Some people are at higher risk of developing heart disease. We offer a range of services to help assess people who for whatever reason, may be at increased risk of heart disease.
Cardiac Screening
Cardiac screening can involve assessing the risks for developing coronary artery disease as well as evaluating for heart muscle and heart valve dysfunction. This can involve a consultation and assessment of risk factors such as high blood pressure, diabetes and body mass index. If there are symptoms that could indicate coronary artery this can be further investigated.
Some younger patients may be at risk of heart rhythm irregularities that may need investigation and risk stratification. This may include tests such as an ECG, 24 hour ECG tape, an echocardiogram and possibly and exercise treadmill test.
Some patients may have a family history of cardiac disease such as cardiomyopathy. Relatives may need screening with an ECG and echocardiogram.
Coronary Angiography
The coronary circulation consists of the blood vessels (coronary arteries) that supply blood to, and remove blood from, the heart tissue. Coronary arteries supply oxygen rich blood to the heart are essentially the fuel pipes. Serious heart damage may occur when the coronary circulation is blocked or restricted.
Angiography is an invasive test that enables your doctor to take x-ray images of the inside of your blood vessels. This procedure is performed by a cardiologist and involves threading a tiny catheter through a small incision into a large artery, usually in your wrist and occasionally the groin. Once the catheter reaches the site of the blood vessel to be viewed, a dye is injected and x-ray images are taken. Angiography enables your doctor to view how blood circulates in the vessels in specific areas of the heart. The clear assessment of the anatomy, the disease severity and location allows the cardiologist to recommend specific treatment.
Coronary Angioplasty and Stenting
Angioplasty is a medical procedure used to treat narrowing of the arteries that supply blood to the heart. This is accomplished by inflating a small balloon inside the artery to increase the blood flow to the heart and a stent which acts as a scaffold is usually inserted to keep the artery open. It may be performed on an emergency basis following a heart attack, or on an elective basis when conservative treatment measures have failed to relieve symptoms of Coronary Artery Disease such as chest pain and shortness of breath.
It is commonly referred to as Percutaneous Coronary Intervention (PCI)
If conservative treatment options are unsuccessful and you continue to have chest pain or are at risk of having a heart attack, your cardiologist may recommend a procedure called balloon angioplasty and stenting.
Angioplasty is performed by an Interventional Cardiologist in the Cardiac Catheterisation Lab of the hospital under local anaesthesia and IV sedation. You will be awake but relaxed and drowsy.
During Angioplasty, the patient is placed lying on their back on an x-ray table.
The catheter insertion area, groin or wrist, is shaved, disinfected, and injected with a local anaesthetic to numb the area.
Your Cardiologist will perform an angiogram first to determine the extent and location of blockage within the coronary arteries prior to proceeding to an angioplasty.
Your cardiologist will make a tiny cut over the insertion site and insert a small tube called a sheath into a blood vessel in the wrist (or groin, depending on your surgeon’s preference).
A flexible tube called a catheter is then gently passed through the sheath into the vessel until the blockage is reached.
A special dye is then injected through the catheter and into the artery so x-ray pictures can be obtained showing the location and extent of the blockage.
At this point, the cardiologist can proceed with the Angioplasty.
Your cardiologist will now insert a guide wire through the catheter advancing it across the blockage.
The catheter with a deflated balloon on its end is then threaded over the guide wire into the blockage.
The balloon is then inflated to push the plaque against the artery walls. This opens up the artery allowing increased blood flow to the heart.
Your cardiologist may deflate and inflate the balloon more than once within an artery to ensure the best result.
Often, the cardiologist will place a stent within the artery. A stent is a wire mesh tube placed within the artery to help keep the artery open. The stent is placed over the deflated balloon at the tip of the catheter before inserting the catheter into the blockage. When the balloon is inflated, the stent is pushed in place against the artery wall. Some stents are coated with medicine to keep blood clots from forming or the artery from closing.
Once your doctor is satisfied with the results, the balloon is deflated and the guide wire and catheter are withdrawn. The stent remains in place within the artery.
Pressure will be applied to the insertion site for 15 minutes followed by a tight pressure bandage to prevent bleeding.
Post Operative Guidelines
After Angioplasty you will be taken to the recovery room and be told to lie still for 6-8 hours to prevent bleeding from the puncture site if carried out from the groin. If the puncture site was performed in the wrist area, you will be able to get out of bed or sit up.
Recovery time varies depending on whether your procedure was an angiogram or an angiogram with angioplasty. If only an angiogram was done, you may be able to go home with a driver after a few hours. If angioplasty was performed, you will likely spend 1days in the hospital.
Common post-operative guidelines following Angioplasty include the following:
- You will need someone to drive you home after you are released. You should not drive for 1-2 days after the procedure.
- Do not remove the dressing over the puncture site until instructed to do so. Keep the area clean and dry.
- Your surgeon may give you activity restrictions such as no heavy lifting for a few days to prevent bleeding from reoccurring.
- You may have soreness and bruising around the puncture site.
o If a stent is placed, your doctor will prescribe blood-thinning medicines to prevent blood clots from forming around the stent. It is very important that you adhere to your prescribed medications to prevent blood clots from forming.
Contact your doctor immediately if you have a fever, chills, redness, bleeding, irregular heart beat, chest pain, shortness of breath, weakness, or dizziness.
Risks & Complications
As with any medical procedure there are potential risks involved. The decision to proceed with the procedure is made because the advantages outweigh the potential disadvantages.
It is important that you are informed of these risks before the procedure takes place.
Most patients do not have complications after Angioplasty; however complications can occur and depend on what type of procedure your doctor performs as well as the patient’s health status. (i.e. obese, diabetic, smoker, etc.)
Complications can be medical (general) or specific to Angioplasty.
Medical complications:
Usually due to the patients well being. Almost any medical condition can occur so this list is not complete. Complications include:
- Allergic reaction to medications or dye
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attack, strokes, kidney failure, pneumonia, bladder infections
- Complications from insertion site such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.
o
Specific complications for Angioplasty:
- Bleeding from the insertion site
- Irregular heart beat
- Chest pain during procedure
- Blood vessel damage from the catheter requiring an operation for repair.
- Kidney damage from dye used with angiogram
- Restenosis- usually occurring within 6 months, restenosis is the re-accumulation of plaque or scar tissue causing narrowing or blockage again of the coronary artery. This risk is lessened with the use of a stent.
- Blood clots
o Need for an emergency Coronary Artery Bypass Graft (CABG or open heart surgery)
Risk factors that can increase the chance of complications following angioplasty include:
- Diabetes, especially if taking a medication called Glucophage.
- Women are at higher risk than men to develop complications.
- History of kidney disease
- Poor cardiac function
- Extensive heart disease
- Poor nutrition
- Smoking
- Obesity
- Age (over 75)
- Alcoholism
- Chronic Illness
- Steroid Use
Permanent Pacemaker Implantation
An artificial pacemaker is a small device that is surgically implanted in the chest, usually under local anaesthesia, that helps to regulate the heartbeat when the heart is beating too slowly (bradycardia) with symptoms of fatigue, fainting sensations or blackouts.
The pacemaker is powered by batteries and uses electrodes to deliver weak electrical impulses to the heart causing contraction of the heart muscles.
The procedure is carried under Local Anaesthetic and sedation and takes 45-60 minutes in theatre. This can be carried out as a day case.
Transoesophageal Echocardiogram
Transoesophageal Echocardiogram is an investigation using ultrasound to assess the anatomy of the heart in a much clearer details compare to a standard (transthoracic) Echocardiogram. This is because the ultrasound transducer is located on a probe which is swallowed by the patient under local anaesthetic and sedation. This therefore has an unobstructed view of the heart from the oesophagus from behind the heart.
The standard Echo views are frequently obstructed by ribs of the chest wall and the chest wall thickness will determine the distance the scanner head from the heart. It can provide only limited information compare to a TOE which sits much closer to the heart and there provides a much more detailed image. This is particularly useful for examining the heart valves and looking at heart masses and for the presence of blood clots in the heart chambers.
Arrhythmia Management
Rhythm disturbance (arrhythmia) is a common condition and the most common arrhythmia is Atrial Fibrillation (AF).
Depending on the type of AF the treatment may be:
Reassurance
Many arrhythmias are benign and cause no short or long term health concerns. Examples are ectopic heart beats or extra-systoles. They give symptoms like the heart ‘fluttering’ or ‘missing a beat’. Reassurance is all that is needed and will avoid adverse reactions from medication.
‘Pill in the pocket’ approach
This is sometimes recommended for patients with a benign arrhythmia which is not acutely life threatening but is causing constant symptoms of either palpitations or dizziness or shortness of breath when it is occurring. The episodes are prolonged enough to give intolerable symptoms and therefore taking a medication as and when required to stop it, would be advisable. The arrhythmia generally occurs infrequently for this approach to be recommended.
Regular Medication
Medication on a daily bases are recommended for arrhythmias that occurs frequently or if the arrhythmia is potentially harmful. They all have their recognised side-effects and trial and error to see the one that suit the patient the best usually is the method of selection. The cardiologist will select the class of medication that he feels will be most appropriate for the patient from the detailed history and examination.
Cardioversion
Cardioversion is the medical term for restoring an abnormal heart rhythm to normal regular heart rhythm (Sinus rhythm). When the heart rhythm is abnormal, the heart beat less efficiently causing shortness of breath, fatigue and leg swelling. Attempts to restore normal heart rhythm can be done either using medication or external electrical energy. Electric shock energy is applied to the chest for a split second under heavy sedation or general anaesthetic is very effective and is one of the safest way to restore normal heart rhythm. Patient is usually treated with a blood thinning medicine to prevent strokes.
Ablation treatment
This Catheter ablation is a minimally invasive procedure to treat atrial fibrillation. It can relieve symptoms and improve quality of life.
During an ablation, the doctor destroys tiny areas in the heart that are firing off abnormal electrical impulses
Thin, flexible wires called catheters are inserted into a vein, typically in the groin or neck, and threaded up into the heart. There is an electrode at the tip of the wires. The electrode sends out radio waves that create heat or freezing cold to destroy the heart tissue. It is carried out under local anaesthetic and sedation.
Ablation might be done if you have symptoms that won’t go away after you take an antiarrhythmic medicine to control your heart rhythm. Either your medicine did not bring back a normal heartbeat, or your medicine caused side effects that are hard to live with.
Monitoring of heart rhythm and blood pressure
Before or after treatment of heart conditions, it is likely the cardiologist would recommend accurate assessment of the heart rhythm and blood pressure before instigating long term treatment with either drugs or intervention. This is to assess the need and also to assess the effectiveness of the treatment. Single measurements of heart rhythm and blood pressure does not provide the true picture of the cardiac condition.
For cardiac health screening, it also provides vital information to confirm or refute whether there is persistent high blood pressure or heart rhythm disturbance. The tests are also mandatory for certain congenital or hereditary cardiac conditions.
Both test are simple, non-invasive and acceptable by the patients.