At IALCH for cardiac investigation and treatment
Number of beds: Adult Cardiology (Ward B2W) = 32
Coronary Care Unit (High Care) = 6
(a) Non-Invasive Facilities
Exercise Testing and Nuclear Cardiology: One computerized exercise testing unit is used for the evaluation of patients with ischaemic heart disease and for the detection and quantification of myocardial ischaemia. A second unit is also used in the nuclear medicine laboratory to assess ischaemia and viability. A technologist is required and usually is responsible for conducting the test. The test has to be supervised by a doctor. The duration of the test is approximately 30 minutes and a further 15 minutes have to be spent on reporting the test.
Holter Monitoring: This is used for 24 hour ambulatory ECG monitoring. One technologist is responsible for putting on the electrodes and attaching the recorder to the patient. Analysis is carried out by the Holter analysis unit using computer techniques, but this has to be over read by the technologist. When the report is printed his report has to be over read by a consultant cardiologist.
Echocardiograpy: Two machines are available at IALCH, both having colour Doppler facilities and transoesophageal facilities for adults. A full transthoracic investigation can take from 45 minutes to 90 minutes. Transoesophageal echocardiography may take longer.
When Doppler studies have to be combined a further 15 to 20 minutes are required. When the studies are completed they have to be reviewed and reported, requiring another 15 to 30 minutes. The review and reporting have to be done and confirmed by a cardiologist.
The echocardiographic investigation is conducted by an ultrasound technologist. There are at present two ultrasonographers at IALCH.
(b) Invasive Facilities
Two biplane cardiac catheterization laboratories: On Monday and Wednesday mornings paediatric cases are done, two cases being done on each morning. The laboratory is closed for service on Monday afternoons. On all other days it is used for the implantation of pacemakers, balloon mitral valvuloplasties, catheterization of patients with valvular heart disease, and aortography.
A second laboratory is available to the cardiologists for the following procedures: coronary angiograms; coronary angioplasties; pacemaker implantation; and electrophysiology studies.
Medical Staff requirements: One consultant cardiologist in each cardiac catheterization laboratory, and a senior registrar in training; one technologist in each cardiac catheterization laboratory, and one technician on the service floor to carry out blood sampling and be available for emergencies. In addition to this, at least 6 nursing staff is required and has been seconded to this unit.
The time taken to do many of these procedures ranges from 20 minutes to 8 hours. Once a procedure is completed films and videos have to be reviewed and reported on. Time taken to report on a procedure is approximately 45 minutes. Prior to reporting a meeting of all consultants and registrars is held so that consensus decision is made regarding patient management.