Latest Advances In Cardiology

Dr Gerald Carr-White

Consultant Cardiologists

Guy’s and St Thomas’ NHS Trust

Copyright / courtesy of Phillip Kilner

Why is cardiology important

• Heart and circulatory disease

causes more than a quarter of all

deaths in the UK (160,000

deaths each year)

• There are around 7 million

people living with heart and

circulatory disease in the UK:

3.5 million men and 3.5 million

women.

• Coronary heart disease (CHD) is

the most common type of

cardiovascular disease.

Why is Cardiology Important

• An estimated 915,000 people alive in the UK today

(640,000 men and 275,000 women) have survived a heart

attack.

• Over half a million people in the UK are living with heart

failure.

• There are more than 30,000 out-of-hospital cardiac arrests

in the UK each year. The overall survival rate in the UK is

less than 1 in 10

Main Areas in Cardiology

Blood Supply

Electrics

Muscle Valves

Atherogenesis: Progressive Process

NormalFattystreak

Atheromatous plaque

Atheroscleroticplaque

Plaque rupture/fissure &

thrombosis Myocardialinfarction

Stroke

Critical legischemia

Clinically silent

Increasing Age

Angina

Transient ischemic

attack

Claudication/PAD

Heart Attack vs Cardiac Arrest

Closed Open artery

Arrival After balloon

Balloon

Latest Advances in Coronary Disease

• Drug eluting stents

• Long term benefit from bypass grafting

• Statins

• Coronary CT scans

Prevention

Cardiac rehab

Med diet

Conducting system

Ventricular Fibrillation

Normal Dual Chamber PM implant

Cardiac Dysynchrony

Biventricular pacing

Latest advances in Pacemakers / ICDS

• MRI Compatable

• Leadless Pacemakers

• Subcutaneous ICDs

Latest advances in Ablations

• Easier AF ablations

• Cryobaloons

Echo

CMR

Mortality in CHF REF Trials

0

10

20

30

40

50

60

70

Placebo ACEi ACEi + BB + CRT MRA

Annual Mortality %

Annual Mortality %

Latest advances in Heart Failure

• Remote monitoring

• PA pressure measurements

• Entresto

• Regenerative Medicine

Mauro Giacca / Regenerative Medicine

Nature Communications 2018

Inherited Cardiac Diseases

Risk factors depend on the individual

The Course of Heart Failure

Years

Qua

lity o

f Life

= utopian = natural course

= ACE-I, ß-blockers, ASA, (Statins,ARBs)

Full Health

Death

Latest Advances in Valve Disease

Latest Advances in Valve Disease

Latest Advances in Valve Disease

• TAVI

• Physiologist led valve clinics

• Percutaneous mitral and tricuspid valve treatments

Conclusions

• Cardiovascular Disease is the largest cause of morbidity and mortality in the UK

• There are many effective treatments

• As well as emerging new treatments we also need to focus on multidisciplinary working and effective pathways