Angina is the form of chest pain originatin from the heart. It can manifest in different ways, ranging from a dull ache to a sharp, stabbing sensation. It's essential to pay attention to associated symptoms, such as shortness of breath, nausea, or sweating. Especially in patients with diabetes, shortness of breath can be an angina equivalent. These could be signs of a heart-related issue. However, chest pain can also stem from gastrointestinal problems, muscle strain, or respiratory issues.Cardiac chest pain is typically related with a mismatch between oxygen demand and oxygen supply to the heart. Narrowing in the vessels supplying the heart (macrovascular) or a dysfunction of the small capillaries of the heart (aka microvascular dysfunction) are the most common mechanisms responsible of such mismatch.Most commonly angina is typically associated with or triggered by some forms of physical activities or intense emotional stressors. Though occurrence is possible also in resting conditions, hence it is usually wise to not underestimate it. How do interventional cardiology specialists work to diagnose and treat angina? Careful consultation and history taking combined with initial non-invasive assessments of the heart-blood-supply represent the first step when investigating the source of chest pain.Interventional cardiology plays a crucial role in uncovering and treating the mechanism of angina. This subspecialty involves minimally invasive procedures to diagnose and treat cardiovascular conditions. Invasive coronary angiogram, typically performed under local anaesthesia and sedation, from the wrist allows to explore the status of the major vessels supplying the heart (coronary arteries), but also to check on the status of the small capillaries of the heart via so called coronary physiology tests.In case of documented restrictions in the major vessels of the heart, the procedure can be completed, even within the same setting if technically feasible, with coronary angioplasty. What is a coronary angioplasty? In layman's terms, coronary angioplasty acts like a highway maintenance team fixing a blocked road. A small balloon is inflated in the narrowed artery, widening it to restore proper blood flow. In some cases, a stent, a mesh-like device, is placed to keep the artery open, preventing future blockages. Why is it important to seek medical advice promptly when experiencing chest pain? In matters concerning the heart, time is of the essence. If chest pain is suspected to be cardiac in nature, seeking medical attention promptly is crucial. Interventional cardiologists not only treat acute conditions but also contribute significantly to preventive cardiology. By educating patients about lifestyle modifications, managing risk factors such as hypertension and high cholesterol, and encouraging regular exercise, they aim to prevent future cardiac events.

Microvascular angina is a condition caused by dysfunction in the small blood vessels of the heart, known as the coronary microvasculature (< 500 micron in diameter; e.g < 1/1000th of mm!!). These vessels usually transport blood to the heart muscle, but in people with microvascular angina, the coronary microvasculature constrict and don’t function properly, limiting blood flow to the heart. The most common symptom of microvascular angina is chest pain, which is often described as a tight, heavy, or squeezing sensation. This pain may radiate to the arms, neck, jaw, or back. Other common symptoms also include shortness of breath and persistent fatigue, even without strenuous activity. These symptoms may come and go and can occur even when at rest. Microvascular angina is often linked to risk factors such as high blood pressure, diabetes, high cholesterol, and a family history of heart disease. Stress, obesity, and smoking can also increase the likelihood. Is microvascular angina the same as typical angina? Typical angina, also known as obstructive or stable angina, is generally caused by atherosclerosis, where plaques of fatty substances build up inside the larger coronary arteries, leading to blockages or narrowing. These blockages restrict blood flow to the heart muscle, resulting in pain during physical activity or emotional stress, which subsides with medications or after surgical procedures to clear the blockages. In contrast, microvascular angina occurs without visible blockages in the large coronary arteries. Instead, it’s related to dysfunction of the endothelium (the inner lining) in the small blood vessels, which prevents the vessels from dilating as needed. This reduced blood flow may not be easily visible on standard angiograms, as these imaging tests primarily focus on the larger coronary arteries. How is microvascular angina treated? Unlike typical angina, microvascular angina can’t be treated with procedures like angioplasty or stenting, as these directly relieve blockages in the larger coronary arteries. Instead, treatment for microvascular angina generally involves medication, lifestyle changes, and addressing risk factors. Medications commonly prescribed for microvascular angina include beta-blockers and calcium channel blockers, which reduce heart rate and the demand on the heart. Nitrates can help dilate and widen blood vessels, while statins are often prescribed to reduce inflammation. Lifestyle modifications are also essential in managing microvascular angina. Adopting a heart-healthy diet, engaging in regular physical activity, managing stress, and quitting smoking can significantly improve heart health and alleviate symptoms. For people with hypertension or diabetes, managing these conditions effectively is crucial to reduce the impact on the microvascular system. In some cases, a cardiac rehabilitation programme can provide structured exercise routines and support for making these lifestyle changes. Actual Interventions to address mirovascular angina are currently under evaluation, but initial promising results are coming for coronary sinus reducer implant. Can microvascular angina lead to heart failure or other complications Microvascular angina is less likely to cause a heart attack than typical coronary atherosclerosis, but it can still increase the overall risk of future cardiac events compared to average population. Over time, reduced blood flow in the small vessels can lead to chronic ischaemia, or insufficient oxygen supply to the heart muscle. This can weaken the heart’s ability to pump blood effectively, increasing the risk of developing heart failure. In addition, ongoing symptoms of chest pain, shortness of breath, and fatigue can lead to frequent visits to the hospital and interference with daily activities. These factors can contribute to anxiety, depression, and reduced quality of life. Long-term outcomes for people with microvascular angina vary. Medications, lifestyle adjustments, and regular monitoring can help to prevent symptoms from worsening and reduce the risk of further cardiovascular events. However, the chronic nature of microvascular angina means that symptoms may persist or recur, and ongoing management is required to keep the condition under control.

What is a coronary sinus reducer? A coronary sinus reducer is a small, hourglass-shaped device implanted into the coronary sinus, a large vein in the heart that collects deoxygenated blood. The purpose of this device is to create a controlled narrowing in the vein, which helps to redistribute blood flowwithin the heart redirecting oxygen   towards those regions affected by an impaired supply. This process can alleviate the symptoms of angina, providing relief for patients who have not responded to other treatments. How does the procedure work? The procedure to implant a coronary sinus reducer is minimally invasive. It is typically performed under local anaesthesia, which means you will be awake but your chest area will be numbed to prevent pain. After a very small incision is made on the right side of neck, and a catheter (a thin, flexible tube) is inserted into the jugular vein. The catheter is guided to the coronary sinus, where the reducer is then placed. The entire procedure usually takes less than an hour, and typically patients can go home the same day after a few hours of monitoring in hospital. Who is a candidate? This treatment is primarily for patients with refractory angina, which is angina (typically during physical activities – either strenuous or mild) that does not respond to standard treatments like medications or heart procedures such as angioplasty/stenting or coronary artery bypass grafting. If you have been experiencing persistent chest pain despite these measures, you might be a good candidate for a coronary sinus reducer. Your cardiologist will assess your specific condition and medical history to determine if this option is suitable for you. Benefits and risks The main benefit of the coronary sinus reducer is the significant reduction in angina symptoms, which can greatly improve quality of life. Many patients report being able to perform daily activities with less pain and discomfort. Like any medical procedure, there are associated risks. These may include bleeding, infection, or an adverse reaction to the anaesthesia. However, complications are rare, and the procedure is considered safe for most patients. The risk of coronary sinus reducer implant is definitely lower when it is compared with risk associated with first-line heart procedure to treat angina as coronary stenting or cardiac surgery with bypass. Aftercare and recovery Following the implantation, you will need to take it easy for a few days, avoiding strenuous activities. Your doctor will provide specific aftercare instructions and schedule follow-up appointments to monitor your progress. The response to the treatment is not immediate as the device elicits its effects on symptoms after a few weeks/months. Typically, a follow up visit is arranged within 6 months to establish whether there has been a response and whether medications to control chest pain can be reduced (and sometimes discontinued).

In simple terms, blood pressure refers to the force exerted by blood as it flows through your arteries. Like any closed system of circulating liquid, a certain pressure is necessary to maintain correct blood flow. Hypertension, or high blood pressure, occurs when these numbers consistently exceed normal levels, typically above 140 mmHg for systolic and 90 mmHg for diastolic. When your blood pressure is measured, your healthcare provider will consider two numbers: Systolic pressure This is the higher number and indicates the pressure when your heart contracts to pump blood. Diastolic pressure This is the lower number and reflects the pressure between heartbeats when the heart is at rest. Understanding Hypertension Why is hypertension concerning? Elevated blood pressure strains arteries, diminishing their elasticity and potentially causing damage to vital organs like the heart, brain, kidneys, and eyes. This heightened pressure increases the risk of severe conditions such as heart attacks or strokes. Hypertension is often termed a "silent killer" because it often goes unnoticed, lacking obvious symptoms until significant organ damage occurs. Regular blood pressure checks are crucial, particularly for individuals over 40 or those with underlying health issues like diabetes or heart disease. What causes hypertension? The precise cause of hypertension is challenging to determine, but it's believed that lifestyle choices, genetic factors, or existing medical conditions contribute to its development in many individuals. Certain medications, like oral contraceptives, can also elevate blood pressure, necessitating regular monitoring if you're using them. What is resistant hypertension? This occurs when blood pressure remains high despite lifestyle adjustments or appropriate medication. Reasons for this resistance vary, from difficulty adhering to medication regimens to physiological factors. Renal denervation may be considered for cases where traditional treatments fail to lower blood pressure adequately. Renal Denervation (RDN) Treatment Is renal denervation treatment suitable for me? Renal denervation (RDN) is typically recommended for individuals with uncontrolled moderate to severe hypertension who are already on multiple medications or have encountered adverse effects from most blood-pressure drugs. Your GP or consultant cardiologist will assess its suitability for you. Can I stop hypertension medications after RDN? The primary goal of renal denervation is not medication cessation but achieving optimal blood pressure control, crucial for reducing stroke or heart attack risks. While dosage or medication numbers may decrease post-procedure, success is also defined by improved blood pressure control, even if some medication continuation is necessary. Furthermore, RDN may offer the advantage of continuous blood pressure regulation compared to medication adherence variability. Are there potential complications? Renal denervation boasts a well-established safety record. Nonetheless, like any invasive procedure, complications are possible. Your cardiologist or GP can provide detailed information. Rare but serious complications include kidney injury or renal artery narrowing, reported in clinical studies at a rate below 0.5%. The most frequent side effect is bleeding at the catheter insertion site (groin), with no major bleeding complications reported in clinical studies. Bruising or hematoma at the entry point is common, causing discomfort for days to weeks post-intervention. However, it typically responds well to pain relief and resolves spontaneously. What is the duration of the procedure? The time taken can vary based on vascular anatomy, but typically, the procedure lasts approximately 60 minutes on average. Will I be conscious during RDN treatment? The procedure involves delivering energy to disconnect nervous fibres, which can be uncomfortable. Hence, it's conducted under local anaesthesia, analgesia, and deep sedation. Patients are usually unconscious but can breathe independently. Awareness levels vary, with most sleeping throughout. Will my blood pressure drop immediately? Your blood pressure won't drop right away after the procedure. It works by resetting connections between the brain and kidney, which takes time. Usually, you'll start seeing results in three to six months, though some may respond sooner. However, like any treatment, about 20% of people might not respond at all. We can't predict who will respond well in advance. How long does the blood pressure effect last? Based on current data, it appears to remain stable over time, supported by the observation that nerves around the renal arteries don't regenerate. The strongest evidence indicates a sustained blood pressure reduction for at least three years, with emerging data suggesting the effect may persist even longer. Oxford Renal Denervation Service For Hypertension

Dr. De Maria runs a private outpatient clinic exclusively at the Manor Hospital in Oxford. His Practice Manager coordinates appointments and procedures and can be contacted at +44(0)1865307461 or drgldemaria@gmail.com. Alternatively, you can fill the Book Appointment Form by Clicking below Book Appointment We recommend that you are referred by your GP (NHS or private), as they help coordinate your care and ensure they stay informed about your appointments, investigations, and procedures. Additionally, most insurance providers require a GP referral to authorize an outpatient appointment. However, if you are self-paying, a referral is not necessary. Once your appointment is booked, we will send you a written confirmation (usually by email) along with details of the expected fees.

When you arrive at Manor Hospital in Oxford, please check in at reception, where the staff will guide you to the Cardiology department. If you have any questions or need assistance, the reception team will be happy to help. Most patients will first undergo an electrocardiogram (ECG)—a quick and painless test that records the electrical activity of the heart. This is typically performed before your consultation. During your appointment, you will have a detailed discussion with Dr. De Maria about your symptoms, medical history, and any concerns you may have. This will be followed by a clinical examination to assess your heart health. In most cases, a transthoracic echocardiogram (TTE)—an ultrasound scan of the heart—will be performed during the same visit to provide further insights into heart function and structure. For some patients, additional tests such as a Prolonged ECG monitor or stress (treadmill) ECG if necessary can be arranged and performed straightaway on the day. Other tests as CT or MRI scan of the heart, as well as invasive procedures, if necessary, will be scheduled for a later date, depending on availability and your specific needs. Our goal is to ensure that your visit is as smooth and efficient as possible, with all necessary tests arranged promptly to aid in accurate diagnosis and treatment planning.

After your appointment, you will receive a detailed clinic letter, summarizing your discussion, key findings, and any test results available at the time. If certain results are still pending, don’t worry—he will write to you separately once they are available. For your convenience, we send all clinic correspondence via email if you have provided an email address. Unless you request otherwise, we will also share your results with your GP, ensuring they stay informed and can continue to support your care. If your test results require further explanation or discussion, a follow-up appointment—either in person or by telephone/telemed consultation—may be recommended to go through the findings in detail and address any questions you may have. Some heart conditions require ongoing monitoring, with check-ups every six months or a year. If this applies to you, rest assured that we will proactively reach out a month before your next follow-up is due, so you never have to worry about keeping track of your appointments. Our aim is to make your care as smooth, transparent, and reassuring as possible, ensuring that you always feel well-informed and supported.