Research aims to understand why some people become ill and others do not, what happens when people become ill, and how best to care for people who are ill. New medicines and new medical devicesmay be tested to see how well they work and to show that they are safe. Cardiology research is vital to the development of improved cardiac care and its delivery. Treatments now commonly in use in the NHS were all developed and tested through research. Many of today's new drugs, devices and treatments might never have been possible without cardiology research, including:
Research has shown doctors the best way to use these treatments, to help people suffering from life-threatening illnesses to live longer and to experience a better quality of life.
A great deal of care is taken to make research projects as safe as possible. There are many criteria that have to be met in order for research to take place. These criteria have been established with the purpose of safeguarding the rights, dignity and welfare of people participating in research. Potential research participants will come under the protection of an independent Research Ethics Committee, who are responsible for ensuring that the research that is taking place is ethical and for protecting the dignity, rights, safety and well-being of all actual or potential research participants. It is the researchers' responsibility to ensure that the research meets the requirements of the Research Governance Framework and the standards of Good Clinical Practice.
Making your decision Research is often done with patients as part of their treatment. Some research offers you an opportunity to try a different treatment. Some research may not directly benefit you, but you may decide it is worth taking part in it because it could help other people in the future. If you are thinking of taking part in research, you need to understand what it will involve. You need to be sure that the benefits, either to you or others who will later benefit from the results, are worth the risk involved.You will be given a lot of information to help you decide if you want to take part in a research project. You will learn who is organising and funding the research, and who has reviewed the study. You will be given information on why you have been chosen to take part and you will learn the purpose of the study. You will be told if there are any side effects of any treatment received when taking part, and if there are any possible disadvantages and risks of taking part in the research. You will also know the possible benefits of taking part. Taking part in the research is entirely voluntary. It is up to you to decide whether or not to take part. If you do decide to take part you will be given this information sheet to keep and be asked to sign a consent form. If you decide to take part you are still free to withdraw at any time and without giving a reason. A decision to withdraw at any time, or a decision not to take part, will not affect the standard of care you receive.Taking part If you decide to take part, you will receive information on how long you will be involved in the research, if you will need to visit us or your GP more often than usual, and if travel expenses are available. You will be told exactly what will happen over and above standard diagnosis and treatment at each visit. You will learn if you have any additional responsibilities and if there is anything you have to do. You will have clear information on who to contact with any questions regarding your participation in the research project. During the research project All information collected about you during the course of the research will be kept strictly confidential. Any information about you which leaves the department will have your name and address removed so that you cannot be recognised from it. The researcher will not tell anyone that you have agreed to take part in the research project without your permission.
We know that without patients, there would be no research, and without research, there would be no advancement in clinical care. We believe in treating each of our patients with dignity and respect and by providing you with information, advice and support while you are in our care - before, during, and after your visit.We try our best to communicate this conviction to you by involving you in decisions relating to your care, and by equipping you with the means to make informed decisions. Providing you with quality information about your heart condition and how it can be treated is also very important to us.The Arrhythmia Alliance website provides phamlets on heart rhythm disease and treatment information.We also thought it might help to include patient testimonials from other people who have been through what you are going through. We hope that these testimonials can shed a little light, from a patient's perspective, on what it means to become one of our patients, and on what life is like after you come home.At the Cardiology Research Department, we know that patients are our most valuable asset and strongly believe in providing our patients with the option of an alternative to standard care. You might not receive the treatment you do now if it were not researched in the past. Through taking part in one of our research projects you may have the opportunity to improve not only your own life but to potentially help improve the lives of future generations.Please feel free to contact us. We are always happy to answer questions if we can so if you write to us we will endeavour to reply promptly. Sometimes it is not possible to give accurate advice this way and it is better to see you in an outpatient clinic. If you are not local to St Bartholomew's and The London Chest you can ask your GP to write to us asking us to see you.
My condition: what is it, what causes it, and what are the symptoms?The pamphlet technical terms explained will answer these questions.
My treatment: what are the risks, how long does it take, how does it feel, and how will I feel?The pamphlet tests for heart conditions will answer these questions.
What can I do to help make the wait easier?Finding out that you need heart surgery and coming to terms with what it entails can be daunting. Added to this, a lack of control over the length of time you have to wait for an operation can cause feelings of helplessness and is often at the root of anxieties during the wait. Everyone copes with the waiting period in their own way. Getting support from friends and family, and learning about what will happen in hospital can help reduce anxiety during this time. It's also important to keep as healthy as possible while you wait - you may find the following guidelines helpful.Learn to manage your condition. This can help you while you wait for your operation. Gradually introducing physical activity (with advice from your GP or the Cardiology Research team), taking time out to relax, and understanding more about your medication will help you to feel more in control of your condition.
What is a pacemaker?A pacemaker is an implanted device that monitors your heartbeat and prevents your heart from beating too slowly. It consists of a box ('generator') attached to one or two 'leads'. The generator is usually placed underneath the skin or muscle beneath your collarbone. The lead or leads pass inside the large veins of your chest from the generator to your heart. The leads transmit information about your heartbeat to the generator. If your heart beats too slowly the pacemaker sends out a tiny electrical impulse to 'pace' the heart, to make it beat at an appropriate speed. If your heart then speeds up again, this is detected by the pacemaker, which then stops pacing your heart. A pacemaker is usually implanted under local anaesthetic. It generally takes ½ to 1 hour, and is performed in a 'cardiac catheterisation laboratory'. All you have to do is lie on an x-ray table. Your heart rhythm, blood pressure and the oxygen level in your blood are monitored continuously. The doctor will put local anaesthetic under the skin below your collar bone. The anaesthetic stings for a few seconds as it gets to work but the area rapidly goes numb. You may also be given light sedation at this time so that you will be awake but relaxed and a little drowsy. An incision about 3-4 cms long is made below the collarbone. The next stage of the procedure is for the doctor to find a vein through which the leads are passed to the heart. This is not in any way uncomfortable although you may feel a few extra heart beats for a short period. Care is taken to find the ideal position for the lead or leads and you will hear numbers being called out, referring to measurements made through the leads. When the doctor is happy that the leads are in the best position, they are sewn in and a pocket is created to house the generator. This pocket may be overlying or underneath the pectoral muscle. Finally the incision is stitched up. For the skin stitch some doctors use a dissolvable suture while others prefer a suture that is taken out at your doctor's surgery after 7 days. You will be told which you had. You may need to stay in hospital overnight following the procedure. In almost every respect, life with a pacemaker is completely normal. Household appliances and mobile telephones do not interfere with your pacemaker's function. If you are concerned about interference from a particular piece of equipment at home or at work, ask your doctor or the cardiac physiologists in the pacemaker clinic.
What happens when the pacemaker battery runs down? The pacemaker battery behaves in a predictable fashion. By following you up regularly we can predict fairly accurately when the pacemaker generator will need replacing. The pacemaker will be functioning perfectly normally throughout this time and we will arrange for you to come into hospital to replace the generator in a planned fashion. Many factors determine how long a battery will last, and currently available generators typically last about 7-10 years under standard conditions. When the generator is replaced the procedure is similar to that of the original pacemaker implant although we aim to use the original leads and simply attach a new generator.
I had a heart attack, how soon can I return to work?Going back to work is often a major concern if you are recovering from a heart attack or an acute cardiac illness. Between 62 per cent and 92 per cent of people who worked before their heart attack are likely to return to work. You are likely to be fit for light work in about 4 to 6 weeks. If your job is more physically demanding, you may need about 12 weeks. If you have had a heart attack and are looking for a new job, your cardiologist may be able to give you a fitness report that you can use to reassure prospective employers of your ability to work.
I had an angioplasty, how soon can I return to work? You can return to light work as soon as you feel able to after having an angioplasty. If you do heavy work you may need to rest for at least a week and you might need to have an exercise ECG before returning to work.
I had valve or bypass surgery, how soon can I return to work?You should be able to go back to work about 8 to 12 weeks after valve or bypass surgery, although a lot will depend on the type of work you do and how well you recover. Your breast bone and muscle tissues need time to heal thoroughly. You should avoid activities that put strain on the breastbone and surrounding muscles.
Will I be able to do as much as before?You might be able to discuss ways of modifying your work to avoid the heaviest jobs with your employer. If your organisation has an occupational health service, talk to them about your heart attack and your return to work. They might be able to suggest ways of modifying your role while you recover to allow you to work in phases. Cardiac rehabilitation programmes have increased the number of people successfully returning to work. Many people find that full recovery from a heart attack makes them more conscientious in their work than before. But even if you have fully recovered, you might be at the age where early retirement is an option.
Does having a heart condition affect driving?Most people with heart conditions will be able to drive again, but you might be advised to avoid long journeys and heavy traffic. While your motor insurers will need to know if you develop a heart condition, theDVLA quidelines for heart patients are less strict than they used to be. The DVLA do not usually need to be notified unless you have had a pacemaker or an implantable cardioverter defibrillator (ICD) fitted. The DVLA guidelines for specific heart conditions are:
Am I able to travel by air?If you are able to walk 100 yards on flat ground, briskly, without chest pain or undue breathlessness, then you should be fit to travel by air. The Aviation Health Institute (AHI) advises that you can travel by air three weeks after a heart attack if you are back into your usual daily routine. After coronary artery bypass grafts and other chest surgery, the AHI recommends you wait at least two weeks. If you have had an angioplasty you will need to wait until you are stable and back into your usual daily routine. It is important to note that the AHI guidelines are a starting point only, and it may be much longer until you feel well enough to cope with having a holiday abroad.
What should I do before I travel?Any traveller who has recently had a heart attack, undergone heart surgery, or has angina may need to seek advice from their doctor before planning air travel. Some patients may need to contact the airline medical department before their journey. This will allow airline medical staff to assist with early boarding or a wheelchair if needed and to provide appropriate in-flight care. Patients may need to ask for a standard medical questionnaire called MEDIF when booking tickets at the airline office. This is completed by your doctor and returned to the airline so that any special provisions such as diet can be made for your journey. This list of travel insurance providers for individuals with medical conditions will be helpful when deciding upon the most appropriate insurer.
How do I travel with an ICD or a Pacemaker?Patients with implantable cardioverter defibrillators (ICD's) usually need to have a certificate of fitness to travel. You can get this from the ICD clinic. The metal in your pacemaker can trigger the alarm in some airport security systems, although this only happens rarely. If you have concerns about passing through airport security systems, it would be wise to discuss this with your pacemaker clinic before you travel. It is always best to carry your Data Card and explain you have a pacemaker fitted. If you show your card, you can bypass the system and security staff may carry out a manual body search. In some airports, staff may use a handheld scanner to do a manual search. The scanner may come close to your pacemaker but there are rarely problems with this. Generally, if you walk straight through the frame without lingering, there should be no effect on your pacemaker. To keep stress to a minimum, it is best to arrive early at the airport and to avoid handling heavy luggage
What about my medication?Make sure that you have sufficient medication to last your holiday. It may be best to keep a supply in your hand luggage and in your suitcase. It's also a good idea to take a list of all your drugs and doses with you. It is safe for angina patients to use GTN spray in a pressurised container during a flight.