Ruber Internacional includes a team of professionals dedicated to diagnosing and treating heart diseases, both in outpatients and inpatients. It includes the support from and also supports the Hospital's entire cardiovascular area (ICU/Coronary Unit, Diagnostic Imaging, Haemodynamics, Electrophysiology, Heart surgery, Cardiology and Paediatric surgery).
The Cardiology Unit has the most advanced diagnostic and therapeutic techniques at its disposal, and is constantly updating the most innovative technology in the cardiology area.
Clinical Cardiology
Just as interventionist cardiology treats cardiac pathologies through catheters in a minimally invasive way and heart surgery uses surgical procedures that require opening the thorax to access the heart, clinical cardiology aims to identify patients' heart issues and decide on the most appropriate treatment.
Diagnostic methods:
We have the most advanced diagnostic and therapeutic techniques at our disposal, and we are constantly renovating our equipment to benefit from the most state-of-the-art technology in cardiology at all times.
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Electrocardiography ECG
Popular electrocardiograms register the electric activity the heart produces with each heartbeat. To obtain the graph, around 10 electrodes are placed on the patient's chest. By interpreting the results, we can know the size and position of the ventricles and atria, as well as the heart rhythm and frequency. -
Transoesophageal Echocardiography
A probe with an ultrasound transducer on the end is inserted into the throat. The cardiologist will guide the probe to the oesophagus and the stomach, where a clearer and more detailed image of the heart can be obtained than through a simple X-ray.
The ultrasound uses sound waves to obtain images, not radiation. -
It is an innocuous, non-aggressive technique that uses ultrasounds for the anatomical and functional study of the heart. It allows us to dynamically see the heart in order to study all kinds of anomalies; it is therefore useful in any area of cardiac pathology (valvopathies, myocardiopathies, ischaemic cardiopathy, congenital cardiopathies, rhythm disorders).
Constant, pulsed and colour Doppler-Echocardiography
Records are always accompanied with a functional study with Doppler technique in its different variants: constant, pulsed and colour, which allow for a functional assessment of the heart, (valvar, contractile function). There are technical variants such as the transthoracic echocardiography, transoesophageal echocardiography, stress echocardiography (conventional or pharmacologic). The standard technique (transthoracic) is the most frequently used and does not require any special preparation of the patient; no fasting is required. -
Ergometry (Exercise test)
The Ergometry or exercise test studies the heart's response to physical overexertion in order to rule out coronary disease and also assess the response with regard to heart rhythm, blood pressure, functional capacity, recovery capacity, etc.
The test consists of walking on a treadmill at a gradually and periodically increasing speed and slope, under strict monitoring of the electrocardiogram and blood pressure. Fasting is not required. The patient's authorisation through an informed consent form is required.
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Holter ECG (ambulatory registration)
It is the ambulatory study of the heart rhythm through ECG monitoring, generally for 24 hours.
A series of electrodes connected to a small ECG recorder are adhered to the patient's skin, which allows the patient to continue with their everyday life. It is useful to study all kinds of heart arrhythmias, as well as to assess the body's response to treatment. No special preparation is required.
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BP Holter (ambulatory registration)
It is the ambulatory study, generally for 24 hours, of blood pressure through a cuff connected to a small recorder that allows the patient to continue with their everyday life. No special preparation is required. It is very useful to rule out high blood pressure and to classify it, as well as to assess the body's response to antihypertensive treatment.
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Pathologies:
Among the pathologies treated by Clinical Cardiology, we find the following:
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Arrhythmias
Alterations of the normal heart rhythm. -
Cardiac amyloidosis
Abnormal protein accumulations can affect the heart, causing problems such as Restrictive Cardiomyopathy or Orthostatic Hypertension. -
Infectious endocarditis
Generally, the valve inner lining is infected by bacteria. -
Heart diseases
Heart disease consists of the narrowing of blood vessels or arteries carrying oxygenated blood to the heart: -
- Ischaemic Heart Disease: The arteries are gradually occluded by fats, collagen and inflammatory cells.
- Congenital Heart Disease: Arterial malformations occur during the embryonal stage. Ebstein's anomaly, Tricuspid atresia, Abnormal pulmonary venous drainage or ventricular septal defects are some congenital anomalies that can occur.
- Ischaemic Heart Disease: The arteries are gradually occluded by fats, collagen and inflammatory cells.
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Heart failure
The heart is not able to pump enough blood to the body. This can be caused by pathologies such as ischaemic heart disease, valvopathies, etc. -
Cardiomyopathies
Diseases that directly affect the myocardium. Arising from multiple causes such as high blood pressure, alcohol, diabetes, etc. -
Valvopathies
The heart has a series of valves that open and close during the cardiac cycle, in a way that blood flows from one cavity to another without returning. The mitral, aortic, pulmonary or tricuspid valves can be affected by a disease and not to perform their function.
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Rehabilitación Cardiaca
La rehabilitación cardiaca es un programa personalizado de entrenamiento cardiovascular que ha demostrado reducir la aparición de eventos cardiovasculares adversos.
Se trata, por tanto, de mejorar la calidad de vida (mejor capacidad física) y reducir el riesgo futuro (mejorar la supervivencia).
Es recomendable a cualquier enfermo cardiológico y a aquellos individuos con elevado riesgo cardiovascular (hipertensión, diabetes, hipercolesterolemia, obesidad).
Áreas de actuación
Las cuatro áreas básicas de actuación de los programas de rehabilitación cardiaca son:
- El entrenamiento aeróbico, que pretende la mejora del rendimiento cardiorrespiratorio.
- El control de los factores de riesgo, con la finalidad de retardar la progresión o incluso invertir el proceso de la enfermedad aterotrombótica (prevención secundaria y primaria).
- El apoyo psicológico.
- La reincorporación social y laboral.
Efectos
Los efectos demostrados de la rehabilitación cardiaca son:
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- Favorece la pérdida de peso
- Mejora el control del colesterol
- Mejora el control glucémico
- Mejora el control de la presión arterial
- Mejora la capacidad de ejercicio
- Mejora el rendimiento del corazón
- Reduce la aparición de angina
- Reduce la aparición de disnea ("falta de aire")
- Reduce el porcentaje de masa grasa corporal
- Reduce la ansiedad y los síntomas de desánimo
- Aumenta la calidad de vida
- Mejora la autoconfianza
- Favorece la deshabituación tabáquica
Recursos
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- Valoración inicial:
- Revisión de pruebas diagnósticas y antecedentes con el fin de diseñar un programa de entrenamiento físico y dietético personalizado.
- Requiere la realización de prueba de esfuerzo o ergo-espirometría.
- Consulta de deshabituación tabáquica
- Sesiones de entrenamiento personalizado:
- Programa de 16 sesiones de entrenamiento (2 horas cada sesión) + consulta inicial + valoración nutricional + ergometría
- Cada sesión de entrenamiento incluye:
- Registro de variables antropométricas (peso, perímetro abdominal)
- Ejercicios calisténicos (calentamiento) y tonificación muscular
- Entrenamiento en bicicleta / cinta
- Enfriamiento
- Consejos de entrenamiento / dieta
- Valoración inicial:
Horario
En nuestra Unidad adaptamos el horario y la frecuencia de entrenamiento a sus obligaciones diarias.
Consulte en Atención al Paciente los horarios y tarifas del programa.
Técnicas
TÉCNICAS INVASIVAS (HOSPITAL RUBER INTERNACIONAL-MIRASIERRA)
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- Ecocardiograma transesofágico
- Cardioversión eléctrica
- Cateterismo cardiaco y coronariografía
- Angioplastia coronaria (stent)
- Cierre de defectos cardiacos
- Tratamiento percutáneo de las enfermedades valvulares
- Implante de marcapasos, resincronización, desfibriladores
- Tratamiento quirúrgico de las enfermedades cardiovasculares
HOSPITALIZACIÓN (HOSPITAL RUBER INTERNACIONAL-MIRASIERRA)
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- Valoración cardiológica urgente
- Síndrome coronario agudo
- Dolor torácico
- Insuficiencia cardiaca
- Crisis hipertensiva
- Mareo de repetición, síncope
- Taquicardias, bradicardias
- Miocarditis, pericarditis
Interventionist Cardiology
The Haemodynamics and Interventionist Cardiology Unit aims to diagnose and treat coronary artery, heart and blood vessel diseases through minimally invasive percutaneous techniques.
Cardiac catheterisation is the gold standard of diagnosis in most heart diseases, and therapeutic catheterisation allows us to treat numerous coronary or structural diseases through different devices (balloons, stents, occluders, valves, etc.). Catheterisations are performed in the outpatient (under observation for 4-24 hours) or inpatient setting, electively or urgently.
I. MISSION
We offer percutaneous diagnosis and treatment of cardiology diseases with the most efficiency and safety for the patient, providing value to each case that has undergone surgery and rationally applying the most advanced techniques to benefit the patient.
During our years of experience in this area, we have aimed to be the most transparent, close and loyal to the numerous patients who have undergone surgery, to undertake the most complex interventions, explaining and attending to all your questions and needs, as well as your friends and family.
II. LOCATION, INFRASTRUCTURE AND EQUIPMENT
The Haemodynamics and Interventionist Cardiology Unit is located on the ground floor of the Hospital Ruber Internacional, in the operating room area, directly connected to the multi-purpose area and the Intensive Medicine area. It offers a room completely equipped for percutaneous intervention and diagnosis with state-of-the-art cardiovascular radiology equipment (General Electrics).
The room is equipped with all the equipment necessary for optimal operation and to solve potential complications. Moreover, the room offers: external defibrillator, pulse oximeters, oximeters, systems for the immediate assessment of PCI, continuous cardiac monitoring, intra-aortic balloon and material for orotracheal intubation and pericardiocentesis.
Consultations are carried out both at the Ruber Internacional de Mirasierra centre and the Paseo de la Habana centre.
III. PROCEDURES THAT WE PERFORM
Diagnostic procedures
For the study of valvar, myocardial, pericardial, coronary, congenital, aortic and great vessel diseases:
- Diagnostic coronary angiography:
Healthy coronary arteries. The heart receives its own blood supply from the coronary arteries. In the absence of atherosclerotic lesions (fat deposits and inflammation) blood circulates freely through them. With X-rays and by injecting iodine-based contrast medium through a catheter inserted into the puncture, we are able to dye the lumen of the coronary arteries and rule out or confirm the presence of obstructions.
A: The trunk of the left main coronary artery quickly splits into two main branches: the left anterior descending artery (ADA) and the circumflex coronary artery (CCA).
B: Right coronary artery (RCA).
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- Right catheterisation.
- Intramyocardial biopsy.
- Ventriculography. Aortography. Pulmonary arteriography.
- Intracoronary ultrasound.
- Intracoronary optimum coherence tomography.
- Intracoronary pressure guide.
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Therapeutic procedures
For the percutaneous treatment of valvar, myocardial, pericardial, coronary, congenital, ascending aortic and great vessel diseases:
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- Simple, multi-segment or conventional multi-vessel angioplasty (only with balloon).
- Simple, multi-segment or multi-vessel angioplasty with intracoronary prosthesis (stent):
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Percutaneous treatment with stent of a severe coronary lesion. Cardiovascular risk factors (high blood pressure, diabetes, hypercholesterolemia, smoking) produce a progressive deposition of lipids (fat) and inflammatory cells on the coronary artery walls. These deposits can end up restricting blood flow, triggering symptoms (angina) and significantly increasing the risk of acute myocardial infarction.
- Highly severe atherosclerotic lesion (arrow) in the right coronary artery that obstructs the lumen.
- Through a catheter inserted into the puncture and a guide (very thin wire) we dilate the obstruction with a balloon to improve blood flow.
- To preserve the lumen and avoid new obstructions, we implant a stent (spring) at the same level.
- Once the stent has been implanted, blood flows freely through the artery again.
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Chronic coronary occlusion angioplasty.- Coronary atherectomy (Rotablator).
- Manual and mechanic thrombectomy.
- Diagnostic and evacuating pericardiocentesis.
- Temporary pacemaker implantation.
- Intra-aortic balloon implantation.
- Percutaneous mitral annuloplasty (Mitraclip®).
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- Percutaneous ventricular assist device implantation (Impella®).
- Wireless pacemaker implant (Micra®).
- Arterial haemostasis device implantation.
- Valvar pathology: Mitral and aortic valvuloplasty. Percutaneous aortic prosthesis implant. Percutaneous closure of periprosthetic leaks with percutaneous and transapical approach.
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- Congenital pathologies: Closure of persistent ductus arteriosus. Closure of ventricular septal defects (congenital or after acute myocardial infarction). Closure of atrial septal defects.
- Percutaneous treatment of cardiac congenital defects. The heart can become altered during its formation and development. Some defects increase the risk of stroke and cause heart function complications.
A: Hole between both atria because of an atrial septal defect (arrow).
B: Blood flow from the left atrium to the right atrium through the hole.
C: Through a single venous puncture, we can place the first metal disc in the left atrium.
D: The second metal disc of the percutaneous device completely closes the interatrial septum defect.
E: Inserted device "sealing" the septal defect.
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- Percutaneous treatment of the aortic coarctation.
- Pericardial pathology: Percutaneous pericardiotomy with balloon.
- Auricle percutaneous closure.
- Renal artery ablation for HBP treatment.
