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Cardiology

The Cardiovascular Health Clinic is an independent provider of cardiac and circulatory health care at Phoenix Hospital Group, providing top quality and specialised care.

We understand that cardiovascular disease is the leading cause of illness and death in the developed world. As a result we are committed to delivering the best lifestyle advice, screening, preventive therapies, investigations and when necessary treatments for specific conditions to optimise long term health and quality of life.

The clinic is committed to delivering specialist care that is tailored to and convenient for individuals’ lifestyles and the many commitments of modern life.

 

Treatments we offer


Much of the treatment of cardiovascular disease can be managed in house with appropriate tests and where necessary treatment with cardiovascular drugs. If however more complex treatment is needed, patients will be offered procedures at one of our partner institutions, either at a private hospital or at a specialist NHS Trust treating private patients.

 

ECG

This is one of the most basic cardiac investigations and involves putting stickers (electrodes) on the skin to detect the electrical impulses of the heart.

Typically the stickers will be put on the arms, legs and chest. This is known as a ’12 lead ECG’. It is entirely painless and can often tell your cardiologist some basic information about the rhythm and condition of your heart. All test results should be treated with caution and interpreted in the context of a clinical assessment.

The ECG provides a ‘snapshot’ in that it records the electrical activity of the heart for a few heartbeats whilst the recording is being made.

This has obvious limitations for heart rhythm problems that come and go in a ‘paroxysmal’ fashion rather than a sustained rhythm abnormality. If a patient is getting palpitation or dizzy spells every day, then a 24 hour tape recording will be able to show the cardiologist how the heart is behaving during symptoms (which should be recorded with the time on a diary card). If the symptoms are less frequent then a 48 hour, 5 day or one week monitor might be helpful. All test results should be treated with caution and interpreted in the context of a clinical assessment.

24hr Blood Pressure Monitor

Blood pressure measurements made in the doctor’s surgery are useful but do have some limitations.

They are really only a ‘snapshot’ of your blood pressure and can also be influenced by anxiety (white coat effect). A series of home blood pressures performed using an automatic blood pressure monitor can be helpful and can give useful information.

When making important decisions about blood pressure management and drug treatment however a 24 hour recording is usually considered the most thorough approach. A 24 hour ambulatory blood pressure monitor (ABPM) measures your blood pressure regularly for a 24 hour period. This reduces the ‘white coat effect’ and usually gives more reliable information on which to base decisions. All test results should be treated with caution and interpreted in the context of a clinical assessment.

Echocardiogram

Diagnostic transthoracic ultrasound scanning ‘TTE’ is harmless and performed using a transducer (Probe) which is placed on the chest with jelly which improves the images.

This scan looks directly at the structure of the heart, its chambers and valves. In addition it can give valuable information about the flow of the blood. Sometimes the echo images will be enhanced with either a contrast agent or a bubble study.

Transoesophageal echo (TOE) is similar in concept to a transthoracic echo ‘TTE’ however it uses a very small transducer fitted to a flexible probe which is passed into the oesophagus (gullet) using local anaesthetic and if necessary mild sedation or occasionally under general anaesthetic. This test is particularly good for looking at the structure of valves of the heart since the heart lies very close to the gullet in the chest allowing high resolution images. All test results should be treated with caution and interpreted in the context of a clinical assessment.

Exercise Stress Test

The resting ECG looks at the electrical activity of the heart when the patient is lying comfortably and therefore doesn’t test the heart under load.

The exercise test allows the cardiologist to see how the heart performs under load. Although the exercise test has some limitations it can be useful in screening, assessing exercise capacity, in the investigation of patients with chest pain and for some other indications such as heart rhythm problems.

Exercise is usually on either a treadmill or exercise bike and performed with ECG electrodes connected. The blood pressure is measured frequently during the test. All test results should be treated with caution and interpreted in the context of a clinical assessment.

Stress Echocardiogram

Whilst the CTCA scan and coronary angiogram give anatomical information about the coronary arteries and any possible narrowing, stress echo looks at the functional performance of the muscle of the heart and by implication the coronary blood supply to the heart.

This is achieved by exercising the heart either with physical exercise (eg treadmill or exercise bike) or in some situations by using a drug infusion to increase the heart rate. Stress echo does not use ionising radiation. In Stress Echo the performance of the heart muscle is evaluated following exercise ‘stress’ and at rest.

Failure of the muscle of the heart to pump harder during stress can suggest limitation in blood supply to the heart and the possible need for further tests or treatment. A further useful function of stress echo scanning is in planning for operations since it is a non-invasive way of assessing the potential cardiac risk of non-cardiac surgery. All test results should be treated with caution and interpreted in the context of a clinical assessment.

CT Coronary Calcium and Angiogram

CT scanning of the heart has developed considerably in recent years and is now a very valuable investigation. It is important to understand the difference between Coronary CT Calcium Scoring and CT Coronary Angiography.

CT coronary calcium scoring is a simple screening test which can help establish the presence of coronary artery disease and help with cardiovascular risk assessment and treatment. CT Coronary Angiography (CTCA) can evaluate the presence, significance and severity of any coronary artery narrowing that might be present. CTCA requires the injection of a ‘contrast agent’.

It is a slightly more complex test and is typically used to investigate chest pain. Your cardiologist can advise you on whether a CT scan of your heart is indicated and if so whether a simple CT calcium scan or a CTCA will be most appropriate. All test results should be treated with caution and interpreted in the context of a clinical assessment.

Cardiac MRI

Magnetic resonance imaging (MRI) of the heart allows doctors to better determine the presence of certain diseases that may not be as easily seen with other imaging methods such as x-ray or ultrasound.

In most patients the test is readily obtainable in 30-60 minutes and offers the most accurate assessment of heart function and allows direct visualisation of heart fibrosis or scarring, for example detection of previous heart attacks.

MRI of the heart and surrounding structures can be used not only to assess the function of the heart but also major vessels, and other important structures such as the sac around the heart and other organs e.g kidneys and adrenal glands. It can help manage a variety of cardiovascular problems – for example high blood pressure – plan appropriate treatment and monitor progress.

MRI of the heart provides unique information other tests are unable to demonstrate. This detail makes MRI an invaluable tool in early diagnosis and evaluation of heart abnormalities, especially those involving the heart muscle. Furthermore, cardiac MRI provides all this without the risks associated with traditional, more invasive procedures or ionising radiation.

Abdominal Aortic Aneurysm Screening

Atherosclerosis usually causes narrowing (stenosis) of arteries however it can also cause bulging or dilatation of arteries (aneurysms).

Abdominal aortic aneurysm (AAA)-bulging of the main artery in the abdomen is a particularly important type of aneurysm because if it ruptures it needs emergency treatment and can be fatal, however AAA develops over many years and if found through screening it can be monitored and often treated electively either with a surgical repair or using a covered stent passed through a catheter when appropriate.

Screening for AAA has been shown to be of benefit in certain patient groups and as such forms an important part of an overall cardiovascular screening program. The abdominal aorta can be scanned in detail using ‘body scans’ such as CT and MRI which give a very accurate assessment however AAA can also be screened for using simple abdominal ultrasound. All test results should be treated with caution and interpreted in the context of a clinical assessment.

Cartoid Artery Scanning

Ultrasound of the carotid arteries (the arteries in the neck supplying blood to the brain) is undertaken for two reasons.

Firstly, in patients who have had a stroke or transient ischaemic attack (TIA) or in whom there is a clinical suspicion of problems with blood flow to the brain, an ultrasound or ‘carotid Doppler’ may be recommended. This is to look for severe narrowing of the arteries that might require treatment with surgical ‘endarterectomy’ or stenting.

A second application however relates to screening. The carotid arteries are very superficial and represent a part of the cardiovascular system which is very easy to access with ultrasound. Since cardiovascular disease also known as hardening of the arteries or atherosclerosis usually occurs diffusely throughout the vascular system, a scan of the carotid arteries allows one to look at a ‘window’ of the condition of the arteries. This is potentially very useful because if there is any evidence of atheroma or hardening of the arteries, one should go to great lengths to prevent further progression and the possibility of cardiovascular events in the future.

All test results should be treated with caution and interpreted in the context of a clinical assessment.

 

Why choose us?


  • A Consultant led service, from experts in their field, providing the highest level of care.

  • Same day diagnostic imaging and screening service.

  • A dedicated and experienced team, able to cater for individual needs.

  • State of the art facilities at the forefront of modern healthcare.

We can offer minor treatments on the same day as your consultation, as well as a prompt diagnosis.

 

Make an enquiry


You or your referring clinician can book an appointment with us using one of three simple methods:

Call us on 020 7079 2102   

Email us on appointments@phoenixhospitalgroup.com

Complete our secure online booking form

Online booking form

We will send a confirmation once your consultation is booked. If you would like to rearrange your appointment please do give us at least 24 hours notice.

Consultants

Dr Mahmoud Barbir
Professor Kausik Ray
Dr Michael Mahmoudi
Dr Tom Wong
Dr Robert Smith
Dr Miles Dalby

 

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