Understanding Lyme Disease

Cardiology

Cardiovascular mortality remains one of the most common causes of death in Ireland. The aim of cardiologists is to reduce this mortality rate and cardiovascular events in patients.

Pre-Travel Steps

 

  1. Identification of Treatment Need: Your GP or consultant will diagnose the need for cardiology treatment, such as surgery, based on your medical condition and symptoms.
  2. Contact Healthcare Abroad: Initiate contact with Healthcare Abroad to kickstart the process of arranging your cardiology surgery in an EU country under the Cross-Border Directive. We specialize in facilitating timely access to medical care, bypassing hospital waiting lists.
  3. Liaison with GP and Diagnostic Tests: Our team will collaborate with your GP to organize a referral letter and any necessary diagnostic tests, ensuring a comprehensive assessment of your cardiac health. Results will be promptly provided to the chosen hospital.
  4. Selection of Hospital and Surgeon: Utilizing our extensive network of hospitals and cardiac surgeons, we will match you with a facility and specialist that meet your specific requirements and preferences.
  5. Financial Assistance: If needed, we can assist you in organizing finances through Irish credit unions to cover the costs associated with your cardiology surgery abroad, allowing you to access treatment without delay.
  6. Arrangement of Surgery Dates: We will liaise with the chosen hospital to secure suitable surgery dates, prioritizing your needs and ensuring timely intervention. Your medical files will be transmitted securely for review by the surgical team.
  7. Confirmation of Travel Dates: Once your healthcare plan is finalized, including surgery dates and logistics, we will confirm your travel arrangements with the hospital team, ensuring seamless coordination for your journey abroad.
  8. Travel Preparation: With all arrangements in place, you are now ready to travel. Upon arrival at the hospital, you will have an outpatient appointment with your consultant the day before your scheduled surgery, providing an opportunity for final pre-operative assessments.
  9. Post-Discharge Paperwork: Following your discharge from the hospital, our team will handle all necessary paperwork, including submission to the Health Service Executive (HSE) for reimbursement. We ensure timely processing to facilitate your refund efficiently.
  10. Update of Medical Records: Your GP will receive a detailed report from the hospital regarding the cardiology treatment you received abroad. This information will be used to update your local medical records, ensuring continuity of care upon your return to Ireland.

These steps outline the process leading up to your travel for cardiology surgery abroad, facilitating timely access to essential medical care through Healthcare Abroad under the Cross-Border Directive, bypassing hospital waiting lists and ensuring optimal outcomes for your cardiac health.

What is cardiology?

The speciality of cardiology focuses on the diagnosis of cardiovascular diseases, from the most common conditions (such as ischemic heart disease, arrhythmia, heart failure or valvulopathies) to the prevention of risk factors that can lead to their appearance such as hypertension, hypercholesterolemia or diabetes.

In Vithas centres, these conditions are addressed with prevention, diagnosis (both in the earliest stages and in acute situations) and treatment, offering patients the best technological options currently available.

Cardiovascular mortality remains one of the most common causes of death in Ireland. The aim of cardiologists is to reduce this mortality rate and cardiovascular events in patients.

 

Which patients is it for?

Patients at high risk of a cardiovascular event, even if they do not yet have symptoms of a cardiovascular disease, are a central part of our activity, because it is prevention that will have the greatest impact in reducing future cardiovascular problems.

Therefore, patients with cardiovascular risk factors such as hypertension, diabetes, dyslipidemia, obesity, smoking, etc. are assessed in our units.

It is also aimed at patients with symptomatic cardiovascular diseases. This included all patients with a clinical history of ischemic heart disease (angina or infarction), arrhythmias, heart failure in any of its forms of presentation.

The main symptoms for which patients go to clinics are chest pain, dyspnoea (fatigue), palpitations, syncope or dizziness and oedema.

Main conditions and diseases

The most prevalent cardiovascular diseases are ischemic heart disease (angina or infarction), arrhythmia, especially atrial fibrillation, heart failure and valvulopathies.

However, ischemic heart disease is nothing more than the reflection of a systemic vascular disease that we call arteriosclerosis, which can also affect other vascular territories such as the arteries of the brain (causing stroke) or the legs. As such, our units provide comprehensive, cross-disciplinary treatment in collaboration with other professionals who also treat these conditions, such as neurologists, cardiac and vascular surgeons, endocrinologists, nephrologists, etc.

Although these are the most common diseases, our work also includes managing rarer but high-impact conditions in society such as the prevention of sudden death, family heart disease, cardio-oncology (prevention of myocardial damage from oncological treatment), congenital heart disease and aortic diseases.

  • Angina
  • Myocardial infarction
  • Syncope
  • Vascular ​​heart disease
  • Heart murmurs
  • Congenital heart defects​
  • Heart failure
  • Hypertension
  • Arrhythmia
  • Prevention of cardiovascular risk

Main diagnostic resources and technology

Our cardiologists at out main hospital groups have all the latest and most up-to-date diagnostic and therapeutic resources used in modern cardiology. Thanks to this, an electrocardiogram, echocardiogram, stress test or 24-hour monitoring with a Holter can be performed in the same consultation.

These are the basic diagnostic techniques performed in consultation, which may be completed with more specific non-invasive diagnostic tests available in our units, such as long-term Holter monitoring (7 to 15 days) or implants, ergospirometry, stress or transoesophageal echocardiograms, tilt table test, blood pressure Holter, etc.

However, if more advanced diagnostic imaging tests are required, our centres can conduct CT angiography, cardioresonances or nuclear medicine studies.

If an invasive procedure is needed either for arrhythmia (electrophysiological studies) or haemodynamics (coronary angiography), we have the latest technology in these fields, enabling us to perform any diagnostic tests or therapeutic actions needed.

  • Electrocardiogram
  • Ergometry/ergogasometry (cardio-pulmonary function test)
  • Holter (24-hour electrocardiogram)
  • Ambulatory blood pressure measurements (ABPM)
  • Tilt bed syncope​ study
  • Real-time colour Doppler 3-dimensional (3D) echocardiography
  • Transoesophageal echocardiogram
  • Carotid​ intima study: vascular age
  • Exercise and/or pharmacological stress techniques with cardiac imaging to detect myocardial ischemia: with ultrasound, isotopes or magnetic resonance imaging
  • ​Electrophysiological study and radiofrequency ablation
  • ​Electrical cardioversion
  • Cardioresonance
  • ​64-slice cardio CT scan: study of coronary calcium score and coronary arteries Cardiac anatomy and function
  • Stress test: Arrhythmic stratification: microvolt T-wave alternans, SDNN, filtered QRS duration, post-potential QRS, QT

Main treatments

In the field of ischemic heart disease, the use of coronary angiography and percutaneous angioplasty with stent implantation is essential. In the field of arrhythmias, all percutaneous ablations are available, as well as the implantation of pacemakers or defibrillators with or without resynchroniser.

In addition, there are new non-surgical treatments available for valvulopathies such as the implantation of percutaneous aortic valves (PAVI) or non-surgical mitral or tricuspid valve repair with the implantation of MitraClips, or the closure of perivalvular leaks and permeable foramen ovale. Cardiac rehabilitation also allows patients who have undergone acute treatment for angina or heart attacks to carry out a multidisciplinary lifestyle modification programme that guarantees a future without new cardiovascular events.

Areas of specialisation

Cardiology is a discipline with a high degree of subspecialisation. The most notable areas are the arrythmia unit and the haemodynamics and catheterisation units.

In some of our larger centres, there are also units specialising in cardiac imaging, heart failure, paediatric cardiology and familial heart disease.

Special services

Many modern cardiology techniques now allow cardiovascular diseases to be treated without surgery and therefore without putting the patient through discomfort or at risk. In the field of arrhythmias, atrial fibrillation ablation due to its high prevalence is a technique we perform in our centres with the highest levels of quality and technology.

In the field of what we call structural cardiology or non-surgical treatment of valvulopathies, the implantation of percutaneous aortic valves without surgery is another technique we offer across our centres.

Why come to our clinic?

The speciality of cardiology has a unique advantage, and this is that most diagnostic and therapeutic tests are performed by cardiologists themselves, so there is no need to request tests from other departments or staff that may delay diagnosis and treatment.

Not only do we have all the means for tests, but they are performed on a one-stop basis, enabling us to conduct most tests patients require in the same consultation. Moreover, our cardiologists work with the HEART TEAM to come up with the best solution for each patient after assessing all the options with the various professionals who will contribute to management and treatment (anaesthesiologists, cardiologists, cardiac surgeons, endocrinologists, neurologists, vascular, etc.)

 

 

Myocardial infarction

Thanks to modern cardiology, patients with acute myocardial infarction with high risk of lethality can now be discharged in three or four days, if they come in early to a centre such as ours. Treatment involves the implantation of stents in coronary arteries and a disease management programme that allows patients to return to family or work life as soon as possible with the accompaniment of the cardiology team to improve their lifestyle and prevent a new event in the future.

The ultimate goal is to achieve a higher quality and longer life for patients with cardiovascular disease or at risk of having it.

FAQs

What are murmurs?

A murmur is a “noise” doctors can hear when they listen to the heart with a stethoscope. It is caused by turbulent blood flow as it passes through the heart’s cavities and valves. Murmurs aren’t always a sign of heart disease. A heart murmur is a sound, not a disease. Finding a heart murmur isn’t necessarily cause for alarm, but it should be followed up.

What is a functional murmur?

Functional murmurs, also called innocent or non-pathological murmurs, are harmless murmurs heard in a normal heart. These murmurs are often found in children (most of them tend to disappear when they get older) and also in pregnant women (since pregnancy increases blood volume), although they usually disappear after giving birth.

Pregnancy-associated anaemia can also increase the chance of developing functional murmurs. Other situations that can cause functional murmurs are hyperthyroidism or maintained tachycardia.

What is the relationship between smoking and cardiovascular disease?

About 40,000 people die each year from heart disease caused by tobacco smoke. Smoking is the main cause of atherosclerosis, a disease that occurs when the lining of the arteries deteriorates due to fat deposits, obstructing the flow of blood through them. This results in a reduced supply of oxygen-rich blood to the heart, which can lead to chest pain (angina) or heart attack.

What is heart failure?

This is a problem of increasing magnitude and high economic impact, with survival in advanced grades lower than that of many types of cancer.

It is a chronic and progressive disease caused by the heart’s inability to pump enough blood to meet the body’s oxygen needs.

Therapeutic resources to treat heart failure range from heart transplantation to new and potent drugs that have been shown to improve the quality of life and increase the survival rate of patients with heart failure.

​Is moderate alcohol consumption good for the heart?

While for some people, drinking alcohol carries significant risks (patients with heart failure, high blood pressure, diabetes, arrhythmias, etc.), for others, moderate alcohol intake may offer a degree of protection (increased levels of “good” cholesterol; reduced blood pressure; inhibition of blood clot formation).

Moderate means no more than one light drink per day for women or people with lower body weight and no more than two drinks per day for men. However, until we know more about the pros and cons of drinking alcohol, doctors recommend avoiding it for better heart health.

What is aortic stenosis?

Aortic stenosis is the partial obstruction of blood flow through the aortic valve. This condition can be congenital or rheumatic, but the most common cause today is calcified degenerative stenosis, which occurs in elderly people.

In fact, it is currently the leading cause of heart valve surgery in Spain. Senile degenerative aortic stenosis, which is the most common cause of this condition today, is caused by prolonged exposure to stress in the valve and is characterised by calcification of the valve. It is more frequent in diabetics and hypercholesterolemia patients.

What is atrial fibrillation?

Atrial fibrillation is an irregular and often abnormally fast heart rate, although it can also be seen at almost normal heart rates. It is a very common arrhythmia, but can be dangerous if it continues over time and cause chest pain, difficulty breathing, palpitations or dizziness.

The most dangerous risk is blood clots forming inside the atrium, which can come out of the heart and cause a cerebral embolism.

There are different types of treatment to control it, including drugs to control the heart rate or the beginning of the arrhythmia and using anticoagulants to prevent embolisms. There are also invasive procedures such as a catheter ablation that can cure this arrhythmia in certain cases.

What are extrasystoles?

Ventricular or supraventricular extrasystolia is an alteration of the heart rhythm that usually appears in young, healthy people without heart disease. It is caused by a premature heartbeat (extrasystole). It is often related to situations of emotional stress and can be triggered by using substances such as coffee, tea, tobacco and alcohol, so it is recommended to avoid these substances and learn to manage stress.

They are usually identified by an ECG or a 24-hour Holter. Most of the time they are harmless and do not pose a risk to patients. With regard to medication, it is always best to consult a cardiologist to study your particular case and determine the treatment to be followed.

What is Wolff-Parkinson-White syndrome?

Wolff-Parkinson-White syndrome is characterised by an abnormal cardiac conduction system (accessory pathway) and the occurrence of arrhythmias. This abnormality occurs from birth.

Although it is not usually associated with structural heart abnormalities, an echocardiogram is recommended to rule them out (especially hypertrophic cardiomyopathy, coronary sinus abnormalities and Ebstein’s anomaly).

WPW syndrome is diagnosed by very characteristic electrocardiographic abnormalities on the electrocardiogram (short PR, delta wave). Sometimes, these electrocardiographic alterations are permanent and in others transient.

In many cases you can carry this syndrome without ever having tachycardia, and in these cases no specific treatment is necessary. If it comes with symptomatic tachycardias, it can be treated with antiarrhythmic drugs. However, the curative treatment is an electrophysiological study and catheter ablation.

The choice of treatment depends on the severity of the symptoms and the patient’s preferences. Ablation permanently cures the disease and avoids you having to take medication for life. However, as it is an invasive procedure, it is important to discuss possible complications with your doctor, however unlikely these may be. If you have a lot symptoms or high-risk arrhythmias, catheter ablation is always the first option.

Continuing Care Advice:

 

  1. Follow Post-Operative Instructions: Adhere strictly to the post-operative instructions provided by your healthcare provider abroad. These instructions are crucial for optimizing your recovery and ensuring the success of your cardiology procedure.
  2. Attend Follow-Up Appointments: It is essential to attend all scheduled follow-up appointments with your local GP and cardiologist upon your return to Ireland. These appointments will allow your healthcare team to monitor your progress, assess surgical outcomes, and address any concerns or complications promptly.
  3. Monitor Cardiac Health: Be vigilant for any signs or symptoms of cardiac complications, such as chest pain, shortness of breath, palpitations, or swelling in the legs. If you experience any of these symptoms, seek medical attention immediately.
  4. Medication Management: Take all prescribed medications as directed by your healthcare provider. Ensure that you understand the purpose of each medication, its dosing schedule, and any potential side effects. Do not discontinue any medications without consulting your doctor.
  5. Adopt Heart-Healthy Lifestyle Habits: Embrace heart-healthy lifestyle habits to promote cardiovascular health and reduce the risk of future cardiac events. This includes maintaining a balanced diet, engaging in regular physical activity, managing stress effectively, avoiding tobacco use, and limiting alcohol consumption.
  6. Monitor Blood Pressure and Cholesterol Levels: Keep track of your blood pressure and cholesterol levels as advised by your healthcare provider. Follow any dietary or lifestyle recommendations to keep these risk factors under control and reduce the burden on your heart.
  7. Stay Informed: Stay informed about your cardiac condition and treatment plan. Ask questions, seek clarification, and actively participate in decision-making regarding your healthcare. Knowledge empowers you to take control of your health and make informed choices.

Steps to Take Upon Return Home:

  1. Update Local Medical Records: Ensure that your local GP receives a detailed report from the hospital abroad regarding the cardiology procedure you underwent. This information is essential for updating your medical records and ensuring continuity of care.
  2. Stay Connected: Stay connected with Healthcare Abroad for ongoing support and assistance. They can provide guidance on navigating the reimbursement process, address any concerns you may have, and offer assistance with any post-operative care needs.
  3. Engage in Cardiac Rehabilitation: If recommended by your healthcare provider, consider participating in a cardiac rehabilitation program to support your recovery and improve your overall cardiovascular health.
  4. Follow Long-Term Care Plan: Work with your healthcare team to develop a comprehensive long-term care plan tailored to your individual needs and goals. This may include regular monitoring, medication management, lifestyle modifications, and preventive measures to minimise the risk of future cardiac events.

In conclusion, we encourage you to prioritise your cardiac health and follow these recommendations for continued well-being. Should you have any questions or require further assistance, please do not hesitate to reach out to Healthcare Abroad or your local healthcare provider.