Patient brochures


Objective of the examination

An electrocardiogram is a basic examination, which is always carried out in the cardiology department. The ECG gives the doctor a lot of information about the electrical activity of the heart muscle but it may also reveal a potential thickening of the heart muscle, oxygen shortages near the heart muscle, the presence or absence of scarring pointing to a past infarct, and so on.

Preparation

  • No special preparation is required.
  • There is no need to stop taking medication.
  • The chest of very hairy men will be shaved a little to obtain optimum contact between the electrodes and the skin.

The examination

You will be instructed to lie down on the examination table with a bare torso and bare limbs in a relaxed position. The electric current, in the heart muscle, will be mapped using electrodes on the skin (four on your limbs, six on your chest). The examination takes just a few minutes.

Attention!

  • This examination is painless.
  • There are no risks associated with this examination.

Objective of the examination

An echocardiography or TTE is a sonogram of the heart. It uses ultrasound techniques to image the heart. It is the most frequently carried out, non-invasive imaging of the heart.

Preparation

  • There is no need to stop taking medication.
  • You may eat before this examination.

The examination

You will be asked to lie on the examination table on your left side, with a bare torso. In this position the heart's contact with the chest is optimal.The gel that is applied to your chest helps to better conduct the ultrasound. The doctor will pass the probe across your chest to generate images of your heart.The probe will emit ultrasound waves which the heart will echo.A computer will capture the echo and convert it into a moving image.On the images we can see the shape and structure of the heart, the pumping action of both chambers and the function of the various heart valves. These images allow the doctor to detect congenital as well as acquired heart disorders.The examination lasts 30 to 45 minutes.

Attention!

  • The examination is painless.
  • The ultrasound is completely risk-free, which is why the examination can be repeated several times.
  • This examination is completely safe for pregnant women and children.
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Objective of the examination

During the transoesophageal echocardiogram the cardiologist uses a probe which is passed into the patient's oesophagus until it sits at the level of the heart.The ultrasound that is emitted travels through the various tissues and is echoed. The echoed waves are analysed and converted into imaging by the echocardiography equipment.The advantage of this examination is that the organs that are close to the oesophagus are mapped in a much better way. The heart and the aorta, as well as the smaller cardiac structures, such as the atria, the large blood vessels and the mitral and the tricuspid valves can be studied in more detail.

Preparation

  • You may not eat or drink before this examination. Normally our doctors will try to schedule this examination in the morning or before lunch. At any rate you can have a meal and drink the evening before and after that you may not eat or drink until after the examination. In other words, no food or drink for 4-6 hours before the examination is a minimum requirement or the examination will have to be cancelled.
  • Your throat will be locally anaesthetised with a spray. This will ensure that you will not feel any pain during the examination. If you are allergic to anaesthetics such as Xylocaine you need to notify your doctor of this.
  • If we have difficulty inserting the probe into your oesophagus, we may administer a short-acting sedative, which will relax your muscles and make you slightly sleepy.

The examination

You will be asked to lie down on the examination table on your left side. The doctor will slowly introduce the probe into your throat and will then ask you to swallow enabling him to pass into the oesophagus. This may feel uncomfortable and may cause nausea. Breathing through your nose and abdomen may prevent or suppress this sensation.Once the probe is in position the doctor will take the necessary images of your heart from various angles.The duration of this examination varies, but usually it does not last any longer than 20 minutes.

Attention!

  • The risk attached to this examination is minimal. In some cases your throat may be sensitive for a few hours after the examination. We recommend that you wait at least another hour before eating or drinking something.
  • If a sedative was administered you may feel slightly dizzy and less alert, meaning it may be dangerous to drive your car. We recommend bringing someone with you who can drive you home.
  • A very rare complication is the perforation of the oesophagus. In order to reduce this risk to a minimum you will be asked whether you have trouble swallowing and if this is the case, then we will first carry out a gastroscopy. This examination is not recommended for patients who are known to have Zenker's diverticulum, or a pharyngeal pouch which often gives rise to swallowing problems, as well for patients who have a tumour in the oesophagus.
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Objective of the examination

A holter is a portable device which registers the heart's electrical activity for a period of 24 to 48 hours while you go about your daily activities.In principle this is an ECG which lasts 24-48 hours.It is mainly used to detect arrhythmias.

Preparation

  • No special preparation is required.
  • There is no need to stop taking medication.
  • The chest of very hairy men will be shaved a little to obtain optimum contact between the electrodes and the skin.

The examination

Skin electrodes will be placed on your bare torso. These are attached to a recorder with thin cables. The recorder can be worn with a strap around your body.After the holter is connected (this takes about 15 minutes) you can return home and go about your daily activities.The next day or two days later you can remove the electrodes yourself at home and return the recorder to the cardiology department where the data will be registered. The results are available after about one week.

Attention!

  • This is a risk-free examination.
  • You may NOT shower or bathe with this recorder.
  • The examination is painless.
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Objective of the examination

The endurance test or cycle test is the most frequently carried out stress test and is first and foremost designed to detect significant narrowing of the heart's arteries.

Preparation

  • Usually this examination is carried to detect narrowing of the heart's arteries, which increase the heart's frequency and raise blood pressure. Medication which slows down your heart rhythm must be stopped 48 hours before the examination. Only then can the test reveal underlying problems of the coronary arteries.
  • We recommend that you confer with your cardiologist to see how you can stop your medication with beta blockers and calcium antagonists in a responsible way. If you experience any problems during this time, due to the stopping of your medication, you need to contact your physician or cardiologist.
  • We recommend that you wear clothes which are suited for cycling.

The examination

You will be asked to get on the bicycle and four electrodes will be attached to your back and six to your chest, and a blood pressure meter will be strapped around your arm.
You will start to cycle at a basic resistance of 50 watts at a certain pace. Every two minutes the resistance will be raised by 25 watts and you will be required to maintain a certain pace for a few minutes or a quarter of an hour. The objective of this test is to elicit a maximal effort from you. During this test your heartbeat, blood pressure and the electrocardiogram will be carefully monitored and any symptoms and complaints will be carefully measured.
We will try to increase your heartbeat to at least 85% of the theoretical maximum heartbeat because the endurance test can only detect narrowing of the coronary arteries at this level.

Attention!

  • The risk associated with a stress test is small but present nevertheless. Careful monitoring in most cases will allow the doctor in most cases to respond to possible complications such as arrhythmias in a timely and adequate manner.
  • Please immediately notify the doctor of any complaints during the test, including pain in your chest.
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Objective of the examination

The stress test that is most frequently carried out in the cardiology department is the exercise test (cycle test). In some cases, however it is insufficient to be able to fully exclude a narrowing of the arteries of the heart.

Before referring the patient for a more invasive diagnosis, i.e., the coronarography, an additional stress test may already shed some more light.
The aim of this examination is to make the heart beat faster so the heart muscle will start to use more oxygen (as it does for example when running or cycling). If the heart's arteries are narrowed the patient will start to experience a lack of oxygen and the heart muscle will contract less as a result. This becomes clear when the heart is required to make an effort.

The additional stress test is carried out by means of an echocardiogram and there are two options: the stress echocardiogram on the recumbent bicycle and the dobutamine stress echocardiogram.

Stress echocardiogram

A stress echocardiogram is used for patients who are capable of making a physical effort such as cycling.

Preparation

  • You can eat or drink before this examination.
  • Because the reason for the examination varies you will need to discuss with your cardiologist whether your medication needs to be adapted or stopped.
  • We recommend that you wear clothes which are suited for cycling.

The examination

You will be asked to get onto a recumbent bicycle which will be slightly tilted into a left lateral position. Electrodes will be placed on your chest and back for continuous ECG monitoring. The stress test starts with a slight effort. The resistance will be gradually raised. In addition to the electrocardiogram we will also carry out an echocardiogram in order to detect narrowing of the coronary arteries during the test.
This type of stress echocardiogram is also used to evaluate certain valve disorders or certain disorders of the heart muscle, including thickening of the heart muscle (hypertrophic cardiomyopathy).
This test lasts about 30 minutes.

Attention!

  • The risk associated with a stress test is small but present nevertheless. Careful monitoring in most cases will allow the doctor in most cases to respond to possible complications such as arrhythmias in a timely and adequate manner.
  • Please immediately notify the doctor of any complaints during the test, including pain in your chest.
  • You can go home after the test.
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Dobutamine stress echocardiogram

The dobutamine stress echocardiogram was specifically developed for patients who are incapable of making a physical effort (for a cycle test for example).
Because of their reduced physical capacity certain complaints may remain hidden such as pain in the chest. To generate and detect these disorders a dobutamine stress echocardiogram is carried out.

Preparation

  • A brief stay in the day clinic (EH19) will be scheduled. Two catheters will be placed in the patient's arm. The dobutamine IV will be inserted in one catheter, a contrast dye can be injected during the test through the other catheter for better image quality (Sonoview). It will not be used if the patient is allergic to contrast dyes or in case of unstable complaints relating to the narrowing of the heart arteries or in case of significant underlying pulmonary disorders.
  • You can have a light lunch, but after that you will not be allowed to drink or eat.
  • The test aims to raise your heartbeat and to this end all medication that slows down your heart rhythm will have to be stopped 48 hours before the examination. We recommend that you confer with your cardiologist to see how you can stop your medication with beta blockers and calcium antagonists in a responsible way. If you experience any problems during this time, due to the stopping of your medication, you need to contact your physician or cardiologist.

The examination

You will be asked to lie on the examination table with a bare torso. Electrodes will be placed on your back and chest for ECG monitoring.
Dobutamine will be administered through an IV and the dosage will be increased. By administering dobutamine we will mimic a physical effort, making the heart beat faster as if the patient were making a physical effort.
This stress will lead to an increased need for oxygen in the heart muscle and if the heart's arteries have significant narrowing then this will become obvious because of the lack of oxygen in your heart muscle. The ultrasound images made by the cardiologist will then highlight deviations, as well as the lack of oxygen.
Usually heart muscle disorders, which are detected with echocardiograms, will occur sooner.
The test lasts about 30 minutes.
These tests are usually carried out in the afternoon so you can leave the hospital around 4 p.m.

Attention!

  • As with every stress test there are always possible complications but this test is widely considered to be safe in medical literature and serious complications are very rare.
  • In case of complaints while cycling, including palpitations or chest pain, you immediately need to notify the doctor.
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Objective of the examination

A myocardial scintigraphy will examine the perfusion of the heart muscle with a SPECT scan.
Perfusion shortages, which are often caused by the narrowing of the coronary arteries, can be detected but this method allows us to check the seriousness of these stenoses and examine the heart's muscular force.

A myocardial scintigraphy consists of two parts: a test at restMIBI at rest and a stress testMIBI during stress or MIBI with persantine.
Sometimes these examinations are organised under a day protocol: MIBI at rest + stress or MIBI at rest + persantine.

Preparation

  • The following medication must be stopped two days before the examination and on the day of the examination itself:
    • Beta blockers
    • Theophylline
    • Nitrates
    • Persantine
    • Calcium antagonists
    • Pain killers containing paracetamol and caffeine.
  • The cardiologist or doctor will determine which other medication should not be taken for the time being because it may influence the outcome of the examination. Notify your cardiologist or doctor immediately in case of complaints due to stopping the medication.
  • You are NOT allowed to drink COFFEE, TEA, COLA or CHOCOLATE MILK in the last 24 hours before the examination. Nor can you eat CHOCOLATE.
  • You cannot smoke on the day of the examination.
  • Usually you need to come to the hospital with an empty stomach.
  • You can bring something to eat from home or eat something in the cafeteria.

MIBI at rest 

The examination

You will report to the Nuclear Medicine Department (Radio Isotopes) with an empty stomach. Here a light dose of radioactive tracer will be injected. To ensure that the radioactive tracer is optimally absorbed by the heart muscle you will be required to wait an hour before the images are taken. During this hour you will be asked to eat something (no tea, coffee, or chocolate), e.g., a sandwich with cheese. You can bring something from home or go to the cafeteria in the hospital.
One hour later you will go to the Nuclear Medicine Department where images will be taken of your heart using a gamma camera. This camera measures the radiation emitted by the radioactive tracer. The photographs will reveal how much of the radioactive tracer has been absorbed by the heart muscle. Based on this the doctor can determine whether the coronary arteries supply the heart with sufficient blood and oxygen.
A MIBI at rest takes about two hours. If this is carried out under a day protocol (with effort or persantine) then it will last four hours.

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MIBI during stress with cycle test 

The examination

First you will register in the Cardiology Department where a traditional cycle test will be carried out. At the time of maximal effort a small dose of radioactive tracer will be injected after which you will be required to cycle for another minute. As is the case with the MIBI at rest, you will be allowed to eat something afterwards (no coffee, tea or chocolate).
One hour later you will go to the Nuclear Medicine Department where images will be taken of your heart using a gamma camera. This camera measures the radiation emitted by the radioactive tracer. The photographs will reveal how much of the radioactive tracer has been absorbed by the heart muscle. Based on this the doctor can determine whether the coronary arteries supply the heart with sufficient blood and oxygen.
A MIBI effort will take about two hours. If this is carried out under a day protocol (with rest) then it will last four hours.

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MIBI during stress generated with persantine 

The examination

If the patient is not capable of cycling then a drug called persantine will be administered through an IV in your arm in the Nuclear Medicine (Radio Isotopes) Department. This drug widens your coronary arteries and mimics a physical effort.
Now a small dose of radioactive tracer will be injected after which you will be given something to eat (you may not have coffee, tea or chocolate).
Then images of the heart will be taken in the Nuclear Medicine Department using a gamma camera.

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Attention !

  • The amount of radioactive fluid used during the examination can be compared with the amount of radiation during an average X-ray examination (e.g., X-rays of the lungs). The dose is very low and well below the standards of the World Health Organisation. The radioactive tracer will have left your body within a few days.
  • If you are pregnant or breastfeeding then you need to notify the doctor of this.
  • Please also notify the doctor if you suffer from asthma.
  • As with any stress there is a certain risk involved but it is minimal. You can obtain more information about this from your doctor or cardiologist.

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Objective of the treatment

Cardioversion is a procedure whereby arrhythmias are treated by means of an electric current to the heart. By administering a dosed electric shock we try to restore the normal heartbeat.
Usually cardioversion is carried out in the context of atrial fibrillation or atrial flutter. The treatment requires you to stay in the hospital for the day.

Preparation

  • For one month you will be required to take blood thinners (Sintrom Mitis® or Marcoumar®) to sufficiently thin your blood, dissolve any possible clots and to ensure that the treatment can be safely administered. The clotting factors in your blood will have to be regularly checked. The cardiologist will provide the necessary information about this.
  • You cannot eat or drink in the morning.
  • You may take your usual medication with a small sip of water.
  • Patients with diabetes will determine their dose of insulin in consultation with the cardiologist or diabetologist.

At the hospital

You will report to the polyclinic unit EH 19 (1st floor) on the scheduled day at the scheduled time.

In the run-up to the cardioversion you will be asked questions about any medication that you take at home and other details that are required for the treatment.

The following examinations will be carried out:

  • Blood test to see if the blood thinning is sufficient for the treatment to be administered.
  • An electrocardiogram to check the heart rhythm.
  • A transoesophageal echocardiogram to check the heart for the presence of clots. This examination will take place in the cardiology department.

The treatment

If the outcome of the blood test, the ECG and the echocardiogram are satisfactory, then you will be taken to the recovery room of the operating quarters for the cardioversion.
If you are wearing dentures then you will be asked to remove them for the duration of the treatment.
You will be placed under ECG monitoring so your heart rhythm can be followed at all times and conduction pads will be adhered to your chest, which send electrical waves through the heart and ensure that you will not experience any burns.
The anaesthesiologist will administer a slight sedative through the IV in your arm so you that you will not be disturbed by the electrical shock.

Once you are asleep, the cardiologist applies a selected volume of energy (shock) in the centre of the pads via the defibrillator. Several shocks may be necessary and in some cases additional medication is administered via the IV in order to restore the heart rhythm. Once the heart rhythm is regular again or if it proves impossible to obtain a regular heart rhythm, the anaesthetist will wake you up again (after approximately 15 minutes).
When you are awake, you will be taken back to EH 19 where you remain under ECG monitoring for a few hours in order to observe your heart rhythm.
The cardiologist will give you the result of the treatment the same day, and under normal circumstances you can return home, accompanied, at around 4.00 pm.

Medication

Depending on the outcome of the treatment your current medication may be adapted. In any event it is crucial that you continue to take the rhythm medication as well as the blood thinners, even if the treatment was successful.
Even if your heart rhythm is regular, there may still be some clotting in the heart in the weeks following the cardioversion. You may run the risk of a relapse if you interrupt the medication for the heart rhythm.

Attention!

  • Complications due to the anaesthesia are extremely rare because the anaesthesia is so short.
  • You may experience a slight irritation/redness on your chest where the conduction pads were applied. These complaints will disappear of their own accord after a few days.
  • You are not allowed to drive yourself home because of the anaesthesia.
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