Assessment of all aspects of cardiology at Brentwood Hospital

What is a cardiology assessment?

A cardiology assessment is a thorough check-up of your heart health, combining a discussion of your symptoms and history with a physical examination and, where needed, a range of tests. It's used to diagnose heart conditions, assess your risk of future heart problems, and guide any treatment you might need.

What conditions does it help identify?

A cardiology assessment can help identify or monitor a wide range of conditions, including:

• coronary artery disease, where the arteries supplying your heart become narrowed, which can cause angina or a heart attack
• arrhythmias, or irregular heart rhythms, such as atrial fibrillation
• heart valve problems, often first picked up as an unusual sound (murmur) during examination
• heart failure, where the heart doesn't pump blood around your body as well as it should
• high blood pressure (hypertension), a major risk factor for heart disease and stroke
• high cholesterol and diabetes, both of which raise your risk of heart problems
• structural or muscle abnormalities of the heart, picked up on imaging such as an echocardiogram or MRI.

What are the benefits of having a cardiology assessment?

A thorough assessment can pick up silent problems, such as early narrowing of the arteries or an arrhythmia, before they cause a medical emergency. It also gives you clarity on what levels of exercise are safe for you, which matters if you're returning to activity or taking up a new sport.

If you already have a heart condition, regular assessment tracks whether your treatment is working and whether anything needs adjusting. For anyone with worrying symptoms, such as chest pain or palpitations, a prompt assessment can also bring reassurance or an early diagnosis.

Are there different types or approaches?

Cardiology assessments generally follow a staged approach, moving from simpler tests to more detailed ones only if needed:

• initial evaluation: a detailed history, physical examination, an ECG and standard blood tests
• non-invasive imaging and functional tests, used if initial findings raise a question or more detail is needed: an echocardiogram, a stress test (exercise ECG or stress echo), a CT coronary angiogram, or an MRI scan
• invasive tests, reserved for when non-invasive results suggest significant disease or symptoms are especially concerning: coronary angiography (cardiac catheterisation), sometimes alongside pressure measurements, or an electrophysiology study if an arrhythmia needs investigating in detail.

Which combination you need depends entirely on your symptoms, risk factors and what earlier tests show.

What happens before the assessment?

It helps to think through your symptoms beforehand, including when they started and anything that brings them on or eases them, along with your family history of heart problems and a list of your current medications. You'll also be asked about lifestyle factors such as smoking, exercise, diet, alcohol and stress, since these all affect heart health.

If your blood pressure is being measured, try to relax beforehand, as anxiety about the test itself can temporarily raise your reading, sometimes called the 'white coat effect'. You may be asked to sit quietly for a few minutes before the reading is taken.

No special preparation is usually needed for the basic tests. If you're booked in for something more specific, such as a stress test or an angiogram, you'll be given tailored instructions in advance.

What happens during the assessment?

A full assessment typically follows this pattern, though not everyone needs every step:

1. Your doctor takes a detailed history, asking about your symptoms, family history, lifestyle and any existing conditions.
2. They carry out a physical examination, checking your pulse, blood pressure and breathing, and listening to your heart and lungs with a stethoscope for any unusual sounds.
3. Baseline tests follow: an ECG, which takes 5 to 10 minutes and records your heart's electrical activity and rhythm, and blood tests covering things like cholesterol, blood sugar and markers of heart strain.
4. If your results suggest a closer look is needed, non-invasive imaging may follow, such as an echocardiogram (an ultrasound of your heart, taking up to 30 minutes), a stress test on a treadmill, a CT coronary angiogram, or an MRI scan.
5. In some cases, more detailed invasive tests are needed, such as a coronary angiogram, where a catheter is guided to your heart through an artery in your groin, wrist or arm and a dye injected to show up any blockages on X-ray.

What does recovery look like?

Most tests need no recovery time at all. An ECG, echocardiogram and blood tests are painless, and you can carry on with your day straight afterwards; blood test results are sometimes ready the same day.

Tests involving a brief anaesthetic or sedation, such as a trans-oesophageal echocardiogram or a stress echocardiogram, typically take a couple of hours in total, and you're usually able to go home the same day. The same applies to coronary angiography, generally carried out under local anaesthetic.

Once your results are all in, your clinical team reviews them together and discusses the findings with you. Depending on what's found, this might mean reassurance, a personalised treatment plan, referral for further tests, or closer monitoring of an existing condition.

What are the risks and complications?

• ECGs, echocardiograms, blood tests and chest X-rays are painless and carry no notable risk
• a stress test involves exercising under close supervision, so your heart rhythm, blood pressure and symptoms are monitored throughout
• scans using a small amount of radioactive tracer, such as a thallium (perfusion) scan, use levels of radiation considered safe
• coronary angiography, a more invasive test using a catheter placed into an artery in your groin, wrist or arm, is usually carried out under local anaesthetic.