PCG Screening

Heart condition tests

There are many different tests to find out how your heart is doing or to diagnose a condition.

Here we explain what some of the PCG Screening tests are for, what happens during them, and where you can find out more.

Coronary angiogram

An angiogram (also known as a cardiac catheterisation) is a special type of x-ray which uses contrast dye to allow your doctor to look at your coronary arteries. The dye lets your doctor see how well the blood is flowing and shows up any narrowings.

Echocardiogram

An echocardiogram, also known as an echo, is a non-invasive test which uses sound waves to build up a detailed picture of your heart. It is similar to ultrasound scanning used in pregnancy.

MRI Scan

Magnetic Resonance Imaging (MRI) is a way of creating detailed images of your internal organs, such as your heart and blood vessels. As MRI machines are not currently available at all hospitals in the UK, you may be referred to a different hospital if you require an MRI scan.

Heart condition tests - further information

An angiogram (also known as a cardiac catheterisation) is a special type of x-ray which uses contrast dye to allow your doctor to look at your coronary arteries (the blood vessels that supply your heart).

The dye lets your doctor see how well the blood is flowing and shows up any narrowings.

Depending on your results, the procedure can help your doctor decide what treatment you might need.

What happens during an angiogram?

The test is done in a cardiac catheter laboratory or ‘cath lab’. You can expect the test to last around half an hour, although it can sometimes take longer. You will need to lie flat for the procedure.

*You will be asked not to eat or drink anything for a few hours before your procedure.

*You’ll be given a local anaesthetic injection in the wrist or groin. The catheter (a thin, flexible tube) will then be passed into an artery.

*The catheter will be directed through your blood vessels and up to your heart. The doctors will use X-ray to help guide them to the arteries.

*A special dye called contrast will then be passed through the catheter and a series of images will be taken. It is very common to feel a hot, flushing sensation as the dye enters your bloodstream, but this is completely normal and only lasts for a few seconds. The dye will show up any narrowed areas or blockages in the artery on the X-ray.

*During your procedure, you’ll be attached to a heart monitor that records your heart rate and rhythm and you’ll have a probe measuring your oxygen levels on your finger. If you feel unwell or uncomfortable at any time, you should tell a member of the hospital staff.

What happens after an angiogram?

After the procedure, the catheter will be removed and a collagen plug called an angioseal will be left in place. This is common if the procedure is performed through the groin. You will need to stay on bedrest for about an hour. Some doctors prefer to apply a pressure pad to the wound, in which case you will need to stay on bedrest a bit longer, usually around 4 hours.  

If your procedure is performed through your wrist, a pressure device to reduce the risk of bleeding is left in place and the nurses will gradually reduce the pressure over a short period of time then remove it altogether. You will be able to sit in a chair almost straight away.

The nurses will check your blood pressure and pulse and keep an eye on your wound. It is important to drink plenty of fluid as this helps to flush the dye out of your system.

As long as you feel well, you should be able to go home the same day, although this may depend on the results. Your doctor will explain these to you before you leave.

The most common after-effect is bruising at the site where the catheter was inserted which may feel tender and numb for a few days. You might feel tired, but you should be back to normal within a few days. If you are worried about any of the after-effects, contact your doctor.

Some people who have a coronary angiogram go on to have a treatment called coronary angioplasty.

What is a CT coronary angiogram?

CT stands for ‘computerised tomography’. A CT scan is a modern, sophisticated type of X-ray.

A CT coronary angiogram shows the blood flow through the coronary arteries. For this test the dye is injected into a small vein in your arm. This makes the test less invasive than a traditional angiogram.

You will then lie on a bed which passes through a doughnut-shaped opening in a CT scanner to show detailed images of your heart. Some people feel a bit claustrophobic during this test, so let the team know if you feel nervous.

A CT coronary angiogram is generally not as reliable at detecting narrowings in small coronary arteries or in small branches as a traditional coronary angiogram. This means that the standard coronary angiogram is still the ‘gold standard’ for diagnosing coronary heart disease

An angiogram can sometimes also be helpful for investigating other conditions, such as congenital heart disease.

What are the risks of having an angiogram?

An angiogram is a relatively safe, very common test. Serious complications are rare and your doctor will discuss these before you have it done.

Following an angiogram, some people may develop a collection of blood under the skin, which is called a haematoma. This can be uncomfortable and cause bruising, but it should go down after a few days. However, contact your doctor if you have any concerns.

A small amount of radiation is used during an angiogram. The doctor will bear this in mind if you have been exposed to higher levels than normal.

An echocardiogram, also known as an echo, is a non-invasive test which uses sound waves to build up a detailed picture of your heart. It is similar to ultrasound scanning used in pregnancy.

What does an echocardiogram show?

An echo looks at the structures of your heart, and gives information on how well your heart is pumping.

It is often done if you have had a heart attack or if you have been diagnosed with heart failure as it shows how much heart muscle is affected. It is also used routinely to diagnose and assess heart valve problems or congenital heart disease (heart conditions people are born with).

What happens when you have an echocardiogram?

You will be given a hospital gown to wear as you will need to remove all clothing from your top half when the echo is done.  Your privacy will be maintained as you will be behind curtains or in a hospital clinic room in the outpatients department.

With a standard echo, sometimes called a transthoracic echo or TTE, you’ll be asked to lie on a couch or bed. A gel used especially for scanning will be used to help the sound waves reach your heart. It feels cold and sticky, but is otherwise harmless.

The healthcare professional (called a sonographer) doing the procedure will move the probe in different areas of your chest around your heart. The probe gives off pulses of high frequency sound waves which pass through your skin to your heart. The ultrasound waves ‘echo’ against the structures of your heart and the probe picks up these reflections and shows them as images on a screen.

Different parts of the heart are seen as the probe is moved around on your chest.

How long will an echocardiogram take?

It varies from person to person and can take from 15 minutes up to an hour. It’s a very common, safe test, and most people find it’s not uncomfortable, although you may feel a bit of pressure as the technician presses the probe onto your chest to obtain the best images.

Other types of echocardiogram

Transoesophageal echocardiogram (TOE)

A transoesophageal echocardiography, or TOE, takes detailed pictures of your heart from your oesophagus (the tube that connects your throat to your stomach) which lies behind your heart. This test is used to get closer and more defined images of the heart as it can detect things that are not as easy to see with a transthoracic echo.

You will be asked to lie on your side and ‘swallow’ a small probe which is mounted at the end of a flexible tube. A local anaesthetic that numbs the area will be sprayed onto the back of your throat and you will be offered a short-acting light sedative to help you relax. The procedure usually takes about 30 minutes.

The technician will obtain the images they need and remove the tube as soon as the procedure is done.

Stress echocardiogram

An echocardiogram may be done while the heart is beating faster – a stress echo is performed while deliberately increasing the heart rate with either exercise on a treadmill or stationary bike, or with medication given through a vein. This test can help to diagnose coronary heart disease as it shows the coronary arteries in the heart aren’t getting as much oxygen rich blood as they should.

Foetal echocardiogram

Foetal echocardiograms are used to help identify heart defects before a child is born. 

Bubble echo

This is sometimes called a bubble study. 

A bubble echo involves performing an echo in the usual way whilst a small amount of salt water (saline) is injected into your bloodstream, through a vein in your arm. The salt water contains tiny bubbles which show up clearly on the scan pictures, and can be a useful way to identify a hole in the heart. It may be carried out after a stroke or TIA, or after complex heart surgery. 

The test is quick and painless, and the bubbles are harmless.

Magnetic Resonance Imaging (MRI) is a way of creating detailed images of your internal organs, such as your heart and blood vessels.

As MRI machines are not currently available at all hospitals in the UK, you may be referred to a different hospital if you require an MRI scan.

What is a cardiac MRI scan?

A cardiac MRI scan is a non-invasive test that uses an MRI machine to create magnetic and radio waves to show detailed pictures of the inside of your heart.

What can a cardiac MRI show?

A cardiac MRI scan is a non-invasive test that uses an MRI machine to create magnetic and radio waves to show detailed pictures of the inside of your heart.

Cardiac MRI scans also look at the blood supply to your heart. They can help your doctor to investigate conditions such as:

What happens during a cardiac MRI scan?

  • You will be asked to lie on a bed, which moves inside a tunnel-shaped scanner. The scanner is open at both ends.
  • You’ll be asked to lie still while the scan is taking place.
  • The scan may last for up to an hour, but there’s a buzzer you can press if you need to speak to the radiographer (the person operating the scanner).
  • The scanner is quite noisy. You’ll be able to hear banging sounds but you’ll usually be offered earplugs or earphones so you can listen to music.
  • For some cardiac MRIs the doctor will use a dye known as contrast agent so that the images of blood flow to your heart show up more clearly on the scan. The dye will be injected into a vein in your arm. Your doctor will give you more information about this if it’s required.

If you’re claustrophobic (afraid of being in small spaces), tell your doctor before the test. You may be offered a mild sedative – a drug to help you relax.

 

Most people that have a cardiac MRI scan will not have to stay in hospital overnight. You should be able to go back to your normal activities straight away. Some exceptions to this are:

  • If you’ve been given a sedative, you won’t be able to drive and will need to be taken home by a friend or relative. You will be advised not to drink alcohol or operate machinery for 24 hours.
  • If you’ve been given an injection of a dye (contrast agent), it’s a good idea to drink plenty of water for the following 24 hours to help flush the dye out of your body.

Usually the doctor who arranged the scan will discuss the results with you when they become available. 

Is a cardiac MRI suitable for everyone?

If you have a pacemaker or an implantable cardiac defibrillator (ICD) you should speak to medical staff before having an MRI scan. Most modern devices can withstand MRI scanning but it’s always important that the make and model number is checked beforehand. An MRI can also affect the settings of your device, as each one is programmed specifically for your heart.

You can’t have an MRI scan if you have:

*inner ear implants or

*any type of surgical foreign body such as a metal clip in the brain or eye.

This is because the scanner uses very strong magnets that could cause anything made of metal to move.

If your kidneys aren’t working well, the dye used during the scan could cause further damage. Your doctor will take a blood test before and soon after the scan to check your kidney function, and explain the risks and benefits to you. You may need some fluids through an intravenous ‘drip’ in your arm before the MRI scan if you have kidney problems.

How can I prepare for a cardiac MRI?

  • Talk to your doctor if you have any medical implants (such as a pacemaker), coronary stents or are pregnant before the test.
  • Unless you have been told otherwise, you can eat and drink normally and continue taking any medication before the test.
  • Remove all electronic devices and credit/debit cards from your pocket. The magnets used in the machine can damage these items.
  • Take off all metal objects such as jewellery, watches and hearing aids.

You’ll have to run through a checklist before the test, so don’t worry about forgetting to do any of these things.