Arrhythmia services

Non-invasive diagnostic testing/analysis

Ambulatory Holter ECG monitoring.

This test is used for the diagnosis of palpitations that occur daily. It involves being connected to a small ECG recorder with three wires. It then records every heartbeat whilst you perform your normal daily duties. We can then correlate your symptoms with any ECG abnormalities found.

Loop event recorder monitoring.

This is used for palpitations that occur weekly because the recorder can store information for up to 5 days.  Once again the aim is to correlate your symptoms with any ECG abnormality.

Reveal device implantation.

This is a more invasive test that involves the implantation of a small ECG recorder under the skin. It is performed under local anaesthetic as a day case. It can be activated to record the ECG after a blackout and can then be read electronically through the skin. It can stay in place for up to 3 years and is useful in the diagnosis of infrequent blackouts.

Tilt table testing.

This is used to confirm the diagnosis of simple faints. It involves coming up to the hospital to a quiet room containing a tilting bed and sophisticated ECG/ blood pressure recording equipment. As you are tilted up and down we can measure the blood pressure and heart rate response. If you are suffering from simple faints the blood pressure will drop when you get your symptoms

Diagnosis and management of the following arrhythmias

AV nodal reentrant tachycardia
Atrial tachycardia
Atrial flutter
Atrial fibrillation
Ventricular tachycardia

Pacemaker implantation and follow-up

Pacemakers are used to prevent blackouts caused by the heart slowing down or stopping. It is a day case procedure performed under local anaesthetic and sedation. A small cut is made in the skin under the collar bone and the wires are fed down a vein and positioned in the heart. They are then connected to a generator box which is sewn under the skin. The pacemaker can be programmed externally and follow up is performed by experienced physiologists to ensure that you get the maximum benefit from your pacemaker.

Cardiovascular diagnostic risk factor evaluation

We can offer a wide range of screening tests to assess your cardiovascular risk. These involve measurement of cholesterol subfractions, blood glucose and plasma homocysteine and the use of CT calcium scoring with non-invasive coronary angiography.

Cardiac ultrasound

Cardiac ultrasound is a test involving sound waves and is used to assess structural and functional abnormalities of the heart. It is painless and safe. 2D/M-Mode transthoracic echocardiograms are used to look at the heart muscle function and the heart valves. Doppler (pulsed, continuous-wave, colour-flow) echo looks at the patterns of blood flow in the heart and can give an accurate assessment of valve leaks and narrowing’s.

Contrast bubble injection is used to look for holes in the heart, which may be linked to unexpected strokes and to the development of migraine attacks.

Dr Clifford has provided an interpretation service for echocardiograms provided by other remote ultrasound facilities. This is a web based service and at the Knaresborough Place practice all echoes can be reported remotely on the day they are performed.

A Dobutamine Stress echocardiogram or a Treadmill stress echocardiogram is used to assess the presence or absence of coronary disease. The scan is performed after the heart has been put under pharmacological or physical stress. If the blood supply to the heart is abnormal some areas of the heart will work less well under stress.

A Transesophageal echocardiogram (TOE) is used to get a closer look at the heart valves by passing an endoscope down the gullet under sedation. It is used to assess valve disease prior to surgical referral and to look for blood clots in the heart.

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