Investigations

ECG (Electrocardiogram - known in the USA as EKG)

A recording of the electrical activity generated by the heart. This can detect abnormalities of the structure and rhythm of the heart but may be normal even in the presence of significant cardiac disease.

Ambulatory ECG Monitoring (Holter Monitoring)

A miniature, portable ECG recorder is attached to the patient for 24 or 96 hours or longer to help detect abnormalities of the heart rhythm which may be causing palpitations, feelings of dizziness or faintness or actual blackouts.

Exercise ECG (Exercise Test or Stress Test)

An ECG recorded during and after exercise. This is better able to detect possible problems with the blood supply to the heart. The patient walks on a treadmill similar to those seen in a gym/health club. The ECG is recorded throughout the test and the patient's blood pressure is also monitored. The patient is asked to walk on the treadmill slowly at first but the effort required increases at intervals because the treadmill speeds up and steepens every three minutes to make it seem like walking uphill.

Echocardiography

Examination of the heart by means of ultrasound. This gives moving images of the heart muscle and can inspect the size and shape of the chambers of the heart and the state of the heart valves.

Transoesophageal Echocardiography - TOE (TEE in the USA)

Ultrasound examination of the heart using a probe, which is inserted into the gullet (oesophagus) to allow even more detailed examination of the heart than standard (transthoracic) echocardiography. The procedure is performed under sedation and after the application of local anaesthetic spray to the back of the throat. The patient usually has to stay in hospital for a few hours after the procedure to recover from the sedative injection.

Dobutamine Stress Echocardiography (DSE)

Echocardiography performed while the patient is having a drug infused intravenously (dobutamine). Dobutamine increases the heart rate and changes the blood pressure to simulate the effects of exercise on the heart. This test may be used when a patient is unable to walk on a treadmill for the purposes of an exercise test or to obtain additional information.

Implantable Loop Recorder

A miniature ECG recorder, about the size of a flattened AA battery, which is inserted under the skin under local anaesthetic. This device can help diagnose symptoms which are infrequent and unpredictable and which are likely to be caused by sudden changes in the rhythm of the heart. The device is particularly useful because it has a very long battery life but is usually used when other tests have failed to detect any abnormality.