Cardiac Risk Assessment

A cardiac risk assessment provides a detailed picture of your current heart health and your likelihood of developing cardiovascular disease in the future. It may be recommended if you have symptoms, a family history of heart disease or risk factors such as high blood pressure, high cholesterol, diabetes or smoking. It can also be valuable for people who feel well but would like a clearer understanding of their cardiovascular health.

During your appointment, your cardiologist will discuss your medical and family history, lifestyle, medications and any symptoms or concerns you may have. Your blood pressure and other relevant measurements will be reviewed, and an electrocardiogram may be performed. Recent blood-test results, including cholesterol and blood glucose levels, may also form part of the assessment. Depending on your circumstances, additional testing may be recommended.

Please bring a current list of your medications, any recent blood-test results and copies of relevant previous cardiac investigations if they are available. At the end of the assessment, your cardiologist will explain your individual risk factors and discuss practical steps to protect your heart health.

Cardiac Stress Testing

A stress test examines how your heart responds to physical activity. Some heart conditions are more easily detected when the heart is working harder than when the body is at rest. Stress testing may be used to investigate symptoms such as chest discomfort, breathlessness, palpitations or reduced exercise capacity, or to assess cardiovascular fitness and the likelihood of coronary artery disease.

During an exercise stress test, small adhesive electrodes are placed on your chest to continuously record your heart’s electrical activity. A blood-pressure cuff is also fitted to your arm. You will usually walk on a treadmill, beginning at a gentle pace. The speed and incline are gradually increased while your heart rate, rhythm, blood pressure and symptoms are closely monitored.

If you are having a stress echocardiogram, ultrasound images of your heart will be taken before exercise and again immediately afterwards. This allows the cardiologist to compare how your heart muscle and valves function at rest and under stress.

Wear comfortable clothing and supportive walking shoes. You may be given instructions about eating, caffeine or particular medications before your appointment. Do not stop any medication unless you have been specifically advised to do so. The test can be stopped at any time if you feel unwell or are unable to continue, and you will remain monitored as your heart rate returns towards normal.

Echocardiography & Advanced Cardiac Imaging

An echocardiogram, often called an “echo,” is a non-invasive ultrasound examination that provides moving images of the heart. It allows the structure and function of the heart to be assessed, including the heart chambers, muscle, valves and the direction and speed of blood flow. An echocardiogram may be used to investigate symptoms such as breathlessness, chest discomfort, swelling, a heart murmur or an abnormal ECG.

For a standard echocardiogram, you will be asked to undress from the waist up and will be provided with a gown or covering. You will usually lie on your left side on an examination bed. A small amount of ultrasound gel is applied to the chest, and a handheld probe is moved gently over several areas to obtain images from different angles. You may hear pulsing or whooshing sounds as the machine measures blood flow through the heart.

The examination is generally painless, although you may feel some light pressure from the probe. Ultrasound does not use radiation, and no special recovery time is required. In most cases, you may eat, drink and take your usual medications beforehand unless you have been given different instructions.

In some instances, your cardiologist may recommend advanced cardiac imaging modalities such as CT coronary angiography, cardiac MRI, nuclear medicine testing among others. These various imaging modalities often have specific indications and provide additional information relevant for certain cardiac conditions.

Cardiac Monitoring

Cardiac monitoring records the heart’s electrical activity over an extended period while you continue with your usual daily routine. It can help identify irregular heart rhythms that may not occur during a short ECG performed in the clinic. Monitoring is commonly recommended for symptoms such as palpitations, dizziness, fainting, unexplained breathlessness or episodes of a racing or unusually slow heartbeat.

At your appointment, a cardiac technician will prepare small areas of skin on your chest and attach several adhesive electrodes. These are connected by fine leads to a compact recording device, often called a Holter monitor. The device is lightweight and can usually be worn beneath or clipped to your clothing. The fitting process is straightforward and should not be painful.

Depending on the reason for monitoring, you may wear the device for 24 or 48 hours, or sometimes longer. You will generally be encouraged to follow your normal routine so the monitor can record how your heart behaves during everyday activity, rest and sleep. You may also be asked to record the time of any symptoms so they can be compared with your heart rhythm.

Wear a loose-fitting top to your fitting appointment. Once the monitor has been attached, keep it connected and follow the instructions provided regarding showering, exercise and sleeping. After the monitoring period, the device is returned and the recording is analysed for your cardiologist to review.