San Heart - Cardiac Health

Cardiac services & procedures

The heart is a highly sophisticated organ which requires considerable skill and knowledge to understand and treat. San Heart has built a comprehensive team of cardiologists, interventional cardiologists, surgeons and therapists which is dedicated to heart health. Our team aims to deliver the best possible patient outcomes in NSW for the investigation, diagnosis and treatment of a broad range of heart conditions.

Investigations & procedures

Using state-of-the-art technology, the San team of cardiac professionals utilise a range of investigations and procedures to support the diagnosis and treatment of heart conditions.

Electrocardiogram (ECG)

As a non-invasive medical test, an electrocardiogram (ECG) is an important tool to assist the diagnosis of heart conditions and abnormalities or to monitor those with high risk factors. Using small sensors called electrodes attached to the chest, the ECG records changes in electrical activity over time as the heart beats. Analysis of the resulting graph shows if the heart is beating irregularly, overworking or showing signs of abnormalities when compared to a normal heart rhythm. As a quick and painless procedure, the ECG is an essential tool both for diagnosis and for planning future cardiac interventions or treatments.

Transthoracic echocardiogram (TTE)

To obtain an overview of heart health, a transthoracic echocardiogram (TTE) is a useful assessment and diagnostic tool. Using soundwaves, this non-invasive imaging test is performed by placing a device called a transducer just above the patient's chest, directly above the heart area. As sound waves are sent towards the chest, they bounce off the heart, and are used to create an image on screen. A TTE gives the cardiologist a good view of the heart's condition including shape, size, valve function and pumping strength. Common uses of TTE are to diagnose conditions such as congenital defects, heart failure and unusual heart function potentially caused by artery blockages.

Transoesophageal echocardiogram (TOE)

When a more detailed picture of heart function is required, a transoesophageal echocardiogram (TOE) may be requested by your cardiologist. A device called a transducer is inserted through the patient's numbed throat using a small flexible tube. As it is guided down the oesophagus, the transducer is brought into closer proximity to the heart, allowing for a more unobstructed view than is possible with an external transthoracic echocardiogram (TTE). A TOE is a safe procedure which generally takes less than an hour and is commonly recommended for detecting potentially serious heart issues such as valve problems or to find blood clots which may be harder to identify using standard echocardiograms.

Exercise stress test

To understand how well a heart is working under stress, an exercise stress test may be recommended by a San cardiac specialist. The test involves connecting electrodes to the patient's chest and monitoring the electrical activity through an electrocardiogram while exercise is underway. The patient typically walks on a treadmill or rides a stationary bicycle. As the test progresses, the intensity is increased to make the heart pump more quickly. An exercise stress test is useful to evaluate the effectiveness of treatments, but may also be used to diagnose heart conditions such as coronary disease or to better understand the cause of shortness of breath or chest pain.

Coronary angiogram

Where detailed imagery is needed to detect or examine blood vessel blockages or abnormalities, a coronary angiogram may be advised by a doctor or cardiologist. The procedure involves a thin tube being inserted into an artery via the groin or wrist and guided to the heart, followed by the injection of a special dye. The arteries become visible under X-ray, highlighting any blockages or narrowing which may be causing pain or other symptoms. The patient may be sedated to assist with relaxation and the procedure generally takes less than an hour to complete. While a coronary angiogram is commonly used for investigating heart-related issues, it is also an effective tool for planning medical treatments such as heart surgery or the insertion of coronary stents.

Sestamibi stress myocardial perfusion study

Sestamibi is a radioactive molecule used during a cardiac investigation procedure to help identify variations in blood flow through the heart. During a sestamibi scan, a small amount of the molecule is injected into a vein to allow its location to be monitored before and during exercise. Any areas of the heart which have damaged tissue or impaired blood flow will be less effective at absorbing the tracer material. The images produced during a sestamibi stress myocardial perfusion study will highlight blood vessels or tissue areas with reduced blood flow. This information is helpful to assess the heart's overall condition when under stress and to inform future cardiac treatments.

Interventional procedures

Where heart investigations identify the need for medical treatment, your San cardiac specialist may recommend an interventional procedure. These types of procedures are generally minimally invasive, with most being conducted in a short time under local anaesthetic.

Percutaneous transluminal coronary angioplasty (PTCA)

Where an artery narrows or becomes blocked, a percutaneous transluminal coronary angioplasty (PTCA) may be used to help restore blood flow. This minimally invasive procedure involves inserting a thin tube into the artery (usually via the wrist or groin) which is then guided to the blocked area. A small balloon at the tip of the tube is inflated, widening the opening and depressing the fatty deposits against the artery wall. The procedure is sometimes accompanied by the insertion of a coronary stent, which helps to keep the artery open. Performed under local anaesthetic, the PTCA can significantly reduce pain symptoms and quickly restore blood vessel and heart function.

Coronary stent insertion

In situations where a blocked or narrowed artery is creating pain or impacting heart function, a coronary stent insertion may be recommended. A stent is a small wire mesh tube which is placed at the site of the issue to keep the artery open and prevent future narrowing or collapse. A coronary stent is usually inserted during a percutaneous transluminal coronary angioplasty (PTCA). The procedure involves inserting a flexible tube into the artery via the wrist or groin to reach the site of the blockage. After re-inflating the area with a small balloon on the tip of the tube, the stent is deposited. The stent remains in place over time, keeping the artery open and preventing future reoccurrence of the blockage.

Pacemaker and leadless pacemaker insertion

An abnormal heart rhythm, known as arrhythmia, can be corrected in some cases with the insertion of a pacemaker. Traditional pacemakers comprise a small device being implanted under the skin near the heart, with wires threaded through a vein into the heart. A newer type of device called a leadless pacemaker is also available. The leadless pacemaker is inserted via a catheter and vein rather than requiring a chest incision, making it less invasive and reducing some risks that can occur with traditional pacemaker insertion. Both devices work in the same way, by monitoring the heart beat and delivering electrical pulses as required to restore and maintain a normal heart rhythm and function.

Electrophysiological study (EPS) and radiofrequency ablation (RFA)

When an abnormal heart rhythm (arrhythmia) requires more detailed diagnostic testing or treatment, the San's cardiac specialist team may consider undertaking an electrophysiological study (EPS) followed by a radiofrequency ablation (RFA) procedure. The EPS is a diagnostic test involving inserting catheters (thin, flexible wires) into veins in the groin or neck, which are then guided to the heart. At the tip of the catheter is an electrode which measures the electrical activity. Once the source of the abnormal heart rhythm is identified, a radiofrequency ablation (RFA) may follow. This procedure involves delivering radiofrequency energy as heat through the catheter, destroying the identified area of faulty heart tissue.

Transcatheter aortic valve implantation (TAVI)

The aortic valve performs vital functions in relation to the direction of heart blood flow. If the valve becomes narrowed, blood flow can be impaired or restricted, causing patients to experience fatigue, chest pain or breathlessness. To repair the valve, a transcatheter aortic valve implantation (TAVI) may be considered, as a lower risk intervention than open heart surgery. The TAVI procedure involves inserting a new valve through an artery to reach the site of the old valve. The new valve is typically made of biological tissue shaped to mimic the natural valve. As the new value is expanded, it pushes the old valve aside and replicates its functions. Being less invasive than open heart surgery, a TAVI may be recommended for patients considered high risk for open heart surgery.

Implantable cardiac defibrillator (ICD or AICD)

In cases where continuous heart monitoring and protection is required, an implantable cardiac defibrillator (ICD) may be recommended by your heart specialist. Also known as an automatic implantable cardioverter defibrillator (AICD), these devices are often deployed where a patient has survived a previous cardiac arrest or has high risk factors for severe heart failure. The ICD is implanted under the skin and is capable of delivering an electric shock to the heart if a potentially fatal fast or irregular heart beat is detected. This continuous protection is vital for providing life-saving treatment in the fastest possible manner for high risk patients.

Patent foramen ovale (PFO) closure

A patent foramen ovale (PFO) is a condition where a small hole between heart chambers does not close after birth. While it is usually harmless, in some cases it can allow blood clots to pass through, causing a stroke. A cardiac specialist may decide that PFO closure surgery is appropriate to close the hole, usually in cases where the person has had a stroke which has no other identifiable causes. The procedure involves inserting a catheter into a vein, which is then guided to the heart. The device to seal the hole (usually a small mesh disc), is delivered via the catheter and placed over the PFO. As heart tissue grows over the device over time, the hole becomes permanently sealed.

Left atrial appendage (LAA) closure

For patients who have atrial fibrillation (AF) a procedure known a left atrial appendage (LAA) closure may be recommended to help reduce the potential for blood clots. The left atrial appendage is a small compartment found in the left atrium of the heart where blood clots are known to form. In those with AF, the left atrium does not work as effectively, increasing the chances of blood clots forming in the appendage and increasing the risk of a stroke. LAA closure surgery may be considered for patients who are unable to take blood thinning medication. The most common approach for this procedure is inserting a device into the heart using a catheter via a vein. Once in place, the device seals off the left atrial appendage, preventing future clots from forming in the area. For some patients the procedure may occur in tandem with other scheduled heart surgery.

Mitraclip implantation

Blood flow between the heart's left atrium and left ventricle is controlled by the mitral valve. Where the valve does not close properly, blood can travel in the wrong direction, leading to patient symptoms such as fatigue, fainting or shortness of breath. Your San cardiac specialist may consider a MitraClip implantation procedure instead of open heart surgery, especially in the case of patients with high risk factors. In this procedure a catheter is used to deliver a small clip device (the MitraClip) through a vein to reach the location of the mitral valve. The MitraClip assists the valve to close in full, reducing the potential to leak. Advanced imaging techniques are used to guide the clip to the location, with the process usually taking just a few hours under general anaesthesia.

Heart surgery

The cardiac specialists at The San treat a wide range of heart surgery conditions using the most appropriate method for each individual case. Depending on the circumstances this may involve minimally invasive, robotic or open heart surgery.

With minimally invasive heart surgery, the surgeon uses small incisions and specialised instruments to perform the task, without the need for significant disruption to the chest cavity. With quicker recovery times, less pain and lower infection risks, minimally invasive surgery is suitable for a wide range of treatments and interventions.

The benefits of robotic heart surgery are similar to minimally invasive surgery, offering smaller incisions, less pain and faster recovery times for cardiothoracic surgery. During an operation, the surgeon controls the surgical instruments via a console, while viewing a high definition image of the surgery site. Robotic surgery offers the surgeon additional stability and dexterity to deliver precise medical treatment.

Traditional open-heart surgery, where the chest is fully opened to access the heart, may be the preferred solution for complex heart conditions. Typical applications include coronary artery bypass procedures or heart valve replacement. Although this type of surgery has longer recovery times than robotic surgery or minimally invasive surgery, it may be unavoidable where surgeons need to directly access the heart with optimum visibility. The type of heart surgery selected will depend on the patient’s condition, their overall health, and the complexity of the procedure being undertaken.

Rehabilitation

Recovering from heart surgery is far easier when you’re in the right place and have the right support. At San Heart’s cardiac rehabilitation department, you’ll have nothing short of the best – with a team of specialists dedicated to getting you back on your feet and maintaining optimum heart health. And from tailored exercise programs to education on healthy lifestyles, we have all the resources you need.

Conditions we treat

Abnormal heart rhythms (arrhythmias / atrial fibrillation)

A heart which beats too fast, too slow or irregularly is described as having an abnormal heart rhythm or arrhythmia. The most common type of arrhythmia is atrial fibrillation (AF), where parts of the heart beat irregularly and ineffectively. This disrupts blood flow and leads to symptoms such as shortness of breath, fatigue and feeling like the heart is racing. A persistent abnormal heart rhythm may also increase the risk of heart failure or stroke. Initial treatments may involve medication, but in some situations the San’s cardiac specialists may consider heart surgery. The types of surgery may be minimally invasive, such as using radiofrequency energy on damaged heart areas, or the insertion of devices to regulate rhythm such as a pacemaker. Other procedures may involve repairs or bypass techniques aimed at improving the blood flow and heart rhythm.

Angina pectoris (angina)

Angina pectoris, more commonly know as angina, occurs when blood flow to the heart is reduced and most commonly presents as pain or discomfort in the chest. While medications can be used to relieve symptoms, angina may be an indication of more serious coronary artery disease. Where diagnostic processes reveal significant or multiple blockages, heart surgery may be considered. The most common type of heart surgery in this case is coronary artery bypass grafting, where the surgeon grafts a healthy blood vessel on to the heart to bypass the blocked area. For less complex cases, minimally invasive surgery such as a coronary angioplasty may be appropriate.

Congestive heart failure

When the heart becomes unable to effectively pump blood, a chronic condition known as congestive heart failure can occur. The resulting buildup of fluid in limbs and tissues can lead to symptoms such as swelling and shortness of breath. Initial treatments to relieve symptoms may include lifestyle changes, medications or minimally invasive interventional procedures. Where these treatments are insufficient, robotic or open heart surgery may be required. Common surgeries include heart valve repair/replacement, coronary artery bypass, or implanting medical devices such as a pacemaker to assist the heart to pump more effectively.

Coronary artery disease

Arteries can become narrow or blocked when arteriosclerosis (a buildup of fatty deposits or plaque) occurs. This can result in coronary artery disease, which reduces the supply of blood to the heart muscle and can develop slowly over time with few initial symptoms prior to a major episode such as a heart attack. Risk factors such as diet, smoking and lack of exercise are known to influence the development of the disease. Depending on the severity of the coronary artery disease, medications or minimally invasive interventions such as the insertion of stents may be considered. For complex or severe cases, the most common type of heart surgery is a coronary artery bypass. In this surgery a healthy blood vessel is taken from an arm or leg, and used by the surgeon to bypass the blocked arteries and restore normal blood flow.

Heart valve disease (mitral valve disease / aortic valve disease)

Heart valve disease results when one of the heart valves (mitral or aortic) fails to open or close properly. These valves control the blood flow between the heart’s atrium, ventricles and aorta. A patient with heart valve disease may experience symptoms such as an irregular heartbeat, swelling in the legs, chest pain or shortness of breath. While the cause of heart valve disease varies from congenital defects to infections or aging, in severe cases surgery may be needed to repair or replace the valve. Repairing the valve may involve tightening or reshaping the existing valve, while a replacement valve may be mechanical or biological. The surgery is generally undertaken through traditional open-heart surgery although robotic surgery or minimally invasive methods such a transcatheter aortic valve implantation (TAVI) may also be options.

Myocardial infarction (heart attack)

Known more commonly as a heart attack, a myocardial infarction occurs when blood flow to the heart is suddenly blocked, depriving the heart of oxygen. The cause of a heart attack is often a blood clot or plaque within the coronary arteries. In the case of a heart attack medical treatment is required immediately to restore the flow of blood. In the first instance, less invasive procedures such as a percutaneous transluminal coronary angioplasty (PTCA) or a coronary stent insertion maybe considered to keep the blocked artery open. However, the patient may also need heart valve replacement surgery, or surgery to insert an assistance device to prevent further attacks. These procedures may be performed using minimally invasive, robotic or open heart surgery approaches, depending on the complexity of the condition.