• Adult Cardiologists and Cardiology

Adult Cardiac Specialties

At Health City we treat a wide range of adult cardiology conditions from atrial fibrillation and cardiac arrhythmias – to uncontrolled blood pressure. Fractional flow reserve (FFR) and other advanced technologies are used for assessment and diagnosis to prevent unnecessary interventions. In line with our commitment to compassionate, patient-centred care, we pride ourselves in being able to consistently achieve an arrival to treatment time of less than 60 minutes for heart attack patients.

Cardiac Electrophysiology (Arrhythmia Service)

Electrophysiology is the cardiac specialty that treats patients with cardiac arrhythmias (fast, slow, or irregular heartbeats). Our arrhythmia management service is the only one of its kind in the Caribbean, with a fully equipped, non-invasive arrhythmia management facility and specialised clinics. We focus on providing proper medical management to arrhythmia patients, rather than relying on invasive procedures. The medical technology we use includes the latest generation 2D and 3D mapping systems in our state-of-the-art Hybrid Cathlab and EP Navigator facility, enabling physicians to visualize cardiac anatomy in 3D.

Non-invasive electrophysiology is used to detect, track, and record irregular heartbeats in patients from the skin’s surface. When heart disease causes irregular heartbeats, they do not always occur when the patient is in the doctor’s office. For that reason, we offer several different ways of recording heart activity so the most accurate diagnosis and treatment plan can be devised. Our surgeons have performed thousands of procedures to effectively treat arrhythmias, which are individualized to meet the specific clinical needs of each patient.

Our physicians conduct safe and effective arrhythmia treatments and procedures including:

Interventional Electrophysiology
Finding and mapping arrhythmias: Using the latest generation 2D and 3D mapping systems, surgeons can pinpoint the heart tissue that cause complex arrhythmia patterns, allowing for accurate diagnosis and effective treatment.

Radiofrequency (RF) ablation: When medication is ineffective or cannot be tolerated by patients with arrhythmias, a nonsurgical procedure called RF ablation may be performed. Under light sedation, thin flexible wires are inserted into a vein in the groin and threaded up into the heart. The surgeon can use small incisions, radio waves, freezing, or microwave or ultrasound energy to create scar tissue. The scar tissue, which does not conduct electrical activity, blocks the abnormal electrical signals causing the arrhythmia. At Health City Cayman Islands, we perform ablation for the following:

  • Short circuit arrhythmias including PSVT and Wolff-Parkinson-White (WPW) syndrome.
  • Atrial fibrillation, an irregular and sometimes rapid heart rate that results in insufficient blood flow through the body.
  • Ischemic and normal heart ventricular tachycardia, which is a rapid heartbeat.

Epicardial mapping of ventricular tachycardia: This is a diagnostic tool that allows cardiologists to determine the source of irregular heartbeats within the heart muscle. During this procedure, ventricular tachycardia, or irregular electrical activity in the bottom chambers of the heart is mapped.

Pacemaker / defibrillator implants (ICD): Implantable cardiac defibrillators are usually implanted in patients with arrhythmias that have not responded to other treatments. They help regulate the heart rate of patients so they can safely pursue activities of daily living. Many types of devices are available at Health City Cayman Islands.

Cardiac resynchronisation therapy (CRT): This involves the implant of a small pacemaker which monitors a patient’s heart rate. Tiny pulses of electricity correct irregularities when detected. As a result, the CRT resynchronizes the heart rate to a healthy state.

Implantable loop recorder (ILR) in patients with syncope: This recorder is implanted just under the skin to detect heart rate. The doctor sets the normal heart rate ranges and when the ILR detects a rate higher or lower than that, or when the patient activates the device, it records the irregular rate and stores it. The electrophysiologist can view the results during an office visit using an external reader.

Cardioversion of persistent atrial fibrillation: Electrical cardioversion is a procedure in which a precise, controlled, clinically formulated electric current is applied externally to reset the heart’s rhythm back to its regular pattern. Patients receive medication for relaxation during the procedure.

Extraction of pacemaker and defibrillator leads: Health City Cayman Islands is one of very few Caribbean clinical facilities offering this procedure because it requires high levels of surgical expertise and experience. Pacemaker and defibrillators work through implanted wires called leads. If they are not working properly or infection occurs, a surgeon removes one or more leads from inside the heart.

Coming Soon: Cryo Ablation for Atrial Fibrillation 

Non-Invasive Electrophysiology

Digital holter monitoring: This is a battery-operated portable device that measures and records heart activity continuously for 24 to 48 hours or longer. It is the size of a small camera with electrodes that attach to your skin. As you go about your daily activities, the monitor records your heart activity.

Event recorder: A cardiac event recorder creates a record of your heart called an electrocardiogram (EKG or ECG). An EKG is a simple, initial test that measures the heart’s electrical efficiency by creating wave patterns. An electrical impulse or wave causes the muscle to squeeze and pump blood from the heart. A normal heartbeat on EKG will show the timing of the top and lower chambers. The test can determine if the electrical activity is normal or slow, fast or irregular. Secondarily, measuring the amount of electrical activity passing through the heart muscle can help determine if parts of the heart are enlarged or working too hard.

Tilt table testing: If a patient complains of frequent fainting or lightheaded spells, a tilt table may be used to diagnose the cause. This test is conducted to measure blood pressure and heart rate. The patient lies on a table that is slowly tilted upward so that the head is elevated 60 to 80 degrees above the rest of the body. A nurse or technician keeps track of blood pressure and heart rate (pulse) to see how they change during the test and respond to the force of gravity.

The following clinics and studies provide treatment and monitoring for patients with implant devices, syncope studies, congestive heart failure, and atrial fibrillation.

Specialized Electrophysiology Clinics
Device optimisation clinic: Our cardiology team, comprised of cardiologists and specialty cardiology nurses evaluate and manage patients before and after the implantation devices including pacemakers, defibrillator systems, implantable loop recorders, and CRTs. We ensure that the patient is prepared for implantation, the device is working as intended clinically, and that it meets the needs of the patient.

Syncope clinic: This clinic is devoted to the evaluation of patients who frequently faint or pass out. This is a one-stop comprehensive diagnostic and management service.

Heart failure clinic: Congestive heart failure is a term used when the pumping action of the heart becomes increasingly less powerful and effective. Typically, heart failure is the end stage of a number of heart conditions and diseases. These complex conditions require careful diagnosis and treatments individualized to each patient. At this clinic, cardiac specialists, including physicians and nurses, care for patients using medical and interventional modalities previously discussed. This clinic helps reduce hospitalisations and leads to improved quality of life for patients who have been treated here.

Atrial fibrillation clinic: Atrial fibrillation is the most common irregular arrhythmia. It originates from the upper right and left chambers (atria) of the heart that leads to the lower chambers (ventricles). If left untreated, atrial fibrillation can result in stroke or heart attack. This clinic is dedicated to the treatment, management, and follow-up care of patients with atrial fibrillation.

Cayman Islands Atrial Fibrillation In The Elderly (Cafe) 
Health City Cayman Islands is leading a stroke prevention study in the Cayman Islands, the first of its kind in the Caribbean. The study aims to check for the presence of atrial fibrillation in adults age 65 years and older, using pulse palpation technique and recording an EKG/ECG using an iPhone. For more information on the CAFE Study, click here.

Interventional Cardiology

Our renowned physicians perform minimally invasive cardiac procedures that previously would have required heart surgery. Our state-of-the-art Hybrid Cath Lab enables us to deliver interventional cardiology services that reduce pain and improve recovery. Nearly all (98 percent) of our catheterization procedures use the more advanced radial access technique because it has been proven to be clinically superior to femoral artery access. The vast majority of our patients experience no complications and positive outcomes.

We offer interventional procedures for the following common conditions:

Coronary Artery Disease
Coronary artery disease (CAD) is the most common type of heart disease, resulting from the buildup of cholesterol and other material called plaque, on the arteries’ inner walls. The narrowing of the coronary arteries limits blood flow to parts of the heart. CAD is the number one cause of death for both men and women in many countries, including the U.S. We treat the underlying causes of CAD with the latest clinically proven techniques and advanced protocols including the following:

TREATMENTS AND PROCEDURES OFFERED:

Radial access coronary angiography: When performing any catheterization procedure, our interventional cardiologists consider vascular access options. In this procedure, the radial artery (the main artery in the forearm) is used rather than the femoral artery in the leg. This option is used based on the level of heart disease in the patient, other illnesses that may affect recovery and / or the personal preferences of the patient. This type of catheterization improves patient comfort and recovery and has fewer complications, which can result in shorter hospital stays and reduced costs. In fact, recent studies have shown that this approach significantly reduces vascular complications for women, who have a higher rate of complications than men.

Primary angioplasty in acute myocardial infarction: Myocardial infarction, (MI) is the clinical term for a heart attack. When heart attack patients arrive at our door, we assess and initiate treatment in less than one hour. When using this procedure, a slim balloon tipped tube is threaded through the groin into the artery of the heart. The balloon is inflated, compressing the blockage and widening the artery so blood can once again flow through the heart.

Elective angioplasty with DES, BMS or Absorb stents: This type of angioplasty (a procedure to open narrowed or blocked blood vessels) is conducted in non-emergency situations. It opens arteries and can be used to implant stents.

Fractional flow reserve (FFR) technology: This innovative, minimally invasive technology helps prevent unneeded interventions, allowing interventional cardiologists to assess the level of blood flow through the arteries and view any plaque buildup that may be clogging the arteries.

Intravascular ultrasound (IVUS): This is a catheter-based system that enables physicians to acquire images of diseased vessels from inside the artery. This technology delivers important clinical data that angiography cannot. IVUS yields detailed and accurate measurements of lumen and vessel size, plaque area and volume, and the location of key anatomical landmarks.

Optical coherence tomography (OCT): This is an imaging technology that provides physicians with high-resolution details of the heart. It allows physicians to detect heart vessel size, plaque, stent expansion, and dissection of the heart muscle.

Valvular Heart Disease
Valvular heart disease occurs when one of the heart’s four valves (mitral, aortic, tricuspid or pulmonary) is not working properly. Two primary valvular conditions can lead to damage. Valvular stenosis is when there is narrowing, stiffening, thickening, fusion, or blockage to one or more valves of your heart. Valvular insufficiency is when abnormal closure of a heart valve causes blood to leak backward across the valve – which is where the lay term “leaky valve” derives. We treat the valvular heart disease with the latest clinically proven techniques and advanced protocols including the following:

TREATMENTS AND PROCEDURES OFFERED:

Valvuloplasties (mitral and aortic): If a stent in the heart valve becomes stiff, this procedure will open it so that it can resume normal functioning. A large balloon at the tip of the catheter is inflated until the flaps of the valve are opened. Then the balloon is deflated and the catheter is removed.

Transcatheter aortic valve implantation (TAVI): This is a new, minimally invasive approach for aortic stenosis in which diseased aortic valves are replaced with artificial valves. This procedure is used for people who have very advanced aortic stenosis (narrowing of the aorta) that leaves no other options. In the past, this required open heart surgery which carried significant risks for severely ill and/or older adults. During TAVI, high-resolution x-ray imaging is used to help guide the catheter through an artery to the exact spot in the heart’s aorta where the new valve will be placed.

Peripheral Artery Disease
Peripheral artery disease (PAD), also called peripheral arterial disease, is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. The goal of treatment is to restore the natural flow of blood through the arteries using several different procedures, based on the individual case.

TREATMENTS AND PROCEDURES OFFERED:

Angioplasty: This is a medical procedure that opens narrowed or blocked blood vessels in the arteries of the heart. In balloon angioplasty, a medical balloon is inserted into the blocked artery. As the balloon is carefully inflated, it presses against the side of the artery to open the narrow space to improve the flow of blood. A stent is inserted into the artery to keep it open and working efficiently.

Peripheral stents: When a peripheral artery is narrowed or blocked, it is opened and then a stent (mesh-like metal cylinder) is inserted to structurally support the opening permanently.

Renal stents: Renal stents are one form of treatment that can help patients with renal artery disease that have poor blood flow. While lifestyle changes, stress reduction and smoking cessation help to improve renal artery disease, medications and surgery may be required. Stents are inserted into the renal artery to keep it open and improve blood flow.

Resistant Hypertension
Resistant hypertension is uncontrolled high blood pressure, which contributes to heart, kidney, and blood vessel damage. It is a risk factor for heart attacks, diabetes, kidney failure, and stroke. It can result from the kidneys producing too many of the hormones that signal the body to raise blood pressure. In the past, invasive surgical procedures were effective, but also carried potential risk and complications. Our interventional cardiologists use minimally invasive procedures whenever possible if clinically indicated as the most effective treatment for the patient.

TREATMENTS AND PROCEDURES OFFERED:

Renal Denervation Therapy: This is one of the newest treatments for resistant hypertension. It treats the hyperactive nerves in the kidneys that send the body erroneous messages to continually raise blood pressure. Once the nerves are calmed down through denervation, patients can experience a significant reduction in blood pressure levels. This minimally invasive technique is also safer for patients, because as it does not require general anaesthesia and results in a short recovery time.

Aortic Disease
Aortic disease includes any condition that affects the aorta of the heart. The aorta is the main artery of the body and supplies blood to the entire circulatory system and all of the body’s organs, making this an especially critical area of cardiology. Our interventional cardiologists have a documented record of successful patient outcomes treating aortic disease, as well as high clinical quality rankings from international rating authorities.

TREATMENTS AND PROCEDURES OFFERED:

Aortic stent grafts for aneurysms and dissection: An aortic aneurysm occurs when there is an unusual bulging or enlargement of the aorta. That area of the aortic wall becomes weaker as it is stretched by the bulge, and the bigger it gets, the more likely it will burst. The chances of surviving an aneurysm is around 50%. Aortic stent grafts are inserted into the aorta to reline the inside of the aorta. This removes pressure from the aneurysm so it won’t burst.

An aortic dissection occurs when the aorta tears, sending blood into the aortic wall, which then causes layers of the aorta to separate. This substantially decreases the strength of the aorta and may cause it to rupture. This restricts blood flow to the major organs which then can cause heart attacks, stroke, renal failure, and other problems including death. An aortic stent graft is used to push the layers of the aorta back together to prevent it from rupturing.

Hybrid surgical procedures for aortic aneurysms: High risk patients who have multiple medical conditions, (called co-morbidities) or who previously have had aortic surgery, may need hybrid procedures for effective treatment. These procedures are offered as alternatives to standard cardiovascular and thoracic surgeries and are performed by only the most highly skilled physicians. Our interventional cardiologists are trained and experienced in hybrid procedures and when clinically indicated, will discuss them with the patient.

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