Cardiology (Heart Services)

We assess patients with a suspected cardiac condition which requires immediate specialist attention. The CSRU provides rapid clinical assessment by a specialist team of doctors and nurses and delivers the most appropriate immediate care before admission to the cardiac ward, transfer to an alternative service or discharge home.

Call 999 if you think you’re suffering from a cardiac condition which requires immediate medical attention. The CSRU is not available to walk-in patients.

Some acute cardiac conditions don’t require admission to the CSRU and we may be able to treat you at Stoke Mandeville Hospital or in the Urgent Treatment Centre at Wycombe Hospital.

Our team includes specialist nurses in heart failure and a consultant cardiologist with specialist interest in heart failure. We care for patients suffering from advanced/chronic and decompensated heart failure. We work closely with other consultant cardiologists, specialist cardiac nurses and cardiac physiologists to provide a holistic service to our patients.

Who do we see?

Any eligible patient who has a GP in Buckinghamshire. This means that we have patients who may be under cardiologists in hospitals in neighbouring counties.

Inpatient service

We see all new patients who’ve been admitted to hospital with heart failure and provide care to patients on our coronary care unit and on general wards across the Trust’s hospital sites.

Heart failure clinics

We have 2 consultant-led and at least 10 nurse-led clinics per week for patients with heart failure. These clinics are held at Wycombe and Stoke Mandeville hospitals.

In the clinics we assess your progress, prescribe, adjust and monitor your heart failure medications. We help to improve your prognosis by providing prompt life-saving therapy. We also teach you how to manage your heart condition and reducing the impact of symptoms. We also support families and carers who are a key part of your healthcare team.

We work closely with our adult community healthcare teams, GPs, other cardiologists, practice nurses, palliative care teams, social care services and cardiac rehabilitation teams. The service also links in with other specialist teams offering treatments for diabetes, respiratory and kidney disorders and psychological needs.

One Stop Clinics for newly suspected heart failure

We run one stop clinics for new patients with suspected heart failure and who have a highly abnormal blood test (NT-pro BNP level >2000pg/ml).  We aim to see you within 2 weeks of the referral. This is led by Dr Mayooran Shanmuganathan, Consultant Cardiologist and is held at both Wycombe and Stoke Mandeville Hospitals. It offers several diagnostic tests including blood tests, echocardiogram, ECG and chest X-ray on the same day of your appointment with the Consultant Cardiologist. At the end of the clinic, if you’ve been diagnosed with heart failure, you’ll be prescribed the medications you need and will be offered a follow-up appointment.

Intravenous Furosemide lounge

This is a nurse-led clinic for patients with heart failure in the community who require intravenous (injections) of diuretics (Furosemide) to help get rid of excess fluid (which is a common symptom in heart failure). This reduces the need for you to be admitted to hospital.
Please note: patients attending this clinic need to be mobile and be able to get themselves to hospital via public or private transport.

 Information for healthcare professionals: How to refer patients to our service

We offer practical and emotional support to patients and their families. We help patients who have been diagnosed with heart disease or heart failure, or who are undergoing cardiac surgery.

We give advice, support and counselling and offer exercise rehabilitation.

Cardiac rehabilitation classes and rehabilitation programmes are available in hospital and community settings across Buckinghamshire.

Our team includes a cardiology and electrophysiology consultant, specialist heart rhythm nurses and cardiac physiologists.

We aim to provide specialist arrhythmia care to patients in Buckinghamshire.

We  aim to see you in a timely fashion, however, due to the significant demand for our services and there may be a waiting time for your appointment.

Arrhythmias

• Cardioversion
  Cardioversion is a day case procedure used to treat abnormal heart rhythms such as atrial fibrillation or flutter. Once patients are referred to the service by their cardiologist they will be added to a waiting list and called accordingly to their clinical priority.Prior to a cardioversion patients will need to be on a blood thinning medication such as warfarin or a suitable alternative for 4 weeks and they may need additional investigations such as an echocardiogram. You will also need a telephone pre-assessment where the benefits, risks and preparation requirements for the treatment will be discussed.You can find additional information in the leaflet (External Electrical Cardioversion – Consent Information for patients). The leaflet also has our contact details if you have any queries you wish to discuss.

• Arrhythmia Clinics
  We have 2 consultant-led clinics and 2 nurse-led clinics running weekly on a Monday afternoon and Friday Morning. We assess patients with all types of heart rhythm problems, organise any necessary investigations and discuss treatment options such as complex devices and electrophysiology treatments such as catheter ablation. Patients are referred to this clinic either by their GP or by other hospital Consultants.

• Amiodarone Clinic
  This is a nurse-led clinic where we see patients which have been advised to start treatment with amiodarone (or dronedarone). This can be a face to face or telephone clinic. In this clinic, we assess patients and provide information on the indication, benefits and risks of treatment.We may need you to have additional tests (such as blood tests, Electrocardiogram (ECG) and chest x-ray) before we can start treatment. We also follow-up patients after initiation of therapy and complete a shared care agreement document to allow treatment to be continued in the community. This clinic runs weekly on a Tuesday and patients will need to be referred by a cardiologist consultant before they can be seen.

• Arrhythmia advice
  We understand that conditions change over time and patients may need advice before any planned appointment. We run an open phone clinic where existing patients can call in to obtain quick advice regarding their condition or treatment. If you are known to the team our contact and clinic operation times will be provided to you.Please note: if you are unwell and think you need urgent or emergency medical care you should contact your GP, 111 or 999 depending on the situation.If have not been under our care previously we will not be able to offer advice and you will need to be referred through the appropriate channels via your GP so a suitable appointment can be arranged. This service is reserved for clinical enquiries, please contact the cardiology bookings team on 01296 838888 for any non-clinical enquiries, for example, for information about appointments.

Device therapy

• Implantable Loop Recorder (ILRs) follow up clinic
  Your consultant may have referred you for an ILR implant if they would like to record ECG tracings at times when you are having symptoms such as palpitations or faints. The ILR follow up clinic is a physiologist-led clinic where recordings can be downloaded and reviewed. This can be done face to face, or more commonly, via a remote monitor (Carelink) from home.The battery life for an ILR will typically last between 2 and 3 years. You can contact the ILR Clinic Monday to Friday, 9am until 4pm, on 01494 425471.

• Pacemaker follow up clinic
  Your consultant may have suggested that you have a pacemaker implanted so stop any slower heart rhythms or allow medications to be adjusted.Once implanted, you will be followed up in the physiologist-led pacemaker clinic, to review the pacemaker measurements and battery. These clinics are either remote, meaning that you can have the checks performed in your own home using a remote monitor (such as Carelink or Merlin at Home) or face to face if your pacemaker isn’t remote monitoring compatible or if we wish to make any programming changes. A copy of the report will be automatically sent to your GP for their records.You can contact the Pacemaker Clinic Monday to Friday, 9am until 4pm, on 01494 425471 or via the email address bht.pacingclinic@nhs.net (for non-urgent communication only).

• Complex device clinicPatients with cardiac resynchronisation devices or implantable defibrillators are followed up in our physiologist-led complex device clinic.The clinic is predominantly remote, which allows patients an opportunity to have their device information and measurements downloaded from home. Face to face appointments are available where remote monitoring isn’t possible or if manual testing or reprogramming is needed.You can contact the Complex Device clinic Monday to Friday, 9am until 4pm, on 01494 42541 or via the email address bht.icdclinic@nhs.net (for non-urgent communication only).If you have a defibrillator and need urgent advice outside of the hours listed above, please contact 111 or you if you are unwell call 999 that can refer you to our Cardiac and Stroke Receiving Unit (CSRU) if needed.

• Amiodarone therapy
• Blood pressure recording advice
• Dobutamine stress echocardiography
• External electrical cardioversion – consent information for patients
• Heart failure diary
• Implantable cardioverter defibrillator and cardiac resynchronisation therapy defibrillator
• Implantable loop recorder (ILR)
• Medicines for your heart
• Pacemaker guide for patients
• Transoesophageal Echocardiogram (TOE) Discharge Advice
• Transoesophageal echocardiography
• Transthoracic echocardiography