We also work closely with other specialist who can provide adjunct services such as gastroscopy, colonoscopy or other urological and gyneacological support. We can also tailor our screening to your needs depending on your risk factors.
In order to have a valid test, your heart rate should go above 85% of your maximal predicted. This is calculated as (220-age) x 85%.
You will need to come in your exercise gear. That is, a pair of comfortable shorts and sneakers. You don’t need to have any period of training before coming for this test.
This is an example of treadmill stress ECG. The top panel below shows the ECG at rest. The arrows denote the portion of the ECG called ‘ST segment’. The bottom panel shows a positive test. The ‘ST segment’ is depressed compared to baseline (Pink arrow). This indicates the presence of blocked arteries.
Essentially, you will lie on your left side for about 15 to 20 minutes while this test is being performed. A probe is placed on your chest to obtain a view of the heart from different angles. This is totally painless process.
In Cardiac Specialist Centre, all echoes are reviewed by specialists who have undergone advance training in echocardiography, and are accredited echo-cardiologists. This ensures that the quality of the examination is of high standard.
The following images are typical example of a normal heart. The still picture has the various structures labeled. This is a 4 chambers view where all 4 chambers of the heart can be see.
This moving image below shows the heart pumping. You can appreciate the muscle of the heart contracting and the valves opening and closing with each beat.
The picture below shows a blood clot in the part of the left atrium called ‘left atrial appendage’. This blood clot may form in a patient whose heart is pumping in irregular rhythm called ‘atrial fibrillation’. This view can only be seen in the trans-oesophageal echocardiogram.
The setting up time for this test may take a fraction longer as a small plastic needle (cannular) needs to be inserted into the vein. During the test, some patient may experience some nausea and strong heart beat. But all these will subside once the medicine is stopped. This test is also useful of certain other conditions such as assessment of viability of the heart muscle or valve function.
"Angio" means "Blood Vessel". "Gram" or "Graphy" means picture. Therefore, angiogram or angiography means to take a picture of your blood vessels. In this case, the blood vessels of your heart or coronary angiography.
Normal X-ray does not show up any blood vessels. Only when a dye is injected into the vessel can the vessel be seen.
In order to inject the dye into the arteries, a tube or ‘catheter’ has to be placed just outside the arteries of the heart. This tube has to enter your body from the groin or the wrist and follow your body’s artery up to the heart.
The whole procedure may only take 10 minutes to perform. There will be slight pain when some local anaesthetic is injected into the groin or wrist. After which, there will be no more pain.
This is done as a day-surgery. Another words, you will stay on the ward for a few hours after the procedure for observation. You will be discharged on the same day.
You may follow the link to see what an angiogram looks like. The 1st movie shows the left coronary arteries. You may see the tube (Catheter) in the left upper corner. As the dye is injected, you can see the arterial tree come into view.
The 2nd movie shows the right coronary artery. This is a roughly 'C' shaped artery.
The 1st picture shows an artery that is completely blocked.
The 2nd picture shows the blood flowing down the artery after the wire is passed across the blockage.
The 3rd picture shows the stent in place.
The final picture shows the presence of the blocked artery after it has been stented. In simple cases with only 1 blocked artery, the whole procedure may take as little as 20 minutes as in this case. Sometimes, with multiple arteries blocked or where a single artery has been totally blocked for a long time, the procedure make take several hours.
In order to place a catheter (tube) in the artery, we have to enter it as it comes close to your body surface. There are 2 common areas where an artery can be felt as a pulse. These are at the wrist and groin. The size of the artery at the groin may be akin to a ballpoint pen. And the size of the radial artery is like the ink tube within the ballpoint pen. Therefore, it is technically more difficult to access the smaller artery at the wrist. However, after the angiogram, pressure has to be applied to the arteries to prevent bleeding. It is more uncomfortable to have pressure applied to the groin than to the wrist. Furthermore, after the procedure from the groin, you have to rest in bed for about 6 hours without moving your leg. This means for a gentleman, passing urine is a little more uncomfortable.
When the procedure is done from the wrist, the tube is removed immediately after the procedure. Since the groin is not affected, you can walk about immediately. The only precaution is to not do strenuous activities with your hand for next 3 days.
Most patients prefer this method of approach. However, since this is technically more challenging, most doctors use the groin for angiogram and angioplasty. We at Cardiac Specialist Centre use the wrist as 1st choice. The groin is used only in complex cases or if the wrist cannot be used for whatever reasons.
The picture shows the set up for a wrist approach angiogram/angioplasty. The patient has the arm by the side of the body. This is a comfortable position. The whole procedure takes only 10 minutes with minimal pain.