Diagnostic Services
Non-invasive treatments are used to diagnose heart conditions without performing surgery or other invasive procedures. The non-invasive methods include-
- Electrocardiogram (ECG)
- Echocardiography
- Stress test (TMT)/ Stress Echo
- Ambulatory Blood Pressure Monitoring
- (ABPM)
- Holter monitoring
- Cardiac magnetic resonance imaging (MRI)
- Blood Profile

Dr Suraj Patil
Consultant Interventional Cardiologist
Electrocardiogram (ECG/EKG):
An electrocardiogram records electrical signals from the heart. It is a simple, quick and painless procedure used to detect abnormalities such as heart attacks or arrhythmias. Electrodes are connected to your body and with the help of a machine, electrical activity of your heart i.e. ECG is recorded. ECG also helps to detect heart attack events in the past.
Generally, Medical practitioner order an ECG in case of:
- Ongoing Chest pain or Chest pain on exertion
- Shortness of breath
- Palpitations/Filling one’s own heart beat
- Syncope/Dizziness/lightheaded
- Swelling over feet or all over body
Echocardiography:
2D Echo is a safe, painless, radiation free test used to visualize your heart. This test uses high-frequency sound waves to create a moving image of the heart. It can help to detect varied problems such as heart valve disease, congenital heart anomalies, heart failure, etc. Period of fasting is not required before the test.
- It shows weakness of heart muscles and whether they are pumping enough blood i.e. Ventricular dysfunction
- It shows size of your heart like any dilatation or hypertrophy
- We can visualize your heart valves and get to know whether they are leaking (regurgitation) or narrowed (stenosis)
- Developmental abnormalities of heart can be seen even in few minutes old baby
- Other entities like collection of fluid around the heart (pericardial effusion), tumors in and around the heart can also be seen
2D echo is generally advised if you are having angina i.e. Chest Pain at rest or on exertion or signs of heart failure like shortness of breath, swelling over the feet or all over body. Abnormal heart sounds on auscultation i.e. heart murmurs can also warrant 2D echo. As part of pre-surgical risk assessment, echo is advised sometimes. Any risk factors for heart disease such as diabetes, hypertension, smoking, obesity, stressful lifestyle, lack of physical activities and those with a family history of cardiac disease may also be advised an echo It is not advisable to do 2d echo annually if you don’t have any heart disease in the past or risk factors for it.
Stress Test:
This test involves walking on a treadmill while monitoring the heart’s electrical activity. Abnormalities in the heart monitored with the help of ECG. It can help to detect problems such as blocked/ narrowed coronary arteries or abnormal heartbeats during exercise.
Preparation for Test:
ECG electrodes are connected to your chest while you are walking on a treadmil. Hence, male patients are asked to shave their chest before coming for the procedure. Continue your old medicines as usual unless your docor asks otherwise. Avoid wearing tight clothes. Do not eat 2 hours before the test and do not drink liquids 1 hour before the test.
Procedure:
Test geneally lasts about 25-30 minutes. Cardiac Physiologist (ECG Technician) will take you to TMT room where you will be asked to remove clothing over chest area. Female patients are given a loose gown to wear. ECG electrodes are attached to your chest along with a BP monitoring cuff around your arm.
A baseline ECG and blood pressure is recorded. Then, you will be asked to walk on treadmill and every 3 minutes, ECG is recorded. After each 3 minutes, speed and slope of treadmill increases. The test will be stoppedimmediately if you develop symptoms such as chest pain, breathlessness or leg pain during the test or if any concerning signs are noticed on the blood pressure or heart rhythm (ECG) monitors. For the test to provide conclusive evidence of coronary artery disease, your heart rate must increase with the exercise to 85% of your predicted maximum possible heart rate (220 minus age in years). After the test is concluded, your blood pressure and heart rhythm will continue to be monitored as they return to normal.
The exercise ECG recordings will be interpreted by our Cardiologist and final report is given along with proper advise.
Stress ECHO:
Ambulatory Blood Pressure Monitoring (ABPM):
This test measures your blood pressure over 24 hours using a portable device. Hypertension also called high blood pressure, is detected with this test. Hypertension is defined as blood pressure measurements in which your systolic (upper) blood pressure is at or above 140, and your diastolic (lower) blood pressure is at or above 80. Ambulatory blood pressure monitoring allows your blood pressure (BP) readings to be recorded over a 24-hour period, whether you’re awake or asleep.
Procedure:
A Blood pressure measuring cuff is tied around your arm and a wearable pocket sized portable device is connected to it through tubing. You will be sent home with the device and asked to return it after 24 hrs. BP readings are taken automatically every 30 minutes during the day and every hourly during night. These readings are then averaged. Changes in BP and heart rate, the BP distribution pattern and other statistics are calculated.
Who needs it?
Guidelines for blood pressure management from the American Heart Association and American College of Cardiology now strongly recommend confirming a diagnosis of hypertension with ambulatory BP monitoring. For most people systolic BP decreases about 10% to 20% during sleep. However, for some people BP might not drop during sleep. It may even rise. Ambulatory BP monitoring provides additional information about how changes in your BP may correlate with your daily activities and sleep patterns.
White coat hypertension:
Some people tend to have high BP recordings when taken in a hospital or clinic, while they have normal BP when measured at familiar surroundings like home. This is known as “white coat hypertension.” White coat hypertension results in patients wrongly labelled as hypertensive and started on medicines. Upto 30% of patients with elevated BP readings, actually have white coat hypertension. Current guidelines don’t recommend starting medicines when ambulatory monitoring shows readings within the normal range even if your clinic recordings are higher. But, regular monitoring is still required as there is a high chance of developing hypertension in the future.
Masked hypertension:
This is opposite of white coat hypertension with normal BP readings at hospital and elevated when you’re at home. It may occur in up to 20% of untreated people. This condition has similar health risk to sustained hypertension, and should be treated with BP lowering medications
Uncontrolled hypertension: In some cases, anti hypertensive drugs don’t control BP effectively throughout the entire day and night. So, knowledge of patient’s BP patterns helps your doctor to adjust the dosage prescribed or the time that the medication is given. In some cases, additional drugs may be prescribed to stabilize BP.
Avoid sleeping on the arm recording BP. You may experience mild discomfort due to 24-hour BP monitoring. Pressure due to repeated BP cuff inflations can cause discomfort in your upper arm. BP readings during the night may interfere with your sleep. Skin irritation or mild rash also seen rarely, usually goes away on its own.This is opposite of white coat hypertension with normal BP readings at hospital and elevated when you’re at home. It may occur in up to 20% of untreated people. This condition has similar health risk to sustained hypertension, and should be treated with BP lowering medications
Uncontrolled hypertension: In some cases, anti hypertensive drugs don’t control BP effectively throughout the entire day and night. So, knowledge of patient’s BP patterns helps your doctor to adjust the dosage prescribed or the time that the medication is given. In some cases, additional drugs may be prescribed to stabilize BP.
Avoid sleeping on the arm recording BP. You may experience mild discomfort due to 24-hour BP monitoring. Pressure due to repeated BP cuff inflations can cause discomfort in your upper arm. BP readings during the night may interfere with your sleep. Skin irritation or mild rash also seen rarely, usually goes away on its own.
Holter Monitoring:
A portable pocket sized device records ECG( the electrical signals of the heart) for 24 hours. It can help to detect irregular heartbeats or other cardiac issues that may not be evident during a regular ECG. Holter monitor can be worn for 1 to 7 days (depending on your physician’s instruction).
Preparation:
Multiple ECG electrodes are attached to your chest. So, Male patient are asked to shave off chest hairs. Its convenient if you wear clothes with easier access to chest. Avoid tight Clothes. Continue your should continue you’re your daily activities as usual, including any old medications. Its better to have a bath before starting the test as you are not allowed while wearing the monitor.
Procedure :
After attaching electrodes, small pocket sized monitoring is connected to it which can be worn as a sling. You will be provided with extra electrodes in case one comes off and will be taught regarding how to apply it. Then, you will be sent home and asked to come after 24hrs. You will be asked to keep a diary of events like palpitations, dizziness etc during the test with the details like date, time and how you felt. This will help us to correlate your ECG recorded data with your symptoms.
After completion of the test, Electrodes are removed and data from the devices is processed on computer. Our Cardiologist will go through your whole data and give you a concise report.
Coronary Angiography:
It is a diagnostic test that uses X-ray imaging to visualize the heart’s blood vessels and identify blockages or other coronary abnormalities. It is also used as a guide for other interventional procedures.
During a coronary angiogram, a special dye that’s visible by an X-ray machine is injected through specially designed catheters into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels. If necessary, your doctor can perform procedures such as an angioplasty during your coronary angiogram.
Who needs it?
Coronary angiography is gold standard test to diagnose coronary artery disease i.e build up of fatty substance in coronary arteries. It can be used to diagnose various heart conditions and help plan future treatments and carry out certain procedures like-
- After a heart attack – where one of the heart’s blood vessel gets blocked
- To help diagnose stable angina – where subtotal blockage of vessel leads to chest pain
Procedure:
You will be asked to fast for 6 hrs before coming for the procedure. You will be taken to cardiac cath lab at the hospital. A small needle puncture is taken in your right wrist or groin, through which a long flexible tube called catheter is inserted and taken up to heart. Catheter is manipulated to hook coronary blood vessels. A special type of dye (contrast) is injected into the catheter which visualizes the vessels. X-ray images are taken during injection and shown on screen. It clearly shows blocked arteries and further procedures can be planned accordingly. You are fully awake during whole procedure with local anesthetic given at wrist area to numb that part of body.
Recovery:
Our cardiologist specialize in doing angiography through wrist, so you will be able to sit up immediately after the procedure. You can have sips of water after the procedure and food can be taken after 2 hrs. Mild pain may persist for a day at the site of puncture with wound healing in next 4-5 days. Any bruising may last for few weeks.
You/ your family members will be shown the result of angiography and further plan is decided. You will be discharged after 4 hrs of observation and asked to follow-up after 5 days.
You will usually be advised to avoid certain activities, such as driving and lifting heavy objects, for a day or two after the procedure. While you are recovering, it’s important to look out for signs of any problems. You should seek immediate medical attention if swelling at the site of your wound gets worse, or if you experience excessive bleeding or circulation problems in your limbs.
Angioplasty:
It is a procedure used to open narrowed or blocked coronary or peripheral blood vessels. A small balloon is inserted through a catheter, then inflated to widen the vessel and improve blood flow. Then, a stent (a metallic hollow tube) is deployed in that part to maintain blood flow. Angioplasty is typically used to treat conditions such as coronary artery disease (CAD) and peripheral artery disease (PAD)
Coronary Angioplasty is also known as percutaneous transluminal coronary angioplasty (PTCA). The combination of coronary angioplasty with stenting is referred to as percutaneous coronary intervention (PCI).
Who needs it?
Every organ in the body needs constant supply of blood to function properly. There are three main vessels supplying blood to heart with their multiple branches. With age, there is deposition of fats inside these vessels and there is narrowing and hardening (called as atherosclerosis) of these vessels. As a result, there is decrease in blood supply to the heart and we feel chest pain, breathlessness, fatigue etc. Medications usually helps to tackle this problem, but in severe cases, medications are not able to relieve your symptoms completely. Coronary angioplasty is required in such cases. Also, angioplasty is done as as emergency procedure when patient presents with heart attack i.e. complete blockage of coronary artery.
Procedure:
Initial few steps in coronary angioplasty are similar to that of angiography.You will be asked to fast for 6 hrs before coming for the procedure. You will be taken to cardiac cath lab at the hospital. You are fully awake during whole procedure with local anesthetic given at wrist area to numb that part of body. A small needle puncture is taken in your right wrist or groin, through which a long flexible tube called catheter is inserted and taken up to heart. Catheter is manipulated to hook coronary blood vessels. A special type of dye (contrast) is injected into the catheter which visualizes the vessels. X-ray images are taken during injection and shown on screen. It clearly defines blocked arteries. Then, a thin wire passed down the catheter into blood vessel across that blockage. A small balloon tipped catheter is advanced over it and inflated when in right position. This high pressure balloon inflation widens the artery and crushing the fatty deposits against the vessel wall. Deflated balloon is removed and a stent (small metallic tube like mesh) is deployed in that same area. This helps to keep that vessel patent for longer duration. In Case of heart attack patients, pain relief is obtained immediately on the operating table itself. Afterwards, all the hardwares are removed and you are shifted to ICU for monitoring.
Benefits and safety:
As mentioned, heart attack patients get immediate pain relief with angioplasty and it increases their life span and reduces further events in the future. Those Patients with chest pain on exertion before the procedure hardly find any symptoms afterwards. They are able to be more physically active as compared to before.
Coronary angioplasty is one of the most common types of treatment for the heart. Around 4.5 lakhs patients undergo angioplasty annually. Coronary angioplasty is most commonly performed in people who are above 65 years of age or older as they are more likely to have a heart disease. As the procedure does not involve making major incisions in the body, it is usually carried out safely in most people. Doctors refer to this as a minimally invasive form of treatment. The risk of serious complications from a coronary angioplasty is generally small, but this depends on multiple factors such as your age, general health and whether you have suffered a heart attack. Serious problems that can occur as a result of the procedure include excessive bleeding, a heart attack and even a stroke. There are some intra-procedure rare adverse events like rupture of blood vessel, collection of blood around the heart, loss of coronary hardware etc.
Complex Coronary Interventions:
These include procedures that are more challenging and technically demanding than traditional angioplasty, such as procedures for multiple blocked vessels, chronic total occlusions, and Calcified or bifurcation lesions. These procedures are performed by interventional cardiologists and require special skills and equipment. Rotablator uses high speed rotating diamond crowned burr to modify heavily calcified narrowings and improves the patency of the vesssle
Coronary Imaging:
Valve Treatments:
Procedures such as transcatheter aortic valve replacement (TAVR) and percutaneous mitral valve repair are used to treat conditions such as aortic stenosis and mitral regurgitation respectively
What is TAVR /TAVI ?
Heart valves regulate blood flow from one heart chamber to other. Damage to valve at aortic level( which controls blood flow from heart into Aorta) leads to major symptoms. Such valve needs replacement. Nowadays, Using transcatheter approach, a new valve is implanted without removing the old, damaged valve. This new valve remains inside old diseased valve. This procedure is called transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).
How does it work?
Similar to coronary angioplasty, where a stent is placed into coronary artery, the TAVR deploys a crimped up valve at the valve site through a catheter.
Once the new valve is expanded with balloon, it crushes the old valve leaflets and the tissue in the replacement valve starts doing the work of regulating blood flow.
How is TAVR differs from surgical standard valve replacement?
Standard surgical valve replacement requires open heart surgery to replace the damaged valve but, in case of TAVI, no big incisions are required, so, in case of high risk surgical patients, TAVR proves to be a boon with faster recovery and low procedural risk. It can be done in all symptomatic severe Aortic stenosis patients with low to high risk of surgery
The TAVR procedure is performed using one of two approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:
- Entering through the femoral artery (large artery in the groin), called the trans-femoral approach, which does not require a surgical incision in the chest, or
- Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the trans-apical approach.
Vascular Interventions:
Procedures such as peripheral angioplasty and stenting are used to treat conditions such as peripheral artery disease and carotid artery stenosis. This is a technique deployed to allow oxygen-rich blood to flow smoothly through the vessel by re-opening those blood vessels. A very useful alternative to open surgical bypass since it asks for a smaller incision, shorter healing period and fewer complications.
In Cardiac cath lab, under imaging guidance of X-ray machine, catheter is advanced and towards the artery that is blocked. Then with the help of wires balloon tipped catheter is passed across the blockage and inflated at high pressures so as to widen the lumen. A stent is implanted at that site to maintain the result for long term.
Consult a noninvasive cardiology specialist in Pune for the best diagnosis and treatment plan.
If you are looking for the best non-invasive cardiology treatment in Pune, look no further than our team at Dr. Patil’s Heart and Skin Clinic. With the highest quality of care and expertise, we ensure you receive the best treatment possible. Whether it is an urgent visit or an appointment, we work hard to make sure all patients receive personalized attention and care.