at the Royal Infirmary, Aberdeen

The Department represents the Regional Cardiology Service for the North East of Scotland. It consists of a 12 bedded CCU equipped with appropriate, modern monitoring equipment and an intervention suite with imaging facilities. A coronary triage service is centred on this unit. There are two step-down wards with a total of 34 beds in addition to an eight bedded area for day-case patient investigation. The inpatient facility is located adjacent to the outpatient facility which is equipped with modern non-invasive imaging facilities and is supported by 18 cardiac technicians. In addition to the elective outpatient service, an acute Chest Pain Service and GP open access to cardiovascular investigation is provided from this area: the Department offers open access to echocardiography, Holter monitoring and a fast track chest pain service for at-risk patients. Annually 35,000 electrocardiograms and 3,500 echocardiograms are performed in the Department. Invasive imaging is provided by a modern digital catheter laboratory. Annually 1900 angiographic procedures, 650 percutaneous angioplasties and 200 pacemaker insertions are performed in this suite. The nuclear cardiological service is provided in close collaboration with the Department of Medical Physics and offers imaging of myocardial function and coronary flow utilising radioisotopes. This service is enhanced by the availability of Magnetic Resonance Imaging and Positron Electron Tomography; this latter imaging modality is available in less than half a dozen centres in the United Kingdom. An Electrophysiology Service has recently been introduced, led by Dr Paul Broadhurst. Implantable Cardioverter Defibrillators are now being inserted in Aberdeen, and patients previously referred and followed up in Glasgow, are seen locally. Both single and dual chamber devices are utilised where appropriate. Cardiac re-synchronisation therapy for severe heart failure will be developed. Radiofrequency ablation, utilising state of the art technology commenced in 2003.

Aberdeen Royal Infirmary

Direct Access Cardiology Outpatient Services Dept of Cardiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN By Fax: 01224 550692

Situations where referral to the Direct Access Echo Service is indicated: Patients with suspected heart failure or reassessment of patients on treatment for presumed heart faillure who have never had an echo. (But, in the presence of a normal ECG, no murmurs and no history of MI, significant LV dysfunction is unlikely to be the cause of breathlessness.) Patients with unexplained murmurs Patients with hypertension to confirm or refute suspected LVH - value of Echo remains unproven, however may be useful if there is mismatch between blood pressure levels and ECG appearances. (LVH on Echo or ECG is predictive of risk.) Those with a family history of sudden death to exclude cardiomyopathy (although this should probably be restricted to those in whom an ECG has been found to be abnormal, since a normal ECG has a greater negative predictive value for screening than an Echo). Assessment of atrial fibrillation, where echo may identify silent mitral valve disease, and can assess chamber dimensions and left ventricular function, aiding management decisions re anticoagulation and cardioversion. At present we do not offer an open access paediatric echo service.

Situations where referral to the Direct Access Holter Service is indicated: The majority of palpitation has an innocent cause and only requires reassurance. In particular, Holter Monitoring (which takes an hour of technician time) is not indicated for patients with symptoms suggestive of simple ectopics. The Holter Service is indicated for patients with: a clear history of sustained fast palpitation or those in whom a suspected arrhythmia is causing haemodynamic effects. If the patient's symptoms are very infrequent a patient activated recorder may be more appropriately be requested.

Direct Access Chest Pain Service The aim of this service is to aid the early diagnosis and plan appropriate treatment strategies in patients presenting with chest pain thought to be definite or possible angina (see below). Appointments can be made using the Direct Access Cardiology Request Form (click on link to open) and sent to the Cardiology Department, or faxed to 550692. We aim to see patients within a week if possible, and therefore ask that to ensure the most appropriate use of these urgent assessment facilities, the following criteria are applied: Patients with recent onset (usually < 3 weeks) definite or possible cardiac pain. Patients with a significant recent change in frequency and severity of previously identified cardiac pain. Patients with a chronic stable angina or chest pain of uncertain aetiology should not be referred to the Chest Pain Clinic, but sent routinely to the Cardiology Out Patient Department. (We do NOT offer open access exercise-testing because of the very low predictive accuracy of this as a diagnostic tool) Working Definition of Angina Definite/typical (all features present): a) Recurrent b) Brief episode of chest pain (up to 15 mins) c)Provoked by exertion or emotion d) Relieved by rest or GTN e) Character and radiation typical of angina Possible: When c) and any one or more of the other characteristics listed above are present.