cardiology.
Hourglass Wellbeing offers expert, Consultant-led Cardiology consultation and investigation services. Our Cardiology services are led by Dr. Benedict Wiles and Dr. Hassan Abbas.
Clinical Cardiology is a vast specialty which encompasses disorders of the heart as a pump (e.g. heart failure), the coronary arteries (e.g. angina and myocardial infarction), the heart’s conduction system (e.g. heart block), rhythm disorders (e.g. atrial fibrillation, atrial flutter, SVT, ectopic beats, ventricular tachycardia) as well as rarer conditions such as those that can be inherited, occur around the time of pregnancy or associated with congenital anomalies.
A variety of investigations can be performed, if recommended by a Cardiologist, to test for and to monitor Cardiac Conditions. The clinic offers BSE accredited Cardiac Echocardiography (heart ultrasound), Holter (heart rhythm monitoring, for 24hrs or 1 week), Electrocardiography (ECG), blood pressure checks and blood investigations (testing of Cardiovascular Risk Factors, including diabetes, thyroid disease and lipid profiles). We also offer Implantable Loop Recorders (ILRs or ‘Reveal’ implants). Patients may be referred for more complex tests or invasive treatments, if these are indicated (either via the NHS or the Private Sector).
As a team we have combined expertise in General Cardiology, Cardiac Failure, Cardiac Devices (pacemakers, defibrillators/ICD, subcutaneous ICD/S-ICD, Cardiac Resynchronisation Therapy/CRT, leadless pacemakers/Micra), Cardiac Electrophysiology and Cardiac Ablation.
MEET YOUR SPECIALIST
Dr. Benedict Wiles
PhD, MA, MBBS, FRCP
Consultant Cardiologist and Electrophysiologist
Dr. Wiles is an expert in managing patients with Heart Rhythm Disorders. He offers his services at Hourglass Wellbeing, alongside his role as Consultant Cardiologist in the NHS. He is trained in cardiac catheter ablation, an invasive treatment option for patients with atrial fibrillation, atrial flutter, SVT, ectopics and ventricular tachycardia. He is also accredited in Cardiac Devices - implanting loop recorders, pacemakers and defibrillators. Dr. Wiles is the only implanter of leadless pacemakers and subcutaneous ICDs in the North of Scotland.
common conditions
Cardiac conditions can manifest as a variety of symptoms. Common symptoms and potential conditions include:
Breathlessness - this may be a result of cardiomyopathy (heart muscle disorders e.g. due to hypertension, coronary disease, valvular disease, arrhythmia or alcohol), arrhythmias (conduction and rhythm disorders that make the heart beat too fast or too slow), less commonly due to coronary artery disease (a variant of angina, which traditionally presents with chest pain). However, breathlessness may also be due to non-cardiac conditions, obesity and deconditioning/lack of fitness.
Palpitations - a variety of heart rhythm disorders (arrhythmias) can cause palpitations. Common arrhythmias include atrial fibrillation, atrial flutter and supraventricular tachycardia (SVT). Ventricular arrhythmias such as Ventricular Tachycardia represent a potentially more sinister cause of palpitations. Some arrhythmias are due to having an abnormal heart (structural heart disease) while others can occur in seemingly normal hearts. Ectopic beats (extra heart beats) can also manifest as palpitations. It is not uncommon that palpitations are perceived, without any underlying heart rhythm disorder. Palpitations may feature in Postural Orthostatic Tachycardia Syndrome or ‘POTS’, a non-cardiac disorder of abnormal autonomic neurological regulation of heart rate.
Chest pain - in those with risk factors for coronary artery disease (family history, raised lipids/cholesterol, smokers, thyroid disease, diabetes), exertional chest pain is a common manifestation. This is termed ‘angina’ and is due to narrowing in the coronary arteries. Chest pain may also be a manifestation of cardiomyopathy (heart muscle disorder), inflammation of the sac around the heart (Pericarditis) or may be entirely non-cardiac (e.g. musculoskeletal pain).
Dizziness, light-headedness and syncope (fainting) - common cardiac causes include conduction disorders (e.g. atrioventricular block or ‘heart block’), rapidly conducted arrhythmias (atrial or ventricular; with or without involvement of an Accessory Pathway or ‘Wolff-Parkinson-White' Syndrome’) and valvular disorders (e.g. aortic stenosis). Non-cardiac causes include disorders of blood pressure regulation, anaemia and medication side effects (to name but a few). These symptoms may also feature in Postural Orthostatic Tachycardia Syndrome or ‘POTS’, a non-cardiac disorder of abnormal autonomic neurological regulation of heart rate.
Cardiovascular investigations
Your Cardiologist may recommend a variety of tests to investigate your symptoms or monitor your recognised condition.
Electrocardiography (ECG) - this test is performed at the clinic and forms a standard part of all initial consultations with your Cardiologist. An ECG can also be requested as a stand-alone test if you require one. An ECG is a harmless, quick test that studies the electrical activity of the heart through electrodes applied to the skin overlying the chest. It can shed light on cardiac anatomy (e.g. atrial and ventricular chamber size), any major risk of heart muscle disorder, conduction abnormality or coronary artery disease (indirectly).
Echocardiography (Cardiac Ultrasound) - Our British Society of Echocardiography accredited Sonographer can obtain a detailed ultrasound scan of your heart at the clinic. This generates pictures and videos of your heart, using ultrasound technology. An Echocardiogram facilitates the diagnosis of a variety of heart muscle disorders, valvular disorders, may clarify the risk of arrhythmias, assess Heart Failure (at baseline and following a trial of medications) and heart function following a heart attack. The dimensions of the heart can be obtained, muscular thickness, measurements of valvular leaks and narrowings, as well as assess the pressures inside the heart and lungs (indirectly using Doppler).
Holter Monitoring - a monitor can be applied to the chest to assess symptoms of palpitations, dizziness or fainting (syncope). This device is easily attached using a skin adhesive and can obtain heart rhythm recordings for 24hrs or an entire week, to clarify a suspected rhythm abnormality. Holter monitors are small and portable, allowing you to gather data representative of your usual daily activity.
Implantable Loop Recorders (ILRs or Reveal Monitors) - for very infrequent symptoms of palpitations or fainting (syncope), particularly where Holter monitors have not captured the arrhythmia and there remains strong suspicion for one, a very small device can be injected under the skin under local anaesthetic. This ‘ILR’ can record heart rhythm data for up to 3 years. ILRs have been shown to capture arrhythmias extremely well, and can be instrumental in obtaining clarity as to whether more complex interventions are required, such as implantation of a pacemaker or a defibrillator (ICD). Likewise, they are invaluable for informing on the risk of resuming driving and/or returning to work.
Cardiovascular interventions
Your Cardiologist may recommend certain interventions once your diagnosis has been clarified. Most cardiac conditions are managed with tablet therapy, but where symptoms persist despite this, or risk is deemed high without intervention, you may be referred for a variety of invasive procedures.
Coronary Angiography - this is not performed at the clinic, but your Cardiologist may refer you to another Cardiologist for this test, either via the NHS or Private Sector. A coronary angiogram is either a CT (non-invasive) or invasive study of the coronary arteries. The invasive form is usually conducted under local anaesthetic via an arterial puncture in the wrist or at the top of the leg (femoral artery, in the groin). This test is for the investigation and management of angina (chest pain due to coronary artery narrowing).
Electrophysiological Study - this is not performed at the clinic, but your Cardiologist may organise for this procedure either via the NHS or Private Sector. This is an invasive, electrical study of the heart to investigate palpitations, or known arrhythmias. It can aid in the diagnosis of Supraventricular Tachycardia (SVT), atrial tachycardias, atrial flutter and ventricular tachycardia. It can also rule out abnormal connections in the heart’s electrics (called Accessory Pathways).
Ablation - This is not performed at the clinic, but your Cardiologist may organise for this procedure either via the NHS or Private Sector. This invasive procedure often follows confirmation of an arrhythmia (either on ECG, Holter, ILR or via Electrophysiological Study). An electrical current is applied to the heart, via catheters introduced at the top of the leg (groin veins) to create a controlled ‘burn’ that can treat a variety of rhythm disorders. This procedure can be used to treat atrial fibrillation, atrial flutter, atrial tachycardia, ventricular tachycardia and Accessory Pathways. Cryoablation is a similar procedure, but this utilises cold energy (a balloon filled with liquid Helium), mainly to treat atrial fibrillation.
Device Implant (Pacemaker, Defibrillator/ICD, Cardiac Resynchronisation Therapy/CRT, Subcutaneous ICD/S-ICD, Leadless Pacemaker/Micra) - Depending on the diagnosed rhythm disorder, a device implant may be recommended. Cardiac device implants usually involve the implantation of ‘leads’ (or wires) that either go into the heart, or are placed under the skin overlying the chest wall. Newer technologies involve systems without any wires. Certain advanced types of pacemakers, such as CRT, are beneficial in the treatment of heart failure. Traditional pacemakers otherwise prevent the heart from dangerously slow rhythms, and defibrillators usually treat dangerously rapid ones.
Rarer conditions
Rare heart muscle disorders - these are cardiomyopathies that are not related to high blood pressure, coronary artery disease or valvular heart disease. Examples include Dilated and Hypertrophic cardiomyopathy, infiltrative disorders (Sarcoidosis, Amyloidosis, Iron overload syndromes), Chemotherapy-induced cardiomyopathy, Arrhythmogenic Cardiomyopathy, rare genetic/inherited disorders and pregnancy-related cardiomyopathy.
Rare causes of arrhythmias - these may include abnormal connections within the heart’s conduction system, those associated with congenital heart disease (particularly in those that have had surgical intervention). They can be a manifestation of rare conditions such as Brugada Syndrome, Arrhythmogenic Cardiomyopathy, Long QT Syndrome and Catecholaminergic Polymorphic VT.
Rare causes of chest pain - on rare occasions can be due to congenital anomalies of the coronary arteries. Classic symptoms of angina can also occur in patients with seemingly normal coronary arteries, due to alternative mechanisms than the simple narrowing of the main coronary vessels (e.g. coronary artery spasm and ‘microvascular angina’).