Cardiology

You will receive an appointment letter and text message notifying you of your clinic appointment. At the clinic visit you will be asked about your family history and their history of heart conditions. Please remember to bring along relevant medication lists, family information including any autopsy reports or clinic letters if appropriate, and details about your previous medical history.

Royal Free Hospital

The CIU at Royal Free Hospital provides a wide range of outpatient and inpatient clinical and diagnostic services that have a key role in diagnosing and treating heart conditions.

The CIU provides different investigations such as Echocardiograms, Stress Echocardiograms, Bubble and Contrast Echocardiograms, Transesophageal Echocardiograms, Electrocardiograms, Exercise Tolerance Testing, Ambulatory 24 hour ECG (Holter) and Blood Pressure monitoring and also pacemaker clinics/follow ups.

Barnet Hospital and Chase Farm Hospital 

The unit at our Barnet Hospital site is the main cardiac device implanting centre for the Trust.  The team implant a wide range of cardiac devices including Pacemakers, ICDs, CRT-Ds, CRT-Ps and ILRs. 

We also follow up cardiac device patients in regular face to face device clinics and we also have a very well-established remote monitoring service, where we can carry out cardiac device checks remotely via monitors in patients’ homes.

At Barnet Hospital and Chase Farm hospital, our diagnostic departments provides different investigations like:

• Echocardiograms
• Stress echocardiograms
• Bubble and contrast echocardiograms
• Electrocardiograms
• Exercise tolerance testing
• Ambulatory 24 hour ECG (Holter) and Blood Pressure monitoring
• Pacemaker clinics/follow ups.

Our rapid access chest pain clinic (RACPC) provides prompt specialist assessment for patients with chest pain that suggests angina, and for patients not currently under a cardiologist who have known ischaemic heart disease (a previous percutaneous coronary intervention — PCI, or coronary artery bypass graft — CABG) and have experienced a recent increase in symptoms of chest pain.  The service is available at Royal Free hospital, Edgware Community Hospital and Barnet and Chase Farm Hospitals.

The RACPC service aims to see all patients for outpatient assessment within four weeks of being referred.

The service provides:

• assessment for suspected angina (including diagnostic cardiac investigations)
• treatment to relieve symptoms and reduce risk
• information on treatment options/modifiable risk factors

Patients with suspected myocardial infarction (MI) or acute coronary syndrome should be sent directly to the emergency department (A&E). 

We run clinics at different sites within our trust. Each clinic is run by cardiac specialist nurses and is supported by our clinical lead consultant.

Please note, this is a nurse-led clinic. Patients requesting to be seen by a doctor only will need to be referred to the general cardiology clinic. 

Clinic locations

Royal Free Hospital

Clinic six, first floor.

The Cardiac rhythm management (CRM) team care for patients with a variety heart rhythm disorders or arrhythmias. Possible treatments include lifestyle changes medications, procedures, and implantable cardiac devices.

The Royal Free London CRM team includes consultant cardiologists, arrhythmia nurse specialists, cardiac physiologists, and cath lab nurses. They provide a variety of services, including:

• arrhythmia clinics
• diagnostic testing
• DC cardioversions
• ablations
• device implants
• pacing clinics.  

Our inherited cardiovascular conditions service (ICC) provides specialised care to patients and families affected with inherited cardiovascular conditions. It is part of the North Thames Genomic Medicine Service Alliance.

We are a multidisciplinary team and work in close partnership with the Clinical Genetics and Genomics Laboratory of the Royal Brompton Hospital, and the ICC multidisciplinary team at Barts Heart Centre. Our service also has close clinical and academic links with University College London, and other adult inherited cardiac conditions services in London and the UK.

Our service offers weekly dedicated cardiomyopathy clinics supported by integrated heart rhythm and heart failure services, with close ties to the Royal Free National Amyloidosis Centre.

We provide specialised management advice on risk stratification for sudden death, cardiac device implantation and other invasive procedures, some of which take place at Barts, our partner site.

We are supported by state-of-the-art cardiac imaging services, including echocardiography, cardiovascular magnetic resonance, computerized tomography and nuclear imaging. We also provide genetic counselling services and offer genetic testing according to the specifications of the national genomic test directory provided by the NHS Genomic Medicine Service.

The Unit actively recruits into large multicentre observational studies and clinical trials with the aim of improving the diagnosis and care of patients with heart muscle disease.

There is a fully integrated cardiology department at Barnet Hospital, with most of our doctors working across the Royal Free Hospital and Barnet Hospital. This ensures standardisation of practice. 

Barnet Hospital has a seven-bed coronary care unit (CCU) and a dedicated cardiac ward (Rowan), with separate areas for men and women. 

There is a cardiac investigation unit (CIU) offering non-invasive cardiac imaging, outpatient diagnostics (such as Holter heart monitors and blood pressure monitors) and pacemaker services.

There is also a nuclear cardiology service which undertakes a large volume of functional, nuclear perfusion scans each year. 

The cardiac rhythm management (CRM) service is based at Barnet Hospital. This includes outpatient clinics and pacemaker interrogation and programming.

All invasive CRM procedures are undertaken at the hospital's cath lab, including insertion of permanent pacemaker systems, complex devices including cardiac defibrillators and cardiac resynchronisation therapy (CRT), and electrophysiology diagnostics and ablation. 

There is also a large heart failure service based at the hospital, including a team of clinical nurse specialists who run clinics and manage patients on the ward.

Virtual wards have been introduced for heart failure and atrial fibrillation patients, whereby patients are monitored remotely to enable them to be either discharged early from the ward or avoid coming into hospital at all. 

There is a cardiac rehabilitation team based at the hospital, which works with patients who have had a heart attack or have undergone cardiac surgery, helping them build up levels of exercise and confidence following their illness.

Chase Farm Hospital is a key outpatient hub for our service in Enfield.

A large range of cardiology clinics and outpatient services are run from the hospital, including a cardiac investigation unit (CIU) which undertakes echocardiography and other diagnostics and pacemaker programming.

It is also the site for other one-stop services including rapid access chest pain and heart failure.

Cardiac rehabilitation services are also located at Chase Farm Hospital.

The cardiology unit at the Royal Free Hospital comprises a seven-bed coronary care unit (CCU) and a designated cardiology ward (20 beds).

There is a dedicated diagnostic department providing a full range of non-invasive investigations, two cardiac catheter laboratories and a day case coronary interventional unit (10 beds). 

The Royal Free Hospital is one of London’s seven dedicated heart attack centres, providing 24/7 on-call emergency services for patients who have had a heart attack.

It has the largest standalone percutaneous coronary intervention (PCI) site in London. It carries out around 1,500 invasive procedures per year, including diagnostic angiography and stenting of blocked coronary arteries. 

Patients at the Royal Free Hospital have access to state-of-the-art technologies, including advanced intra-coronary imaging and adjunctive therapies — these include ‘shock-wave’ therapy for heavily calcified and diseased vessels, which helps make treatment effective and achieve the best possible results. 

Patients who attend as day cases are treated in a dedicated day interventional unit, which includes a lounge to encourage patients to move around after their procedure.   

There is a large cardiac imaging facility, providing access to the latest technology and a wide range of different diagnosis and treatment options, including 3D echocardiography, transesophageal echo, cardiac MRI (magnetic resonance imaging), cardiac CT (computerised tomography) and nuclear perfusion imaging.

There are several specialist cardiology clinics available: 

• rapid access chest pain
• pulmonary hypertension
• resistant hypertension
• one-stop valvular heart disease
• heart failure 
• carcinoid heart disease
• amyloidosis
• obstetric cardiology
• adult congenital cardiology
• cardiology psychology service

There is also a nurse-led acute chest pain service and a cardiac rehabilitation programme, which helps patients who have suffered a heart attack or undergone cardiac surgery to build up levels of exercise and confidence following their illness.

Finchley Memorial Hospital has been developed as a community diagnostic centre as part of NHS England’s drive to expand the availability of diagnostic tests.

The service includes a range of outpatient diagnostic tests, including echocardiography, Holter heart monitors and blood pressure monitors.

There are also one-stop community clinics at the hospital, where patients can have their test and see a hospital consultant on the same day, to speed up time to diagnosis and treatment.

Referrals to the cardiology team can be made via a GP or hospital doctor. Patients cannot be seen without an appointment.

Electronic referrals from a GP are made through the NHS e-Referral Service. Tertiary referrals (from other hospital consultants) are also available.

A referral from your GP will not automatically lead to an outpatient appointment at one of our hospitals. Referrals to the cardiology team are reviewed by a clinician and then one of the following happens:

1. You will receive an outpatient appointment at one of our hospitals.
2. You will receive an appointment for a test or an investigation before your first outpatient appointment. 
3. You and your GP will receive a letter explaining how best to manage your symptoms. This is if one of our clinicians has reviewed your symptoms and does not think you need to attend an outpatient appointment.

More information about what to expect when you are referred to the Royal Free London can be found on our outpatient page.

If you have any questions about your referral, please email rf.cardiocasenquiries@nhs.net.

• www.cardiomyopathy.org
• www.bhf.org.uk/informationsupport/support/inherited-heart conditions
• http://guardheart.ern-net.eu
• http://theaicc.org
• https://www.bhf.org.uk/informationsupport/tests/genetic-testing
• https://geneticalliance.org.uk/information/service-and-testing/benefits-and-risks-of-genetic-testing/