Matters of the heart: Advice from a cardiologist
Worried about your heart, but not sure where to begin? Diana Holdright, Consultant Cardiologist at The Harley Street Clinic, answers your most common questions.
Symptoms such as chest pain, breathlessness and dizziness can leave people confused about where to turn for help. They can often be a sign of so many things that it can be difficult to know which specialist to book an appointment with. Specialists like Dr Diana Holdright, a Consultant Cardiologist at The Harley Street Clinic, are where patients often start.
Q: When should people make an appointment to see you, and how do they do it?
Undiagnosed symptoms should always be investigated, and I see many patients with a wide spectrum of cardiac problems, some seeking a second or third opinion. We are seeing more and more people acting preventatively, requesting a cardiovascular screen because of their family history.
Cardiology is a vast specialty with many subspecialties, covering all aspects of cardiovascular health including prevention, screening, the investigation of symptoms and management of common problems such as raised blood pressure, high cholesterol, palpitations, angina, dizzy spells and the effects of diabetes on the heart.
The genetic contribution to illness is increasingly recognised such that genetic testing plays an increasingly important role, for example in patients with heart muscle disease or electrical problems and in patients with a strong family history of heart problems.
Many of my patients come on personal recommendation or are referred by their GP or another specialist. For patients wishing to use private medical insurance, a letter of referral may be required to establish a claim.
Q. What can people expect at their first appointment?
In the first instance a careful patient history is taken to try to understand the symptoms or concerns, followed by a physical examination and a discussion about the investigations that may be required.
There are many ways to investigate the heart. To assess the performance of the heart and heart valves, the blood supply to their heart, and the electrical pathways which generate the heartbeat, we may use ultrasound, ECG monitoring, CT scanning, MRI scanning and nuclear imaging.
The full range of investigations can usually be set in motion swiftly, which is of value to patients with tight time schedules and those travelling from abroad.
We would also schedule a follow-up consultation, at which the results of investigations are considered in detail and discussed with the patient to create a management plan.
Q: When all the results are in, how can you help them?
That comes down to the individual; this is where we see pathways become more tailored and individualised.
It may be that a patient has an overriding electrical problem, for example a condition called atrial fibrillation, the most common rhythm disturbance we see in adults, which can cause an irregular or abnormally fast heart rate. We would then make a referral to an electrophysiologist to discuss treatment options and the role of catheter ablation.
Patients might present with discomfort in their chest when they exercise, which could be a sign of severe narrowings in the coronary arteries. This would lead on to further investigations such as a CT coronary angiogram, perfusion MRI scan or conventional angiogram, likely followed by a multidisciplinary team meeting (MDT), which is a gathering of cardiologists, imaging doctors and cardiothoracic surgeons. In that way a group of specialists can recommend the best treatment pathway for the patient, and if intervention is deemed appropriate by way of a stent or bypass surgery, the patient would be referred on to the relevant subspecialist.
Q: Open heart surgery is less often required these days. What are the alternatives?
These days narrowed and blocked coronary arteries are more often treated with coronary stents (angioplasty) rather than with open heart surgery. A coronary angioplasty is usually performed as a day case procedure with very rapid recovery, in contrast with open heart surgery which requires an inpatient stay of up to a week with a gradual recovery over the next 2 to 3 months.
Open heart surgery used to be the only option to treat severely narrowed and leaking heart valves. During the last two or more decades new technologies have been developed enabling us to treat certain valve conditions in a far less invasive way. For example, the TAVI procedure, known in full as transcatheter aortic valve implantation, which has been developed to treat patients with narrowed aortic valves. The procedure fits the valve through a small, 1cm incision in the top of the leg, therefore avoiding open heart surgery and resulting in excellent outcomes and a much shorter hospital stay. The technique is starting to be used to treat some mitral valve problems as well. Specially designed clips can be used to treat leaking mitral and tricuspid heart valves in preference to open heart surgery and with much more rapid recovery.
Q: In your opinion, what makes The Harley Street Clinic well placed to treat people with heart problems?
The Harley Street Clinic has focussed on cardiac care for decades. With my colleagues and the facilities available at The Harley Street Clinic patients are guided through the entire journey from investigation to diagnosis and treatment. We offer many different options and provide state-of-the-art facilities for the investigation and treatment of heart and circulatory problems.
Meet our specialist
Dr Diana Holdright
Dr Holdright graduated from UCL and UCH, London in 1984. She completed her specialist postgraduate training in cardiology at The National Heart Hospital, The London Chest Hospital, The Royal Brompton Hospital and UCL Hospitals, London. As part of her training, Dr Holdright undertook a period of research at The National Heart & Lung Institute, London. She worked in the NHS for 30 years, and was appointed as a consultant interventional cardiologist in 1997. She now works exclusively in the private sector, managing a wide spectrum of cardiological conditions and concerns, ranging from cardiovascular risk screening to the investigation and management of palpitations, dizzy spells, blackouts, chest pain and breathlessness, valvular heart disease, and heart failure.