Non-Invasive Cardiac Lab at Fortis Hospital, Bannerghatta Road
It is located at the cardiology department on the 3rd floor of the main building and offers a wide range of non-invasive cardiac testing. The diagnostics is broadly divided into 2 sections
Non Imaging
- ELECTROCARDIOGRAM (ROUTINE ECG)
- TREADMILL TEST (TMT)
- HOLTER MONITORING (AMBULATORY ECG)
- HEAD UP TILT TABLE TEST (HUTT)
- AMBULATORY BLOOD PRESSURE MONITORING (ABPM)
- 6 MINUTE WALK TEST
Imaging
- ECHOCARDIOGRAM (ECHO)
- DOBUTAMINE STRESS ECHO (DSE)
- TRANS-ESOPHAGEAL ECHO (TEE)
- PEDIATRIC ECHO
- CONGENITAL HEART DISEASE ECHO
- FOETAL ECHO
- CAROTID INTIMA-MEDIA THICKNESS (CIMT)
Advanced echo techniques available (3D Echo, Strain Echo, Tissue Doppler Imaging & Contrast Echo)
Supported by Radiology at ground floor
Non Imaging section
ELECTROCARDIOGRAM (ROUTINE ECG) is the most widely used, simplest and fastest test when investigating or screening for heart diseases.
- The ECG measures electrical activity of the heart through electrodes, which are placed on specific parts of the body (chest, arms, and legs).
- The electrical activity of the heart is recorded on paper as a graphical trace
- Any change from the normal pattern (or fresh changes when compared to earlier ECG’s) may indicate one or more heart-related conditions.
TREADMILL TEST (TMT OR EXERCISE ECG OR STRESS ECG) is performed to assess the heart’s blood circulation at rest and its response to stress or exercise.
- An ECG is connected to the chest and monitored while the person exercises on a treadmill in a controlled environment.
- It is done as per a defined protocol where ECG monitoring, heart rate, blood pressure & symptoms are recorded & documented by trained staff.
- Results are not just used for diagnosing heart blockages, but they are also a reflection of a person’s overall general physical condition:
- To assess patient’s stress/exercise tolerance
- To determine how much exercise is safe if one is starting a cardiac rehabilitation program or recovering from a heart attack or heart surgery
- To assess heart rhythm during exercise.
HOLTER MONITORING (AMBULATORY ECG) is a portable device used to continuously monitor the heart’s electrical activity for at least 24 hours (a 48 hours device is also available)
- An ECG is connected to the chest from a small wearable device strapped around the waist. The device records the ECG signals continuously which is later analysed on a computer.
- It can be worn during regular daily activities, helping the doctor correlate symptoms of dizziness, palpitations (a sense of fast, slow or irregular heart rhythm) or blackouts.
- If one is using a Holter monitor, there is no need to limit the daily activities since its very purpose is to record how the heart works under various conditions over an extended period.
HEAD UP TILT TABLE TEST (HUTT) is used to evaluate someone with suspected or unknown cause of fainting or dizziness
- The procedure attempts to provoke symptoms in a controlled environment by creating changes in posture from laying to standing.
- During the test, patient is required to lay flat in a quiet room on a special bed with safety belts and a footrest, while being connected to an ECG and blood pressure monitor. The bed is then gradually elevated to a vertical angle of 60 to 80 degrees, simulating a standing position.
- Blood pressure, symptoms and ECG are recorded during the test to evaluate changes that correspond to the changes in position.
AMBULATORY BLOOD PRESSURE MONITORING (ABPM) is a portable device that is used to monitor and record variations in blood pressure during routine activities.
- It is a small, wearable device that automatically records blood pressure levels at pre-determined periods during daily activities which is later analysed on a computer.
- Normally worn for 24 hours or more.
- It allows the person to follow routine activities and can even be worn while asleep.
- It is also used for a more accurate measure of checking average blood pressure.
6 MINUTE WALK TEST is a submaximal exercise test that measures the distance walked in 6 minutes. It is usually done in heart failure, coronary artery disease and pulmonary hypertension patients.
- It is a reflection of the cardio-pulmonary and skeletal systems functions in response to exercise.
- It is simple, easy, standardized and can be done even on frail or elderly patients with an objective to walk as far as possible in 6 minutes in a controlled environment with monitoring of various parameters.
- It provides information on functional capacity, response to therapy and prognosis of the patient
Imaging section
ECHOCARDIOGRAM (ROUTINE ECHO) is an ultrasound based & the second most widely used test in cardiology.
- With the help of sound waves, grey scale and coloured images of the moving heart & blood flow are created that provides information about the pumping action, size of heart chambers, valve function, blood flow, pressures within the heart, etc.
- It is widely available, harmless, economical, can be done bedside and can be repeated any number of times
- It is done as per standard protocol in a darkened room where images are analysed by trained staff. Advanced echo techniques can be combined with conventional techniques if additional information is needed
- An echocardiogram may be performed for the following reasons:
- To assess the overall function and general structure of the heart
- To detect various abnormalities of the heart like, cardiomyopathies, birth defects, heart failure, valve disease, aneurysms, fluid around the heart, etc.
DOBUTAMINE STRESS ECHO (DSE) is a special procedure that is done to assess blood circulation to the heart muscle when stress is applied.
- It is usually indicated if medical conditions prevent exercise on a treadmill.
- Dobutamine is an intravenously given medication that causes the heart to beat faster, mimicking the effects of exercise on heart.
- Echo, blood pressure, ECG and symptoms are closely monitored and recorded as the drug is increased in a graded manner. It is done as per standard protocol by trained staff in a controlled environment. Advanced echo techniques are available to complement existing conventional stress echo techniques.
- There are several reasons for conducting this test:
- To assess for any blockages to the circulation supplying the heart muscle
- To assess the degree of known heart valve disease
- To evaluate cardiac status before a major surgery
TRANS-ESOPHAGEAL ECHO (TEE) is a special procedure to assess the heart structure and function by imaging from behind the heart.
- It is a semi-invasive procedure and done only in certain scenarios by trained personnel in a controlled environment
- It is performed by inserting a special ultrasound probe down the oesophagus (food pipe) where a clear image of the heart is obtained since the probe is just few millimetres from the heart (unlike routine echo done from the chest wall, where images may not be clear or cannot provide complete information)
- While TEE is being done, blood pressure, ECG and other vital signs are closely monitored during the test. Advanced echo techniques are now available to supplement existing routine TEE techniques
- A TEE may be recommended to better visualize:
- Valve disorders, masses inside the heart, dissection of the lining of the aorta, congenital heart diseases, etc
- To guide and monitor complex cardiac treatment procedures
PEDIATRIC ECHO is to detect birth defects of the heart in children & infants
- It is a safe test, painless with no risk to the child & is performed by trained personnel
- Usually the first line of investigation, its widely used when congenital heart defects are suspected in a child, like a hole in the heart, etc
- Most cardiac interventions in children are done with guidance of echo and it is also useful as a follow-up test to monitor the defects as the child grows
CONGENITAL HEART DISEASE ECHO is similar to pediatric echo, but can also be termed as that which is done in older age individuals to diagnose birth defects of the heart
- Echo is done in an elaborate way, slightly different from the routine approach.
- Defects can involve the heart, as well as the blood vessels close to the heart
- It can be used, both as a diagnostic and monitoring test and also to guide treatment
FOETAL ECHO is an ultrasound test of the unborn baby’s heart
- It is usually done in the second trimester of pregnancy, between the weeks of 18-24 to look for heart defects
- The scan by itself is harmless to the baby or the mother and is done from across the mother’s abdomen
- It is recommended only when there is a suspicion or a high risk of the foetus having a heart defect
CAROTID INTIMA-MEDIA THICKNESS is the ultrasound measurement of the walls of the large arteries called carotid arteries, seen on either side of the neck
- The carotid artery supplies blood to the neck and head where the intima-media are the two innermost layers of this arterial wall
- It is a very simple and quick procedure, which involves measuring the thickness of this layer
- An increased thickening of this inner layer hints to a high possibility of presence of atherosclerotic changes in the heart arteries
CARDIAC CT SCAN is a special X-ray based computerized scan to evaluate the heart & usually done to either confirm findings from another test or chosen as an alternate test to another imaging modality
- Safe amount of radiation along with a dye and special camera is used to create images of the heart and blood vessels to detect abnormalities
- Since it is a radiation based test, it cannot be done frequently, unlike an ultrasound based echocardiography which can be done any number of times
- CT coronary angiogram is another variation of the same CT scan to look at the blood vessels supplying the heart, when heart blockages are suspected
- This test is limited by its specialized nature and infrastructure that is required
CARDIAC MRI is a test that uses a magnetic field, radio waves and a computer to image the heart. It provides for excellent images, but is prohibitive in terms of cost
- It is used to detect and monitor heart diseases which can either be a birth defect or acquired after birth.
- It is usually chosen as a second line test when a confirmatory diagnosis is needed or a complex intervention is being considered
- This test is again limited by to its specialized nature and infrastructure that is required
