London Bridge Hospital’s Cardiology Department has gained a world-wide reputation as a centre of excellence, and offers innovation in the diagnosis, investigation and treatment of patients with all forms of cardiovascular disease in Central London. We have a dedicated unit of 18 registered Clinical Physiologists trained to the highest standard in cardiological assessment as well as highly skilled cardiologists, divided into teams of specialists within fields such as electrophysiology, implantable devices and non-invasive investigation.
Our Cardiology Department benefits from a close professional partnership with our team of internationally-recognised Consultant Cardiologists, ensuring rapid analysis, diagnosis and treatment of heart conditions. We are fully-equipped with state-of-the-art facilities and offer a complete range of services for all cardiological conditions, including echocardiograms (an ultrasound scan of the heart), electrophysiology (the use of catheters to analyse the heart’s internal electrical activity) and stress testing (used to evaluate heart function by combining physical activity with an echocardiogram).
The Cardiology Department now offer the innovative first generation Sensei™ Robotic Catheter System. London Bridge Hospital is the first private hospital in the UK to offer this system, which is designed to give surgeons accurate and stable control of catheter movement during complex cardiac procedures performed to diagnose patients suffering from abnormal heart rhythms or arrhythmias. Please visit this link for further information on the Sensei™ Robotic Catheter System.
24-hour blood pressure monitoring
Ambulatory Blood Pressure (BP) monitoring is a painless, non-invasive method to obtain BP recordings over a 24-hour period. It involves wearing a small cuff around the non-dominant arm; this cuff is then attached to a monitoring device (about the size of an iPod) worn on a belt fastened around the 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 BP increases only due to being in a medical environment) and hypertension to be measured effectively. The readings can then be used to determine the most effective medication, or to ascertain whether current medication is having the desired effect on blood pressure.
The patient is advised to undertake normal activities, including work, so that 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. Once patients return the monitor, measurements are downloaded within the Cardiology Department and sent to the referring doctor within 24 hours.
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. This test offers assistance to doctors by investigating how well the heart functions under strenuous workloads.
As the body works harder during an exercise test, the working muscles require more oxygen, so the heart must pump more blood. The test can show if there is a reduction in blood supply in the arteries that supply the heart itself. If positive, this test can predict possible ischemia in the heart. It also helps doctors ascertain the mode and level of exercise appropriate for the patient.
We ask our stress test patients to bring loose clothing for this test, or clothing that is appropriate for exercise, as the test involves walking on a treadmill. Electrodes are attached to the chest, connected to an ECG and used to monitor the heart rhythm/waveform. Blood pressure will also be monitored at three minute intervals throughout the test. Tests generally last around 30 minutes, with approximately 10-15 minutes treadmill time. Reporting on results is usually carried out within 24 hours.
Tilt-table testing is performed when patients are experiencing syncope (passing out/fainting), dizziness or unexplained loss of consciousness.
The patient is asked to lie down, face up, on the tilt table bed. The physiologist will then attach ECG electrodes and blood pressure monitoring equipment, with the option of a cannula insertion into the patient’s hand. The patient is then tilted at a 60 degree angle (this is a head-up position, so the patient feels slightly ‘leant backwards’) for 45 minutes and monitored closely. During the procedure, the patient’s blood pressure and heart rate may fall, which can result in the patient fainting. This is indicated as a positive result. The patient will then be returned to the horizontal position and monitored closely until the heart rate and blood pressure return to their initial values. All patients are advised to have a light breakfast or light lunch before attending this test and to avoid caffeine on the day of the test.
An echocardiogram 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. The patient 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 the 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 the chest. The patient may be asked to momentarily hold their breath, as this improves the quality of the pictures. The procedure takes between 15-30 minutes.
A stress echocardiogram is a derivation of an echocardiogram. This test is used to detect functionally-important coronary disease, stratify the risk of coronary events and detect viability in apparently infarcted tissue. There are two possible methods of obtaining the ultrasound images in a stress echo. The heart rate required in this test needs to be elevated – this can be done either through exercise on a treadmill or through administration of drugs such as dobutamine. With both methods, the patient is monitored with ECG and blood pressure recordings, with pre-test and post-test echocardiogram measurements.
24-hour tape (with S-T analysis)
A 24-hour Holter monitor provides a constant recording of the heart’s electrocardiogram (rate and rhythm) over a 24-hour period. A 24-hour Holter monitor with S-T analysis allows the physician to take a detailed look at the S-T segment deviant, and operates in parallel with arrhythmia analysis. The S-T segment of the ECG provides information on ischemic status. It is a safe and painless recording, which involves wearing a small monitor (the size of a match box) attached to the chest, with five small wires connected to electrodes. It is worn either clipped to the patient’s belt, or with a cord that hangs around the neck. While wearing the monitor, the patient is instructed to carry out normal daily activities. The doctor may request this monitor, to see the patient’s heart 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 the doctor within 24 hours.
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 carried out to evaluate the results of bypass surgery.
Myocardial Perfusion Scanning involves the patient undergoing two scans, with a stress test in between. This stress test is used to evaluate the changes in blood flow to the heart, involving the patient performing monitored exercise to their maximal capacity, at which time a radioactive compound will be administered through an IV leading into the patient’s arm. This radioactive compound then circulates to the heart, providing 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 one hour later, the patient will attend the Nuclear Medicine Department and asked to lie on an examining table. A gamma camera will then be used to detect rays given off from the compound collected in parts of the heart where there is 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 the patient was resting.
This is done to determine whether coronary blood flow has changed and to check for coronary disease. In preparation for the test the patient is asked to avoid caffeine (coffee, tea) and smoking for 48 hours before the examination and not to eat anything after midnight before the procedure. Patients are still advised to continue taking medicines unless their cardiologists have specified not to do so.
24-hour E.C.G tape for arrhythmia /palpitations
A 24-hour Holter monitor provides a constant recording of the heart’s 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 the chest, with five small wires connected to electrodes. It is worn either clipped to the patient’s belt or with a cord that hangs around the neck. While wearing the monitor, the patient is instructed to carry out normal daily activities.
The doctor may request this monitor to see the heart’s 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 the doctor within one to two working days.
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 two to five minutes with ten electrodes attached to the 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 then calls a receiving centre for analysis of the event. Event recorders are quite small, weigh about four ounces and fit into a patient’s pocket, purse or briefcase.
A 7-day tape monitor provides a constant recording of the patient’s hearts electrocardiogram (rate and rhythm) over a seven day period. It is a safe and painless recording that involves wearing a small monitor (the size of a match box) attached to the chest with three small wires connected to electrodes. It is worn either clipped to the patient’s belt or with a cord that hangs around the neck. While wearing the monitor, the patient is instructed to carry out normal daily activities. The monitor may be removed for personal washing.
The doctor may request this monitor where arrhythmias and palpitations are less frequent and therefore less amenable to capture on a 24-hour Holter monitor. Longer-lasting arrhythmias, which may be days in duration, are appropriately investigated using this monitor.
After the monitor is returned the results will be analysed and sent to the doctor within one to two working days.
Implantable event recorders
An implantable event recorder is a small heart rhythm recording device, about the size of a chewing gum packet, which is inserted under the skin, generally in the upper chest region. This device is activated either automatically or via a small hand-held monitor provided to the patient.
This monitor is appropriate where arrhythmias, palpitations or fainting episodes are rare, and therefore difficult to capture via Holter analysis.
Insertion of an implantable event recorder is a minimally-invasive procedure and can be performed as a day case. Analysis of the cardiac data and setup of the recorder is performed via telemetry by a qualified clinical physiologist.
Arrhythmia Stress Testing
Arrhythmia stress testing is available via two methods; a conventional exercise stress test, which may help to promote the arrhythmia in a controlled environment, or a pharmaceutical stress test, where specific drugs are administered under the control of a Consultant Cardiologist. These drugs can also have the effect of promoting arrhythmia, making the arrhythmia more amenable to analysis and diagnosis.
Pacing, ICD and Implantable event recorders follow up
Single and Dual Chamber Pacemaker follow up
Pacemaker follow-up (both single and dual chamber) is performed the morning after implant, generally six weeks post-implant, and thereafter possibly six-monthly or annually (depending on patient circumstances). Pacemaker follow-ups are performed by a qualified clinical physiologist.
During a pacemaker follow-up, the clinical physiologist/doctor will communicate with the device via a compatible analyser (PSA,) to establish patient/device diagnostics, alter pacemaker settings and test device function. This appointment lasts 30 minutes and gives the patient ample time to ask questions and discuss living with the device.
Single and Dual Chamber Defibrillator follow-up
Defibrillator (ICD) follow-up (both single and dual chamber) is performed the morning after implant, generally six weeks post-implant and thereafter every six months or following a device ‘shock’. ICD follow-ups are performed by a qualified clinical physiologist.
During an ICD follow-up, the clinical physiologist/doctor will communicate with the device via a compatable analyser (PSA) to establish patient/device diagnostics, alter ICD settings, record arrhythmia episodes and test device function. This appointment lasts 30 minutes and gives the patient ample time to ask questions and discuss living with the device.
Bi-ventricular follow-up and resynchronisation
Bi-ventricular Defibrillator (CRT-D) and Pacemaker (CRT-P) follow-ups are performed the morning after implant, generally six weeks post-implant and thereafter every six months or following a device ‘shock’ (CRT-D only). Bi-ventricular follow-ups are performed by a qualified clinical physiologist.
During a bi-ventricular follow-up, the clinical physiologist/doctor will communicate with the device via a compatible analyser (PSA) to establish patient/device diagnostics, alter settings, record arrhythmia episodes and test device function. The clinical physiologist/doctor will also assess heart failure status according to the device parameters. This appointment lasts 30 minutes.
With bi-ventricular devices, we also perform resynchronisation programming to optimise the settings of the device. The objective of this test is to configure the device to provide the best cardiac output, using differentiated programmable settings. This test lasts around 45 minutes and involves the clinical physiologist/doctor working in conjunction with an echocardiographer to measure cardiac outputs in various device configurations. This protocol ensures the device is working at optimal levels. This is a non-invasive procedure.
Downloading of implantable event recorders
Implantable event recorder follow-up (both single and dual chamber) is performed the either following an arrhythmia episode, or after a patient-activated recording has taken place. These follow-ups are performed by a qualified clinical physiologist.
During an Implantable Event Recorder follow-up, the clinical physiologist/doctor will communicate with the device via a compatible analyser (PSA) to establish rhythm analysis download and alter device parameters. This appointment lasts 30 minutes and gives the patient ample time to ask questions and discuss living with the device.
A pacemaker/ICD test is conducted to assess the efficiency of your implanted pacemaker/defibrillator. It is a quick, painless procedure that involves you lying on a bed for ten 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.
Remote home monitoring
Remote monitoring enables the physician to obtain almost the same information as from a hospital clinic visit (with just a few exceptions) while the patient is in the comfort of their home. This service offers patients and their families the convenience of regularly scheduled remote follow-ups and monitoring from home, with fewer in-clinic visits. At the same time, patients enjoy increased peace of mind and the assurance that their doctor can monitor specific device information continuously.
The system is able to work with a small piece of equipment, roughly the size of a home telephone. The small communicator, which sits in a convenient place in the home, is able to download the device information and send it securely via the internet, where it is accessed in the hospital.
The Consultant is able to determine the frequency of downloads that is appropriate for each individual patient and set up the monitoring schedule according to the individual clinic, patient or clinician’s needs.
Remote follow-up provides valuable clinical information that cannot normally be obtained until the next scheduled clinic visit. This allows the team at London Bridge Hospital to provide individualised and comprehensive cardiac care, promoting the earlier detection, notification and intervention of any potential cardiac device-related problems.
Inter-disciplinary physiologist support
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, which gently inflates within the artery 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. If this is deemed successful, the patient should be able to go home the day after the procedure. The patient should organise a friend or a relative to take them home. Medicines such as anti-platelet drugs that help to stop blood clots forming around the stent will be issued to the patient following the operation.
Advice will be given on about improving the patient’s diet and lifestyle once they go 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 heavy goods vehicle is to be driven. Before angioplasty, the patient will be asked not to eat or drink. A nurse may shave the groin or arm area where the catheter will be inserted during the operation.
The procedure normally takes about 30 minutes depending on how many branches of the coronary arteries need to be treated. We provide 24-hour on-call clinical physiologist cover for emergency coronary angiography procedures.
Pacemaker implant/ICD/CRT implant.
Device implants are supported by qualified clinical physiologists during the implantation procedure. The clinical physiologist will test the leads, provide support for the Consultant Cardiologist, provide the equipment specific to the device, and the device itself. They ensure professional set-up for the device at implant, safety of cardiac support for the patient and expertise in the administration of the patient’s device data. We provide 24-hour on-call clinical physiologist cover for emergency implantation procedures.
Electrophysiology and Ablation
Our qualified clinical physiologists support the Consultant Electrophysiologist in the set-up of the complex electrophysiology and ablation equipment (EP), provide expertise during the procedure and ensure patient safety through cardiac analysis support.
Transoesophageal echocardiography (TOE)
Transoesophageal echocardiography is a special ultrasound scan of the heart, performed via a probe inserted into the patient’s gullet which provides detailed pictures of the heart; it is an endoscopy procedure. We place a small ultrasound probe into the mouth, which then travels over the back of the throat and down the oesophagus towards the stomach. This technique can provide detailed images of the heart structure and is required in very specific circumstances. In electrophysiology, TOE can be used to check for blood clots in the heart, pre-procedure. Patients undergoing the TOE procedure are given local anaesthetic spray to the back of the throat to ensure the procedure is completely painless, with the addition of local sedation via a cannula in a vein in the arm for relaxation. It is usually performed as a day-case investigation.
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Email: [email protected]