· Resting ECG |
£ |
70 |
· Exercise Treadmill Test |
£ |
270 |
· 24 Hour ECG Monitoring |
£ |
245 |
· Echocardiogram with Doppler |
£ |
385 |
· Lipid Profile (Fasting Blood Test) |
£ |
40 |
· Cardiovascular Risk Evaluation Profile (Fasting Blood Test) |
£ |
180 |
· The EBCT Heart Scan |
£ |
525 |
The electrocardiogram (Resting ECG)
The electrocardiogram (ECG)
An electrocardiogram, or ECG, records the rhythm and electrical activity of your heart. Some people have an ECG before having an operation. Others have one as part of a routine health check-up, even if there is no suspicion of heart disease. Motor racing drivers, scuba drivers, marathon runners, sport person should have screening cardiac tests routinaly.
What happens?
Several small patches, set in sticky plaster, are put on your arms, legs and chest and connected to a recording machine. The patches, called 'electrodes', are connected to wires which lead to the ECG recorder. This recorder picks up the electrical signals produced by each heartbeat. The machine records a few beats from each set of electrodes onto paper.
The ECG machine only records signals from your body. The whole test takes about five minutes and will not be uncomfortable at all.
What can the test show?
An ECG can detect problems with your heart rhythm. It can show if you have had a heart attack, either recently or some time ago. It can also tell if your heart has become enlarged or is working under strain.
The ECG is a simple and useful test but it has some limitations. An abnormal reading does not always mean that there is something wrong. On the other hand, some patients who have serious heart disease may have a normal ECG.
Exercise Treadmill ECG
Also known as an exercise electrocardiogram, exercise electrocardiography or exercise stress testing.
An exercise ECG is an electrocardiogram that is recorded while you are exercising on a treadmill (a running machine) or on an exercise bike. If you get a chest pain or feel uncomfortable when you are physically active, this test can help to tell if your symptoms are caused by coronary heart disease. If you have recently had heart surgery, an exercise ECG can help doctors decide what level of exercise you should do as part of your cardiac rehabilitation programme. Your exercise performance can be asses during the Test.
Getting ready for the test
Wear light, comfortable clothes and shoes. Don' t have a heavy meal before you have your ECG.
What happens?
Several small patches, set in sticky plaster, are put on your chest and connected to an ECG recorder, in the same way as for the ECG described earlier. You will then be asked to exercise on a treadmill.
The test starts off at a very easy rate and is gradually made harder either by increasing the speed and slope of the treadmill. A doctor will supervise the test and will carefully check your ECG readings, blood pressure and breathing. The medical staff will tell you when to stop - usually when they have the measurements they need. They will also tell you to stop if you get tired or very short of breath, or if you start getting unpleasant chest pains. Let them know if you get any of these symptoms. You can also tell the staff if you cannot carry on with the test. They will then take more ECG readings after you have stopped exercising.
The exercise test usually lasts about 15 minutes. It can be hard work, but should not be too much for you. Many people are pleasantly surprised by how much they can achieve. The value of the test is much greater if you try to work as hard as you can.
What can the test show?
The exercise ECG shows doctors the pattern of your heart activity during exercise. The doctors also need to know how much exercise you can do.
After the test, you may be told that you have had a 'positive' or a 'negative' exercise ECG.
· A positive exercise ECG is when significant changes are seen on the ECG during exercise. This means that you probably have coronary heart disease.
· A negative exercise ECG means there are no unusual or obvious changes shown on the ECG during the test.
The exercise ECG is a very useful test, but it is still not 100% accurate. Sometimes people with a normal heart have an exercise ECG that shows abnormalities. (For some unknown reason this often happens with young women). And sometimes a person who does have coronary heart disease may have a normal exercise ECG.
24-hour ECG recordings
Also known as Holter monitoring
This technique involves continuously recording an electrocardiogram (ECG) over 24 hours. It is usually done as an outpatient. This test can help to diagnose symptoms such as palpitations, which don't happen very often and which rarely happen in the doctor's surgery!
What happens?
Small patches, set in sticky plaster, are put on your chest. Wires are attached to these and are taped down. The wires lead to a small portable tape recorder, similar to a personal stereo, which you wear on a belt round your waist. The whole system is very comfortable and quiet so you should hardly be aware of it. You can do everything you normally do, except have a bath or shower. It is best to wear loose clothing.
The doctor will ask you to spend a normal day and do any activity which might bring on your symptoms.
What can the test show?
A 24-hour ECG recording can give a lot of useful information. For example, it can show if you may need treatment. It can also reassure you if you think you have palpitations but are in fact just 'over-aware' of your normal heartbeat.
Echocardiogram
An ultrasound picture of the heart which shows the structure of the heart and how it is working. A pulse of high frequency (inaudible) sound is transmitted through the skin of the chest by placing a recorder (probe) on the chest wall. Jelly is rubbed on the chest first, to help make a good contact. The probe then picks up the echoes reflected from various parts of the heart and displays them as an echocardiogram - a picture on a screen.
Bats can fly in the dark by sending out pulses of sound and listening for echoes reflected from objects around them. A similar idea is used in echocardiography.
£385
What happens?
A recorder (probe) is placed on your chest and a pulse of high-frequency sound is passed through the skin of your chest. Lubricating jelly is rubbed on your chest first, to help make a good contact with the probe. The probe then picks up the echoes reflected from various parts of the heart and shows them as an echocardiogram - a picture on a screen. You can see different parts of the heart as the probe is moved around on your chest.
What can the test tell?
Echocardiography gives information about the condition of your heart muscle. It is used routinely to assess people with valvular heart disease (disease of the heart valves).
It gives useful information about how the heart valves are working. The procedure does not affect the heart and does not cause any discomfort.
Lipids Profile (Fasting Blood Test)
| · Triglycerides |
| · Cholesterol |
| · HDL Cholesterol |
| · LDL Cholesterol |
Lipid Profile
A lipid panel usually includes four measurements: three types of fats (lipids) in your blood, plus a total:
· Low-density lipoprotein (LDL) cholesterol. This is sometimes called the "bad" cholesterol because too much of it in your blood causes an accumulation of plaques in your arteries (atherosclerosis), leading to heart disease.
· High-density lipoprotein (HDL) cholesterol. This is sometimes called the "good" cholesterol because it can carry away LDL cholesterol, helping keep arteries open and your blood running more freely.
· Triglycerides. These lipids help your body store fat and are usually found in the fat tissue, with only low levels in your blood.
· Total cholesterol. This is the sum of your blood's cholesterol content.
Together, the four numbers can provide clues about your risk of having a heart attack. Although these lipids are necessary for your body to function normally, the kind and amount present in your blood might indicate if you're at increased risk of developing heart disease.
If your numbers are anything but optimal, talk to your doctor about making changes in your diet and lifestyle or taking medications.
Cardiovascular Risk Profile (Blood Test)
· FBC + 5-part Diff |
· LDH |
Homocysteine, Activated Factor XII, Lipoprotein (a), Fibrinogen + hsCRP, B-Natriuretic Peptide (BNP)
Your blood offers many clues about your health. It can indicate, for instance, whether you're having a heart attack or if you're likely to have one down the road.
If your doctor suspects you have a heart problem or that you might be at increased risk of heart disease, your blood is one of the first places to start searching for early indications of trouble. That's because the presence or absence of certain substances in your blood can reveal a problem. Excess "bad" cholesterol, for instance, can alert you and your doctor that you could be at risk of developing life-threatening blockages (plaques) in your coronary arteries.
Here's a look at some specialized blood tests that might be ordered to help predict or detect heart problems.
BNP level
Severe shortness of breath ? air hunger ? is often the main symptom of heart failure as emphysema and pneumonia.
A simple, rapid test to check the concentration of BNP in your blood can help doctors quickly determine what's really causing your symptoms.
BNP, or B-type natriuretic peptide, is a protein your heart and blood vessels naturally produce. BNP acts as a diuretic, eliminating fluid, relaxing vessels and funneling sodium into the urine. When you're in heart failure, though, very high levels of BNP are secreted into your blood in an effort to ease the potentially dangerous strain on your heart.
The BNP concentration can even offer some evidence of how severe your heart failure might be. Check with your doctor about normal ranges for your situation.
C-reactive protein A simple and inexpensive blood test to detect inflammation within your blood vessels may indicate whether you're at increased risk of developing heart disease. A protein called C-reactive protein (CRP) is produced by the liver as part of a normal immune system response to injury or infection. High levels of CRP in the blood also have been associated with an increased risk of cardiovascular disease, including heart attack and stroke. In fact, some researchers say that CRP is a better predictor of your risk of heart disease than cholesterol levels are. If your cholesterol is low but your CRP is high, evidence shows you're at an increased risk. CRP alone, however, isn't enough to predict your risk of heart disease. In addition, a very high level CRP probably isn't related to blood vessel disease. That's because your CRP level can be elevated by other conditions, such as connective tissue diseases, or infections, such as gingivitis or a urinary tract infection. And CRP's role in heart disease isn't yet clear. Researchers think that buildups of cholesterol and fatty material (plaques) that line the blood vessels can become inflamed as the body sends in white blood cells to fight what it thinks is infection. As the inflammation increases, it can cause plaques inside the arteries to rupture. Blood clots then form on the ruptured plaque, blocking the vessel and cutting off blood supply to the heart or brain, causing a heart attack or stroke. Guidelines issued jointly by the American Heart Association and the Centers for Disease Control and Prevention in January 2003 suggest whose CRP level should be checked. The CRP test shouldn't be used as a standard screening tool for the general public. And if you've already got heart disease, or are at a very high risk of developing it, you don't need the test, either, because you should be getting standard treatment anyway. Rather, the test is recommended only if you have an intermediate risk of developing coronary heart disease in the next 10 years. The test can help your doctor decide on further evaluations or whether you need more aggressive therapy to help prevent cardiovascular disease. To test for CRP, blood is drawn with a simple, inexpensive finger-prick test or from a vein. Testing is generally done twice, two weeks apart. C-reactive protein is measured in milligrams per liter (mg/L) of blood. What the results indicate:
| · Low risk: Less than 1 mg/L |
| · Average risk: 1 to 3 mg/L |
| · High risk: Over 3 mg/L |
If your CRP is greater than 10mg/L, the result is likely due to an infection or other condition. In that case, the test should be repeated in the future to assess cardiovascular risk.
The guidelines recommend that the CRP test be used only in conjunction with assessments of known risk factors, such as cholesterol levels.
Special preparations
Many of these blood tests require fasting overnight for the greatest accuracy. Some require you to restrict fat or alcohol in your diet before the test. In addition, medications, herbs or supplements might skew the results. Talk to our doctor about any special preparations to make before you have such tests.
EBTC Heart Scan (Calcium Scoring)
Do I need a heart scan?
The heart scan is aimed at those who are at increased risk of developing coronary heart disease (CHD). A heart scan is advisable if you are a man of over 35 or a woman of over 40 years, and one or more of these risk factors applies to you:
· Family history of heart disease
· High cholesterol
· High blood pressure
· Smoking
· Overweight and sedentary lifestyle
· Diabetes
· Stressful lifestyle
The EBCT heart scan is also an important tool for diagnosing the presence of CHD in people with non-specific symptoms, such as shortness of breath of chest pain, and for checking the progression of disease in those patients who have already been diagnosed with the condition.
A 3D image of an EBCT Heart Scan
The diagnosis of heart disease using EBCT
CHD is still the cause of most deaths in the UK; one third of men and a quarter of all women will die from it. 350,000 people suffer a heart attack every year, 125,000 of which are fatal, and in a significant proportion of deaths there are no previous symptoms.
CHD results from hardening and furring up of the coronary arteries (atherosclerosis). Small deposits (plaques) of fat containig calcium build up on the inside of the arteries and the amount of this calcification has proved a very reliable indicator of the extent of heart disease. EBCT can pick up even minute amounts of calcium very accurately and thus atherosclerosis can be detected ten to fifteen years before it causes symptoms.
With the EBCT heart scan we can locate and quantify any calcium deposits within your coronary arteries to calculate your 'calcium store'. This personal score is compared to those of tens of thousands of other patients to determine your individual risk of CHD.
Once the risks are known, we can advise on appropriate treatment. Fortunately there is overwhelming evidence to show that atherosclerosis, if identidied early enough, can be stabilised and controlled with modern therapies and lifestyle changes.
Do I need to prepare for the scan?
No special preparation is needed for the heart scan and you remain fully clothed throughout. The actual time you spend in the scanner is about 15 minutes.