Cardiology

Cardiology provides diagnosis and management for a full range of acute and chronic cardiac disorders. Inpatient services include a cardiology ward that incorporates a 6 bedded coronary care unit.

Non-invasive services including echocardiography (transthoracic and transoesophageal), cardiac and blood pressure monitoring and nuclear cardiology are performed at the Chelsea and Westminster site.  Permanent pacemaker insertion is performed in the Chelsea and Westminster Treatment Centre.  Cardiac MRI and invasive procedures such as coronary intervention are provided at the Royal Brompton Hospital by the Chelsea and Westminster Consultants.

Services

• Coronary artery disease
• Cardiac Arrhythmias
• Cardiac Failure
• Stable angina
• Myocardial Infarctions (heart attacks)
• Unstable Angina
• Valvular heart disease
• Cardiomyopathies
• Syncope
• Black-outs
• Pacemakers
• Implantable devices

Clinics

• General Cardiology Clinic (includes One-Stop Clinic)
• Rapid Access Chest Pain Clinic
• Diagnostics
• Cardiac Rehabilitation

Consultants and Key Staff

• Dr Julian Collinson, Consultant Cardiologist
• Dr Sam Kaddoura, Consultant Cardiologist
• Dr Simon Davies, Consultant Cardiologist

Patient leaflets

• Cardiology—12 Lead ECG
• Cardiology—Autonomic Function Test (AFT)
• Cardiology—Ambulatory Holter Monitoring
• Cardiology—Cardiocall
• Cardiology—Echocardiogram (ECG)
• Cardiology—Exercise Testing
• Cardiology—Lung Function
• Cardiology—Tilt Testing

General Cardiology Clinic

We run five general cardiology clinics per week, providing the full range of secondary care services. One of the clinics is carried out at the South Westminster Centre, and the remainder are carried out at Chelsea and Westminster Hospital.

One Stop Clinic

Three of the General Cardiology clinics at Chelsea and Westminster are run as "One Stop" Clinics. This is an 'express' service offering rapid access to all the usual non-invasive cardiology investigations plus a cardiologist's opinion in a consultant-led clinic.  Routine patients are seen, on average, in about 4 weeks and urgent patients within 1-2 weeks.

Patients have access to non-invasive investigations (ECG, echocardiography, exercise stress testing, 24-hour blood pressure monitoring and 24-hour Holter monitoring) plus the usual x-ray and blood investigations on the same day as their initial clinic appointment. Patients can expect to be in clinic for a maximum of 2-3 hours.

This service has significantly reduced the time taken for our patients to be diagnosed and treated and the feedback from patients on this service has been extremely positive.

List of clinics

Referrals

All referrals should come in to the central appointments office, either by:

Choose and Book: As above

Referral process for One-Stop Clinics

Both Dr Collinson and Dr Kaddoura run their clinics as one-stop clinics and patients can be referred via the 'general cardiology' service via Choose and Book, email, fax or post. If using indirect booking, please note on the referral letter that you feel the patient is suitable for the one-stop clinic and we will endeavour to ensure that the patient attends one of these clinics. If using direct booking, please book your patient into any appointment on a Monday, Tuesday or Thursday. We hope to roll the one-stop service out across all of our general cardiology clinics in the near future.

Contact Details

New appointments: 020 3315 6666 (Appointments Office)
Follow-up appointments: 020 3315 8883

Rapid Access Chest Pain Clinic

The Rapid Access Chest Pain Clinic (RACPC) provides a specialist assessment of people who present to their GP with symptoms suggestive of new onset angina.
All patients will be seen at their convenience within a maximum waiting time of two weeks. It is a nurse lead service with cardiologist support and provides:

• rapid assessment of patients with suspected angina
• provide information on treatment options available regarding their diagnosis
• rapid diagnosis and development of a management plan including revascularisation if necessary
• estimates of cardiac risk
• provide information regarding modifiable risk factors
• reassurance to patients and their families who we believe do not have significant coronary artery disease

The clinics are run daily and appointments are booked to suit the patient.

Referral sources

• GP practices
• Patients attending Accident and Emergency with typical symptoms

Referral Criteria

Inclusion:

• Chest pain of new or recent onset with possible ischaemic origin
• Known ischaemic heart disease with new onset of symptoms
• Shortness of breath on exertion presumed to be cardiac in origin

Exclusion:

• Suspected acute myocardial infarction or an unstable acute coronary syndrome should be referred to Accident and Emergency
• Those who request to be seen by a doctor

Referral process

• The RACPC referral form should be used and faxed to 020 3315 8814:

• Rapid Access Chest Pain Clinic referral form
  Plain (.doc) | EMIS (.rtf) | Vision (.doc)
• Referrals are not accepted via post due to the 2 week appointment target
• Please give the patient's phone number so that they can be easily contacted

If the patient cannot be contacted by phone, an appointment will be forwarded to them by post within 48 hours. The patient is requested to contact the clinic co-ordinator on receipt of the letter to confirm their attendance.

Diagnostics

GPs can refer patients in directly to echocardiography and electrocardiography using the appropriate referral forms.

In addition, the following diagnostic and therapeutic tests are now carried out at the hospital:

• We have introduced cardiac memo recorders. These are recorders that can be carried by the patient for up to six weeks and therefore could be used to record relatively infrequent events and symptoms (such as dizziness or black-outs).
• We have continued to develop the tilt test service and this has been found to be extremely useful investigation of patients with dizziness, light-headedness and syncope.
• As well as continuing to expand our transthoracic echo service, we have now introduced transoesophageal echocardiography.
• We have now started permanent pacemaker insertion at Chelsea and Westminster Hospital. This has been done through the extremely high quality facility in the Treatment Centre. As part of this, we are also following pacemakers up at the Chelsea and Westminster Hospital.
• Reveal device implant. This is a device that can be put under the skin of the patient for periods of up to several years, if necessary. It records events, blackouts and any symptoms the patient may have so that it can correlate them with heart rhythm at that time. This can be an extremely useful device in the investigation of infrequent events that the patient may be suffering.

Cardiac Rehabilitation

Cardiac Rehabilitation is a comprehensive programme of exercise, education and psychosocial intervention which has been proven to speed up the recovery process and reduce the chance of having future heart problems. The Cardiac Rehabilitation Programme at Chelsea and Westminster offers an individualised rehabilitation service to all patients with a new diagnosis of heart disease or post cardiac procedure or intervention. The rehabilitation programme consists of an initial consultation with the Cardiac Rehabilitation Nurse Specialist followed by provision of a tailored exercise or lifestyle programme.

Consultation with Cardiac Rehabilitation Nurse

Patients will initially see the Cardiac Rehabilitation Nurse Specialist in clinic, which provides an opportunity for the patient to discuss their recovery process and treatment plan. The nurse will review the medicines prescribed with the patient and any further investigations such as blood tests may be arranged. Health education and advice will also be provided.

Patients will then be given the option to participate in the exercise component of the programme. If they do not wish to progress further in the programme alternative options such as advice on a home exercise programme can be discussed.

Exercise Programme

The exercise component of the programme consists of a 6-12 week supervised exercise and health education programme held in community and hospital venues. The exercise class generally comprises of a combination of aerobic and resistance exercises individually prescribed for the patient.

The Exercise Programme promotes the ethos of recovery rather than illness, and the community setting is particularly suitable for patients who have resumed employment. It provides a new and innovative means of delivering rehabilitation by providing an integrated community class run by CR, and the programme has been featured in the 'Cardiac Rehab UK' journal as an example of best practice.

Continuation of the Exercise Programme

On completion of the Cardiac Rehabilitation Programme, patients can be referred on to an exercise programme within the community. These programmes are run by British Association for Cardiac Rehabilitation (BACR) exercise instructors who are specially trained in delivering exercise programmes for individuals with heart disease.

There are classes currently running in Kensington & Chelsea, Wandsworth and Battersea, Putney and Westminster. A referral from the local cardiac rehabilitation service is required in order to attend these programmes.

Contact details

The service is led by a Cardiac Rehabilitation Sister who can be contacted on 020 3315 8505 or email cardiacrehab@chelwest.nhs.uk