Useful information about working in Cardiology

Who to call

On call registrars

After hours and weekends

Weekdays 0800-1600 hrs

Suspected STEMI: Call on call CCU Registrar. If on-call CCU Registrar is not immediately available and the diagnosis is definite, call the Interventional cardiologist for STEMI
Cardiac Rhythm Monitoring service for wards: call Acute CCU/ward 34. Refer to CRM policy and decision tree available on intranet
Echo Department
Consultants are on call for intervention, Cardiology (Ward 31), and Acute Cardiac Care Unit (CCU) at all times (24/7). They can be contacted on their mobile via the operator. If a Registrar is not available phone on-call Consultant.

Does a patient need to be admitted to the Acute Cardiac Care Unit?

Discuss with on-call CCU or Ward Referral Registrar. Decision is made on a case by case basis. Acute clinical scenarios can include:

Acute coronary syndromes (ACS): STEMI, non-STEMI and unstable angina, Takotsubo syndrome
Complex arrhythmias e.g. VT, SVT, fast AF, complete heart block
Acute pulmonary oedema
Cardiogenic shock
Severe hypertension
Some congenital heart disease patients
Need for intravenous infusions e.g. Glyceryl trinitrate (GTN), dopamine, dobutamine, milrinone

There is no age limit for admission to CCU.

Echocardiography

TTE should be performed in all patients to assess left and right ventricular function, presence of cardiac thrombi or pericardial effusions, valve structure and function, chamber size and to assess alternative diagnoses. e.g. Takotsubo syndrome. All patients should have an echo to assess ejection fraction before discharge.

Smoking cessation

All patients should be advised to stop smoking and commenced on nicotine patches or lozenges on the first day after admission (consult Specialist Smoking Cessation Nurse).

Discharge

The discharge summary is an important document. It is important to include the final diagnoses, results of relevant investigations, plans for ongoing management and follow-up, and changes to medication and reasons.

Many STEMI patients can be discharged on day 3 with transfer to the transition lounge rather than needing a bed in CCU.

Patients from Northland District Health Board catchment can be transferred back to the base hospital on day one for continuing management, including rehabilitation.

Cardiac rehabilitation

Most patients should be referred to the Cardiac Rehabilitation Service and encouraged to attend rehabilitation programmes, to quit smoking, undergo regular exercise (30 minutes of brisk walking or equivalent on most days of the week), and have a cardio-protective diet. The rehabilitation nurse will tailor advice to the individual patient about return to work, sexual activity and flying.

Indications: post cardiothoracic cardiac surgery (includes CABG, valves and aortic dissections), acute coronary syndrome (ACS), moderate CAD on angiogram, myocardial infarction with non-obstructive coronary arteries (MINOCA), spontaneous coronary artery dissection (SCAD), Takotsubo syndrome.

Patients not suitable: severe confusion and dementia, active psychosis, extremely frail or for palliative care. Renal dialysis patients are seen on a case by case basis (as per patient’s wishes).

Contacts

Referral pathway. We screen referrals ourselves, however you can contact any of the team: Wendy Marshall, Cathy Gasparini, Sarah Jane Brown, Susan Reed, Melinda Copley

Information needed on referral: If you need something specific like follow up of BP management, AF heart rate management please let us know.

For driving guidelines see Medical Aspects of Fitness to Drive issued by the Land Transport Safety Authority (available on the wards) or in pdf format: Medical aspects of fitness to drive – A guide for health practitioners | NZ Transport Agency Waka Kotahi (nzta.govt.nz)

In general, patients should not drive for 1 day post-angiogram and 2 weeks post-MI.

For heavy truck drivers, 3 months off work is required. Advice needs to be tailored for individual patients e.g. those with LV ejection fraction ≤35%, heart failure, continuing arrhythmias, or complications of PCI.