This information is provided for the general interest of all patients. Note
that Clinical Diagnostix can only answer queries from their own patients.

Please use the headings located below to find the information you require.

AMBULATORY ECG MONITORING

To find out more use the headings below:

An Ambulatory ECG is usually recorded for a 24 hour or 48 hour period and is sometimes
called Holter monitoring. It is a way of continuously recording your heart rhythm/ECG over a
period of time. It is a very straightforward procedure with no side-effects and there are no
special preparations that you have to do for this investigation.

Ambulatory ECG monitoring is done to see what your heart rhythm does when you are going
about your normal daily activities. The test can help to diagnose symptoms such as palpitations
which do not happen very often and may not occur when you have a normal ECG recording which
takes less than 1 minute. The test may be done if you have feelings of your heart racing or beating
irregularly or if you feel dizzy. It can also be undertaken so that your Consultant can check that certain
medications you may have been prescribed are doing their job.

You will need to make two visits to the hospital – once to have the monitor fitted and another visit to
return it. The test will be performed by a Clinical Physiologist who will ask you to undress to the waist. ECG
electrodes (small sticky patches) will be applied to your chest after your skin has been rubbed slightly to
ensure a good contact. Men may need to be shaved in the small areas of the electrode sites. Wires from the
recorder will be attached to the electrodes and the recorder, which is a small device, can either be clipped to your
belt or clothing or be worn in a pouch under your clothing. The wires will be concealed underneath your clothing and
the recording device does not make any noise. You should try to do all your normal activities during the day and also to
undertake any activities which might bring on your symptoms. You will be given a diary card to keep a record of your
activities and also to note if you have any symptoms.

After you have returned the recorder the results will be analysed and sent to your Consultant.

ECHOCARDIOGRAM

To find out more use the headings below:

An echocardiogram is a scan using ultrasound (high frequency sound waves) to take pictures of your
heart. The procedure is not painful and usually takes approximately 30 minutes. Ultrasound is not
known to cause any harm to the body and is routinely used for scanning during pregnancy.

Echocardiography is done for many different reasons and can be used as a screening procedure even if
you have had no problems with your heart. The scan gives information to your doctor about the size of your
heart, how well the heart muscle is functioning and also about the condition of the valves inside the heart. It is
often done if your doctor has heard a "murmur" when they listened to your heart with a stethoscope or if you
have an irregular heart beat, high blood pressure, are short of breath or have had a heart attack or operations on
your heart in the past.

The test is performed by a Clinical Physiologist or your Consultant. You will be asked to undress to your waist
and lie on a couch and ECG electrodes will be attached to your chest. The room will be darkened so that the
screen on the equipment can be seen clearly. A small probe will be moved around over different areas of your
chest using a lubricating jelly to ensure good contact with the skin. Images and measurements are taken and stored
during the scan and, during some measurements (Doppler), you will hear noises which relate to the blood flowing
around the heart. It is not always possible to give you the results of your scan directly as the measurements and pictures
are replayed later, prior to reporting, and may need to be reviewed by your Consultant. You may have a friend or relative
present during the procedure if you wish.

EXCERCISE TEST

To find out more use the headings below:

A cardiac exercise test, often also called a stress test or exercise ECG, is an electrocardiogram (ECG)
recorded on a computerised machine whilst you are walking on a treadmill.

The test is done to provide your doctor with information about how your heart performs during physical activity
and provides information about blood flow to the heart muscle which cannot be detected on a resting ECG. The
test can show if symptoms such as chest pain or breathlessness are related to your heart.

The test will be performed by a Clinical Physiologist and your Consultant will usually also be present. You will be
asked to undress to the waist and ECG electrodes will be applied to your chest. Men may require their chest to be
shaved to ensure good contact with the recording electrodes during the procedure. Ladies will be given a gown to wear.
A blood pressure cuff will be attached to your arm and baseline ECG and blood pressure readings will be taken whilst you
are at rest. You will then be asked to walk on a treadmill which starts off very slowly and gradually increases in speed and
slope and recordings of your ECG and blood pressure will be recorded at intervals. You will be asked to report symptoms such
as chest pain/tightness, breathlessness, palpitations or dizziness or if you feel that you cannot walk any further. If you are
limited with arthritis or lung disease this will be taken into account by the staff during the test. After the test the recordings will
be continued usually for 5 to 10 minutes until your heart rate has returned to its resting reading.

You should wear light comfortable clothes and flat shoes. You should not eat a heavy meal or drink alcohol for 3 hours
prior to your test but light snacks and soft drinks are alright. You should bring a list of all the medication you are taking
with you and you may need to stop taking any beta blockers (e.g. atenolol, bisoprolol, propranolol) 24 or 48 hours before the
test – please check your appointment letter.