Cardiology

Policlinico San Donato

KEY FIGURES

CLINICAL SERVICES:

  • Heart failure diagnosis, clinical follow-up and therapy
  • Valvular Heart Disease, Diagnosis and Clinical Follow-up
  • Cardiomyopathies, Diagnosis, Clinical Evaluation and Therapy
  • Cardiopulmonary Exercise Testing
  • Advanced Echo-Imaging (3D, 4D, speckle tracking analyses)
  • Exercise Imaging
  • Lung Function Evaluation at Rest and during Exercise
  • Sleep Disordered Breathing Evaluation
  • Biomarkers assay

PROCEDURES PERFORMED PER YEAR:

  • 600 Cardiopulmonary Test
  • 200 Cardiopulmonary Test combined with Echocardiography
  • 180 Spirometry and DLCO Evaluation
  • 500 Echocardiograms (M-mode, 2-Mode, 3-D, 4-D, Speckle Tracking and Doppler Analyses)

The University Cardiology department is composed by the University Cardiology Ward and the Rehabilitation Ward with an average of 350 patients treated and followed-up per year.  There is a worldwide expertise on the study and therapy of pulmonary hypertension and right heart failure. The procedure mainly performed are: right heart catheterization, coronary angiography, angioplasty, cardiac MRI, cardioversion, Echocardiography TEE and TTE, CT-scan, Chest X-ray.

 

TREATMENTS:

The Cardiology University Unit is composed by outpatient and ward activity for patients with heart failure and other chronic cardiovascular diseases.  

The outpatient activity counts on an average of 2.500 patients per year who are evaluated through echocardiography, stress-echocardiography, right heart catheterization and cardiopulmonary test.

Heart Failure

Heart failure normally evolves over the years and depends on the function of the heart. This condition leads to a loss of function of the left side or both sides of the heart. Whenever the heart cannot pump enough blood rich in oxygen to the entire body we have a left-side heart failure, while right-side heart failure may lead to pulmonary variations and congestion. Symptoms are shortness of breath and tiredness. Principal causes of heart failure may be coronary heart disease, high blood pressure, atrial fibrillation, infection, diabetes, excess of alcohol and drugs.

Main Pathologies Treated:

  • Congestive Heart Failure
  • Left-Side Heart Failure
  • Right-Side Heart Failure

Top procedures:

  • ECG (Electrocardiogram)
  • Chest X Ray
  • BNP Blood Test
  • Echocardiography
  • Doppler Ultrasound
  • Holter Monitor
  • Cardiac Right Heart Catheterization
  • Coronary Angiography
  • Stress Test
  • Cardiac MRI
  • Thyroid Function Tests

Cardiomyopathies

Cardiomyopathies are a series of diseases that concern the heart muscle. Some signs and symptoms may be shortness of breath, tiredness, irregular heartbeat, fainting and also sudden cardiac death. The heart muscle enlarges, thickens, stiffens and weakens according to the specific type of cardiomyopathy.

It happens that if the cardiomyopathy worsens, the heart is not able to pump blood properly through the body, the electrical rhythm becomes irregular and it can cause arrhythmias and heart failure. Sometimes the impaired function and geometry of the heart can also trigger secondary heart valve diseases.  

Main Pathologies Treated:

  • Alcoholic cardiomyopathy
  • Congestive cardiomyopathy
  • Diabetic cardiomyopathy
  • Familial dilated cardiomyopathy
  • Idiopathic cardiomyopathy
  • Ischemic cardiomyopathy
  • Hypertrophic cardiomyopathy

Top Procedures:

  • Blood Tests
  • Chest X Ray
  • ECG (Electrocardiogram)
  • Holter And Event Monitors
  • Echocardiography
  • Stress Test
  • Right Heart Catheterization
  • Coronary Angiography
  • Cardiopulmonary Exercise Testing

Heart Valve Disease

Heart valve disease involve one or more of the four valves of the heart. The aortic and bicuspid valves are located in the left side of the heart, while the pulmonary and tricuspid valves are on the right side. Each valve has tissue flaps that open and close repeatedly at every heartbeat, which are responsible for the blood flowing in the right direction through the heart and to the whole body. So, when the heart valves do not open correctly the heart works harder and the blood is not pumped in the right way. This may happen because of congenital abnormalities or as a consequence of aging.
Valve failure can result in reduced heart functionality and its consequences depend on the type and the severity of the disease.

Main Pathologies Diagnosed:

  • Aortic regurgitation and stenosis
  • Aortic valve disease
  • Congenital valve disease
  • Mitral regurgitation and stenosis
  • Mitral valve disease and prolapse
  • Pulmonary valve disease
  • Tricuspid regurgitation and stenosis

Top Procedures:

  • ECG (Electrocardiogram)
  • Chest X Ray
  • Transthoracic Echocardiography
  • Transesophageal Echocardiography
  • Stress Test
  • Cardiac MRI
  • Cardiopulmonary Exercise testing combined with Echocardiography

Coronary Heart Disease

Coronary heart disease normally occurs when coronary arteries develop atherosclerosis. In this case, the lining gets hardened, stiffened and the muscle grows a deposit of fats, calcium and inflammatory cells, ending up in a plaque. Plaques get stuck into the channel of an artery and, with the time passing by, obstruct the blood flow. A coronary artery can be partially or totally obstructed, with one, two, or uncountable plaques, which may cause a rupture as well. Generally, symptoms occur with exercise or stress and improve with rest. Those symptoms can result in heartburn, chest, shoulder, arm, back and neck pain. Risk factors are, among others, smoking, diabetes, obesity, excessive alcohol and high blood cholesterol.

Main Pathologies Treated:

  • Angina
  • Atherosclerosis
  • Coronary artery disease
  • Heart disease
  • Ischemic heart disease

Top Procedures:

  • ECG (Electrocardiogram)
  • Stress Test
  • Echocardiography
  • Chest X Ray
  • Coronary Angiography and Cardiac Catheterization
  • Cardiopulmonary Exercise testing combined with Echocardiography

Hypertension

High blood pressure is a common disease in which blood pressure is constantly and persistently elevated. It means that blood flows through the vessels and the arteries at a higher power than in normal conditions, by pushing against the walls of arteries. When high blood pressure lasts over time, it results in hypertension and is normally split into primary and secondary hypertension. Primary hypertension depends on genes and environmental factors, while secondary hypertension depends on kidney disease, endocrine conditions and lifestyle habits. Symptoms are not so evident, even if we can assume that high blood pressure presents itself as headache (especially in the back of the head), lightheadedness, vertigo, buzzing in the ears, altered vision and possible fainting). Long-term hypertension can lead to coronary artery disease, stroke, atrial fibrillation, heart failure and other pathologies. In order to manage and lower high blood pressure is recommended to modify the lifestyle by reducing excess salt, weight, smoking and alcohol. If this does not work it is possible to resort to medications and tailor-made therapies.

Main Consequences Diagnosed:

  • Aneurysms
  • Chronic kidney disease
  • Eye damage
  • Heart attack
  • Heart failure

Top Procedures:
Lifestyle changes, managing stress and guidelines-approved therapies:

  • ACE inhibitors (angiotensin converting enzyme inhibitors)
  • ARBs (angiotensin receptor blockers)
  • Beta-blockers
  • Ca++ antagonists
  • Diuretics

Pulmonary Hypertension

Pulmonary hypertension is high blood pressure in the arteries carrying blood from the heart to the lungs. It is a pathophysiological condition with many possible causes. Pulmonary hypertension may arise from family history, sleep apnea, drug use, mitral valve disease and high altitudes. It can be also caused by pulmonary embolus, chronic obstructive pulmonary disease (COPD) and left heart disease. Treatments can be based on oxygen therapies, diuretics, epoprostenol, bosentan, macitentan and sildenafil. If this does not work a lung transplant may be an option.

Main Conditions Treated:

  • Right Heart Failure
  • Pulmonary Congestion

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT:

  • CPET metabolic cart (n= 2)
  • Echocardiography (3D, 4D, TOMTEC software, speckle tracking software)
  • Pulmonary function test
  • DLCO
  • Polysomnography
  • Right Heart Catheterization