Electrocardiogram (ECG)

The ECG is a recording of the heart's electrical activity and assesses the rate, rhythm, and possible cardiac enlargements. It may also detect underlying coronary artery disease. This non-invasive test is quick, safe and painless.

 

Trans-thoracic Echocardiogram (TTE)

Also known simply as an "Echo", this safe, painless test uses ultrasound to obtain images of the heart and its various structures. The sound waves bounce back from the heart's various components, producing images and sounds that can be used by the physician to detect abnormalities.

 

Chest X-ray

A basic chest x-ray provides valuable information on the general condition of the heart and thoracic cavity. The x-ray can indicate the size and position of the heart, and any abnormalities and changes in the lungs, which can serve as a primary indicator of heart failure or congenital abnormalities.

 

Cardiac Calcium Scoring

Cardiac calcium scoring is a procedure for detecting calcium build-up in the coronary arteries. Coronary artery calcium is a marker for the presence of atherosclerosis, or hardening of heart arteries. The test is fast, non-invasive, and absolutely painless.

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Stress Test

This test is usually performed with the patient walking and/or running on a treadmill machine. ECG electrodes are attached to the body during the test to monitor the heart's electrical activity. Its main purpose is to assess the heart's performance under stress, exercise capacity and adequacy of blood supply to the heart.

 

Holter Monitoring

A Holter monitor is a portable device that continually monitors the electrical activity of a patient's heart over a period of time. Wires or electrodes from the monitor are taped to prepared areas of the patient's body, after which patients are sent home to go about their daily routines (except bathing), and to keep a diary of their activities, and any symptoms that may be experienced.

 

Ambulatory Blood Pressure Monitoring

A special blood pressure monitor is used to measure the patient's blood pressure readings intermittently over a 24-hour period. The patient is asked to keep a diary of his/her activities during the monitoring period.

 

Nuclear Perfusion Scan

This test is similar to the stress test, but can also be used to assess patients who are unable to exercise on a treadmill. It allows the physician to assess blood flow to the heart muscle. The test requires injections of a tracer into a vein in the arm for heart images to be captured with a gamma camera. Scanning is generally done twice (with up to 4–6 hour intervals in between), but at times, only post-stress images are required.

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Coronary Angiogram

This X-ray procedure detects the presence of blockages within the coronary arteries. These blockages are usually the result of the progressive build-up of deposits within the walls of the blood vessels (atherosderosis). This is the "Gold-Standard" test for the diagnosis of coronary heart disease. It is required before a decision or recommendation on ballooning/stenting or bypass surgery can be made.

 

Trans-oesophageal Echocardiogram (TEE)

This procedure involves introducing a transducer into the oesophagus (the long tube that connects the throat to the stomach). Since the oesophagus is located just behind the heart, clearer images of the heart structures and valves can be obtained by this method. It is very useful for assessing heart valves (both native and artificial) and diseases involving the aorta.

 

Electrophysiological Study

This is a study of the functioning of the internal electrical circuitry of the heart, and is done for selected patients who have a problem with a sudden onset of tachycardia or fast heart rhythm, which can be a serious or even life threatening problem for some patients. The study is performed in a Cardiac Diagnostic Laboratory under local anaesthesia. A number of thin flexible electrical monitoring catheters are threaded into the patient veins, and positioned in various parts of the heart to monitor its internal electrical currents. This way, the source of the electrical abnormality can be diagnosed with pin-point accuracy. In many cases, after having localised the problem area in the heart, the offending abnormal electrical activity is neutralised. This procedure cures the patient permanently of the arrhythmia with very high success rates. The procedure is called Radio-Frequency Catheter Ablation (RFA).

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Percutaneous Coronary Intervention

Percutaneous transluminal coronary angioplasty (PTCA) or balloon angioplasty is a widely-used technique for opening blocked arteries. The procedure widens the narrowing artery to improve blood flow. In most instances, a stent is also implanted following balloon angioplasty. A stent is a specially designed wire mesh used to prop open a narrow segment of the artery. Drug-coated stents are stents coated with very small amounts of medication that help to limit the amount of scar tissue that may form after stenting. Such stents ensure better long term results of the stented artery segment.

 

Radiofrequency Catheter Ablation Of Arrhythmias

This procedure is recommended for patients who have palpitations due to an abnormal heart rhythm caused by extra "nerves" in the heart or "short circuits". It is done by placing catheters in a blood vessel in the groin or neck to access the heart. The electrical system of the heart can be studied, and the cause of the palpitations determined. Then a decision can be made as to whether the condition is curable by using radiofrequency current through the catheter, to "burn" or get rid of the extra nerve or focus. It is done under light sedation and local anaesthetic. The usual length of stay in the hospital is one night after the procedure.

 

Pacemaker Implantation

Patients who have heart rates which are "too slow" for their needs may need a pacemaker. Too slow a heart rate may cause giddiness, breathlessness and fainting spells. A pacemaker is a small device that monitors the heart rate and automatically sends out a small electrical current to make the heart beat faster. A biventricular pacemaker is recommended for patients with heart failure when medication alone is not enough to control the symptoms.

Pacemaker implantation is done under local anaesthesia, and although it only takes one to two hours, patients are usually required to stay overnight after the procedure.

 

Defibrillator (AICD) Implantation

Patients who have had cardiac arrest due to ventricular fibrillation or ventricular tachycardia (two types of lethal arrhythmias) are candidates for an AICD (automatic implantable cardioverter defibrillator) implantation. Patients who are thought to be at high risk of developing these two arrhythmias are also candidates for the device.

The AICD is a small device like a heart pacemaker, but it is much more sophisticated than an ordinary pacemaker. This device automatically detects lethal arrhythmias, charges up, and delivers a shock to restart the heart. The procedure is similar to pacemaker implantation, except that deep sedation is required for the short period of testing of the device, to check if it can detect and stop the arrhythmia automatically by electric shock. Usually a one night stay in hospital is required after the procedure.

 

Thoracic Aortic Vascular Surgery And Endovascular Aneurysm Repair

The current standard surgical treatment of thoracic aortic aneurysm is the open-chest approach. The main purpose of open-chest surgery to treat a thoracic aneurysm is to replace the weakened portion or bulge of the aorta with a fabric tube called a graft. Repairing a thoracic aneurysm is surgically complicated, and requires an experienced thoracic surgical team, but neglecting the aneurysm would present a higher risk. In addition, whereas open thoracic aortic surgery is invasive and may require an open chest and heart lung machine (cardiopulmonary bypass), another method called the Endovascular Aneurysm Repair can achieve the same purpose of replacing the aneurysm using a minimally invasive method without cardiopulmonary bypass.

For example, for the replacement of a descending thoracic aortic aneurysm, a small 4–6 cm incision is made in the groin to expose the groin artery. An introducer, containing the crimped stent graft, is passed through a guide wire up the femoral artery into the descending aorta. Under X-ray fluoroscopic control, the introducer is positioned and pulled back to deploy the crimped endovascular graft, which expands out and self anchors to the neck of the aneurysm with fixation to the walls of the aorta. The aneurysm is excluded from the main blood circulation and prevented from rupture. This procedure is applicable in selected cases of thoracic aortic disease.

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Coronary Artery Bypass Grafting (CABG)

More commonly known as bypass surgery, this surgery creates a detour around blocked arteries, and is the surgical method of treating coronary artery disease. Depending on the number of blocked arteries, one or more bypasses may be created.

With today's expertise and technology, bypass surgery has generally high success rates, and significantly improves and lengthens the patient's quality of life. Most patients will be discharged from hospital in about a week.

 

Heart Valve Repair/Replacement Surgery

Over the past few years, there have been great advances in the surgical treatment of diseased heart valves via surgery. There are 2 types of heart valve surgery: valve repair surgery and valve replacement surgery. Valve repair allows the surgeon to fix the faulty heart valve, often without the use of artificial parts, and the advantages are lower risk of infection, decreased need for life-long blood thinner medication, and preserved heart muscle strength.

If valve repair is not an option, the native valve can be removed and an artificial prosthetic valve can be sewn to the annulus of the native valve. This is known as heart valve replacement. The new valve can either be mechanical or biological. This procedure can be done either by traditional methods or using a minimally invasive approach.

 

Surgery For Atrial Fibrillation

Atrial Fibrillation is an abnormal heart rhythm which originates in the atria (top chambers of the heart). Instead of the impulse travelling in an orderly fashion through the heart, many impulses begin simultaneously and spread through the atria, causing a rapid and chaotic heartbeat. It can be a dangerous condition which can double the risk of death, increase the risk of stroke by five times or more, and may cause congestive heart failure and uncomfortable symptoms related to a rapid heart rate.

The goals of surgical treatment for atrial fibrillation by the "Maze Procedure" are: to regain a normal heart rhythm (sinus rhythm), normal atria contraction, preventing blood clots and reducing the risks of stroke. Depending on the indication the "Maze Procedure" can be performed as a sole procedure or concomitantly with surgery for another heart condition, such as valve surgery or coronary artery bypass surgery.

 

Surgery For Heart Failure

Surgery for heart failure is aimed at stopping further damage to the heart and improving the heart's function. Surgical procedures include high risk conventional surgeries, such as coronary artery bypass surgery, valve surgery and surgery of the ventricle (such as left ventricular reconstruction surgery-Dor's Procedure) and implantable Left Ventricular Assist Device (LVAD).

 

Paediatric/Congenital Heart Repair Surgery

Congenital heart disease is a type of defect in one or more structures of the heart or blood vessel that occurs before birth. They affect 8 to 10 out of every 1000 children. They may produce symptoms at birth, during childhood, and sometimes not display any symptoms until adulthood. The most common congenital heart disease in children are atrial and ventricular septal defect, patent ductus arteriosus, tetralogy of Fallot, congenital valve defect, transposition of the great vessels and coarctation of the aorta. The ParkwayHealth hospitals have a specialised team comprising paediatricians, cardiologists and surgeons who specialise in treating congenital heart disease.

 

Stem Cell Therapy

In patients with heart failure or coronary artery disease not amenable to conventional revascularisation, cardiologists and heart surgeons are able to perform stem cell transplantation. This can improve the quality of life of patients, relieving debilitating symptoms such as chest pain, shortness of breath and loss of energy. Patients who have exhausted treatment options, such as coronary artery bypass surgery (CABG) or balloon angioplasties are candidates for this therapy. For patients with other medical conditions, which make it too risky or otherwise unsuitable for conventional procedures, adult stem cell therapy may be a viable alternative.

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