A summary of our PROCEDURES
DIAGNOSTIC PROCEDURES
CORONARY ANGIOGRAPHY
Coronary angiography (or cardiac catheterisation) is an X-ray procedure that allows your doctor to look at your coronary arteries (the vessels that supply blood to your heart muscle) to see if they are narrowed or blocked.
Coronary angiography is undertaken when your doctor suspects that you may have coronary artery disease. It will help your doctor to make a diagnosis and plan future treatment to reduce your risk of angina or heart attack.
Treatment following coronary angiography is designed to improve blood flow to your heart muscle. This might involve medications or procedures such as angioplasty and stent or coronary artery bypass surgery. Coronary angioplasty or stenting (to open narrow arteries) can usually be done during your coronary angiogram, to avoid the need for you to have a second procedure.
IMPLANTABLE LOOP RECORDER
An implantable loop recorder (ILR) is a small device, smaller than a USB stick, that is able to continuously monitor your heart rate and rhythm. The ILR is inserted underneath your skin, near your breastbone. The device is able to pick up the electrical activity from your heart.
Your doctor will recommend an ILR to determine whether particular symptoms (e.g. dizziness/light-headedness, unexplained blackout, heart palpitations, seizures) you might be experiencing are related to electrical/rhythm problems with your heart.
Insertion of an ILR is a very common procedure that is performed under local anaesthetic in a cardiac catheter laboratory.
TRANSOESOPHAGEAL ECHOCARDIOGRAM (TOE)
This is an ultrasound scan taken using a probe inserted via your mouth into your oesophagus. You are given a light general anaesthetic so you are not awake during the procedure. The ultrasound pictures taken with a TOE are more detailed than a regular echocardiogram (which uses a probe on the outside of your chest) as the probe is much closer to your heart. TOE allows ultrasound pictures to be taken of your heart valves, aorta and structures from the back of your heart.
This procedure helps your doctor detect and diagnose problems associated with the structure and function of your heart.
TREATMENT PROCEDURES
CORONARY ANGIOPLASTY AND STENT PROCEDURE
Coronary angioplasty is a procedure in which a catheter-guided balloon is used to open a coronary artery. A stent (a wire mesh tube that expands to hold the artery open) is usually inserted into the narrow section of the artery during angioplasty. Angioplasty is sometimes undertaken immediately following a diagnostic coronary angiogram.
Your doctor will want to undertake an angiogram when you are experiencing angina (frequent or severe chest pain) that is not responding to medicine or when you have a heart attack. These events are caused by narrowing or blockage of the coronary arteries. The goal of angioplasty is to open narrowed arteries to quickly restore the flow of blood to your heart muscle and minimise damage to your heart.
DIRECT CURRENT CARDIOVERSION (DCR)
Direct Current Cardioversion (also known as DCR or electrical cardioversion) is a procedure that aims to restore the heart’s abnormal rhythm to a normal rhythm. A low energy electric shock is delivered through the chest wall to the heart via special pads that are applied to the skin of the chest and back. The synchronised shock causes the heart cells to contract simultaneously, to reset the heart rhythm. Up to three sequential shocks at increasing energy levels are used.
Your doctor may recommend DCR if you have atrial fibrillation or atrial flutter that has not responded to medication. Atrial fibrillation can make your heart beat too fast/slow and irregularly, which causes blood to pump less efficiently. Some patients have no symptoms whereas others may feel palpitations, shortness of breath or fatigue.
PACEMAKER INSERTION
A pacemaker is a sophisticated electronic device that consists of a battery and leads. It sits under the skin, usually on the left side under the clavicle (collar bone), and sends electrical signals to your heart to help it beat normally. Specialised pacemakers e.g. cardiac resynchronisation therapy [CRT] pacemakers) may have an additional lead on the left side of the heart.
The pacemaker monitors the heart’s own electrical system. When it senses the failure of your heart to send an electrical message, the pacemaker will provide the beat. When necessary, it regulates the frequency of the heartbeat (i.e. it sets the heart rate) and coordinates the contraction of the heart muscle, so that the heart beats effectively.
Most pacemakers are designed to correct bradycardias (slow heart beats). Abnormally slow heart rhythms can cause weakness, fatigue, dizziness, loss of consciousness or even death. Your doctor may also recommend a pacemaker if you are experiencing heart arrhythmias (irregular heartbeats) that are not being treated effectively with medication.
Insertion of a pacemaker is a common procedure. It requires minimally invasive surgery, which is done under local anaesthetic and sedation and takes approximately one hour.
TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI)
TAVI is a procedure to replace a damaged aortic valve that fails to open properly. The aortic valve is the valve between the main pumping chamber of your heart (left ventricle) and the main artery to your body (aorta). The aortic valve usually opens when blood is pumped from your heart to the rest of your body. In TAVI, an artificial valve is implanted into your heart using a long narrow tube called a catheter that is fed from your groin artery, through your blood vessels to the heart.
Heart valve surgery is not routinely performed by cardiologists but by heart surgeons. However, the field is evolving rapidly as more and more keyhole procedures are introduced, allowing interventional cardiologists to perform these traditionally surgical procedures in the cath lab or hybrid cath/surgery labs.
Peninsula Private Hospital offers keyhole TAVI procedures. Dr Gregory Szto is and accredited TAVI operator who works side-by-side with surgeons in a state-of-the-art hybrid cath lab to enable this less invasive valve replacement procedure, which results in shorter healing times and faster discharge from hospital.
TAVI will be recommended if you have aortic stenosis, a condition where the aortic valve cannot open and close properly. This condition puts extra strain on your heart and can result in breathlessness, chest pain, dizziness, and sometimes, blackouts.
You will also be considered for a TAVI if your health status makes you too high risk for open heart surgery. Your medical history and test results will be discussed with the TAVI team.
LEFT ATRIAL APPENDAGE OCCLUSION (LAAO)
A left atrial appendage closure (LAAO) is a keyhole procedure that involves closing off an area of the top chamber of the heart called the left atrial appendage. This is to prevent blood entering, pooling and forming a clot that can lead to a stroke. The watchman is a plug -like device, that ultimately becomes part of the heart structure.
LAAO may be offered to you if you have a history of a condition called atrial fibrillation and have problems taking blood thinners that are required to prevent stroke.
Atrial fibrillation is a condition whereby the top chambers of the heart do not contract regularly and can cause blood to pool in the left atrial appendage. Approximately 90% of strokes are caused by clots that form in this area.
You will be prescribed strong blood thinners “anticoagulants” to prevent clotting if you have had a prior stroke or TIA “mini stroke” or have two of the following risk factors: aged 65 or over, diabetes, high blood pressure, heart muscle weakness or cardio/vascular disease.
