Risk assessment
A standard cholesterol result estimates risk across a population; it does not establish yours. The department counts the particles that cause arterial disease directly, measures the inherited factor that diet and statins cannot alter, and reads both alongside the inflammatory and metabolic state in which they act, so that risk is measured for the individual rather than inferred from the average. Where the family history warrants it, the genetic contribution is resolved with Genomic and precision medicine.
Cardiac imaging
Imaging is used to answer three questions that matter: whether disease exists, where it is, and whether it is progressing. The department uses advanced diagnostics to examine the structure and function of the heart itself. Every study is reported by a cardiac specialist radiologist or cardiologist, and surveillance is repeated at the interval at which the finding could have changed.
· Coronary arteries. Calcium scoring and coronary angiography on the Siemens NAEOTOM Alpha.Pro, with plaque quantified by composition and inflammation of the arterial wall analysed by Cleerly, since soft plaque is the plaque that ruptures and calcium scoring alone cannot see it.
· Heart structure and function. Echocardiography on the GE Vivid E95 with strain imaging, which detects impairment before conventional measures, and cardiac magnetic resonance imaging on the Siemens MAGNETOM Sola where tissue characterisation is required.
· Rhythm. Resting electrocardiography and ambulatory monitoring for up to fourteen days on the iRhythm Zio patch, which finds the rhythm disturbance a single trace misses.
Vascular assessment
Arterial disease often appears in the neck, the aorta and the legs before it appears in the heart, and each of those sites can be examined without radiation. The department assesses them as part of every cardiovascular evaluation, so that disease is found wherever it first shows, and follows the aorta over time where its size warrants surveillance.
· Carotid arteries. Plaque assessment by ultrasound on the Canon Aplio i800, where arterial disease frequently declares itself first.
· Arterial stiffness. Carotid-femoral pulse wave velocity on the AtCor SphygmoCor, the reference measure of vascular ageing and an axis of risk separate from cholesterol.
· Aorta and limbs. Aortic assessment and surveillance where an aneurysm or dilatation is found, and peripheral arterial assessment for the legs.
Lipid management
Treatment is directed by apolipoprotein B rather than by low-density lipoprotein cholesterol alone, prescribed to a target, and adjusted against results rather than at a scheduled review. Where statins are not tolerated, the department has the alternatives to reach the target without them. This includes treatment by lipoprotein apheresis using the Terumo Spectra Optia.
Blood pressure
Hypertension is the largest single modifiable cause of cardiovascular disease. The department diagnoses it by ambulatory measurement across twenty-four hours, including the overnight pattern that carries the greatest prognostic weight, investigates the secondary causes that account for a meaningful minority of cases, and treats it with a personalised plan.
Inherited cardiac conditions
Inherited cardiac conditions are among the few causes of sudden death that can be identified in advance and often can be treatable once identified. The department assesses them jointly with Genomic and precision medicine, including in families in which a sudden or unexplained death has occurred, and screens relatives who share the risk. Conditions that we diagnose and manage include familial hypercholesterolaemia, inherited cardiomyopathies, inherited arrhythmia syndromes and disorders of the aorta.
Cardio-oncology
Several cancer treatments injure the heart, and the injury is preventable or reversible when it is detected early. The department assesses cardiac function before cancer treatment begins, monitors it through treatment with imaging sensitive enough to detect change before symptoms, and manages what is found so that the cancer treatment can continue. Surveillance continues after treatment ends, since some effects emerge years later.
Performance assessment
Cardiorespiratory capacity is the single measure most strongly associated with how long and how well a person lives, and it cannot be estimated at rest. The department measures it directly under load and uses it to investigate symptoms that appear only on exertion, through Cardiopulmonary exercise testing with maximal oxygen uptake on the COSMED Quark CPET. The measured capacity and individual risk profiles are used to create strategies for preventive cardiac care, for athletes and for those who have never trained alike.
