A Coronary Angiogram is a procedure where a special X-ray of your heart’s arteries is taken to see if they are narrowed or blocked. A catheter (a long tube) is inserted into an artery in your groin and is moved up inside your artery until it reaches your heart. A special dye is then injected into the tube and X-ray images are taken as the dye is pumped through your heart and coronary arteries (the arteries supplying blood to your heart). These X-rays give clear and accurate information about the state of your heart and coronary arteries.
Angina is a type of chest pain or discomfort that occurs when fatty deposits build up in the coronary arteries (the arteries supplying the heart itself), reducing blood flow to the heart. Angina is not a disease in itself, but a symptom and warning sign of coronary artery disease.
Arrhythmia is a general term for any heart rhythm that is abnormal. Abnormal heart rhythms include a heart beating too fast, too slow or irregularly/inconsistently. Arrhythmias occur when the heart’s electrical conduction system is not working properly and can occur at any age. There are many different types of arrhythmias, some of which do not affect your overall health, however, some can be life-threatening. They can be associated with symptoms, including palpitations (an awareness of your heart beat), dizzy spells and shortness of breath, or you may not notice anything abnormal. Treatment for an arrhythmia depends on its type and how much it is affecting your health and daily life. Some treatments include medications, removing rhythm-altering triggers, lifestyle changes (i.e. diet and exercise) or ablation.
Atrial Fibrillation (or AF) is one of the most common types of heart rhythm disorder whereby the electrical system of the heart is disrupted and causes the heart to beat in an irregular fashion. Atrial fibrillation can be asymptomatic or cause shortness of breath and palpitations. It also increases the risk of stroke. An ECG or Holter monitor is used to confirm Atrial Fibrillation.
Atrial flutter is an abnormal heart rhythm that occurs in the atria of the heart. In patients that have not had any previous cardiac procedures or surgery, atrial flutter tends to arise from the right atrium. When it first occurs, it is usually associated with a fast heart rate or tachycardia (beats over 100 per minute). It can be associated with two major problems: 1. Symptoms of a rapid heart beat or shortness of breath. 2. Increased risk of stroke.
Bradycardia is a resting heart rate of under 60 beats per minute. It is rarely symptomatic until the rate drops below 50 BPM, however, it can result in fatigue, weakness, dizziness, and at very low rates, fainting. During sleep, a slow heartbeat with rates around 40–50 BPM is common, and is considered normal. Highly trained athletes may also have athletic heart syndrome, a very slow resting heart rate that occurs as a sport adaptation and helps prevent tachycardia during training.
Bundle Branch Block
A bundle branch block is caused by disease of the normal conduction system of the heart. It is picked up on an Electrocardiogram and is associated with a number of different heart conditions.
Cardiomyopathy (literally “heart muscle disease”) is the measurable deterioration of the function of the myocardium (the heart muscle) for any reason, usually leading to heart failure. Common symptoms include dyspnea (breathlessness) and peripheral edema (swelling of the legs). People with cardiomyopathy are often at risk of dangerous forms of irregular heart beat and sudden cardiac death.
Cardioversion is a medical procedure by which an abnormal heart rhythm is returned to normal (sinus) rhythm. This can be achieved with medications (anti-arrhythmics) or with an electrical shock under anaesthesia.
Congestive Heart Failure
Congestive heart failure (CHF) is an ongoing condition where the heart muscle is weakened and cannot pump blood around the body as efficiently.
Coronary Artery Disease
Coronary artery disease (CAD) also known as atherosclerotic heart disease, coronary heart disease, or ischemic heart disease (IHD), is the most common type of heart disease and cause of heart attacks.
The disease is caused by plaque building up along the inner walls of the arteries of the heart, which narrows the arteries and reduces blood flow to the heart.
While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a “sudden” heart attack, finally arises. Symptoms of stable ischaemic heart disease include angina (characteristic chest pain on exertion) and decreased exercise tolerance. Unstable IHD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina.
The risk of artery narrowing increases with age, smoking, high blood cholesterol, diabetes, high blood pressure, and is more common in men and those who have close relatives with CAD. Other causes include coronary vasospasm, a spasm of the blood vessels of the heart, it is usually called Prinzmetal’s angina.
Defibrillation is a common treatment for life-threatening cardiac arrhythmias including ventricular fibrillation and ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the heart with a device called a defibrillator.
Defibrillators can be external or implanted (implantable cardioverter-defibrillator), depending on the type of device needed. Some external units, known as automated external defibrillators (AEDs), automate the diagnosis of treatable rhythms, meaning that lay responders or bystanders are able to use them successfully with little or no training at all.
Echocardiogram or Echo is an ultrasound assessment of the heart that can evaluate the structure and particularly the function of the of the heart. A trained technician will place a special probe on various parts of the chest wall to view the heart from different directions. A detailed assessment of the heart valves, heart muscle and blood flow is then performed. The test usually takes 30 minutes.
A premature ventricular contraction (PVC), also known as a premature ventricular complex, ventricular premature contraction (VPC) or ventricular premature beat (VPB), is a relatively common event where the heartbeat is initiated by a focus from the ventricle. It is usually a benign process but in a proportion of people it can result in weakening of the heart muscle.
A holter monitor is a small device that records the electrical activity of every single heart beat for up to 48 hours. The test is ordered by your GP to see whether a rhythm disturbance is responsible for your symptoms.
Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated.
Blood pressure is summarised by two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). This equals the maximum and minimum pressure, respectively.
Normal blood pressure at rest is within the range of 100–140mmHg systolic (top reading) and 60–90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is often at or above 140/90 mmHg.
Mitral Valve Disease
Mitral regurgitation (MR), mitral valve disease or mitral incompetence is a disorder of the heart in which the mitral valve does not close properly when the heart pumps out blood. This causes blood to flow backwards (i.e. regurgitate) from the left ventricle into the left atrium and therefore reduces overall cardiac output. MR is the most common form of valvular heart disease.
Heart murmurs are pathologic heart sounds produced when blood flows across one of the heart valves that are loud enough to be heard with a stethoscope (“or auscultation”).
Myocardial infarction or acute myocardial infarction (AMI) is the medical term for an event commonly known as a heart attack. It happens when blood stops flowing properly to part of the heart and the heart muscle is injured due to not receiving enough oxygen. Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to an unstable build-up of white blood cells, cholesterol and fat. The event is called “acute” if it is sudden and serious.
A pacemaker is a medical device that uses electrical impulses, delivered by electrodes contracting the heart muscles, to regulate the beating of the heart. The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart’s natural pacemaker is not fast enough, or there is a block in the heart’s electrical conduction system. Modern pacemakers are externally programmable and allow the cardiologist to select the optimum pacing modes for individual patients. Some combine a pacemaker and defibrillator in a single implantable device. Others have multiple electrodes stimulating differing positions within the heart to improve synchronisation of the lower chambers (ventricles) of the heart.
Palpitations are an abnormality of the heartbeat that ranges from often unnoticed skipped beats or accelerated heart rate to very noticeable changes accompanied by dizziness or difficulty breathing. Palpitations are common and occur in most individuals with healthy hearts. Palpitations without underlying heart disease are generally considered benign. However, heart palpitations can be a symptom of a serious illness such as coronary heart disease, asthma, or emphysema. A holter monitor is used to see whether your symptoms of palpitations correlate with a significant rhythm disturbance.
Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism).
PE most commonly results from deep vein thrombosis (a blood clot in the deep veins of the legs or pelvis) that breaks off and migrates to the lung, a process termed venous thromboembolism (VTE).
A small proportion of cases are caused by the embolization of air, fat, or talc in drugs of intravenous drug abusers or amniotic fluid. The obstruction of the blood flow through the lungs and the resultant pressure on the right ventricle of the heart lead to the symptoms and signs of PE. The risk of PE is increased in various situations, such as cancer or prolonged bed rest.
In medicine, sinus rhythm is the normal rhythm of the heart, as measured by an electrocardiogram (ECG). It has certain generic features that serve as hallmarks for comparison with normal ECGs.
In the technical vocabulary of medicine, a stent is a mesh ‘tube’ inserted into a natural passage/conduit in the body to prevent or counteract a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow access for surgery.
Stress ECG Test
This test measures the performance and capacity of the heart and blood vessels in response to increasing workload (exercise).
Testing consists of walking on a treadmill, the speed and gradient of which are increased every three minutes.
Throughout the test a doctor will be present and your pulse, blood pressure and electrocardiography will be monitored. The test will stop if there are any observations that concern the doctor, if you become tired or breathless or if you develop chest pain or other symptoms.
Stress Echocardiogram Test
This test measures the performance and capacity of the heart and blood vessels in response to increasing workload (exercise). Testing consists of walking on a treadmill, the speed and gradient of which are increased every three minutes.
An Echocardiogram (an ultrasound of your heart) will be taken immediately before and after the exercise period to see how your heart responds to stress. A trained technician will place a special probe on various parts of the chest wall to take a series of images and videos the heart from different directions.
A stroke, sometimes referred to as a cerebrovascular accident (CVA), or colloquially brain attack is the loss of brain function due to a disturbance in the blood supply to the brain. This disturbance is due to either ischemia (lack of blood flow) or hemorrhage.
Sudden Cardiac Arrest
Sudden Cardiac arrest essentially occurs when the heart stops. Treatment for cardiac arrest is immediate cardiopulmonary resuscitation (CPR) and defibrillation using an Automated External Defibrillator (AED) if a ‘shockable’ rhythm is present.
Supraventricular tachycardia (SVT) is a condition presenting as a rapid heart rhythm originating at or above the atrioventricular node. Supraventricular tachycardias can be contrasted with the potentially more dangerous ventricular tachycardias – rapid rhythms that originate within the ventricular tissue.
Syncope, the medical term for fainting or passing out, is defined as a transient loss of consciousness and postural tone.
It is characterized by rapid onset, short duration, and spontaneous recovery, and is due to low blood flow to the brain that most often results from hypotension (low blood pressure).
Many forms of syncope are preceded by symptoms including dizziness and loss of vision (“blackout”), loss of hearing, nausea and abdominal discomfort, weakness, sweating, and palpitations. Presyncope is when you feel these symptoms and the sensation of ‘almost passing out’ but do not lose consciousness.
Syncope is extraordinarily common, occurring in people of all ages, particularly teenagers and the elderly.
Tachycardia is a resting heart rate that exceeds the normal range of 100 beats per minute. Tachycardia can either be appropriate e.g. running up a hill or inappropriate due to an arrhythmia (rhythm disturbance).
Ventricular fibrillation (VF) is a life-threating cardiac rhythm disturbance leading to uncoordinated and ineffective contraction of the ventricle and sudden death.
Pre and Post Procedure Care
A few days before your procedure:
Your Cardiologist may order blood tests if you are on certain medications, to make sure they are within acceptable levels. You may be asked to stop taking some medications before your procedure.
On the day of the procedure:
You are required to fast (i.e. no food or drink) for 6 hours prior to your procedure (If you are diabetic, please let our office know on (08) 9389 8658 so we can give you more specific instructions).
Please bring an overnight bag to the hospital – just in case you need to stay overnight for observation.
Please also arrange transport to and from the hospital, as you won’t be able to drive after the procedure.
If you live alone, please arrange for a friend or relative to stay overnight with you. If this is not possible, please notify our office on 9389 8658 before your procedure date.
For Mount Hospital Procedures: (Private patients)
When you arrive at the hospital, enter via the main entrance at 150 Mounts Bay Road, Perth 6000 and report to Admissions. From there you will be directed to the Ward. All enquiries should be directed to Mount Hospital on (08) 9327 1100. https://www.mounthospital.com.au/
For Fiona Stanley Hospital Procedures: (Public patients)
Once your Cardiologist identifies the need for you to have a procedure at Fiona Stanley Hospital, our office will send them a form requesting a procedure on your behalf. Once this is done, a staff member from Fiona Stanley Hospital will contact you with further information (please note that it may take up to 6 weeks for them to contact you). All enquiries should be directed to Fiona Stanley Hospital on (08) 6152 2222. https://www.fsh.health.wa.gov.au/
Immediately after you procedure:
You will be taken to a recovery area for observation and monitoring. When your condition is stable, you will be moved to a patient room where you will be monitored regularly. You will need to lie flat for a few hours to ensure optimal healing of the catheter incision site.
Depending on what procedure you have done, you may be able to go home the same day (i.e. if you have a Coronary Angiogram or EP Study), or it may be necessary for you to stay in hospital overnight for further observation (i.e. if you have a Coronary Angioplasty, Ablation, Pacemaker/ICD Insertion or Renal Artery Denervation). Ask your hospital health care team when you should resume taking your medications, shower, return to work and resume all other normal activities.
Once you return home:
Drink plenty of fluids to promote recovery. Avoid strenuous activity and heavy lifting for several days.
Please call your Cardiologist if you notice any of the following:
Bleeding, new bruising or swelling at the catheter site.
Increasing pain or discomfort.
Any numbness, tingling, change in skin colour or weakness that develops in your legs.
Chest pain, shortness of breath, light-headedness, fever or vision impairments.