Referral letter - GP referral letters are valid for 12 months. Specialist referral letters are valid for 3 months.
Medicare or concession card
Regular medication list
Any previous cardiac investigations - ECG, Echo, Holter reports
If you were recently discharged from a hospital or emergency department, please bring your discharge letter.
If you are seeking a second opinion, please indicate this when making the appointment as additional time will be required to review your previous investigations and documentation.
At your appointment, you will be asked various questions about your symptoms and the concerns that have led to your appointment. You will also be asked a range of questions about your other medical conditions, your social history (smoking, alcohol) and your family history. This will allow the doctor to gain a more wholistic understanding of your health situation. You will then undergo a physical examination.
Depending on the reason for your appointment, you may be asked to have some tests performed. This might occur before or after you have spoken to the doctor.
After the tests have been analysed, you will have a discussion with your doctor about the results and any further treatments that may be required.
An ECG is an electrical tracing of your heart rhythm. It provides information on the health of your heart's electrical conduction system.
10 sticky patches called 'electrodes' are placed on your chest, arms and legs. The electrodes are connected to an ECG machine by wires. The ECG machine records and prints out traces of your heart rhythm. For this test to be performed, you will be asked to expose part or all of your chest. This test will be performed in a private location, with just the cardiac technician and/or doctor present.
It is possible for some to have an allergic reaction to the adhesive used to attach the ECG leads to your chest, but this is very rare.
An ECG takes approximately 5-10 minutes.
You do not need to prepare for an ECG.
An echocardiogram, or 'echo' is an ultrasound test that allows us to assess the structure and function of your heart muscle and valves. It is similar to the baby scan that pregnant women are offered during pregnancy, but our scan looks at the heart.
You will be asked to lie down and to roll over to one side. Your chest wall will need to be at least partially exposed for this scan. A sonographer or doctor will place 3 sticky patches, or 'electrodes', to your chest wall. A gel-covered transducer will then be placed in various positions against your chest wall, pointing in the direction of your heart. Information from this transducer will be transmitted to the echo machine and captured.
There are no risks associated with an echo. This is a painless, non-invasive test.
An echo takes approximately 30-40 minutes.
You do not need to prepare for an echocardiogram. However, you will need to expose at least part of the front of your chest. If you do not wish to remove your top completely, you will need to be wearing clothes that allow for this exposure.
A stress test allows us to assess your heart's response to physical exertion. Physical exertion places additional demands on your heart, and may reveal conditions such as arrhythmia or coronary artery disease, that are not readily apparent under resting conditions. Your doctor may choose to perform this test if they suspect that you have these conditions.
There are two types of stress tests:
1) Exercise stress test (EST)
2) Exercise stress echocardiogram (ESE)
10 sticky patches called 'electrodes' are placed on your chest, arms and legs. The electrodes are connected to an ECG machine by wires. You will then be asked to walk on a treadmill. The treadmill will start on a very gentle incline and at a very slow pace. This pace is slower than most people's walking speed. Every 2 or 3 minutes, the treadmill will gradually increase in speed and steepness. You should try to do as much exercise as possible, to allow for a thorough assessment of your heart. However, you may also ask for the test to be stopped at any time. Your heart rhythm and blood pressure will be monitored throughout this test. For this test to be performed, you will be asked to expose part or all of your chest. The test will be performed in a private location, with just the cardiac technician and/or doctor present.
An exercise stress echo is performed in the same way as an exercise stress test but with the addition of an ultrasound scan (or 'echo') before and after exercise. This gives us additional information about your heart muscle's response to exercise. Your heart muscle's response to exercise is a surrogate marker for the presence or absence of blood vessel disease.
A stress test attempts to mimic conditions during which you experience cardiac symptoms. For example, if you get chest pain when you walk up a hill, the stress test aims to recreate those conditions, in a monitored environment. Therefore, the risk of a stress test includes the possibility that you may experience the condition for which you have come to see the doctor. This could include heart attacks or dangerous heart rhythms, though in this case, it would be much safer to experience these conditions in a monitored environment, as compared with getting it at home or in an unmonitored space. Other risks include allergic reactions to the adhesive used to attach electrodes to your chest (very rare), or falling off the treadmill.
An exercise stress test (EST) takes approximately 30 minutes. You should add another 15 minutes if you are having an exercise stress echo (ESE).
You should wear comfortable clothes and shoes that you can exercise in. You will need to expose at least part of the front of your chest and we provide gowns to allow for access to the chest and to preserve your modesty.
Coming soon
A coronary angiogram is a minimally invasive procedure that allows us to assess the patency of your coronary arteries. Coronary arteries are the blood vessels that supply your heart muscle with blood. Blood vessel disease is usually what leads to a heart attack. This test is generally performed in individuals with chest pain, dyspnea or heart failure.
Unlike a CT coronary angiogram, an invasive coronary angiogram is performed in a cardiac catheterization lab, which is located within a hospital. You may be asked to change into a hospital gown. You will usually wait in the recovery bay where a technician will insert a cannula (a tiny plastic tube) into a vein in your arm. This cannula allows clinicians to administer any required medications during the procedure.
When the lab is ready, you will be moved into the cardiac cath lab, where you will be asked to lie on a procedure bed. Please try to lie still while on this bed, as the procedure has to be performed under sterile conditions and if you move a lot, you may inadvertently de-sterilize your environment. Technicians and nurses will help to cover you with drapes to maintain the sterile field.
Your doctor will administer a small amount of local anesthetic into the access site (either wrist or groin) to numb this area. A small plastic tube will then be inserted into the artery to allow access to your vascular system. Your doctor will pass medical wires and tubes to your heart. Once they are in the appropriate location, contrast dye will be injected gently into your blood vessels. X-ray images will then be obtained, using the C-arm that moves around you.
There are three possible outcomes at this stage:
You are not found to have coronary artery disease, or you have disease that does not require treatment or cannot be treated. In this case you will be treated with tablets only.
You are found to have disease that can be fixed immediately, or can be fixed during a second "staged" procedure. This is called "coronary angioplasty" or "stenting".
You are found to have diseased that is better treated by open heart surgery ("coronary artery bypass grafting"). This does not happen immediately. Your doctor will discuss this option with you after you have been moved back to the recovery room. Your doctor will refer you to a suitable cardiothoracic surgeon.
There is a 1% risk of an adverse outcome, which can include heart attack, stroke and death. Other less severe complications can include: dissection (damage to the inner lining of the blood vessel wall), bleeding, infections, allergic reactions and kidney impairment due to the contrast dye that is used.
An coronary angiogram without stenting takes approximately 30-45 minutes. Any additional procedures such as haemodynamic assessment or stenting will add on a varying degree of additional time, depending on the complexity of your procedure.
You will receive information from the hospital about your procedure. Please follow the instructions provided. You can usually take most of your regular medications. The only medication that may be withheld is your anticoagulation therapy (eg warfarin, apixaban, rivaroxaban or dabigatran).
Angina is a type of chest pain which is caused by reduced blood flow to the heart muscle. It is often described as a heavy or squeezing sensation in the chest, which may move to the jaw, shoulders, back or down the arms. There are two types of angina – stable angina and unstable angina. Stable angina is predictable and comes about with a predictable level of physical exertion and is relieved by rest. Unstable angina is more unpredictable and dangerous - you may notice it ‘out of the blue’ or with minimal exertion, and it may not improve with rest.
Angina occurs when there is progressive narrowing of the blood vessels of the heart. This is often due to the build up of cholesterol, within the walls of the blood vessels. Risk factors that can contribute to the development of angina, includes smoking, high cholesterol, high blood pressure, overweight / obesity and unfavourable genetics.
Angina treatment is important to prevent symptoms, and to reduce complications such as heart attacks and stroke. Patients with stable angina will be given a glyceryl trinitrate (GTN) spray, which can be used under the tongue, when you experience an attack. You may also be given a beta blocker or calcium channel blocker tablet. Patients with unstable angina, are usually started on aspirin and a cholesterol-lowering medication, whilst awaiting further investigations.
Your doctor may recommend surgery to treat your blood vessel disease. This can come in two forms: stenting (minimimally invasive) or coronary artery bypass surgery ("open heart surgery"). The type of surgery recommended will depend on how much disease is present in your blood vessels, and whether it can be treated with medications only.
Angina treatment usually continues lifelong. Most patients with well treated angina are expected to live normal, comfortable lives, without a reduced life expectancy.
Coming soon
High blood pressure, or "hypertension", is diagnosed when your blood pressure reading is higher than 140 / 90 mmHg. The larger number is your systolic blood pressure. It is a measure of the force exerted by blood against the blood vessel walls, when your heart contracts. The lower number is your diastolic blood pressure, which is measured when your heart and blood vessels relax.
Everyone's blood pressure rises and falls throughout the day, and varies from day to day. What you are doing, and how you feel, can cause a change in your blood pressure. Normally, blood pressure decreases during the night, then increases during the early hours of the morning. Many experts believe that early morning surges in blood pressure may be a factor contributing to the occurence of heart attacks and other serious heart problems.
High blood pressure does not usually cause symptoms, but even if you "feel fine" it is very important that high blood pressure is treated and kept under control. If it is not controlled, you can develop serious complications such as heart attack, heart failure, strokes and kidney failure.
Blood pressure is regulated by complex group of factors. Physiological factors that influence blood pressure include the strength and ability of your heart muscle to pump blood, the stiffness of your blood vessels, and the total volume of blood circulating in your body.
10% of hypertension cases can be attributed to another medical condition. This is called "secondary hypertension". The main causes of secondary hypertension include kidney and hormone disorders, and some birth defects.
In 90% of cases, no other medical conditions are found, that might lead to high blood pressure. This is called "primary hypertension" or "essential hypertension". Essential hypertension is associated with age, sex, family history, weight, cigarette smoking, physical inactivity and dietary salt. Although hypertension can develop at any age, over half of people over the age of 64 have hypertension. Before the age of 50, it is more common in men. By about 55 to 60 years, it becomes more common in women.
Blood pressure control is important to prevent complications such as heart attacks, kidney failure and strokes. It may be possible to lower your blood pressure through lifestyle changes, such as by achieving and maintaining weight loss, restricting your dietary salt intake and learning to manage stress.
Weight loss - Poor eating habits are the most likely reason for being overweight and this is usually difficult to change without proper advice and guidance from doctors, nutritionists and dieticians. You can expect about 1mmHg of systolic blood pressure improvement with every 1kg of reduction in body weight.
Reducing salt intake - Some simple steps to reduce dietary salt, includes eating fresh rather than processed meat, vegetables and fruits. Read food labels and avoid those with high salt or "sodium" content. When preparing food, switch from adding salt to alternatives such as herbs or lemon juice. Avoid saltier foods such as bacon, sausages, pickles and some cheeses. Aim for no more than 1 teaspoon of salt per day.
If lifestyle changes are not sufficient to achieve normal blood pressure, then you may be started on blood pressure medications. It is important that you take your medications exactly as instructed, and not skip doses because you feel fine. Medications that may be used to treat hypertension include: diuretics, beta blockers, alpha blockers, ACE-inhibitors, calcium channel blockers.
Some life-saving cancer treatments can increase your risk of cardiovascular disease. This segment is a work in progress, and I will continue to add information here over time.
Normal heart rates range from 60-100 beats per minute. If your heart rate is below 60 bpm, you are said to be bradycardic. If your heart rate sits above 100 bpm, you are tachycardic. There are multiple different causes of tachycardia, but sinus tachycardia (that is, elevated heart rates originating from the sinus node) is one form that is commonly seen in cancer patients.
Why does this occur?
There are a number of possibilities:
Tumor burden causing increased metabolic demand and sympathetic overdrive
Response to chemotherapy
Cardiotoxicity - decline in cardiac function secondary to chemotherapeutic agents
Pulmonary embolus
Dehydration
Infections
Physical deconditioning
Stress / Anxiety
Is this a problem?
An elevated heart rate is known to be a predictor of cardiovascular mortality. In fact, every 10 bpm increase in heart rate has been seen to correspond to a 15% increase in all-cause mortality and a 22% increase in cancer-specific mortality (this is based on observational data). Essentially, sinus tachycardia could be indicative of an elevated cardiovascular risk in that person.
What can be done about this?
You should see a cardiologist so your heart function can be assessed. This is mainly done through an echocardiogram, preferably including the assessment of Global Longitudinal Strain (GLS).
Your cardiologist will determine your suitability for medications to slow down your heart rate. Not everyone needs to or should be treated with rate control medications.
Non-pharmacological interventions should be considered as well. This includes avoiding excessive caffeine or alcohol, hot environments, dehydration or stress. Your doctor should also address any possible driving factors such as thyroid dysfunction, inflammation, infection or anaemia.
Further Reading
If you would like to read some journal articles on sinus tachycardia in cancer patients, please consider this review, and this one.