Both Holter and event monitors are devices used to record the heart's electrical activity outside of your doctor's office. About the size of a pack of cards or smaller, these monitors are small enough to be worn comfortably on the body, and can usually be carried in a pocket or special monitor holder worn around your waist or over your shoulder. The monitors feature sensors that are placed on your chest with adhesive patches so the devices can pick up electrical signals from your heart. 

What are Prolonged Ambulatory Heart Mmonitoring patches?

Long-term, continuous cardiac monitoring patches provide the option of monitoring the heart rhythm for longer duration.  These devices are wireless and continuously monitor the heart rate with the option of recording an event if it occurs. By continuously recording beat-to-beat patient data for up to 14 days, these patches are cost-effective and efficient arrhythmia detection platform that uniquely provides true AFib burden.

Monitors are most frequently used to diagnose and manage arrhythmias, or abnormalities and irregularities in your heartbeat. They can also be used to monitor a condition called silent myocardial ischemia, a condition that occurs when too little oxygen-rich blood is being transported to the heart. Dr. Ahmed may also order a Holter or event monitor to evaluate a treatment plan and determine its effectiveness. Although they operate much like the ECG in the doctor's office, they offer the advantage of longer recording time and ability to record during physical activities.  Our Newcastle Heart Clinic also provides only long-term, continuous cardiac monitoring option for a minimum of 14 days which helps in the ealy detection of Atrial Fibrillation, True AF burden, Atrial Flutter, Supraventricular Tachycardia, Supravaentricular Ectopy(SVE/PAC), Ventrcular Tachcardia, Ventricular, Ectopy/Premature Ventricular Contarctions (VE/PVC), AV Blocks and Pauses.

The primary difference between Holter monitors and event monitors is that Holter monitors record your heart's activity the entire time you're wearing the monitor, while an event monitor only records activity during an event. Many monitors turn on automatically when an event is detected, while a few require you to turn the monitor on manually. One type of event monitor, called an implantable loop recorder, is implanted under your skin and records events automatically. Wireless monitors can send information directly to your doctor's office or monitor provider using cellular technology.  Prolonged ambulatory monitor provides the option of long-term, continuous ambulatory cardiac monitoring.  Dr. Ahmed will be able to recommend the type of monitor that's best for your needs and symptoms.

Prolonged Wireless Ambulatory Heart monitoring:

The Right Test,The First Time

Our goal is to reduce healthcare costs and improve arrhythmia detection, characterization and diagnosis by providing simple, seamless integration of heart rhythm data from client to cloud to clinician. iRhythm’s innovative digital healthcare technologies are improving doctors’ ability to detect arrhythmias, and have the potential to change the course of treatment. Our ZIO^® Service analyzes up to 20,000 minutes of heartbeat data per patient in order to give you the most efficient and cost-effective platform for evaluating patients with suspected arrhythmias.

Did you know that one-third of UK population have an irregular heartbeat, such as atrial fibrillation (AFib), and don't know they have it? Research has found that AFib increases risk of stroke by 5 times. Fortunately, treatments are available. To assess your risk for stroke, you'll need to find out if you have an arryhtmia. The ZIO® Service does just that.

We’re committed to helping you deliver high quality cardiovascular care – from planning ZIO^® Service implementation to professional support before, during and after the prescription period.

By continuously recording beat-to-beat patient data for up to 14 days, the ZIO Service is a cost-effective and efficient arrhythmia detection platform that uniquely provides true AFib burden.

The ZIO Service integrates a discreet patch that continuously monitors and records up to 20,000 minutes worth of patient heartbeats, with delivery of a concise, high quality report.

We are the only centre in the Northeast to provide this service

The ZIO Patch records continuously, and can detect:

The ZIO XT Patch is designed to facilitate patient compliance, and because it is a small, single-use device, it is used not only in cardiology services, but also in cardiology offices, primary care offices, and emergency rooms.

The ZIO Patch records continuously, and can detect:

• Atrial Fibrillation
• True AF burden
• Atrial Flutter
• Supraventricular Tachycardia
• Supravaentricular Ectopy(SVE/PAC)
• Ventrcular Tachcardia
• Ventricular Ectopy/Premature Ventricular Contarctions (VE/PVC)
• AV Blocks
• Pauses
• Silent Ischamia

Meet Dr Javed Ahmed

Dr Javed M Ahmed is a leading consultant Interventional cardiologist in Newcastle-upon-Tyne area providing skilled and compassionate care in all areas of cardiology. Dr. Ahmed provides care for heart problems in multiple areas, including angina pectoris, coronary hear disease, angioplasty and stenting, hypertension, lipid disorders, heart failure, cardiomyopathies, and arrhythmias etc.

Dr Javed Ahmed is now providing regular Cardiology Clinics at Newcastle Heart Cliniic, Newcastle upon Tyne. 

Dr Javed Ahmed has several years of experience in the field of Cardiology and has been a Consultant Cardiologist at Freeman Hospital NHS Trust, Newcastle upon Tyne since 2001.

Dr Javed Ahmed has considerable experience in the field of cardiology for several years and has developed expertise in all aspects of clinical and Interventional cardiology including:

• Coronary angiography
• Coronary angioplasty and Stenting
• Elective DC Cardioversion

Other special interests include:

• Angina Pectoris
• Hypertension
• Lipid management
• Heart Failure
• Cardiomyopathy
• Echocardiography
• Ambulatory Heart Monitoring
• Ambulatory Blood Pressure Monitoring
• Arrhythmias particularly Atrial Fibrillation

 Dr Javed Ahmed is a member of British Cardiac Society (BCS) and British Cardiovascular Interventional Society (BCIS). 

Dr Javed Ahmed did his advanced fellowship at the world renowned heart centre in Washington DC, USA. He has produced several publications in peer reviewed journals.  His research interests include Invasive Coronary Imaging and Re-stenosis after coronary stenting.

Dr Javed Ahmed provides a fully comprehensive private practice service in all types of cardiac problems at Newcastle Heart Clinic.

Please send all Cardiology referrals to Dr Javed Ahmed, Consultant Cardiologist at Newcastle Heart Clinic.

For consultations with Javed Ahmed please contact Newcastle Heart Clinic at:

Phone and Fax no: 0191 284 1355

Or write to

Newcastle Heart Clinic

18 Elmfield Road

Gosforth

Newcastle upon Tyne

NE3 4BP

Dr. Ahmed provides treatment for several types of heart-related diseases and conditions, including:

• Coronary artery disease (also called CAD), which occurs when the blood supply to the heart is diminished due to blocked or narrowed Coronary arteries.  Dr Ahmed has considerable expertise in Angioplasty and Stenting
• Cardiomyopathy, a disease that affects the heart muscle tissue
• Valve disease, which may involve leakage or other problems involving the function or structure of the heart valves
• Peripheral vascular disease (also called peripheral artery disease or PAD), which causes circulation to be restricted in the legs
• Carotid artery disease, which restricts blood flow to the brain and can result in stroke
• Rhythm diseases that affect the speed at which the heart beats

Meet Dr Stephen Murray

Dr Stephen Murray is Consultant Cardiologist with special interest in Heart Rhythm problems.  He has been working at the tertiary center, Freeman Hospital Newcastle upon Tyne for several years.

Dr Stephen Murray provides consultations for all types of general cardiology problems especially he has got excellent experience in dealing with cardiac arrhythmias including Atrial Fibrillation, Supraventricular tachycardia and Ventricular Tachycardia.

Dr Muray has got vast experience in performing ablation procedures for heart rhythm disorders.

Dr Stephen Murray is a Council member of the British Heart Rhythm Society, UK specialist body, and a member of the Royal College of Physicians (London) Educational Faculty.

Dr Stephen Murray in conjunction with Newcastle Heart Clinic will also be providing the following non-invasive investigations for patients with cardiology problems.  

• 12 Lead resting Electrocardiogram
• Full Transthoracic Echocardiogram
• Exercise Stress Test
• 24-48 Hours Holter Monitoring
• 24 Hour Blood Pressure Monitoring
• CT Coronary Angiography
• MRI-Heart

Other invasive cardiology treatments available are:

• Permanent Pacemaker Insertion
• All types of Heart Rhythm Ablation Procedures
• Elective DC Cardioversion

Please send all Cardiology referrals to Dr Stephen Murray at Newcastle Heart Clinic.

For consultation and treatment please contact Newcastle Heart Clinic at:

Phone and fax no: 0191 284 1355

or write to

Newcastle Heart Clinic

18 Elmfield Road

Gosforth

Newcastle upon Tyne

NE3 4BP

Dr. Murray provides treatment for several types of heart-related diseases and conditions, including:

• Heart Rhythm problems such as Atrial Fibrillation,
• Supraventricular tachycardia
• Ventricular Tachycardia 
• Heart Rhythm Ablation Procedures

• Cardiomyopathy, a disease that affects the heart muscle tissue Valve disease, which may involve leakage or other problems involving the function or structure of the heart valves
• General Cardiology problems

Coronary Angioplasty and Stenting are part of minimally invasive treatment of narrowing’s in the coronary arteries (Percutaeneous Coronary Interventions) using catheters, balloons and stents.

When it comes to matters of the heart, expertise matters most.  Newcastle Heart Clinic’s Cardiologists are excellence in coronary, Vascular and Electrophysiology procedures, pioneering and perfecting significant innovations over the years that have revolutionized the field of interventional cardiology.

Percutaneous Coronary Interventions

Percutaneous coronary interventions (PCIs) are minimally invasive procedures used to open blocked or narrowed coronary arteries. PCI procedures use catheters (thin, flexible tubes) to deliver various treatments to affected areas of coronary arteries. The catheter is generally inserted through a small incision in the arm or groin area and threaded to the area of the blockage. Common PCI procedures include:

• Stent Placement: Stents are thin mesh tubes generally made of metal or plastic that are often used to open up clogged or blocked arteries.

• Rotational Atherectomy: A procedure to clear blocked arteries using a catheter with a diamond burr attached to the tip that scrapes away the plaque (hardened fatty deposits) to restore blood flow.

• Excimer Laser Procedures: In excimer procedures, a laser catheter (thin, flexible tube) is used to “vaporize” arterial blockages.

• Coronary Thrombectomy: A procedure used to remove a thrombus (blood clot) from a coronary artery. It is particularly useful in patients experiencing acute myocardial infarctions (heart attacks).

Do I need PCI?

Clearly it is necessary to demonstrate the presence of narrowing’s in the coronary arteries before performing angioplasty. This is usually done via angiography. Angioplasty is at its most effective in treating unstable angina and treating patients having a heart attack.

What is involved and what are the risks?

You’ll have an angiogram before your angioplasty to look inside your arteries and check where the blockages are and how much they are blocked. An angiogram often happens as part of the same procedure

The risks of Angioplasty are broadly similar to those of Coronary Angiography, however, there are more specific risks associated with the Angioplasty procedure itself. These tend to be damage to the coronary artery wall, the provocation of a heart rhythm disturbance or damage to the artery such that the patient may require a bypass operation. This tends to occur in less than 1:200 patients treated.

Coronary Angioplasty and Stenting Procedure

An angioplasty normally takes between 30 minutes and two hours, although it can take longer depending on the complexity of the narrowings. Angioplasty procedure is performed either through the wrist or groin

1. At the start of the procedure you'll be given a local anaesthetic to numb the area. Then a catheter – a fine, flexible, hollow tube – with a small inflatable balloon at its tip is passed into an artery in either your groin or your arm.
2. A special shape tube (catheter) is passed up the femoral or radial artery and sited at the mouth of the coronary artery that is narrowed.
3. Through this tube, a very fine steel wire, 1/14,000 of an inch in diameter is navigated across the narrowing. When the steel wire tip is safely positioned at the far end of the artery, a tiny balloon is slid over the steel wire.
4. Once the coronary artery has been successfully treated, the catheter in the wrist or leg is removed and the hole closed by pressure devices or a plug.
5. Sometimes there might be a small amount of bleeding when catheters are taken out. A nurse or doctor will press on the area for a short period. 
6. In the first few hours afterwards you might get some chest discomfort. If this happens, tell the doctor or nurse.
7. After the procedure, you’ll need to stay in bed for a while. If there are no complications, you will be allowed home the same day or early next day

4. Dye (contrast) is injected into the catheter and the arteries can be seen on an x-ray screen. It's normal to feel a hot flushing sensation when the dye is injected.
5. The operator then directs the catheter up to the heart and into a coronary artery until its tip reaches a narrow or blocked section. When this balloon is in the position of the narrowing artery, it is gently inflated to high pressure using a special hydraulic inflation device. The pressure delivered to the balloon is transmitted to the arterial wall. The pressure cracks and stretches the plaque of cholesterol.  This results in widening of the artery and allowing the blood to flow more easily.  The catheter is then removed.
6. Then, STENT - a small tube of stainless steel mesh - already mounted on the balloon is placed at the site of narrowing and once in correct position, the stent balloon is inflated and  the stent expands so that it holds open the narrowed artery. The balloon is let down and removed, leaving the stent in place.
7. Some people may feel a palpitation, and you might feel some angina. If you feel unwell, or have pain at any time during the procedure, tell the team.

Most people can go home the same day or the next day, but if you’ve had an emergency angioplasty particularly after you had a heart attack it’s likely you’ll need to stay in hospital for longer.

When you get home, check the area where the catheter was inserted.  There is a possibility that you may develop some mild bruising and tenderness, but if you get any significant redness or swelling, or if the bruising worsens, contact your doctor.

Before you leave hospital, someone will have a chat with you about your recovery and what you can and can’t do. It’s normal to feel tired afterwards but most people find that they’re back to normal after a few days. However if you’ve also had Angioplasty after a heart attack it will take longer to recover.

• It’s best to avoid doing any demanding activities, such as heavy lifting, for a week or so.
• You shouldn’t drive for at least a week after having angioplasty – longer (6 weeks) if you also had a heart attack.
• If you’ve had a planned angioplasty with no complications you may be able to return to work within a few days, depending on the type of work you do.
• If you’ve had an emergency angioplasty or a heart attack you may need to take a few weeks off.

You should also be invited to go on a cardiac rehabilitation programm a course of exercise and information sessions that help you to recover as quickly as possible.

If you have a stent, you’ll need to take certain anti-platelet drugs (such as aspirin or clopidegrel, Prasugrel or Ticagrolor) to help reduce the risk of blood clots forming in and around the stent.

Stents are not affected by security systems at airports or MRI scans.

If you get chest pain, stop and rest and take your GTN as prescribed. If the pain doesn't ease, call 999 immediately. You could be having a heart attack.

In most cases the blood flow through the artery is improved after angioplasty. Many people find that their symptoms get better and they’re able to do more activities.

Sometimes the artery can become narrowed again, causing angina to return. But advances in stent technology mean that the risk of this happening is getting lower. Many people are now symptom-free for a longer period of time.

A small number of people have complications. The risk varies depending on your overall health and your individual heart condition. Have a chat with your doctor about the benefits and possible risks of having an angioplasty and any concerns you may have.

Dr Javed Ahmed has considerable expertise in coronary stenting and performs all his Angioplasty procedures at the Freeman Hospital, Newcastle-upon-Tyne.  Dr Ahmed provides Angioplasty and Stenting treatment to both insured and self-pay patients

What are the risk factors for heart disease?

Managing risk factors is one of the most important things you can do to keep your heart healthy. During your cardiology consultation, Dr. Ahmed will perform an evaluation to help identify risk factors that could make you more prone to heart disease, including:

• older age
• obesity
• diabetes
• high blood pressure
• high cholesterol levels
• smoking
• sedentary lifestyle
• family history of heart disease

Although not every risk factor is modifiable (for instance, age and family history), Dr. Ahmed will work with you to develop a plan for managing those factors that can be modified to help you stay as healthy as possible.

Echocardiography is a type of ultrasound test which is used to measure the structure and function of the heart walls and valves. During the test, sound waves are emitted through your skin using a handheld device called a transducer. These waves bounce off your heart and return signals to a computer, which uses those signals to create images that show the heart and the blood flow through your heart and the vessels around it. Echocardiography plays an important role in the diagnosis and management of many different types of heart disease.

The test is a simple outpatient procedure that can be completed in about 20-30 minutes. Before the test begins, several electrodes will be adhered to your chest and shoulders to monitor your heart function. You'll be asked to lie down on your left side and a clear gel will be applied to your skin to enable the transducer to move smoothly across the area to be evaluated. During the test, the transducer will be moved across your skin with firm pressure to ensure the sound waves penetrate properly so the images are clear. You may also be asked to change position or hold your breath during the test so the transducer can get better “pictures” of your heart and the surrounding area. Once the test is complete, Dr. Daneshrad will look at the pictures and video and discuss the results with you.

Generally, no; however, at some points during the test, the transducer may be pressed firmly into your skin to get specific images, causing some mild and temporary discomfort.

Yes, echocardiography is not invasive and it doesn't require sedatives. You'll be able to drive home and resume your normal activities right after your test.

A stress test is a type of test used to determine how the heart responds to exertion, or stress caused by exercise. Stress tests can be used to help diagnose a problem with the heart's structure or function, to evaluate blood flow to the heart and to determine the effectiveness of treatment.

Most stress tests are performed using a treadmill. In this test, your heart is evaluated using an electrocardiogram while you're walking on a treadmill, usually at increasing speeds. The electrocardiogram can tell if your heart is receiving enough blood during physical activity (i.e. when the heart being stressed).

There are no specific instructions but generally, you'll need to:

• Avoid caffeine for 12 hours before the test.
• Do not eat or drink for four hours before the test (except for water).
• Bring your inhaler to the appointment if you have asthma or other breathing-related problem.
• Ask Dr. Ahmed if you can still take your regular medications prior to the test.
• Wear comfortable shoes and loose clothing that's comfortable to walk in.
• If you have diabetes, be sure to follow instructions about taking your medication and eating.

• CT stands for computed tomography, a type of imaging test that provides 3-D images of your organs, blood vessels and other tissues.
• A CT coronary angiogram uses CT technology to look inside the arteries that supply blood to your heart.
• Unlike traditional angiograms that use a catheter inserted into your arteries, a CT scan is completely noninvasive, which means the doctor can see inside your arteries without any incisions.

• CT scans use a powerful x-ray machine to produce images of the inside of your body.

• During a CT coronary angiogram, you'll lie on a special platform that will move you through the CT scanner.

• As you move, the x-ray device will rotate rapidly around you, creating a series of 3-D images that provide the doctor with an in-depth, detailed look at your coronary arteries.

• During portions of the scan, you may be asked to hold your breath so the scanner can gain more detailed images. Most scans take about 10 minutes to complete.

Calcium scoring is a recently developed technique for identifying calcified plaque in the coronary arteries. Plaque buildup is the primary cause of arterial blockage that slows the flow of blood to your heart. It's also a primary cause of chest pain, or angina, and heart attack. In calcium scoring, a CT angiogram is performed to evaluate the presence and location of plaque in your coronary arteries. Those findings are interpreted as a calcium “score” that can determine the presence of coronary artery disease (CAD) as well as your risk of heart attack or other complications. Scores range from 0 (no evidence of CAD) to 400 (extensive evidence of CAD). Calcium scores can also be helpful to determine if a specific treatment is working as it should.

Newcastle Heart Clinic would be able to arrange Cardiac Magnetic Resonance Imaging Scan (MRI) should you require one:

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

What is a Cardiac MRI?

A cardiac MRI scan is a non-invasive test that physicians use to diagnose and treat medical conditions. Detailed MR images allow physicians to evaluate various parts of the body and determine the presence of certain diseases. The images can then be examined on a computer monitor, transmitted electronically, printed or copied to a CD.

Cardiac MRI uses magnetic and radio waves to create clear pictures showing the inside of your heart and blood vessels. Unlike a CT scan, an MRI does not use radiation. It is considered a safer alternative for pregnant women. If possible, it is best to wait until after the first trimester

Uses of Cardiac MRI

A cardiac MRI scan is a non-invasive test used to view your heart’s structure (the muscle, chambers and valves of the heart) and to assess how well it’s pumping. A cardiac MRI is useful for checking structural problems with your heart, such as:

• Diagnosis of coronary heart disease
• Assessment of healthy heart muscle if you have heart failure
• Diagnosis of congenital heart disease
• Evaluation of the effects of surgical changes, especially in patients with congenital heart disease.
• Assessment of your heart valves
• Estimate the damage to your heart after a heart attack
• Evaluating the effects of coronary artery disease such as limited blood flow to the heart muscle and scarring within the heart muscle after a heart attack.

• Asessment of reduced blood flow to the heart muscle that may cause chest pain (angina)
• Asessment of large blood vessels such as Aorta

How Cardiac MRI is performed

• You 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, better still, earphones so you can listen to music and relax
• As it’s important to stay still during the scan, babies and young children are often given a general anaesthetic before an MRI scan.
• 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.

The test is pain free, but 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.

After the Cardiac MRI scan?

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 not be allowed 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 a lot of water for the following 24 hours to help flush the dye out of your body.

It’s unlikely that the results of your scan will be available immediately. Usually the doctor who arranged the scan will discuss the results with you a couple of weeks after the scan.

Is Cardiac MRI suitable for every one?

You may not be able to have an MRI scan if you have:

• Artificial heart valves
• implanted drug infusion ports
• Artificial limbs or metallic joint prostheses
• implanted nerve stimulators
• metal pins, screws, plates, stents or surgical staples
• A pacemaker
• A implantable cardiac defibrillator (ICD)
• A 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 deactivate the pacemaker or defibrillator and 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 the scan to check your kidney function, and explain the risks and benefits to you. You may need some fluids through a ‘drip’ in your arm before the MRI scan if you have kidney problems.

Limitations of Cardiac MRI

High-quality images are assured only if you are able to remain perfectly still and follow breath-holding instructions while the images are being recorded. If you are anxious, confused or in severe pain, you may find it difficult to lie still during imaging.

A person who is very large may not fit into the opening of certain types of MRI machines.

Risks of Cardiac MRI Scan

There are no risks for an MRI and few, if any, side effects.

The test does not use radiation, and to date, there have been no documented side effects from the radio and magnetic waves it uses. Allergic reactions to the dye are rare.

If you have a pacemaker or any sort of metal implant from previous surgeries or injuries, you may not be able to receive an MRI because it uses magnets. Be sure to tell your doctor about any implants you have before the test.

If you are claustrophobic or have a hard time in enclosed spaces, you may feel uncomfortable in the MRI machine. Try to remember that there is nothing to fear. Talk to your doctor about your concerns before the test. They may prescribe an anti-anxiety medication to help with your discomfort.

• artificial heart valves
• clips
• implants
• pins
• plates
• screws
• staples
• stents

Your doctor may need to use a special dye to highlight your heart. This dye, called gadolinium, is administered through an IV. It’s different from the dye used during a CT scan.

Allergic reactions to the dye are rare. However, you should let your doctor know before the IV is given if you have any concerns or a history of allergic reactions in the past.

Ambulatory Blood Pressure Monitoring (ABPM) involves recording of your blood pressure as you move around and living your normal daily life. It is normally performed over a period of 24 hours.  It uses a small digital blood pressure machine that is attached to a belt around your body and which is connected to a cuff around your upper arm.  The monitor is small enough to carry while you can go about your normal daily life and even sleep with it on.

Why might I need a 24-hour monitor?

By measuring your blood pressure at regular intervals over 24 hours, your doctor is able to get clear pictures of how your blood pressure changes throughout the day. There are a number of reasons why your doctor might suggest this test:

• They may want to find out if your high blood pressure readings in the clinic are much higher than they are away from the clinic (called the “white coat effect”).
• They may want to see how well your medicines are working, to make sure they are controlling your blood pressure through the day.
• They may want to see if your blood pressure stays high at night. If this is the case, they may need to change or adjust your medicines.

What happens during 24-hour blood pressure monitoring?

A 24-hour blood pressure measurement is just the same as a normal blood pressure check: a digital machine takes your blood pressure by inflating a cuff around your upper arm and then slowly releasing the pressure. The machine is small enough to be worn on a belt on your waist while the cuff stays on your upper arm for the full 24 hours.

The machine then takes blood pressure readings at regular intervals throughout the day: usually, every 15-30 minutes during the daytime and 30-60 minutes at night. You will need to keep the monitor on through the night – you could put the machine under the pillow or on the bed while you sleep.

Because the test is being carried out to find out what your normal daily blood pressure is, it is important to carry on with your normal routine activities and do all the things you would normally do. The only things you should avoid doing for the day are swimming and having a bath or shower.

At the end of the 24 hours you can remove the machine and cuff and give it back to the clinic. The machine will have stored all your readings and these will then be analysed on a computer.

What do I need to do during 24-hour blood pressure monitoring?

To allow the machine to work properly, it is important to make sure that the tube to the machine is not twisted or bent. Also, just before the machine is about to take a reading, it will beep. When this happens you should:

• Relax and sit down and, if possible 
• keep the cuff at the same level as your heart
• keep your arm steady.

You will also be asked to keep a diary of what you were doing just before the reading was taken, what time you went bed and got up and if and when you took medications. Some people find 24-hour ABPM distracting and uncomfortable: if you feel like this when the readings are being taken, speak to us doctor as it may affect your reading.

The term “white coat” comes from references to the white coats traditionally worn by doctors.  The white coat effect means that your blood pressure is higher when it is taken in a medical setting than it is when taken at home.  On average, when your blood pressure is taken at home the top (systolic) number can be around 10mmHg lower than it would be if taken by a doctor and 5mmHg lower on the bottom (diastolic) number.  For some people this difference can be even greater.

What causes the white coat effect?

Your blood pressure is not fixed – it rises and falls throughout the day in response to what you are doing and what is happening around you.  White coat effects will often happen because you are nervous about having your blood pressure tested by a doctor or nurse.  Most of us tend to feel more tense in medical settings than we do in surroundings that are familiar to us, although we do not always notice it.

The white coat effect can influence some peoples’ blood pressure more than others.  If you are very anxious your systolic blood pressure can rise by as much as 30mmHg.  This can make it more difficult for your doctor to get an accurate measurement of your blood pressure.

What is white coat hypertension?

The term white coat hypertension may be used if you have high blood pressure readings (i.e. readings that are consistently 140/90mmHg or above) only when you are in a medical setting.  Your blood pressure readings may be normal when they are taken at home.

Sometimes it can be difficult to establish whether you actually have high blood pressure, or are just experiencing white coat hypertension.

How will I know if my blood pressure is affected?

Anyone can be affected by the white coat effect, but white coat hypertension is less common.  You may be nervous or anxious about having your blood pressure taken without you or your doctor realising it.  The only way to be sure is to compare readings taken in the clinic with readings that are taken at home.  There are two ways of doing this.

• Measuring your blood pressure at home – You could measure your blood pressure at home.  Measuring your own blood pressure regularly can be helpful as it allows your doctor or nurse to see what your readings are like outside of the clinic.  Keeping a personal record of your blood pressure can help to show what your blood pressure is like from day to day

• 24-hour blood pressure monitoring – This kind of blood pressure monitoring can show in more detail how your blood pressure changes throughout the day.  You will be given a small digital monitor to wear which measures your blood pressure regularly and automatically over a day and night.  Your readings are stored in its memory so you don’t need to do anything apart from keeping the monitor on.  Some GP surgeries can provide 24-hour monitors; alternatively you may have to go to your local hospital outpatients department to have one fitted.

What can I do about white coat hypertension?

If you are experiencing white coat effects when having your blood pressure measured, it is important to try and manage your anxiety if you can.  This might just mean resting for a while before having your blood pressure measured.  If you have had to rush to your appointment or are feeling nervous, taking a moment to relax and calm down can help to bring your blood pressure back down to normal.

Sometimes it may not be possible to overcome the white coat effect. In this case your doctor will discuss options with you.  To gain a clearer picture of your blood pressure your doctor may ask to see home blood pressure readings or decide to monitor you more closely for a period of time.

I have been diagnosed with high blood pressure, but could it be white coat hypertension?

Your doctor or nurse will be aware of white coat hypertension and will take it into consideration before making any diagnosis about your blood pressure.

People with white coat hypertension can go on to develop high blood pressure.  For this reason it is important to have your blood pressure checked regularly (perhaps every 6-12 months with a medical professional).  This will allow you to take appropriate steps to lower your blood pressure, should it start to rise.

If you have any queries or concerns about the white coat effect or white coat hypertension, speak with your doctor or nurse.

 
A blood test is a quick and simple way to measure the amount of certain proteins, minerals, fats and sugars in your blood. By looking at the levels of these in your blood, your doctor can find out how well your body is working and whether or not you have certain conditions or health problems.

When you are first diagnosed with high blood pressure, your doctor or nurse may carry out one or more blood tests to help them plan the best treatment for you. This will show them:

• if you have a raised cholesterol level
• if you have another medical problem, such as a kidney condition or diabetes
• whether or not you have a problem with your adrenal glands or kidneys
• which medicines might work best for you.

How is a blood test carried out?

Blood tests are very common and taking blood is a simple procedure. It can usually be carried out at your local surgery by your doctor or nurse.

If your doctor or nurse only needs to know your blood sugar levels (for example when looking for diabetes), then just a small prick on the tip of a finger is needed to release a few drops of blood.

However, most tests normally require a test tube of blood, which will need to be collected by a syringe. If needles make you feel uncomfortable, speak to your doctor or nurse. They will be able to help.

Since no anaesthetics or special procedures are needed, you will be able to leave the surgery straightaway and carry on with your day as normal. If you feel faint while the blood is being taken, you may be asked to rest for a while afterwards.

Do I need to do anything before the test?

Depending on what your doctor or nurse is testing for, you might be asked to avoid eating anything for a period before the test. For example, if they want to look at your blood sugar levels, they may ask you to come in first thing in the morning, before having breakfast.

How soon will I know the results?

Your blood sample will need to be sent to a laboratory for testing, and the results will then be analysed by your doctor. This can take up to a few weeks.

An echocardiogram is a scan which gives a detailed view of the structures of your heart, and which can show how well your heart is working. The scan uses a probe that sends out sound waves, which are reflected back by the muscles and tissues in your heart. These reflected waves are picked up by the probe and translated into images on a screen.

Echocardiograms can show if your heart is working as well as it should. They are particularly useful for revealing if you have an enlarged left side of the heart, or problems with your heart valves. They can also be used to investigate the causes and effects of heart murmurs and heart attacks.

How is an echocardiogram carried out?

An echocardiogram is a painless test that takes roughly 30-45 minutes. It can be carried out in one of two ways.

If your doctor is looking for an enlarged heart muscle or heart valve problems, the probe is normally placed on your chest. Lubricating jelly will be put on your chest and a small probe will be moved around on your chest. Moving the probe around will give different views of your heart.

If your doctor is looking for more detailed information about how your heart is working, a small probe will be passed down your throat so that it lies behind your heart. This means that your doctor will have a much clearer view, as your heart and ribcage will not be in the way. You will receive a sedative and/or local anaesthetic for this procedure, but it should not require an overnight stay in hospital.

What do I need to to before an echocardiogram?

If the probe is going to be placed on your chest, you do not need to do anything beforehand.

If the probe is going to be passed down your throat, you will be asked not to eat anything for a few hours before the test because you will be given a sedative. Also, you will be asked not to drive for 24 hours after the test because you may still be slightly sleepy.

For both tests you should continue to take your blood pressure medicines and any other medicines as normal.

Vascular ultrasound is a type if diagnostic imaging test that uses sound waves to look inside your blood vessels without “going inside” your body. Instead, it uses a handheld device called a transducer to send the waves painlessly through your skin to obtain images of your vessels and to evaluate the way your blood is flowing through your vessels.

Vascular ultrasound is primarily used to look for signs of narrowing or clots that might be interfering with the flow of blood to your extremities or organs. It can also be used to monitor certain treatments.

During a vascular ultrasound, you'll be asked to lie down on an exam table in a darkened room so the images made during the exam can be seen more clearly. A special gel will be placed on your skin over the area to be evaluated. The gel helps the transducer move smoothly over your skin and enables the sound waves to penetrate more easily. If your legs are being evaluated, you may also be asked to walk on a treadmill so the test can evaluate how blood flow occurs during exercise. During a cerebrovascular exam of the vessels that supply blood to your brain, you may be asked to sit up during the exam while the transducer is used to obtain images of the vessels in your neck.

Most tests take about an hour to perform.

Yes, ultrasound has been shown to be one of the safest forms of diagnostic imaging. No radiation is used and the test is completely noninvasive.

Yes, vascular ultrasound is completely noninvasive and uses no sedation, so you can drive yourself home after your test is complete.

PREVENTION AND SCREENING OF HEART DISEASE

One of the most important services offered is a cardiac evaluation and consultation. During the appointment, Our cardiologists will evaluate your risks for heart disease and discuss the important steps you can take to decrease those risks. Even if you aren't exhibiting noticeable symptoms of heart disease, having an evaluation can help identify “silent” or hard-to-spot risks like high blood pressure and high cholesterol that could be placing you at high risk even without causing noticeable symptoms.

The most common risk factors include:

• older age
• male gender
• obesity or being overweight
• diabetes
• smoking
• high blood pressure
• high cholesterol levels
• sedentary lifestyle
• family history of heart disease

Some risk factors can be lessened with lifestyle changes, such as quitting smoking, exercising or eating a healthy diet; others may require medication. And of course, some risk factors like age and gender cannot be changed.

That depends in part on your risk factors and any signs or symptoms you might currently be experiencing. Some people can manage their risks with simple lifestyle changes while others may also need medication. Here are few of the most important ways to prevent heart disease:

• Follow a low-fat, high-fiber diet.
• Stop smoking and avoid secondhand smoke.
• Control your alcohol consumption, limiting it to one to two drinks per day.
• Take blood pressure medicine to control hypertension when necessary.
• Lose weight if you're overweight or obese.
• Become more active, exercising at least 30 minutes three times a week.
• If you're diabetic, make sure to keep your blood sugar levels under control.
• Lower cholesterol with medication when needed.
• See a cardiologist for regular assessments and evaluations to determine if your needs or risks change over time.

What symptoms can heart disease cause?

Heart disease can present with multiple symptoms, including:

• shortness of breath or difficulty breathing
• chest, neck or arm pain or pressure
• lightheadedness or dizziness
• heart palpitations or pounding
• chronic fatigue
• pain, cramping or swelling in the legs or feet
• weakness on one side of the body or face

If you experience any of these symptoms, you should seek medical care right away and contact us at Newcastle Heart Clinic.