Procedures

Cardiology is a broad speciality with many sub specialities. Depending on the cardiac condition, there are several different types of investigations and treatments available.

Coronary Angiogram

A coronary angiogram is a procedure where a small tube is placed into an artery either in the wrist or at the top of the leg, through which longer finer tubes (catheters) are passed up to the heart. The Cardiologist can then inject contrast dye down the coronary arteries to give a clear and definitive understanding of whether there is any coronary disease and the extent of any narrowings or blockages to the coronary arteries. At the end of the procedure the puncture is either closed with a small plug if at the top of the leg, or with a compression band if at the wrist. The result is available immediately. Angiography is more often done as a proceed test. This means that once some initial pictures are taken the Cardiologist can perform further testing of the arteries if required with either a pressure wire or with a camera (ultrasound or infrared light). The Cardiologist can also expand any narrowings or blockages with balloons and/or stents. See Coronary angioplasty for more detail.

A coronary angiogram is an invasive procedure and therefore carries some risks. There are alternative tests that can provide some of this information and you will be counselled about alternate tests before being listed for an angiogram. You will be consented for these risks before you can have this procedure. This test is normally done as a day case, unless undertaken in the evening when it may be more appropriate to stay in hospital overnight.

Angioplasty and Stenting is called a variety of names including percutaneous coronary intervention or PCI. It is only done after a coronary angiogram has already been performed either on a separate occasion, or immediately before or part of the same procedure. Small balloons are inflated in a narrowed or blocked coronary artery to improve the blood flow to relief angina symptoms or following a heart attack. The procedure can take an hour or sometimes more to complete. It is usually done as a day case for planned elective patients, and if performed following a heart attack you will normally be sent home the following day. There are a number of additional tools that can be used to help treat the coronary artery disease by PCI. These include a variety of specialist equipment such as imaging cameras (intravascular ultrasound or IVUS and optical coherence tomography or OCT) and a tiny pressure probe mounted on a wire to measure the blood pressure within the coronary arteries to assess whether the narrowing is severe enough to require treatment. Other tools such as rotablation (a tiny drill to unblock heavily calcified and very hardened arteries) and specialist equipment to open completely occluded arteries (chronic total occlusions or CTOs) can also be used. Dr Gray undertakes all these types of procedures and is one of a few operators in Greater Manchester, Lancashire and Cheshire that has the skill set and experience to undertake the most complex of procedures. The risks of this type of procedure varies according the anatomy and patient factors, and you will be consented appropriately depending on the level of risk involved.

Angioplasty and Stenting

DC Cardioversion

A DC Cardioversion is a short procedure requiring a very brief general anaesthetic, followed by the application of an electrical current across the chest via pads to restart the heart for patients with either atrial fibrillation or atrial flutter. You are required to take blood thinners for a period before and after this procedure to reduce the risk of stroke, but this is otherwise a very low risk procedure. This procedure is only undertaken for patient who are symptomatic from their rhythm disturbance despite optimal medical therapy.