• Hemodynamics unit. Cardiac catheterisations
  • Cardiac imaging department
  • Stress testing department. Ergospirometry
  • Arrhythmia Unit
  • CV Research
  • Cardiology Hospitalisation Unit
  • Coronary Unit
  • Cardiac Insufficiency Unit
  • Pulmonary Hypertension Unit
  • Cardio-oncology Unit

Consultations

Consultations are available at the hospital itself and at Pontones and Quintana Speciality Centres.

Hospitalisation unit

This is made up of 20 single rooms, supported by rooms on other floors when necessary. These rooms are mainly used to admit patients who have seen their condition worsen, meaning they cannot be adequately treated in the consultation room.

Acute Cardiac Care Unit (ACCU)

This currently has 7 single rooms, plus a lead-lined emergency room. It is intended for patients admitted in a critical condition, such as those suffering a myocardial infarction. It has everything necessary for the monitoring and care of such patients.

Hemodynamics Unit

Different procedures are performed in the Cath Lab, all based on introducing catheters into the patient's arteries and veins, known as cardiac catheterisation. The procedures do not require general anaesthesia, simply a local anaesthesia in the catheterisation area, ensuring a painless, well-tolerated experience for the patient. Except for some more complex procedures, the patient can usually go home on the same day or the day after the procedure.

  • Coronary angiography: A test performed to study and treat coronary arteries. In some cases, there is a narrowing of the arteries of the heart (ischaemic heart disease), generally due to the accumulation of cholesterol and calcium inside, causing a lack of blood to the heart, which usually manifests itself as angina pectoris. Using X-rays and contrast, catheters (thin tubes) are introduced through an artery, usually in the arm, and advanced to the coronary arteries. This approach allows arterial narrowing to be examined and assessed, determining whether a stent implantation or aorto-coronary bypass surgery is necessary.
  • Angioplasty with stent: Once a narrowing has been identified in a coronary artery, various devices are inserted into it via catheters in order to open it, ultimately culminating in a stent or metal coil being implanted in the constricted region.
  • Angioplasty in Acute Myocardial Infarction (Primary Angioplasty): Arteries may sometimes experience a sudden complete blockage, interrupting blood flow to a specific part of the heart and resulting in the condition commonly referred to as Acute Myocardial Infarction. In such cases, the patient undergoes immediate catheterisation to open the occluded artery and reestablish the blood supply by implanting a stent, halting the necrosis (death) of the heart muscle.
  • Transcatheter aortic valve implant (TAVI): This is a procedure indicated in patients with aortic valve obstruction (aortic stenosis). Under sedation and local anaesthesia, an aortic valve is fitted by means of catheters to replace the diseased valve. This procedure removes the need for cardiac surgery, and allows a quick recovery with a lower risk of complications.
  • Closure of ASD/PFO: Atrial septal defect (ASD) and Patent Foramen Ovale (PFO) are "holes" in the heart that some people have from birth, which sometimes need to be closed. This involves implanting devices that act as "plugs" in these holes through the use of catheters.
  • Atrial appendage closure: The atrial appendage is a part of the heart where thrombi (clots) can sometimes accumulate. Whenever anticoagulant drugs are contraindicated, a device can be placed in the auricle through catheters, preventing the spread of thrombi.
  • Alcohol septal ablation: Some people have an overly thickened heart muscle, which causes fatigue, chest pain and other symptoms. This technique involves injecting alcohol into a small artery of the heart, causing thinning of the heart muscle and alleviating the symptoms.
  • Mitral valvuloplasty: This is a procedure performed in people with narrowing of the mitral valve (mitral stenosis). An inflatable balloon is introduced through the narrowed valve by means of catheters, with the valve opening when inflated.

Arrhythmia Unit

This Unit treats heart rhythm disorders, which are basically divided into tachyarrhythmias, in which the heart beats faster, and bradyarrhythmias, in which it beats more slowly than normal.

  • Pacemaker implant (single and dual chamber): a pacemaker is a device that allows the heart to be stimulated to maintain an adequate heart rate in patients with bradyarrhythmias. It consists of one or more electrodes (wires) connected to a pulse generator. The electrodes are placed inside the heart through a vein, and the generator is implanted in the subcutaneous space of the pectoral region.
  • Defibrillator implant (intravenous or subcutaneous): the defibrillator (ICD) is a device for treating severe ventricular arrhythmias. It consists of an electrode (cable) that is placed inside the heart through a vein, along with a generator implanted in the pectoral region. Subcutaneous defibrillators differ in that the electrode is implanted subcutaneously at sternum level and connected to a generator under the skin on the patient's left side.
  • Cardiac resynchronisation implant: a device that allows the heart to be stimulated from different points of the ventricle, improving the synchrony of myocardial contraction in patients with ventricular dysfunction. It consists of two or three electrodes connected to a pulse generator. The electrodes are placed inside the heart through the vein, and the generator is implanted in the subcutaneous space of the pectoral region.
  • Pacemaker, defibrillator or resynchroniser generator replacement. Generator replacement is an outpatient procedure that is carried out when the battery is depleted. The old generator is removed under local anaesthesia and replaced with a new one, preserving the electrodes.
  • Electrophysiological study of tachycardias and bradycardias. Consists of introducing catheters in the heart through the femoral vein. It allows the electrical properties of the heart to be studied, inducing tachycardias for diagnosis and study. Nowadays, apart from conventional catheters, there are navigation and cardiac activity recording systems that enable three-dimensional reconstructions of the heart, facilitating ablation procedures with greater precision and reduced radiation levels.
  • Cardiac ablation (supraventricular, atrial fibrillation, atrial flutter and ventricular arrhythmias). After completing the electrophysiological study and determining the substrate responsible for the arrhythmias, the treatment involves ablating (cauterising) with radiofrequency or cryoablation.
  • Subcutaneous Holter monitor implant. The implantable Holter is a small device inserted under the skin that constantly records heart rhythm in order to diagnose any disorders.
  • Holter monitor: A non-invasive cardiac rhythm recording system in which the patient is fitted with a simple device that can last from one or two days to 3-4 weeks.
  • Tilt table test. Test used to provoke and diagnose vasovagal or orthostatic syncopes.
  • Pharmacological test. Some intravenous drugs allow the risk of a range of cardiac diseases to be diagnosed or studied.

Cardio-Oncology Unit

Our Cardio-Oncology Unit was created in response to the need for heart care for cancer patients. Cardiovascular problems are frequent in patients undergoing cancer treatment, and are often more important in determining prognosis than the cancer itself. Driven by this major clinical need, we have formed a multidisciplinary team of Cardiologists, Oncologists and Haemato-Oncologists working in close collaboration.

Our mission is focused on treating and, ideally, preventing the onset of these cardiovascular disorders that pose a risk to ongoing optimal oncological treatment. Given the complex needs of our cancer patients, its task is to coordinate the active involvement of the Cardiology service's different units (Arrhythmias, Haemodynamics, Cardiac Imaging, etc.), with a view to providing the most effective treatment for cancer patients.

The goals of our Cardio-Oncology unit can be summarised as:

  • Prevent the appearance of cardiovascular complications in susceptible cancer patients, with special emphasis on controlling cardiovascular risk factors.
  • Early detection of cardiovascular problems derived from cancer or its treatment.
  • Early treatment of cardiovascular pathologies.
  • Provide continuous, personalised care for such patients during hospital admissions.
  • Carry out close cardiological follow-up, even after oncological treatment is complete.

Non-invasive Cardiology and Cardiac Imaging Unit

Electrocardiogram

This is the oldest cardiology diagnostic test. It consists of simply recording the heart's electrical activity by placing electrodes on the extremities and chest. Despite its age, it is still an essential tool in evaluating cardiac patients thanks to the large amount of information it provides.

Transthoracic echocardiogram

The transthoracic echocardiogram is a non-invasive diagnostic imaging test that uses ultrasound to study the heart by placing a transducer on the patient's chest. It is therefore a non-invasive test, which does not cause pain or side effects, and does not radiate the patient. It provides information about the structure and function of the heart. It can also provide information on pulmonary circulation and pressures, initial portion of the aorta, and see if there is fluid around the heart (pericardial effusion).

Transoesophageal echocardiogram

This technique entails capturing images of the heart by inserting a probe or tube through the mouth to the oesophagus. It is therefore a semi-invasive technique. It generally goes hand-in-hand with the transthoracic echocardiogram, as it allows us to see some cardiac structures better. It is especially indicated to rule out the presence of thrombi (clots) inside the heart before performing electrical cardioversion of atrial fibrillation or atrial flutter, visualising not only some mitral valve problems but also tumours or congenital heart disorders that are difficult to see with a transthoracic echocardiogram. It is performed with superficial sedation. The cardiologist will insert the probe into the patient's mouth to access the oesophagus. The close relationship of the heart with the oesophagus allows for a very detailed, high-quality image.

Three-dimensional echocardiogram (3D)

This is a type of echocardiography that obtains 3D images. A 3D image is created from multiple 2D images. Three-dimensional echocardiograms are currently considered essential in monitoring non-coronary interventional procedures, valve surgery and congenital heart disease, as well as in studying left and right ventricular function. Technological advances have simplified image post-processing, which is now only necessary when quantitative measurements are required. Today's 3D imaging allows accurate, reproducible anatomical assessment in real time, without the need for reconstructions once the image has been captured.

Contrast echocardiogram

Contrast echocardiograms involve viewing the heart and heart valves via ultrasound while an echocardiographic contrast agent (microbubbles) is introduced through a vein. It therefore provides much more detail in observing the heart and blood vessel structures, aiding in the diagnosis of numerous pathological conditions.

Stress test or ergometry

This is performed to evaluate the heart's response to stress or exercise. It consists of checking the heart's response to exercise on a treadmill or bicycle, observing the electrocardiogram during exercise, along with the patient's blood pressure and symptoms. Sometimes the electrocardiogram is not enough, and an imaging technique is added to visualise the heart. These include the echocardiogram, which uses this technique to evaluate the heart's contraction before and immediately after exercise, since a worsening of ventricular contractions after exercise suggests that the heart is suffering, which may be due to coronary heart disease. This test is called a Stress Echocardiogram. The other type of imaging test is the Isotope Stress Test. A radioactive isotope is injected into a vein to see if the blood reaches the myocardium through the coronary arteries. This test is used less frequently because it radiates the patient, but may be necessary in some cases, e.g. when the patient's anatomy does not allow good images to be captured via echocardiogram.

At other times, a stress test cannot be performed because the patient is unable to walk or pedal a bicycle. In these cases, a Pharmacological Stress Echocardiogram is performed to increase the work of the heart as a substitute for physical exercise. Drugs such as Dobutamine and Adenosine, which modify heart contraction and heart rate, are used. In these pharmacological tests, one of the previously described imaging techniques (echocardiography or isotope perfusion) is always performed in addition to the electrocardiogram.

Ergospirometry: a conventional stress test in which the exchange of oxygen and CO2 during exercise is also measured using a mask and a gas analyser. It allows a global assessment of the behaviour of the cardiovascular and respiratory systems and energy metabolism during exercise.

Cardiac CT

This is a diagnostic technique (computed axial tomography) that is used to capture radiological images of the heart with submillimetre resolution. There is an examination table and a rotating X-ray C-arm. Advanced software for post-processing can be used for three-dimensional images (3D volume rendering), enabling a range of cardiac projections. The drawback is that it radiates the patient, even though, being a non-invasive test, it does not cause discomfort. A cardiac CT allows us to evaluate the following aspects:

  • Anatomy of coronary arteries and veins, existence and composition of atheromatous plaques, and identification of significant stenosis of the vascular lumen.
  • Cardiac anatomy: number and location of pulmonary vein drainage. Study of anomalous vessels.
  • Ventricular function: global and regional contractility, with calculation of diameters, ventricular volumes and ejection fraction.
  • Anatomical assessment of the thoracic aorta and main pulmonary vessels.
  • This provides information on valvular anatomy: congenital (bicuspid valve, etc.) and acquired disorders (degree and location of valvular calcifications, annular calcification, etc.). Pre-TAVI planning studies.

Cardiac Magnetic Resonance Imaging

  • Cardiac magnetic resonance (CMR) is an imaging technique for the non-invasive study of the heart which, unlike CT, does not radiate the patient and is also non-invasive. It allows us to study the function and structure of the heart in a single scan, providing a detailed image.
  • It is indicated in the anatomical and functional study of different heart diseases, in myocardial viability and cardiac muscle perfusion studies (with contrast administration), ventricular function studies, pericardial diseases (layer of tissue covering the heart), and in evaluating cardiac masses.
  • The technique allows us to capture high-quality images in any cardiac plane, and presents outstanding capability in terms of tissue differentiation without the need for intravenous contrast.

Cardiac Insufficiency Unit

This consists of a Consultation Unit with Cardiologists and Internists, along with specialised nurses. It is complemented by our institution's Day Hospital, attending to patients who must regularly receive intravenous treatments.

Research Unit

This is currently located in the Haemodynamics Area, but will shortly have its own space with consultation rooms to attend to clinical trial patients, draw blood, and store clinical test medication.