Cardiology and sleep conditions

The aortic valve can degenerate and become hardened and narrowed (akin to a rusting hose nozzle that will no longer loosen or open) or sometimes is can become very leaky or both.

The aortic valve is the main outflow valve from the left sided pumping chamber of the heart (the left ventricle). The left ventricle pumps blood to the brain and the rest of the body (including the kidneys, liver, arms and legs) through the aortic valve. The aortic valve is a normally a thin, flexible structure with three leaflets that opens to let blood through and closes to stop blood coming back (acting as a one-way valve).

When the aortic valve narrows this is termed ‘aortic stenosis’ (see Figure 1 below) and when it leaks it is called ‘aortic regurgitation’ or ‘aortic incompetence’. This can occur for many reasons:

• Part of the ageing process
• Related to genetic / inherited factors
• Abnormalities from birth (such as a ‘bicuspid valve’) that are associated with premature wearing out of the valve
• Traditional cardiovascular risk factors such as diabetes, high blood pressure, high cholesterol and tobacco smoking
• Infections include Rheumatic fever
• Previous radiation therapy to the chest
• Degeneration of previously placed surgical aortic valve replacement

Treatment of aortic valve disease has several potential management options. Once aortic valve disease is advanced (and this assessment is made by your treating doctors, including your general practitioner, your cardiologist in addition to other treating specialists) the outlook can be poor without an intervention such as TAVR / TAVI or surgical aortic valve replacement (SAVR).

However, and importantly, for less advanced disease the most appropriate treatment is often ongoing medication treatment and close observation by your care team. Also of special note, the assessment and exploration potential management options are performed by your treating doctors.

One potential management option for the treatment of aortic valve disease for patients who at elevated risk of complications because of co-existent health conditions and or advanced age is transcatheter aortic valve replacement / implantation (TAVR / TAVI).

Figure 1: Aortic stenosis (narrowing of aortic valve akin to a narrowing hose nozzle)

Atrial fibrillation, or AF, is a common type of arrhythmia which causes the heart to beat irregularly and often fast.

Atrial fibrillation is where the normal electrical trigger for the heart beat becomes disrupted in the heart's top chambers, the atria. The regular pumping action is replaced by rapid, erratic electrical signals that result in a quivering motion in the atria.

The risk of developing AF increases as you age. You may hear AF being described as paroxysmal, meaning you switch in and out of AF or permanent, meaning your heart is continuously beating in an irregular fashion.

The quivering motion of the lower chambers of the heart reduces the efficiency of the hearts pumping function. The increased heart rate experienced by patients in AF can lead to symptoms which affect their quality of life.

Symptoms of AF can include:

• palpitations (a fluttering or thumping feeling in the chest or throat)
• shortness of breath
• lightheadedness or fainting
• chest pain or heaviness, fatigue
• feelings of irritability
• anxiety or general unwellness
• reduced exercise capacity or endurance

Not all people with AF experience noticeable symptoms, and there is tremendous variety in symptoms from person to person.

Episodes of atrial fibrillation may come and go, or you may develop AF that doesn’t go away. When properly treated, AF itself usually is not usually life-threatening. It is however a serious medical condition that sometimes requires prompt treatment.

While the exact cause of AF isn’t always known, there are a number of risk factors that can increase your risk of developing the disease including:

• Age (increased risk as you get older)
• Underlying heart problems
• High blood pressure
• Other medical conditions (such as thyroid problems, diabetes and sleep apnoea)
• Surgery (some surgeries can cause AF)
• Excessive alcohol consumption
• Obesity
• Family History

A small number of people may go through life with AF and have little or no health problems from the condition. However, the inefficient pumping action caused by AF may lead to weakness of the heart muscle resulting in heart failure, or it may worsen any existing heart problems.

One of the greatest health risks from AF is an increased risk of stroke1.

• People with a current or past diagnosis of AF have around five times the risk of having a stroke as a person without AF
• AF leads to an increased risk of a blood clot forming in the top chambers of the heart (in particular, the left atrial appendage) which can dislodge and travel to the brain, causing stroke

For people with AF, the risk of blood clots and stroke is not necessarily reduced when the heart is in normal rhythm.

How well AF responds to treatment depends on the type of AF, which is characterised by the duration of the arrhythmia and individual episodes.

Lifestyle modifications – your GP and cardiologist will work together to support you to make the necessary lifestyle changes required to reduce their impact on your atrial fibrillation.

Rate/rhythm control – reduce symptoms and risk of heart muscle damage that can lead to heart failure. Your cardiologist will first discuss drug treatment. If drug treatment is unsuccessful at managing how fast your heart is beating and you continue to experience symptoms your cardiologist may discuss a minimally invasive option of catheter ablation with you.

Stroke prevention – ischemic strokes caused by AF can lead to significant disability or death. To reduce this risk you will often be prescribed lifelong oral anticoagulation. The choice of anticoagulation will depend on your age and other conditions you have. If you have or develop a contra-indication to these treatments you may be offered an alternative procedure to reduce your risk of stroke.

To diagnose AF, your doctor will review your symptoms, conduct a physical examination and run some tests. You may then be referred on to a cardiologist for further testing.

One of more of the following tests may be conducted to diagnose AF:

• Holter monitor – to record your hearts activity over a 24 hour period
• Echocardiogram – to see how your heart chambers and valves are pumping blood through your heart.
• Electrocardiogram – to measure your hearts electrical signals
• Stress echo or stress ECG – to see how your heart performs during exercise

If none of these tests return a clear result and you are still experiencing symptoms, you may have loop recorder implanted.  This will continually record the electrical activities of your heart, and detect abnormal heart rhythms.  It is a small device implanted using a small incision under your skin around the chest area.

If you are concerned about your heart health, talk to your GP about a healthy heart check.

Coronary artery disease is the most common form of heart disease diagnosed in Australia.

Coronary artery disease (CAD) is a disease that develops when the major blood vessels that supply blood to your heart become narrowed or blocked. If the heart is unable to get enough blood, it will lack the oxygen and nutrients it needs to function properly.

The disease starts when cholesterol builds up in the blood vessels that supply blood to your heart. This build up eventually turns into plaque. This plaque build up can narrow the artery and reduce the flow of blood to your heart. If this condition is left untreated and the artery blocks either partially or completely it may lead to a heart attack

CAD often develops over decades. You might not notice a problem until you have a significant blockage. You can take steps from an early age to prevent coronary artery disease.

CAD is a progressive condition, it may take years to develop symptoms, and not everyone’s symptoms will be the same.

Three common symptoms are:

1. Chest pain (angina): Often triggered suddenly by physical or emotional stress. You may feel pressure, heaviness, or tightness in your chest
2. Shortness of breath: You might have noticed that you are struggling to walk as far as normal without feeling a bit out of breath
3. Heart attack: Can feel like chest pain, this is a medical emergency, if your symptoms are severe call Triple Zero (000)

If you have any symptoms that you are concerned about, discuss this with your local doctor or call Triple Zero (000).

It is thought that CAD develops after the inner lining of your artery becomes damaged. There are several risk factors which increase your risk of developing coronary artery disease. Some risk factors can be managed from an early age while some you are unable to change.

• Smoking – a significant risk factor which can be reduced by quitting
• Elevated cholesterol – it is important to work with your GP and cardiologist to reach your target cholesterol
• High blood pressure (BP) – depending on your risk profile your cardiologist and GP will set a personalised target BP
• Being overweight or obese – aiming for a healthy BMI of less than 25 will help to decrease your long term risk factors
• Not being active (sedentary lifestyle) – aim for a minimum of 30 minutes exercise daily to reduce your risk
• Diabetes – Type 2 Diabetes (T2DM) significantly increases your risk of developing coronary heart disease. If you have T2DM, you may be asked by your GP or cardiologist to aim for lower blood pressure and cholesterol targets. Making the advised lifestyle changes can have a positive impact of the severity of both coronary artery disease and T2DM
• High stress – finding ways to manage your stress levels can help to reduce your risk
• Unhealthy diet – reducing your saturated fat intake is a simple way to reduce your risk

• Family history of premature heart disease – classified as a first degree relative with heart disease before the age of 60
• Age – overall risk increases with age
• Gender – there is a small increased risk in males

If you are aged between 40 and 75 (or 35 – 75 if Aboriginal or Torres Strait Islander) you should have a heart health check with your doctor to determine your cardiovascular risk.

There are several tests available to diagnose you with CAD. To understand how your heart is functioning your doctor might refer you for one or more of the following tests at GenesisCare.

• Electrocardiogram
• Coronary artery calcium score
• Computed Tomography Coronary Angiography
• Exercise Stress Echocardiogram

There are several treatment options for patients with CAD. Your doctor will design a management plan based on your risk factors, symptoms and severity of disease.

Medical management and lifestyle modification are treatments used to reduce the risk of you suffering a heart attack. Sometimes when the disease is advanced this may also be combined with a referral for a coronary angiography.

If CAD is not controlled early, it can lead to the heart becoming weak and being at significant risk of developing heart failure.

A healthy heart is able to contract and relax to pump enough blood around the body. We can measure a healthy heart by the percentage of blood that leaves your heart each time it contracts; this is called the ejection fraction. A normal ejection fraction is between 50-70%.

There are many causes for the heart muscle not working properly including:

• Previous heart attack
• History of high blood pressure
• High cholesterol
• High levels of alcohol consumption
• Diabetes
• Infections (viruses)
• Previous chemotherapy treatment
• Genetic causes
• Symptoms of heart failure may include:
• Shortness of breath when walking, at rest, or when lying down
• Swollen feet or legs
• Palpitations or rapid heartbeat
• Extreme tiredness
• Feeling dizzy or lightheaded
• Sudden weight increase
• A frequent, long-lasting cough

Chest pains – if severe please call Triple Zero (000) and ask for an ambulance. This is an emergency.

Talk to your doctor to learn more about your symptoms and how you can check and manage them.

In order to understand how your heart is functioning, you may be referred for one or more of the following tests. It is important to complete these before your appointment with the GenesisCare Heart Failure Management Clinic, to give our team all the information needed to best support you.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is used to assess the electrical activity in your heart. It gives your team information regarding the rate and rhythm of your heart and can help identify abnormal rhythms (arrhythmias). It is non-invasive, painless and provides information very quickly.

• Small sensor pads called electrodes will be attached to your chest, arms and legs
• The electrodes have wires which are attached to an electrocardiogram machine that will record and then print out cardiac electrical activity
• Within minutes, the test is complete and your team will review the results

Echocardiogram (Echo)

Echocardiography is an ultrasound and serves as an easy way for your cardiologist to assess your heart muscle, valves and large blood vessels. The test may take up to 45 minutes and you shouldn’t experience any pain or discomfort during it.

• You will lie on the examination bed
• To get the images of your heart, the technician will place a thick gel on your chest
• The technician will then place a transducer directly over the left side of your chest over your heart
• The technician will press firmly as they move the transducer and will ask you to hold your breath for a short time
• The results will be sent directly to your cardiologist

Pathology

Your doctor may send you for blood tests to assess your heart function.

Pathology or blood tests are an important way to help your team monitor how your medications and heart function are affecting other aspects of your overall health. For instance, some tablets can affect your kidney function, and electrolytes such as sodium and potassium in the bloodstream. Initially testing may be required frequently as your medications are increased to help strengthen your heart and reduce your symptoms. Once stable, monitoring will not need to be as often.

Your GenesisCare doctor will provide you with a personalised management plan to support you with an holistic approach to your heart failure treatment. Though medication is the primary treatment, there are a number of other factors you will need to be aware of to ensure the best results.

Your treatment plan will include:

• Names of your team of doctors and nurses
• Daily fluid allowance
• Your target daily weight
• Initial medications
• When to increase or decrease your diuretics
• Salt restriction and nutrition advice
• Strategies for daily exercise
• How to recognise signs and symptoms of heart failure concerns
• When to contact your team for help

Blood pressure is the pressure of the blood in your arteries as the heart pumps it around your body.

Blood pressure is recorded as two numbers (e.g. 120/80). The larger number indicates the pressure in the arteries as the heart squeezes out blood during each beat. This is referred to as systolic blood pressure. The lower number indicates the pressure as the heart relaxes before the next beat. It is called the diastolic blood pressure.

Normal: Under 120/80 is considered to be a normal range for blood pressure.

Not Normal: Between 120/80 and 130/80 is elevated but not yet considered high blood pressure. This needs to be watched carefully.

High: More than 130/80.

Blood pressure varies

It’s best to measure blood pressure when you’re relaxed and sitting or lying down.

Blood pressure does not stay the same all the time. It’s always changing to meet your body’s needs and depending on your physical situation.

If a reading is high, your doctor may measure your blood pressure again on several occasions to confirm the level.

Managing high blood pressure can significantly improve your quality of life by reducing the risk and effect of related health issues such as heart attacks and strokes.

It’s important to get your blood pressure checked regularly because high blood pressure can be present without any symptoms or signs. You can have high blood pressure and feel perfectly well. Many people live with high blood pressure (and take medication for it), but there are ways to help lower your blood pressure.

At GenesisCare we look beyond treatment to your overall well-being. Your GenesisCare team can recommend steps you can take to help maintain a healthy blood pressure or reduce your blood pressure if it is high. If you do have high blood pressure, it’s best to have it checked more frequently, or as advised by your doctor.

1. Quit smoking
2. Reduce the fat in your diet (especially saturated fat) and salt intake
3. Maintain a healthy weight
4. Exercise regularly
5. Limit alcohol intake

A stroke is caused by the blood flow to an area of the brain being cut off, reducing the supply of oxygen. This can result in damage to the brain.

There are a number of causes of stroke but one of the causes involves the heart. A type of abnormal heart rhythm called atrial fibrillation (AF), can increase the risk of a stroke occurring. AF can result in the formation of blood clots in the heart that lead to a stroke. About 1 in 3 of all strokes in Australia occur because of atrial fibrillation. Even so, many people go through their whole lives with AF and don’t have a stroke.Better care is helping people reduce the risk of stroke. There are steps we can all take that can reduce the risk. By cutting out smoking, managing your cholesterol and maintaining a healthy weight, you can take big steps to reduce your risk.

• For people with AF there are a number of treatment options that can reduce the risk of stroke, by reducing the chance of blood clots forming:
• Blood thinner medications such as warfarin, apixaban, rivoroxaban or dabigatran.
• A procedure to remove or block a small area of the heart called the left atrial appendance where most of the blood clots form in atrial fibrillation.
• Your care team will help you understand if either treatment is right for you.

Structural heart disease is the term used to describe conditions affecting the valves, muscles or walls of the heart.

This is different from coronary artery disease, which concerns the heart’s “plumbing,” or problems with the blood vessels that feed the heart, and an arrhythmia, which refers to problems with the electrical system of the heart. Structural heart problems may be present from birth (congenital), but they often can develop with aging or as a result of other diseases. The most common form of structural heart disease is often related to the heart valves and is usually discovered when a heart murmur is detected by listening to the heart, or when a cardiac ultrasound is performed.

The most common structural heart diseases include:

• Aortic valve stenosis: When the aortic valve has become hardened and narrowed.
• Mitral regurgitation: A condition caused by the mitral valve (which is the major valve between the 2 heart chambers on the left side of the heart) not closing properly.
• Chamber wall defects: A hole in the wall (septum) that separates the two upper (atrial) or two lower (ventricular) chambers of the heart.

With a highly experienced and dedicated clinical team across Australia and access to innovative technology and minimally invasive approaches, GenesisCare provides leading specialised diagnosis, treatment and management of structural heart disease.

Though the symptoms and signs of structural heart disease can vary, the most common may include:

• Chest pains – if severe please call Triple Zero (000) and ask for an ambulance. This is an emergency.
• A tight feeling in the chest
• Shortness of breath when walking, at rest, or when lying down
• Palpitations
• Swollen feet or legs
• Extreme tiredness
• Feeling dizzy or lightheaded
• Sudden weight increase
• Cough
• High blood pressure
• Stroke

Talk to your doctor to learn more about your symptoms and how you can check and manage them.

In order to understand how your heart is functioning, you may be referred for one or more of the following tests. It is important to complete these before your appointment with the GenesisCare Clinic, to give our team all the information needed to best support you.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is used to assess the electrical activity in your heart. It gives your team information regarding the rate and rhythm of your heart and can help identify abnormal rhythms (arrhythmias). It is non-invasive, painless and provides information very quickly.

• Small sensor pads called electrodes will be attached to your chest, arms and legs
• The electrodes have wires which are attached to an electrocardiogram machine that will record and then print out cardiac electrical activity
• Within minutes, the test is complete and your team will review the results

Echocardiogram (Echo)

Echocardiography is an ultrasound and serves as an easy way for your cardiologist to assess your heart muscle, valves and large blood vessels. The test may take up to 45 minutes and you shouldn’t experience any pain or discomfort during it.

• You will lie on the examination bed
• To get the images of your heart, the technician will place a thick gel on your chest
• The technician will then place a transducer directly over the left side of your chest over your heart
• The technician will press firmly as they move the transducer and will ask you to hold your breath for a short time
• The results will be sent directly to your cardiologist

Pathology

Your doctor may send you for blood tests to assess your heart function.

Pathology or blood tests are an important way to help your team monitor how your medications and heart function are affecting other aspects of your overall health. For instance, some tablets can affect your kidney function, and electrolytes such as sodium and potassium in the bloodstream. Initially testing may be required frequently as your medications are increased to help strengthen your heart and reduce your symptoms. Once

Once you have been diagnosed, your GenesisCare doctor will provide you with a personalised management plan to support you with an holistic approach to your structural heart treatment.

Your treatment plan may include one of the following procedures:

• Transcatheter Aortic Valve Replacement (TAVI/TAVR)  A valve replacement completed by inserting a catheter through a blood vessel in the leg as an alternative to open heart surgery.
• Mitra Clip A clipping procedure to treat a leaking heart valve completed by inserting a catheter through a blood vessel in the leg as an alternative to open heart surgery.
• Highlife Minimally invasive prosthetic mitral valve to prevent mitral regurgitation.
• Left Atrial Appendage Occluder Implant (LAAO)  A device used to help prevent stroke.
• Patent Foramen Oval, Atrial Septal Defect, Ventricular Septal Defect (PFO/ASD/VSD) A heart wall repair device.
• Transcatheter Alcohol ablation of Septal Hypertrophy (TASH) Treatment for the thickening of the heart muscle.

• Diagnosis and required surveillance will be completed at your local GenesisCare centre to reduce travel inconvenience.
• We provide diagnosis, treatment and support tailored individually to you and your needs.
• Greater support with specialist team-based care that is designed to give you an improved outcome and better care, faster.
• Access to structural heart research program, giving you access to innovative treatments.

Your structural heart team

At GenesisCare we specialise in the diagnosis and treatment of structural heart conditions. You can trust in our experience; our team are well respected locally and internationally as experts in their field of minimally invasive procedures to repair or replace your damaged heart valve or chamber wall.
We work in a collaborative team ensuring you get the best outcome available. Our minimally invasive procedures can mean a faster recovery time compared to traditional surgery, which can improve the control of your symptoms.

Pericarditis is a condition that causes inflammation of the pericardium, a flexible two-layered membrane that functions to keep the heart in place and protect it from infection. The pericardium can become swollen and irritated, which can cause chest pain and sometimes other symptoms. Recurrent pericarditis is when the signs and symptoms of pericarditis reoccur. Pericarditis can be caused by a bacterial or viral infection, chest injury, heart attack or heart surgery, or long-term health problems, such as autoimmune diseases, kidney failure or cancer. The condition can affect anyone, however the age group most at risk of pericarditis are men aged between 20 and 50 years¹

Treatment varies depending on the type of pericarditis, however there is currently no approved treatment options for recurrent pericarditis. The condition can be managed with rest, pain relief, surgical drainage, treatment of symptoms such as inflammation and arrhythmia or antibiotics.¹

We are currently looking for patients to take part in a new clinic trial, with the goal of testing a new investigational medication for people with recurrent pericarditis. Recurrent pericarditis is very debilitating condition due to the pain and limitations in physical function that it causes. We are hopeful the results of the trial could be life changing for those patients where available treatments are not working.

This study is currently enrolling suitable patients in various locations across Queensland and Victoria. The study is particularly important for those patients who have had 2 or more recurrent episodes of pericarditis and their current treatment is not managing their condition.