Treatments

Whilst most patients with heart disease can be managed medically (ie with lifestyle interventions and tablets) others may need to have invasive or interventional treatment procedures performed. These will be usually be performed personally by your Cardiologist at a local hospital. if you require highly specialised treatments not undertaken by West Kent Cardiology Partnership Consultants you may be referred to a Consultant in London who has a special interest in your particular condition.

When you see your Cardiologist to review the results of your tests and your diagnosis he will discuss in detail the procedure that your require explaining the aim of the treatment, what the procedure involves and any risks that may be associated with it. You will be given a detailed information sheet regarding the procedure to take home with you to read. If you do not have medical insurance you will also be given a quote for the cost of your procedure which will include the hospital charges, your Consultant’s fees and also the anaesthetic fee (if necessary).

When you are ready to book your procedure our Administration Department will offer you a variety of dates and you will be able to choose the one that best suits your needs. Where appropriate we are happy to contact your medical insurance company directly to seek authorisation for your procedure. Patients generally find this helpful as often the insurance companies require procedure codes and other technical information. This will also help us to reassure you that you are properly covered to have the procedure performed as often these treatments can be expensive. With a small number of insurers there may be a shortfall on your Consultant’s professional fee (ie your medical insurer does not cover the fee in full, leaving you liable to settle the shortfall directly). Where necessary our Administration Team will point this out to you both verbally and in writing prior to booking your procedure. We hate our patients to have nasty surprises once there treatment has been completed!

Once your medical insurers have confirmed cover for your treatment or, if you do not have insurance, you have agreed to settle the quoted fees we will book your procedure directly with the hospital. You will then be sent a detailed letter with information and instructions on the day of your procedure. We encourage you to contact our Administration Team directly if you have any queries regarding these arrangements and if you have any questions directly relating to your treatment your Consultant will be happy to answer them for you.

Within 24 hours of your procedure having been performed and your discharge from hospital your Consultant will write a detailed summary to your General Practitioner outlining what was done and the results of the procedure. This will also include details of any changes of medication or post-procedure instructions. Our Administration Team will ring you on the day following your discharge to see how you are and to answer any questions you may have. If necessary they will also arrange a follow-up consultation for you to come and meet your Consultant.

For your convenience we have listed the main treatment procedures that may be recommended to you. These may include:

Coronary angioplasty and stenting
Coronary artery bypass graft surgery
Heart valve surgery
Cardioversion
Permanent pacemaker
Implantable defibrillators
Ablation
Cardiac resynchronisation therapy

We have given a brief summary of these procedures below but more detailed information will be given if these procedures are required.

Coronary angioplasty and stenting

This procedure is performed when a coronary angiogram reveals an obstructive narrowing in one or more of the coronary arteries which is reducing the blood supply to your heart, often causing angina, breathlessness or other related symptoms. It is performed in a similar way to the angiogram and avoids the need for you to undergo coronary artery bypass graft surgery. It involves passing a small balloon into the affected coronary artery via an artery in your leg. This balloon is then dilated to re-open the narrowing in the artery. Once this is done one or more tiny metal stents are inserted and left to help keep the artery open. The improved blood supply to your heart will usually result in a significant improvement in symptoms, often with complete resolution.

If you require an angioplasty procedure your Consultant Cardiologist will perform this procedure personally. Currently these procedures are performed in London ( London Bridge Hospital , St Thomas ’ Hospital or King’s College Hospital ) as they require specialist equipment which currently we do not have locally. Like your coronary angiogram this is performed under a local anaesthetic and once this has been performed you will usually need to stay in hospital overnight. All being well you will then be able to go home on the morning after your procedure.

Following your angioplasty you will be advised to increase your activities back to normal over a 2 week period. Your Cardiologist will review you 6 weeks following the procedure and may arrange for you to have an exercise test or echocardiogram to assess the effect and function of your coronary stent(s).

Coronary artery bypass graft surgery

Your Consultant may recommend this treatment if your coronary angiogram has revealed that you have severe narrowings in one or more of your coronary arteries and where it is not possible to treat your condition with either medications or angioplasty/stenting. It involves open heart surgery where blood vessels taken from your legs, chest or forearm are used to bypass the narrowed or blocked arteries. It is a highly proven and effective treatment for severe coronary artery disease, can be life-saving for some patients and will usually significantly improve or completely alleviate angina and other related symptoms.

Your Cardiologist will discuss this procedure in detail with you following your coronary angiogram but the operation itself will be performed in London by a Consultant Cardiac Surgeon. Our Cardiologists work closely with a number of surgeons and will be able to recommend and refer you on to one of these highly experienced professionals. The cardiac surgeon will arrange to meet you in out-patients prior to booking your procedure to discuss your surgery in more detail and to answer any questions that you might have.

Following your coronary artery bypass graft surgery we will contact when you are discharged home to reassure you that we are available should you have any questions or concerns. You will normally see your surgeon for out-patient review at 6 weeks following your surgery. If he is happy with your progress he will then discharge you back into the care of your Consultant Cardiologist locally for ongoing monitoring and management. We will then arrange an appointment for you to be seen by your Cardiologist to review your progress and also to assess the medications that you are taking. If everything is progressing well we would then plan to review your progress on an annual basis.

Heart valve surgery

Many medical conditions can affect the valves in your heart. Sometimes these are progressive and over time they may lead to a severe deterioration in the function of the valve. This may necessitate surgical replacement or repair of the affected valve. These procedures are usually performed as ‘open heart surgery’ and are very effective treatments often resulting in a complete resolution of symptoms. There are several surgical approaches to replace or repair heart valves and these will be discussed with you. It is likely that you will need to have a cardiac catheter study performed prior to undertaking valve surgery. This will be performed personally by your Consultant Cardiologist and give more detailed information regarding the affected valve(s). It will also establish if you have any coronary artery disease which could be treated by bypassing at the same time as your valve surgery.

Your Cardiologist will discuss your heart valve surgery in detail with you following your cardiac investigations but the operation itself will need to be performed by a Consultant Cardiac Surgeon in London . Our Consultant Cardiologists work closely with a number of surgeons and will be able to recommend and refer you on to one of these highly experienced professionals. Your Cardiac Surgeon will arrange to meet you in his Consulting Rooms in London to discuss the procedure in more detail including recommending the most appropriate surgical technique to treat your condition.

Following your heart valve surgery we will contact you when you are discharged home to reassure you that we are available should you have any questions or concerns. You will normally see your Cardiac Surgeon for review in out-patients 6 weeks after your surgery. If he is happy with your progress he will then discharge you back into the care of your Consultant Cardiologist locally for your ongoing care. We will typically arrange an appointment for you to be seen by your Cardiologist to review your progress and also assess the medications that you are taking. If all is progressing well we would then plan to review you on an annual basis with an echocardiogram (heart scan) to assess the function of your new or repaired heart valve.

Cardioversion

If your Cardiologist finds that your heart has a persistent abnormal rhythm (typically atrial fibrillation or flutter) causing your symptoms he may recommend a cardioversion procedure. This involves giving a small, controlled electric shock which is aimed at restoring a normal heart rhythm. It is a very safe and usually very effective treatment. Prior to this procedure and for a few weeks after you will need to take Warfarin tablets and your blood will need to be monitored to ensure that the levels in your blood are at therapeutic.

Your Cardiologist will discuss this procedure in detail with you and will perform the procedure personally. Cardioversion is performed as a day case procedure as it requires a brief general anaesthetic. You will be admitted during the morning to a local hospital and your Warfarin blood level checked either that day on the previous day. You will be discharged home once you have recovered from the anaesthetic, typically after a few hours.

Within 24 hours of your cardioversion your Cardiologist will write to your General Practitioner with a detailed report of the procedure and its results. We will contact you on the day after your cardioversion to see how you are feeling and to arrange a follow-up appointment with your Consultant, usually 4 weeks after the procedure to review your progress and your medications.

Permanent pacemaker

Your Cardiologist may recommend that your have a permanent pacemaker implanted if you have an abnormally slow heart rhythm. This involves passing thin electrical wires into the right side of the heart and attaching them to a small battery-powered pulse generator which is implanted below the skin. This will ensure that heart beats at an appropriate rate. This procedure is very safe and highly effective in alleviate the symptoms caused by a slow heart rate (eg dizziness, fainting). Modern pacemakers are very advanced: most patients are able to forget that they have them and are able to enjoy leading a normal life.

Your Consultant Cardiologist will discuss the pacemaker treatment in detail with you and will perform the procedure personally at a local hospital. The procedure is performed under local anaesthetic and is undertaken as a day-case.

Within 24 hours of your pacemaker procedure having been completed your Cardiologist will send a detailed report of the procedure to your General Practitioner, requesting that his/her Practice Nurse reviews your pacemaker incision 1 week after the procedure and cuts or removes any skin stitches. We will contact you on the day after your pacemaker has been implanted to see how you are feeling and to answer any questions that you might have. We will organise an appointment for you to come back and see your Cardiologist 2 weeks after the procedure to check your progress. Once you have had a pacemaker implanted its function will need to be checked every 6 months in a pacemaker clinic. We will arrange this for you and you will be contacted directly to arrange a convenient appointment time.

Implantable defibrillator

There are a number of serious heart conditions that can cause very dangerous and unpredictable fast heart rhythms. These can lead to a catastrophic fall in blood pressure resulting in collapse or the heart stopping altogether. The only way to treat this condition is to give an electric shock (with a cardiac defibrillator) but this must be done without delay. Unfortunately most patients are not in the right place at the right time (ie in a hospital environment) when this occurs and these rhythm disturbances are often fatal.

Technology has now led to the development of an implantable defibrillator device which is very similar to a pacemaker. The device monitors your heart beat but will give an internal shock if it detects a dangerous heart rhythm. The aim is to shock the heart back into a normal rhythm as soon as possible and these devices are proven lifesavers for high risk patients.

If your cardiac investigations suggest that you would benefit from an implantable defibrillator your Cardiologist will discuss this procedure in some detail with you and will be able to perform this procedure personally at a local hospital. The procedure is performed under a local anaesthetic and involves some small electrical wires being fed to the right side of the heart and then connected to a battery-powered pulse generator box which is implanted under the skin. Following the procedure you will need to spend one night in hospital but all being well will be ready to go home on the morning of the next day.

Within 24 hours of your defibrillator implantation you Cardiologist will write to your General Practitioner with a detailed report of the procedure. We will contact you on the day after the procedure to see how you are feeling and to answer any questions that you may have. We will also make an appointment for you to come back to see your Cardiologist 2 weeks after the procedure to assess your progress. Your defibrillator function will need to be checked every 6 months by our specialist cardiac technicians and we will arrange this for you. They will contact you directly to arrange a convenient appointment.

Ablation

An ablation procedure may be recommended if you have a heart rhythm disturbance which causes unacceptable symptoms and proves resistant to medical therapy and/or cardioversion procedures. In some patients these rhythm disturbances are caused by regions of abnormal electrical tissue in the heart which can effectively ‘short circuit’ normal heart beats causing fast abnormal heart beats and palpitations. Ablation therapy involves identifying the normal and abnormal electrical circuits in your heart and then using a special probe to burn the abnormal tissue permanently to stop it from causing further problems. This can be a very effective treatment of persistent heart arrhythmias with a significant reduction in symptoms.  In some cases it can prove a curative procedure.

Your local Cardiologist will discuss ablation therapy with you but if you decide to have this undertaken you will need to be treated by a Consultant Cardiac Electrophysiologist in London who specialises in these treatment as this is a highly specialised field. Our Consultant Cardiologists work closely with a number of Cardiac Electrophysiologists and will be able to recommend and refer you on to one of these highly experienced professionals who will arrange a consultation with you to discuss this treatment in more detail.

Once your ablation has been performed you will normally see your Consultant Cardiac Electrophysiologist for review 6 weeks after the procedure. Once he is happy with your progress he will discharge you back into the care of your Cardiologist locally for ongoing monitoring and management.

Cardiac resynchronisation therapy

Advanced technology in cardiac pacemakers has allowed the development of specialised pacemakers designed to help patients with resistant heart failure which has not responded adequately to medical therapy. The action of this ‘bi-ventricular’ pacemaker improves the coordination and pumping action of the heart and san result in an significant improvement in symptoms and quality of life for many patients.

Your Cardiologist will discuss the rationale for cardiac resynchronisation therapy with you in detail. If you decide to have this procedure undertaken you will need to be referred to a Consultant Cardiologist with an expertise in complex pacemaker devices as this is a very specialised procedure. Our Consultant Cardiologists work closely with a number of these specialists and will be able to recommend and refer you on to one of these highly experienced professionals. They will arrange to meet you in their Consulting Rooms and will discuss the procedure in detail with you.

Following implantation you will need to go back and see your Cardiac Device Specialist for review. If he is happy with your progress and the function of your pacemaker he will discharge you back into the care of your local Cardiologist for your future monitoring and management. We will then contact you to arrange a convenient appointment. Once you have had a bi-ventricular pacemaker its function will need to be tested every 6 months at a specialist pacemaker clinic. We will arrange this for you and they will contact you directly to arrange a convenient appointment.