Consultant Interventional Cardiologist
Circle Bath Hospital
01761 422 222
Our perfect chest pain and angina pathway
Not all angioplasty is the same… and there is quite a lot of variability in the way chest pain and symptoms of angina are assessed and treated across the UK in both the NHS and private sector.
Many people come to see me because they have been experiencing chest pains and are concerned about what these may signify. Pains in the chest at any time can understandably be quite a worry, but with modern non-invasive techniques we can quickly get to the bottom of things with complete assessment usually within 2 weeks from start to finish.
Angina describes the symptoms of central chest discomfort (pressure, tightness, indigestion-like discomfort) and is brought on by physical or emotional stress. The pain can radiate to the arms, jaw or teeth, and it can also be associated with breathlessness. This is usually as a result of narrowing or furring of the coronary arteries which restricts the flow of blood to the heart muscles, and this is part of the spectrum of illnesses called cardiovascular disease.
At Circle, we have worked hard to design the perfect chest pain and angina pathway.
Our pathway includes access to all diagnostic options, ranging from the old-fashioned exercise ECG treadmill test (a simple elegance when done correctly) to stress echocardiography and modern non-invasive imaging techniques including CT coronary angiography and cardiac stress MRI. Our CT pathway has the most modern hardware and software, which allows advanced analysis using the latest Heartflow (FFRCT) techniques that not only provides anatomical data but can also analyse flow even when arteries are calcified (a traditional limitation of older-style CT scanners).
Unlike most protocolised services, we are not limited to a specific option and therefore can personalise the best test for your particular risk profile and symptoms.
If diagnostic tests and examination highlight a coronary problem, our first approach is to consider a non-invasive approach. This will include optimal medical therapies, prescribed exercise and personalised dietary and lifestyle interventions targeting risk factors. If the symptoms resolve or the risk is low, we may not need to progress to more invasive treatments and can continue to track and monitor progress using our non-invasive diagnostics.
In cases where a severe or high-risk coronary problem is either identified or suspected, we will go directly to our advanced angiography and complex angioplasty service.
An angiogram is a minimally invasive procedure where catheters (fine hollow tubes) are inserted through the wrist radial artery under local anaesthetic and passed up from within the blood vessels to take detailed pictures of the heart arteries using X-rays.
An angioplasty involves using a small balloon to stretch open an artery that is either fully or partially blocked. Most modern angioplasty procedures now also insert a stent (or multiple stents) into the artery in order to keep it clear and to prevent it blocking again in the future.
There are also situations where heart bypass surgery may be considered or have previously been suggested. With advanced techniques and tools we can offer angioplasty as a minimally invasive option in the majority of patients we see, with very good long-term results.
Unfortunately, current NHS waiting times are long and people waiting to have an angioplasty will often have a number of different appointments and visits before they are finally able to have treatment. Not only can this be quite frustrating, it also means they will continue to be concerned about their ongoing chest pains for even longer. We provide an efficient second opinion service to go through the data in detail and decide on a personalised solution with the least invasion. Sometimes just being able to discuss things and understand the problem can be a huge help.
With our state-of-the-art facilities and well-developed angioplasty treatment pathway, we will aim to provide everything you need in just one appointment; from taking the images (angiogram) to doing the measurements (pressure wire) and carrying out any treatment required (angioplasty), we are a ‘one-stop shop’ if you like. We really do appreciate the importance of prompt treatment and work very hard to reduce the length of time, and the number of times, you need to visit with us.
Our approach to angioplasty also differs from the standard pathway in a variety of ways:
- Patient experience and comfort: We are very particular about patient comfort and experience, and focus a lot of energy and attention on this aspect. This starts with the reassurance of explanation, good communication and a pre-procedure relaxing environment. During the procedure, effective local anaesthetic techniques and sedation ensure a comfortable experience. We pay attention to the little things that make a big difference and always aim for a painless service.
- Optimal access: To gain access to the arteries for an angioplasty, the historical approach has been to use the leg femoral artery. I prefer to use what is now seen as the ‘gold standard’, gaining access through the wrist (this is known as a ‘radial approach’ as it uses the radial artery). Accessing through the wrist is associated with a lower risk to you, a quicker recovery and reduced risk of bleeding.
- Latest technology: We use the narrowest and most ‘slippery’ access sheaths for the radial artery. The specific ones I use are called Glidesheath Slender®, and they are extremely good. As they are finer than the standard sheaths commonly used, they minimise discomfort and bleeding.
- Quick recovery / day case procedures: As a result of minimally invasive techniques, the vast majority of these procedures are done as a day case procedure, meaning you can return home the same day (although very occasionally there may be a requirement for an overnight stay).
- Pressure wire assessment: We will measure the blood flow across any narrowing using a pressure wire. This can help us to see if the narrowing in the artery is leading to limitation of blood flow and definitely needs treatment. If it is, an angioplasty can be carried out to restore function and to maximize blood flow once more. This fastidious approach to assessment means that we can target the most specific areas causing a problem.
- Intravascular imaging: We have access to all modern adjuncts to maximise the quality of the angioplasty procedure. There is increasing data to show that using intravascular ultrasound imaging to optimise angioplasty and stenting procedures is associated with better outcomes and durability of treatment. This technology isn’t always available or used across all healthcare providers.
- The latest kit: As well as advanced imaging technologies, I am trained and regularly perform complex angioplasty procedures with access to the full ‘tool kit’ of modern interventional cardiology, including the latest drug-coated balloons and drug-eluting stents (these release a drug that blocks re-narrowing, lowering the risk of the artery becoming blocked in the future) and devices to help treat hard ‘calcified’ coronary narrowing such as cutting balloons, intra-coronary lithotripsy (Shockwave), and laser and rotational atherectomy (Rotablation). In fact, Bath is the only Laser Centre in the region.
Should you be concerned about chest pains, please contact my PA, ‘Tash’ (Natasha Jones), on 01761 422287 to schedule a consultation with me. You will be able to select a time that is convenient to you, including evening appointments. When we meet, I will discuss and arrange any diagnostic tests needed to determine exactly what is causing your chest pains. With our advanced diagnostic equipment, pacing technologies and surgical techniques, you can be assured that we will provide you with a convenient, effective and efficient pathway to get your chest pains successfully controlled and treated.
Following problems with my heart, I was admitted to hospital on the cardiac care ward. I was booked in for an angiogram the following day to determine what was wrong.
This angiogram was carried out by Ali, and I found his demeanour inspired confidence; he was very clearly incredibly competent. I was fully awake and alert, so could follow along with things. The angiogram showed that I had diffuse coronary artery disease, which meant a number of blood vessels around my heart were blocked to varying degrees. Ali explained that I would need an angioplasty to open up these blockages with stents in order to restore good blood flow to my heart.
When I went in for my angiogram, I hadn’t been expecting to need an angioplasty as well. Having said that, I wasn’t worried at any stage as Ali knew what he was doing; indeed, he dominated the operating theatre! (Actually, I didn’t have time to worry as everything was done so quickly and professionally by Ali and his team.)
Since my angioplasty, I haven’t looked back. I now see Ali once a year at Circle for a check-up and he is always very helpful and informative. He is very open about everything, and it’s good to be able to talk through things with him and to ask any questions I have. My wife came to meet him at my first review and we both found that helpful.
When I had been looking for help through the NHS, I had been given an information booklet which told me all the things I couldn’t do as a result of my condition and the angioplasty. Ali was a breath of fresh air, helping me to focus on what I could do. Being given positive things to focus on was so much better.
I was, and am, very relieved that my coronary artery disease was picked up and dealt with so quickly and I count myself fortunate to have met Ali. It has been nice to feel like a ‘client’ rather than a ‘patient’, and I appreciate being able to contact him directly with any queries. Ali is helping me focus on maintaining a healthy lifestyle to reduce the risk of any future cardiac problems.
I have been so impressed with Ali’s approach that I have introduced three people to him for help with their cardiac issues. Circle itself is well located and has a good ambience; I haven’t found anywhere better.
- Cardiac arrhythmia treatment
- Cardiac pacing
- Cardiology diagnostics
- Cardiovascular screening
- Non-invasive cardiology treatments
- Coronary angioplasty (PCI)
- Heart failure treatment
- Hypertension treatment
- Transthoracic echocardiography
- Microbubble testing (myocardial contrast echocardiography)