An exercise ECG is a non-invasive test used in cardiovascular assessment to evaluate how the heart responds to physical stress, primarily to detect signs of myocardial ischemia indicative of coronary artery disease. It also helps assess exercise capacity, identify exercise-induced arrhythmias, and provide prognostic information in patients with known heart disease. During the test, the patient exercises on a treadmill while ECG, heart rate, blood pressure, and symptoms are monitored.

Transthoracic echocardiography is a simple and safe heart scan that uses sound waves (like an ultrasound) to create pictures of the heart from outside the chest. It helps doctors see how well the heart is beating, how the valves are working, and whether there’s any fluid around the heart. It’s often used to check for heart problems like heart failure, valve issues, or unusual heart shapes. The test is painless, done by placing a probe on the chest, and gives doctors important information to help diagnose and treat heart conditions.

Transoesophageal echocardiography (TOE) is an advanced ultrasound technique used to obtain detailed images of the heart by inserting a specialized probe into the oesophagus, which lies close to the heart. This close proximity allows for clearer, higher-resolution images than transthoracic echocardiography of various cardiac structures. TOE is commonly used in the assessment of heart valves preoperatively, or in suspected valve infection, prosthetic valve function, suspected thrombus (e.g., before cardioversion in atrial fibrillation), and certain congenital heart defects. It is semi-invasive and performed under sedation, offering crucial diagnostic and procedural guidance in both acute and elective cardiac settings.

Exercise stress echocardiography is a diagnostic test that combines treadmill exercise with ultrasound imaging of the heart to assess how the heart functions under physical stress. It is primarily used to detect coronary artery disease by identifying wall motion abnormalities that occur when the heart muscle is not receiving enough blood flow during exertion. Compared to a standard exercise ECG, stress echo provides more accurate and direct visualization of cardiac function. It also helps evaluate overall heart performance, assess valvular disease severity under stress, and determine prognosis in various cardiac conditions. The test is non-invasive, safe, and provides valuable real-time information for diagnosing and managing patients with suspected or known cardiovascular disease.

A 24-hour ambulatory blood pressure monitor (ABPM) is a diagnostic device that measures and records a patient's blood pressure at regular intervals over a full day and night as they go about their normal activities. Its primary role is to provide a more accurate and comprehensive assessment of a person's blood pressure profile than a single in-office measurement. This is particularly valuable for diagnosing and managing conditions like "white-coat hypertension," where a patient's blood pressure is elevated due to anxiety in a clinical setting, or "masked hypertension," where blood pressure is normal in the office but high at home or at work. Additionally, ABPM is the gold standard for evaluating nocturnal blood pressure, which is a key predictor of cardiovascular risk. By providing a detailed picture of blood pressure fluctuations throughout the day, ABPM helps physicians make more informed diagnoses, assess the effectiveness of antihypertensive medications, and ultimately reduce the risk of future cardiovascular events.

Holter and event monitors are portable, non-invasive devices used to continuously record the heart's electrical activity over an extended period, typically ranging from 24 hours to several weeks. Their primary role is to detect and diagnose cardiac arrhythmias (irregular heart rhythms) that may not be captured during a standard, resting ECG performed in a clinic. A Holter monitor provides a continuous, comprehensive recording over a set time frame, while an event monitor is patient-activated, recording only when the user experiences symptoms like palpitations, dizziness, or chest pain. These devices are crucial for identifying intermittent arrhythmias, such as atrial fibrillation, supraventricular tachycardia, or ventricular tachycardia, which can be difficult to diagnose otherwise. By correlating the patient's symptoms with the recorded heart rhythm, physicians can accurately determine the cause of the problem and tailor an appropriate treatment plan.

The CT calcium score is a non-invasive imaging test that measures the amount of calcium (hardening) build up in the coronary arteries, serving as a marker of underlying atherosclerosis. It helps to assess a person’s risk of future coronary artery disease events, especially in those without symptoms or with intermediate risk based on traditional factors. A higher calcium score indicates greater plaque burden and increased risk of heart attacks, guiding decisions about preventive treatments like statins, lifestyle changes and in selected cases, aspirin. It is particularly useful for refining risk assessment when traditional risk scores are uncertain, but it does not detect non-calcified plaque or provide information about blood flow obstruction. The test is generally not recommended in men under 40 or women under 50 years old as the build up of calcium is unlikely in younger patients.

CT coronary angiography (CTCA) is a non-invasive diagnostic imaging test that uses a powerful X-ray machine and an injected contrast dye to create detailed, three-dimensional images of the heart and its coronary arteries. Its primary role is to accurately visualize the inside of the arteries, allowing clinicians to detect the presence and extent of plaque buildup, blockages, or narrowing (stenosis) that can restrict blood flow to the heart muscle. Unlike a CT calcium score, which only identifies calcification, CTCA can also identify non-calcified, "soft" plaque, which can be a significant risk factor for heart attacks. This makes it a crucial tool for diagnosing coronary artery disease in patients with symptoms like chest pain or in those with an intermediate risk of the condition, helping to guide treatment decisions and determine if an invasive angiogram is required.

Cardiac MRI (CMR) is a non-invasive imaging test that uses a powerful magnetic field and radio waves to create detailed, high-resolution images of the heart without using radiation. Its role is to provide a comprehensive and highly accurate assessment of the heart's structure and function. CMR is particularly valuable for diagnosing and monitoring complex heart conditions, such as cardiomyopathies, myocarditis (inflammation of the heart muscle), and congenital heart disease, where it offers superior tissue characterization compared to other methods like echocardiography. It can also identify areas of limited blood flow, assess the extent of scarring from a previous heart attack, and evaluate diseases of the aorta and major blood vessels. By providing detailed anatomical and functional information, CMR helps physicians make precise diagnoses, plan treatment, and monitor the progression of cardiovascular disorders over time.