Everything you need to know

Planned Care

  • Peter Jones

    Cardiac Physiologist

    Echocardiography

    What is an Echocardiogram?

    An echocardiogram is an ultrasound scan of the heart. It is sometimes just called an ‘ECHO‘

    Ultrasound is a very high frequency sound that you cannot hear, but it can be emitted and detected by special machines

    The scan can give accurate pictures of the heart muscle, the heart chambers, and structures within the heart such as the valves.

    Why is an Echo done?

    It may be done to check how well your heart is working after a heart attack or to check how well the valves are moving inside.

    An ECHO can also help to see any fluid that may have collected around the heart.

    What happens during the test?

    You will need to undress to the waist and lie on the couch. A probe is placed on your chest (it is a bit like a very thick blunt pen). Also, lubricating jelly is put on your chest so the probe makes good contact with the skin. The probe is connected by a wire to the ultrasound machine and monitor. Pulses of ultrasound are sent from the probe through the skin towards your heart. The ultrasound waves then echo (‘bounce back’) from the heart and various structures in the heart.

    The amount of ultrasound that echoes back depends on the density of the tissue the sound has hit. Therefore, the different structures send back different echoes. For example, ultrasound travels freely through fluid so there is little echo from blood in heart chambers. But, heart valves are dense tissues so ultrasound waves hitting a valve will echo back clearly.

    The echoes are detected by the probe and are sent to the echocardiogram machine. They are displayed as a picture on the monitor. The picture is constantly updated so the scan can show movement as well as structure. (For example, the valves of a heart opening and closing.) The operator moves the probe around over the skin surface to get views from different angles. Some abnormalities can be seen quite clearly. For example, damaged heart valves, thickened heart muscle, some congenital heart defects, etc.

    The test is painless and takes about 20-30 minutes. You may have to turn on your side during the test so the operator can scan the heart from different angles.

    You do not need any special preparation before the test.

    You eat and drink normally before and after the test. Continue to take your usual medication.

  • Helen Nixon

    Cardiac Physiologist

    Ambulatory Electrocardiogram (ECG)

    What is an Ambulatory ECG?

    This test records the electrical activity of the heart when you are walking about (ambulatory) and doing your normal activities.

    What happens during the test?

    Small metal electrodes are stuck to your chest

    The wires from the electrodes are connected to a small lightweight recorder.

    The recorder is attached to a belt which you wear round your waist and records for 24-48 hours, depending on what the GP has requested.

    There are some variations in the equipment that may be used.

    When the device is returned the readings will be viewed and a report will be sent to your GP.

    You may be given an Event Monitor which you will keep for up to two weeks.

    Event monitors are used if you experience symptoms less frequently, for example two or three times a week.

    The Event monitor is very easy to use and will be turned on by you, at the time you experience symptoms.

    The monitor will record your heart rhythm at that time, and store the information, which will be viewed when you return the monitor.

    The Event monitor can store up to 300 separate recordings so you can use the monitor as often as you feel you need to.

    On returning the monitor the information will be viewed and a report of the findings will be sent to your GP.

  • Nicola Tomlinson

    Ultrasound Sonographer

    Non-Obstectric Ultrasound

    What is an Ultrasound scan?

    An ultrasound scan uses sound waves (echoes) which the human ear cannot hear to create pictures of the major organs and blood vessels inside the body.  These echoes are sent through the skin by a special hand-held camera and are reflected by the internal organs and structures. The echoes form a picture which is displayed onto a TV screen and can be examined by the person performing the scan. There is no pain from an ultrasound examination.

    What happens before the Ultrasound scan?

    You may be asked to starve either overnight for a morning appointment or for 6 hours for an afternoon appointment and/or drink plenty of water to make sure you have a full bladder. This is so that the area being examined can be seen as clearly as possible. Sometimes no special preparation is needed, it depends which area is being looked at. Full instructions will be given on your appointment letter.

    What happens during the Ultrasound scan?

    You may be asked to undress to the waist depending on which area is to be looked at.  You will be taken into a special examination room and asked to lie on an examination couch. You may be asked to change position during the scan to allow the area to be looked at from different angles. You may also be asked to take deep breaths and hold your breath for a few moments during the scan. The examination will be performed with the room lights dimmed so that the pictures on the TV screen can be seen more clearly.

    The Sonographer will stand by your side and a clear gel, which has usually been warmed, will be put onto your skin over the area to be examined. A small hand-held camera which sends out sound waves is moved through the gel on your skin to form pictures on a TV screen.  The examination will take approximately 10-20mins. No results will be given to you at this time.  The gel will be removed from your skin and you will be able to get dressed.  There are no effects from the scan so you may return to your normal activities as soon as you wish.

    How will I get my results?

    The results will be sent to your Doctor within a 24hour period and you can discuss the results with them when you next visit.

  • Abigail Ankers

    Audiologist

    Audiometry (Hearing Tests)

    What is audiometry?

    Audiometry is the medical word used to mean hearing tests. Audiometry checks whether there are problems with any of the different mechanisms that allow us to hear sound.

    How does audiometry work?

    There are various types of tests that can be carried out to check hearing ability. They vary according to who is being tested and why.

    Testing in adults

    Testing in adults mainly uses a technique called pure tone audiometry. This uses a machine called an audiometer to play a series of tones through headphones. The tones vary in pitch (frequency, measured in hertz) and loudness (intensity, measured in decibels).

    The health professional conducting the test will control the volume of a tone and reduce its loudness until you can no longer hear it. Then the tone will get louder until you can hear it again. You signal by raising your hand or pressing a button every time you hear a tone, even if the tone you hear is very faint. The health professional will then repeat the test several times, using a higher-pitched tone each time. Each ear is tested separately.

    The results of the test are plotted on a special graph called an audiogram which helps to show the pattern of any hearing loss.

    What is audiometry used for?

    Audiometry is used in a number of different circumstances including:

      • To evaluate possible hearing loss in anyone who has noticed a persistent hearing problem in one or both ears or has had difficulty understanding words in conversation.
      • When determining the type and amount of hearing loss (conductive, sensorineural, or both).
      • Screening babies and young children for hearing problems that might interfere with their ability to learn, speak, or understand language.
      • To screen for hearing loss in people who are repeatedly exposed to loud noises or who are taking certain antibiotics, such as gentamicin.

    What should I do to prepare for audiometry?

    Usually very little preparation is needed for audiometry. If you are known to have wax in your ears you may have this removed before the test so that it does not interfere with the results.
    Let the person doing the test know if you have had, a recent cold or ear infection, as this may interfere with the results.

    What will happen during my first appointment?

    The Audiologist will take a brief look into both your ears and examine the eardrum and outer ear. Then audiometry will take place this normally takes approximately 20 minutes. Depending on the results of this test and the outcome of your hearing requirements the audiologist will carry the following:

    • Discharge with no further treatment
    • Refer for further clinical investigation eg ENT
    • Referral to outreach services eg Action on hearing loss
    • Fitting of hearing aid/s.
    • In certain circumstances when a hearing aid is prescribed this may be fitted on the same day.

    Are there any side-effects or complications from audiometry?

    These are very safe tests; complications arising from these tests are extremely rare.

  • Paul Cresswell

    Nerve Conduction Lead

    Nerve Conduction Studies

    What is a Nerve Conduction Study (NCS)?

    It is a test used to find out how the nerves in your arms and/or legs are working.

    These tests are used to investigate a number of different muscle and nerve problems and it will assist your Consultant in their diagnosis and management of your medical condition.

    The doctor or healthcare scientist performing the test will explain the procedure before starting.

    What do the tests involve?

    A number of sticky electrodes are placed on the hands or feet.

    To test the nerve a small electrical pulse is given to the skin, and a measurement taken.  This is repeated at 2 or 3 points along the arm or leg.

    On arrival in the department it will be necessary for us to obtain your consent before your investigation begins.

    Who will perform the test?

    A doctor or healthcare scientist will perform the test.

    Will I feel anything?

    Most people say that the electric pulse is not painful, but that they feel an unusual sensation such as tingling or pulsing.

    How long will the test take?

    Approximately 15-30 minutes.

    Should I stop taking my medication/tablets before the test?

    Do not stop taking any of your medication unless you have been told to do so by your Consultant.  However, if you are taking blood-thinning tablets such as Warfarin you should tell the doctor/clinical physiologist before the test starts.

    It would be helpful if you would bring a written list of your medication with you.

    Are there any after-effects?

    After the test you will be able to continue your daily activities as normal, including driving. This test is not a treatment but will help the doctor to understand the reasons for your symptoms.

    Are there any risks?

    Please tell the doctor if you have a pacemaker or implanted device fitted, it  is usually  still safe to have the test but please bring details of your pacemaker with you to discuss prior to the test.

    What are the consequences of not having a NCS?

    NCS is a well established method of helping doctors to diagnose and treat a range of medical conditions.

    Your doctor would not have as complete a picture as they require and hence you diagnosis may take longer and/or you treatment may not be the most appropriate.