Your carotid arteries are a pair of blood vessels located on each side of your neck to deliver oxygen-rich blood to your brain and head. If your specialist suspects a build-up of fatty deposits, called plaque, on the inside of your carotid arteries (which may lead to carotid artery disease), a safe, simple and painless test called a carotid ultrasound will help to better assess your condition. This test uses high-frequency ultrasound waves to generate images of any build-up inside your carotid artery.
Carotid ultrasound will allow your specialist to identify any narrowing of your carotid arteries as a result of plaque accumulation over the years. It is important to detect this early as this narrowing of your arteries may cause clogging, reducing the blood supply to your brain. The plaque can also rupture and form a blood clot, blocking one of the brain’s smaller arteries, causing a stroke.
Where relevant, a Doppler ultrasound may be recommended, to show the blood movement through your blood vessels. Based on the results of both ultrasound tests, your specialist will then fully evaluate the blood flow problem in your carotid arteries.
An electrocardiogram is a quick, safe and pain-free test that detects and records the heart’s electrical activity. It assesses the heart’s rhythm and rate, and helps detect signs of heart diseases and potential cardiac enlargements.
Your doctor will request an electrocardiogram to assess the heart’s rate and rhythm. An electrocardiogram may be ordered before a surgery to check the effect of a pacemaker, or as part of a routine check-up after heart surgery.
The results of your electrocardiogram will help the doctor to determine heart problems including irregular heartbeat, irregular blood flow to the heart muscles, and if part of the heart is enlarged.
Trans-thoracic echocardiogram (TTE)
A trans-thoracic electrocardiogram is a non-invasive, safe and painless diagnostic test that uses ultrasound (high frequency) waves to record images of your heart and its various structures including the heart chambers and valves. The resulting images of the beating heart with blood circulating through it will allow the doctor to detect heart abnormalities and assess the pumping function of your heart.
The results of the echocardiogram will allow the doctor to detect, evaluate and monitor any functional and structural abnormalities in your heart. These abnormalities may include tumours, fluid around the heart, a hole in the heart, heart murmur, infection on or around the heart valves and damage to the heart muscle following a heart attack. It also allows your doctor to assess if your heart is pumping blood adequately and if the valves are working normally.
An echocardiogram can also detect congenital heart diseases and can be used to detect the source of a blood clot after a stroke.
A chest X-ray is a common diagnostic examination and also one of the first screening methods for the heart. It uses a standard X-ray machine to produce images of the heart, lungs, airways, blood vessels, and the bones of the chest and spine.
Chest X-rays are most commonly used to determine if there is any abnormality with the size and shape of the heart and the connected blood vessels. An enlarged heart or a distorted artery can mean that there is a problem with the heart that requires further investigation.
Cardiac calcium scoring
Coronary artery disease occurs when plaque builds up and narrows your arteries (atherosclerosis). This plaque is often made up of fat, cholesterol and calcium. A heart calcium test measures the amount of calcium in the walls of your coronary arteries and helps calculate the coronary calcium score.
A high coronary calcium score may indicate that you have a higher risk of having a heart attack before you have any other obvious symptoms of heart disease. When combined with other detailed heart screening information, the score can help determine your future risk of coronary artery disease.
Some people with coronary artery disease may have minimal to no symptoms during rest, but symptoms may be more likely when the heart is under stress, such as during exercise. During exercise, healthy heart arteries enlarge to accommodate increased blood flow. Narrowed arteries are unable to compensate for increased blood flow needed during exercise. This compromises blood flow to the heart muscle resulting in heart muscle being “starved” of oxygen.
A stress test is performed by comparing the results of an ECG during rest with the results of an ECG during exercise. Reduced heart activity during exercise may indicate blockages in the one or more of the major arteries. When this happens, your heart specialist may recommend undergoing an angiogram to accurately determine the source of your problems.
This is a non-invasive diagnostic test that uses a portable device called a Holter monitor. Unlike the common electrocardiogram that records the heart’s electrical activity for a few minutes, the Holter monitor allows the electrical activity of the heart to be recorded continuously for 24 to 48 hours. You will be required to carry the Holter monitor on you while you perform your, daily routine, and to keep a record of your activities. The heart specialist will assess the readings of the Holter monitor against your physical daily activity to determine abnormal heartbeat and disorders.
If you suffer from palpitations, fainting and dizzy spells, the doctor may recommend Holter monitoring in order to correlate these symptoms to your heart rhythm. This test allows transient rhythm disorders of the heart to be detected.
The heart specialist may recommend Holter monitoring to assess the electrical activity of your heart under normal activity or following a heart attack. Holter monitoring also allows the cardiologist to diagnose heart rhythm abnormalities (including serious arrhythmias), and to monitor the effect of a new heart medicine. It is also useful for monitoring your heart rhythm following a heart procedure.
Ambulatory blood pressure monitoring
Ambulatory blood pressure monitoring is a test that allows your blood pressure and heart rate to be recorded at set intervals for a period of 24 hours, during which you carry on with your usual daily activities. Your blood pressure varies throughout the day depending on your emotional state and the activities you are performing. Therefore, when the doctor measures your blood pressure at one time, it may not reflect your actual blood pressure. The results of ambulatory blood pressure monitoring allow your doctor to assess the variations of your blood pressure throughout the 24-hour monitoring period.
Ambulatory blood pressure monitoring is very useful if you suffer from high blood pressure. It allows your doctor to assess if your blood pressure medications are effective. It is also useful in the assessment of mild hypertension, which might be over-diagnosed based on a single point blood pressure measurement. The results of this test can also indicate any blood pressure swings you may have.
Your doctor may also order ambulatory blood pressure monitoring if you suffer from palpitations, giddiness, fatigue and spells of rapid heartbeat. The correlation of blood pressure readings with your daily activity allows your doctor to determine what activities trigger your symptoms, and if these symptoms are related to high blood pressure.
Nuclear perfusion scan
The nuclear perfusion scan is used to assess the flow of your blood to your heart muscles during exercise and when you are resting. During the procedure, a radioactive compound (called a tracer) is injected into a vein in your arm. The tracer is swept from the blood quickly by the heart muscle cells. Heart images are then captured using a gamma camera. Abnormalities in radioactivity readings may indicate a lack of blood supply to certain parts of the heart.
The doctor may request a nuclear perfusion scan if you experience chest pain occuring for no clear reason or during exercise. The results of the scan may help to determine the cause of the pain. The doctor may also recommend this test to assess blood flow to the heart walls, and to check if any coronary arteries are blocked and the extent of the blockage.
This test is also useful if you have experienced a heart attack. It allows your doctor to determine the extent of damage to your heart. In addition, it is a good test to assess blood flow if you have undergone heart bypass surgeryor angioplasty (the re-opening of the blocked heart arteries using a balloon or a stent).
Coronary angiography is an invasive test used to visualise the coronary arteries that supply blood to your heart muscle. The procedure requires the injection of a special dye through a catheter (small tube) into the large artery in the groin or the wrist. The catheter is placed at the openings of the coronary arteries before the dye is injected.
Coronary angiography presents an effective way to accurately detect any narrowing or blockage in the coronary arteries and other abnormalities that may be present. It allows your doctor to determine the treatment that suits you best.
Your doctor may request a coronary angiogram before your scheduled coronary angioplasty (ballooning)to visualise a route to guide the procedure. A coronary angiogram may also be requested after a coronary bypass surgery
(open heart surgery) to check if the grafts are still open.
Transoesophageal echocardiogram (TEE)
Echocardiography is a technique that visualises the heart and its blood vessels using ultrasound waves. A trans-oesophageal echocardiogram is an invasive procedure that consists of the insertion of a long, thin and flexible probe into the mouth and down the oesophagus (food tube). The resulting echocardiographic images allow the doctor to take a closer and clearer look at the valves of the heart and its chambers without interference from the chest wall.
Your doctor can usually request a trans-oesophageal echocardiogram to evaluate a stroke or transient ischemic attacks (mini strokes) as a result of blood clots in your heart. It is also useful to assess the success of previous heart procedures including valve replacements and bypass surgeries, as well as heart conditions including congenital heart diseases.
The trans-oesophageal echocardiogram detects blood clots, tumours and abnormal masses situated within the heart, which may not be clearly visible in standard echocardiographic images. It can also detect particular valve problems including infected heart valves.
An electrophysiological (EP) test is a study to record the electrical activity and conduction pathways of the heart. It is used to determine the cause and location of abnormal heart activity, such as arrhythmia.
EP tests are minimally invasive diagnostic procedures where electrodes are inserted into the heart through a small insertion point. The electrodes are able to map out the electrical pathway in the heart, and the cardiologist can use a pacemaker to increase or decrease the heartbeat in order to trigger possible arrhythmia.