Our Services & Specialties

Our cardiology team deal with the diagnosis, investigation and treatment of patients with all forms of heart disease. The London Bridge Hospital is fully equipped to provide a complete range of services for all cardiological conditions, including echocardiograms (an ultrasound scan of the heart) and stress testing (used to evaluate heart function by combining physical activity with an echocardiogram).

A team of 14 clinical physiologists run the cardiology department at the hospital, providing the range of services outlined below.

Hypertension/Hypotension (High blood pressure/Low Blood pressure)

• 24 Hour blood pressure monitoring

  Ambulatory Blood Pressure (BP) monitoring is a painless non-invasive method to obtain BP recordings over a 24hour period. It involves wearing a small cuff around your non-dominant arm that is attached to a box (the size of an Ipod) worn with a belt around your waist. The cuff will automatically inflate at regular intervals throughout the 24 hour period, every 20 minutes throughout the day and hourly after 11pm.

  This consistent monitoring at regular intervals allows ‘white coat hypertension’ to be eliminated (where your BP increases only due to being in a medical environment) and your hypertension to be managed effectively. The readings can then be used to determine the most effective medication or to ascertain whether current medication is having the desired affect.

  You are advised to undertake normal activities including work, so a true reflection of daily measurements can be obtained. The monitor must be removed before showering or bathing. There are no known side effects or complications with this procedure.

• Stress testing (Exercise tests)

  A stress test or exercise tolerance test is designed to provide information about coronary artery disease, cardiac arrhythmias, possible heart related chest pain, dizziness and shortness of breath. It assists your doctor in investigating how well your heart functions under strenuous work loads.

  As your body works harder during the test, it requires more oxygen, so the heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart indicating possible ischemia. It also helps your doctor ascertain the mode and level of exercise appropriate for you.

  You are required to bring loose clothing that is appropriate for exercise as you will be walking on a treadmill with 10 electrodes attached to your chest to monitor your ecg. Your blood Pressure will also be monitored at two minute intervals throughout the test.

• Tilt Table Testing

  Tilt testing is performed when patients are experiencing Syncope, Dizziness and unexplained loss of consciousness. The procedure is explained to the patient and the patient is then asked to lie down on the tilt table bed, ECG electrodes and blood pressure monitoring equipment is then attached to the patient, a cannula is inserted into the patients hand .The patient is then tilted at a 60 degree angle for 45 minutes and monitored closely. During the procedure the patient’s blood pressure and heart rate may fall this is due to blood pooling in the legs resulting in the patient fainting. The patient will then be returned to the horizontal position and monitored closely until the heart rate and blood pressure return to its initial value. All Patients are advised to have a light breakfast or light lunch before attending this test.

• Echocardiogram

  An Echocardiogram is an ultrasound of the heart. It uses standard ultrasound techniques to image two dimensional slices of the heart. The latest ultrasound systems now employ 3D real time imaging. In addition to creating two-dimensional pictures of the cardiovascular system, an echocardiogram can also produce accurate assessment of the velocity of blood and cardiac tissue at any arbitory point using pulsed or continuous wave, this allows assessment of cardiac valve areas and function. Echocardiograms are commonly performed on patients with valvular heart disease, CHD, cardiomyopathy and heart murmurs. The procedure is explained to the patient and the patient is asked to lie on the bed once all images have been obtained the patient can then get dressed and leave. The test normally takes 15-30 minutes.

• Stress Echo

  To detect functionally-important coronary disease, stratify the risk of coronary events and detect viability in apparently infarcted tissue.

Chest pain

• Stress testing (Exercise tests)

  A stress test or exercise tolerance test is designed to provide information about coronary artery disease, cardiac arrhythmias, possible heart related chest pain, dizziness and shortness of breath. It assists your doctor in investigating how well your heart functions under strenuous work loads.

• 24 Hour Tape (with S-T analysis)

  A 24 hr holter monitor provides a constant recording of your hearts electrocardiogram (rate and rhythm) over a 24 hr period. A 24 hr holter monitor with S-T analysis allows the physician to have a detailed look at the ST segment deviant and operates in parallel with arrhythmias analysis. It is a safe and painless recording That involves wearing a small monitor (the size of a match box) attached to your chest with 5 small wires connected to electrodes. It is worn either clipped to your belt or with a cord that hangs around you neck. While wearing the monitor you are instructed to carry out normal daily activities. Your doctor may request this monitor to see your hearts activity for various symptoms such as chest pain irregular or fast heart rates, dizziness and fainting spells. It also provides information on the effectiveness of medication. After the monitor is returned the results will be analysed and sent to your doctor within 1-2 working days.

• Stress Echo

  To detect functionally-important coronary disease, stratify the risk of coronary events and detect viability in apparently infarcted tissue.

• Myocardial Perfusion Scanning

  Myocardial Perfusion Scanning enables the visualization of blood flow patterns to the heart walls. The test is important for evaluating the presence and extent of suspected or known coronary artery diseases as well as the results of previous injury to the heart from a heart attack. It can also be done to evaluate the results of bypass surgery. Myocardial perfusion scanning involves the patient undergoing a stress test to evaluate the changes in blood flow to the heart, the patient is monitored during this time and expected to reach a maximum point of exercise, at this time a radioactive compound will be administered through an IV leading into the patients vein in the arm, this provides the best opportunity to identify regions of the heart that are not receiving adequate blood flow. One minute later the patient stops exercising and will be monitored until ECG and BP return to pre-test readings. Approximately 1 hour later the patient will attend the nuclear medicine department and asked to lie on an examining table. The gamma camera will then be used to detect rays given off from the compound which will collect in parts of your heart with good blood flow. Subsequently a computer following a set of complicated mathematical formulas will construct images of the heart based on the detected gamma rays. The images obtained after exercise must usually be compared with images of the heart obtained after injection of the same radioactive compound whist patient was resting, this is done to determine whether coronary blood flow has changed once you have rested and to check for coronary disease. In preparation for the test the patient is asked to avoid caffeine (coffee, tea) and smoking for 48 hrs before the examination and not eat anything after midnight before the procedure. Patients are still advised to continue taking medicines unless their cardiologists have specified not to do so.

Arrhythmias / Palpitations

• 24 Hour E.C.G Tape

  A 24 holter monitor provides a constant recording of your hearts electrocardiogram (rate and rhythm) over a 24 hour period. It is a safe and painless recording that involves wearing a small monitor (the size of a match box) attached to your chest with 5 small wires connected to electrodes. It is worn either clipped to your belt or with a cord that hangs around your neck. While wearing the monitor you are instructed to carry out normal daily activities.

  Your doctor may request this monitor to see your hearts activity for various symptoms such as chest pain, irregular or fast heart rates, dizziness and fainting spells. It also provides information on the effectiveness of medication.

  After the monitor is returned the results will be analysed and sent to your doctor within 1-2 working days.

• Electrocardiogram

  An electrocardiogram (ecg) is a quick and painless way to assess the rate, rhythm and electrical activity of the heart. This allows the physician to check for cardiac arrhythmias, palpitations and the effectiveness of medication. It is a simple procedure involving lying down on a bed for 2-5 minutes with 10 electrodes attached to your chest.

• Trans-telephonic event recorders

  Trans- telephonic event recorders are portable hand-held patient activated arrhythmia recorders which enable a patient experiencing transient cardiac symptoms to press a single button that records into solid state memory a 32 second electrocardiogram. The event recorders are designed with built in electrodes for ease of use. Once in the cardiology unit the procedure is explained and demonstrated to the patient. It is advised that the patient place the device directly on the chest when symptoms occur. ECG recordings are taken at the touch of a single button, the patient calls then a receiving centre for the analysis of the event. Event recorders are quite small and weigh about four ounces and fit into a patients pocket, purse and briefcase.

• Long term Loop recorders
• Implantable event recorders
• Echocardiogram

  An echocardiography is a painless ultrasound scan of the heart designed to examine the chambers, valves and major blood vessels of the heart. This allows screening for valve regurgitation, heart chamber function, heart size, infections, hypertension and clots in the heart. The probe takes images from the heart structures using ultrasound. Sound waves pass through the chest wall and ‘bounce’ back from the structures, providing two dimensional images.

  No special preparations are required for this test. You will be provided with a gown to wear as all clothing from the waist up must be removed. The test is conducted lying down on a bed with electrodes attached to your shoulders and chest attached with wires. A colourless painless gel is then applied to the chest allowing the technician to take pictures from various areas of your chest. You maybe asked to momentarily hold your breathe as this improves the quality of the pictures. The procedure takes between 15-30 minutes.

• Arrhythmia Stress Testing

Pacing, ICD and Implantable Event Recorders Follow Up

• Single and Dual Chamber Pacemaker follow up
• Single and Dual Chamber Defibrillator follow up
• Bi-artial pacing follow up
• Bi-ventricular follow up and Resynchronisation
• Downloading of Implantable Event Recorders
• Pacemaker / Defibrillator Test

  A pacemaker check is conducted to test the efficiency of your implanted pacemaker/defibrillator. It is a quick, painless procedure that involves you lying on a bed for 10 minutes with electrodes attached to your hands and feet and a small programmer placed over the site of your device. This provides your consultant with vital information about any recent episodes of arrhythmia, fast heart rates or shocks you may have received, depending on what type of device you have. It also provides information about the effectiveness of medication and allows any programme changes to be made to ensure you are receiving the most appropriate therapy.

The department also provides technical cover for:

• Coronary Angiography

  Coronary Angiography is a diagnostic procedure in which a long thin tube called a catheter is placed in a blood vessel and then guided to the heart. A contrast medium (commonly called “dye”) is injected through the catheter to determine whether narrowing or blockages are present in the coronary (heart) arteries, and to measure precisely how well the heart valves and heart muscle function. Before the examination the consultant will ask you to sign a consent form and find out if you have any allergies. Patients are usually asked to come in the evening before or the day of the procedure. A chest x-ray, Ecg and routine blood tests will probably be administered. Patients will be advised not to eat or drink before the procedure. The procedure is commonly performed via the groin and normally takes between 30-45 minutes. A pressure bandage will be placed on the groin, you will then need to lie flat and keep your leg straight. After the procedure it is very important to keep the head of the bed flat or slightly elevated, this will be raised 4- 6 hours later. Your consultant will give you a brief idea of the results of your procedure and set an appointment date to discuss any further treatment if needed. Upon discharge a nurse will advise you about any post exam instructions you should follow. A doctor will evaluate you before discharging you from hospital.

• Coronary Angioplasty

  PTCA often called angioplasty- is a procedure to treat coronary artery disease. It involves flattening the fatty material (atheroma) that can build up inside the walls of the main blood vessels( arteries) to the heart causing them to narrow. Angioplasty does not involve open heart surgery, a catheter is threaded through an artery in the groin or arm to reach the coronary arteries of the heart. Angioplasty opens the narrowed arteries by using a balloon to gently inflate to squash the fatty material; the balloon will then be deflated after about a minute and removed so that blood can flow more easily to the heart muscle. A short tube of stainless- steel mesh (a stent) is commonly used to hold the artery open after the balloon has been removed. All being well, you should be able to go home the day after the procedure. You should organise a friend or a relative to take you home. You will be given medicines, such as anti-platelet drugs that help to stop blood clots forming around the stent after your operation. You will be given advice about how you can improve your diet and lifestyle once you get home .It is advised that patients take it easy for the first week after angioplasty. Patients should not drive until they can perform an emergency stop without discomfort; this is generally about a week after angioplasty or six weeks if a large vehicle is to be driven. Before angioplasty you will be asked not to eat or drink. A nurse may shave your groin or arm where the catheter will be inserted during the operation. The procedure normally takes about 30 minutes depending on how many arteries that needs to be treated.

• Pacemaker implant/ICD/CRT implant
• Electrocardiography

  Echocardiography is ultrasound scanning of the heart. It is usually harmless and painless and is used to provide information about the structure and function of the heart. In particular, it is used to assess the pumping function of the heart, assess the heart valves and to detect congenital heart disease. The technique can be applied in several different ways. A standard transthoracic echocardiogram involves placing 3 electrodes and a probe with gel on the chest wall. The probe is moved over the chest surface to obtain different views of the heart. More recently at London Bridge Hospital I have introduced a new technique of 3D echocardiography which provides even more detailed and accurate assessment of the heart pumping function and assessment of the valves. Many cardiologists are now referring their patients for 3D rather than standard 2D echocardiograms for this reason. Other types of echocardiography that you may be referred to me for include stress echocardiography where the the heart is made to work harder using a drug or physical exercise whilst it is being scanned. This provides information about the blood supply to the heart muscle. Bubble/contrast echocardiograms involve an injection of a contrast agent into a vein to detect holes in the heart that can be a congenital defect or be associated with strokes, mini-strokes or possibly migraine attacks.

• Electrophysiology and Ablation
• TOE

  Transoesophageal echocardiography is an endoscopy procedure. It involves placing a small tube over the back of your throat and towards the stomach. This technique can provide even more detailed images of some heart structures and is required in very specific circumstances. You would be given local anaesthetic spray on to the throat area to make sure that it is completely painless and, in addition, you would be sedated during the procedure. It is usually performed as a day-case investigation.

  Transoesophageal echocardiography is a special ultrasound scan of the heart performed via a probe inserted into the patients gullet which provides very detailed pictures of the heart.

Download Reports

Angioplasty Report 2004