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Cardiology

The Cardiology Department at Sevenoaks Medical Centre has a close professional partnership with our team of internationally recognised consultant cardiologists. This ensures rapid analysis, diagnosis and treatment of a variety of heart conditions. We utilise state-of-the-art facilities and provide a complete range of diagnostics and treatments for a range cardiological conditions.

Cardiology procedures at Sevenoaks Medical Centre

24-hour blood pressure monitoring

Ambulatory blood pressure (BP) monitoring is a painless method of obtaining blood pressure recordings over a 24-hour period. This involves wearing a small cuff attached to a monitoring device. The cuff then obtains a blood pressure reading at intervals throughout the day.

The readings from this can help to determine the most effective medication, or to assess the success of a patient’s current medication.

The patient is advised to undertake normal activities, including work, so that a true reflection of daily blood pressure changes can be obtained. Once patients return the monitor, measurements are downloaded and provided to the referring doctor within 24 hours.

24-hour tape (with ST analysis)

A 24-hour Holter monitor provides a constant recording of the heart’s electrocardiogram (rate and rhythm) over 24 hours. This is a safe and painless recording, which involves wearing a small monitor (the size of a match box) attached to the chest, with small wires connected to electrodes.

While wearing the monitor, the patient is instructed to carry out normal daily activities. The doctor may request this monitor, to assess the patient’s heart activity for various symptoms, such as chest pain, irregular or fast heart rates, dizziness and fainting spells. This can provide information on the effectiveness of medication. After the monitor is returned, the results will be analysed and sent to the doctor within 24 hours.

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. This is a simple procedure, where the patient rests on a bed for a few minutes with a series of electrodes attached to their chest.

Transtelephonic event recorder

Transtelephonic 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 a 32-second electrocardiogram. The event recorders are designed with built-in electrodes for ease of use.

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, light and can fit into a patient’s pocket.

7-day tape

A 7-day tape monitor provides a constant recording of the patient’s heart over a seven-day period. It is a safe and painless recording that involves wearing a small monitor attached to the chest. While wearing the monitor, the patient is instructed to carry out normal daily activities.

The doctor may request this monitor when symptoms are less frequent and more difficult to capture using other monitors. This is mainly used to assess arrhythmias and palpitations.

After the monitor is returned the results will be analysed and sent to a doctor within one to two working days.

Single and dual chamber defibrillator follow-up

Defibrillator (ICD) follow-up (both single and dual chamber) is performed the morning after implant, six weeks post-implant and then every six months or following a device ‘shock’.

During an ICD follow-up, the clinical physiologist/doctor will carry out patient/device diagnostics; alter ICD settings, record arrhythmia episodes and test device function. These appointments normally take 30 minutes.

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 then every six months or following a device ‘shock’ (CRT-D only).

During a bi-ventricular follow-up, the clinical physiologist/doctor will communicate with the device, establish patient/device diagnostics, adjust settings, record arrhythmia episodes and test the device is functioning correctly. The clinical physiologist/doctor can also assess heart failure status. This appointment normally lasts around 30 minutes.

With bi-ventricular devices, we also perform resynchronisation programming to optimise the device. This is done to provide the best cardiac output. The test lasts around 45 minutes and involves the clinical physiologist/doctor working with an echocardiographer to measure outputs. This ensures the device is working at optimal levels and is a non-invasive procedure.

We also provide access to a range of additional diagnostics and treatments from our sister facility, London Bridge Hospital. These include:

Stress testing (exercise tests)

A stress test or exercise tolerance test is designed to provide information about coronary artery disease, cardiac arrhythmias, heart-related chest pain, dizziness and shortness of breath. This test helps doctors to investigate how well the heart functions under strain.

Tests generally last around 30 minutes, with approximately 10-to 15-minute treadmill time. The results are then normally provided within 48 hours.

Tilt-table testing

Tilt-table testing is carried out when a patient experiences syncope (passing out/fainting), dizziness, or loss of consciousness.

The patient is asked to lie on the tilt-table bed. The physiologist will then attach electrocardiogram (ECG) electrodes and blood pressure monitoring equipment. The patient is tilted at a 60-degree angle for 45 minutes, while being closely monitored.

During this procedure a patient’s blood pressure and heart rate may fall. This can cause the patient to faint. The patient will then be returned to a horizontal position and monitored closely until the heart rate and blood pressure return to normal. Patients are advised to have a light meal prior to this test and to avoid caffeine on the day of the test.

Echocardiogram

An echocardiogram is a painless ultrasound scan of the heart. This helps examine the chambers, valves and major blood vessels of the heart. The scan helps look for valve regurgitation, heart chamber function, heart size, infections, hypertension and clots in the heart.

The test is conducted lying down on a bed, with electrodes attached to the shoulders and chest with wires. A colourless, painless gel is then applied to the chest, allowing the technician to take pictures of it. This diagnostic procedure usually takes between 15 and 30 minutes.

Stress echocardiography

A stress echocardiogram is used to detect functionally important coronary disease and assess different coronary issues. The heart rate required for this test needs to be elevated, which is accomplished by running on a treadmill or using drugs, such as dobutamine. With both methods, the patient is monitored with ECG and blood pressure recordings, taking pre-test and post-test echocardiogram measurements.

Myocardial perfusion scanning

Myocardial perfusion scanning enables the visualisation of blood flow patterns to the heart walls. The test is important for diagnosing and evaluating suspected or known coronary artery diseases. This test can also assess the results of treatment for 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 involves the patient performing monitored exercise, at which time a radioactive compound will be administered. The compound then circulates to the heart, helping to identify regions of the heart that are not receiving adequate blood flow.

When the patient stops exercising they will be monitored until ECG and BP return to pre-test readings. The patient attends our Nuclear Medicine Department where a gamma camera will be used to detect rays given off from the compound. This highlights the parts of the heart where there is good blood flow. A computer then constructs images of the heart based on the detected gamma rays. The images obtained after exercise are then compared with images of the heart, obtained when the patient is resting.

This is done to determine whether coronary blood flow has changed and to check for coronary disease.

Implantable event recorders

This is a very 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. The device is activated either automatically or by a small hand-held monitor provided to the patient.

This monitor is used when arrhythmias, palpitations, or fainting episodes are rare and, therefore, difficult to capture via Holter analysis.

Fitting the 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 by 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 easier to analyse and diagnose.

Single and dual chamber pacemaker follow-up

Pacemaker follow-up (both single and dual chamber) is performed the morning after implant, then again – usually six weeks post-implant – and possibly six-monthly or annually depending on the patient.

During a pacemaker follow-up, the clinical physiologist/doctor will examine the device to establish patient/device diagnostics, alter pacemaker settings and test device functions. This appointment lasts around 30 minutes and gives the patient ample time to ask questions and discuss living with the device.

Downloading of implantable event recorders

An implantable event recorder follow-up is performed following an arrhythmia episode, or after a patient-activated recording has taken place.

During the appointment, the clinical physiologist/doctor will communicate with the device to establish rhythm analysis, download and alter device settings, if necessary. The appointment lasts 30 minutes and allows the patient to discuss living with the device, as well as asking any questions they may have.

Pacemaker/defibrillator test

A pacemaker/ICD test is conducted to assess the efficiency of a pacemaker/defibrillator. This quick, painless procedure involves the patient lying on a bed for about ten minutes with electrodes attached to their hands and feet and a small programmer placed over the site of the device.

This provides the patient’s consultant with vital information about any recent episodes of arrhythmia, fast heart rates, or shocks they may have received, depending on what type of device you have. This helps to provide information about the effectiveness of medication and allows changes to be made to ensure they are receiving the most effective therapy.

Remote home monitoring

Remote monitoring enables the physician to obtain almost the same information as from a hospital clinic visit, while the patient is at 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.

The system uses a small piece of equipment, which sits in a convenient place in the home. This downloads device information and sends 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 an appropriate monitoring schedule.

Remote follow-up provides valuable clinical information that cannot normally be obtained until the next scheduled clinic visit. This allows the team at Sevenoaks Medical Centre to provide comprehensive cardiac care, promoting earlier detection and intervention of any potential cardiac device-related problems.

Interdisciplinary physiologist support coronary angiography

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 involves a catheter, 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.

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 procedure normally takes about 30 minutes, depending on how many branches of 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 stage, 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

We work with qualified clinical physiologists, who support consultant electrophysiologists in the set-up of the complex electrophysiology and ablation equipment (EP). They also provide valuable expertise throughout procedures and provide cardiac analysis support to help ensure patient safety.

Transoesophageal echocardiography (TOE)

TOE is a specialised ultrasound scan of the heart. It involves using a small ultrasound probe placed into the mouth, which then travels towards the stomach. It can provide detailed images of the heart structure.

The scanning technique can be used to check for blood clots in the heart, before various procedures take place. Patients are given a local anaesthetic spray to the back of the throat to ensure the procedure is completely painless, with the addition of local sedation to help with relaxation. It is usually performed as a day-case investigation.

Why use our Cardiology department at Sevenoaks Medical Centre?

We have a strong working-relationship with a team of globally renowned, expert physiologists. These industry leaders oversee procedures and provide valuable advice on a range of conditions to our patients.

We aim for quick results from our diagnostic procedures and try to provide appointments for patients within 24 hours of them getting in touch.

Through our use of advanced technology, we are able to provide rapid diagnosis and more effective treatment. More procedures are also now available as day cases, due to the technology we use.

The care we provide to patients is catered to each individual patient’s needs and requirements. This allows us to deliver effective results, provide successful treatments and help our patients return to a healthy and active lifestyle.

To find out more about our Cardiology facilities at Sevenoaks Medical Centre, or to arrange an appointment with one of our consultants, please call 01732 775 800 or alternatively, use our online appointment request form.