479 Crown St
West Wollongong NSW 2500

+61 2 4228 4377

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Referrer Information

  • Stress ECG/ECHO
  • Lung Function
  • Holter Monitor
  • Ambulatory BP Monitor


Stress ECG is performed primarily for patients in whom dyspnoea with exertion or chest pain is a problem. Stress ECG's can have false positives in young to middle age women and a stress echo is recommended in this group. If there is left ventricular hypertrophy or resting ST changes such as with Digoxin etc then again a stress echo would be recommended. Indications for a stress ECG have diminished with the availability of stress echo. Another indication for stress testing would include checking for BP control with exercise. Contraindications include severe aortic stenosis.


Stress echo has surplanted stress ECG to a large extent as there is imaging of the heart as well as ECG monitoring. Stress echo tests for left ventricular function and left ventricular thickness at rest and then images of the left ventricle in various views are taken at the peak of exercise. Please note that stress echo does not negate the need for a resting echo to check for significant valvular problems, pulmonary hypertension, congenital heart disease etc. If these clinical problems are suspected then a resting echo is required as a stress echo primarily checks on LV function and LV thickness prior to the stress test.


Stress echo has the same sensitivity and specificity as nuclear medicine myocardial perfusion scanning (Sestamibi, Thallium, Myoview) and takes only 1 hour whereas nuclear cardiac stress tests can take up to 3 hours and are much more expensive. A stress echo requires no injections. Often this test is performed in patients who have had coronary intervention (bypass, stents) to see how their graft or stent function is progressing. Most referrals are performed because of atypical chest pain or dyspnoea with exertion or to check for coronary artery disease prior to major surgical procedures. I would be happy to discuss specific details about stress echo. There is no major contraindication to stress echo apart from severe aortic stenosis.


Patients with pacemakers or marked abnormalities on resting ECG such as left bundle branch block or ST depression (eg Digoxin, LVH) are often referred for stress echo as the test does not rely only on ECG changes for the diagnosis of coronary artery disease as does a stress echo. Certain patients who cannot exercise to any degree such as with claudication or arthritis of the hips, knees etc will require nuclear medicine scanning and CT Scanning to try and achieve a tachycardic response and exclude coronary artery disease.

Lung Function
Patients with dyspnoea, people who are smokers or have been exposed to asbestos or dust often require lung function testing. Similarly for patients who need to have major surgery. Patients who are applying for Veterans' Affairs reimbursement or for disability require complicated lung function testing. There are three main lung function tests.

Spirometry/flow volume loops is particularly helpful to diagnose restrictive or obstructive lung disease and can be performed after bronchodilator inhalation to detect reversibility.

Oxygen saturation via pulse oximeter at rest or with exercise is another lung function test and is useful for patients with significant airways disease or CCF who may desaturate with exercise.


Holter Monitor
Holter monitoring should be performed in most coronary artery disease patients every 6-12 months to exclude silent ischaemia or arrhythmias. Any patient who presents with dizziness, presyncope or syncope requires Holter monitoring to exclude arrhythmias. Three consecutive 24 hour Holter monitors would exclude most arrhythmias. I also have an Event monitor which patients can leave in place for 3 days to detect infrequent arrhythmias. Other indications for Holter monitoring would include arrhythmic detection such as patient with palpitations, brady or tachy-arrythmias or ectopic beats. Patients being assessed regarding suitability for major surgery require Holter monitoring prior to surgery.


Ambulatory BP Monitor
Ambulatory BP monitoring is useful in hypertensive patients to exclude white coat syndrome and also to double check on BP readings in a work or home situation. Ambulatory BP monitoring should be performed annually in most hypertensive patients. Some patients find sleeping with the monitor stressfull in which case I recommend Home BP Monitors which I lend to patients at no cost. However these do not give feed back as to nocturnal BP which is best assessed with an ambulatory BP monitor as patients who have sustained nocturnal hypertension have a poorer prognosis (non dippers). Sleep apnoea should be excluded in these patients.


Referral Forms
Please find referral form for uploading and insertion into your Medical program or printing. PDF WORD DOC

Opening Hours


Mon - Thur 8:30am - 4:30pm

Fri - 8:30am - 2:00pm

Closed Weekends and Public Holidays
Appointments by referral only


479 Crown St

West Wollongong  2500


T: +61 2 4228 4377
F: +61 2 4226 1629
E: stephene@ihug.com.au