Cardiac services

Cardiac Services comprises three main areas: Cardiac Surgery, Cardiac Anaesthesia & Intensive Care and Cardiology (including adult congenital heart disease).  Secondary and tertiary services are provided to patients from all over the South-West. 

Outpatient facilities provide care for all cardiac patients as well as providing pacemaker checks and diagnostic tests such as exercise electrocardiograms (ECG tests) and recording and monitoring of heart rate/rhythm or blood pressure. 

Cardiology

The Cardiology Department consists of the Catheterisation Laboratories (Cath Labs), Coronary Care Unit (CCU), heart failure services and Adult Congenital Heart Disease Services (GUCH). 

There are a number of different patient pathways to enter the Cardiology Department: 

1. GP referral to cardiology/arrhythmia service.  Palpitation/arrhythmia assessment clinics run by doctors and cardiac physiologists.
2. GP referrals into the Rapid Access Chest Pain Clinic.  Appropriate patients are seen within two weeks, have exercise tests if appropriate and then receive a treatment plan.  Run by a team including Cardiac Physiologists, Nurse Consultant, staff grades, SpR's.
3. GP referral to a Cardiologist.  Patients are then seen in general cardiology outpatients where tests or treatment is decided. 
4. Emergency admission via the medical admissions unit or from Accident and Emergency to the Coronary Care Unit, Ward 18, Ward 7 or directly to the Cath Labs.
5. Urgent in-patient referred from other hospitals within the region.
6. Cardiologist to tertiary specialist referral e.g. for electrophysiology studies, ablation, ICD, complex pacemaker, adult congenital services (can be out-patients or in-patients). 

Out-patient facilities including general cardiology outpatient clinics, device follow-up, adult congenital, heart failure and pre-operative assessment.  Diagnostic tests such as exercise electrocardiograms, myocardial perfusion scans, trans-thoracic, trans-oesophageal and stress echo, ambulatory electrocardiograms and blood pressure recording are available on an in or out-patient basis.  These tests are performed in the cardiology department.  More invasive tests such as angiography and electrophysiology studies are offered as day case or in-patient procedures are undertaken in the Catheter Laboratories. 

Catheterisation Laboratories (Cath Labs) 

There are three Cath Labs for cardiology diagnostics and treatment are currently located on level 6 of the BHI. 

There a number of diagnostic and interventional procedures are carried out: 

• Diagnostic Angiogram (usually as a day case) or urgent in-patients
• Angioplasty (also known as PCI)
• Electrophysiology Studies (EP) and Ablations including Radiofrequency and cryothermy ablation
• Adult congenital heart disease procedures including Atrial septal defect closure (percutaneous)
• Echocardiograms
• Exercise tests (treadmill tests)
• Stress echo tests
• Primary angioplasty (instead of Thrombolysis) & Rescue Angioplasty
• Implantable Cardioverter Defibrillator
• Pacemaker implant (emergency or planned) including cardiac resynchronisation therapy (CRT) for heart failure patients (bi-ventricular pacing); pacemaker checking
• Plus a range of procedures carried out on a less frequent basis eg. Valvuloplasty, thoracic aortic stents, post infarct VSDs 

There is also one hybrid theatre where surgeons and cardiologists will be able to joint procedures. This hybrid theatre is only one of three in the country. 

The Cath Labs are run by a multidisciplinary team consisting of Doctors, Nurses, Physiologists and Radiographers. Consultants from other centres also carry out sessions in our Cath Labs. 

Ward Areas 

There are four main wards, three of which are used by Cardiac Services and one by Medicine.

• Ward 51 - Mixed Cardiac Surgery and Cardiology
• Ward 52 - Cardiac Surgery
• Ward 53 - Cardiology
• Ward 54 - Medicine - respiratory 

Each ward has 24 beds, divided into four bays of four beds each and eight single rooms. To help patients, staff and visitors keep the hospital free from infection each bed has its own sink. In addition each room or bay has its own bathroom with a walk-in shower. We also have additional bathrooms that have baths. 

Coronary Care Unit (CCU) 

The Coronary Care Unit (CCU) is used as a high dependency area to treat cardiology patients and is where primary angioplasty patients will come straight after their procedure. Primary angioplasty is where we insert a tiny wire into the arteries of someone who is having a heart attack. By doing this we are able to unblock their arteries. 

Adult Congenital Heart Disease (ACHD)

Also known as GUCH (Grown-Up Congenital Heart disease), The Adult Congenital Heart Unit at United Bristol NHS Trust provides inpatient and outpatient services to the increasing number of people born with congenital heart disease who are now adults. 

The service provides support to 2,500 patients in the South West, Devon, Cornwall and parts of South Wales, covering a population of approximately 5 million.  As well as providing services at the BHI, the ACHD consultants also provide outpatient clinics at satellite centres across the South West and Peninsula. 

Outpatients, cardiology procedures and cardiac surgery are all undertaken as part of the GUCH service, and there are specialist consultants in both cardiology and cardiac surgery.  The service works in close conjunction with the cardiology department atBristolRoyalHospitalfor Children, and both surgeons and cardiologists work across both sites.  The cardiologists also hold a joint pregnancy clinic at St Michael's clinic for expectant mothers who have congenital heart problems, thus combining obstetric and cardiologist care. 

Cardiac Surgery 

There are two wards (51 and 52), a CICU (Cardiac Intensive Care Unit), usually known as an Intensive Care Unit (ITU) and a CCU (Coronary Care Unit) usually known as a High Dependency Unity. Cardiac Rehab also comes under cardiac surgery. 

Following a referral from a Cardiologist, patients are seen in outpatients by a Consultant (either at the BHI or at a peripheral clinic) and if suitable are then listed for surgery.  There are two main types of surgery - heart bypass (coronary artery bypass grafting or CABG) and valve replacement surgery. 

Patients are admitted onto Wards 51 and 52 on the day of surgery where appropriate following surgery patients proceed through CICU (usually for 24 hours), onto CCU and then back to the ward. Patients normally stay for 5-7 days and are then usually seen six weeks after surgery in outpatients. 

Since 1996, a comprehensive annual audit report for adult cardiac surgery has been produced - one of four centres in the UK to make such information available to the public.  Now included in the report is patient mortality outcomes for individual surgeons, Bristol being one of the first hospitals to do so. 

Cardiac Anaesthesia 

There are 13 cardiac anaesthetists/intensivists that work across the service, both in the cardiac theatres and with GUCH patients and thoracic stents in the Cath labs. The intensivists also act as the lead clinician in the CICU. 

Cardiac anaesthesia and intensive care are vital to the successful operation of a cardiac unit.  Everything from the pre-operative assessment of patients, to the operation itself and the post operative care have a high level of anaesthetic input. Every patient needs careful management on an individual basis, even though the number of patients we treat is large. 

The anaesthetists work as a coordinated group to be sure full cover is maintained at all times.  They are led by Dr Ian Ryder, Lead Cardiac Anaesthetist.