- Treatments and procedures
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Treatments and procedures

 

If you are diagnosed with cardiovascular disease and you are advised to have surgery you will want to know that you are in the very best of hands.

 

Our consultants will explain the various treatment options available for specified cardiac conditions.  If necessary St Joseph's Hospital, in collaboration with your consultant, will seamlessly refer you for onward care.

 

Cardioversion


If your heart has an irregular (uneven) beat or is beating too fast, cardioversion is a way to restore a regular rhythm.  Abnormal heart rhythms are called arrhythmias.  Cardioversion at St Joseph’s will be performed by experienced cardiologists, consultant anaesthetists, theatre nurses and cardiac nurses.

 

There are two kinds of cardioversion.  Your doctor may give you one or more medicines to bring back your regular heartbeat.  This is called pharmacologic (chemical) cardioversion.  Doctors also restore regular rhythms by sending an electrical shock to the heart.  This is called electrical cardioversion.

 

Quick facts

 

  • Arrhythmias may prevent blood from circulating properly to your heart and brain.
  • Most often, doctors use cardioversion to treat a fast, irregular heart rhythm called atrial fibrillation.
  • If you have electrical cardioversion, you’ll get medicine to put you to sleep so you don’t feel the shock.

 

Why do people have cardioversion?

 

It is not uncommon for people to have non-emergency or elective cardioversion to treat arrhythmias.  The electrical signals that control your heartbeat start in the upper right chamber of your heart (atrium).  In atrial fibrillation, very fast, irregular electrical signals move through both of the upper chambers of your heart.  This can make your heartbeat fast and irregular.  Some people who have atrial fibrillation don’t notice any changes in the way they feel.  Others feel:

 

  • a very fast heartbeat
  • short of breath
  • very tired


Cardioversion also treats other kinds of abnormal heartbeats, including atrial flutter, atrial tachycardia and ventricular tachycardia.

 

Conventional coronary angiography

 

Coronary angiography is a test that uses a contrast agent and x-rays to show the insides of your coronary arteries and is an invasive test.  A thin, flexible tube called a catheter is inserted into a blood vessel in your arm, groin (upper thigh) or neck.  The tube is threaded into your coronary arteries and the dye is released into your bloodstream.  X-ray pictures are taken while the dye is flowing through the coronary arteries.

 

Coronary angioplasty & stenting

 

This is a treatment for narrowed heart arteries, which cause angina.  It is performed in the same way as an angiogram from the leg or wrist, avoiding the need for open-heart surgery.  A tiny balloon is used to stretch open the narrowed or blocked artery and following this a metal coil (stent) is stretched open and left behind in the artery to provide a scaffold to reduce the chance of the artery re-narrowing.

 

Coronary Artery Bypass Surgery (CABG)


This is a treatment for severe narrowing in the arteries of the heart and angina.  It is an ‘open heart’ operation. Either an artery from the wall of the chest or sometimes wrist and/or veins from the leg are used to ‘bypass’ the narrowed or blocked heart arteries.  It is an extremely effective treatment for angina and can sometimes be lifesaving.

 

Electrophysiology and Ablation (EP)


Many heart rhythm problems are caused by abnormal electrical tissue in the heart producing ‘short circuits’ of the normal heart beat.  These can cause fast heartbeats and palpitations.  Electrophysiology & Ablation procedures involve passing fine wires via groin arteries up into the heart to map the normal and abnormal electrical circuits of the heart.  Once identified a special tube is then used to heat up and produce a controlled burn of the abnormal tissue to permanently stop it from causing further symptoms.  In many cases, this results in a complete cure of the problem.

 

Heart valve surgery


A number of conditions can lead to severe damage of and progressive failure of one or more of the valves of the heart.  The valves of the heart may then need to be replaced.  This is a form of ‘open heart’ surgery.  A number of different types of valve replacement are available and your surgeon will talk to you in detail about the various options.  In some cases, the damaged valve can be repaired rather than replaced.  Occasionally patients require a combined valve replacement and bypass operation.

 

Medicines (medical treatment)


Medicine or tablet treatment is the mainstay of treatment for a wide range of heart problems.  Tablets are either used to treat the symptoms of heart disease or else to prevent the progression or complications of heart disease.  Your cardiologist will explain any new medicine that may be recommended and ensure any changes to your tablets are communicated to your GP.

 

Pacemakers for heart failure


In the past, pacemakers have only been helpful in patients with abnormally slow heartbeats.  However, a specifically designed type of pacemaker is now available to improve the pumping function of the heart in those patients with a weakened heart muscle.  These pacemakers have three wires (electrodes) the third of which activates the left ventricle which is the main pumping chamber of the heart.  This improves the coordination and pumping of the heart and has been shown in major worldwide trials to improve symptoms and quality of life in patients with heart failure.

 

Permanent pacemaker


Permanent pacemakers are used to correct abnormally slow heart rhythms.  Fine electrical wires are passed into the chambers on the right side of the heart and attached to a small battery, which is buried just below the skin.  The procedure is usually performed under local anesthetic.  Modern pacemakers are extremely advanced and can very accurately mimic the body’s natural heartbeat.  Most patients forget they even have a pacemaker and can lead a completely normal life.

 

Implantable defibrillator

 

Some serious heart conditions can lead to very dangerous fast heart rhythms, which can lead to the patient collapsing or the heart stopping altogether.  In the past, the only way to restart the heart was to shock the heart externally with electrical paddles.  There are now, however, implantable versions of this technology, which are very similar to standard pacemakers.  They constantly monitor the heartbeat but will ‘kick in’ instantly in the event of a dangerous abnormal rhythm to deliver an electrical pulse internally.  These sophisticated devices have been proven to be lifesaving in patients with known, sustained ventricular tachycardia or fibrillation.  The defibrillator is inserted in the same way as a standard pacemaker under theatre-like conditions.

 

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