Deer Park Medical Centre | Medical Practice

Heart Clinic

Electrocardiogram (ECG)

What is an ECG?

An electrocardiogram (ECG) is a medical test that detects cardiac (heart) abnormalities by measuring the electrical activity generated by the heart as it contracts. The machine that records the patient’s ECG is called an electrocardiograph.

The electrocardiograph records the electrical activity of the heart muscle and displays this data as a trace on a screen or on paper. This data is then interpreted by a medical practitioner.

ECGs from healthy hearts have a characteristic shape. Any irregularity in the heart rhythm or damage to the heart muscle can change the electrical activity of the heart so that the shape of the ECG is changed.

A doctor may recommend an ECG for people who may be at risk of heart disease because there is a family history of heart disease, or because they smoke, are overweight, or have diabetes, high cholesterol or high blood pressure.

They may also recommend an ECG if a person is experiencing symptoms such as:

chest pain
shortness of breath
dizziness
fainting, or
fast or irregular heartbeats (palpitations).

ECGs are often performed to monitor the health of people who have been diagnosed with heart problems, to help assess artificial cardiac pacemakers or to monitor the effects of certain medications on the heart.

The ECG procedure

There is no need to restrict food or drink before having an ECG test. Always let your doctor know what medications you are taking before you have an ECG, and if you have any allergies to adhesive tapes that may be used to attach electrodes.

When you go for an ECG test, you will need to remove your upper clothing so that electrodes can be attached to your chest and limbs. (For women, wearing a separate top with trousers or a skirt can allow easy access to the chest.) The selected sites are shaved, if necessary.

Electrodes (sensors) are attached to the chest, arms and legs with suction cups or sticky gel. These electrodes detect the electrical currents generated by the heart – these are measured and recorded by the electrocardiograph.

The three major types of ECG are:

resting ECG – you lie down for this type of ECG. No movement is allowed during the test, as electrical impulses generated by other muscles may interfere with those generated by your heart. This type of ECG usually takes 5 to 10 minutes
ambulatory ECG – if you have an ambulatory or Holter ECG you wear a portable recording device for at least 24 hours. You are free to move around normally while the monitor is attached. This type of ECG is used for people whose symptoms are intermittent (stop-start) and may not show up on a resting ECG, and for people recovering from heart attack to ensure that their heart is functioning properly. You record your symptoms in a diary, and note when they occur so that your own experience can be compared with the ECG
cardiac stress test – this test is used to record your ECG while you ride on an exercise bike or walk on a treadmill. This type of ECG takes about 15 to 30 minutes to complete.

Please note, only RESTING ECG is done at our clinic.

Cardiac stress test coming soon.

Immediately after an ECG procedure

When the procedure is completed, the electrodes are removed. An ECG is completely painless and non-invasive, as the skin is not penetrated.

The doctor can interpret the results of your ECG straight away based on your medical history, symptoms and clinical examination.

Possible complications of an ECG

The ECG is a safe procedure with no known risks. It does not send electric current to the body. Some people may be allergic or sensitive to the electrodes, which can cause local skin reddening.

Taking care of yourself at home after an ECG

After an ECG you can resume normal activities immediately. An ECG is non-invasive and doesn’t involve medications (such as anaesthetics) or require recovery time.

Long-term outlook – heart problems diagnosed by ECG

The results of your ECG will determine what treatment you need, if any.

Some of the various heart problems that can be diagnosed by ECG include:

enlargement of the heart
congenital heart defects involving the conducting (electrical) system
abnormal rhythm (arrhythmia) – rapid, slow or irregular heart beats
damage to the heart such as when one of the heart’s arteries is blocked (coronary occlusion)
poor blood supply to the heart
abnormal position of the heart
heart inflammation – pericarditis or myocarditis
cardiac arrest during emergency room or intensive care monitoring
disturbances of the heart’s conducting system
imbalances in the blood chemicals (electrolytes) that control heart activity
previous heart attacks.

A person with heart disease may have a normal ECG result if the condition does not cause a disturbance in the electrical activity of the heart. Other diagnostic methods may be recommended if heart disease is suspected.

Treatment for a heart condition depends on the diagnosed condition but may include:

medication
surgery
dietary changes
quitting smoking
regular exercise.

For example, the following conditions diagnosed by ECG may require the treatment specified:

disturbances in heart rhythm – medication or surgery (such as installing an artificial pacemaker)
coronary artery disease or heart attack – medications, stenting, quitting cigarettes, dietary changes and coronary artery bypass surgery
high blood pressure – dietary changes, regular exercise and medications.

Information sourced from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ecg-test 11/12/18

What cost is involved?

The ECG is bulk billed with Medicare at DPMC, However there can be a fee incurred by third party if the report is referred to a specialist.

24hr Cardiac Holter Monitor

What is a Holter monitor?

A Holter monitor is a device that continuously records your heart's rhythm as it beats for a 24 hour period. It contains electrodes, wires and a small machine that attaches to your waistband or shirt.

Why do I need a Holter monitor?

You may need a Holter monitor if your doctor thinks there could be a problem with your heart rate or rhythm. You might have symptoms such as:

Fainting
Dizziness
Shortness of breath
Chest pain
Irregular heartbeat (arrhythmia)

Even if you’ve had an ECG, you may still need to wear a holter monitor. ECGs only monitor your heartbeat for a short time - which isn’t always long enough to identify potential problem.

What are the risks of having a holter monitor?

Holter monitoring is a safe and painless test with no significant risks. Some people experience minor skin irritation from the sticky dots (electrodes) used to monitor the heartbeat.

How do I prepare for a holter monitor?

There’s not a lot you need to do to prepare - but you will need to shower. After your holter monitor has been fitted, you can’t get it wet or remove it. The hair on your chest may need to be shaved to help the electrodes stick to your skin.

You also will not be able to sleep on an electric blanket whilst wearing it, as this can interfere with the readings.

What happens during a holter monitor?

The holter monitor test is a very straightforward procedure:

Electrodes are stuck to your chest
The electrodes are connected to the small holter machine device
You’ll be shown how to attach the device to your clothes

While the device is fitted, you’ll need to:

Wear it during your usual activities
Keep it on at all times, even during sleep
Never take it off nor take the batteries out while you have it on
Keep a diary of all your daily activities and the time you did them
Record any specific symptoms you feel (dizziness, light-headedness, chest pain, shortness of breath

What happens after a holter monitor?

After wearing the monitor for 24hrs, you can remove the sticky dots (electrodes) and return to your doctor’s office with the machine and your diary.

Generally your report will be available within a week. Once your report is returned to your clinic, your GP with discuss your results with you and recommend an appropriate treatment plan to help you manage your symptoms moving forward.

What cost is involved?

The holter monitor will cost you $180 up front and then you can claim $146.85 back from Medicare. There is a gap fee of $33.15 associated with holter monitor assessment. This can be paid on the day at Reception.

Information adapted from https://www.svhhearthealth.com.au/procedures/tests/holter-monitor 11/12/18

24hr Ambulatory Blood Pressure Monitor (ABPM)

What is an ambulatory blood pressure monitor?

An ABPM is a device that records your blood pressure at set intervals for a 24 hour period. It contains a blood pressure cuff fitted by our practice nurse attached to the ABPM device worn in an over the shoulder bag.

Why do I need an ambulatory blood pressure monitor?

You may need an ABPM study if:

you have newly diagnosed hypertension
you have borderline or labile hypertension
your blood pressure is poorly controlled despite being on medication
you experience episodic hypertension
your doctor wants to rule out 'white coat syndrome'*

*White coat syndrome is loosely defined as when your blood pressure is high because you have visited the doctor.

What are the risks of having an ambulatory blood pressure monitor?

An ABPM is a safe and painless test with no significant risks. The repeated blood pressure test may cause some interference to your day to day activities and should be planned on a day when you haven't got too much going on. The cuff will constrict around the arm in the same way it does when your doctor checks your blood pressure in the clinic.

How do I prepare for an ambulatory blood pressure monitor study?

There’s not a lot you need to do to prepare - but you will need to shower. After the ABPM has been fitted, you can’t get it wet or remove it.

What happens during an ambulatory blood pressure monitor?

The ABPM study is a very straight forward procedure:

The cuff is fitted around your arm
The times you plan to wake up and go to sleep are entered into the device
The device is put into a bag which you can wear over your shoulder

While the device is fitted, you’ll need to:

Wear it during your usual activities
Keep it on at all times, even during sleep
Never take it off nor take the batteries out while you have it on
Keep a diary of all your daily activities and the time you did them
Record any specific symptoms you feel (dizziness, light-headedness, chest pain, shortness of breath

What happens after an ambulatory blood pressure monitor?

After wearing the monitor for 24hrs, you can remove the cuff and return to your doctor’s office with the machine and your diary.

Generally your report will be available within a couple of days. When you return the device it is a good idea to book in with your GP in two days time for your report.

What cost is involved?

The ABPM monitor will cost you $125 up front and then you can claim $91.15 back from Medicare. There is a gap fee of $33.85 associated with ABPM monitor assessment. This can be paid on the day at Reception.

Information adapted from https://www.nps.org.au/australian-prescriber/articles/24-hour-blood-pressure-monitoring-what-are-the-benefits 09/11/2020

Echocardiogram (ECHO)

What is an ECHO?

An echocardiogram uses sound waves to produce images of your heart. This common test allows your doctor to see your heart beating and pumping blood. Your doctor can use the images from an echocardiogram to identify heart disease.

Depending on what information your doctor needs, you may have one of several types of echocardiograms. Each type of echocardiogram involves few, if any, risks.

Why is it done?

Your doctor may suggest an echocardiogram to:

Check for problems with the valves or chambers of your heart
Check if heart problems are the cause of symptoms such as shortness of breath or chest pain
Detect congenital heart defects before birth (fetal echocardiogram)

The type of echocardiogram you have depends on the information your doctor needs.

Transthoracic echocardiogram

In this standard type of echocardiogram:

A technician (sonographer) spreads gel on a device (transducer).
The sonographer presses the transducer firmly against your skin, aiming an ultrasound beam through your chest to your heart.
The transducer records the sound wave echoes from your heart.
A computer converts the echoes into moving images on a monitor.

Risks:

No risks are involved in a standard transthoracic echocardiogram. You may feel some discomfort from the transducer being held very firmly against your chest. The firmness is necessary to produce the best images of your heart.

Food and medications:

No special preparations are necessary for a standard transthoracic echocardiogram. You can eat, drink and take medications as you normally would.

During the procedure

An echocardiogram can be done in the doctor's office or a hospital.

For a standard transthoracic echocardiogram:

You'll undress from the waist up and lie on an examination table or bed.
The technician will attach sticky patches (electrodes) to your body to help detect and conduct your heart's electrical currents.
The technician will also apply a gel to the transducer that improves the conduction of sound waves.
The technician will move the transducer back and forth over your chest to record images of sound-wave echoes from your heart. You may hear a pulsing "whoosh," which is the ultrasound recording the blood flowing through your heart.
You may be asked to breathe in a certain way or to roll onto your left side.

Most echocardiograms take less than an hour.

After the procedure

Most people can resume their normal daily activities after an echocardiogram.

If your echocardiogram is normal, no further testing may be needed. If the results are concerning, you may be referred to a doctor trained in heart conditions (cardiologist) for more tests.

Results

Information from the echocardiogram may show:

Changes in your heart size. Weakened or damaged heart valves, high blood pressure or other diseases can cause the chambers of your heart to enlarge or the walls of your heart to be abnormally thickened.
Pumping strength. The measurements obtained from an echocardiogram include the percentage of blood that's pumped out of a filled ventricle with each heartbeat (ejection fraction) and the volume of blood pumped by the heart in one minute (cardiac output). A heart that isn't pumping enough blood to meet your body's needs can lead to symptoms of heart failure.
Damage to the heart muscle. An echocardiogram helps your doctor determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Areas of heart wall that move weakly may have been damaged during a heart attack, or be receiving too little oxygen.
Valve problems. An echocardiogram can help your doctor determine if your heart valves open wide enough for adequate blood flow or close fully to prevent blood leakage.
Heart defects. An echocardiogram can show problems with the heart chambers, abnormal connections between the heart and major blood vessels, and complex heart defects that are present at birth.

Information adapted from https://www.mayoclinic.org/tests-procedures/echocardiogram/about/pac-20393856 11/12/2018

Kardia

Kardia technology allows our GPs to take a medical-grade ECG in just 30 seconds using an app on a modified smartphone. This can assist in quickly and accurately identifying irregular heart rhythms (arrhythmia) such as Atrial Fibrillation.