Having a heart to heart with Lister over tackling one of UK’s big killers

PUBLISHED: 09:36 11 December 2017 | UPDATED: 09:36 11 December 2017

Dr Manivannan Srinivasan performing the angiogram procedure.

Dr Manivannan Srinivasan performing the angiogram procedure.

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Having chest pains or a heart attack are fears that loom over many of us – especially for us men – in middle age and beyond.

Dr Manivannan Srinivasan , centre, lead nurse Clare Young, left, and staff nurse, Amy Hevey. Picture: Martin Elvery Dr Manivannan Srinivasan , centre, lead nurse Clare Young, left, and staff nurse, Amy Hevey. Picture: Martin Elvery

They can be life-threatening or at the very least life-changing events which, can kill or leave people prematurely aged.

But with state-of-the-art technology being used in our hospitals to treat patients with blocked arteries – the most common cause of heart disease – there is a lot to be hopeful about.

Last week, I visited the Hertfordshire Cardiac Centre at Stevenage’s Lister Hospital to watch a consultant and his team perform a heart procedure.

I looked on from a control room as consultant Dr Manivannan Srinivasan and his team of nurses, radiographers and physiologists robed up in special radiation skirts and aprons, before gathering round a treatment table ready for the day’s procedures.

Key facts about the Hertfordshire Cardiac Centre

The cardiac suite sees about 1,900 patients per year for treatment including a combination of angiogram, angioplasty, primary PCI and fitting pacemakers.

The unit is performing well above national and local standards:

For primary PCI treatments in October this year, 87.5 per cent of patients had a call to balloon time – time between the patient calling for an ambulance and the artery being reopened in the cardiac suite – of less than 150 minutes. 80 per cent had a door-to-balloon time – time between patient arriving at hospital and artery being opened – of 45 minutes.

The unit is open 24 hours a day and staff work in shifts. Patients are brought here from Stevenage, North Herts and further afield if it is the most appropriate place to treat them.

The unit has two cardiac suits and a recovery ward.

The symptoms to watch out for are pain and severe tightening in the chest that sometimes radiates to the jaw, shoulder and back.

If you get these symptoms you should call 999 immediately.

First up today, Mani – as he is known for short – has to secure a catheter in the wrist of the 56-year-old patient so he can feed it into the his arteries. Dye fed into the catheter will show the arteries on an X-ray screen so Mani can see whether blood is flowing through them. Heart attacks or chest paints are caused when it can’t and the heart muscle is deprived of oxygen.

It is clear from the air of calm in the lab that this is a routine procedure for the staff, and it is also relatively routine for the patient who will remain awake and only has to be treated with local anaesthetic and possibly sedatives.

Sometimes patients are brought here after being referred by their GPs with chest pains, sometimes they are admitted through A&E having suffered heart attacks. Others are referred for planned treatment by specialists.

Procedures can vary from an angiogram – investigating the arteries to see how blocked they are – angioplasty, placing a metal stent in the artery to force it open, and primary PCI – inflating the artery with a balloon if a patient has suffered a heart attack and usually placing a stent inside.

Looking on as the team gather in the cardiac lab. Picture: Martin Elvery Looking on as the team gather in the cardiac lab. Picture: Martin Elvery

This man suffered a heart attack overseas and was fitted with a stent, a small tubular metal mesh which keep the artery open and allows blood to flow to the heart.

Mani wants to make sure it is fitted properly and is doing its job before checking the patient’s other coronary arteries to see if they are blocked.

I watch an X-Ray image as Mani skilfully moves the curved catheter so that it hooks into one of the three coronary arteries leading to the heart.

To me the image is just a grey outline, but Mani knows exactly what he is looking for.

A blocked coronary artery with a stent fitted. You can clearly see the blood flowing through it. Picture: East annd North Herts NHS Trust . A blocked coronary artery with a stent fitted. You can clearly see the blood flowing through it. Picture: East annd North Herts NHS Trust .

A coronary artery suddenly stands out on the screen like the branches of a tree as dye from the catheter is fed into it.

It’s very clear that the blood is flowing well through the stent and into the heart, and Mani declares himself satisfied before turning to the other arteries.

He quickly finds them and delicately hooks the catheter into them. They too light up on the screen and Mani announces he is happy with the blood flow and will not need to insert any further stents.

Incredibly, these days a heart attack patient might be able to get up off the table and be back home within 48 hours. Mani tells me afterwards this man will be able to return to work within just three days – five if he has a manual job.

Timing, he says, is key. This patient had the stent fitted within the target time of one hour 20 minutes. This means that after his heart attack no damage was done to the heart muscle.

If you’re having any kind of chest pains one of the nurses tells me – you shouldn’t get in your car and try to drive to hospital as many people do, or feel it’s not serious enough to call 999. You must pick up the phone and call an ambulance to avoid damage to your heart straight away.

Modern life is – of course – catching up with us, causing the amount of heart disease to increase. Lead nurse Clare Young tells me the key is prevention – encouraging people to give up smoking, to exercise, watch their cholesterol and blood pressure. Sometimes, though, arterial narrowing can be genetic and Mani suspects this to be the case with his current patient.

To this end the unit hosts a chest pain clinic to try to help people manage their conditions.

Its main purpose is in disease prevention – for example identifying those people with suspected angina so that they can receive initial medication, lifestyle advice and refer them for further investigations and treatment as needed. The idea is to help prevent these patients experiencing more serious illness, including heart attacks, and needing more interventional treatment.

Those who are recovering from heart attacks can expect help with managing their diet and changing their lifestyles to try to avoid a repetition. They will also be placed on medication – statins for cholesterol, blood thinners to help the stents settle into the body and beta blockers to reduce stress on the heart.

Patients are seen six weeks after their procedure to be monitored and then – if all goes well – are discharged to their GP.

Mani tells me he has done thousands of these procedures – you have to do at least 1,000 before you’re fully trained to cope with all eventualities. For him it is quite routine, but to me – watching this for the first time ever – it’s incredible, and shows a heart attack does not necessarily spell disaster.

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