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Cardiac Physiology

Maidstone and Tunbridge Wells hospitals both have a diagnostic department specialising in Cardiac Physiology.

Our team of Cardiac Physiologists and Cardiographers perform a range of investigations and ongoing monitoring that have been requested by a Consultant, GP or specialist nurse in charge of your care.

Your appointment letter will advise you whether you need to stop any medication prior to attending your test. Your appointment will be in the Cardiorespiratory Unit in the Blue Zone on the ground floor at Maidstone Hospital or Zone 1 Outpatients on level 0 at Tunbridge Wells Hospital.

Both departments carry out the following diagnostic tests:

Ultrasound imaging of the heart (Echocardiography)

Echocardiography is one of the most common tools to assess heart function. It uses sound to build a moving picture of your heart. The physiologists will use this technique to assess the size and shape of heart structures, how the various structures move, and the patterns of blood flow through the heart.
The test is painless, and there are no documented side effects of medical ultrasound. It will take between 20-60 minutes to perform the test depending on the type of scan being performed. There is no preparation required for a routine scan (Transthoracic Echo cardiogram).
You will be asked to completely undress to the waist and lie and relax on your left side on the couch as this is the best way to get clear pictures. The machine uses a gel on the chest to ensure a good contact for the transducer which collects the sound reflections to build a picture on the screen. Once the test is complete the physiologist will review the images, and compile a report for the requestor. The images are also stored for future review by a Cardiologist if required.

Types of scan available:

In addition to the Transthoracic Echocardiogram we also provide:

Contrast Echocardiography

Adding contrast to the scan enhances the pictures and provides detail that would not normally be visible. There are two types of contrast scan:

Bubble Study
Salty water is agitated and injected into a vein, the bubbles pass into the right side of the heart, and then absorbed by the lungs. We are particularly interested to see if the bubbles can be seen in the left side of your heart which would suggest there is a communication between the two sides of your heart.

Contrast Echocardiography
A special ultrasound contrast agent is injected into a vein, the contrast is designed to pass through the lungs so that the outline of the left side of the heart can be seen in detail. This is useful if the Doctor needs to have an accurate measure of how well you heart is pumping.

Transoesophageal Echocardiogram

It is sometimes necessary to obtain images in greater detail. This can be achieved by passing a small probe down behind your heart via your food pipe (oesophagus). These tests are performed as day case procedures as you will be lightly sedated for the test. There will be some preparation required for this test and this information will be sent with your appointment letter.

Electrocardiography (ECG)

An electrocardiogram is a painless test that records the very tiny electrical impulses that make the heart contract. Up to 10 small stickers (electrodes) are positioned on your arms, legs and chest to pick up these very small signals, the machine amplifies the signals and prints them on a chart. The test provides lots of information, such as heart rhythm.

Types of ECG:

A standard ECG is commonly requested and may be performed at each attendance to clinic. It only takes a few minutes to complete.

Stress Test: The ECG is recorded while you walk on a treadmill, it is most commonly requested if your symptoms are suggestive of angina. You may be asked to stop certain medications prior to the test, but if this is required if will be clearly marked on your appointment letter.

Ambulatory ECG: A simplified ECG is recorded over a longer period of time, from 24hrs up to 7 days if necessary. It is used to investigate symptoms such as palpitations or dizzy spells that occur infrequently. If your palpitations are very infrequent then a loop recorder may be requested that can be worn for even longer periods of time.

Ambulatory Blood Pressure Monitoring

Blood pressure is most accurately measured over a prolonged period and in your own environment. A single measurement in clinic will not provide the same information as multiple readings over the day and night.

You will be asked to wear a monitor and a cuff for 24hrs, the cuff will inflate every 30minutes during the day, and once an hour overnight. When the data is downloaded and analysed, a report will be provided to the Doctor who requested it.

Pacemaker Clinic

If you have a pacemaker, implantable defibrillator or an implantable loop recorder you will be followed up in our pacemaker clinic. At the clinic we will check your implantable device and ensure it is working optimally for you. This is achieved by performing some simple tests on the device, reviewing any stored information and by talking to you.

Increasingly, with the newer generations of pacemaker we are able to perform these checks over the internet. Instead of receiving a letter to invite you to a hospital based appointment, the letter will ask you to download the information in the pacemaker. The physiologist will review the data on the date stated in the letter. This has many advantages, including reducing the need to come to the hospital as frequently for checks.

Once you have had your pacemaker implanted we will explain how to transfer the information to the clinic for your specific device.