HEART TREATMENTS
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Dr Steingo will always tailor treatment plan to best suit your needs and will be discuss with you in detail during your consultation.
Below are a selection of common procedures performed in the assessment and treatment of heart problems
Not all these treatments are performed by Dr Steingo but if not personally done the patient will be referred to the appropriate practitioner.
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There are a variety of options that can be used to treat conditions affecting the heart.
These treatments fall into the following categories:
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Surgical: this includes open heart surgery, such as coronary artery bypass surgery or heart valve repair/replacement.
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Interventional: minimally invasive techniques via the blood vessels in the groin or arm to access and treat specific areas of the heart. Principally, this includes coronary stenting and various other techniques to treat heart valve disease or hole in the heart problems.
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Medication: there are a wide variety of medications used to treat heart conditions and to reduce the future risk of developing serious heart problems. These broadly include, but by one means is this list exhaustive:​
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Anti-arrhythmic drugs
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Lipid lower ing medications
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Others
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Medications to treat heart failure
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Blood pressure medications
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​​​Anti-platelet and anti-clotting medications
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Conservative/Lifestyle: it is really important to recognise the positive effect that lifestyle adaptations have on the wellbeing of the heart, as they improve its capacity to cope with illness and reduce the risk of developing problems in the future.
Dr Steingo will always tailor treatment plan to best suit your needs and will be discuss with you in detail during your consultation.
Below are a selection of common procedures performed in the assessment and treatment of heart problems.
CORONARY ANGIOGRAPHY & BYPASS GRAFT ASSESSMENTS
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A coronary angiogram is an invasive procedure that allows a detailed assessment of the coronary arteries to be made. This is usually performed through the blood vessels in the wrist or groin. Other tests can be performed during the angiogram such a pressure wire study (an accurate assessment of coronary blood flow), and intravascular imaging tests (eg IVUS or OCT) described below.
CORONARY PRESSURE WIRE ASSESSMENT
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During coronary angiography, an assessment of the blood flow in one or more coronary arteries can be preformed using a pressure wire test. This involves passing a thin wire into the heart artery and measuring the pressure/flow in the artery during an infusion of a short-acting 'heart stress' drug. This is a very useful test in determining the functional significance of coronary artery disease and is often useful in assessing the need for coronary angioplasty (coronary stenting)
CORONARY INTRAVASCULAR IMAGING (IVUS & OCT)
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Intravascular ultrasound (IVUS) and Optical coherence tomography (OCT) accurately assess the structure of one or more of the heart arteries. These tests help identify any underlying disease that may be present. This can be done during a coronary angiogram to understand any disease seen on angiogram, but can also be used to accurately assess the health of an old stent or can be used to optimize the insertion of a new stent.
As the name suggests, IVUS is an ultrasound based test that involves the passage of a thin probe into an artery which allows its internal structure to be visualised. OCT is a light detecting probe technique that gives a much better resolution and a clear picture of the internal structure of an artery. When intravascular imaging is required, the choice between these tests is dependent on a number factors including a variety of clinical factors and also the heart disease in question.
CORONARY ANGIOPLASTY / STENTING (PCI)
Coronary artery disease can be treated with percutaneous coronary intervention (also known as PCI, angioplasty or coronary stenting). A narrowing of a heart artery (coronary artery disease) can reduce the flow of blood to the heart muscle causing angina (chest pain). If the there is sudden blockage of a heart artery then his causes a heart attack. PCI can be used to treat these coronary artery problems with thin tubes, wires, small balloons and stents to restore the blood flow to the affected area of the heart. If the disease involves a point where the artery divides into two or more branches, specific 'bifurcation' techniques can be used to insert more than one stent to treat the diseased area.
Coronary stenting can be guided by the use of pressure wire assessment or intravascular imaging and can also include the use of complex adjuvant techniques, such as Rotational Atherectomy, which is used to help clear the artery of tough or calcific material. This is where a tiny diamond tipped drill is inserted into the artery to remove material before conventional stenting techniques are used.
PACEMAKER & OTHER DEVICE IMPLANTATION
Cardiac pacemakers are required by people who have heart rhythm abnormalities causing the heart rate to be too slow. This may be a persistent or transient problem and may cause blackouts or near faints.
Cardiac pacemaker implantation is often done with sedation and a local anaesthetic. Often two wires are implanted into the chambers of the heart via a large vein in the chest. The wires are connected to a small metal box (which includes a battery and circuitry) and is implanted under the skin on the chest below the collar bone. It then can sense when the heart is in an abnormal rhythm. If this rhythm is too slow then it will transmit electrical impulses to regulate the beating of the heart.
ELECTROPHYSIOLOGICAL STUDY AND ABLATION
This is an invasive procedure that is used to find the source of an abnormal electrical activity that may cause atrial fibrillation and other heart arrhythmias. A thin catheter is passed to the heart (usually from the groin) and electrical pathways in the heart are mapped using specialized equipment. Once the source of arrhythmia is detected, small areas of the heart muscle can be treated to break any abnormal electrical circuits in the heart.
CORONARY ARTERY BYPASS GRAFT SURGERY
Coronary Artery Bypass Graft Surgery (also known as a bypass operation) is open heart surgery performed for a severe pattern of coronary artery disease (narrowing of the heart arteries). This involves taking a healthy blood vessel from another part of the body (normally the chest, arm or leg) and attaching it to effectively ‘bypass’ the blockage in the heart arteries.
There are a number of clinical factors which help to determine which patients may be suitable for a heart bypass rather than less invasive approaches, such as stenting or treatment with tablets. The patient is always put at the heart of the decision making process and the treatment options and each of their merits will be discussed with you in depth during your consultation.
HEART VALVE SURGERY & TAVI
There are four valves within the heart and several types of surgery can be performed to either replace or repair a diseased valve. Heart valve replacement surgery can be performed using metallic or biological tissue. There are advantages to both techniques and treatment will take into account a variety of clinical factors and will be tailored to the individual and their preferences. For some individuals, surgery may not necessarily be required and surveillance scans may be used to monitor the disease at regular intervals allowing intervention to be instigated if and when the disease progresses.
​In addition to open heart surgery, there are also some minimally invasive techniques that can be used to treat heart valve problems. One such treatment is TAVI (transcatheter aortic valve implantation) where the aortic valve of the heart can be treated with a valve delivered to the heart via one of the large blood vessel in the body (as opposed to open heart surgery).
​There are multiple options for the treatment of valvular heart disease and these will be discussed in detail with the cardiologist