Treatments

A coronary angiogram is used to diagnose the severity of your heart disease and show us whether and where your arteries are narrowed or blocked. 

We insert a small, flexible tube into the artery at the top of your leg or wrist and up into your heart. Then we pass a fine wire tube, called a catheter, through that tube into your heart’s arteries. 

We use this to inject a special dye into the blood vessels around your heart. This contrast allows us to see how many of your coronary arteries are narrowed and precisely where that narrowing is occurring. 

We’ll also use intravascular ultrasound, and other imaging technologies like X-ray to help us build a true picture.

We’ll talk you through the procedure beforehand, giving you time to ask any questions you might have. Typically, a coronary angiogram is performed as a day case, with a local anaesthetic used to numb your wrist or groin and, in some cases, a light sedative to relax you. This means you won’t need to stay overnight. However, you will need someone take you home, as you won’t be able to drive.

Depending on the results and severity of the narrowing in your arteries, we may decide that we need to perform a coronary angioplasty. If the narrowing isn’t too severe, we may advise a course of medication instead.

A coronary angioplasty is a procedure to treat narrowing of the  blood vessels surrounding the heart. This can be caused by a number of cardiovascular risk factors including smoking, diabetes, high blood pressure and high cholesterol. Potentially leading to angina, which can be a risk factor for heart attacks.

The procedure involves inserting a small balloon and a stent into any blocked artery we’ve located using a coronary angiogram and inflating it. The stent is a small, meshed wire tube used to keep the artery open, and allow the blood to flow more freely in the expanded arterial space.

First, a needle is introduced into an artery in the wrist. A wire is then passed up into the heart, over which  a tube, called a catheter, is introduced. This allows us to inject contrast dye into the blood vessels surrounding the heart, highlighting exactly where, and how many narrow vessels there are.

Intravascular ultrasound, and other imaging techniques, can be used to get a better understanding of these narrowings before we treat them by introducing the balloon and stent via the catheter. Once in place, the balloon is then inflated to open the artery, and then deflated, leaving the stent in place working as a scaffold, to keep the vessel open. Finally, the balloon and catheter are then removed.

The procedure is likely to be carried out with the patient lying down under local anaesthetic, with mild sedation, meaning they will be awake and able to speak to the doctor and to the team throughout the procedure. Either Dr Lipkin or Dr Guttmann will oversee the procedure, supported by an expert team including a specialist nurse, electrophysiologist, radiographer and an anaesthetist, amongst others.

We’ll talk you through the procedure beforehand, explaining everything in detail, so you’ll have plenty of time to prepare and ask any questions you have. 

This procedure can take up to two hours to complete, with a local anaesthetic used to help numb your groin or wrist. 

Typically, it’s performed as a day case, which means you won’t need to stay overnight. However, you will need someone to take you home, as you won’t be able to drive.

We’ll continue to monitor the success of the procedure with regular checkups to see how you’re doing.

Intravascular ultrasound (IVUS) is a diagnostic procedure that uses high frequency sound waves to help your consultant see the inside of your coronary arteries.

The images are used by your consultant in procedures including coronary angioplasties to help determine the size of stent required, improve the precision of the stent placement and check that it's working as it should to improve blood flow through narrowed arteries.

Your consultant will insert a catheter into an artery through a small cut in either your groin or your wrist. This is done using a local anaesthetic to numb the affected area. 

The IVUS probe is located on the end of the catheter, which is then guided to your heart. Your consultant can then use the images being captured as a guide to help them place the stent accurately.

You’ll have a consultation beforehand during which we’ll talk you through the procedure. We’ll detail the risks and possible side effects of the procedure and answer any questions you may have. 

You may need to spend the night in hospital after your stent procedure. You should rest for a few days afterwards to allow your wrist or groin area to heal. We’ll let you know when you can get back to your usual routines and activities, and follow-up with advice on any medication you might need and lifestyle changes, if needed.

Rotational atherectomy/shockwave/intravascular lithotripsy is a surgical procedure that is commonly used to unblock the heart’s arteries. It’s typically recommended for patients with conditions such as coronary heart disease, when the blood flow around the heart becomes impaired due to the arteries narrowing or becoming  blocked. 

Rotational atherectomy/shockwave/intravascular lithotripsy is a minimally-invasive procedure, carried out through a small incision near the groin or wrist. The procedure is often performed under local anaesthetic, meaning the patient is awake during surgery, though they may have sedation to make them feel more relaxed.

A catheter is inserted into the patient’s artery, and  a thin wire fed through the catheter. The wire has a small rotating head, which the surgeon uses to smooth out and remove any deposits that are causing the build-up. Shockwave therapy uses a new application of lithotripsy, an innovative technology that uses high frequency focused ultrasonic waves to break up the calcium.

Once this has been done, a stent is often introduced to keep the artery open, as with a coronary angioplasty. 

Most patients will stay in hospital overnight following the procedure so that we can make sure that everything is as it should be.

In the majority of cases, we advise patients to avoid strenuous activity for a few weeks, and give individual advice on any appropriate medication or lifestyle changes. We’ll also continue to monitor the success of the procedure with regular checkups to see how you’re doing.

More commonly called heart bypass surgery, a coronary artery bypass graft (CABG) is a surgical procedure used to treat coronary heart disease. The aim is the diversion of to divert blood around blocked or narrowed arteries to increase the flow of oxygen-rich blood into the heart muscle. 

The procedure involves transferring a healthy artery or vein from another part of your body – usually your arm, leg or chest wall – and grafting it to your heart. The graft will be between the aorta; the main artery leaving your heart, and a point past the narrowed area of your coronary artery. 

You’ll typically be in surgery for about three hours. 

We’ll have a detailed consultation with you ahead of time to discuss the procedure itself, as well as any possible side effects, risks involved with the procedure, and the risks of not going ahead.

The operation takes place under general anaesthetic, so you’ll be asked to stop eating and drinking for six hours before the surgery takes place.

After your procedure, you’ll be transferred to intensive care, where our specialist team will monitor you closely until you wake up. You’ll stay in intensive care until your condition is stable, then be moved to a high dependency unit, or the cardiac ward. 

We aim to get you out of bed the next day, but you’ll still need specialist care. You’ll stay with us until you’re ready to be discharged.

Once you’ve been discharged from hospital, you’ll still be in recovery. You’ll need someone to take you home and someone to stay with you for a couple of weeks. You shouldn’t drive for at least a month.

We’ll arrange a follow-up consultation about six weeks after the procedure, and you should make a full recovery after approximately three months. Recovery times do vary from individual to individual, depending on how extensive your condition was, your general fitness and your age.

If you’re experiencing certain heart arrhythmias such as atrial fibrillation (AF), atrial flutter, ventricular tachycardia or supraventricular tachycardia, electrical cardioversion could be a suitable procedure for you. 

All of the above conditions occur when the electrical signals that make your heartbeat are disrupted, making it beat irregularly or abnormally fast. 

Electrical cardioversion helps to restore a regular heart rhythm by sending controlled and rapid shocks to your heart, getting it back into a regular or slower rhythm. These shocks are timed to arrive in between heartbeats. 

There are two types of procedure we may recommend. External cardioversion uses electrodes connected to a defibrillator machine to deliver fast, controlled shocks to your heart. With internal cardioversion, electric shocks are delivered to your heart internally via a small tube inserted in your leg.

In urgent cases where you have severe arrhythmia, we’ll need to perform the procedure at speed, without much preparation. Generally, however, the surgery is scheduled in advance. 

We recommend that you have a transoesophageal echocardiogram (TOE) before we go ahead with planned surgery, as any pre-existing blood clots in your heart can create extra risks. If we find one or more clot, we’ll usually delay the procedure by a couple of weeks and prescribe blood thinners. 

Please avoid eating, drinking and taking medication just before the procedure.

You’ll be monitored in the recovery room immediately after surgery to check that everything’s as it should be. For scheduled treatments, all being well, you’ll be able to go home the same day. You can’t drive however, so will need to arrange alternative transport or have someone who can give you a lift home.

Our team is here for you throughout the recovery period and will often recommend that you keep – or start – taking blood thinning medications, even if we didn’t find any blood clots in your heart. 

This can help to prevent them from forming in the future. We’ll book you in for a follow-up consultation and ask you to let us know about any serious or ongoing side effects that you may experience.

We’ll also let you know when you can return to normal activity. This will depend on your individual case. 

Catheter ablation is a minimally invasive cardiac procedure which helps to correct and manage problems or abnormalities with heart rhythm. This is caused by parts of the heart muscle sending irregular electrical signals that result in abnormal rhythms (arrhythmia). Atrial fibrillation (AF) is one of the most common types of arrhythmia we treat this way.

First, a small flexible tube is inserted into a vein at the top of the patient’s leg. Next, we’ll guide catheters, which are fine wires, through that tube into the heart and identify and destroy the tissue that’s causing the arrhythmia. 

We’ll use radiofrequency energy or cryoablation, essentially freezing, to destroy the tissue that’s causing the arrhythmia, thus restoring a regular heartbeat.

The whole procedure usually takes about an hour, sometimes a little longer if you’re being treated for AF. You’ll have a local anaesthetic to numb your groin and, if needed, a light sedative. In some cases, we may carry out the operation under general anaesthetic.

You’ll have a consultation beforehand, during which we’ll talk you through the procedure. We’ll detail the risks and possible side effects of the surgery and answer any questions you may have. 

If you choose to go ahead, you’ll be asked to stop eating and drinking a few hours before the procedure.

Although you may be able to go home on the same day of your operation, it’s best that you ask someone to take you home. We advise that you rest for three to four days to allow the top of your leg to heal. 

If you had the procedure to treat AF, you may need to stay in the hospital overnight. Our advice is to rest for up to two weeks. We’ll let you know when you can go back to your usual routine and start taking any medication you may need to support your recovery.

Sometimes the best way to support your heart is to have an electrical medical device implanted which helps manage how fast your heart beats. 

A pacemaker can help to speed it up, while a defibrillator can help to slow it down. Both devices are much smaller than a matchbox and implanted just below your collarbone, usually on the left side of your body, near your heart. 

They work like a generator, attached by one or more wires passed through a vein into your heart, regulating and correcting your heartbeat. 

If you have heart failure, a pacemaker or defibrillator can improve how your heart pumps.

All procedures involve some risks and side effects. We’ll meet with you beforehand to talk you through these and answer any questions you may have in good time. 

The implant procedure usually takes a couple of hours. Before we start, we’ll give you a local anaesthetic to numb your upper chest, and sedate you to make you feel sleepy and relaxed.

There’s a good chance you’ll need to stay in hospital overnight. You’ll definitely need someone with you the next day to take you home. 

We recommend resting for a week after the procedure. We’ll also consider your individual case and let you know when you can return to your usual routine, advising of any dietary, exercise or travel restrictions.

You need to let the DVLA know if you’ve had a pacemaker or defibrillator fitted. You’re not allowed to drive for a week after having a pacemaker implant. If you’ve had a defibrillator fitted, you’ll need to wait six months before you can drive.