An electrocardiogram (also called ECG), is a test that measures the electrical activity of your heart. An ECG gives a first indication of a possible cardiac abnormality and can provide the cardiologist with information on cardiac arrythmias (irregular heart rhythm), lack of oxygen in the heart muscle, acute myocardial infarction, a previous myocardial infarction and/or enlarged heart. If an ECG is abnormal, other tests are needed to make a definitive diagnosis. Preparation Your torso is cleared of clothing, cleaned and possibly shaved locally. 10 electrodes are placed on your chest, arms and legs. They are connected to the device recording the electrical signals produced by your heart every time it contracts (beats). Procedure The ECG is risk-free and painless procedure. It takes only a few minutes for ECG to be done. Aftercare No specific aftercare.

An echocardiogram uses ultrasound to visualise the structure of the heart (the heart muscle, the heart valves and major blood vessels). This procedure generates images of the heart’s pumping action so the function of the heart can be measured. An echocardiography using the Doppler technology also works with ultrasound and records the velocity of the blood flowing through the heart and blood vessels. The computer displays the results as a coloured flame-like pattern in the echography image. Preparation For transthoracic echocardiogram you will be asked to take off the clothes from the upper part of the body. An apparatus (probe) is placed in the upper region of your body, on the thorax at the different places, which correspond to acoustic windows. Procedure The physician rubs a conductive gel on your skin in the upper region of your body, on the thorax, as the ultrasounds do not propagate well in the air, there need to be a physical contact between the probe and the patient’s body. Using a kind of pen (the probe), the physician, sends pulses of ultrasound towards your heart. The ultrasound waves then bounce back (echo) and are converted into sound and image by the Doppler machine connected to the probe. The scan is entirely painless and takes about 30 minutes. Aftercare After the examination the conductive gel will be wiped off from your body. Further no specific aftercare is needed.

How and why we perform the test? In an exercise stress test, you pedal on an exercise bike, while the physician performs a continuous electrocardiogram (ECG) of you heart and measures blood pressure. During the test the physician can see: • Your heart rate during exercise • Your blood pressure evolution (it is normal that the blood pressure increases within certain limits during exercise) • Any abnormalities in the electrocardiogram (ECG) • Whether the heart muscle has shortage of oxygen during exercise (which is mostly due to coronary heart disease) Preparation You should not have heavy meal before the test. Bring loose clothing and a pair of trainers. Procedure You sit on the exercise bike. The suction electrodes are placed on your thorax and a first electrocardiogram is recorded. Afterwards, when the physician asks you, you need to pedal with a stable pace (around 60 rotations per minute, the number is visible on the screen on the guidance of the bike, in front of you). Every minute the bicycle will increase the resistance, until your heart achieves the maximal heart rate or until you express the desire to stop exercise. The test will last approximately 20 minutes. The physician measures the electrocardiogram (ECG) while you exercise in order to be able to compare it during different stages of exercise. Aftercare No specific aftercare. The cardiologist will discuss results with you.

It is an exercise test on the bicycle but with extra measurement of ventilation by means of facial mask. How and why we perform the test? In an exercise stress test, you pedal on an exercise bike, while the physician performs a continuous electrocardiogram (ECG) of you heart and measures continuously ventilation (by special mask) and blood pressure. During the test the physician can see: • Your heart rate during exercise • Your blood pressure evolution (it is normal that the blood pressure increases within certain limits during exercise) • Any abnormalities in the electrocardiogram (ECG) • Whether the heart muscle has shortage of oxygen during exercise (which is mostly due to coronary heart disease) • Ventilation (whether the longs deliver enough oxygen to the body) • After combination of findings from ECG and ventilation, the physician will be able to estimate your physicial endurance and establish what are the factors which limit exercise capacity Preparation You should not have heavy meal before the test. Bring loose clothing and a pair of trainers. Procedure You sit on the exercise bike. The suction electrodes are placed on your thorax and a first electrocardiogram is recorded. Then the facial mask would be fitted on your face. Afterwards, when the physician asks you, you need to pedal with a stable pace (around 60 rotations per minute, the number is visible on the screen on the guidance of the bike, in front of you). Every minute the bicycle will increase the resistance, until your heart achieves the maximal heart rate or until you express the desire to stop exercise. You need to get to the maximum of your exercise capabilities. The physician measures the electrocardiogram (ECG) while you exercise in order to be able to compare it during different stages of exercise. Aftercare No specific aftercare. The cardiologist will discuss results with you.

A Holter monitor allows the cardiologist to trace any abnormal heart rhythms (with a high heart rate, as well with low heart rate or pauses). A Holter monitor works like an ‘super long’ electrocardiogram. The electrical activity of your heart is recorded for 24 or 48 hours via electrodes stuck to your chest and connected to a portable recorder. This provides the cardiologist with a picture of your heart activity over a longer period. Based on the recording, the physician determines whether you have a cardiac arrhythmia. This is especially useful in patients who experience palpitations or syncope’s, as we need the registration of electrocardiogram during these symptoms, which often occur when the patient is at home and not at the cardiologist practice. Preparation You are advised to wear loose clothing and a belt when you come to the hospital for this procedure. Your torso is cleared of clothing, cleaned and possibly shaved locally. Electrodes are stuck onto your body and connected to the device, the Holter monitor, via wires. The Holter is strapped to a belt. Procedures During the test, you should be doing the activities that you would normally do. You should go to work, to school or do housework. You should exercise, as usual (except from swimming). The recorder must always remain connected , even at night. You need to keep a special diary in which you describe exactly what you did and when exactly. There also is a button you can press on the recorder in order to indicate that you are experiencing cardiac problems. If that happens, you must record those symptoms accurately in the diary. Recording with a Holter monitor is a risk-free and painless procedure Aftercare No specific aftercare. Once the test is finished, you can disconnect the recorder yourself. This is simple and it would be explained to you at the moment that you get the recorder. You will return the recorder to our practice. After analysis, the test results will be discussed with the cardiologist.

Twenty-four-hour ambulatory blood pressure monitoring is a way of measuring and managing high blood pressure (hypertension). Hypertension is a blood pressure measurement in which the systolic (upper) blood pressure is at or above 140 and the diastolic (lower) blood pressure is at or above 90. Ambulatory blood pressure monitoring allows many blood pressure (BP) readings to be recorded over a 24-hour period, whether the patient is awake or asleep. At a doctor’s office or clinic, an instrument called a sphygmomanometer is used to take BP readings. Usually, only one or two readings are taken during a doctor’s visit. However, ambulatory BP monitoring yields many readings over a continuous period. Preparation You will be asked to free your arm where de blood pressure cuff will be installed. Procedures The monitor is fitted for you at our practice and it looks like a normal blood pressure cuff that is attached to a small device which is worn on your belt for the next day. In most cases, with ambulatory BP monitors, readings are taken every 20 to 30 minutes during the day and every hour at night. The heart rate can also be measured at the same time. Multiple BP readings can be averaged over the 24-hour period to obtain the mean or average BP. Variations in BP and heart rate, the BP distribution pattern, and other statistics can be calculated. Aftercare No specific aftercare. Once the test is finished, you can disconnect the recorder yourself. This is simple and it would be explained to you at the moment that you get the recorder. You will return the recorder to our practice. After analysis, the test results will be discussed with the cardiologist.