Managing cardiovascular health
THE CARDIOLOGY Unit at the University Hospital of the West Indies is dedicated to the early diagnosis and effective management of cardiac and vascular diseases. Our cardiovascular services include:
• Electrocardiography (ECG).
• 24-hour Holter monitoring.
• Exercise treadmill stress testing.
• Transthoracic echocardiography echo).
• Transoesophageal echo-cardiography.
• Exercise stress echocardiography.
•Dobutamine stress echocardiography.
• Electrical cardioversion.
• Cardiac catheterisation.
• Minimally invasive electrophysiology study/cardiac ablation.
• Pacemaker interrogation.
• Automated implantable cardiac defibrillator (AICD) interrogation.
Our invasive cardiovascular procedures are performed in the University Hospital of the West Indies Interventional Suite.
UNDERSTANDING THE VARIOUS CARDIOVASCULAR TESTS AND PROCEDURES ELECTROCARDIOGRAM
An electrocardiogram is a heart test that records the heart’s electrical activity over 10 seconds. It assesses the electrical impulses that travel through the heart and demonstrates the heart’s rate and rhythm. This test is often used to help diagnose a heart attack, an irregular heart rhythm or an abnormality in heart size or structure.
24-HOUR HOLTER MONITORING
This is a continuous 24-hour ECG recording of the heart’s rhythm recorded on audio tape or a computerised recorder. This test is done in patients who have palpitations or unexplained fainting, who are suspected to have an irregular heartbeat.
ECHOCARDIOGRAM
An echocardiogram is an ultrasound of the heart which enables doctors to evaluate the
structure and function of the heart’s muscle and valves. Patients who have had a heart attack should have an echocardiogram done to determine the areas and severity of damage. Patients who have a significant heart murmur should also have an echocardiogram in order to assess the heart’s valves and whether there is a hole in the heart. For a transthoracic echocardiogram, the ultrasound images are obtained from the chest wall. A transoesophageal echocardiogram requires the patient to swallow a narrow camera as the images are obtained from the oesophagus. The patient is sedated for a transoesophageal echocardiogram.
TREADMILL EXERCISE STRESS TEST
A treadmill stress test assesses the heart’s activity during exercise. This test helps the doctor to
determine how much exercise the patient can tolerate and whether there is sufficient blood supply to the heart’s muscles during exercise. It is used to help assess your risk for having a heart attack. When echocardiographic images are taken before and immediately after exercise, this test is known as an exercise stress echocardiogram.
DOBUTAMINE STRESS ECHOCARDIOGRAM
A dobutamine stress echocardiogram involves the continuous intravenous infusion of dobutamine, a drug that increases one’s heart rate. An echocardiogram is done before and during the dobutamine infusion to determine whether there is sufficient blood supply to the heart’s muscles. This test is used as an alternative to the
exercise stress echocardiogram in patients who are unable to exercise adequately.
ELECTRICAL CARDIOVERSION
This procedure is used to convert abnormally fast heart rhythms, such as atrial fibrillation and atrial flutter, to a normal heart rhythm. During this non-invasive procedure, the patient is sedated and paddles are used to apply a small amount of energy to the heart through the chest wall.
CARDIAC CATHETERISATION
This percutaneous procedure takes place in the hospital’s Interventional Suite and can be either an outpatient or inpatient procedure. During this sterile procedure, a long slender plastic tube (a catheter) is inserted into an artery in the patient’s wrist or groin and is passed up into the patient’s heart via the long arteries under X-ray guidance. Dye is then injected through the catheter into the heart chambers and into the vessels that feed the heart muscle with blood, allowing one to determine the structure and function of the heart
chambers and whether there are any blockages or aneurysms of the heart’s blood vessels. Catheters may also be used to measure the pressures in the heart. The imaging of the heart’s blood vessels is also called a coronary angiogram. If a blood vessel is found
to have a blockage, a small balloon can be inflated and other small catheter-based devices used to open the blockage. A small stent is then placed in that area to keep the blood vessel open. The process of opening a blockage in a heart’s blood vessel is known as a percutaneous coronary intervention or coronary angioplasty.
MINIMALLY INVASIVE ELECTROPHYSIOLOGY STUDY/CARDIAC ABLATION
This sterile percutaneous procedure takes place in the hospital’s Interventional Suite and is usually an outpatient procedure. Long catheters are inserted into the blood vessels in the patient’s groin and passed up into the patient’s heart under X-ray guidance. These catheters are used to determine the electrical pathways in the heart. Abnormal electrical pathways can be interrupted by applying a small amount of energy to the area of the pathway (cardiac ablation). This procedure can be useful in patients who have abnormal heart rhythms that are difficult to control with medication.
PACEMAKER/AICD INTERROGATION
Persons wearing a pacemaker (electrical device that sends impulses that stimulate the heart to contract at a normal rate) or an AICD (electrical device that can shock the heart out of a life-threatening, irregular rhythm) have them checked with the aid of a computer. This is done at regular intervals to ensure proper functioning of the device.
Let us work together to promote cardiovascular health. Don’t miss a beat. Beating strong, living long. Preserving hearts and preserving lives.
The University Hospital of the West Indies Cardiology Unit. Tel: 876 927 1620-9 Ext. 2127/8. Fax: 876 977 6771. Email: uhwicardiovascularweek@gmail.com