Medical therapy refers to the use of prescription medication to treat specific risk factors or medical illnesses. There are a wide range of proven and effective drug therapies in the field of cardiovascular medicine aimed at improving symptoms, slowing progression of disease and improving survival. Your cardiology specialist will advise you as to the best available treatment options, potential side effects and monitoring requirements.
Coronary angioplasty, or PCI, involves the direct treatment of a narrowing or blockage of the coronary arteries to improve angina or treat a heart attack in an emergency setting. The procedure is performed after coronary angiography, under local anaesthetic with direct X-ray guidance and contrast dye. A very thin metal wire is passed across the culprit arterial narrowing to allow the use of a balloon and coronary stent to open the blood vessel and improve circulation. The patient usually spends one night in hospital and requires the strict use of long term blood thinner medication called anti-platelets. There are small risks to consider and should be discussed with your cardiac specialist.
Catheter ablation is performed to treat symptoms caused by various forms of arrhythmia including atrial fibrillation, atrial flutter, SVT and accessory pathways. Thin catheters are inserted in the groin area to access the right side of the heart under X-ray guidance. A transoesophageal echocardiogram may be required to exclude clots and aid access to the left side of the heart. Radiofrequency energy is then transmitted to specific targets identified within the heart. This creates heat which destroys the affected area and aims to block abnormal electrical activity to treat the underlying condition. This is an invasive procedure that carries a small degree of risk which your cardiac specialist should discuss with you in detail.
A conventional permanent pacemaker is a small electronic device which contains a battery and automatic generator. This device is implanted by a cardiologist under local anaesthetic and sedation. The procedure requires a 4-5cm incision below the collar bone and placement of electrical wires to the heart under direct X-ray guidance.This procedure is used to treat slow abnormal heart rhythms, known as bradyarrhythmia, by placing an electrical lead within the right ventricle and often the right atrium and connecting to a pacemaker device. Selected patients with symptomatic heart failure may benefit from an additional electrical lead placed within the coronary sinus vein. This is known as cardiac resynchronisation therapy, or CRT, which can improve heart function, symptoms and prognosis. Patients with a known history of cardiac arrest and ventricular tachyarrhythmia, or considered at high risk, may also be offered a defibrillator electrical lead and device called an ICD.
These are invasive procedures which carry a small degree of risk and should be discussed further with your cardiac specialist.
A DC Cardioversion procedure may be offered to you if you are suffering from a persistent arrhythmia such as atrial fibrillation, in order to restore a normal heart rhythm. This is a day case procedure, which generally lasts 10-15minutes, requires a short-acting general anaesthetic or heavy sedation, administered by an anaesthetist. Your cardiology team will then deliver a controlled electrical shock from a defibrillator machine to you through pad electrodes whilst continuously monitoring your heart rhythm. It is important to be aware that cardioversions aren't always successful and there is a risk of recurrence of arrhythmia which may require further treatment. There are small risks attached to the procedure which can be discussed with your cardiologist.
Cardiac surgery is considered if you have severe valvular heart disease and/or severe multi-vessel coronary artery disease. These are major open heart operations performed routinely under general anaesthetic. Patients should expect to stay in hospital for one week, if there are no complications, and expect a minimum recovery period of 6-10 weeks.
A detailed pre-operative assessment is required to assess suitability for surgery including blood tests, echocardiography, ECG, coronary angiography, lung function testing and carotid artery scanning. It is important to determine the type, complexity and risk of operation and establish that potential benefit outweighs risks. It is also important to have a discussion with regards the choices available to you, such as most suitable type of heart valve replacement.
Certain high-risk patients with severe aortic stenosis, not amenable to conventional surgery, may be suitable for a less invasive transcatheter aortic valve intervention, known as TAVI. In this procedure a replacement valve is generally passed via the femoral artery (trans-femoral) or directly (trans-apical) and positioned in the heart.