One of the most common diseases affecting people across our country is heart disease. At St. Joseph’s Health Centre, our experienced team of cardiologists and cardiac diagnostic technicians provide people living in West Toronto with the best heart care when they need us the most. Keeping your heart healthy and strong is our number one priority.
Our cardiologists diagnose and manage a wide range of cardiovascular diseases including:
- Coronary artery disease
- Heart rhythm problems (arrhythmias)
- Heart valve problems
- Heart failure
We specialize in a number of cardiology fields including:
- Pacemaker insertion (view the Pacemaker Clinic in the Outpatient Clinics – Ambulatory Care Centre)
- Coronary angiography
- Heart failure (view the Heart Failure Clinic in the Outpatient Clinics – Ambulatory Care Centre)
- Nuclear cardiac imaging
- Cardiac rehabilitation
Our outpatient services include diagnostic tests like electrocardiograms (ECGs), echocardiograms (ultrasound of the heart), stress tests and many more. Please read the section “Preparing for your visit” to see a full list of tests we offer, what they are and what you can expect when you arrive for your appointment.
An appointment is required for all tests with the exception of an ECG (walk in from Monday to Friday 7:30 a.m. to 3:30 p.m.). To make an appointment for a test or to see a cardiologist, a referral is required from a physician or nurse practitioner. Please read the section “How to refer a patient” for referral information.
For additional information please visit:
What to bring to your appointment
If you are coming for a test or an appointment with your doctor, please bring your health card and your St. Joe’s hospital card if you have one.
If you are seeing a cardiologist or having a stress test, please bring all of your medications, a list of your medical concerns that you want to discuss and any other health records that may be helpful.
The types of tests you may have during your visit:
Preparation required: none
Time required for this test: about 40 minutes
- An echocardiogram or “ECHO” is an ultrasound of your heart (similar to other medical ultrasounds including those conducted on pregnant women and those to look at organs). It provides detailed information about the heart’s structure and function – including the pumping function of the heart as well as the function of the valves in the heart. The technology makes use of sound waves to create images and therefore does not involve any radiation exposure.
- Normally the echocardiogram is performed through the chest wall – this is called a transthoracic ECHO. Occasionally when more detailed information is required, the ECHO probe may be passed down the esophagus (the swallowing tube, which sits just behind the heart) – this is called a transesophageal ECHO.
- Sometimes contrast is required so we can see the heart. This involves inserting an intravenous and injecting a small amount of a contrast liquid.
Transesophageal Echocardiogram (TEE)
Preparation required: nothing to eat for at least eight hours before the test
Time required for this test: about two hours, however, the test itself only lasts about ten to 30 minutes. The rest of the time is spent preparing for the test and monitoring you after.
- A transesophageal echocardiogram, or TEE, is a specialized type of heart ultrasound, where instead of the ultrasound being placed on the chest wall, it is put down the esophagus (the swallowing tube).
- Because the heart sits right in front of the esophagus, very detailed information about the heart can be obtained during this test.
- A TEE is sometimes requested so we can clearly see a heart valve to confirm there’s no infection on the heart valve or blood clot in the heart.
- A TEE is a day procedure.
- An intravenous will be inserted and you will be given a medication to relax you but not completely put you to sleep. A medication will also be sprayed at the back of your mouth to numb it.
Preparation required: none
Time required for this test: about ten minutes
- An electrocardiogram, “ECG” or “EKG” is a tracing of the electrical activity of the heart. It is a non-invasive test and involves applying ten stickers to your chest, arms and legs.
- From the ECG, the rhythm of the heart can be determined. Normal rhythm is called sinus (originating from the sinus node). Other abnormal rhythms that can be identified by the ECG include atrial fibrillation and forms of heart block.
- An ECG may also provide clues that a chamber in the heart is enlarged and can sometimes show evidence of a previous heart attack.
Preparation required: none
Time required for this test: about ten minutes to set up and then you will drop off the monitor in one or two days, depending on how long your doctor has asked for your heart to be monitored.
- A holter monitor is a device that is used to look at your heart’s rhythm and detect fast or slow heart rhythms. It may be ordered if you complain of palpitations or if you feel dizzy or lightheaded.
- A holter monitor can be requested for 24 or 48 hours. You will come in to hospital to have the holter connected, which involves placing stickers on your chest and connecting wires to a small that box that you will carry around with you for the duration of the test. You will then go home and return the monitor after a day or two.
- While you are wearing the monitor, it is important to take note of your symptoms. You will be given a diary and if you have your typical symptoms (palpitations, dizziness, etc.) you should mark them in the diary. This will allow the technologist to go back and see if there was any abnormal heart rhythm correlating with those symptoms.
Preparation required: none
Time required for this test: about ten minutes to set up and you will drop off the monitor in two weeks.
- This is a test similar to a holter monitor (see that test description for more information), except that it can be worn for much longer – up to two or four weeks.
- It is a test to look at the heart rhythm and to try to detect abnormal fast or slow heart rhythms.
- Similar to a holter monitor, you will have stickers applied to your chest, attached by wires to a monitor.
Ambulatory Blood Pressure Monitor (ABPM)
Preparation required: none
Time required for this test: about ten minutes to set up and then you will drop off the monitor after one day
- This is a blood pressure monitor that you wear to take your blood pressure periodically throughout the day.
- In some people, their blood pressure is high only when they come in to hospital or when they see their doctors. This is called white coat hypertension. An ABPM may be helpful to diagnose this condition. It can also be used to see how well a person’s blood pressure is controlled on medications.
Exercise stress test
Preparation required: none
Time required for this test: about 45 minutes. The actual duration of exercise will be about ten to 15 minutes.
- An exercise stress test may be performed for a number of reasons, but it is usually requested to determine a person’s risk of having coronary artery disease (cholesterol plaque causing blockages in the arteries around the heart).
- The test involves placing stickers on your chest and limbs to allow for continuous monitoring of the electrical activity of the heart. Your blood pressure is also checked every few minutes.
- You will exercise for as long as you can, usually on a treadmill. The treadmill increases in speed and incline every few minutes. There is no set length for the stress test.
- In order to obtain the most information from the stress test, there is usually a target heart rate set, which is based on your age.
Nuclear stress test
Preparation required: No caffeine (coffee, tea, chocolate, decaffeinated pop, coffee, tea, etc.) for 12 hours before the test. Your doctor may also recommend that you do not take certain medications before the test but please be sure to discuss this with them.
Time required for this test: about four hours
- A nuclear perfusion scan is a special type of stress test that uses a small dose of an intravenous radioactive material to look at the blood flow to the heart. Pictures of the heart are taken at rest and then after stress. If there is reduced uptake of the radioactive tracer in a certain part of the heart, this may suggest that there is a narrowed or blocked artery supplying that territory of heart muscle.
- There are two ways to test stress on your heart. We prefer to use exercise, similar to a treadmill stress test. However, if you are not able to exercise, then a drug can be used to stress the heart (pharmacologic stress).
- A nuclear perfusion scan is more sensitive than a plain exercise stress test at detecting coronary artery disease and determining the extent of disease.
Multi-gated Acquisition (MUGA) scan
Preparation required: none
Time required for this test: about onehour
- A MUGA scan is a non-invasive test. It is a nuclear medicine test which involves the injection of a small amount of a radioactive tracer. After the radioactive tracer is injected, several pictures of your heart will be taken using a special camera.
- The purpose of a MUGA scan is to get a very accurate assessment of the left ventricular ejection fraction.
Physicians or nurse practitioners can fax patient referrals to the Cardiology department at 416-530-6702. Please use this fax number for all cardiac tests, consultations and urgent requests for chest pain evaluations.
Physicians referring a patient for a cardiac test or consultation can complete the requisition form and fax it to our department.
Requests for cardiology consultations should be faxed to us with all relevant information included.
Urgent requests for chest pain evaluation (including consultations and stress tests) can be faxed directly to our department.
What is pacemaker implantation?
Pacemaker implantation is a procedure in which a doctor places a pacemaker in your chest, either on the left or right side, underneath the skin below your collarbone.
What is a pacemaker?
A pacemaker is a device, about the size of a watch, which monitors your heart rate. It contains electrical circuits and a battery (called a “pulse generator”). The pacemaker is connected to a wire called a lead, that is placed inside your heart. The lead makes contact with your heart muscle. It is able to sense your heart’s electrical impulses and deliver electrical impulses to your heart. When your heart rate falls below a certain level the pacemaker will pace your heart, via the lead, to maintain your heart beat at a particular rate.
When is it used?
The procedure is most often done when your heart rate is too slow. When this happens, not enough blood is pumped out of your heart to the rest of your body. This can cause symptoms such as fatigue, shortness of breath, chest pain, dizziness or fainting.
How will it affect my life?
Hundreds of thousands of people have pacemakers and are able to lead completely normal and full lives. You will have to get your pacemaker checked periodically (usually every six months or less).
What are the benefits of getting a pacemaker?
Having a pacemaker can help your heart maintain a particular heart rate. If your heart rate is too low, you may have significant symptoms and even have a risk of injury or death. Pacemakers can help reduce this risk.
What are the risks of getting a pacemaker?
As with every surgical procedure, there’s a low rate of risk involved. Most of the complications are minor and easily treated. Some of the more rare complications can be serious. The risks include:
- Bruising, bleeding, pain or infection at the implant site
- An internal infection of the pacemaker and lead requiring its removal
- Puncturing the lung, artery, vein, or heart itself
- A very slow or very rapid heart rate requiring external pacing or shocks
- If other cardiac conditions are present these could be worsened during or after the procedure despite the pacemaker working
- The lead may move requiring a second procedure to reposition the lead
- The anaesthetist will discuss the risk of anesthetic with you on the day of surgery (local anesthetic is considered safer than general anesthetic but sometimes does not numb the area enough)
As with all medical equipment, there is a chance that either the pacemaker device or the lead may have a problem once implanted in you. This may result in an advisory or a recall from the manufacturer. This may not affect you directly in any way but it could result in your device or lead having to be checked more frequently, or perhaps changed to another device or lead because of concerns about how it may affect you. The chance of this is generally small.
How long does the pacemaker battery last?
The pacemaker battery lasts for years. How long it lasts varies and cannot be predicted before the implantation. Most people will require a battery change. The battery change procedure is very similar to a pacemaker implantation. Usually the same wire is left in place and a new pacemaker is inserted underneath the skin. Rarely is a new wire inserted.
How do I prepare for a pacemaker implantation?
Before your surgery, you will be seen by one of the doctors who does pacemaker implants . The doctor will explain the procedure and get you to sign a consent form. You will be given further instructions for the surgery itself, including the date and time for your surgery. It is possible that the date or the doctor may change depending on the need for more urgent cases or other unexpected circumstances.
Do not eat or drink anything after midnight prior to the surgery or on the day of the surgery. The doctor may tell you to stop taking some medications before surgery or to take others on the morning of the surgery with a few sips of water – do NOT drink any water, coffee, tea or juice unless told to take little water with your pills on the day of the surgery.
What happens during the procedure?
You will be given a local anesthetic and a mild sedative for the procedure. This is usually enough to keep you from feeling pain and will keep you relaxed. General anesthetic is rarely used. If you have any symptoms or discomfort you should tell the surgeon, nurse or anesthesiologist during the implantation.
The surgeon will clean and sometimes shave your upper chest area and make a cut in the skin below the collarbone and separate the tissues to make a little pocket for the pacemaker to sit under the skin. One or two wires called leads are then passed through a vein that runs along the collarbone into the heart. This is done with the help of a moving X-ray. Most of the time, one wire is placed in the bottom chamber of your heart called the right ventricle. Sometimes a second wire is placed in the top chamber of your heart called the right atrium. One the wire(s) are in place, the surgeon connects them to the pacemaker and places it under your skin. The cut is then closed up with sutures to keep the pacemaker in place.
What happens after the procedure?
If you are having a new pacemaker system implanted with a new lead you will most likely stay overnight and be discharged the next day. If you are only having a battery change, without a new lead, you will most likely go home the same day. Depending on your condition after the procedure you may have to stay longer.
After your procedure, and before you leave the hospital, your pacemaker will be checked. You will be given a package that contains information on how to care for your wound, extra dressings and tape, a card that contains information on your particular pacemaker (keep this with you at all times) and a follow-up appointment to be seen in the pacemaker clinic approximately one week after discharge from hospital. If, for some reason, you are discharged from hospital before you receive your package, call the pacemaker clinic the next weekday morning. The clinic will get back to you the same day with further instructions.
What about precautions when I leave the hospital?
According to regulations, you are not allowed to drive for one week after you get your pacemaker. You also cannot lift the arm on the side you received your pacemaker, above the level of the shoulder, for one month. You can move your arm as much as you like below the level of the shoulder. In fact, you are encouraged to move your arm as much as possible, as keeping the shoulder or arm immobile can result in a frozen shoulder or blood clots.
How is a pacemaker checked?
A small table-top computer called a programmer (or interrogator) is used to check your pacemaker. A wand, which is about the size of a fist, is connected to the programmer and placed on your chest over the pacemaker. Information from your pacemaker is downloaded to the programmer and can be checked to see how well your heart and your pacemaker are working. Periodically the pacemaker will be reprogrammed to optimize its function. This procedure is not painful.
When should I call the pacemaker clinic?
Call the pacemaker clinic immediately if your pulse becomes abnormally slow, fast or irregular, if your symptoms before surgery return, or if you have any other unusual symptoms. If these occur outside the pacemaker clinic hours, go directly to the nearest hospital emergency room. Call 911 if you feel you cannot be driven to the hospital safely. Do not drive yourself. Do not wait until the next pacemaker clinic day.
Pacemaker Clinic contact info:
Hours: Monday to Friday 8 a.m. to 4 p.m.
Note: The pacemaker clinic does not book or change appointments for follow-up after your pacemaker implantation. To book or change appointments, please call 416-530-6325.
What about electrical equipment affecting the pacemaker?
Some equipment may affect the electrical circuit in your pacemaker. Household and office electrical appliances generally do not affect pacemakers. However, if you start to feel dizzy or lightheaded or experience the symptoms you had prior to surgery, avoid that particular appliance and contact the pacemaker clinic.
Equipment you should keep your distance from or avoid altogether include: electric arc welding, very powerful large magnets, devices that shock the body, high voltage industrial machines and transformers, and relay stations for television or radio. Very rarely equipment that causes a lot of vibrations such as electrical chainsaws or motorcycles can cause minor interference but it is often not significant. You may use such equipment but be aware of any new symptoms or other changes.
You may go through the metal or security detectors at stores and airports, but do not linger around these areas for too long. At the airport notify security about your pacemaker and present them with your pacemaker card.
Who should I tell about my pacemaker?
You should tell all medical personnel involved in your health care about your pacemaker. This includes doctors, nurses, dentists, physiotherapists and other health care professionals even if their involvement in your health care is not related to your heart.
What is a coronary angiogram?
A coronary angiogram is a medical test to look at your heart. A doctor will place a tube called a catheter in your upper thigh or arm and pass it to a blood vessel in your heart. A dye is put through the tube and into the blood vessels of your heart. Pictures of the heart are taken with an X-ray and can show if there are any narrowings or blockages in the heart.
When is a coronary angiogram done?
A coronary angiogram is done when you have one or more of the following:
- Chest pain or other symptoms of coronary artery disease (blockage of arteries to your heart)
- Chest pain that is new or increasing in severity
- Pain in your chest, jaw, neck or arm that cannot be explained by other tests
- A chest injury or other blood vessel problems
- Abnormal results on a heart stress test
- A heart valve problem that requires surgery
- A heart defect that you were born with
What are the benefits of having a coronary angiogram?
A coronary angiogram helps the doctor determine the amount and degree of blockage of the arteries in the heart. The procedure provides clear images of the blood vessels in the heart which is very useful when considering surgery. Therefore, a coronary angiogram also helps the doctor determine the best mode of treatment to be carried out.
What are the risks of having a coronary angiogram?
The main risk of having a coronary angiography is radiation exposure from the X-ray, but the benefits outweigh the risks of radiation. There also might be some bleeding, soreness or bruising in the arm or leg where the catheter is inserted. More serious complications are rare, such as an allergic reaction to the dye, getting an infection after the procedure or excessive bleeding.
How do I prepare for a coronary angiogram?
You will have an electrocardiogram and blood tests done the morning of your test. Talk to your cardiologist about your medications and let them know about any allergies to X-ray dyes.
What happens during the procedure?
During the procedure, a nurse will start an IV in your arm and clip the hair on your groin. You will be given a mild sedative but will be awake during the procedure. A tube called a catheter will be inserted into either a vessel in your groin or arm and passed to your heart. A dye will be injected through the catheter into the blood vessels of the heart, and pictures will be taken with an X-ray to see if there are any blockages in the heart. The whole procedure takes about 30 to 45 minutes. If your arteries are clogged, your doctor might do a procedure to open them but only after informing you and receiving your consent prior to the procedure. In this case, the procedure can be as long as 1-2 hours.
What happens after the procedure?
The recovery time is three hours. During this time, do not bend the arm or leg the test was done on to prevent bleeding. You can go home 3-4 hours after the procedure. Arrange to have someone drive you home.
You may also experience some soreness at the place the catheter was inserted into. This could last for a few days after the procedure.
How can I decrease my risk of heart disease?
Here are some of the important things to do to decrease your risk of heart disease:
- Stop smoking
- Try to limit fast food
- Lower salt diet
- Stop sugary drinks like juice and pop
- Monitor your blood pressure and blood sugars regularly
- Incorporate vegetables and high fibre foods in your diet
- Exercise at least three days per week