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Clinical Specialties - Cardiac

Heart Procedures & Investigations

Sydney Adventist Hospital has a strong reputation and decades of experience in caring for patients with heart disease, and this has established the San as one of the leading providers of complete private cardiac care. We have outstanding specialists and surgeons to deal with a range of cardiovascular and cardiothoracic conditions.

For a complete list and understanding of the various cardiac conditions we treat please click here.

Depending on your condition, you may be able to be treated in the Cardiac Catheterisation Lab (CCL). To get a better understanding of the various procedures carried out in the CCL click here.


The following cardiac procedures and investigations may or may not be advised for you however brief explanations of each are provided here. If you have any further questions or should your doctor request an investigation which is not listed here, they will discuss this with you.

Electrocardiogram

Electrocardiogram (ECG) is a recording of the electrical activity of the heart. The ECG machine is able to amplify and record on paper the electrical impulse of your heart from a variety of angles. Electrodes are placed on your chest, wrists and ankles, and then connected to the ECG machine. An ECG shows your heart’s rhythm and may indicate areas of possible damage to the heart muscle. This is a painless procedure.

An ECG takes approximately 5-10 minutes and no preparation is required. Your doctor will discuss the results with you.

Transthoracic Echocardiogram

A transthoracic echocardiogram (TTE) is a test that uses ultrasound waves to show the size of your heart and the thickness of the muscle wall, whether there are problems with the heart’s valves and how well the heart contracts. This is a painless procedure where ultrasound waves are passed through your heart and converted into a picture on a screen while you rest.

This procedure may be done whilst in your bed, in the ward or in the echocardiography department. A probe with clear gel is placed on your chest and the technician moves it slowly around your chest so different images of your heart can be seen. After the doctor has reported on the echocardiogram the results will be discussed with you.

Transoesophageal Echocardiogram

A transoesophageal echocardiogram (TOE) is a more complicated type of echocardiogram. The transducer is fixed to a flexible tube and manoeuvred down the oesophagus, which passes close to the back of the heart. This enables the cardiologist to get a closer and more definitive look at your heart’s function, its valves and the aorta. You need to fast for 6 hours before the procedure. You are sedated whilst the procedure is being carried out and your throat is sprayed with a local anaesthetic to ease the discomfort of swallowing the probe. It is therefore important you are monitored for a time after the procedure and you have to remain in hospital for at least 4 hours.

After the TOE your throat will be numb due to the local anaesthetic used. This will wear off in a couple of hours and you may have a sore throat which can take a little time to resolve. The nursing staff will ask you to drink a sip of water after two hours to ensure you can swallow properly. It is advisable to remain on a soft diet for the day after the procedure and resume your normal diet the following day. You should also not drive, operate machinery or drink alcohol for 24 hours after the TOE because of the medication you have received.

This procedure may be done in the coronary care unit or in the radiology department.

Exercise Stress Test

An exercise stress test is an assessment by a doctor to help diagnose heart disease and rhythm abnormalities, and to assess work capacity. It is performed either on a treadmill or a stationary bicycle. You are connected to an ECG machine so the doctor can see if there are changes in your heart’s rhythm and ECG appearance whilst the heart is under stress due to the exercise. The test lasts approximately 30 to 60 minutes. You should wear loose, comfortable clothing and suitable footwear.

Coronary Angiogram

This procedure will identify any blockages in coronary arteries, problems with the heart’s pumping action, heart chambers and heart valves. A long, thin catheter is inserted through the artery in your groin or arm. It is carefully guided to your heart where dye is injected into the coronary arteries. The dye shows up on X-rays so when the X-ray is taken of the heart (called an angiogram), the cardiologist is able to view any blockages.

The procedure itself takes approximately 30 minutes. You will need to fast from food and drinks beforehand, however the staff will advise you. After the procedure, the doctor will discuss with you the test results. The staff will give you guidelines to follow when you are ready to go home.

There are several different ways that bleeding from the femoral artery in the groin may be controlled after your coronary angiogram or percutaneous transluminal coronary angioplasty (PTCA)/stent procedure. The following method(s) may be used:

  • Direct Manual Pressure
    A doctor or nurse may apply pressure to your groin for 10-15 minutes with their hands.
  • Femstop
    This is a clamping device that applies pressure to the puncture site. It will remain in place until your doctor and nurse are satisfied that the puncture site is not bleeding. This device may cause some discomfort.
  • Angio-seal
    This device is made of three absorbable components: a small anchor and a collagen sponge which are drawn together by a suture to seal the puncture hole. A small plastic tube, which applies pressure on the sponge, is removed after about 20 minutes. It takes about 60 – 90 days for the Angioseal to be absorbed by your body and the site must not be reused within this time.
  • Perclose
    This is a device inserted into the artery to allow the doctor to stitch it. You will experience some pressure briefly.

You will need to stay in bed after your coronary angiogram or PTCA/stent procedure. How long before you can get up will depend on the method used to stop the bleeding from the puncture site and the results of your procedure.

Once you are home continue to check the puncture site and report to your doctor any bleeding, swelling, bruising or ongoing discomfort. Avoid heavy lifting, bending over and straining on the toilet for 48 hours. Support the puncture site with light pressure when performing the above activities and also when coughing.

If you have had an angiogram via the radial artery in the arm continue to observe the puncture site for any bleeding or significant swelling and avoid heavy lifting.

Sestamibi Stress Myocardial Perfusion Study

This test is performed to assess blood supply to the heart muscle (myocardium) via the coronary arteries at rest and with exercise. To obtain the images of the heart a radioactive tracer, Sestamibi, is injected into the bloodstream and concentrates in the myocardium according to the blood supply, so areas with diminished flow can be detected. It is performed in one continuous session over a period of approximately 5 hours.

The Rest Study: You will be given the first dose of Sestamibi into the vein in your hand with a needle. About 30 to 45 minutes later you will have the resting scans or pictures which take about 45 minutes.

This is followed by the Stress Study: The principal aim of exercise is to raise the heart rate to a certain level. This causes the coronary arteries to dilate and increase cardiac blood flow. If fairly vigorous exercise is medically inadvisable or the patient is physically unable to exercise adequately, Persantin Infusion (to dilate the arteries chemically) with little or no exercise, may be done. In either case, a further injection of Sestamibi is given. Then 30 to 60 minutes later the stress scanning is done.

It is not necessary to be an in-patient to undergo this test.

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Sydney Adventist Hospital Clinical Specialties and Services