GP Information

Referring my patient to Midland Cardio Vascular Services (MCVS)

Midland Cardio-Vascular Services Ltd  is a privately owned angiography and interventional suite. It is located within Braemar Hospital, Hamilton, New Zealand. We have been operating for 16 years for the wider Waikato area and extending to the whole of NZ.

We offer:

  • Interventional cardiac procedures. This includes stenting coronary arteries and all structural heart procedures. Read more
  • Our cardiac diagnostic arm includes 3 D ultrasound and all angiography. We have Transoesophageal Echo (TOE) and Transthoracic Echo (TTE) available.
  • Diagnostic peripheral and interventional procedures and PICC line insertion. Read more
  • All facets of procedural cardiac rhythm management including electrophysiology and ablation, pacemaker insertion and removal and cardioversion. Read more

Referral Pathway

Patients require a referral from their General Practitioner to a consultant Cardiologist/ Vascular Surgeon/ or Interventional Radiologist.

http://mapofmedicine.com/

The consultants who practice at MCVS are all experienced senior Physicians or Surgeons. All of our Consultants have international experience and many are leaders in their field.

Your patient may have specific heart rhythm, structural heart, heart failure or ischaemic heart disease issues that would be best suited to a referral to a Cardiologist with an interest in that specific area of cardiology. Go to the profiles and Bios

MCVS provides a full range of facilities and equipment within Braemar Hospital. This is designed to provide patients with the most appropriate level of care. This includes a Special Care Unit (ICU/HDU) .

If the patient requires an anaesthesiologist for their procedure this is organised by MCVS – see anaesthesiologist

MCVS accepts all patients – regardless of which insurance company they may belong to, or whether they have insurance cover or not.

Quotes are provided for all procedures.

Atrial Fibrillation

Clinical InformationStiles ResearchReview 2017 4 pillars AF

Martin Stiles

High Radiation Dose

With nearly all procedures that we perform here at MCVS we will use x-rays. fluoroscopy, digital angiography or ‘single shot’ x-ray. We adhere to the ALARA (as low as reasonably achievable) principle of radiation safety. (MOH CSP)

We always ask if a woman of childbearing age could be pregnant. A blood test may be required if they are not sure.

We monitor the radiation dose received for each procedure which is measured in ‘Grays’ (Gy).
If a patient receives a skin dose of greater than 2Gy we notify their GP.

We then assess whether the dose is spread over a large area or concentrated in one spot to indicate the likelihood of possible skin changes.

It is important to note that epidermal damage may take some time to show effect – see chart below.

 

               Effect        

      Threshold

           Dose

 

Time to onset

of effect

Early transient erythema 2Gy          hours
Main erythema 6Gy         ~10 days
Permanent epilation 7Gy        ~3 weeks
Dry desquamation 10Gy         ~4 weeks
Dermal atrophy 11Gy         >14 weeks
Telangiectasia 12Gy         >52 weeks
Moist desquamation 15Gy          ~4 weeks
Late erythema 15Gy          ~6-10 weeks
Dermal necrosis 18Gy          >10 weeks
Secondary ulceration 20Gy          >6 weeks

 

Contrast Reaction

We use iodine based x-ray contrast for angiograms. (Visipaque or Omnipaque)
Patients can get a ‘warm’ sensation with some contrast injections. This is quite normal and only lasts a few seconds.

As part of our patient consent process, we enquire about any allergies, especially to contrast.

A person can have a reaction to contrast as late as 7 days post administration. This is commonly a torso rash but could be facial oedema, skin peeling &/or difficulty in breathing.

Treatment: Any of these reactions are treated with 3 days of Loratidine 10mg and Predisone 40 mgs daily. Occasionally the Predisone needs to be extended to 5 days.

We recommend any person who has a reaction to contrast get a medic alert bracelet.

Please notify MCVS if you suspect a patient has had a late contrast allergy so we can put an alert on their NHI and notify their cardiologist.

Creatinine

Creatinine levels are checked prior to every procedure we do. Contrast is metabolised and excreted through the kidneys. It can cause significant renal impairment in high doses and diabetic patients are more susceptible to contrast induced nephropathy.

Diabetic patients

Metformin is stopped 24 hours pre procedure because the combination of metformin and contrast increases the risk of contrast induced nephropathy.

Insulin dependent patients are managed on a case by case basis and should contact us for advice.

Psuedoaneurysms

Patients having femoral artery punctures can occasionally develop a pseudoaneurysm.

Signs and symptoms: Increasing bulge in groin, a thrill or bruit is heard or felt, pain in groin. Bruising on its own is not generally an indication.

These require an ultrasound for definitive diagnosis and occasionally a fibrin injection.

Contact

If you have any queries, contact Kath Phillips, Manager.

Ph: 0275342382

Email: kath.phillips@mcvs.co.nz