Cardiology & sleep services

Ambulatory blood pressure monitoring provides your doctor with detailed information about what’s happening with your blood pressure.

If you have suspected high blood pressure (hypertension) or your high blood pressure is difficult to manage with medication, ambulatory blood pressure monitoring (ABPM) will provide your doctor with more detailed information about what’s happening. Some people get nervous when they visit their doctor, which can cause their blood pressure to rise temporarily. For these people ABPM can be used to accurately measure blood pressure in a more usual environment.

ABPM is simply a portable blood pressure machine that you wear for 24 hours. There’s a small computer device you wear on a belt or around your neck. It is attached to a blood pressure cuff wrapped around your upper arm, just like when your doctor checks you blood pressure.

At regular, preset intervals the computer inflates the cuff around your arm to measure your blood pressure as you go about your daily routine.

The same computer stores the measurements so they can be analysed by your cardiologist later.

It only takes approximately 15-30 minutes for one of our technicians to fit the ABPM device and even less to remove it the next day.

The technician may ask you to keep a written record of any symptoms you experience during the recording period.

• Please bath/shower in the morning, as you will NOT be able to swim/shower whilst the monitor is being worn.
• Please wear a 2 piece out-fit.

Requires that a blood pressure cuff be placed on the upper arm and a small recording device be worn across the shoulder or around the waist.

During the period of monitoring, should you have difficulties with the equipment or feel it may have been dislodged, please notify the office.

• The equipment and symptom diary must be returned at the specified time.
• A full report will be sent to your Doctor after the results have been reviewed by a Cardiologist.

A CT coronary angiogram, or CTCA, is a scan using dye to highlight any blockages in your coronary arteries, including those caused by a build-up of soft plaque which may not show up in other tests. It is a quick and painless scan used to evaluate the condition of your coronary arteries.  A CTCA includes all the information of a CAC score but also identifies the degree of narrowing of the arteries caused by calcified or non-calcified plaque which are the known cause of heart attacks. Your doctor may recommend a CTCA to assist with early detection of heart disease, especially if you are experiencing symptoms such as chest pain, breathlessness, excessive sweating, irregular heartbeat, or dizziness.

1. Do not take any stimulants such as tea, coffee, soft drinks or energy drinks for 12 hours before your test
2. Do not eat anything in the 2 hours before your scan
3. Drink plenty of water to ensure you stay hydrated
4. Do not wear lotions, perfumes or powders around the chest area, and remove any jewellery around your neck or chest
5. Wear an outfit on the day to enable you to easily change into a gown from the waist up, such as a shirt or blouse
6. You should consult your doctor prior to the test as they can advise if you should cease any of your regular medications during the test that may interfere with the results

After the test you will be monitored for 15 to 30 minutes and the cannula removed before you can go home. The results will be reviewed by a specialist cardiologist and a full report will be sent to your referring doctor who will be able to advise you if a follow-up course of action is required.

Doncaster in Victoria

Milton in Brisbane

Murdoch in Perth

St Andrew’s in Adelaide

A measurement of the amount of calcium built up inside the arteries of your heart. This is done by conducting a non-invasive CT scan to produce images of your coronary arteries.

CAC scoring assesses the presence of coronary artery disease (CAD) by providing an overall calcium score. Your calcium score is based on the results from the low dose computed tomography (CT) images of your coronary arteries. The lower your score, the lower your risk of developing symptomatic CAD. Depending on your score, your doctor may make recommendations on lifestyle changes, medications or treatments to reduce your potential risk from CAD.

Coronary Artery Disease (CAD) is a disease that develops when major blood vessels supplying blood to your heart become narrowed or blocked. If the heart is unable to get enough blood, it will lack the oxygen and nutrients it needs to function properly. This can cause chest pain (angina) or in the case of a complete block, a heart attack. Coronary artery disease can be detected early, before it causes any symptoms by the identification of calcification of the coronary arteries, so called “hardening of the arteries”.

A calcium score is a way to find out if you have early heart disease before it gets worse. Knowing your risk can allow you and your doctor to make decisions about how to reduce your risk. These may be things such as lifestyle changes or medication. Your doctor may also suggest you have a calcium score if you have one or more potential risk factors for CAD such as family history.

A coronary artery calcium score in many cases de-risks an individual. In cases where a personalised decision needs to be made about treatment, such as starting medication for cholesterol, a CT calcium score can provide very useful information. If the score is 0, it is often possible to avoid active medication therapy for slightly elevated cholesterol.

Even if you are low risk, however, it is important to maintain a healthy lifestyle and monitor your heart health.

Anyone can have a calcium score, however usually it is healthy adults aged between 40 and 75 years (over 35 years for Aboriginal or Torres Strait islanders). The majority of people in Australia who have a cardiac event are those that are considered low to intermediate risk. These people usually have only one traditional cardiac risk factor or no risk factors. A calcium score can help reclassify a person’s risk, either up or down, and lead to better cardiac management.

If you are already experiencing symptoms such as chest pain, your doctor may refer you to have a computed tomography coronary angiography (CTCA) instead.

The procedure should only take around 10-15 minutes. A radiographer will first position you on the CT exam table, lying flat on your back with your arms above your head.  Small metal disks (called ECG electrodes) will then be attached to your chest and to an electrocardiograph (ECG) machine.  To attach the electrodes, your cardiac technician will clean the areas on your chest with alcohol wipes. This may feel slightly cold or sting a little but should not damage the skin.  The ECG records your hearts electrical activity and co-ordinates x-ray picture timing.

A CAC test is non-invasive and does not require any injections or dyes.  The examination table may shift during the scan to capture the required images.

You will be asked to hold your breath for a period of 10 seconds during the scan while the images are being recorded.

NOTE: This test is not rebated through medicare.

During the test, you will only be exposed to a very minimal amount of radiation.  Should you experience any issues on the day, our team are onsite to assist.

1. Do not take any stimulants such as tea, coffee, soft drinks or energy drinks for 12 hours before your test
2. Do not wear lotions, perfumes or powders around the chest area, and remove any jewellery around your neck or chest
3. Wear an outfit on the day to enable you to easily change into a gown from the waist up, such as a shirt or blouse

Depending on your referral, one of our cardiologists may discuss the results with you. When the test is complete, your referring doctor will receive a full report.

Doncaster in Victoria

Milton in Brisbane

Murdoch in Perth

St Andrew’s in Adelaide

A Dobutamine Stress Echocardiogram (DSE) is performed to assess your heart’s function and structure both at rest and under stress.

Some heart symptoms or problems occur only during physical activity, especially aerobic style exercise which increases the blood supply to your heart. Your doctor or specialist may recommend a stress echocardiogram to check for any problems with your coronary arteries. The more common version of this procedure requires the patient to be monitored whilst exercising on a treadmill. For people who are unable to exercise, this alternative test simulates the effect of exercise on the heart muscle using the drug dobutamine.

Your cardiologist might order a dobutamine stress echocardiogram if you have mobility issues or are unable to exercise to help determine whether enough blood is getting to your heart and if the blood flow is restricted by narrow arteries.

• Echocardiography is a type of ultrasound that does not use radiation or X-ray and carries no known adverse effects
• Allow an hour from preparation through to post observation time for this test
• You will be asked to undress to your waist (a gown can be provided) and lie on an examination bed
• A cardiac sonographer will attach small metal disks (ECG electrodes) to your chest which will be used to monitor your heart rhythm during the test. An inflatable cuff will monitor your blood pressure throughout, and you will have a cannula inserted into your arm to administer the dobutamine.
• The sonographer will conduct an ultrasound by applying cool gel on your skin and using a handheld wand (transducer) to send and receive waves from your heart to generate pictures. Your sonographer will provide instructions throughout the examination and may require you to hold your breath a few times
• Dobutamine will be administered through the cannula in your arm and further ultrasound images recorded
• Experienced medical staff are in attendance throughout your test to manage any rare complications.

1. Wear loose, comfortable clothing, bearing in mind you will need to undress to the waist (you may request a gown if you like)
2. Please bring a list of current medications with you
3. You should consult your doctor prior to the test as they can advise if you should cease any of your regular medications for the echo (some can affect the accuracy of results)

One of our cardiologists may discuss your results with you when the test is complete, and a full report will be sent to your referring doctor.

Echocardiography, which is often referred to as a cardiac echo or simply an echo, uses sound waves to create images of your heart. An echo test is a simple painless procedure carried out by trained sonographers to view your heart structure and how well it is working. The sonographer will use ultrasound images of your heart to detect things such as:

• Blood flow
• Size, shape and movement
• Function and performance
• Strength of muscles/tissue
• Congenital defects (from birth)

Your cardiologist might order an echocardiogram to check the health and function of your heart. Symptoms such as shortness of breath, an irregular heartbeat, high or low blood pressure can require further investigation.

The type of echocardiogram you need will depend on the information your doctor requires. The most common type is a transthoracic echocardiogram which is conducted using an ultrasound wand with gel applied on the outside of the chest, near your heart. Other types include:

1. Stress echocardiography
2. Dobutamine echocardiography
3. Transoesophageal echocardiography

• Echocardiography is a type of ultrasound that does not use radiation or X-ray and carries no known adverse effects.
• The test usually takes about 45 minutes.
• You will be asked to undress to your waist (a gown can be provided), and lie on an examination bed on your left side.
• Your cardiac sonographer will attach small metal disks (ECG electrodes) to your chest which will be used to monitor your heart rhythm during the test.
• As with other ultrasound procedures, a cool gel is placed on your skin and a handheld wand (transducer) is used to send and receive waves from your heart to generate pictures.

1. You do not need to do anything to prepare for your test, however you will need to wear a two-piece outfit on the day so you can easily undress to the waist.
2. Avoid applying lotions, perfumes or powders to the chest area and remove any neck jewellery to assist with adhering the electrodes and ensure good skin contact for the ultrasound wand.
3. No fasting is required.

One of our cardiologists will review your results and provide a full report to your referring doctor who will be able to assist you with any follow up course of action.

An electrocardiogram or ECG is a recording of the electrical signals of your heart.

An electrocardiogram (ECG) is commonly used to detect heart problems and monitor the heart in different situations. An ECG is a routine and painless cardiac investigation procedure that provides your doctor with information about your heart’s electrical rhythm, how well it conducts electricity, and even the heart muscle mass. It is an important diagnostic tool when investigating a range of potential problems that could be affecting your heart’s function, however a standard ECG can record an abnormal heart rhythm only if it happens during the test.

• An ECG is a quick, painless and non-invasive test, often performed by a technician in a doctor’s office, clinic or hospital.
• You may be asked to change into a hospital gown and lie on an examining bed.
• Small metal disks called electrodes will be attached to your chest and your limbs.
• The electrodes have wires which are attached to an electrocardiograph machine that will record and then print out cardiac electrical activity.
• The test is usually completed in a few minutes.

1. You do not need to do anything to prepare for your test, however you will need to wear a two-piece outfit on the day so you can easily undress to the waist.
2. Avoid applying lotions, perfumes or powders to the chest area and remove any neck jewellery to assist with adhering the electrodes.
3. Tell your doctor about any medications you are taking as some may affect the results of your test

You may resume normal activities immediately following your ECG. The results will usually be discussed with you following the test and a comprehensive report sent to your referring doctor. If your electrocardiogram is normal, you may not need any other tests. If the results show an abnormality, you may need further diagnostic tests. Your doctor will be able to advise the best cause of action depending on your symptoms.

Exercise stress testing uses electrocardiogram (ECG) monitoring to measure your heart’s performance and capacity whilst exercising on a treadmill.

Used in a similar way to a Stress Echocardiogram, an exercise stress ECG tests for any problems with your coronary arteries. Some heart symptoms or problems occur only during physical activity, especially aerobic style exercise which increases the blood supply to your heart. This test requires the patient to undergo an electrocardiogram (ECG) whilst exercising on a treadmill to monitor changes in blood pressure levels and heart rate.

Your cardiologist might order an exercise stress ECG to assess your heart rate and blood pressure response to exercise to help determine the likelihood of artery blockages or narrowing.

• The stress test usually takes between 30-45 minutes but we recommend allowing an hour from preparation through to cool-down recovery time.
• You will be asked to undress to your waist (a gown can be provided) and a cardiac sonographer will attach small metal disks (ECG electrodes) to your chest which will be used to monitor your heart during the test.
• Before you start exercising, the cardiac physiologist will record your blood pressure, pulse, and your heart’s electrical activity in a resting phase.
• Next you will be asked to walk on a treadmill and we will gently adjust grade and speed at regular intervals in order to increase the intensity and achieve the most accurate results. It’s important to exercise as long as you can to assist with diagnosis and determining appropriate treatment options.
• Afterwards you will have time to cool down and recover and be able to return to normal eating routines and activities.
• Experienced medical staff are in attendance throughout your test to manage any rare complications.

1. Wear loose, comfortable clothing and comfortable walking shoes, bearing in mind you will need to undress to the waist (you may request a gown if you like), separate shirt and pants are advised
2. We recommend only having a light meal on the day of your test and not to drink coffee, energy drinks or alcohol or smoke for 2 hours beforehand
3. Please bring a list of current medications with you
   
4. You should consult your doctor prior to the test as they can advise if you should cease any of your regular medications during the test that may interfere with the ECG results.
5. Avoid applying lotions, perfumes or powders to the skin and remove any jewellery to assist with adhering the electrodes

The results will be reviewed by a cardiologist and a full report will be sent to your referring doctor who will be able to advise you if a follow-up course of action is required.

Ambulatory ECG monitoring provides your cardiologist with a recording of your heart’s electrical activity over a prolonged period. There are two types of ambulatory ECG used to establish the nature of suspected heart function problems:

• Holter monitoring – a small device records your heart rate and rhythm continuously, usually during a 24 or 48 hour period
• Event monitoring – similar to holter monitoring but the device is worn for up to seven days and only records when the patient activates it upon feeling symptoms

1. Each monitor takes about 20 minutes to fit at one of our testing centres
   
2. Small electrodes are attached to your chest and connected to the monitoring device for collection of data
3. Patients should go about their typical routines and are requested to keep a diary of activities while wearing the monitor to provide clues about potential triggers for any abnormal readings
4. In the event that an electrode or lead detaches from your chest, simply reattach it to continue recording. The diagram above illustrates lead placement by colour as a guide.
5. You will need to return to the test centre for removal of the monitoring equipment

• If you are being fitted with a holter monitor, shower before you arrive as you will not be able to remove it during the monitoring period and cannot get the device wet
• Event monitors can be removed for showering
• Avoid applying lotions, perfumes or powders to the chest area and remove any neck jewellery to assist with adhering the electrodes
• You should also avoid using certain heating devices that may interfere with readings, your clinician can advise you on this at your fitting

At the end of the recording period, return to the test centre to have the equipment removed. Once the results have been reviewed, a full report will be sent to your referring doctor who will be able to advise you on any further course of action required.

Exercise stress echocardiography assesses the likelihood that you have significant narrowings in your heart arteries.

By comparing your heart function before and after exercise your cardiologist can determine whether enough blood is getting to your heart muscle, or if narrowing of the arteries is restricting the supply.

For people who are unable to exercise, a drug called dobutamine is used instead. This drug is administered through a vein in your arm.

Everything we do is done to give you the best experience possible through your treatment and beyond. Your care team is here to make sure you’re comfortable and confident about your procedure.

Here’s a quick look at what you can expect:

• The test takes about 1 hour to complete.
• We suggest you wear comfortable clothing and shoes that are suitable for exercise.
• At the beginning of the test your heart will be imaged using ultrasound (called echocardiography). The technician will put a thick gel on your chest, which may feel cold but is not harmful. Then, the technician will use a hand-held piece of equipment (called a transducer) to send and receive sound waves from your heart.
• The technician will press firmly as they move the transducer across your chest and abdomen and you will be asked to briefly hold your breath at times during the test.
• If you’re having an exercise stress echocardiogram, you’ll walk on a treadmill and the grade and speed will gradually increase to make it feel like you are walking uphill.
• If you are having the dobutamine stress echo test, you will be in a lying position throughout the examination. As the dose of dobutamine is increased, your heart will pump harder and faster and the technician will take images of your heart with the echo machine throughout.

Cardiac device remote monitoring allows your implanted devices like pacemakers and defibrillators to be monitored and checked without you having to come into a clinic.

Cardiac device remote monitoring uses sophisticated technology across mobile and wireless networks to enable implanted devices (such as pacemakers, defibrillators, and loop recorders) to be monitored and checked remotely, without a patient needing to attend a clinic.

Traditionally, patients needed an in-clinic face-to-face follow-up every 6 to 12 months to verify the integrity of implanted devices and, if necessary, make any changes to its settings. Your clinician may offer you the opportunity to take advantage of this latest technology to have your new pacemaker or other cardiac device monitoring remotely. This provides a safer, more convenient way for you and your doctor to manage your heart condition. Your cardiologist will have faster access to critical information and you get to spend less time in hospitals.

As well as continuously monitoring and regulating your heart’s rhythm, your device stores information about your heart’s performance, such as your heart rate and rhythms, as well as the performance and integrity of the device itself, eg. battery life, lead function. If your device has remote monitoring capability, it will send this information to your care team via an integrated aerial that connects to the internet.

It’s important to note that even with remote monitoring, you will still need to attend a follow up appointment after your device is implanted to check your wound is well-healed. You will also need to attend all clinic appointments as recommended by your care team.

To use this service, you will need to have a smartphone, wireless internet service or mobile network coverage subscription that will work with your special transmitting device. Your clinician will be able to answer questions about the type of connection you can use, and what you need to do at the first visit after your implant procedure. Once set up, the wireless remote monitor will check your implanted device once every day. If an issue is detected, it will send an alert and associated data to the clinic where it will be reviewed during normal office hours.

The latest devices and monitors are very sophisticated and, if they are wireless, will automatically check that your implanted device is working properly every day while you sleep. Once it’s set up there’s usually nothing else for you to do. In the event of any issues with the device you will be contacted to visit the clinic for review/adjustment. Should you experience any symptoms that cause you concern, contact your clinic and they will be able evaluate your cardiac condition remotely and advise on a course of action. In the event of a medical emergency, call 000.

The required interval between follow-up appointments is dependent on each patients individual condition and the device implanted. It is very important that you attend all clinic appointments as recommended by your care team.

1. This service is not an emergency monitoring system. In an emergency or in case of any type of medical complaint, notify your physician or GP immediately or call 000
2. The remote monitoring service will reduce but not totally replace the need for standard in-clinic (i.e. face-to-face) follow-up visits, which are necessary to maintain optimal device performance
   
3. Your physician will only evaluate data during office hours, and will contact you if necessary
4. Information gathered will only be used in support of your medical treatment
5. You should only use your monitor when instructed by your physician to do so

A tilt table test is undergone to determine whether you are susceptible to fainting or near fainting due to a common cause, called orthostatic blood pressure intolerance.

A tilt table test is used for people who regularly feel faint when they stand and involves using a specialised platform to change their position from horizontal to vertical while measuring the response of their blood pressure and heart rate.

In order to conduct a tilt table test, you will be required to lie on a specialised tilting bed. During the first part of the test, the bed will be tilted to an upright position for several minutes while we monitor your pulse and blood pressure. You will then be returned to a horizontal position and administered medication, usually as a spray under your tongue or continuously through the IV line before being tilted upright again for further monitoring of any symptoms.

• You should allow up to one hour for this test, including preparation and debriefing after the test
• As a safety measure (as mandated according to Medicare), we will place an intravenous catheter in your arm which may be used for administration of medication if you need it during the test
• Small metal discs called ECG electrodes will be placed on your body and a blood pressure cuff will be placed on your arm
• Should a definite diagnostic change occur during the test, it will be immediately stopped

The physician and the cardiac technologist/nurse will discuss the exact details and risks of the test with you. They may ask you to sign a consent form acknowledging that you understand the nature of this test, including its purpose and possible outcomes.

• Do not eat any food or drink any fluids for ONE hour prior to your test
• Ask your physician if you should take your medications as usual prior to the test. Most medications should be continued as prescribed, but you may be asked to cease those that could interfere with the test

1. We advise you not to drive a motor vehicle immediately after your test
2. You may feel weak and tired following the test, so do not schedule a heavy day at work that day
3. You may eat and drink as normal immediately following the test