Department of Cardiology

Health care is provided in accordance with the latest findings of medical science, based on evidence-based medicine, and according to the concept of the Ministry of Health of the Slovak Republic in the field of cardiology. The Department of Cardiology cooperates with other departments and specialties, such as anesthesiology and intensive care, emergency pre-hospital and initial hospital care, general internal medicine, angiosurgery, and radiodiagnostics.

The Department of Cardiology at Nitra University Hospital has a total of 57 beds, including 9 acute-intensive care beds and 12 beds for interventional cardiology.

30 physicians work at the department, including:

• 7 cardiologists

• 3 endocrinologists

• 7 internists

• 2 angiologists

Department Structure

• ICU – coronary unit, arrhythmias, and cardiac pacing section
  (acute cardiology department – 9 intensive care beds)

• Standard care inpatient section

  • men’s ward: 24 beds, including 12 interventional cardiology beds

  • women’s ward: 24 beds, including 1 premium room

• Non-invasive cardiovascular diagnostics section

• Interventional cardiology section

Premium accommodation

Patients have the option of staying in a premium room equipped with private bathroom facilities, TV, refrigerator, and microwave. The fee per night is €30.

The Standard Inpatient Care Section provides comprehensive hospital diagnostic and nursing care for patients with cardiovascular diseases requiring hospitalization. It is a facility with 24/7 operation. It utilizes the services of other sections of the clinic and cooperates closely with them. Acute cardiac conditions are admitted for hospitalization directly within the immediate catchment area of the facility, or as transfers from other departments and healthcare facilities – by arrangement. Patients whose health condition does not require immediate hospitalization are placed on a waiting list and are invited for hospitalization according to the queue. Our cardiology facility was mainly oriented towards non-invasive cardiovascular diagnostics and conservative treatment of cardiovascular diseases. By initiating interventional cardiology methods (coronary angiography, coronary angioplasty, and primary coronary interventions, neurological intervention program), we are supplementing the spectrum of procedures in this area of professional services, and the perspective is the development of interventional cardiology in a 24/7 operational mode. It should be emphasized that non-invasive diagnostics and conservative treatment apply to all cardiovascular diseases, including acute coronary syndromes. Many patients with acute coronary syndrome are hospitalized at our clinic immediately after examination in the emergency department. And imaging methods, including examinations used for risk stratification, are an essential part of our diagnostic process. Thanks to long-term cooperation with radiologist colleagues specializing in cardiovascular diagnostics from Jessenius s.r.o. Nitra, we have a wide range of non-invasive examination methods at our disposal, which allow us fast and accurate diagnosis of cardiovascular diseases. Among the examinations, I would like to mention CT coronary angiography used in the diagnosis of chest pain. Calculation of the Ca score, which also provides information regarding the patient’s prognosis. In the case of intermediate (borderline stenoses), we also have cFFR available. In the future, the spectrum of CT examination methods is to be expanded to include the assessment of AS (atherosclerotic) plaque stability. Another modality is magnetic resonance imaging (MRI). We use this in the diagnosis of myocarditis, cardiomyopathies, and myocardial viability. Contrast MRI examination using a contrast agent – gadolinium chelate, helps us recognize scars after myocardial infarction and infiltrative cardiomyopathies. In the case of borderline stenoses, stress MRI examination is also available. Doctors from our facility also participate in stress diagnostics, as it is necessary that, in addition to the radiodiagnostician, a clinician skilled in the management of arrhythmias, which are the most feared complication of this type of examination, is available for this type of examination.

The ward – men’s and women’s section, serves to continue the comprehensive diagnostic and treatment process of patients who are stabilized, but require medical resolution of their health condition. During their stay in the ward, patients undergo, in addition to the necessary cardiological examinations, other examinations according to medical indication, e.g., sonography of the abdominal cavity, arterial and venous system of the lower limbs, ultrasound examination of the thyroid gland, endoscopic examination of the digestive tract, CT or MR examinations of various organ systems. Our goal is a holistic approach to every single patient and personalized medicine, where the diagnostic and treatment process is “tailor-made” for the given patient.

ICU – coronary unit, arrhythmias, and cardiac pacing section is a 24/7 facility providing acute care for patients with severe acute cardiovascular impairment requiring comprehensive acute cardiological care, including monitoring of vital functions. The section ensures the possibility of defibrillation, cardioversion, urgent temporary pacing, implantation of long-term pacemakers, invasive and transesophageal electrophysiological examination, and invasive examination and monitoring of hemodynamics.

Together with other sections of the clinic, it ensures comprehensive cardiological diagnostics and treatment.

Invasive and semi-invasive methods:

• Temporary transvenous pacing
• Implantation of permanent pacemakers (single-chamber, dual-chamber)
• Implantation of long-term loop ECG recorders
• Invasive assessment and monitoring of hemodynamics
• Central vein punctures
• Electrical cardioversion of cardiac arrhythmias

We perform interventional cardiology methods (coronary angiography, coronary angioplasty, primary coronary interventions, neurological intervention program), so far only on an elective basis, with the perspective of 24/7 operation.

The Non-invasive Cardiovascular Diagnostics Section provides comprehensive non-invasive cardiovascular diagnostics. It has the following examination methods at its disposal:

Non-invasive examination methods:

• Echocardiography
• Transesophageal echocardiography
• Ultrasonography of peripheral vessels (venous and arterial system)
• Ultrasonography of the abdominal cavity
• Duplex Doppler examination of the arterial system
• Ultrasonography of the thyroid gland
• Bicycle stress ergometry
• Electrocardiography
• Ambulatory 24-hour ECG Holter monitoring
• Ambulatory 24-hour BP monitoring
• Transesophageal electrophysiological examination
• HUT (head up tilt table test)
• CT angiography, CT coronary angiography, MR examinations (note: in cooperation with the X-ray department)

Coronary Angiography

What is coronary angiography and why is it important?

This invasive diagnostic imaging is considered the gold standard in cardiology. It allows doctors to map the condition of your heart vessels (coronary arteries) with the highest precision. The procedure accurately reveals the presence, location, and severity of any narrowings or blockages.

Note: Coronary angiography itself does not treat your health problem. It serves as a necessary first step to determine the best further treatment plan.

How does the procedure work?

The procedure is performed by a specialized cardiology team in the sterile environment of an operating room.

1. Access route: The examination is performed by inserting a fine tube (catheter) through an artery. The artery in the right wrist or right groin is most commonly used.
2. Anesthesia: The puncture site (wrist or groin) is numbed with a local injection. The insertion of the catheter itself is painless after this step. The patient lies on their back during the procedure.
3. Navigation to the heart: The doctor carefully guides the catheter through the inside of the artery to the opening of the heart vessels.
4. Imaging of the arteries: A special liquid – a contrast agent, which is visible under X-ray radiation, is applied through the catheter. The doctor can thus see the exact anatomy and patency of your vessels on the screen. The injections are repeated from several angles and recorded.
5. Patient status: During the entire process, you are conscious, communicating with the staff, and can ask questions.
6. Duration: If no complications arise, the entire examination, including preparation, takes less than half an hour.

What happens after the examination? (Treatment options)

Based on the data obtained, the medical team, together with you, will decide on one of the three main treatment paths:

1. A) Pharmacological (conservative) treatment (“pills”)

This approach is chosen if:

• The finding on the vessels is less severe and does not require an invasive procedure.
• The finding is severe, but for technical reasons, no other solution is possible (complex vessel impairment).
• The patient explicitly wishes so after considering all options.

1. B) PTCA / PCI (Angioplasty with stent placement)

If the narrowing of the vessel is suitable for this type of procedure, the doctor will perform it.

• Procedure: Using a special balloon, the narrowed spot in the vessel is widened and a stent is inserted into it.
• Stent: It is a small, flexible mesh tube that keeps the vessel open and restores blood flow. Stents are often coated with a layer of medication that is gradually released into the vessel wall.
• When: If the situation allows, this procedure is performed immediately after coronary angiography during a single procedure. Other times it is planned for later and performed in multiple sessions.

1. C) CABG (Bypass – heart surgery)

This is a cardiac surgery procedure in which narrowed or closed spots are bypassed with another healthy artery or part of a vein (e.g., from the lower limb).

• Procedure: Surgery usually does not follow immediately. It is preceded by a complete examination of the health status and approval of the procedure at a cardiac surgery indication seminar.
• When: A bypass is recommended if the vessels are treatable but cannot be resolved by angioplasty (ballooning/stenting), usually with multiple affected spots.

Why must you agree to every option in advance?

Because before coronary angiography, doctors do not know what your vessel findings look like, they cannot determine the best procedure in advance. However, in order to examine you and, if necessary, intervene immediately (for example, insert a stent during a single procedure), they must have your consent for every possible solution in advance.

Why agree to a possible surgery (bypass) as well? Even if the surgery is not done immediately, consent is necessary. If the patient were to refuse the proposed surgery after the examination, it would mean that the coronary angiography (which is an invasive procedure with certain risks) was performed unnecessarily, because the finding could not be treated.

Preparation for the examination: What must you do?

• Food and fluids: You must not eat from the evening before the examination and you must not drink from the morning before the examination.
• Allergies: If you have a known allergy or hypersensitivity to medications, dust, feathers, or contrast agent, be sure to inform the doctor. You will be prepared with a special medication protocol before the examination.
• Local preparation: In the evening, you must thoroughly shave both groins.

Post-examination regimen: Your role in healing

For successful healing and prevention of complications, it is crucial to follow these rules:

• Stay at rest in bed: After the examination, you must lie on your back for 24 hours with a weight on the puncture site (most often in the right groin). Inconsistent adherence to this position significantly increases the risk of bleeding.
• Hydration: After the examination, you must drink a lot so that the body eliminates the contrast agent as soon as possible and the kidneys are protected.
• After PTCA (stenting): The regimen is the same, the 24-hour lying is counted from the time the introducer is removed from the groin (which is performed in the ward).

Complications and risks of the examination

Although coronary angiography is now a routine examination, it is an invasive procedure with certain risks:

• Common: A small bruise at the puncture site (wrist/groin), which usually resolves and does not restrict the patient.
• Less common: Larger bleeding into the subcutaneous tissue and the formation of a larger bruise (hematoma), which needs to be monitored.
• Rare: Damage to the vessel at the puncture site (in the groin).
• Exclusively rare: More serious complications (usually only in a very severe patient condition or other serious concurrent diseases).
• Other: The examination is associated with X-ray radiation (irradiation), to which the medical staff is also exposed in addition to the patient.

Do you have questions? If you have any uncertainties regarding your examination, we will be happy to answer them. Do not hesitate to ask before the start of the examination.

Cardiac Pacemaker

A pacemaker is a small medical device that helps control heart activity. It sends gentle electrical impulses to the heart to maintain a regular heart rhythm. It is used especially when the heart beats too slowly or irregularly.

Patients may experience various difficulties, such as fatigue, shortness of breath on exertion, weakness, dizziness, uncertainty when walking, or even short-term loss of consciousness. An ECG examination is necessary to confirm a rhythm disorder.

In some acute cases, temporary pacing is used. Electrodes are placed on the chest or inserted through a vein into the heart to stabilize the patient’s condition until a permanent solution is implemented.

How does pacemaker insertion work?
A permanent pacemaker is implanted during a procedure that usually takes 1 to 2 hours. Most patients are conscious and receive only local anesthesia. The doctor inserts thin wires (electrodes) through a vein into the heart and places the device itself under the skin, most often under the collarbone. After the procedure, it is checked whether the device is working correctly.

Types of Pacemakers

• Single-chamber – stimulates one part of the heart
• Dual-chamber – stimulates two parts of the heart (atrium and ventricle)

Modern devices can adapt to the needs of the organism, for example, by speeding up the heart rate during movement.

Risks and complications
Complications are rare. Infection, bleeding, or damage to surrounding tissues may occur. Most problems are well treatable.

Post-procedure check-ups
After implantation, it is necessary to go for regular check-ups. The doctor will check the function of the device, battery status, and heart rhythm. Check-ups are especially important before battery replacement.

Life with a pacemaker
Most patients can lead a normal life. However, it is recommended to:

• avoid strong impacts to the area of the device
• limit contact sports
• not use magnets near the pacemaker
• keep a mobile phone at least 20 cm from the device and use it on the opposite side of the body

Some devices (e.g., powerful electrical devices or magnetic resonance imaging) can affect its function. At airports, it is recommended to show your pacemaker patient card.

Before every medical examination or procedure, inform the medical staff that you have a pacemaker. Routine examinations such as X-ray, ultrasound, or CT are safe.

The clinic significantly participates in the teaching of students in full-time and part-time forms of study at the FSVaZ of the Constantine the Philosopher University in Nitra, in bachelor’s and master’s studies in the field of nursing and in bachelor’s studies in the field of emergency medical paramedic. Teaching aimed at high-quality theoretical and practical preparation of students, carried out in the inpatient and outpatient parts of the clinic, is led by qualified staff.

The goal of creating the Cardiology Clinic was to improve the quality of health care for patients with cardiovascular diseases in the region as well as in supra-regional scope. The cooperation of the Clinic with other medical-preventive components of FN Nitra, located in the FN premises, provides the prerequisites for meeting the most demanding criteria of quality medical-preventive care for patients with cardiovascular diseases in a comprehensive scope, with the exception of providing cardiac surgery services. At the same time, a base for the development of scientific research activities in connection with the Constantine the Philosopher University in Nitra was created.

The area code before the extension is 037 / 6545 + extension