TREATMENTS

HEART TREATMENT: YOUR HEART IN SAFE HANDS

Dr Omar Ali is a specialist in coronary and valve disease. He offers world-class patient-tailored treatment having years of experience and training in internationally recognized centers. He is the clinical lead for heart attack treatment (primary angioplasty service and acute coronary syndromes) and cardiac rehabilitation service. He is also the clinical lead for patient safety in the catheter laboratory. Dr Omar Ali also works closely with colleagues to provide a full range of heart treatments from coronary angioplasty to complex devices and arrhythmia management and cardiac surgery. He is committed to providing excellent care by making sure all complex cases are reviewed in a Heart MDT meeting in line with international guidelines.

Coronary Angioplasty

This treatment helps improve the blood supply to your heart muscle by widening narrowed the coronary arteries and inserting a small metal tube called a stent. Angioplasty can help to relieve angina symptoms and is also used as an emergency treatment for people who've had a heart attack.You’ll have an angiogram before your angioplasty to look inside your arteries and check where the blockages are and how much they are blocked. An angiogram often happens as part of the same procedure.

A catheter (a fine, hollow tube) with a small inflatable balloon is passed to the heart from your wrist (or occasionally the top of the leg). Dr Omar Ali prefers to perform all of his procedures from the wrist (also called radial access) as there are a number benefits to you-please read below. An X-ray is used then to direct the catheter to a coronary artery to reach the narrowed segment. The balloon is then gently expanded so that it squashes the fatty tissue inside the artery. The balloon is removed and another balloon which is covered with a mesh tube is inserted into the blocked artery. This balloon is then expanded to press the stent against the vessel wall to keep the artery open. The balloon is then removed.

Coronary angioplasty is now a routine procedure and is almost invariable carried out with stents placed inside the coronary artery unless the artery is not large enough to accept one. We can also carry out coronary angioplasty if you have had coronary artery by-pass graft surgery but your graft has become narrowed. Coronary angioplasty normally takes between 30 minutes and two hours.

Preparation for Angioplasty

Prior to having an angioplasty, you will be given 'anti-platelet drugs'. This includes Aspirin and Clopidogrel daily starting few days before your procedure date. You will be asked to continue taking both drugs for at least 12 months.

At the start of the procedure Dr Omar Ali will give you a local anaesthetic to numb a small area over the right wrist. Then a catheter – a fine, flexible, hollow tube – with a small inflatable balloon at its tip is passed through the wrist artery (radial artery).

Dr Omar Ali will inject some dye (contrast) into the catheter and the arteries can be seen on an x-ray screen. It's normal to feel a hot flushing sensation when the dye is injected.

The balloon is then gently inflated so that it squashes the fatty plaques - or deposits - against the artery wall, widening the artery and allowing the blood to flow more easily.

A stent - a small tube of stainless steel mesh - is already in place on the balloon. As the balloon is inflated, the stent expands so that it holds open the narrowed artery. The balloon is let down and removed, leaving the stent in place.

Sometimes when the balloon is inflated in the coronary artery to place the stent mild chest pain (angina) can be experienced. This can be normal and you may let Dr Omar Ali know at the time of the procedure. The pain normally passes away once the stent is placed and the balloon is removed.

Dr Omar Ali will then remove the catheter at the end of the procedure and a special compression wrist band is applied to the puncture site to stop any bleeding.

You will then be able to walk to your chair or bed accompanied by a nurse

We will continue to monitor you for the next two hours or until you feel back to normal.

You will be given a copy of the report and your GP will be informed of the result as well.

After care:

The special wrist band will be removed over the next 2 hours

You’ll usually be able to go home the same day when you feel ready or the next day, but make sure someone can take you home

Special instruction and a contact number will be given to you in case you have any problems

Dr Omar Ali will arrange a follow up appointment after the procedure to check on your progress and response to the treatment

It’s best to avoid doing any demanding activities, such as heavy lifting, for a week or so.

You shouldn’t drive for at least a week after having angioplasty .

If you’ve had a planned angioplasty with no complications you may be able to return to work within a few days, depending on the type of work you do.

If you’ve had an emergency angioplasty or a heart attack you may need to take a few weeks off.

Dr Omar Ali will arrange cardiac rehabilitation programme for you.

Why am I having the procedure through the wrist (radial artery access)?

Many modern centers are now offering coronary angioplasty through the wrist. Dr Omar Ali has many years’ experience using the radial artery. International research suggests that this should be the preferred access in most patients.

Because the radial artery in the wrist is smaller than the femoral artery in the groin, it is much easier to apply direct pressure to the puncture site to stop the bleeding.

No collagen plug is left behind in the radial artery unlike the use of the femoral artery in the groin where large collagen plug is routinely used to stop any bleeding

Also, radial artery access allows many patients to get out of bed and walk around right after their procedure.

Some discomfort may be experienced with radial artery access however, the femoral artery in the groin is also associated with some discomfort. Both can be minimised with the use of local anaesthetics and analgesia.

Patients tend to prefer to have the wrist exposed during the procedure rather than the groin.

How successful is coronary angioplasty?

Coronary angioplasty is a highly effective and successful procedure. Complications are rare. There is a tiny chance that a small tear could occur in the artery or the artery could block in the process of it being stretched in which a stent or rarely by-pass surgery may be required. The chance of that happening is probably less than 1 in 3-400.

Valve Disease Pre-assessment

There are four valves in your heart (aortic, mitral, tricuspid and pulmonary valves). Normally these valves open to let blood flow through or out of your heart, and then shut to keep it from flowing backwards. If your valve is diseased or damaged this can affect the flow of blood to your heart in 2 ways: If the valve does not open fully, it will obstruct the flow of blood. This is called valve stenosis. If the valve does not close properly, it will allow blood to leak backwards, in the wrong direction. This is called valve incompetence or regurgitation. We offer assessment for both valve stenosis and regurgitation and consider whether valve surgery is required. Dr Omar Ali has experience in also assessing patients for non-surgical valve intervention called Transcatheter Aortic Valve Intervention (TAVI).

Pacemakers

Pacemakers are small devices used to treat abnormal heart rhythms. A pacemaker is made up of a small box- the pulse generator: a battery powered electronic circuit and one or more electrode leads. Dr Omar Ali is an experienced specialist in pacemaker implantation for slow and irregular heart rhythms with excellent outcome. He will choose the most appropriate device in consultation with yourself that allows you to get the most out of your pacemaker to maintain a healthy life-style. The procedure is normally done as a day case under local anaesthetics. An overnight stay can be arranged if you prefer. It can take between 30 minutes to 1 hour to do.

Preparation for Pacemaker Implantation:

There is minimal preparation for pacemaker implantation

Please inform Dr Omar Ali or a member of his team if you are right or left handed. This is so that he can implant the pacemaker on the side without interfering with your dominant/writing hand.

Antibiotic will be given on the day of the procedure to reduce the risk of infections. Please inform Dr Omar Ali or a member of his team of any allergies.

We may need to do a blood test to make sure your inflammatory markers and kidney function are normal prior to giving you antibiotics.

If you are taking warfarin, we will ask you to stop it for 3-5 days prior to the procedure until your INR is low. You can continue to take aspirin if you are on it. We will go through your medications list prior to the pacemaker implantation so that you know exactly what to take on the day.

What does a pacemaker implantation procedure involve?

Dr Omar Ali makes a small cut just under your collarbone (usually on your left side) under local anaesthetics. Light sedation can be offered if you are anxious.

The leads are then fed through a large vein and into your heart.

The ends of the leads are positioned so they are touching your inner heart muscle. This is so we can monitor your heart rhythm and correct it if that’s needed.

Once the leads are in place, Dr Omar Ali will make a small pocket for the pacemaker box to sit in under the muscle or skin, close to the cut that he made. Then he attaches the pacemaker box to the leads and close up the wound using absorbable stitches and glue. Therefore no stiches will need to be removed.

After care:

You will be monitored for few hours or until you feel ready to go home.

You should always have a relative or friend taking you home

A final pacemaker check will be done prior to going home. A chest X-ray may also be required to check the position of the leads.

You will be give specific instructions before you go home.

You need to be careful not to put too much pressure on the arm nearest your pacemaker (usually your left arm) for at least two weeks after you get home. You should also make sure you don’t lift that arm up above your shoulder for 2 weeks. No driving is also advised for the same period of time. This helps to prevent the pacemaker leads from moving before they settle into your heart.

Dr Omar Ali will arrange a follow up appointment for you to check the pacemaker is working and make sure the wound is healing well.

Everyday life and your pacemaker:

A pacemaker shouldn’t affect your day to day life. You may need to make a few small changes for a short time, such as not driving for a while and doing less physical activity.

All pacemakers have a metal shell to protect them from other electrical signals so you can use most household equipment without any bother. But you do need to be careful around some equipment with magnets in it, like metal detectors.

If you are travelling through an airport, make sure you tell the security staff that you have a pacemaker so they don’t hold the metal detector over your pacemaker.

A pacemaker battery usually lasts between eight and ten years. We will keep a close check on the life of your battery and we will not allow it to run out fully. When the battery is running low you will need to go back into hospital and have a new pacemaker box fitted.

Cardiovascular Assessment

If you are about to have surgery (for example, orthopaedic or urology surgery or any operation requiring general anesthetics), your doctor may refer to us for cardiovascular assessment prior to your surgery to make sure your heart is able to withstand the anaesthetic and surgery itself. We will offer you a full assessment and investigation of your heart in a timely fashion prior to your surgery. This may lead to adjustment of your tablets or recommendation regarding the state of your heart. We do this to make sure your heart is as strong as possible to undergo the necessary operation.

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Heart Tablets

There are hundreds of tablets that are available for the treatment of heart conditions and many more are being manufactured and tested for the benefits of heart patients. Therefore many heart conditions can be successfully treated with medications with or without other forms of heart treatments. Once you have your consultation with Dr Omar Ali, he will explain to you the different types of medications you might need, how they work and what beneficial effects and potential side-effects you might experience. We will only choose the best possible medications for you with the best scientific evidence behind them.

Cardiac Rehabilitation

No heart treatment is complete with a structured programme of cardiac rehabilitation or cardiac rehab. Cardiac rehab – is a programme of education, exercise sessions and relaxation. If you’ve had a cardiac event such as a heart attack or if you’ve had treatment like a coronary angioplasty, cardiac rehab aims to help you recover and get back to living your life as fully as possible so you can get on with life as normal. Dr Omar Ali will explain to you after your treatment how this works and what you can do to help maintain a healthy heart. We aim to get you back to your baseline as quickly as possible. Maintaining a healthy heart: lifestyle changes

Bypass Surgery

A coronary artery bypass graft (CABG) is a surgical procedure used to treat coronary heart disease. It diverts blood around narrowed parts of the major arteries to improve blood flow and oxygen supply to the heart. Around 20,000 coronary artery bypass grafts are carried out in England every year. Most of these are carried out in men, and around 80% are used to treat people who are at least 60 years of age.

The procedure

A coronary artery bypass graft involves taking a blood vessel from another part of the body – usually the chest, leg or arm – and attaching it to the coronary artery above and below the narrowed area or blockage. This new blood vessel is known as a graft. The number of grafts needed will depend on how severe your coronary heart disease is and how many of the coronary blood vessels are narrowed.

A coronary artery bypass graft is carried out under general anaesthetic, which means you'll be unconscious during the operation. It usually takes between three and six hours.

Recovery

Most people will need to stay in hospital for at least seven days after having a coronary artery bypass graft.

Recovering takes time and everyone recovers at slightly different speeds. Generally, you should be able to sit in a chair after one day, walk after three days and walk up and down stairs after five or six days.

When you go home, you'll need to take things easy for a few weeks. You should be able to return to most of your normal activities after about six weeks, including working, driving, and having sex – most people make a full recovery within 12 weeks.

Risks of surgery

As with all types of surgery, a coronary artery bypass graft carries a risk of complications. These are usually relatively minor and treatable, such as an irregular heartbeat or a wound infection, but there's also a risk of serious complications such as a stroke or heart attack.

Overall, more than 95% of people who have a coronary artery bypass graft will live for at least one year, and around 90% will live at least five years.

Alternatives

A coronary angioplasty is the main alternative to a coronary artery bypass graft. It's a less invasive operation where a long, flexible hollow plastic tube called a catheter is inserted into a blood vessel in your arm or groin.

A balloon attached to the catheter is then inflated to widen the artery and a small metal tube called a stent is often used to help keep the artery open.

It usually takes less time to recover from a coronary angioplasty than from a coronary artery bypass graft, but there's a higher chance that the procedure will need to be repeated.

Also, a coronary angioplasty may not be recommended if multiple coronary arteries have become blocked and narrowed or the structure of the blood vessels near your heart is abnormal.

Maintaining a Healthy Heart lifestyle changes

Maintaining a healthy heart is easy!. Watch the video below to see how a healthy heart works?. Your heart is a muscle about the size of a fist. It is in the middle of your chest tilted slightly to the left. Each day, your heart beats about 100,000 times. It pumps about 23,000 litres (5,000 gallons) of blood around your body.

Simple lifestyle changes make a huge difference and keeps your heart healthy. Look through the suggestions made below and see what you can do to improve your heart health:

Eating well

Eating well and maintaining a healthy weight

Managing

Mangaing blood pressure, cholesterol and diabetes

Keeping active

Staying active boosts energy health overall

Smoke-Free Life

Quitting smoking and reducing stress

Disclaimer: Information provided on this page has been linked to the British Heart Foundation Website. The inclusion of any links does not necessarily imply a recommendation.

THE HEART SPECIALIST