Cardiology

Heart diseases are still the main cause of death among the adult population in the western world.

Cardiology is the medical specialisation which focuses on the identification, diagnosis and treatment of various heart-related diseases.

Each of the doctors of our team has been trained in general cardiology and they will gladly help you with any questions you may have relating to heart disease.

As is the case with each aspect of medicine, cardiologists can also specialise in their discipline. Find out more about the various specialisations in the "What do we do?" section.


During a cardiology consultation, the cardiologist will try to explain most of the patients' complaints and, where applicable, also treat them.

In addition to questioning the patient and a physical examination, the cardiologist will also rely on the electrocardiogram, the exercise test and the holter monitoring.

You can make an appointment with any of the CHVZ's cardiologists for a cardiology consultation.

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Often the cardiologist uses imaging technology for a more detailed diagnosis.

The three main techniques are:
The cardiologists that have specialised in these disciplines are Profs. Steven Droogmans and Caroline Weytjens, and Drs. Dirk Kerkhove and Daniele Plein.
Thanks to these examinations, the cardiologist can arrive at a correct diagnosis and the patient, where applicable, will be referred to the heart surgeon or the interventional cardiologist.

Echocardiography    

This is a technique which makes moving images of the heart using sound waves with a very high frequency.
The sound waves are broadcast by a transducer which is moved across the patient's chest. The sound is reflected by the tissue of the heart muscle and the heart valves and is converted into a moving image on the screen.

During the examination, the doctor will look at the heart's size and functioning, as well as leaking heart valves. Also other heart diseases will be identified, including congenital heart disease.

This examination provides a clear idea of the size of the various heart chambers, the wall thickness, the functioning of the heart valves, the speed and direction of the blood flow and the pressure in the heart and the pulmonary arteries.
As a result the seriousness of a heart attack and the location of the affected zone can be accurately determined.
This is a completely painless and harmless examination.

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Magnetic resonance      

Magnetic resonance uses a magnetic field and radio waves (not X-rays) which generate certain signals in the body.
During the examination, the patient lies down on a table which slides into the MR tunnel.

The computer then calculates the composition of the various tissues based on the images recorded providing a cross-section of this tissue.

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Coronary CT scan

In order to achieve clear imaging during a coronary CT scan we use contrast dye and X-rays.
The coronary arteries are highlighted as well as other structures including the heart's valves and the heart muscle using a high-res scanner. This examination is first and foremost designed to exclude a coronary disease.

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The Heart Revalidation Department helps patients to change their lifestyle, for example after a heart attack or after heart surgery.

Research has shown that 90% of all heart problems are due to factors which can be remediated by the patient him/herself. Providing support to patients with medication and a change of lifestyle clearly reduces the risk of a relapse and also increases the patient's life expectancy.

As a certified heart revalidation centre our multidisciplinary team treats the hospital's own patients as well as patients that have been referred by other hospitals.

The revalidation cardiologists, Prof. Caroline Weytjens, Drs. Benedicte Heyndrickx and Dirk Kerkhove coordinate the heart revalidation. They work closely together with three physiotherapists (Dirk Verdaet, Peter Thys and Marlies Van Der Voorde), the clinical psychologist (Marina Mallefroy), the social assistant (Elise De Vulder) and the dietician (Anne-Sophie Verloes).

After an introductory discussion with the various team members the team will draw up an individual revalidation plan for every patient with a number of key objectives:
  • to provide information about the heart disease and the risk factors associated with it as well as provide information about the use of the administered medication (which, where applicable, is adapted).
  • to improve the patient's physical condition and provide guidance to him/her so he/she can reprise his/her daily activities. A personal training schedule is drawn up based on the results of an ergospirometry.
  • to inform the patient about healthy nutrition and potential specific dietary requirements.
  • to provide psychological guidance for stress management (stress as a result of the heart disease as well as so-called background stress related to the patient's living conditions).
  • to provide smoking cessation counselling by the psychologist (who is a qualified tobaccologist).
As a result of our ageing population the number of patients suffering from heart failure continues to rise, which, in turn, results in a reduction of our life expectancy and quality of life.
The frequent hospitalisations associated with this can generate high societal cost.

The Heart Failure Clinic's objective is to make sure that the patient and his family are informed as much as possible about the various aspects of his/her disease (symptoms, treatment with/out medication) on the one hand and to provide guidance to the patient and the GP on the other hand in order to avoid frequent hospitalisations.

Attention is mainly focused on improving compliance with therapy (proper intake of medication) and on the early recognition of symptoms. The patient also learns how to respond in case certain symptoms are recognised (i.e., short of breath, swollen feet).

 
Prof. C. Weytjens and Mrs. Nancy De Laet
Profs. Caroline Weytjens and Steven Droogmans and dr. Daniele Plein coordinate the treatment of patients with heart failure. They work closely together with 2 heart failure nurses, Mrs Nancy De Laet and Mss Helena Frederix.

The team works in conjunction with the patient's GP to achieve an optimal treatment, which will be adapted individually to the needs of every patient. The patient will regularly be seen during consultations with the heart failure nurse.

If the results of the medicine-based treatment of heart failure are unsatisfactory, more advanced treatment options such as resynchronisation by means of a tri-chamber pacemaker, kidney replacement therapy, heart transplants, etc. can be discussed for very symptomatic patients.
The treatment can be adapted to suit the patient's needs thanks to the optimal collaboration between the various specialists and sub-disciplines.

Sport cardiology and the treatment of overuse or overload injuries are two very important yet very diverse disciplines in sports medicine.

In sport cardiology the emphasis is on identifying any potential underlying cardiac diseases which (may) give rise to complaints during or after sports.

Potential examinations during the consultation with the sports doctors include:
an electrocardiogram at rest
an exercise test on the bicycle
an echocardiogram

Based on the outcome of these examinations, the sports doctor, Dr. Frank Pauwels will formulate a recommendation or refer the patient to the cardiologists or rhythmologists for further examinations or elaboration.

Sports are and continue to be a very healthy activity but in some cases they are associated with pain of the knee, shoulder, Achilles heel, lower back, etc.
Often this is due to a repeated wrong use during the sports activity, which, in turn, gives rise to chronic overload injuries.

Based on an extensive clinical examination and potential additional examinations (ultrasound, X-rays, CT scan, MRI scan and isotope scan) the sports doctor will start up treatment and provide advice about specific sport training. He will try to remediate the overload injuries so the patient can continue to practice his/her sport.

In the context of cardiac diseases, the team works closely with the Cardiology Department and the Heart Rhythm Management Centre. Chronic overload injuries are treated in collaboration with the radiology, isotopes, orthopaedic and physiotherapy departments.

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The coronarography is the most frequently used examination in interventional cardiology.

This internal heart examination will provide a clear idea of the condition of the coronary arteries and any potential arterial stenoses or blocks.
This is not an operation or a treatment. It is a painless examination conducted under local anaesthesia, which is why it is known as a minimally invasive procedure.


The cardiologist will insert a few thin tubes (catheters) into the patient's body via his wrist or his groin pushing them towards the heart. This enables the cardiologist to see at all times where the catheter is located using a mobile X-ray arm which can be moved across the patient's heart. This X-ray equipment will also provide images of the coronary arteries.

Thanks to these images the cardiologist can identify any potential stenoses of the coronary arteries as well as potential problems of the heart valves. During the procedure the cardiologist can dilate any narrowed coronary arteries and introduce a stent or, where applicable, an artificial aorta valve.

The team of interventional cardiologists is made up of Profs. Danny Schoors and Jean-François Argacha, and Drs. Peter Kayaert, Jeroen Sonck and Stijn Lochy.

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PTCA stands for Percutaneous Transluminal Coronary Angioplasty.

During the procedure the patient is usually awake and on the operating table in the cath lab. The procedure will take place via the groin or the radial artery, which is anaesthetised with a light injection. The patient's heart rhythm and blood pressure are closely monitored.

A sheath introducer (short tube) is inserted into an opening in the groin or radial artery in order to insert a guiding catheter (long, flexible wire) to the mouth of the aorta. The catheter then travels through the aorta to the coronary artery. A guidewire is then introduced through the guiding catheter and into the coronary artery past the site of the stenosis.

The X-ray machine will photograph the coronary arteries from various angles, which are shown on the screens. The guiding catheter and guidewire are easy to see on the screen.

(click on the photograph for a larger image).



By injecting a contrast dye it is possible to pinpoint the exact location of the stenosis. Once the guidewire is in position it will act as a pathway for the balloon catheter, which is pushed forward and can be inflated with a special pump. In the case of an ordinary balloon the plaque will be pressed into the artery wall ensuring that the artery is once again sufficiently expanded to supply the heart with oxygen-rich blood. The balloon is then deflated and pulled out again using the guidewire. (click the photograph for a larger image).

Before and after the dilatation

Before the dilatation



After the dilatation




Stenting

Often your doctor will choose to implant a stent immediately.
The principle is the same except that an expandable stent is on the balloon which is then pressed into the artery wall when the balloon is inflated. The stent ensures that the artery will not 'shrink' again over time.

The animation below shows:

1. the balloon catheter near the stenosis

2. the balloon is inflated and pushes the stent
into the artery wall

3. the stent remains in place after the catheter
is removed


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