Access to an interventional cardiology service, 24 hours a day, 7 days a week.

Immediate medical treatment for patients experiencing a suspected heart attack is essential. A heart attack happens when blood flow in a coronary artery to the heart muscle is blocked. This is a life-threatening situation and medical treatment is urgently needed at this time.

In this urgent situation, the facilities on the North Shore campus enable North Shore Private Hospital direct access to emergency diagnostic and treatment services around the clock. Your treatment is our first priority and, in this unique integration of acute cardiac services, all patients benefit from the collocated cardiac unit available at North Shore Private Hospital and Royal North Shore.

What is a Heart Attack?

Each year, around 54,000 Australians suffer a heart attack. This equates to one heart attack every 9 minutes. Heart Research Australia has produced this episode to help people understand what a heart attack is, learn about the warning signs, and how a heart attack is treated.

 

An angiogram provides valuable information for the ongoing management of a patient’s health. An angiogram is the procedure of introducing a fine plastic tube (catheter) into an artery and then injecting a dye into the bloodstream. The x-ray pictures taken during this procedure are used to provide information to your doctor regarding the arteries to your heart. Most angiograms are performed using a local anaesthetic.

Your cardiologist will then tell you if your coronary arteries are blocked or narrowed, and can then advise you of your treatment options.

About Coronary Angiogram: this episodes offers information about coronary heart disease, the angiography procedure and a personal insight into life after a heart attack. Please visit www.heartresearch.com.au for further life-saving heart health information.

Blood flow to a narrowed area of your artery may be improved by stretching open the narrowing with a small cylindrical balloon. The balloon is position across the narrowed area of the artery, and when inflated the balloon stretches the artery wall and compresses the fatty plaque/ cholesterol.

Once the narrowing has been widened, a stent is usually inserted. A stent is a very fine mesh cylinder usually composed of stainless steel or cobalt. The stent then acts as a metal scaffolding to support that section or artery, Once the stent has been positioned, it cannot be moved or removed and over time the stent will become embedded in the artery wall.

Following a PTCA/stenting procedure, it is current practice for most patients to remain monitored in hospital overnight.

At all times, please do not hesitate to ask questions about your procedure or your hospitalisation. Not all coronary artery narrowings are suitable for angioplasty. Some lesions (narrowings) diagnosed during angiography may best be treated medically and others may best be treated surgically, that is, by coronary artery bypass grafting. Your doctor will discuss treatment options with you and explain the reasons for his/her recommendations.

A minimally invasive procedure that assesses the electrical activity and conduction pathways of the heart

Radiofrequency ablation is a procedure to cure rapid heart rhythms (tachycardia) in the heart. Abnormal electrical pathways are usually the cause.

The purpose of a PVI is specifically to treat an abnormality of the pulmonary veins by isolating electrical activity within the pulmonary veins. Treatment involves the use of balloons and stents to open the narrowing and hold it open.

This procedure is done to measure pressures in the right side of the heart and lungs, determine your cardiac output and measure oxygen levels in and around your heart.

Structural heart disease is a defect or abnormality of the heart that is non-coronary, meaning that it does not affect the blood vessels in the heart.  Many structural heart conditions are congenital (present at birth), but these abnormalities can also form later in life due to wear and tear from aging, infection or result from an underlying condition.

A special catheter is inserted into a vein, usually in your groin. The catheter is then positioned in your right ventricle. Under x-ray guidance, your doctor uses the biopsy catheter to take tissue samples, usually from your right ventricle. The tiny pieces of heart tissue are sent to the lab for examination under a microscope and a biopsy may be done to: biopsy may be done to diagnose the cause of heart failure or heart disease, such as dilated cardiomyopathy. This is caused by a bacterial or viral infection. The procedure can also diagnose restrictive cardiomyopathy, caused by many different pathological processes. Knowing the cause of heart failure can help to determine the treatment plan.

A pacemaker is implanted to treat an abnormally slow heart rate. Pacemakers can also adjust the heart rate to meet the body’s needs, whether during exercise or rest. Implantation of a pacemaker involves positioning leads (thin, insulated wires) in the heart and placing the device in a pocket of the skin, usually in the shoulder area. In 2017 North Shore Private Hospital implanted its first leadless pacemaker.

An ICD is a device that helps correct fast and slow heart rates as it assists the heart to pump more effectively by coordinating the left and right ventricular contractions. It is also designed to deliver an electrical shock to the heart to restore extremely rapid and irregular heart rate to a normal rhythm.

A TOE is a procedure that looks at the heart chambers and valves using ultrasound. The probe is passed through the mouth and into the oesophagus. This is always done under anaesthetic or heavy sedation.

An ICD is a battery-powered device placed under the skin that keeps track of your heart rate. Thin wires connect the ICD to your heart. If an abnormal heart rhythm is detected the device will deliver an electric shock to restore a normal heartbeat if your heart is beating chaotically and much too fast.

Cardioversion is a process that involves applying electrical energy to the heart in an effort to shock the heart out of AF. In an external cardioversion you are given a medicine to help you relax then external paddles are placed on your chest or back. An electrical shock is sent through the paddles and travels through to the heart.

A loop recorder is a small device that is inserted to allow the monitoring of your heart’s rhythm. When a patient becomes light headed or feels palpitations they can activate the loop recorder to record their heart rhythm at the time. This allows your cardiologist to review and interpret the rhythm and decide upon the best management plan for your condition.

The dedicated cardiac lab is located on the ground floor at North Shore Private. The facility contains a newly built lab with a pre-operative and post-operative area. This allows for more streamlined patient care and an overall better patient experience. The Lab has been fitted with Siemens Artis Zee equipment providing great technology and image quality enhancing the procedural experience for both interventional cardiologists and their patients.

The opening of this new facility has seen the move of all our Structural Heart cases from our main operating theatre into the Cardiac Catheter Lab. Our Structural heart patients now move between our newly built coronary care unit and the catheter lab which has improved the patient pathway and allowed patients to access highly sophisticated treatment from leading specialists and nurses.

The North Shore campus has recently performed a milestone of over 200 TAVI procedures. The new Lab will allow us to enhance our ability to increase the number of cardiology cases and also to provide leading care in the Structural Heart specialty.

This wealth of experience, together with positive patient outcomes, has reinforced the campus’s status as a tertiary training facility, particularly for cardiology and interventional cardiology. Specialists from the North Shore campus provide teaching not only to medical students, but also their colleagues around the world. The lab has been fitted with the MedInBox (the first in NSW) which is a highly sophisticated educational tool, using real time videography of procedures that can be accessed remotely – such as other teaching facilities around the world.

Transaortic valve implantation (TAVI) is a treatment for patients with severe aortic stenosis who would otherwise be deemed at high risk for surgical aortic valve replacement (AVR). The TAVI procedure is minimally invasive and so allows patients to recover post operatively more quickly. Following TAVI, patients are generally admitted to our coronary care unit, are able to mobilise the same day of surgery, experience minimal pain and have a short length of stay in hospital.

North Shore Private Hospital is one of only a few private hospitals that are accredited to offer this procedure and have the experience of over 200 TAVI procedures.

Structural Heart Team

The Structural Heart Team have been performing TAVI procedures since 2013 at North Shore Private Hospital. Once identified as a potential TAVI patient, a patient usually comes into hospital for a few days to conduct pre-operative tests. This Multidisciplinary Structural Heart Team then meet to determine the best treatment for the patient.

Our Structural Heart team includes:

• Professor Ravinay Bhindi & Dr Peter Hansen – Interventional Cardiologists
• Dr Chris Choong - Imaging cardiologist
• Dr Laura Ahmadry – Geriatric Physician
• Dr Peter Brady & Dr Levi Bassin - Cardiothoracic surgeons
• Dr Roger Levy – Cardiac Anaesthetist
• Alex Baer - Structural Heart Coordinator

Referrals for potential TAVI patients can be made to our interventional cardiologists or cardiothoracic surgeons, or call our Structural Heart Co-Ordinator on (02) 8425 3006. They will then make the necessary assessments and organise the TAVI workup process if appropriate.