Heart Matters Medical Centre provides treatment to both the sick and apparently healthy individuals too. Sudden Cardiac Death can strike anyone at any time. It is therefore essential to reduce the risk of cardiovascular diseases and sudden cardiac death through appropriate cardiac health screening. Those who have proven heart disease can benefit from an assessment utilising our advanced cardiac equipment and treatment with state-of-the-art therapies. Elite athletes and those taking part in strenuous sporting activities or competitions should also be effectively screened to understand ones heart function prior to these events.
The following cardiac health screening is available:
- 12-lead Electrocardiogram (ECG)
- Treadmill exercise test (TMX)
- Carotid Ultrasound for evaluation possible future CAD
- Ambulatory ECG monitoring
- 24-hour Ambulatory Blood Pressure monitoring (ABP)
- Comprehensive range of blood / urine investigations
- Exercise testing and exercise prescription
- Cardiac stress testing (echocardiographic and radionuclide)
- Multi-slice CT coronary angiography and calcium scoring Computed Tomography
- Invasive coronary angiography, intravascular physiological assessment and angioplasty (stenting)
- Cardiac Positron Emission Tomography (PET) study
- State-of-the-heart Hybrid PET CT Hybrid
Electrocardiography (ECG or EKG) is a test that captures the electrical activity of the heart, externally, at a point of time and is recorded by electrodes placed on the skin. By placing the electrodes at specific locations on the body (chest, arms, and legs), a graphic representation of the electrical activity can be obtained. The ECG is essential for the diagnosis and management of abnormal cardiac rhythms. It helps in the diagnosis of the cause of chest pain and shortness of breath among others. It also provides clues to many forms of heart enlargement, thickened heart muscle, and more importantly, any prior heart attack.
The treadmill exercise test is a test that measures the heart’s tolerance for exercise and helps to detect coronary heart disease. The treadmill stress test involves walking and /or running on a treadmill machine while recording the patient’s ECG and blood pressure throughout the test. It is non-invasive, painless and generally safe. During the test, the patient is exercised in a controlled manner on a treadmill at various increasing speeds and elevations (with an increase every 3minutes). This increases the heart’s need for oxygenated blood. In patients with coronary heart disease, this provokes symptoms or signs that would indicate heart disease. The higher the level of exercise, the higher the demand for oxygen, the harder the heart has to work. Hence, it allows the evaluation of blood supply to the heart during different levels of exercise intensity. The treadmill exercise test can also help monitor any sustained abnormal rhythm during exercise and monitor how one’s blood pressure truly changes with exercise stress.
Echocardiography uses ultrasound energy that is directed over the chest wall to obtain images of the heart. These images show the heart’s position, motion of the walls of the heart, the interior chambers, valves of the heart and blood flow within the chambers of the heart. This can help to determine if the heart valves are functioning properly or if there is an abnormal communication or flow between the chambers or the major blood vessels.
A Carotid ultrasound uses sound waves to create pictures of the insides of the two large arteries in the neck. It is a safe, non-invasive, painless, yet powerful technique. These arteries are carotid arteries that supply the brain with oxygen-rich blood. It is able to show whether a substance called plaque that narrows the carotid arteries is present in these vessels. Plaque is mainly made up of fat, cholesterol, calcium, and other substances found in the blood. The plaques build up as one ages. This condition is known as carotid artery disease. When there is too much plaque in a carotid artery, it can cause stroke. The plaque can slow down or block the flow of blood through the carotid artery, allowing a blood clot to form. A piece of the blood clot can break off and get stuck in the artery, blocking blood flow to the brain, thereby causing a stroke.
Holter monitoring involves a portable device that enables continuous monitoring of the electrical activity of the heart or ECG. Most conventional Holter monitors consist of electrodes that are attached to the chest of the patient. The electrodes are then connected to a small unit that records the electrical signals of the heart. As it does not interfere with patient’s daily activities, it helps in the clinical correlation of symptoms, such as dizziness, palpitations (a sensation of fast or irregular heart rhythm) or black-outs, with ECG monitoring. Recordings last for more than 24 hours, making it much more likely to detect an abnormal heart rhythm as compared to the resting ECG which lasts less than a minute. In our clinic we have equipment that can monitor heart rhythms for 2 weeks and more. It can also detect transient and short cardiac arrhythmias (abnormal heart rhythms). In addition, it can monitor pacemakers or evaluate how well medications are working and evaluate the patient’s ECG during episodes of chest pain.
Ambulatory blood pressure monitoring is done by taking blood pressure (BP) readings over a 24- or 48-hour period. In the present market, 2 types of devices are available. They measure the blood pressure with the aid of an arm cuff (sphygmomanometer) or radial pulse. We offer both modalities. BP monitoring is beneficial for adjusting doses of medication for high blood pressure, diagnosis of high blood pressure, differentiation of high blood pressure and white coat hypertension; and even predicting cardiac events in certain patients.
Blood tests are necessary as they aid in making a medical diagnosis. Our comprehensive range of blood tests include full blood count; lipid profile, kidney, liver and thyroid function tests; diabetes, bone, gout, Hepatitis B and cancer screening.
Exercise prescription refers to assessing, interpreting clinical information and applying it to achieve maximum exercise benefit to patients. The major parameters of exercise prescription are the mode, frequency, duration, and intensity. For patients with known coronary heart disease, it is important that safe and effective exercise prescription is performed with careful consideration of the individual patients’ functional status, comorbid conditions, medications, contraindications, and personal goals and preferences.
Cardiac stress testing (ECG stress test) is used in the diagnosis of coronary heart disease and for risk stratification and monitoring of patients with known heart disease. In patients with coronary blockage, a blood supply that is adequate at rest, may not be adequate when there is an increased need for oxygen. Stress testing is less invasive and less expensive than cardiac catheterization, and it detects abnormalities of blood flow. The cardiac demand can be increased by exercise or drugs. In echocardiographic stress testing the patient can be stressed by exercising on a treadmill or by giving drugs such as dobutamine. The heart is stressed to a minimum of 85% of target heart rate (220 – age = 100%). Once the appropriate heart rate is achieved or when patient is tired, a range of echocardiographic images are captured and compared with the resting images. Radionuclide myocardial perfusion imaging is more sensitive (85%) and specific (70%) than ECG stress testing. It is particularly useful for patients with resting ECG abnormalities that may interfere with interpretation of ECG changes during a stress test.
Coronary Angiography (CTA) is a non-invasive heart imaging modality that produces high-resolution, 3-dimensional pictures of the heart and great vessels, to determine the presence of fatty or calcium deposits (plaques) in the coronary arteries. The preparation for the test includes injecting an iodine-containing contrast dye into the patient’s bloodstream to improve the quality of the images. Drugs that slow down or stabilize the patient’s heart rate may also be given to improve the imaging results. During the test, X-rays pass through the body and are picked up by special detectors in the scanner. Although more and more people are using coronary CTA to diagnose coronary blockage, coronary angiogram remains the “gold standard” for detecting coronary artery stenosis ( narrowing of the blood vessels of the heart). However, coronary CTA is able to rule out significant narrowing of the major coronary arteries and detect “soft plaque,” in the coronary artery walls that may lead to heart problems in the majority of individuals.
The calcium-score screening is a test used to detect calcium deposits found in atherosclerotic plaque in the coronary arteries, but does not give sufficient anatomic detail. It is however used to evaluate the risk for future coronary artery disease, without utilizing contrast and using less radiation. If calcium is present, the system is able to create a calcium “score” that estimates the extent of coronary artery disease based on the number and density of calcified coronary plaques in the coronary arteries. An absence of calcium is considered a “negative” exam. However, the presence of soft plaque atherosclerosis can escape the detection by the machine. Therefore, a negative test indicates a low risk but does not absolutely exclude the possibility of a future cardiac event, such as a heart attack. The Calcium score test and the CTA are usually used together to give a more precise assessment of the coronary artery disease extent.
Invasive coronary angiography and intravascular physiological assessment involves a medical imaging technique that is used to visualize the inside of blood vessels. This is done by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy. Angioplasty (stenting) or percutaneous transluminal coronary angioplasty (PTCA) or Percutaneous Coronary Intervention (PCI) is widely used for the treatment of the blockages of the coronary arteries. Primary angioplasty is the mechanical reopening of an occluded vessel using a balloon-tipped catheter in patients with heart attack. The earlier primary coronary intervention is provided, the more effective it is.
Positron emission tomography (PET) scanning is a form of nuclear medicine which involves a doughnut-like scanning device that takes the images. PET provides information such as biological functions, like blood flow or glucose metabolism of the heart. It has higher sensitivity and specificity compared to conventional nuclear SPECT imaging with ability to calculate blood flow.
PET CT involves the combination of Positron Emission Tomography (PET) and Computed Tomography (CT) systems. The main advantage of hybrid PET CT is the visualisation of both coronary artery anatomy and understanding physiological significance during the same imaging session. Whereas coronary CT angiography provides information on the presence and extent of the stenosis in the coronary artery that leads to coronary artery disease (CAD), these new PET blood flow tracers provide information on the downstream functional significance of these obstructive lesions. Currently, the clinical applications mainly focus on the identification of coronary artery stenosis, which can be treated by coronary interventions. With advances in technology, CT angiography may allow imaging of the plaque morphology, not only going beyond the assessment of the luminal stenosis but also allowing the new radio-labelled ligands in the application of PET, to assess plaque biology and instability. This is particularly relevant in asymptomatic patients with coronary risk factors.