Your trusted heart specialists on the North Shore of Auckland since 1998
Comprehensive contemporary cardiology care
A typical patient journey:
You or your GP will contact Waitemata Cardiology. We don’t require a referral but your health insurer is likely to.
On your first visit, you will see a cardiologist who will listen to your story, ask questions and examine you. The nurse will place sticky dots around your chest. These are connected to a machine that measures the voltage signals from your heart and displays it as an ECG (electrocardiograph). This may give an indication of issues such as previous heart attack (myocardial infarction or MI), thickening of the heart muscle (hypertrophy) and disturbances of the heart’s rhythm (arrhythmias).
It is likely that next you will have an exercise ECG (treadmill test). For this, you will walk upon the treadmill, while the ECG is monitored to detect any restriction of blood flow to the heart (myocardial ischaemia) or disturbance of the heart’s rhythm.
At this point, the cardiologist will decide what is going on, or whether further tests are needed.
Echocardiography (cardiac ultrasound) is a common next step; without any risk or danger to yourself, it provides a wealth of information about the heart’s structure and function:
- The size and function of all four heart chambers will be assessed
- Every segment of heart muscle will be examined to determine if it contracts normally.
- The heart’s four valves will be examined in detail to detect any restricted opening (stenosis) or back leak (regurgitation).
- An estimate will be obtained of the pressures inside the heart (left ventricular filling pressure, pulmonary pressure)
Further tests will depend upon your reason for attending:
If you have chest discomfort or shortness of breath then further diagnostic procedures may be recommended:
- Exercise stress echo
- Nuclear scintigraphy
- Dobutamine stress echo
- Coronary angiography
- Computed tomographic coronary angiography (CTCA)
- Cardiac magnetic resonance imaging (CMR or MRI)
Coronary arteries with severe narrowings may need an intervention:
- Coronary angioplasty with placement of a metal or absorbable stent (PCI)
- Coronary artery bypass graft surgery (CABG)
If you have palpitations, dizziness or fainting, you may benefit from further monitoring of the heart rhythm:
- Holter monitor
- Event monitor
If a problem is found then treatment may include:
- Pacemaker implantation for slow heart rates (bradycardia) or pauses
- Defibrillator (ICD) implantation to terminate rapid heart rhythms such as ventricular tachycardia (VT) and ventricular fibrillation (VF)
- Medication to control the irregular heart rhythm of atrial fibrillation (AF)
- Electrophysiology procedure to cure some rapid heart rhythms such as supraventricular tachycardia (SVT), atrial tachycardia, AV re-entrant tachycardia, AV node tachycardia, Wolff-Parkinson-White syndrome
If you are attending for a review of risk factors for heart attacks, stroke and other manifestations of atherosclerosis:
- Carotid intima media thickness ultrasound scan (CIMT)
- CT calcium score
A note on diagnostic tests:
There is no test that is completely accurate. All tests occasionally miss detecting a problem (false negative) and occasionally indicate a problem where none exists (false positive). The way to maximise the accuracy of a test is for an experienced person to interpret the test result in the light of everything else known about you.
A note on risks and benefits:
Many diagnostic tests and all treatments carry some risks in addition to their intended benefit. The aim is to only use a test or treatment when its benefits outweigh its risks. This may be hard to judge as the risks and benefits are usually difficult to know exactly. In addition, each of us will place different weight on various risks and benefits, so it is important that you are an informed participant in any decisions.
Further information is to be found at the NZ Heart Foundation and Merck Manual consumer edition. These two sources of information are reliable, frequently updated and professionally edited to be easily read by lay persons.