Pathologies and treatment

THE MEDICAL AND SURGICAL CARDIOLOGY DEPARTMENT

Croix urgences  Useful cardiology numbers

This site is addressed to individuals, whether or not they suffer from heart disease, and also to medical students, general practitioners, specialists and cardiologists, in view of providing useful information on cardiovascular pathologies, their treatment, and the activities of the cardiology department of the university hospital center of Poitiers.

The medical and surgical cardiology department of the Poitiers CHU optimizes its qualities on behalf of your at times worrisomely palpitating organ: proactive organization built around coping with emergencies; a highly complete technical platform; physicians, surgeons and intensive care specialists who work as a cohesive team; timely offers of tangible solutions based on preventive thinking and therapeutic education.

Our objective is to provide excellent care of cardiac and vascular pathologies while privileging teaching and research.

Definition:  Cardiology is the medical specialty that deals with the heart and the blood vessels, particularly their diseased states.  Cardiac surgery: Cardiac or heart surgery is the surgical specialty dealing with diseases of the heart and the large blood vessels. Thoracic surgery: Thoracic surgery is the surgical specialty dealing with diseases of the lung and thorax. 

THE TREATMENT OF PATIENTS IN CARDIOLOGY

The medical and surgical cardiology department treats all the acute and chronic cardiovascular pathologies: myocardial infarction and all clinical forms of coronary disease, acute and chronic heart failure, cardiac rhythm and conduction disorders, valvular heart disease, treatable thoracic pain, thromboembolic disorders such as phlebitis and pulmonary embolism, arterial hypertension, pulmonary hypertension, controllable vascular risk factors. We also provide athletes with cardiologic check-ups and, more generally, we propose a wide variety of examinations, particularly as regards congenital pathologies of the child and the adult.

To carry out its tasks, the medical and surgical cardiology department has 106 beds spread out in 4 hospitalization units, including a cardiothroacic surgery unit, a cardiologic consultation and exploration unit, a cardiac intervention unit, an electrophysiology and cardiac stimulation unit, a cardiovascular disease prevention center and a town-hospital network for home treatment of persons suffering from chronic heart failure  (Radic).

The department is one of the few in France to have brought together, in the same entity, medical and surgical treatment.


Providing patients with a warm welcome

cardio

Proper admission of a patient consists not only in answering his need for information, but also in providing him with the many forms of attention that, taken as a whole, can help to allay his anxieties. For more than five years, all the ingredients of a warm welcome have been embedded in the protocol applied in the heart and lung center. There now exists a comprehensive introductory booklet presenting the center and its activities.

In English, please!
Given the increasing number of English patients and the corresponding need for an effective therapeutic approach during an interview, the medical and surgical cardiology department is planning to dedicate a monthly consultation to these patients.

P25-26 CHUMAG65

A CARDIO-GERIATRIC UNIT HAS OPENED 

CHU-magazine n°65 – Dec. 2012

 

EMERGENCIES AT THE CENTER

As soon as the patient is admitted, intensive cardiological care, operation theaters, medical or surgical “reanimation” (resuscitation/intensive care), interventional cardiology, interventional rhythmology and the technical exploration platform are all close at hand. The men and material are ready for every emergency and determined to gain time, when time is of the essence.

As the only center in the Vienne department authorized to practice interventional cardiology, 24 hours a day the department treats infarction by angioplasty, management of the most severe rhythm disturbances, and responses to all other cardiac emergencies.

Organization

cardioProximity allows immediate confrontation, at any time, of the opinions voiced by the different specialists:

  • specialized cardiologists,
  • cardiac surgeons,
  • intensive care anesthetists … present 24h/24, 7 days/7.

A coordinating nurse ensures the relay between the cardiology department and doctors exterior to the CHU, who consequently always have the same interlocutor and a direct phone line to the department, whatever their request: advice, hospitalization, consultation…

CARDIAC SURGERY AND THORACIC SURGERY

cardioThree surgeons practice in the cardiology department, the only center in the region to perform heart surgery; the department is consequently the regional “recourse” or referral center. Its surgeons perform more than 500 heart operations a year, more than half of which (55%) are coronary bypass operations, while 40% are for valve repair and replacement.

While the cardiac surgery unit of Poitiers does not carry out heart transplantation, its surgeons are tasked with implanting external and artificial ventricles in patients having had an infarctus or urgently requiring oxygenation or higher blood pressure. Artificial cardiac assistance can “buy” time for both the patient and the doctor.

Over recent years, the department’s cardiac surgeons have developed several techniques contributing to care quality and patient comfort. For ten years, in view of minimizing operative risks, some surgeries have been conducted on a beating heart. Practitioners can install aortic valvular prostheses by making 8-centimeter incisions in the thorax.

The Poitiers team also carries out triple bypass from two internal mammary arteries. They strongly prefer mitral valve repair to its replacement with a prosthesis. In point of fact, biological prostheses only have a limited life span, and installation of a mechanical prosthesis requires anticoagulants during the entire life span. Valve repair is consequently preferable in terms of everyday comfort and reduced risk of complications. However, when insertion of a biological valve is necessary, it will be surely one day be done – this is in the study phase – by minimally invasive surgery; the valves would enter in a folded position via the femoral artery or the apex of the heart and unfold at the desired location.

If necessary, a surgeon can treat cardiac rhythm disorders by applying radio-frequency clamps around the heart. This is a supplementary illustration of one of the original aspects if the CHU Poitiers cardiology department: the grouping together of medical and surgical treatment and the close proximity of all relevant specialties are highly conducive to synergy and optimized action.

To sum up, the quality of the treatment provided by the medical and surgical cardiology department of the Poitiers CHU is based on genuinely multidisciplinary discussions revolving around a platform of technically sophisticated equipment — and it is thanks to the humanism characterizing its teams that the center continually improves the way it receives is patients.

DIAGNOSTIC AND INTERVENTIONAL ELECTROPHYSIOLOGY AND CARDIAC PACING

In the cardiology department, rhythmology is carried out by three practitioners. In two exploration rooms, the unit’s diagnostic and therapeutic tests are performed.

Rhythmology facilitates diagnosis and treatment of cardiac rhythm disorders, particularly in prevention of sudden cardiac death caused by abnormal heart rhythms.

There are two main activities:

  • treatment of rhythm disorders including flutters, Wolff Parkinson syndrome, ventricular tachycardia and atrial fibrillation;
  • implantation of pacemakers and implantable automatic defibrillators. Practitioners implant not only pacemakers, but also “multi-site” defibrillators that facilitate resynchronization of myocardial walls in treatment of certain types of heart failure.

The department contributes to the development of innovatory technologies, and serves as a reference center in this field.

THE LABORATORY OF HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY

As the only authorized interventional cardiology center in the Vienne department, the laboratory is composed of two recently installed cardiac catheterization rooms.

This department treats acute coronary syndromes,  24h/24, 7 days /7.

The procedures performed in this unit include:

  • diagnostic hemodynamic explorations;
  • coronarography and interventional cardiology (coronary angioplasty: endocoronary prostheses, Rotablator, new intra-coronary imaging technologies: OCT, FFR…),
  • aortic valve replacement by percutaneous route (TAVI),
  • septal alcoholization,
  • left atrial appendage closure.

This section is particularly invested in the new interventional treatment modalities applied during the acute phase of myocardial infarction and in acute coronary syndromes.

EXTERNAL CONSULTATIONS AND CARDIOLOGICAL EXPLORATIONS

The department provides consultations in:

  • general cardiology;
  • pediatric cardiology and congenital cardiopathies;
  • monitoring of pacemakers and cardiac defibrillators.

It also contains a technical platform dedicated to thoroughgoing cardiac exploration.

THE HEART FAILURE HOME ASSISTANCE NETWORK (RADIC)

Understanding one’s illness and living longer 

In France, from 600,000 to a million persons have a heart that can no longer correctly carry out its tasks as a pump and can no longer ensure the flow of blood essential to the normal functioning of bodily organs; this condition is known as heart failure.

This disease presents distinctly high morbidity and mortality levels and occasions, on the average, one or two hospitalizations a year. However, American and Scandinavian studies have shown that when patients are properly informed and monitored, morbidity can be reduced by 30 to 50%.

In fact, in 2004 one of the first French cells in therapeutic education was created in the CHU of Poitiers: the heart failure assistance network, the Radic. It is aimed at improving the quality of life of heart failure patients by providing them with therapeutic education adapted to their pathology, their life habits and their environment. The Radic also organizes treatment by optimizing health care connections between the hospital and the private sector.

To date, more than 1000 persons have been monitored by the network. After establishment of a synthesis of the patient’s knowledge on heart failure, treatment, diet and physical activity, the educational program is meant to help the patient to adapt his behavior according to his disease and thereby reduce potential complications.

Access to the Radic site (in French).