Ambulatory ECG Monitoring

What is it?

An Ambulatory ECG is usually recorded for a 24 hour or 48 hour period and is sometimes called Holter monitoring. It is a way of continuously recording your heart rhythm/ECG over a period of time. It is a very straightforward procedure with no side-effects and there are no special preparations that you have to do for this investigation.

Why is it Done?

Ambulatory ECG monitoring is done to see what your heart rhythm does when you are going about your normal daily activities. The test can help to diagnose symptoms such as palpitations which do not happen very often and may not occur when you have a normal ECG recording which takes less than 1 minute. The test may be done if you have feelings of your heart racing or beating irregularly or if you feel dizzy. It can also be undertaken so that your Consultant can check that certain medications you may have been prescribed are doing their job.

How is it Done?

You will need to make two visits to the hospital – once to have the monitor fitted and another visit to return it. The test will be performed by a Clinical Physiologist who will ask you to undress to the waist. ECG electrodes (small sticky patches) will be applied to your chest after your skin has been rubbed slightly to ensure a good contact. Men may need to be shaved in the small areas of the electrode sites. Wires from the recorder will be attached to the electrodes and the recorder, which is a small device, can either be clipped to your belt or clothing or be worn in a pouch under your clothing. The wires will be concealed underneath your clothing and the recording device does not make any noise. You should try to do all your normal activities during the day and also to undertake any activities which might bring on your symptoms. You will be given a diary card to keep a record of your activities and also to note if you have any symptoms.

After you have returned the recorder the results will be analysed and sent to your Consultant.

Echocardiogram

What is it?

An echocardiogram is a scan using ultrasound (high frequency sound waves) to take pictures of your heart. The procedure is not painful and usually takes approximately 30 minutes. Ultrasound is not known to cause any harm to the body and is routinely used for scanning during pregnancy.

Why is it Done?

Echocardiography is done for many different reasons and can be used as a screening procedure even if you have had no problems with your heart. The scan gives information to your doctor about the size of your heart, how well the heart muscle is functioning and also about the condition of the valves inside the heart. It is often done if your doctor has heard a "murmur" when they listened to your heart with a stethoscope or if you have an irregular heart beat, high blood pressure, are short of breath or have had a heart attack or operations on your heart in the past.

How is it Done?

The test is performed by a Clinical Physiologist or your Consultant. You will be asked to undress to your waist and lie on a couch and ECG electrodes will be attached to your chest. The room will be darkened so that the screen on the equipment can be seen clearly. A small probe will be moved around over different areas of your chest using a lubricating jelly to ensure good contact with the skin. Images and measurements are taken and stored during the scan and, during some measurements (Doppler), you will hear noises which relate to the blood flowing around the heart. It is not always possible to give you the results of your scan directly as the measurements and pictures are replayed later, prior to reporting, and may need to be reviewed by your Consultant. You may have a friend or relative present during the procedure if you wish.

Exercise Test

What is it?

A cardiac exercise test, often also called a stress test or exercise ECG, is an electrocardiogram (ECG) recorded on a computerised machine whilst you are walking on a treadmill.

Why is it Done?

The test is done to provide your doctor with information about how your heart performs during physical activity and provides information about blood flow to the heart muscle which cannot be detected on a resting ECG. The test can show if symptoms such as chest pain or breathlessness are related to your heart.

How is it Done?

The test will be performed by a Clinical Physiologist and your Consultant will usually also be present. You will be asked to undress to the waist and ECG electrodes will be applied to your chest. Men may require their chest to be shaved to ensure good contact with the recording electrodes during the procedure. Ladies will be given a gown to wear. A blood pressure cuff will be attached to your arm and baseline ECG and blood pressure readings will be taken whilst you are at rest. You will then be asked to walk on a treadmill which starts off very slowly and gradually increases in speed and slope and recordings of your ECG and blood pressure will be recorded at intervals. You will be asked to report symptoms such as chest pain/tightness, breathlessness, palpitations or dizziness or if you feel that you cannot walk any further. If you are limited with arthritis or lung disease this will be taken into account by the staff during the test. After the test the recordings will be continued usually for 5 to 10 minutes until your heart rate has returned to its resting reading.

Preparation for the test.

You should wear light comfortable clothes and flat shoes. You should not eat a heavy meal or drink alcohol for 3 hours prior to your test but light snacks and soft drinks are alright. You should bring a list of all the medication you are taking with you and you may need to stop taking any beta blockers (e.g. atenolol, bisoprolol, propranolol) 24 or 48 hours before the test – please check your appointment letter