No, a coronary artery calcium scan is not a blanket recommendation for all patients undergoing a cardiac risk assessment. For people with high or very low risk of heart disease, or those with symptoms, other investigations or management strategies may be more appropriate. A CAC score is most useful for patients who are asymptomatic and at intermediate risk of heart disease. Calcium scoring is also not currently rebateable under Medicare and generally is associated with an out-of-pocket cost.
Yes, a cardiac risk assessment is most valuable before you notice symptoms as its purpose is to prevent you from developing heart disease at all. The general recommendations for a routine heart health risk check is to have one if you are aged between 45-79 years old, or between 35-79 years old if you live with diabetes. If you identify as a First Nations person, we recommend getting your first cardiac risk assessment from the age of 30.
We’re pleased to be able to offer most cardiac diagnostic tests in-clinic at Harbourside Cardiology. The main exception is CT imaging, for which we refer to a leading radiology provider. As we have a cardiology subspecialist (Dr Adam Berger) on the team, these imaging results can be interpreted in-house to streamline your care.
Stress echocardiography attracts a Medicare rebate for eligible patients, which will reduce your final out-of-pocket fees. The anticipated cost of your stress echocardiogram will be quoted prior to your initial consultation. Please ensure you have a valid doctor’s referral to apply the Medicare rebate.
Echocardiography has a wide application as a diagnostic imaging technique. Cardiac conditions that can be diagnosed with echocardiography include blood clots, congenital heart disease, cardiomyopathy, infections, pericarditis, and heart valve disease.
The echocardiography procedure itself is completely safe; ultrasound imaging uses soundwaves rather than radiation, and a stress echocardiogram is non-invasive and taken externally. Any risks during stress echocardiography comes from exertion during the exercise stress test, which may cause chest pain, arrhythmia, or dizziness. Your wellbeing will be monitored closely by your cardiologist during the test. Certain heart conditions are a contraindication to having a stress test, and it will only be recommended for you if safe and clinically necessary.
In Australia, transthoracic echocardiography may be performed by a cardiac sonographer or cardiologist. More complex procedures such as a transoesophageal echocardiogram is performed by a cardiac imaging subspecialist. In all cases, interpretation of your results is undertaken either by a cardiologist or specially trained radiographer.
No, it is not possible to get an electric shock during an ECG; electrocardiography is a safe and painless test. However, you may experience some minor skin irritation to the adhesive on the electrodes if you have sensitive skin.
Your cardiologist will want you to go about your normal day while wearing the Holter monitor, as this provides real-world information about how your heart’s activity responds to typical activities. The only exception is to avoid swimming, bathing, or using a sauna while wearing the monitor.
Measuring your BP at home using a commercially available device can provide additional readings at different times of the day compared to once-off in a doctor’s office. However, these measurements are typically taken only a few times a day when you are in a resting state and are not representative of your BP during different activities. Conversely, ABP monitoring automatically measures your BP at frequent intervals (every 20-30 minutes throughout the day and hourly overnight), giving a more detailed and accurate picture of how your BP changes over the course of 24 hours.
Your GP is likely to be your first port of call when investigating POTS. If your GP is familiar with POTS, they may organise initial testing to exclude other conditions that mimic POTS. Alternatively, they can refer you immediately to a POTS cardiologist in Sydney or other POTS specialist in Australia, who can conduct all the necessary investigations and provide a diagnosis. Other clinicians that may be involved in supporting people with POTS include neurologists and paediatricians.
The active stand test is generally the first-line test used when investigating POTS. This test is widely accessible with a cardiologist and does not require special equipment beyond what is normally found in a cardiology clinic. The tilt table test may be preferred over the active stand test in some cases, such as if there is a high risk of fainting or if the active stand test has yielded inconclusive results.
It is possible to screen for POTS yourself at home using the active stand test with a blood pressure monitor. However, incorrect technique and user error with the monitor may influence your results, and you will still need specialist input to confirm a POTS diagnosis and exclude other conditions.
An ICA is generally considered to be safe, though it does come with a low risk of complications due to its invasive nature and catheterisation of the coronary artery. Possible complications include pain or bruising at the site the catheter is inserted or allergy to the contrast dye. Serious complications occur in less than 2% of procedures, and may include heart attack or stroke.
Both CTCA and ICA have their advantages and disadvantages, and neither is inherently better than the other. CTCA is less invasive, comes with fewer complications, and may be the most appropriate for patients with low- to intermediate-risk of coronary artery disease. However, in higher risk patients or those who are expected to also need intervention to treat an artery blockage, an invasive coronary angiogram may be more suitable.
A coronary calcium score gives your cardiologist information about the degree of calcified plaque in your coronary arteries, which relates to your future heart disease risk. You may consider getting a coronary artery calcium scan if you have risk factors for heart disease such as hypertension, diabetes, high cholesterol, or a family history of premature heart disease. A coronary calcium score can be helpful in identifying whether preventative treatment will be beneficial for you or if it is safe to simply monitor.
PCI is not considered to be a high-risk procedure, but does come with a degree of risk. The most common of these are minor bleeding or bruising at the insertion site of the catheter; some individuals may experience a reaction to the contrast dye used during the procedure. Less commonly, serious risks include unintentional injury to the coronary artery, blood clots leading to stroke or heart attack, or bleeding into the abdomen. All risks will be discussed with you prior to your procedure so you can make a fully informed decision about your treatment.
We are fortunate to have two highly competent interventional cardiologists on the team at Harbourside – Dr Giuseppe Femia and Dr Avedis Ekmejian. They are extremely experienced in performing coronary angiography, both percutaneous coronary intervention and angiography without stent where clinically appropriate. In addition to caring for private patients through Harbourside, Dr Ekmejian offers public procedures at the Royal North Shore Hospital.
Catheter-based treatments are minimally invasive, which means they are associated with shorter recovery times, reduced risk of bleeding and infection, less post-operative pain and other complications, and a shorter hospital stay. They are also an invaluable life-saving approach to treatment for high-risk, frail, or elderly patients who would not be able to endure open heart surgery.
Yes, in some cases, the atherosclerosis associated with coronary artery disease can partially regress, although it is more common for treatment to stabilise the condition and prevent it from progressing further. There is some evidence that soft (non-calcified) plaque may shrink or regress with medical treatment.
Coronary artery disease is often silent until angina develops or your first heart attack. You may suspect you have coronary artery disease if you experience chest pain during physical exertion, which may feel similar to indigestion. Even if you do not have any symptoms, it is recommended to have regular heart health checks with your GP or cardiologist if you are over the age of 45, or over the age of 35 and living with diabetes, or over the age of 30 and identify as a First Nations person. Screening tests can diagnose coronary artery disease even in the early stages, allowing your doctor to plan preventative treatment strategies.
No, coronary artery disease and heart attack (also known as myocardial infarction) are two different conditions, though are closely linked. Most heart attacks are complications of coronary artery disease. Coronary artery disease arises from plaque accumulation and stiffening in the walls of the coronary arteries supplying the heart, reducing blood flow to the heart muscle. A heart attack occurs when a coronary artery becomes completely blocked, often due to an inflamed and ruptured plaque from coronary artery disease.
Excess sodium increases fluid retention in the body in an effort to dilute the high salt concentration. This increases the total volume of blood, which leads to increased pressure against the walls of your blood vessels. The estimated average sodium intake in Australia is currently almost double the recommended daily amount.
Stress may cause transient increases in blood pressure due to your body’s fight or flight response, but does not directly cause hypertension as per the definition of a sustained elevation in blood pressure. However, stress can often lead to unhealthy coping mechanisms, such as drinking alcohol, smoking, or stress eating, which all can contribute to hypertension.
If unmanaged, hypertension causes an increased risk of life-threatening cardiovascular conditions, including heart attack, heart failure, and aneurysm. The sustained, excessive pressure also damages blood vessel walls, which may manifest in the eye (retinal disease), kidney (chronic kidney disease), and brain (stroke and dementia).
Yes, alternative cholesterol-lowering medications are available if statins are causing you intolerable side effects. These other options include medications such as ezetimibe, injectable PCSK9 inhibitors, or bempedoic acid.
The current recommendations are to have your cholesterol tested every five years if you are aged 45 or older, or starting from age 35 if you are a First Nations person. Getting checked regularly allows your doctor to detect high cholesterol early and implement measures to protect you against heart disease, including advice on how to lower cholesterol with lifestyle changes.
Cholesterol levels naturally increase with age as the way the body deals with cholesterol changes, so having a parent with high cholesterol does not necessarily mean you have an inherited predisposition to elevated cholesterol, too. Lifestyle factors such as smoking, drinking, physical activity, and your diet have a greater impact on your cholesterol levels than your family history. The exception to this is those with a condition known as familial hypercholesterolaemia, where a genetic defect impairs how the liver manages LDL cholesterol from birth.
Unfortunately, there is currently no treatment that can reverse or cure heart failure. The condition is chronic and progressive, meaning it will be present long-term and has a tendency to get worse. However, heart failure management strategies can be effective at improving your symptoms, help you to live for longer, and make your quality of life the best it can be.
Heart failure management programs are a multidisciplinary approach to support those living with heart failure by providing clinical care and patient education. Clinicians involved in these programs often include a cardiologist, dietitian, heart failure nurse, exercise physiologist, and pharmacist, who work together to optimise your health.
While heart failure itself is not considered an inheritable disease, the risk factors that may contribute to you developing heart failure can be influenced by genetics or the similar environment you share with your family. For example, if you have a family history of cardiomyopathy or a family lifestyle that predisposes to hypertension, these conditions will increase the risk of heart failure for both yourself and your family members.
Heart valve disease may be avoided by taking measures to prevent the underlying causes. This typically involves healthy lifestyle changes, such as getting enough exercise, eating well, quitting smoking, reducing alcohol intake, and maintaining your weight within the recommended range. Even if you have already developed heart valve disease, making these positive behavioural modifications can help to prevent your condition from deteriorating.
Valve replacement surgery is within the scope of a cardiothoracic surgeon, a medical doctor who has subspecialised in surgical procedures involving organs within the chest. A transcatheter approach to valve replacement or repair, such as the TAVI procedure or MitraClip, however, is often performed by an interventional cardiologist.
As valvular heart disease does not always cause symptoms, it is estimated that a quarter of a million Australians have the condition without realising. Regular heart health check-ups can help to detect heart valve disease even if you have no symptoms, enabling early treatment that can make a meaningful difference to long-term outcomes.
Your arrhythmia symptoms will provide a clue to the type of irregularity present, which can be confirmed with diagnostic testing. Investigations can confirm the type of arrhythmia, the underlying cause, and also rule out other conditions. Tests for arrhythmia can include an electrocardiogram, Holter monitor, echocardiogram, or stress test. These days, smart watches and other wearables are useful adjuncts to diagnosis, allowing arrhythmias to be detected and even diagnosed in the community setting.
Heart palpitations are not necessarily problematic, and are often triggered by harmless and temporary events such as stress, anxiety, caffeine, or dehydration. However, if your heart palpitations cause you to feel short of breath, pain in your chest, or lightheaded, it is best to get checked by a doctor.
Physical exercise alone is not expected to cure an arrhythmia but can be an important part of managing it. Maintaining physical fitness strengthens your heart muscle, reduces blood pressure, and supports a healthy weight, all of which can help to manage arrhythmia symptoms and often the underlying causes, too.
Yes, maintaining regular physical activity is important for overall heart health, even when you have atrial fibrillation. However, exercise may be a trigger for atrial fibrillation in some people, so it is worthwhile discussing with your cardiologist about what sort of exercises and what level of intensity is right for you.
Yes, asymptomatic atrial fibrillation can still increase your risk of serious complications like stroke or heart failure just as much as for those who do have atrial fibrillation symptoms. Because of this, it is important to keep up with annual routine heart health checks with your doctor if you are aged 45 and older, or earlier if you have known risk factors.
A heart-healthy lifestyle is important for reducing your risk of developing atrial fibrillation but is not typically recommended in isolation if you have already been diagnosed with the condition. Other atrial fibrillation treatments such as medications, catheter ablation, or cardioversion are often still needed to restore and maintain a normal heart rhythm, though lifestyle changes still go a long way in supporting these interventions. Lifestyle modifications for helping manage atrial fibrillation include getting regular exercise, maintaining a healthy diet, quitting smoking, reducing alcohol intake, and ensuring your body weight stays within the healthy range.
Unfortunately, there is no known way of reducing your risk of developing POTS. However, you can minimise your episodes by avoiding known triggers and making lifestyle adjustments such as increasing your salt and water intake.
POTS is not considered a life-threatening condition, though can increase your risk of falls due to dizziness and fainting. The greatest impact of POTS is through affecting your ability to perform daily tasks, including work and study. Associated POTS symptoms or co-existing conditions such as gastrointestinal upset or low mental health may contribute independent health risks, but POTS treatment with a specialist can support you in reducing these effects and restoring your quality of life.
It is possible for POTS to naturally self-resolve over time in a small percentage of people. Sometimes, POTS symptoms may disappear for a period but then return. This can be dependent on the underlying cause. If the cause is something that can be addressed or is expected to self-resolve, such as a viral illness or younger patients going through puberty, POTS may eventually go away on its own.
Bicuspid aortic valve is the most common form of congenital heart disease, where the aortic valve develops abnormally. This can predispose to the development of stenosis (a narrowed valve outlet) or regurgitation (a leaky valve) later in life. It is also associated with aneurysm of the thoracic aorta, and even spontaneous tears (dissection), which can be life threatening.
A patent foramen ovale is where an abnormal opening remains between the left and right atrial chambers of the heart. The foramen ovale is a normal developmental aperture in the foetus, but typically seals over during infancy. Patent foramen ovale symptoms are not common, and many people are unaware they have this congenital heart defect as it usually causes no problems. Approximately 20% of adults have a patent foramen ovale and this is usually not clinically significant. In a small minority of individuals it can be associated with an increased risk of stroke.
Not necessarily. Congenital heart disease encompasses a wide range of specific conditions; some of these are minor and asymptomatic, and don’t require intervention. Depending on the type of defect, if treatment is needed it may involve medication, cardiac catheterisation, or heart surgery.
Some forms of cardiomyopathy are inheritable, though the situation is more complex than simply sharing the same genes and expressing the condition in the exact same manner. The risk of your child developing cardiomyopathy can depend on their age, gender, and number of affected relatives. Dilated cardiomyopathy and hypertrophic cardiomyopathy are the most common inheritable forms of the condition.
No, these are two different heart conditions but one can lead to the other. Cardiomyopathy refers to a problem with the heart muscle such as thickening, stiffening, stretching, or weakening. This change in structure impacts the heart’s pumping ability, which then may result in heart failure. Heart failure can also develop independently of cardiomyopathy through issues such as heart valve disease or hypertension. Over time, inefficient pumping can lead to structural changes of the heart muscle and subsequent cardiomyopathy.
Not necessarily. Some people with mild disease and no signs or symptoms may opt to be monitored without treatment. Some forms of cardiomyopathy that are caused by reversible causes, such as dilated cardiomyopathy due to pregnancy or excessive alcohol intake, may self-resolve once the causative factor has been addressed.
