time you get symptoms if any and how you feel and what you are doing at the time. You will also need to write down what time you eat, drink, slept, wake up, exercise and take your tablets at.
The physiologist will tell you the time you are to return back to the cardiology department with the monitor. When you return, the physiologist will remove the monitor. The information on the monitor will be analysed by a physiologist and the results reported by a cardiac doctor. The report will then be sent to your doctor. When you are wearing a Holter or an event monitor you cannot take a bath or a shower. If the monitor gets wet it will be destroyed. The monitors are very expensive to replace.
What information can the doctor get from the Holter or Event Monitor?
If you feel any symptoms such as palpitations, light headedness or shortness of breath while wearing the monitor the doctor will be able to find out if your heart is the cause.
The result of the test will be sent to the doctor requesting the test and/or filed in your hospital chart. The physiologist cannot give you any results from this test.
What is an Echocardiogram?
An echocardiogram or echo is a test, which uses sound waves to create a picture of the heart. The picture is more detailed than an x-ray and there is no radiation involved. The test is performed by a cardiac physiologist or a doctor.
How is an Echocardiogram performed?
The test is carried out in the cardiology department on the ground floor. The Health care attendant, physiologist or doctor will ask you to remove all of your top clothes. You will be asked to lie up on the examination couch. The doctor or physiologist performing the test will ask you to sit you upright and turn onto your left side and to put your left hand behind your head.
The physiologist or doctor will place three stickers on your chest called electrodes. These are to record your heart beat (E.C.G.). The physiologist or doctor then places a scanner called a "transducer", which is covered in a watery gel onto your chest. The physiologist may also take some pictures of your heart from your stomach and your throat. Firm pressure is applied but is does not hurt.
The transducer sends out sound waves towards the heart. These sound waves bounce off the heart and are collected by the transducer. The sound waves are than computerised and appear on a TV screen as a picture of the heart. By aiming the transducer over certain parts of the chest the various parts of the heart can be examined. During the echocardiogram the sound wave are used to listen to the blood flow through the heart. You will be able to hear these sounds. During the study the physiologist will take several measurements of your heart and assess how well it is working. Once the physiologist has recorded all the pictures and measurements, they will remove the E.C.G. stickers.
You will be given paper towel to wipe off the gel. Only a doctor can discuss the results of the echocardiogram with you. The procedure will take approximately 30 to 45 minutes.
What information can be obtained from an Echocardiogram?
The echocardiogram can show if the size and shape of the heart is normal or abnormal. How the valves inside the heart are opening and closing. If you have had a heart attack it can show which part of the heart was affected.
What is an ambulatory blood pressure monitor?
An ambulatory blood pressure monitor records your blood pressure at regular intervals over a 24 hour period. "Ambulatory" just refers to the fact that you can walk around and perform all your normal activities during the day. Just as the doctor or nurse in the clinic takes your blood pressure, this monitor takes it over a longer period of time, normally 24 hours.
When you arrive for your appointment the cardiac physiologist will bring you into a cubicle in the diagnostic cardiology department. They will ask you to remove your top clothes and then to sit on a couch. Next the physiologist will place a blue cuff around your arm.
The physiologist will make the monitor take one blood pressure reading to show you what to expect. The cuff will start to fill with air and get quite tight on your arm for a few seconds while it takes your blood pressure. This may feel a little uncomfortable but it is very normal. Do not worry. Then the cuff deflates and the reading is recorded in the monitor. The monitor will do this every 20 minutes from 7.30am until 11.30pm; it records every 60 minutes from 11.30 until 7.30am.
You need to wear the monitor on your arm for an entire 24 hour period
The physiologist will give you a diary sheet to record any symptoms you may get during this time. You will also need to write down what time you eat, drink, and go to sleep, wake up, perform exercise and take your tablets. The doctor needs this information.
You will need to go about your normal activities while wearing the monitor. Once the monitor is fitted and the physiologist has explained everything you can leave the department with the monitor and diary. You will be asked to return the next day at a specified time to have the monitor removed.
The monitor provides details of how your blood pressure behaves when you are going about your normal daily life. It gives us information about what your blood pressure is like when you are stressed, relaxed, working, sleeping, eating, drinking etc. It is very useful if your GP believes your blood pressure is only high when you visit a doctor. This is called “White-Coat-Hypertension” and is quite common. This way we can see what your blood pressure is like when you are away from doctors and a hospital.
How do I prepare for an ambulatory blood pressure monitor?
You do not need to prepare for this test. Take all your medications as you would normally unless your doctor tells you not to. You should wear comfortable loose clothing so the monitor is not visible when you are wearing it.
What happens when you return your ambulatory blood pressure monitor?
When you return with the monitor and diary, the physiologist will remove it and transfer the details into a computer and a report will be printed. This report is sent to the doctor who requested the test. The physiologist cannot give you any results from the test
What is an exercise stress test?
This test records the electrical activity of your heart during physical exercise and can sometimes be referred to as an EST.
How is an Exercise E.C.G. or stress test performed?
The test is carried out in the exercise room in the cardiology department. The cardiac physiologist will ask you to remove all of your top clothes. The physiologist will place 10 stickers (electrodes) on your chest. These stickers are than attached to the E.C.G. machine, which will monitor your heartbeat throughout the test.
The doctor will put a blood pressure cuff on your arm. Before, during and after the test the doctor will check your blood pressure.
The physiologist will then explain how to walk on the treadmill. The treadmill will start very slowly. At intervals of three minutes the speed and the incline (rise) of the treadmill will be increased.
The test will continue until you have reached your maximum heart rate or if you experience symptoms or are too short of breath to continue. When the test is finished the physiologist will monitor your heartbeat and blood pressure for a further 10 to 15 minutes. The Physiologist will encourage you to exercise for as long as possible.
How do I prepare for an exercise stress test?
Do not drink any beverages containing alcohol on the day of the test. Eat only a light breakfast or lunch before your appointment. Please wear comfortable shoes and loose clothing. Continue all medications unless your doctor instructs you otherwise.
Although the test itself only takes about 30 minutes you might need to be in the department for up to one and a half hours altogether.
Is there any risk to an exercise stress test?
The stress test is generally very safe. It poses the same level of risk as taking a brisk walk or walking up hill. There are small risks such as collapse, heart attack or dangerous heartbeats. Throughout the test however, trained staff are always present to deal immediately with any problems.
Why is an exercise stress test performed?
The test is performed to find out the cause of chest pain, shortness of breath or to assess how well a patient is doing following a heart attack or cardiac surgery.
What is a Device Check?
If you have had a pacemaker, implantable cardiovertor defibrillator (ICD) or cardiac resynchronisation device (CRT) implanted you need to have it checked at regular intervals. This is the timetable for your check-up’s:
- The same day or 24 hours after device has being implanted
- Six weeks after the implant date
- Six months after the six week date
- One year after the six month date
The check-ups are performed in the diagnostic cardiology department by a cardiac physiologist who will use a computer to check to ensure the device is working properly. They can modify it for you at each appointment to best suit your own heart
How is a Device check performed?
You will be brought into a cubicle in the pacemaker room. The physiologist will ask you to remove your top clothes.
When you are undressed you will be asked to lie flat on an examination couch. The physiologist will apply 3 or 4 small stickers called "electrodes" to your chest. A special magnet will be placed over the device on your chest called a wand.
The computer then "talks" to the device and tells us how it has been working. The physiologist can adjust the settings on the device using this magnet and computer. You will not feel anything during the check. The physiologist may ask you various questions during this to see how you are getting on. The check-up can take up to 30- 40 minutes, depending on how complicated your particular device is.
How do I prepare for a Device check?
You do not need to do anything for this test. Please arrive at least 10 minutes before your appointment. The device clinic is held on Tuesday, Thursday and Friday, by appointment only. If you are unable to attend for your appointment, please telephone the Cardiology Reception Tel: 01 414 3440 / 414 3439 in advance so we can make another appointment for you and so that someone else can avail of your appointment if you cannot come.
What information can be obtained from Device check?
Along with checking the battery levels and that it is functioning correctly the pacemaker can be re-programmed to best suit your heart. As everyone is different, the pacemaker needs to be set-up specifically for you. All this information is kept in a special chart in our department.
What happens after a Device check?
The stickers will be taken off your chest and you may get dressed again. You will then be given an appointment for your next device check. The result will be recorded in your special pacemaker chart and kept until your next check-up.
What is a Dobutamine Stress Echocardiogram (D.S.E)?
A Dobutamine Stress Echocardiogram is a test used to assess the pumping function of your heart in patients who are unable to exercise on a treadmill for a Stress Test.
- A drug called "Dobutamine" is given gradually during the test as it causes the heart to beat stronger and faster (just like taking exercise).
- The heart is scanned with an echo/ultrasound machine throughout the test.
How do I prepare for a Dobutamine Stress Echocardiogram (D.S.E.)?
- The appointment for the test is generally sent out in the post.
- The appointment letter will give you appointment details and advise you which medications not to take before the test.
- Stop taking your beta blocker medication (such as Atenolol, Tenormin, Metoprolol, Betaloc, Emcor, Nebilet) from Wednesday (last dose on Tuesday morning), that you do not take these tablets for 72 hours before you have this test.
- If you have any questions about the medications please phone 01-414 3059.
- On the day of your test call to the first office on the right called ECHO ADMIN
- You do not have to fast for this test. You can have your breakfast before you come to the hospital.
- You must be collected after the test as we advise you NOT to drive yourself home
How is a D.S.E. performed?
- The test is carried out in the Cardiology department on the ground floor.
- The doctor carrying out the test will explain the test and ask you to sign a consent form agreeing to have the test.
- Your weight is recorded in order to give you the medication.
- You are required to remove all your top clothes and to lie on the examination couch. (A blanket is provided, hospital gown for women)
- E.C.G. electrodes (stickers) are placed on your chest to record your heartbeat.
- The doctor inserts a needle in your arm. This needle is used to give the Dobutamine.
- You will also have a blood pressure cuff attached to your arm to monitor your blood pressure during and after the test.
- The Doctor/nurse will ask you to sit upright, turn onto your left side and to put your left hand behind your head.
- The Doctor then scans your heart before starting the Dobutamine.
- The Dobutamine is gradually increased and your heart is scanned throughout.
- The test usually takes 20-30 minutes
Are there any risks associated with Dobutamine?
- The risk with this medication is very low.
- You may experience minor side effects such as chest pain, a headache, and shortness of breath, palpitations or flushing.
What is a Transoesophageal Echocardiograph (T.O.E.)?
This is a test that enables the Doctor to view the inside of the heart and the major blood vessels.
How do I prepare for a T.O.E.?
- You will be asked to phone and confirm that you will attend the appointment made for you.
- You will be asked to fast from 12 midnight the night before
- You will need someone to collect you as it is advisable not to drive home after the procedure
How is a T.O.E. performed?
- A T.O.E. involves having a probe (a thin flexible tube with a special tip) inserted down your throat by a doctor. You will be given drugs to sedate (induce sleep) you during the procedure
- On the day of your test you will go to the Day Ward. This is situated on the first floor; you should take the lift to level 2.
- When you arrive in the day ward go directly to the reception desk.
- You will be brought to a ward. Here you will change into a hospital gown.
- A doctor or a nurse explains the test to you.
- You will be asked to sign a consent form agreeing to have the test.
- A doctor will put a needle in your arm. This allows the doctor or nurse to give you some medication to relax you.
- You will be brought to a room to have your test.
- The nurse will place some E.C.G. stickers on to your chest to record your heartbeat.
- A small clip will be placed on your finger to monitor the amount of oxygen in your blood throughout the test.
- You will have a blood pressure cuff attached to your arm to monitor your blood pressure during the test.
- A local anaesthetic is sprayed to the back of your throat. This will numb the throat and the tongue and makes the probe easier to swallow.
- A mouth guard placed in your mouth. This is to prevent you biting down on the tube.
- The doctor will ask you to turn onto your left side.
- You will be given drugs to sedate (induce sleep) you during the procedure.
- The probe is passed gently and pictures of your heart are taken.
- The test takes about 20-30 minutes.
What information can be obtained from a T.O.E.?
This test will help your doctor to assess your heart function and the major blood vessels going to your heart.
What happens after a T.O.E.?
After the test you cannot eat for 1-2 hours, as your throat will be numb from the anaesthetic. You are required to stay in the day ward for 3-4 hours after the test until the effects of the sedation wears off. The test results will be sent to your Doctor.
Are there any risks, complications or discomfort associated with a T.O.E.?
T.O.E. is a low risk procedure. Any procedure however has a small risk.
The most common problem is gagging and some throat discomfort during the procedure and your throat may feel sore for a few days after the test.