Cardiology

At The Trowbridge Health Centre, we run a community cardiology service for the area.

This allows us to perform investigations that would normally be done in a hospital setting and is therefore convenient for the patient who does not then need to travel to a large district general hospital.

Dr Bimbh and his team perform exercise tolerance tests, echocardiograms and analyse 24 hour tapes. This is a service that we provide for NHS patients in the whole locality and access is through referral from your G.P.

A report of the tests is sent back to your own GP for any treatment necessary. If a referral is necessary to hospital for further or urgent treatment this can be done directly as we work closely with our colleagues at RUH, GWH and Sailsbury.

This service can only be accessed via a referral from your G.P.

Echocardiogram

What is an echocardiogram?

An echocardiogram is an ultrasound scan of the heart. It is sometimes just called an 'ECHO'. Ultrasound is a very high frequency sound that you cannot hear, but it can be emitted and detected by special machines. The scan can give accurate pictures of the heart muscle, the heart chambers, and structures within the heart such as the valves.

What happens during the test

You will need to undress to the waist and lie on the couch. A probe is placed on your chest (it is a bit like a very thick blunt pen). Also, lubricating jelly is put on your chest so the probe makes good contact with the skin. The probe is connected by a wire to the ultrasound machine and monitor. Pulses of ultrasound are sent from the probe through the skin towards your heart. The ultrasound waves then echo ('bounce back') from the heart and various structures in the heart.

The amount of ultrasound that echoes back depends on the density of the tissue the sound has hit. Therefore, the different structures send back different echoes. For example, ultrasound travels freely through fluid so there is little echo from blood in heart chambers. But, heart valves are dense tissues so ultrasound waves hitting a valve will echo back clearly.

The echoes are detected by the probe and are sent to the echocardiogram machine. They are displayed as a picture on the monitor. The picture is constantly updated so the scan can show movement as well as structure. (For example, the valves of a heart opening and closing.) The operator moves the probe around over the skin surface to get views from different angles. Some abnormalities can be seen quite clearly. For example, damaged heart valves, thickened heart muscle, some congenital heart defects, etc.

The test is painless and takes about 10-20 minutes. You may have to turn on your side during the test so the operator can scan the heart from different angles. You do not need any special preparation before the test. You eat and drink normally before and after the test. Continue to take your usual medication.

Exercise Electrocardiogram (ECG)

What is an exercise ECG?

An exercise ECG records the electrical activity of your heart whilst you exercise. This test is sometimes called an exercise stress test or exercise tolerance test.

How is an exercise ECG test done?

Small electrodes are stuck onto your chest. You will need to undress from the waist up for the electrodes to be attached. Please bring a loose fitting tee shirt to put back on top once the electrodes have been attached. Wires from the electrodes are connected to the ECG machine. You will then be asked to exercise on an exercise bike. The exercise starts at a very easy pace, and is gradually made more strenuous by increasing the speed and by putting some resistance on the bike wheel.

Whilst you exercise, ECG tracings are made and you will also have your blood pressure measured from time to time. The test lasts about 10-20 minutes.

Why is an exercise ECG test done?

The exercise ECG test helps to diagnose and assess the severity of ischaemic heart disease (sometimes called coronary heart disease or coronary artery disease). This disease is due to narrowing of the coronary arteries. It can cause angina (chest pains) and other problems. So, if you develop chest pains you may be advised to have an exercise ECG to help to clarify the cause.

Many people with ischaemic heart disease have a normal ECG at rest. During exercise the heart beats faster and needs more oxygen. If one or more of your coronary arteries are narrowed, part or parts of the heart muscle do not get enough oxygen. This can cause the ECG tracing to become abnormal when you exercise. Therefore, if you have a 'positive' exercise ECG test (an abnormal reading) you are likely to have ischaemic heart disease.

If you already have ischaemic heart disease, the degree of abnormality on the exercise ECG tracing can give a good idea of the severity of the disease. Therefore, an exercise ECG test is often done to help to decide if you need further investigations or treatment.

Will I cope with the exercise required?

Most people manage to do the exercise ECG test. It can be hard work, but the level of exercise chosen aims to match your normal capabilities. At any stage you can tell the person doing the test if you feel it is too difficult, and the test will stop. The test will also be stopped if you develop unpleasant pains or if you become very tired, or very short of breath.

What should I do to prepare for the test?

You should not have a heavy meal within one hour of the test. Otherwise, there is no special preparation needed. For the test, wear loose fitting clothes and shoes that are comfortable to walk in. Continue to take your usual medication unless advised otherwise by a doctor.

Are there any risks when doing an exercise ECG?

An exercise ECG test is done without any problems in the vast majority of cases. If you do not have ischaemic heart disease then complications are very rare. However, serious complications occur in a small number of cases in people who have ischaemic heart disease. The risk is to develop a heart attack or a serious heart irregularity (arrythmia) during the test. One or other of these problems occurs in about 3 in 1000 tests done on people with ischaemic heart disease. Medical help is near to hand to deal with possible problems. However, if you have ischaemic heart disease, you have about a 3 in 10,000 risk of dying during an exercise ECG test.

You have to weigh up the pros and cons before deciding on having this test. The test can give very valuable information about your condition, but with a small risk of serious problems developing.

Ambulatory Electrocardiogram

What is an ambulatory electrocardiogram?

This test records the electrical activity of your heart when you are walking about (ambulatory) and doing your normal activities. Small metal electrodes are stuck onto your chest. Wires from the electrodes are connected to a small lightweight recorder (often called a Holter monitor). The recorder is attached to a belt which you wear round your waist. (It is like wearing a personal CD stereo.) The electrical activity is usually recorded for 24 hours.

Why is an ambulatory electrocardiogram test done?

Your doctor may advise this test if he or she suspects that you are having bouts of an abnormal heart rate or rhythm (arrhythmia). For example, if you have palpitations or episodes of dizziness. Some arrhythmias 'come and go', and may only last seconds or minutes. They may never be found when you are examined by a doctor. So, the test may detect an arrhythmia.

How is the test done?

It takes about 10 minutes for the electrodes and recorder to be fitted. You then go and do what you normally do over the next 24 hours. You wear the recorder when asleep in bed too. (However, you should not have a bath or shower as the recorder should not get wet.)

You will be given a diary to record the times when you develop any symptoms (such as palpitations). The ECG tracing is analysed at the end of the test. But, any times you record when you had symptoms will be most carefully analysed to see if you had an arrhythmia to account for the symptoms. A doctor may ask you to do some activities which have previously brought on symptoms to try and provoke the same symptoms.

The monitor and electrodes are removed in another appointment approximately 24 hours after they were fitted. The ECG tracing is analysed and a report sent to your GP.