Download winter 16 - HeartCare Western Australia

WINTER 16
E-NEWSLETTER
Thank
THURSDAY 19TH MAY WE
CELEBRATE WORLD FAMILY
DOCTOR DAY.
The members of HeartCare WA would like to
acknowledge the important role that General
Practitioners play in effectively translating evidence from
clinical trials into practice. Widespread use of effective
therapies including statins, antiplatelet, anticoagulant
and antihypertensive therapies have vastly improved
the clinical outcomes of patients with common chronic
conditions - hypertension, coronary artery disease, heart
failure and atrial fibrillation.
ECG ROUNDS
Diagnosis:
28 year old female with intermittent palpitations and syncope. The 12 lead ECG demonstrates:
a Old Inferior myocardial infarction b Antero/lateral ischaemia. c WPW/ventricular pre-excitation d Sinus rhythm with LBBB
Author: Dr Pradyot Saklani, HeartCare Electrophysiologist
heartcarewa.com.au
*ANSWER ON PAGE 3
WE ARE PLEASED
TO ANNOUNCE
HeartCare Western Australia has been granted early
access to the Abbott Vascular bioresorbable Absorb
scaffold for privately insured patients through selected
health funds.
The Absorb stent is a bioresorbable vascular scaffold that
is designed to dissolve over a 2-3 year period. To date,
data from over 13,000 patients from clinical trials are
promising however more data are required to determine
the superiority of the these stents compared with current
generation metal stents.
Although you will start seeing more of your patients with
this type of stent, it will not affect management decisions
related to the duration of their antiplatelet therapy.
BASELINE
YEAR 2
YEAR 5
REPAIRS
stenosed vessels1
RESTORES
vessel function2
RENEWS
vessel wall structure2
ALL HEARTCARE WA INTERVENTIONAL CARDIOLOGISTS ARE
EXPERIENCED IN THE IMPLANTATION OF THE ABSORB SCAFFOLD
Dr Alan Whelan
Dr Donald Latchem
Dr Randall Hendriks
Dr Allison Morton
*Small platinum markers at scaffold edges remain.
OCT images courtesy of RJ van Geuns, Erasmus Medical Center, The Netherlands; De Bruyne B. ABSORB Cohort B
5-year, TCT 2014. Sources: 1. Serruys, P, et al. Lancet. Sept. 2014; http://dx.doi.org/10.1016/S0140-6736(14)61455-0.
2. Serruys PW et al. ABSORB Cohort B Presentation. TCT 2015.
heartcarewa.com.au
As part of GenesisCare and HeartCare Western
Australia’s commitment to evidence-based
clinical practice we have implemented
the GenesisCare Percutaneous Coronary
Interventional (PCI) database. The PCI database
captures details of PCI procedures to enable a
better understanding of patient conditions,
with continued follow-up of patients to ensure
quality outcomes and guideline adherence.
With over 6,700 patients who have completed
a 12 month follow up our results compare
favourably with the US National Cardiovascular
Data Registry (NCDR).
A MEMBER OF THE
NETWORK
CARDIAC TESTING
ECG ROUNDS
ANSWER: C - WPW/ventricular pre-excitation.
There is evidence of a manifest accessory
pathway. Accessory pathways are typically
capable of rapid conduction. The ventricles
are prematurely activated (pre-excited) via
the accessory pathway before AV nodal
conduction via the bundle branches catches
up. This results in the Delta wave, which
is the initial slurred portion of the QRS.
The resulting QRS is wider than normal AV
nodal conduction and can be mistaken for
aberrancy/bundle branch block. As a result
of ventricular pre-excitation, the PR interval
is typically truncated. A short PR interval is
not seen with aberrancy however. The Delta
wave if negative can mimic Q waves and be
mistaken for established infarction. Because
of abnormal ventricular depolarization
(compared to pure AVN/Bundle branch
depolarization), corresponding abnormal
repolarization (ST changes) is often observed
and are not related to ischaemia. Such
ST changes are also commonly seen with
PVCs, where ventricular depolarization is
abnormal. In summary the hallmarks of WPW
ECG are: Short PR interval, slurred Delta
wave, broad QRS and T wave changes. These
ECG features can be subtle if the degree of
ventricular pre-excitation is minimal, since
it is a race between AV node and accessory
pathway conduction.
Patients with asymptomatic ventricular
pre-excitation are deemed to have a WPW
ECG, whereas those with palpitations (and
especially documented tachycardia) are
diagnosed with WPW syndrome. This patient
has WPW syndrome. Accessory pathways
may facilitate supraventricular tachycardia as
well as pre-excited tachycardia including pre
excited atrial fibrillation. Patients with WPW
ECG and especially those with symptoms/
syndrome have a small risk of sudden death
from rapidly conducted pre-excited AF.
Syncope could represent a case of aborted
sudden death. Accordingly all such patients
should be assessed by a cardiologist/
electrophysiologist.
2100 REASONS FOR
CARDIAC REHABILITATION
Greater uptake of life-saving cardiac rehabilitation
programs for heart attack survivors could reduce
costs to the national health system by $35.5
million and stop 2,100 heart attacks across the
country per year, according to new research published in Heart, Lung and
Circulation (2016) http://www.ncbi.nlm.nih.gov/pubmed/26442971.
Cardiac rehabilitation helps people get back on their feet and return to living an
active and satisfying life after their heart event. Currently less than one in three
heart attack survivors attend cardiac rehabilitation programs in Australia. The
published cost benefit analysis is based on increasing the participation rates
from the current 30% to 65%. This analysis shows that if uptake was increased
to 65% the benefits nationally per annum could be:
•
•
•
$35.5 million in savings in healthcare costs
$58 million in social and economic benefits
reduction in 2,100 hospital admissions for heart attacks
The National Heart Foundation of
Australia’s Chief Medical Advisor,
Professor Garry Jennings AO said
this analysis shows investing
in cardiac rehabilitation makes
Simply by recommending cardiac
financial sense for governments and rehabilitation you can help prevent
importantly will reduce disability
someone having another heart attack.
and save lives.
“Of the 55,000 heart attacks that will occur this year, each will cost around
$30,000 in healthcare costs. That’s more than $1 billion every year,” Prof
Jennings said.
“In stark contrast, a cardiac rehabilitation program costs the health system an
average $885 per person to attend.”
For more information about cardiac rehabilitation
visit www.heartfoundation.org.au or call the Heart Foundation Health
Information Service on 1300 36 27 87 – they can help find a local cardiac
rehabilitation program.
SPOTLIGHT ON
EXERCISE STRESS
TESTING
Exercise stress testing remains an
important test for both diagnosis of
coronary artery disease and prognosis
in those with known ischaemic
heart disease. It is a simple, relatively
quick and cost effective test done
on either a treadmill or exercise bike
with minimal patient discomfort.
The strength of the test is that a
negative test at a good workload has
a low rate of serious cardiac events.
The weakness of the test is a lot of
false positives can occur resulting in
further investigation. Patient groups
likely to have a false positive test
are those with ECG abnormalities
on a resting ECG and valvular heart
disease. There is a moderate rate of
false positive tests in low risk female
subjects as well. For that reason
other more accurate forms of testing
including exercise or dobutamine
stress echo are recommended
for those patient groups.
REFERRER EDUCATION MEETINGS
HeartCare WA believes that to ensure best practice, the medical
community needs to be kept up-to-date with any clinical and
technological advances through ongoing education.
PLEASE REFER TO
www.heartcarewa.com.au/medical-professionals/referrer-events
where you can also register online.
UPCOMING EVENTS
28
JUN
19
JUL
SOUTH
PERTH
Pagoda Resort 6.45PM FOR
& Spa
7PM START
Meet the Specialists - Rotating Dinner
Dr Ben King, Dr Pradyot Saklani &
Dr Antonius Steven
MURDOCH
Blue
Water Grill
Applecross
6.45PM FOR
7PM START
Meet the Specialists - Rotating Dinner
Dr Alan Whelan, Dr Xiao-Fang Xu, Dr Vince Paul
FOR FURTHER DETAILS OR TO REGISTER FOR AN
UPCOMING EDUCATIONAL EVENT, GO TO:
For any queries, call Marketing & Relationship Manager
Tracey Horsley on 0437 849 061
HeartCare Western Australia provides a comprehensive range of
cardiology services and procedures across all Cardiac sub-specialties
ACCESS A
CARDIOLOGIST 24/7
WITH OUR NEW MOBILE
&+
DESKTOP WEB TOOL
INSTANT SECURE
REFERRALS
CONSULTATIONS
CARDIOLOGISTS
INVASIVE & STRUCTURAL
HEART PROCEDURES
› Including Employment &
Dr Randall Hendriks
Dr Bernard Hockings
Dr Mark Ireland
Dr Ben King
Dr Donald Latchem
Dr Allison Morton
Dr Mark Nidorf
Dr Vincent Paul
› Angiography and Coronary
Immigration Related
Consultations
›
› ECG & Exercise Stress Testing
› Echocardiography
› Transoesophageal
ELECTROPHYSIOLOGY
› Electrophysiology Studies and Radio
Echocardiology
› Stress Echocardiography
›
including Dobutamine
› Ambulatory Blood Pressure
Monitoring
Interventions including *Acute
Primary Angioplasty *SJOG Murdoch
ASD Closure, PFO Closure, Left
Atrial Appendage Occlusion
& Valvuloplasty
frequency Ablations of SVT, Extensive
experience of AF ablation, Specialist
interest in ablation of VT
Permanent Pacemaker Insertions,
Recorders
› Cardiac Resynchronisation Therapy –
implantation and optimisation
Pacemaker Checks and
programming
› Holter & Event Monitoring
›
RESOURCE & ADVISORY SERVICE
TO GENERAL PRACTITIONERS
ACCESS TO PRIVATE &
PUBLIC HOSPITALS
METROPOLITAN
Cockburn
Duncraig
Joondalup
Kalamunda
Midland
FOR BOOKINGS
(for urgent advice)
JOONDALUP (Shenton House)
Ph 9400 6161 Fax 9400 6100
BUNBURY
Ph 9722 1679
Fax 9722 1678
MURDOCH (SJOG Wexford)
Ph 6332 2300 Fax 6332 2310
MANDURAH
Ph 9584 6500
Fax 9584 6520
NORTH OF THE RIVER
SOUTH OF THE RIVER
6332 2350
Murdoch
Nedlands
Perth (Mount)
Rockingham
Yokine
REGIONAL
Albany
Augusta
Bunbury
Busselton
Collie
Denmark
ON CALL DOCTOR
1300 4 HEART
(1300 443 278)
Dr Peter Purnell
Dr Pradyot Saklani
Dr Nigel Sinclair
Dr Isabel Tan
Dr Angus Thompson
Prof. Peter Thompson
Dr Alan Whelan
Dr Xiao-Fang Xu
Dunsborough
Karratha
Mandurah
Manjimup
Margaret River
Port Hedland
NEDLANDS (Hollywood)
Ph 6389 9100 Fax 6389 1835
PERTH (Mount)
Ph 9480 3000 Fax 9321 1012
FOR ALL OTHER SITES
Ph 9480 3000 Fax 9321 1012
Scan our heart with your QR
heartcarewa.com.au
HEARTCARE IS A MEMBER OF