Dr. Nicholas Pegge : Cardiologist

• DR PEGGE: RESUME
• APPOINTMENTS
• CONTACT

• Symptoms
  • Chest pain: is it angina?
  • Breathlessness
  • Palpitations, arrhythmias and blackout
  • Heart Murmur
• Conditions
  • Coronary artery disease: angina and heart attack
  • Heart Failure and Cardiomyopathy
  • Heart Valvular Disease
  • Arrhythmias
  • Hypertension
  • Cholesterol and other risk factor management
• Investigations
  • ECG and heart rhythm monitoring
  • Echocardiography
  • Exercise treadmill testing
  • Cardiac MRI, CT and other scans of the heart
  • Cardiac catheterisation: coronary angiography
  • Electrophysiology investigations
• Treatments
  • Drug treatment for heart disease
  • Percutaneous coronary intervention: angioplasty and stents
  • Coronary artery bypass grafting
  • Valve replacement
  • Pacemakers, Defibrillators
  • Cardioversion and Ablation

Pacemakers have been around for a while now, and elective implantation of a standard permanent pacemaker usually occurs on Dr Pegge’s patients with one night in hospital, or in some cases as a day-case. The procedure is carried out under a local anaesthetic in the cardiac catheter lab, and follow up is through the dedicated pacemaker and device clinic in the Cardiac department at Worthing Hospital, where monitoring of the device is undertaken by Cardiac Physiologists.

Patients with weakened heart muscle are now recommended by NICE to be considered for primary protection from cardiac arrest by implantation of a defibrillator. This is similar to implantation of a permanent pacemaker, but can sometimes take a little longer.

An ICD is a complex device, and follow up is more involved; there is more potential for teething problems with these implants, but the benefits in increased life expectancy for the patients who require such devices is considerable. On average, one in every nine or ten patients who qualifies for a primary prevention ICD will have their life saved by that device within a couple of years. Dr Pegge implants ICD devices again in the cath lab at Worthing Hospital.

Patients with breathlessness from heart failure, and weakened, dilated hearts, and a certain pattern on the ECG (technically, left bundle branch block) may benefit from implantation of a cardiac re-synchronisation pacemaker (CRT) which may or may not also be a defibrillator. These CRT pacemakers stimulate both the left and right ventricle and are also known as Bi-Ventricular pacemakers - or Bi-Ventricular ICD.

Implantation takes longer than conventional pacemaker procedures - 2 or 3 hours can be needed, and occasionally, two procedures are required for this developing technology.

Benefits are considerable, and feedback from Dr Pegge's patients who have benefited from CRT indicates how CRT can transform the lives of some patients with severe heart failure. Not all patients are suitable for this technology.