Non-Invasive Investigations

bp check

Ambulatory ECG Monitoring (ECG Holter Monitor Test)

The Holter monitor is designed to continuously record your heart beat over a period of 24 or 48 hours or longer such as 7 days if required.

This test is primarily used to determine the cause for symptoms such palpitation, dizziness, fainting or breathlessness.

How is the monitor fitted?

The monitor is a small and light device the size of a mobile phone which is fitted around your waist clipped into a belt of a waistband. Thin wires from the monitor are attached to 2 or 3 electrodes on your chest (small sticky patches placed on the skin). The monitor is then worn for the desired recording period (for example 24 or 48 hours) and continuously records every heart beat.

The monitors are normally fitted in our consulting rooms after which you can return home. It is important that the monitor is worn all the time and we encourage you to continue with your normal daily activities during the test. Fitting of the monitor is completely painless and takes around 20 minutes. The electrodes and wires will not be visible from beneath your clothing.

You will also be given an “event diary” to record the time and nature of any abnormal sensations or symptoms that you may experience during the monitoring period. This information will be used to determine the activity of your heart during symptomatic episodes and is very helpful in making accurate diagnoses.


You will be asked to bring the monitor back to our practice after the monitoring period has been completed (for example the following day for 24 hour tapes). The medical team will then download the recordings and analyse the traces using specialist software. Where relevant special attention will focus on sections where symptoms are recorded in your event diary. The report will then be discussed during your consultation.

24-Hour Ambulatory Blood Pressure Monitoring

Ambulatory blood pressure monitoring is designed to measure your blood pressure at regular intervals during a 24-hour period.

A single blood pressure measurement is often not representative or your true blood pressure value as this may be artificially high or low. This happens because blood pressure fluctuates throughout the day and is regularly affected by events such as visiting a healthcare professional.

This test is very useful in making an accurate diagnosis of high blood pressure (hypertension) in individuals with borderline high values or in the context of “white coat hypertension” (a phenomenon where patients experience high blood pressure in a clinical setting but not at other times). It is also useful in fine tuning of blood pressure medication in patients with difficult to control blood pressure (resistant hypertension).

How is the monitor fitted?

A blood pressure cuff is fitted to one of your arms just above the elbow and connected via a small tube to a monitor worn around your waist. The monitor will then take a reading every 20 to 30 minutes throughout the day and every hour during the night. Inflation of the blood pressure cuff can be mildly uncomfortable but patients often report getting used to the sensation (which is no different to having your blood pressure taken at other times) after a few inflations. It is important to keep your arm relaxed when the blood pressure cuff inflates.

The monitors are normally fitted in our consulting rooms after which you can return home. It is important to continue with your normal daily activities. However, we would not encourage you to undertake physical activities during the monitoring period as artificially high blood pressure values will be recorded. Fitting of the monitor is completely painless and takes around 20 minutes. The blood pressure cuff and tube can be worn underneath lose clothing and should not be visible.


You will be asked to bring the monitor back to our practice after 24 hour of monitoring. The medical team will download the recordings and analyse the results to determine your blood pressure control over a 24-hour period. The report will then be discussed during your consultation.

Trans-thoracic echocardiogram (or echo for short)

An echocardiogram is an ultrasound scan of the heart which uses sound waves to assess the function of the heart. It is similar to the ultrasound scan used during pregnancy and is an extremely safe non-invasive method of scanning the heart.

An echocardiogram provides detailed assessment of the structure of the heart by measuring the size and function of the different chambers. It can also provide accurate information on blood flow through the various heart valves and diagnose narrowed (stenotic) or leaky (regurgitant) heart valves.

How is an echocardiogram performed?

The scan is often performed by a cardiac physiologist or a cardiologist. You will be asked to remove your clothes from the waist up and to lie on you back on a couch. During the scan you may need to roll onto your left side.

The physiologist / doctor will then place hand held ultrasound probe (echo transducer) in various positions on your chest to obtain the necessary images from different angles. The probe will have a small amount of lubricant jelly. This helps to provide a better contact between the skin and ultrasound probe. Black and white ultrasound images are the displayed in real time on a monitor and recorded.

Echo images can now be taken in 2 (2D) as well as 3 (3D) dimension.

Echocardiography is an extremely safe test. There are no known risks form the clinical use of ultrasound and there is no exposure to radiation.

A basic 2D scan, including assessment of blood flow through the valves, will normally take around 20 to 30 minutes. However, more detailed studies which require 3D images can last anything up to 40 minutes.

All scans are performed on an out-patient basis and do not require admission to hospital. Basic 2D scans will be performed in our consultation rooms or if not possible in the Cardiology Department at London Bridge Hospital. However, more complex 3D scans are always performed in the Hospital.


The images which are recorded are analysed off line and detailed report is produced. However, the physiologist or doctor performing the scan can often provide you with a brief indication of the findings. The final report will be discussed with you during your consultation. A digital copy of your scan can be provided for your records on request.

12-Lead Electrocardiogram (12-lead ECG)

The ECG is a simple but very useful screening test. It is often the first cardiac test that patients undergo.

An ECG can provide information on different aspects of the heart function. It measures the heart rate and can detect real time abnormalities of the heart rhythm. In patients with chest pain it can be used to screen for a heart attack. In addition, it can indicate whether your heart is enlarged or whether the heart muscle is thickened.

How is an ECG performed?

The ECG is often performed during you consultation. You will be asked to lie on your back on a couch. A number of electrodes (small sticky patches) will be positioned on your arms, legs and chest. These are connected by wires to a recording machine which picks up electrical signals from the heart. These signals are recorded and printed on a paper.

The test takes about 5 minutes to perform and is completely pain free. However, you will need to remain still during the test as movement can interfere with the recording of the traces.


The results will be used during your consultation in conjunction with other information.