SERVICES
I am available for cardiac consultations, cardiac investigations and treatments.
New and follow up consultations
A new consultation is up to 45 minutes. It will consist of me taking a detailed history, review of your existing records and examination of your cardiovascular system. A follow up is up to 30 minutes.
cardiac investigations
Electrocardiogram (ECG)
This is a non invasive test which provides a point in time assessment of the electrical activity of the heart. Ten electrodes / ECG cables are attached to a patient's chest and the test takes less than 5 minutes, from which 12 snap shot electrical images (leads) are obtained.
An ECG does not directly assess the contractility of the heart, as provided by echocardiography. However, it can provide information of the patient's heart rhythm, rate and an indirect assessment of whether there has been any damage to the heart.
Transthoracic Echocardiography (TTE)
This is the one of most common and important cardiac investigations. In this test real time ultrasound-based images of the heart can be acquired using an echocardiogram machine. In this case, the probe (or ultrasonic transducer) is placed on the chest or abdomen of the subject to get various views of the heart.
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It is a crucial cardiac investigation and its uses include identifying suspected problems with the heart's structure (its chambers, surroundings and valves) and function including the heart's ability to pump blood effectively.
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Ambulatory ECG Monitoring
Ambulatory Heart rate monitoring (electrocardiogram [ECG]) records the electrical activity of your heart while you do your usual activities. Ambulatory monitors are referred to by several names, including ambulatory electrocardiogram (ECG), Holter monitoring, 24-hour ECG, or cardiac event monitoring. The period of monitoring is typically 24-72 hours but can be up to 7 days.
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Many heart rhythm problems become noticeable only during activity, such as exercise, eating, stress, or even sleeping. A continuous recording is more likely to detect any abnormal heartbeats that occur during these activities or when they occur periodically over a 1-7 day period.
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The importance of irregular heartbeats depends on the type of pattern they produce, how often they occur, how long they last, and whether they occur at the same time you have symptoms. Because cardiac rhythm disturbances are often intermittent, it may be difficult to record an arrhythmia while you are in the doctor's office. Ambulatory monitors may be continuous as above or intermittent which are used when symptoms (suggesting an abnormal heart rhythm) are infrequent. An intermittent recorder can be used for a longer time than a continuous recorder and include external loop recorders or internal loop recorders.
Implantable Cardiac Monitor (ICM) / Internal Loop Recorder (ILR)
This is a miniaturised device that is inserted under the skin and fat over the front of left side of your chest. The device is often called also known as an insertable cardiac monitor.
The devices I use are the smallest on the market and are as small as an AAA battery.
This device can be used to wireless record your heart's activity for up to three years and is an ideal device in patients with infrequent and significant palpitations or blackouts.
Ambulatory Blood Pressure Monitoring
This test allows for the recording of blood pressure throughout normal activities and during sleep.
This is typically done every 20-30 minutes over a 24 hour period.
These devices are the gold standard for the diagnosis of hypertension (genuine high blood pressure).
They can help to differentiate genuine hypertension from white coat hypertension (increased blood pressure in the presence of health professionals only).
Exercise Treadmill test
This test is often done for DVLA licencing using an upright treadmill with 12 lead ECG recording and can be part of a cardiopulmonary exercise test (CPET). During this test your blood pressure and symptoms are also recorded. The treadmill speed and incline will be increased every 3 minutes during a typical protocol.
Cardiopulmonary Exercise Test (CPEX, CPX, CPET)
This is a minimally invasive assessment of the heart, lungs and circulatory response to exercise either on a bicycle or upright treadmill. It is the most robust assessment of cardiopulmonary fitness. Unlike most stress tests CPX is unique in that it assesses the heart, lungs and circulation in one test. It involves attaching a facemask and ECG electrodes during rest, exercise and recovery. It involves assessing the patient's consumption of oxygen, continuous ECG monitoring, cardiac output, assessment of oxygen saturation, carbon dioxide production among a huge number of other measured variables.
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A typical test takes about 40 minutes to complete in total. At the Heart Clinic Poole a state of the art system with fully integrative diagnostic and interpretative software are used. We are recognised as a tertiary centre for this service. Please click link for information on preparing for this test
Pulse Trace PCA2 Device
Arterial Stiffness Assessment
This is an indirect and non invasive test used to assess the stiffness (hardening) of the major arteries. Increasing arterial stiffness and associated reducing elasticity occurs with age and in association with a number of cardiac risk factors.
It is a robust and useful heart risk or heart screening assessment tool which is rapidly moving from the research to the clinical setting. At Heart Clinic Poole the Pulse Trace PCA2 device is used. The test takes less than 2 minutes to perform and involves attaching a transducer to a finger tip. The technology uses the principle of pulse contour analysis to measure the speed of the forward and reflected pulse waves with an immediate result available.
Coronary Angiography (cardiac catheterisation)
This is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is a day case procedure and is performed for both diagnostic and interventional (treatment) purposes (PCI).
Coronary catheterization generally takes about half an hour and access to the coronary circulation is gained either via the right femoral artery (in the groin) or right radial artery (wrist) under local anaesthetic. The procedure is performed in order to identify the presence of narrowing or occlusion in the coronary arteries which supply the heart with its own blood supply. It is also performed as part of a work up for major cardiac surgery such as valve surgery. The risk of a major complication from the procedure is generally less than 0.3%.
cardiac TREATMENTS
Cardiac Pacing and Device Therapy
This broad terminology incorporates a number of differing pacing treatments for the heart which include permanent pacemakers, implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT) and biventricular pacing. Simple brady pacemakers prevent the heart going too slowly or temporarily pausing which can cause blackouts, fatigue and breathlessness.
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A typical brady pacemaker involves either one or two wires (leads) placed into the heart. This is done under local anesthetic.
Cardiac Resynchronisation Therapy
The procedure typically involves the use of 3 lead (wires) pacemaker to help coordinate the electrical activation and physicial contraction of the main pumping chamber of the heart.
This can be included in a smaller box when it is termed cardaic resynchronisation with a normal pacemaker (CRTP). When it is combined with the ability to shock the heart from abnormal fast rhythm back to normal rhythm it is termed cardiac resynchonisation therapy with a defibrillator (CRTD). Because CRT improves the heart’s efficiency and increases blood flow, patients have reported alleviations of some heart failure symptoms - such as shortness of breath. Clinical studies also suggest decreases in hospitalization and morbidity as well as improvements in quality of life.
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In general, CRT is for heart failure patients with moderate to severe symptoms and whose left and right heart chambers do not beat in unison. However, CRT is not effective for everyone and is not for those with mild heart failure symptoms, diastolic heart failure or who do not have issues with the chambers not beating together. It is also not suitable for patients who have not fully explored correcting the condition through medication therapies. To date, studies show CRT to be highly effective at improve the heart function, patient's quality of life and heart failure-related symptoms and reduces heart failure hospitalisation and cardiovascular death.
To learn more:
Implantable Cardioverter Defibrillator (ICD)
An ICD is an electronic device that constantly monitors your heart rate and rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle either as aggressive anti tachy pacing (painlessly to restore the heart rhythm back to normal) or in the form of a heart shock (defibrillation). Furthermore, it can function as a routine pacemaker.
The procedure consists of a generator (placed under the skin and fat in the left upper chest) which is attached to one or more leads which are positioned into the relevant chambers via a vein under the collar bone on the left side usually.
Cardioversion
Cardioversion is a procedure that uses an electric shock delivered from a defibrillator to restore your heart rhythm to normal if you have arrhythmia. Arrhythmia is caused by faulty electrical signals in your heart. There are different types of arrhythmia that can be treated with cardioversion. This most commonly atrial fibrillation or atrial flutter.
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It is done using a short acting general anesthetic and is a short day case procedure.
Cardioversion isn’t suitable for everyone. It will depend on how long you have had arrhythmia for, your general symptoms and your medical history. Please click link for more information
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Exercise Prescription
This involves the provision of a tailored exercise programme based on a patient’s baseline level of fitness. This frequently includes the use of baseline cardiopulmonary exercise testing (see under heart investigations).
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