Designing better care for people with heart disease

At Doctor360 we bring together the right people, the foremost technology and the newest techniques to make sure each person treated by us gets the best possible medical outcome. We provide a comprehensive range of cardiology service that involves consultation, cardiac testing, and invasive procedures. We will show a quick response to your needs with access to multiple sites for services, fast turnaround of reports and priority service for patients who are in urgent need.
We are dedicated to understanding the requirements of our patients so that we provide on-going care and professional service that is beyond your expectations. Along with this, all our practices make use of modern cardiovascular equipment, technology and techniques to ensure the maximum accuracy of diagnosis.

Cardiac Consultations and Assessments

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Cardiac Consultations

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Cardiac Telehealth Consultations

Cardiac Tests We Can Help Organise

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Ambulatory Blood Pressure Monitoring

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Cardiac Device Remote Monitoring

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Dobutamine Stress Echocardiogram

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ECG Monitoring

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Echocardiogram

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Electrocardiogram ECG

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Exercise Stress Test

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Stress Echocardiogram

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Tilt Table Test

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CT Coronary Angiography (CTCA) Score

Cardiac Procedures We Can Help Organise

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Cardiac Resynchronisation Therapy

Recounting one amongst the most exciting recent advancements in heart failure treatment, Cardiac resynchronization therapy (CRT) has to be the one. By targeting ventricular dyssynchrony, a condition that plagues as many as one-third of patients with highly symptomatic systolic attempts to give the failing heart a mechanical advantage that can substantially improve symptoms and mortality it proves to be a modern-day boom.

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Catheter Ablation for Atrial Fibrillation

Considering the most common sustained tachyarrhythmia encountered in clinical practice which affects ∼1% of the general population with increased incidences in the elderly population has to be Atrial fibrillation (AF). Currently,∼5 million people are affected in Europe. About 6% of the population group aged 60 years or more has AF. Atrial fibrillation has an important impact on morbidity and mortality in these patients. Pharmacological therapy to suppress arrhythmia is frequently unsuccessful due to low efficacy and/or side effects. Catheter ablation of AF has advanced since 15 years to a well established and widely performed interventional therapy for many patients with symptomatic AF. Several prospective randomized trials have demonstrated the superiority of catheter ablation over anti-arrhythmic drug therapy in patients with paroxysmal AF and structurally normal hearts.

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Cardioversion

The vital method to bring an abnormal heart rhythm back to normal can be termed as Cardioversion. Broadly dealt with two alternatives it can be done using an electric shock or with drugs. An individual is diagnosed with an irregular heartbeat (the word called arrhythmia, atrial fibrillation, or AFib might ring any bells for you), your doctor will probably suggest a treatment referred to as cardio version to help you get a normal rhythm back. If your heart beats too fast or unevenly, it can be dangerous.Insufficient pumping of enough blood to meet your body's needs might be one of the serious consequences. Non-rhythmic or clearly an irregular heartbeat also can lead to grave conditions like a stroke or a heart attack.

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Coronary Angiography

The major or minor arteries supplying blood in or out of your heart can become blocked or narrowed from a buildup of cholesterol, cells, or other substances (plaque) ultimately reducing the blood flow to your heart and cause chest discomfort and pain. In some instances even a blood clot can suddenly form and dislocate and get into circulation or get worse and completely block blood flow, leading to a heart attack. Here the savior procedure is Angioplasty which opens blocked arteries and restores normal blood flow to your heart muscle. It is a minimally invasive surgery. The procedure starts by threading a catheter (thin tube) through a small puncture in a leg or arm artery directing its way to the heart and on reaching the desired narrowed region of the artery, the blocked artery is opened by inflating a tiny balloon in it.

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Coronary Angioplasty and Stenting

Also called percutaneous coronary intervention (PCI), intravenous coronary angioplasty is a procedure used to open clogged heart arteries. In this procedure, a tiny balloon is temporarily inserted into the artery that is clogged and inflated to help widen the artery. The procedure of angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent (which is also available with a medicinal coat on it to prevent further formation and deposition of plaque) to help keep the artery open and decrease the chance of narrowing. Subsequently, the angioplasty can phenomenally improve symptoms of the blocked arteries, such as chest pain and shortness of breath, and can also be used during an episode of heart attack to unblock a blocked artery and reduce the amount of damage done to the heart thereby impairing it. Angioplasty is commonly used to treat a type of heart disease known as atherosclerosis, which is the slow build-up of fatty plaque in the blood vessels of the heart.

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Electrophysiological Study

This test is performed to assess your heart's electrical system or activity and is used to diagnose abnormal heartbeats or arrhythmia and is called electrophysiology (EP) study. The procedure for this test involves the insertion of catheters and then wire electrodes, which measure electrical activity, through blood vessels that enter the heart. Upon arriving at the hospital, the final steps to prepare for the EP study are as follows:
• Initially considering your own comfort, empty your bladder as completely as possible. A bedpan or urinal will be available during the procedure. Depending on the length of your procedure, a catheter may be inserted to drain your bladder of urine during the procedure.
• There is a possibility that several intravenous medications could be administered in your body with the help of a small intravenous (IV) needle.

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Implantable Cardiac Defibrillator

This is a very small and fine electronic device connected to the heart called an implantable cardioverter-defibrillator (ICD). Its usage is to continuously and rigorously monitor and help regulate potentially fast and life-threatening electrical problems associated with the heart.
Just under the skin just below the collarbone atransvenous or “traditional” ICD, about the size of a stopwatch, is implanted. Its constituents are a pulse generator and wires called leads. The pulse generator, in turn, contains the battery and a tiny computer. Lead wires may be one or multiple are connect the pulse generator to specific locations in the heart.
Resetting of the heart rhythm to prevent sudden cardiac arrest is done by the ICD that responds to irregular life-threatening heart rhythms from the lower chambers of the heart with pacing that corrects a fast rhythm and encourages a normal heartbeat, or a shock (defibrillation). Additionally, the ICD also records and eventually stores information about your heart rhythm and therapies delivered by the ICD for your doctor to review for any further assistance.

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Implantable Loop Recorder

A heart recording device that is implanted in the body underneath the chest skin is termed as an implantable loop recorder or ILR.
It has several important uses.
Looking for causes of fainting, palpitations, very fast or slow heartbeats, and hidden rhythms that can cause strokes are the most common ones. When a loop recorder is implanted, your heart healthcare provider (cardiologist) does a minor procedure. The operator places the small device underneath your skin, on your chest wall, overlying the heart and the machine works as an electrocardiogram (ECG), which continuously picks up the electrical signals from your heart. This can help find abnormal heart rhythms that can cause a number of problems such as fainting.
When observed in-depth it was observed that it’s a special group of cells that begin the electrical signal to start your heartbeat whichis in the sinoatrial (SA) node. Specifically, this node lies in the right atrium, the upper right chamber of your heart. The signal quickly travels down your heart’s conducting system to the ventricles. These are the 2 lower chambers of your heart. On traveling, the signal triggers nearby parts of your heart to contract which eventually helps your heart pump blood in a coordinated way.

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Left Atrial Appendage Occluder Implant

Patients with atrial fibrillation who are at an increased risk for stroke, but who are not good long-term candidates for oral anticoagulation, may derive benefit from left atrial appendage (LAA) occlusion. Among these benefits is a decreased risk of life-threatening bleeding.However, implantation of a anLAA occluder device also entails short-term and long-term risks. In particular, patients who undergo LAA occluder placement are subject to the unintended consequence of having a foreign object in the left atrium that can serve as a nidus for thrombus formation. A recent observational study suggested that the risk of device-related thrombus (DRT) with LAA occluder placement is 7% per year. In the case of the Watchman device, a short course (45 days) of warfarin followed by dual antiplatelet therapy until 6 months after LAA closure has been recommended in the Food and Drug Administration–approved label to prevent DRT before the device is completely endothelialized.

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MitraClip

The mitral valve allows blood to flow from the atrium to the ventricle and is a one-way valve located between the heart’s two left chambers and consists of two leaflets, or flaps, that open and close to make sure blood flow is unidirectional. If due to dysfunction the mitral valve does not close properly, blood is allowed to leak backward in the heart which is called mitral regurgitation (MR).
Eventually causing the heart to work harder to push blood through the body. Common symptoms caused because of this increased workload are fatigue, shortness of breath, coughing, an irregular heartbeat, and swollen feet or ankles.
Characterized as a progressive disease MR can eventually decrease your quality of life and result in increased difficulty performing your regular daily activities is a debilitating one. Altogether depending on your current health condition, and the severity of your symptoms, your doctor may refer you to the MitraClip team for further assessment.

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Percutaneous Closure Procedures

A less-invasive surgical procedure that is used for the treatment of patients who are a victim of the atrial septal defect (ASD) or patent foramen ovale (PFO) is called a percutaneous closure procedure. Clinicians have already discovered multiple and less invasive methods in treatment, such as catheterization as the utilization of percutaneous closure has evolved over the years.
Very extensive and contemporary research proposes the use of this procedure as an alternative to other common and more invasive methods available to date. Although the percutaneous closure is also a surgical process, its success rate and ease-of-use over alternatives have made it a primary choice in treating ASD and PFO very conveniently.
As the patients with AS and PFO were empirically found to have higher survival rates when treated using surgical procedures, it turned many heads and many interventional studies on the topic have been published. Very clearly, there is evidence of catheterization and percutaneous occlusion devices as effective treatment modalities for the subsequent condition. As the percutaneous closure is very limited and restricted only to small diameters, current research projects are trying to expand the treatment scope of the procedure.

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Permanent Pacemaker Implantation

A medical device that uses electrical impulses, delivered by electrodes contracting the heart muscles, to regulate the beating of the heart is termed a pacemaker (PM) (or artificial PM, so as not to be confused with the heart’s natural PM). The primary purpose of this device involvesmaintenance of an adequate heart rate, either because the heart’s natural PM is not fast enough, or there is a block in the heart’s electrical conduction system. The modernized PMs are externally programmable and allow the cardiologist to select the optimum pacing modes for individual patients as need be. Fewer of them even combine a PM and defibrillator in a single implantable device. The PMs can be a temporary or permanent device.
Treatment of short-term heart problems, such as a slow heartbeat that’s caused by a heart attack, heart surgery, or an overdose of medicine is done byTemporary PMs. On the contrary, permanent PMs are used to control long-term heart rhythm problems. A PM can relieve some arrhythmia symptoms, such as fatigue and fainting. The prime job of a PM also can help a person who has abnormal HRs resume a more active lifestyle. On reviewing a current mini-review we will focus on the insertion of a PM and the possible pneumothorax that can be caused.

What is a paediatric sleep study?

Transcatheter Alcohol Ablation of Septal Hypertrophy (TASH)

The Transcatheter Alcohol ablation of Septal Hypertrophy (TASH) procedure involves the following:
• General anesthetic (fully put to sleep) with a breathing machine to support breathing.
• An ultrasound probe (transoesophageal echocardiogram probe) is placed down your food pipe to visualize the heart.
• Tubes are also inserted in the veins in the neck and or leg in addition to a tube in the artery in the arm/wrist or leg (groin). These tubes are called sheaths.
• A temporary pacemaker may be inserted via the tubes in the veins.
• This causes the heart muscle in this area to die (a type of permanent heart attack) reducing the amount of thickened muscle.

What is a paediatric sleep study?

Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) is a procedure for patients who are suffering from severe and symptomatic aortic stenosis (narrowing of the aortic valve opening). The entire procedure of TAVR is performed on a beating heart and does not require cardiopulmonary bypass. Patients when considered at medium or high risk for surgical aortic valve replacement (SAVR) or are inoperable, then the TAVR is approved.
In consideration of patient with low risk for SAVR may be enrolled in a clinical trial called PARTNER-3 that randomizes patients to either TAVR or SAVR. Herein thus for all patients, the decision of whether a specific patient is treated using TAVR or SAVR is based upon an assessment of clinical and anatomic features by the Heart Team that consists of cardiologists, interventional cardiologists, cardiac surgeons, imaging specialists, and nurses.
Bovine (cow) pericardium and is supported with a metal stent (frame) is used to make the TAVR valve. When considered on broader terms, the TAVR does not need traditional anticoagulation or "blood thinners" like mechanical heart valves.

What is a paediatric sleep study?

Transoesophageal Echocardiography

A test that produces pictures of your heart is called Transesophageal echocardiography (TEE). To make detailed pictures of your heart and the arteries that lead to and from itTEE uses high-frequency sound waves (ultrasound). The echo transducer that is responsible for the production of the sound waves for TEE is attached to a thin tube that passes through your mouth, down your throat, and into your esophagusunlike a standard echocardiogram as the esophagus is very to the upper chambers of the heart, very clear images of those heart structures and valves can be obtained.

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Catheter Ablation for Supraventricular Tachycardia

A narrow plastic tube, or catheter, to kill cells responsible for the heart rhythm problems caused by supraventricular tachycardia is used by catheter ablation.
• Catheters: Can be classified as narrow plastic tubes, usually 2-3 mm in diameter, inserted into the body, and leads to the heart chambers.
• Ablation: Is the procedure of killing islands of cells, which are responsible for the heart rhythm problems.
Eventually, fluoroscopy can be used, and here the catheters are commonly inserted into the femoral artery or vein and advanced to the heart. A weak form of X-ray is fluoroscopy which is used to guide the catheters.
As its positioning in the heart is accomplished, the catheter is used to record electrical signals. Within the heart,the measurements of the electrical conduction are made. To send small electrical impulses to the heart the catheters positioned in the heart are used eventually these impulses may be used to trigger or induce the supraventricular tachycardia.
In rare instances, isoproterenol, a medication similar to adrenaline, is used to help create the tachycardia. It is possible to determine the location from which the supraventricular tachycardia, a process called mapping after the supraventricular tachycardia is produced. By comparing the timing of the electrical signals recorded from the various catheter positions within the heart, the location of the supraventricular tachycardia is determined.
Several technologies have flourished that may be used to help in the mapping process and eventually these technologies use magnetic sensors or electrical impulse measurements in order to create a map similar to GPS of the electrical activation of the heart. The site at which catheter ablation should be performed is determined by this electrical activation map.

Frequently Asked Questions:

Q: What tests and procedures does Doctor360 offer?

A: What tests and procedures are provided by Doctor360 cardiology team? We provide a wide range of cardiology tests and procedures. You can also speak to a member of the team for detailed information.

Q: Who can be referred?

Q: How long does a referral remain useful?

Q: What's the referral process?

Q: What's covered by my healthcare fund?

Q: What will it cost me to come to Doctor360?

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