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Patient care is the sole focus and, with this in mind, only investigations which are essential to answering the clinical question in hand, are arranged. This way, patients do not go through unnecessary tests and avoid the inconvenience and costs associated with these.

Investigations can include:

Electrocardiogram (ECG)

This is an inexpensive and extremely useful test examining the heart rate and rhythm whilst also providing other important information regarding the heart muscle and arteries of the heart.

Transthoracic Echocardiogram

This is an invaluable ultrasound scan of the heart performed from the chest wall; it provides a myriad of information regarding the heart muscle and valve function. 

Holter Monitor

This test is particularly advantageous for patients presenting with palpitations as it provides information about the heart rhythm and can monitor for a prolonged period of time. The duration of this often depends on the frequency of your symptoms.

24hr Ambulatory Blood Pressure Monitor

This is an excellent test for patients with hypertension (high blood pressure). It helps to confirm the diagnosis of hypertension which should never be diagnosed from only a small number of blood pressure readings (especially in the clinic setting). It also allows us to further assess the effectiveness of treatment in patients who are already taking anti-hypertensive medication.

Stress Testing

This usually involves exercise on a treadmill or bicycle and is associated with continuous ECG monitoring; where required, echocardiography is also utilised. In patients where physical exertion is not possible (due to such things as knee or other joint problems) the heart is artificially stimulated with medication. Stress testing is particularly useful for assessing the significance of documented coronary artery and valvular disease.

Cardiac Computer Tomography (CT)

Cardiac CT has become an essential investigation in the field of cardiology, especially in patients with symptoms of chest pain. CT coronary angiography (CTCA) in such cases can inform us of the presence of significant narrowings in the heart arteries. Most importantly, it can also risk stratify patients with conditions which predispose to coronary artery disease such as diabetes, high cholesterol, high blood pressure, current or previous smoking history and positive family history for heart disease.

Myocardial Perfusion Imaging (MIBI)

Although nuclear stress testing has decreased since the advent and expansion of stress and perfusion cardiac MRI, this imaging modality is still helpful in assessing heart viability and the presence of haemodynamically significant, coronary artery disease

Transoesophageal Echocardiography

This is a more detailed ultrasound scan of the heart, effective in assessing patients with valvular and congenital heart disease. It is also used, procedurally, for the treatment of a variety of structural heart conditions such as patent foramen ovale (PFO) and mitral valve regurgitation. 

Invasive Coronary Angiography and Pressure Wire Assessment

The use of diagnostic only coronary angiography has declined since the advent of CTCA. It is now more often used in procedures where percutaneous coronary artery intervention (PCI) and/or pressure wire assessment is being considered. However, it continues to have a role in cases where CTCA results are inconclusive and for patients undergoing cardiac surgery for the treatment of valvular heart disease.

A consultation with Dr Charis Costopoulos will help you go through your symptoms and guide further investigations, and treatment, if required.

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