Service types: Coronary angiogram | Cardiac catheterisation.

Lakes DHB patients can be referred to Waikato DHB for coronary angiograms.
 
This test is performed by a cardiologist in a sterile operating theatre environment.
 
Most people will need to have routine tests before the procedure. These tests may require separate appointments and are usually planned the day before or the day of the procedure.
You will be asked not to eat or drink after midnight the evening before the procedure.

You are not given a general anaesthetic but may have some medication to relax you if needed. Local anaesthetic is put into an area of skin to the side of your groin or in your arm. A needle and then tube are fed into an artery here and advanced through the blood vessels to the heart. Dye is then injected so that the heart and blood vessels can be seen on x-ray.  X-rays and measurements are then taken giving the doctors information about the state of your heart and the exact nature of any narrowed blood vessels. This allows them to plan the best form of treatment to prevent heart attacks and control any symptoms you may have.

Cardiovascular disease is a general term for any condition that affects the heart or blood vessels.

Common types of cardiovascular disease include:

• Coronary artery disease – narrowing or blockage of the arteries that supply the heart, which can lead to chest pain or heart attack.
• Heart failure – when the heart can’t pump blood effectively.
• Arrhythmias – abnormal heart rhythms.
• Stroke – damage to the brain caused by blocked or burst blood vessels.
• Peripheral artery disease – narrowing of arteries in the legs or arms.
• Heart valve problems – issues with valves that control blood flow through the heart.

Risk factors:

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Obesity
• Family history of heart disease
• Are older (your risk increases as you get older)

Heart failure refers to the heart failing to pump efficiently. There are many diseases that cause this including cardiovascular disease, high blood pressure, viral infections, alcohol, and diseases affecting the valves of the heart. When the heart is inefficient a number of symptoms occur depending on the cause and severity of the condition. The main symptoms are tiredness, breathlessness on exertion or lying flat, and ankle swelling. Doctors often refer to oedema, which means fluid retention usually in your feet or lungs as a result of the heart not pumping efficiently.

Tests looking for possible causes of heart failure include: Chest x-ray, Electrocardiogram (ECG), Echocardiogram (Cardiac ultrasound), Angiogram.

You are likely to be given several medications over time, started and monitored by your cardiologist and GP. These include medication to control the amount of fluid that builds up (diuretics), medication to protect your heart and slow it down as well as to thin your blood. You will often be referred to a dietitian or given advice about restricting the amount of fluid and salt you take as this can contribute to symptoms.

Heart rhythm refers to the electrical source that is driving the heart rate and whether or not it is regular or irregular. Heart rhythm can be affected by a number of conditions.

Some common terms

• Sinus rhythm is the normal rhythm
• Arrhythmia means abnormal rhythm
• Fibrillation means irregular rhythm or quivering of one part of the heart
• Bradycardia means slow heart rate
• Tachycardia means fast heart rate
• Paroxysmal means the arrhythmia comes and goes

Tachycardia

The most common form of this is atrial fibrillation. This is where the heart rhythm is irregular and often too fast. Symptoms include fatigue, palpitations (where you are aware of your heart racing or

pounding), dizziness and breathlessness.

Other tachycardias include supraventricular tachycardia (SVT) or ventricular tachycardia (VT). These have similar symptoms as atrial fibrillation but can also cause you to lose consciousness (faint).

Bradycardia

The most common form of this is called heart block. This is because messages from the electrical generator of the heart don't get through efficiently to the rest of the heart and hence it goes very slowly or can pause. Symptoms of the heart going too slowly include feeling tired, breathless or fainting.

Tests

Tests to diagnose what sort of arrhythmia you have include an electrocardiogram (ECG) and an ambulatory ECG (Holter monitor or Event recorder).

Treatment

Most treatments for tachycardias consist of medication to stop the abnormal rhythm or make it slower if and when it occurs. Atrial fibrillation, if you have other problems, can increase your risk of stroke so blood-thinning medication is often used as well.

If you have bradycardia, you may be referred to the surgeons for a pacemaker. This is a small operation where a battery powered device is placed under the skin with wires that lead to your heart and provide it with electrical stimulation to prevent it from going too slowly. You can't feel it doing this but will be aware of a small flat lump under your skin just below your collar bone.

Your heart consists of four chambers that receive and send blood to the lungs and body.

Disorders affecting valves can either cause stenosis (a narrowing) or regurgitation (leakage after the valve has closed). Depending on what valve is involved and how severe the damage is it may result in symptoms of heart failure, as it makes the heart pump inefficiently.

Suspicion of a heart valve problem is usually picked up by your doctor when they listen to your heart and hear a murmur. A murmur is heard with the stethoscope and is turbulence of blood flow that occurs through a narrowed or leaky valve. Not all heart murmurs mean serious problems but are best investigated further.

The echocardiogram is the main test to diagnose what valve is involved and how severe it is.

Treatment depends on the type and severity of the valve lesion. You may simply be monitored over years to see if anything changes. Some conditions require medication to thin the blood or treat any complicating heart problems. You may be referred to a heart surgeon for consideration of a valve replacement or dilatation of a narrowed valve.