For Patients

What is a 12 lead ECG?

An electrocardiogram (ECG, also known as EKG) records the electrical activity of the heart – its rate and rhythm. A 12 lead ECG can be used to identify:

• arrhythmia (irregular heartbeat),
• conduction abnormalities (heart rhythm disorders),
• coronary artery disease (impaired blood flow due to calcium deposits in the arteries),
• cardiomyopathy (thickening/enlargement of the heart muscle walls),
• ischaemia (insufficient supply of blood to the heart structures).

While you may be ordered to have an ECG on its own, you will also have an ECG during other forms of cardiac testing, such as echocardiogram or exercise testing. You may be required to have an ECG prior to undergoing anaesthesia for surgery.

What happens during an ECG?

You will be asked to remove your shirt and lay down on your back on a treatment bed. The cardiac technician will apply adhesive electrodes to your arms, legs, and chest and connect these to an ECG machine. Over a couple of minutes this machine will create an image (“tracing”) of the heart rate and rhythm.

Electrocardiography is not painful and there is no associated risk. You may have an ECG during consultation with your cardiologist, but usually the test will be performed by a trained cardiac technician. The technician will not give you your result on the day, as one of our expert cardiologists interprets the ECG tracings before sending a report to your referring doctor.

How do I prepare for an ECG?

There is no special preparation required for an ECG. You can eat and drink as normal prior to your test.

A two-piece outfit is ideal (e.g., shirt and pants or skirt), as you will be asked to lift or remove your shirt to attach arm and chest electrodes (women can leave their bra on but may be asked to unhook or loosen it to enable correct electrode placement). You may be asked to remove tights/stockings or slightly adjust your pants to attach the leg electrodes. We are happy to provide a medical gown or sheet if required.

If you have hairy arms, legs, or chest the technician may need to shave a small patch to stick the electrodes to the skin. It is best to avoid moisturising within a few hours prior the test as this can affect the adherence of electrodes.

How long does an ECG take?

An ECG only takes about 5 minutes but please allow 15 minutes for your appointment to check in and pay afterwards.

What is a 24-hour blood pressure monitor?

A 24-hour blood pressure monitor – also known as an ambulatory blood pressure monitor – is a wearable device that measures your blood pressure as you go about your daily life over a 24-hour period. The device will take blood pressure readings regularly throughout the day – approximately every 20-30 minutes – providing insight into the variability of your blood pressure.

24-hour ambulatory blood pressure monitoring is used to:

• identify hypotension (low blood pressure) and hypertension (high blood pressure),
• assess blood pressure response to medication,
• identify likely sleep apnoea (abnormal breathing interruption during sleep),
• evaluate episodes of near-syncope or syncope (fainting/loss of consciousness),
• assess blood pressure variability across the day.

What happens during ambulatory blood pressure monitoring?

A blood pressure cuff, like the one you may have worn previously in your doctor’s office, is placed on the upper arm and attached to a small recorder which is carried over the shoulder. The monitor is worn non-stop for a 24-hour period and measures your blood pressure at regular intervals, including while you sleep.

You will be asked to keep a diary of your activities and symptoms (such as feeling dizzy or faint), which the interpreting cardiologist will correlate with any blood pressure variance. You ought to go about your usual activities, such as working, exercising, driving a car, and so on, to give an accurate representation of your blood pressure, but you will not be able to bathe, shower, or swim.

A trained cardiac technician will apply your blood pressure monitor in our rooms and you will wear it for the full 24-hour period. You will return to our rooms after 24 hours, have the device removed, and the readings will be reviewed by one of our cardiologists, with a report being sent to your referring doctor.

How do I prepare for 24-hour blood pressure monitoring?

As you will not be able to shower, bathe, or swim for the duration of the 24-hour monitoring period, please ensure that you are refreshed before attending. Wear a loose, short-sleeved shirt to your appointment; you will be asked to pull up the sleeve or slip your arm out of the shirt so the cuff can be attached. There are no risks associated with this type of test, but you may feel some mild discomfort when the cuff inflates.

Please ensure that you are available to return the monitor along with your symptom & activity diary to us at the end of the 24-hour testing period. This will usually just take a few minutes; the cardiac technician will give further instructions for return at the time of fitting the monitor.

What is an echocardiogram?

Transthoracic echocardiogram (or “echo”) visualises the heart and blood flow using ultrasound to assess the structure and function of the heart. You may be referred for an echocardiogram to assess:

• the function of the heart valves and check for regurgitation (blood flowing in the opposite direction to normal),
• the size, structure, movement, and behaviour of the heart,
• stenosis (narrowing that affects blood flow) of the heart valves and large external vessels,
• the presence of tumours, blood clots, and inflammation of the pericardium (pericarditis),
• other forms of heart disease and changes to any of the above over time.

We offer both adult and paediatric echocardiography and have a large team of male and female cardiac sonographers. Please let us know if you have a preference – we will try out best to accommodate your request.

What happens during an echocardiogram?

You will be asked to undress to the waist and the sonographer will attach ECG electrodes before asking you to lie down on your side. The room is darkened to better allow the sonographer to see the ultrasound images. The sonographer applies conductive jelly and moves a small transponder around your chest. You may be asked to briefly hold your breath or move slightly to improve imaging, and apart from the pressure of the probe on the chest there is nothing else to feel and no risks.

How long does echocardiography take?

Approximately 45 minutes. Please arrive 10 minutes early to check in with reception.

How to prepare for an echocardiogram?

No specific preparation is required for echocardiography, and you may eat and drink as normal prior to the test. It is ideal to wear a two-piece outfit as you will be required to remove your top (and bra for women) to enable easy access to your chest. A sheet or gown is available for comfort.

Multi Day Holter Monitor (8days)

The multi day monitor is used to detect and assess abnormal heart rhythms over an eight day period. The 8 day monitor continuously records the electrical activity of your heart without impacting on your day to day activities.
There is no preparation for the test.
A Cardiac Technician will apply the monitor to your chest using a large electrode (if you have chest hair this will be shaved off to allow good skin contact). You will be asked to write in a diary provided, activities undertaken and any symptoms experienced during the 8 day period.
You can shower with the monitor on and carry out your normal activities (note advise if you undertake any work that may be affected by the device). On completion of the 8 days, you will return the Monitor for analysing.

What is an exercise stress test?

An exercise test or stress test is an electrocardiogram (ECG) that measures your effort capacity, heart rate, and cardiac rhythm during activity (walking/running on a treadmill or cycling on a stationary bike).

It is used to:

• diagnose the cause of exercise-related adverse symptoms, such as chest pain, lightheadedness, or excessive shortness of breath (dyspnoea),
• determine whether exercise-based risk factor modification is appropriate for your circumstance (ie., safety of commencing an exercise program after heart attack),
• identify coronary artery disease that contributes to impaired blood flow to the heart (ischaemia),
• assess for congestive heart failure,
• monitor the behaviour or progression of cardiac arrhythmias,
• exclude the presence of the above.

A doctor and a trained cardiac technician will supervise your test, monitoring your ECG and blood pressure throughout the examination.

What happens during a stress test?

You will be asked to undress to the waist (bra can be left on for ladies) and a blood pressure cuff and ECG electrodes attached to your arm and chest.

Exercise will begin at a low, gentle level and, while monitoring your blood pressure and heart rate, the intensity will gradually increase until the doctor feels it is appropriate to stop. Your recovery will then be monitored for a short time.

One of our specialist cardiologists will review your ECG, blood pressure recordings, and symptoms after your test, determining your exercise capacity and identifying any matters of concern. A report will be sent to your referring doctor, indicating your result and any recommendations for further assessment and treatment.

How long will an exercise test take?

An exercise test takes around 40 minutes, with the exercise component lasting up to approximately 20 minutes. Please arrive ten minutes early to check in with reception.

Exercise will be terminated if/when:

• you experience an excessive rise or drop in blood pressure with ECG changes,
• there is evidence of certain ventricular arrhythmias (irregular heart rhythm) or stenosis (narrowed heart vessels inhibiting blood flow to the heart),
• you begin feeling unwell, including nausea, dizziness, or weakness, or you exhibit concerning symptoms such as loss of colour to the face or excessive sweating,
• you experience chest pain (angina) with excessive ECG changes,
• you achieve the target heart rate (85% predicted maximum heart rate for age).

How to prepare for exercise stress testing:

Unless specifically told, please continue to take all your usual medications prior to test. Bring a list of current medication (including dosage and time of day you take it).

Do not eat for 2 hours prior to the test. Wear a comfortable two-piece outfit and rubber soled shoes that are suitable for exercise.

You will be asked to undress to the waist (ladies may leave their bra on) as electrodes are attached to the chest. Men may require some chest hair to be shaved to facilitate application of electrodes – this will be done at the appointment if necessary.

What is a stress echocardiogram?

The exercise stress echocardiogram (“stress echo”) combines standard transthoracic echocardiography with exercise testing (monitoring of ECG and blood pressure during exertion), taking images of the heart to assess for structural and/or functional abnormalities before and after exercise. This test is used when standard exercise testing alone will not provide adequate information or when additional information about heart function is required.

Your doctor may have ordered a stress echocardiogram to:

• determine your risk in relation to known or suspected coronary artery disease,
• identify cardiac causes of dyspnoea (shortness of breath) or other symptoms,
• assess the impact of exercise or other strenuous effort on valvular dysfunction, blood pressure, or heart rhythm,
• evaluate risk prior to surgery or following heart attack,
• monitor the effectiveness of cardiac medications.

What happens during a stress echo?

A doctor and cardiac sonographer will be present for the duration of your stress echocardiogram test.

You will be taken into the testing room and asked to remove your top so that electrodes for a 12 lead ECG can be applied to your chest and limbs. A blood pressure cuff will be put on your arm and your resting blood pressure and ECG recorded by the doctor.

The sonographer will ask you to lie on a treatment bed and will perform a resting echocardiogram study. A small probe covered in water-based gel will be moved around your chest to view your heart structure and function via ultrasound imaging. While you will feel some pressure from the probe, this procedure is painless and risk-free.

You will then be asked to walk on a treadmill or ride on a stationary bike. You will start with gentle exercise, with intensity (speed, incline, and/or resistance) increasing gradually over time. The doctor will monitor your blood pressure and ECG, looking out for concerning symptoms such as shortness of breath, fatigue, and chest pain. The test will be stopped if you experience these adverse symptoms or reach your target heart rate.

Immediately on ceasing exercise the sonographer will do a second echocardiogram study of your heart while the heart rate is still elevated, and your heartbeat and blood pressure will be monitored for a brief recovery period.

How to prepare for a stress echo?

• Fast for 2 hours prior to the test.
• Wear comfortable two-piece clothing (such as shorts and t-shirt) and rubber-soled shoes (sneakers/joggers) that are suitable for exercising.
• Please let us know at the time of booking if you have mobility problems that inhibit your use of a treadmill or bicycle. If you are unable to exercise you may need to be referred externally for a pharmacologic stress echocardiogram, which uses medication to simulate the effects of exercise by raising your heart rate and blood pressure.
• Take all your regular medication unless your doctor tells you not to. Bring a list of current medications (including dosages and the time of day you take your medication) and your referral.

What is a Holter monitor?

A Holter monitor is a small wearable/portable electrocardiogram (ECG) device used to continuously record your heart rate and rhythm. Most Holters are worn for a 24-hour period, but you may also be referred for multi-day monitoring (usually 3 or 7 days). Holter monitors:

• assess for arrhythmias,
• check the effect of medications,
• identify pacemaker/defibrillator problems,
• surveillance/observation of changes over time.

Many cardiac rhythm abnormalities are transient, rather than persistent, and may be more easily identified during this extended monitoring than during a standard 12 lead ECG.

What does Holter monitoring involve?

You will be asked to remove your shirt. A cardiac technician attaches adhesive electrodes on the chest – these connect to a small recording unit worn on a belt or over the shoulder. You will be asked to keep a diary of your activities and any symptoms experienced during the 24 hours. You ought to go about your usual activities, including exercise, but will not be able to bathe/shower/swim. You will return to the office with the device at the end of the monitoring period, and the rhythm tracings will be interpreted by a cardiologist and a report sent to your referring doctor.

How to prepare for a Holter monitor:

• 24-hour monitor: Bathe/shower in the morning before receiving your monitor – you will not be able to do so while wearing the 24-hour Holter monitor.
• Multi-day monitors have electrodes that may be detached and reattached for bathing.
• Wear a two-piece outfit – you will need to remove your shirt to attach the electrodes.
• Men may require some shaving of chest hair.

Please ensure that you are available to return the monitor along with your symptom & activity diary to us at the end of the 24-hour (or longer) testing period. This will usually just take a few minutes; the technician will give further instructions for return at the time of fitting the monitor.