Hi. Sorry it’s me again with more questions. You have all been such an amazing help to me.
I am seeing an EP cardiologist , as a private patient, at the end of this month. Should I book an appointment for an echocardiogram before I see him? I met a friend who told me her husband had done that. I’m afraid to say, that’s something else I knew nothing about. Would you recommend me having one first? Thank you in advance.
Waiting lists on NHS can be ridiculous at present but an Echocardiogram will likely be needed at some point to assess the mechanical workings and output of your heart. Having one as a private patient may not be cheap.
Thank you for your advice. I’m going to find somewhere to book as a private patient. It will be money well spent. It really annoys me that going private is our only real option nowadays
I had a private one during the pandemic following a private cardiologist consultation and then had to have another private follow up consultation for the results. So if you are going the private route it might save you to have one before. My NHS echo came through over a year later. Even privately now, you may need to wait a few weeks for an echo.
Best wishes
I agree totally with your sentiments that this forum is really helpful. I didn't know what an EP was before visiting this site. Everyone has been incredibly helpful. I agree with others, that the echocardiagram is necessary. I was lucky in that I had one on the NHS following a hospital stay and prior to a follow up NHS cardiology appointment. I didn't want to wait for the NHS follow up, as it was weeks away and, like you, booked with a private cardiologist/EP. Best money I ever spent. However, I do resent having to go down this route, but many of us have no option with the NHS and long waiting lists. Not the fault of the medical staff as they've always been brilliant whenever I've been treated. Good luck and hope everything gets sorted out for you. All the best, Maglyn
Hi Maglyn. You have summed up my thoughts so well. I would love to get treated on the nhs but there is such a long waiting list. I’ve decided to go privately because I feel a bit lost by it all and would like clarification. I’m very lucky because, at 67, I haven’t really been ill. Thank you for taking the time to reply.
Hello Wilky 57. The infuriating thing was, that the private cardiologist I'm seeing, actually visited me when I was admitted to A&E with high BP and high heart rate as he also treats NHS patients, as they all do. Sometimes, people think that if you take the private route, you get a better qualified doctor, but not true. He actually remembered me as he told me I was a "puzzle" as nowhere on my ECGs did it indicate AFib. I was told in A&E that I'd had a heart attack but not by the private cardiologist. He subsequently told me that there is a question mark as to whether I'd had a heart attack. After spending 5 days in hospital, I only saw my assigned cardiologist (not the private one) for 5 minutes and when discharged there was no explanation as to why I was taking all the medication, nor was I seen by a cardiologist with any follow up treatment. Since seeing the private cardiologist, he has "indicated" that my treatment was somewhat lacking which left me in a quandary as to what was happening. I think many of the NHS medical staff are more frustrated than we are at the way things are going. Keep us posted as to how you get on.
BHS can advise on this. When I first was diagnosed they told me I needed one (I called BHS because I was left without any guidance) and especially if you never had one done, I'd say you'll definitely have to do it. The EP should be able to see you and comment on the Echo after via phone or email without need to see you again I suppose.
When I looked into private echo, it was about 400-500£. If you have to do more test, I suggest to look abroad if you can, as in Italy an echo is 100 Euro and it is ALWAYS done by a cardiologist.
Thank you for your advice. I’m going to book one as soon as I can. My doctor didn’t say I needed one but he did say there was almost a year's wait to be seen by a specialist on the NHS.
In my area the wait for cardiologist is 2 years but the arrhythmia nurse can book you one. I asked my GP to do so after speaking to BHF nurse and he refused it (mind I was 37 and in permanent but super healthy for all the rest, so as far as anyone knew I could've been walking around with heart defect). I went to A&E and that's when they referred me and I got the letter for Echo in 2 weeks. Meanwhile I booked private EP (on suggestion of a fb group, wait was 1 month for my EP) and he requested NHS hospital to view the echo, luckily it was all good. If I'd go back now, I would just book a week abroad and do all, as this took 2 months of trying to figure out what was happening, and it was really not worth the pain.
Thank you for your advice. Where would you go abroad to get help? Where do you research this? I am very interested to find out. Thanks.
I have friends and relatives in Italy so it was kind of easy for me, I would say the only difficult part could be the language. I have a EP in Milan and for Holter and Echo I went here in Rome
salute.marilab.it/?utm_sour...
My EP in London accepted the echo from this lab, as most of terms are latin anyway. They told me they have many British customers but I wonder if there are specialised labs that give exams back in English. During the echo they explain what they are looking at so you'll know straight away if something is unusual.
Some doctors working there are internationals and I spoke to them in English but I think it might be difficult to go through secretaries as they may not speak it. I can try and look if there is something all in English.
Your GP can refer you for a echo, you don't need a cardiologist to do that. Since an echo is necessary information for prescribing anti-arrythmia drugs such as Flecainide that should be a reasonable request for you to make.
I was interested in your comments in that an echo is necessary for prescribing anti-arrhythmia medication. I had an echo as had been (possibly incorrectly) diagnosed with AFib by my GP. Cardiologist/EP said that my echo was normal but have still been prescribed flecainide! Not sure about all this.
That's correct. Flecainide is contraindicated if heart structure is not sound.
Where did you get the information that in Italy an Echocardiagram would cost 100 Euro? I would advise anyone thinking of having any treatment done here in Italy to find out just how much things would cost before doing anything. In Italy you pay what is called a "ticket" towards any medical costs and I have always found that private treatment costs are similar to those in the UK. Also the waiting lists are just as long unless you are willing to travel a long way, which I believe is similar to the UK.
I saw a teaching hospital, general cardiologist privately, for a heart valve problem last year.
Straight after the appointment, I had an echocardiogram. When that was completed, the cardiologist came through, discussed the findings with the technician and then repeated a couple of measurements.
The cardiologist and the echocardiographer seemed to have a good working relationship.
I would say the ideal situation if you are going privately is to replicate the above scenario, so that the EP trusts the report.
At which hospital are you seeing the EP? What is his name?
I’m seeing Dr David Fox at Spire in Manchester. Do you think I should see if I can have one done there? It seems there is one at Manchester diagnostics suite somewhere else in Manchester
I suggest you ring Dr Fox’s PA at Spire Manchester. She will tell you where Dr Fox likes to have his private echocardiograms done. If she says it would be best done there, ask her if she can book the Echo to coincide with your appointment with Dr Fox.
Thank you so much!
Yes, always good to be able to present all the facts for discussion with your medic.
An echo provides a great deal of information about the structure and workings of your heart. If heading down the route of on going cardiac support, I suspect it provides very useful reference information for the consultant and also as a base line for comparatives in the future. I’m fortunate to have had several over the last decade or so and can spot impacts and trends from changes in my circumstances and treatments. I’ve always requested a copy of the report as a copy is not always provided to the patient. However, if you are inclined to worry and over analyse then it may be best to leave the report with the consultant so he can share just what is relevant and provide context - Dr Google is not for the anxious.
Hi
Your public Dr should be able to schedule for an ECG.
Before I saw the Heart Specialist I had an ECHO, ECG and 24-hr H/R Monitor.
Then when meds changed I had another 24-hr H/Monitor.
I had 2 in 2021 between Feb and following January.
As BBs neither Metoprolol (with night pauses) or Bisoprolol didn't control my H/Rate, 186 and 154 avge, when I ended up with private H/Sp who put me on CCB Diltiazem, he wrote to the same public specialist referring me back for another 24hr Heart Monitor.
3 within 12 months.
My clinic has an ECG and a year later when H/Rate dropped to 60s I tried stopping Bisoprolol but ECG bad. Then I tried ECG having stopped Diltiazem. It was bad so I reckon I am on the least med.
It is great when Drs will only put your dose up of BB instead of trying a CCB which saved me. But some heart damage done.
Its how you feel!!!!! Stroke, with rapid uncontrolled persistent AF H/Rate. Then within 4 days diagnosed thyroid cancer which caused AF whch caused the stroke.
cheri JOY. 75. (NZ)
Hiya, you need to request an ejection fraction as part of your echo, this is a % of the pumping ability of the heart, do to issues I required an echo with contrast media to calculate my EF.Hope this helps
My GP will do an ECG on request, typically annually if I want. But presumably you have had one anyway as you're on this forum. If I was paying a private consultant I would assume that he/she would look after that because that's what I'm paying them for. Typically ECGs take about 10 seconds of monitoring time.
I think the OP is talking about getting a transthoracic echocardiogram, not a "10 second" electrocardiogram.
Makes sense, but again,if seeing a specialist I'd expect the specialist to arrange what they thought necessary, that's part of their job.
yes, if the budget will allow. An echo will give the cardiologist a lot of insight into your condition. Have you had a BNP blood test?
I don’t know. I’m not sure what that is. My GP hasn’t taken any bloods. I had a routine blood test in February but that was before I had any idea I had AFib. Thanks for your help.
Depending on your symptoms, I expect the cardiologist will want more bloods taken. What are your symptoms?
I have had a couple of AFib episodes. The first time it happened I made an appointment at the doctors but, by the time I was seen, my heart had gone back to normal. The GP said if it happened again to go to A&E, which is what I did and I was admitted to hospital overnight. I haven’t really felt great ever since. I’m on beta blockers and anticoagulants. I had to wait 3 weeks to see a GP but I did have a 24 hour ECG beforehand. The GP said there was a long wait to see an NHS consultant so I’ve opted to see someone privately so that they can confirm what the doctor has said. I didn’t realise I would need more tests, like and echocardiogram. I’m a bit lost by it all to be honest.
The beta blocker could be the reason you don't feel well. Some people just do not tolerate them especially if they are on a higher dose. If your heart rate is low normal when you are in NSR a beta blocker can push it down so low you feel lacking in energy. You need to learn more about afib and how it might imoact your life - there is lots of info on this site. A good investment is a Kardia device that can tell you your heart rate when in afib and when in NSR . JeanJeanie has a list of do's and don'ts for helping not to trigger afib attacks. The main advantage of seeing a specialist so early in your afib journey is to get a proper treatment plan -GPs are not able to prescribe anti arrythmic drugs like Flecainide - and see if an ablation might help.
Thank you for your help. Why aren’t GPs able to prescribe that drug? I’m seeing a private specialist but I’d much rather be on the NHS. Unfortunately the waiting list is very long
You need to have a heart with no structural problems like blocked arteries for Flecainide and GPs are not able to determine that. Maybe that is the reason. You need to look at your lifestyle - what you eat , sleep ,exercise , stress etc as all these can have an effect on afib. You mention weight. It is near impossible for many women to lose weight on a beta blocker but if you have a sweet tooth and indulge it you need to address that. Both sugar and artificial sweeteners can trigger afib attacks in some people. As can alcohol.
Thanks for the information. I’m really disappointed that it won’t be easy to lose weight. I am trying so hard!
If the Beta blocker is making you feel bad there are other rate control drug s that can be tried like calcium channel blockers. You do not say what you are taking or the dose.
Try not to worry too much - easy for me to say, I know. I had Afib for many years which was controlled with medication. It's important you are seen early, so it's good that you're able to go private. Hope all goes well.
Where I am (South wales) a cardiac MRI can take up to a year but an echo is pretty routine and the cardiologist can book you in when you need one... so can be done urgently (like on the day or next day) or routinely within couple of months.
An echocardiogram (i.e. cardiac ultrasound) will cost around £5-700, if I recall. A 12-lead ECG (at your GP practice for free, or around £200) might also be worth having done as that can reveal other cardiac issues, so both diagnostic tests seem likely to be useful prior to the appointment. I would ask your GP whether any blood tests would be useful in preparation, too.
Steve
I find this discussion interesting. Here in South Africa if you book with a private cardiologist (as most do) he/she has equipment in his rooms- at my last consultation I had according to the invoice a Cardiac Examination (2 dimensional) plus ECG . I think the 2 dimensional examination is a standard echocardiogram. I have an annual examination and the same tests.
Last echo says I have normal left ventricular function, normal valves, no left atrial enlargement, and the right heart is normal. Is there anything else I should know? in which case I can ask for a referral to a radiologist - their practice is just down the passage from the cardiologist!
Same here in France. I had my echo at my cardiologists office and he did it not a technician. Because I have a lot of rib pain and was wincing throughout he was unable to complete it - I think it bothered him that he was hurting me- and said next time I could have a cardiac MRI but that would have to be at the hospital. Private medicine in the UK is ridiculously expensive.
Yes I am horrified when I see the costs in pounds and then translate it into rands (bearing in mind our awful exchange rate)- at my last visit the echo was R1178. (divide it by 20 to bring it to pounds!) - this of course is not a true comparison, as everything else is charged in rands, but you can at least imagine my horror when I read a consultation fee is 250 pounds and multiply it by 20! BTW, my Cardio gained his post grad. degree at Edinburgh Uni. so the training is just as good!
I don't know what my cardiologist charges now as I am "prise en charge" for my heart which means all things to do with it are paid for by the state part of my medical insurance and I don't get a bill for the visit . I started going in 2011 and for years till I became prise en charge his fee never went up. The bill was paid by the "complementaire" the private insurance that pays for the roughly one third not covered by the state. I have a policy that allows me to go to a private clinic for ops if I want. This does often mean getting quicker treatment.
When I was finally diagnosed by paramedics on the way to the hospital where I spent the night, I was told at the hospital that I would receive an invitation “shortly” to have an echocardiogram and several months later I did get to have one. Mine showed that there was nothing structurally wrong with my heart which cheered me up considerably. So it was just the intermittent electrical fault that was the problem that had to be dealt with. Hope yours doesn’t show up any other problems.
Thank you. Did you get yours done on the NHS?
Yes, as I wrote, the NHS hospital doc told me I would get one very soon when they finally let me leave the hospital and a month or more afterwards I received a letter with a date to have it at a different NHS hospital. There was nothing wrong with my heart structure which was encouraging and hope it works out that way for you too.
You should consider calling the rooms of your EP cardiologist and explain the situation and ask whether there are any tests you should have done for your appointment. You mentioned your Dr is writing to the EP cardiologist so he/she may already know enough about you to start ordering tests. Conversely he/she might want to discuss your situation and options with you before deciding what tests to order.
I'm not a medical professional so don't know whether echo is done with all heart patients.
What I do know is that I had echo done and echo stress test done at request of my cardiologist when I was first diagnosed with AF 5 years ago. I'm pretty sure it was to rule out any pre-existing heart conditions or damage (undetected heart attack etc) before commencing Flecainide for rhythm control. I notice you're only on a beta blocker at this stage so that could one reason for needing an echo but don't know if required if you go for ablation or if Flecainide is already ruled out because of your medical history or conditions.
I have my annual check up with cardiologist in 2 weeks and he requested an echo and stress test echo, presumably to see whether there have been any changes after 5 years of paroxysmal AF episodes and medications. So clearly not just used to check heart before going on Flecainide.
Good luck with your EP cardiologist.
Hello Wilky57,
Depending on cost and availability, an echocardiogram in advance may be worthwhile. I hope your EP consultation goes well.
I had a private EP consultation 5yrs ago (approx £250) when my PAF frequency increased to every 48hrs despite 2x100mg Flecainide a day. I went armed with Kardia printouts as evidence of PAF frequency and was surprised when the EP did an echocardiogram at no extra cost. He said I would be an ideal candidate for PVI cryoablation and put me on his NHS waiting list. The same EP performed a successful ablation on me 3 months later. Amongst other things an echo shows the physical structure of the heart including pulmonary veins. PVI cryoablation requires regular shaped pulmonary veins so that the cryo balloon makes 360 deg contact and ablates rogue electrical signals. If the pulmonary veins are irregularly shaped, an RF ablation may be required instead.
Can you possibly message your EP before the appointment, asking him about the echo?
I’ve had several. One private during the pandemic when Covid affected AF. I think they’re necessary to give cardiologist a good idea of what’s going on. If you go private ask if they give an assessment there and then. I didn’t and all I got was the electrocardiogram the results of which were sent my gp. I’d have preferred to have a consultation straightaway. A subsequent NHS scan picked up moderate problem with a valve. A year later it was only a low problem. The opinion was that the first picked up issues arising from Covid a few months earlier. The second saw an improvement. Either private or NHS, an electrocardiogram is best way forward
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