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Cardiology Outpatients

London Bridge Hospital's Cardiology Department has gained a global reputation as a centre of excellence, and takes a patient centric approach to the diagnosis, investigation and treatment of patients with all forms of heart disease.

Our Cardiology Department benefits from a close professional partnership with our team of internationally recognised consultant cardiologists, ensuring rapid analysis, diagnosis and treatment of heart conditions. We are fully equipped with state-of-the-art facilities and offer a complete range of services for all cardiological conditions. This includes echocardiograms (an ultrasound scan of the heart), electrophysiology (the use of catheters to analyse the heart’s internal electrical activity) and stress testing (used to evaluate heart function by combining physical activity with an echocardiogram).

Cardiology procedures at London Bridge Hospital

Electrocardiogram

An electrocardiogram (ECG) is a quick and painless way to assess the rate, rhythm and electrical activity of the heart. This allows the physician to check for cardiac arrhythmias, palpitations and the effectiveness of medication. It is a simple procedure, involving lying down on a bed for two to five minutes with ten electrodes attached to the chest, wrists and ankles.

24-hour blood pressure monitoring

Ambulatory Blood Pressure (BP) monitoring is a painless, non-invasive method to obtain blood pressure recordings over a 24-hour period. This involves wearing a small cuff around the non-dominant arm. The cuff is then attached to a monitoring device (about the size of a smart phone) and worn on a belt fastened around the waist. The cuff will automatically inflate at regular intervals throughout the 24-hour period to assess blood pressure.

24 & 48 hr ECG

A 24 hour or 48 hour electrocardiogram monitor provides a constant recording of your heart rate and rhythm over that period. The test is prescribed for a variety of symptoms including, dizziness, fainting spells, irregular or fast heart rates and palpitations. It also provides information on the effectiveness of medication and treatments. This is a safe and painless recording involving electrodes placed on your chest and attached to wires. These wires are connected to a small monitor worn around your waist.

7-day tape

A 7-day tape monitor provides a constant recording of the patient’s heart, delivering safe and painless electrocardiogram (rate and rhythm) readings over a seven-day period. During the monitoring period the patient wears a small monitor attached to the chest with three small wires connected to electrodes.

Exercise stress test

A stress test or exercise tolerance test is used to provide information about coronary artery disease, cardiac arrhythmias, possible heart related chest pain, dizziness and shortness of breath. This diagnostic involves the use of a treadmill so you will be asked to bring comfortable clothing appropriate for exercise.

Electrodes are attached to the chest, connected to an ECG and used to monitor the heart rhythm/waveform and ensure patient safety. Blood pressure is monitored at three-minute intervals throughout the test.

Baseline measurements of heart rate and blood pressure are taken prior to exercising. You then begin walking on the treadmill while the pace and incline of the treadmill slowly increases. The test continues until you reach a target heart rate, are advised to stop, or need to stop due to fatigue or symptoms. You are then monitored after exercising until your heart rate and blood pressure return to a baseline reading.

Echocardiogram

An echocardiogram is a painless procedure, consisting of an ultrasound scan of the heart, designed to examine the chambers, valves and major blood vessels of the heart. This allows the specialists in the Cardiology Department to screen for valve regurgitation, heart chamber function, heart size, infections, hypertension and clots in the heart. The probe takes images from the heart structures using ultrasound. Sound waves pass through the chest wall and ‘bounce’ back from the structures, providing two-dimensional images.

3D Echocardiogram (3D-ECHO)

This is an ultrasound scan of the heart. It involves a probe placed on various areas of the chest to evaluate the heart’s structures and functions. It will look at the different chambers of the heart; the valves and blood flow in a more detailed way. This scan is used for more specific cardiac conditions.

No preparation is necessary for this test, you will be provided with a gown to wear, as clothing from the waist up must be removed. The scan will take approximately 15-30 minutes.

Echocardiogram with Bubble Contrast Injection

A bubble echocardiogram is an extension of an echocardiogram that uses simple air bubbles as a contrast medium during the test. This procedure is used to detect holes in the heart. A cannula is inserted in your arm then a small amount of blood is mixed with sterile salty water and a small amount of air. This mix is injected during the scan to look for bubbles moving from one chamber of the heart to another.

Stress Echocardiogram - Exercise

This test compares the function of the heart at rest and under stress (i.e. exercise). Electrodes are placed on your chest and connected to wires in order to monitor your heart rate (Electrocardiogram) throughout the test.

While lying down, a resting ultrasound image is obtained by placing the probe on various areas of the chest. To analyse the heart under ‘stress’, a treadmill is used to increase the heart rate through incremental exercise, which increases in both speed and incline every 3 minutes. After completing as much exercise as possible, the treadmill is abruptly stopped and another set of ultrasound images are taken while the heart is still beating fast..

This test allows us to evaluate pre-exercise and post-exercise contraction of the heart muscle. This is used to rule out any possible underlying cardiac conditions that may be causing chest pain and palpitations. Please bring clothes that you feel comfortable exercising in. A gown will be provided, as clothing from the waist up must be removed for the scans to take place. This test can take between 30 – 50 minutes..

Stress Echocardiogram - Dobutamine

This test is used to compare the function of the heart at rest and also under stress, by utilising a short-acting medication called Dobutamine. We place electrodes on your chest and use these to carry out an Electrocardiogram throughout the test. Resting ultrasound images are obtained by placing a probe on various areas of the chest to assess heart function..

The medication is administered via a needle into the hand or arm. The dosage is increased every 3 minutes, until the desired heart rate is reached..

If the heart rate is not achieved using this medication alone, another drug called Atropine may also be administered to assist in raising the heart rate. It may also be necessary to use a dye contrast to provide clearer ultrasound images. Once the infusion of Dobuamine is stopped, the heart rate gradually returns to normal, this is monitored for approximately 10 minutes afterwards..

This test is specifically for patients who are unable to exercise for any reason (i.e. injury) and usually takes between 30 -60 minutes..

Pacemaker follow up

Pacemaker follow ups (single, dual chamber and Bi-ventricular devices) are performed the morning after the implant procedure; 6 weeks post implant and 6-12 months thereafter. Pacemaker follow ups are performed by specially trained Cardiac Physiologists..

During a pacemaker follow up, the physiologist will communicate with the device using a compatible programmer. They then evaluate diagnostics, test pacemaker function and make any necessary changes. We allow 30 minutes for each appointment, which provides ample time for any questions relating to the pacemaker to be answered..

Defibrillator follow up

Implantable Cardioverter Defibrillator (ICD) follow ups (single, dual chamber and Bi-ventricular devices) are performed the morning post implant; 6 weeks post implant and 6 monthly thereafter. ICD follow ups are carried out by specially trained Cardiac Physiologists..

During an ICD follow up, the physiologist will communicate with the device via a compatible programmer. They can evaluate diagnostics, test the ICD function and make any necessary changes. We allow 30 minutes for each appointment, which gives patients time to ask any questions relating to the ICD..

Biventricular device optimisation

Optimisation is specific to biventricular (CRT) devices. It combines a normal CRT follow up (performed by a specially trained physiologist) and an echocardiogram (usually performed by a Consultant Cardiologist). The objective is to compare how different device configurations affect cardiac output. The configuration that results in the best cardiac output is considered ‘optimal’ and is programmed permanently. We allow 45 minutes for each optimisation..

Implantable Event Recorders

Implantable Event Recorders, also called Implantable Loop Recorders (ILR), are downloaded following a patient activated recording, or after a potential arrhythmic episode has taken place. Specially trained Cardiac Physiologists oversee these follow ups. .

During an ILR follow up, the physiologist uses a compatible programmer to communicate with the device to review any arrhythmic episodes that have been captured. We allow 30 minutes for each appointment, giving ample time for any questions from the patient relating to the ILR to be answered..

Home Monitoring

Remote home monitoring enables patients to download information from their device to the clinic trans-telephonically, where it is analysed by a specially trained Cardiac Physiologist .

Remote home monitoring leads to fewer in-clinic visits and provides valuable clinical information. Home monitoring facilitates earlier detection, notification and intervention of any potential cardiac device related problems. This technology is compatible with all CRT-D, ICD and ILR patients. It is compatible with the majority of pacemaker and CRT-P patients.

Respiratory Outpatient Diagnostic Testing

We provide a wide range of respiratory tests to assist in the investigation of a range of symptoms. These include shortness of breath, coughing, wheezing, exercise intolerance and more. Our close professional partnership with internationally recognised respiratory consultants ensures rapid analysis, diagnosis and treatment of respiratory conditions such as:

  • Asthma
  • COPD
  • Pulmonary fibrosis
  • Sarcoidosis
  • Cough of unknown cause
  • Exercise induced Asthma
  • Shortness of breath on exercise

 

We perform a wide range of tests, including:

Spirometry

Spirometry is a basic assessment of how quickly you can move air into and out of your lungs. It gives your doctor an indication of whether your airways are obstructed or the movement of your lungs is restricted. For patients who already have a respiratory diagnosis spirometry is used to monitor the progression of a condition or their response to medication.

Full lung function

Full lung function testing involves three different breathing tests to gain an overall view of how your lungs are working; these tests are all non-invasive and involve you breathing though a tube.

A full lung function test includes:

  • Spirometry (see above) to assess the movement of air into and out of the lungs
  • Gas transfer test to assess how effectively the oxygen you breathe into your lungs transfers across into your blood system for delivery to where it’s needed
  • Body plethysmography to look at how large your lungs are (total lung capacity) and how much air is left in your lungs when ‘emptied’ (residual volume)

 

Reversibility

A reversibility assessment is always done in conjunction with either spirometry or full lung function. After the spirometry or full lung function is complete the physiologist will ask you to take a dose of Salbutamol (Ventolin) from an inhaler; after waiting 20 minutes to allow the medication to take effect the spirometry will be repeated to see if the inhaler has improved the results. This test is often done in patients with or who are suspected of having Asthma. If you are currently taking any inhalers it is important to discuss with your doctor if these should be stopped prior to the test taking place

Mannitol

A mannitol test is known as a bronchial challenge test. This involves performing a baseline spirometry, we then ‘challenge’ your airways by asking you to breathe in increasing doses of a dry powder called Mannitol and we will repeat the spirometry after each dose to assess for any changes. If your airways are normal then they will not react to the mannitol and the results of the spirometry will remain stable throughout. If however you have hyper-sensitive airways (such as in Asthma) then the mannitol will affect the airways and we will see a change in the spirometry results as the test progresses.

Cardiopulmonary exercise test

A cardiopulmonary exercise test (CPET/CPX) is a maximal exercise test where we simultaneously monitor your heart and your lungs while you exercise on a bicycle. Throughout the test we monitor your ECG (heart rhythm), heart rate, blood pressure, oxygen saturations (SpO2) and your oxygen uptake and carbon dioxide output through breathing. We ask that you push yourself during this test so that we can achieve and record the highest values you are capable of. All the information gathered provides your consultant with a large amount of data they can use to identify what factors are affecting your exercise performance.

This test is also known as a VO2 max test. The VO2 max is the amount of oxygen you are breathing in per minute at your maximum point of exercise; this is often used as a marker as to how fit/athletic you are.

A CPET is used in a wide range of situations:

  • To assess the severity of a known exercise limitation; particularly assessing over time with repeat testing
  • To determine the cause of exercise limitation
  • To determine the fitness level/suitability to perform an upcoming exercise related task
  • To investigate physiological correlates to patients symptoms under exercise

 

Capillary blood gases (CBG)

We take a small sample of blood from your earlobe to assess the levels of different gases and biological substances within your blood. We look at levels of oxygen, carbon dioxide, lactate, bicarbonate and the pH of the blood. The test gives information on the current oxygenation status and a picture of long-term respiratory and metabolic status.

Fit to Fly assessment (hypoxic challenge)

A hypoxic challenge test will determine if you require supplemental oxygen during a flight. In a commercial aircraft the cabin is pressurised to the equivalent of 8,000ft where the oxygen levels in the air are 15% and lower than at sea level (21%). In a normal healthy individual this will result in the blood oxygen levels dropping a small amount but this would not cause any symptoms or adverse effects.

However, altitude exposure in patients with pre-existing lung disease and those with low oxygen levels at sea level may have more significant adverse effects from the lower oxygen levels in the aircraft. During the test we will monitor your blood oxygen levels, heart rate and symptoms whilst you breathe 15% oxygen; this is all done non-invasively via a clip on your finger. If your doctor requires we may do this test in conjunction with capillary blood gases (see above).

If the oxygen levels in your blood remain stable the test is finished after 15 minutes; however if your oxygen levels fall we will give you supplemental oxygen to breathe until your blood oxygen levels remain stable; in this instance your doctor is likely to advise you can fly but only with supplemental oxygen.

MIPs/MEPs

This test comprises of several breathing manoeuvres to assess the strength of the respiratory muscles; these tests would be suggested in cases of suspected respiratory muscle weakness or paralysis. We record both the maximum inspiratory pressures (MIPs) and the maximal expiratory pressures (MEPs)

Supine VC

A baseline spirometry is carried out in either a sitting or standing position; the patient is then asked to lie down on their back and the spirometry is repeated to determine if there is any difference between the sitting and supine values. This test is done in cases of suspected diaphragm weakness or paralysis.

Sleep Centre Outpatient services

At London Bridge Hospital we offer a comprehensive selection of both home based and in-hospital diagnostic tests to aid in the diagnosis and management of a range of sleep disorders.

The Outpatient services we offer include:

  • Oximetry and home respiratory sleep studies
  • Actigraphy
  • A full CPAP service (treatment for sleep apnoea)

For more information please go to the London Bridge Sleep Centre website http://www.londonbridgesleepcentre.co.uk

Imaging Services

Patients at London Bridge Hospital Outpatients benefit from the latest techniques in non-invasive assessment of the function and structure of the cardiovascular system. We have state-of-the-art equipment and use only specialist radiologists and cardiologists to interpret scans and generate reports. Our multidisciplinary team carries out in-depth consultations with patients to establish whether a screening is required. London Bridge Hospital is proud to be one of the first hospitals to carry out MRI scans on pacemaker patients (specific types only).

Our services include:

  • Aortic ultrasound Cardiac imaging Cardiac MRI (stress and rest)
  • Carotid and deep venous/ arterial scans
  • CT aorta
  • CT coronary calcium scoring
  • Full cardiac programme
  • Low dose CT
  • CT coronary angiography – provides a non-invasive alternative to standard coronary angiography
  • Nuclear Medicine – myocardial perfusion scanning (stress and rest)

 

Why use the Cardiology Department at London Bridge Hospital

  • We strive for quick results from diagnostic procedures and aim to arrange appointments between patients and consultants on either the same day or within the next 24 hours.
  • We have a team of globally renowned, highly qualified physiologists who we have a strong working-relationship – these experts oversee our procedures and provide invaluable knowledge and support to our patients.
  • We utilise the latest technologies, allowing for more accurate diagnosis, more effective and more rapid treatment, with more procedures now available as day-cases as a result of the technology we use.
  • The care we provide to patients, in terms of recovery and ongoing care is catered to each individual patient’s needs and requirements. This helps us to achieve more favourable results, provide more successful treatments and help our patients return to living healthy and active lives.

 

To find out more about our Cardiology Department at London Bridge Hospital Outpatients, or to arrange an appointment with one of our consultants, please call 020 3131 6395 or 020 3553 6628 or request an appointment online.

 

This service can be found at the following facilities: