Referrer Info

Stress ECG/ECHO

Stress ECG is performed for a variety fo reasons eg. chest pain, breathlessness etc. Stress echo has surpassed stress ECG to a large extent as there is imaging of the heart as well as ECG monitoring. Various images 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, congenital heart disease etc.

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. This test can be 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 chest pain or breathlessness with exertion or to check for coronary artery disease prior to major surgical procedures. We would be happy to discuss specific details about stress echo. There are few contraindication to stress echo.

Certain patients who cannot exercise to any degree such as arthritis of the hips, knees etc will require nuclear medicine scanning, CT Scanning or angiography.

Lung Function

Patients with breathlessness, 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. Spirometry is particularly helpful to diagnose restrictive or obstructive lung disease and can be performed after bronchodilator inhalation.

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

Holter Monitor

Holter monitoring excludes silent ischaemia or arrhythmias. Patients who present with dizziness or fainting requires Holter monitoring to exclude arrhythmias. Three consecutive 24 hour Holter monitors would exclude most arrhythmias. We also have an Event monitor which patients can leave in place for 3 days to detect infrequent arrhythmias. Other indications for Holter monitoring include arrhythmic detection such as patient with palpitations. Patients being assessed regarding suitability for major surgery may 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. Home BP Monitors can be loaned 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. Sleep apnoea should be excluded in these patients.

Referral Forms

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