Conventional hospital cardiological clinical care is located on the 11th. floor of the main hospital tower. A medical team made up of three specialists, together with residents in Cardiology and other specialities, plus the nursing and nurse assistants teams work there. The annual number of patients admitted is approximately 2,100, mostly due to infarction, angina, heart failure and alterations in cardiac rhythm.

HF is a pathology that occurs when the heart is unable, for whatever reason, to expel as it should the blood that arrives in each cardiac cycle . It is a pathology with a very high mortality rate and prevalence of associated diseases.

The German Trias Hert Failure Unit was created in 2001 in response to the high number of HF patients and the difficulty many of them have living with it and getting the proper treatment. This is a truly multidisciplinary unit where cardiologists, Internal Medicine specialists, family doctors, geriatricians, rehabilitation doctors, psychiatrists, nephrologists, dietitians, social workers and specialized nurses work together.

From the start, the Cardiology Service has opted for treating acute myocardial infarction (AMI) by performing an emergency coronary angioplasty (PCAP or Primary Angioplasty) in the Hemodynamics and Interventional Cardiology Unit. Briefly, this procedure consists of introducing a catheter through the arteries to reach the heart to be able to quickly unclog the clogged coronary artery.

Thus, a thorough protocol of action was designed, and in 2007, the 24- hour, 365-day care system was implemented. In 2010, this protocol was extended all over Catalonia (Code Infarction or Code AMI), and Germans Trias became the pilot centre and today is part of the technical monitoring committee.

The idea is to improve coronary artery condition by means of the so-called stents, a type of small device placed inside the arteries through a catheter to keep them from clogging. It is all done under control with intravascular radiological images at the d' Hemodynamics and Interventional Cardiology Unit .

In 2002, a pioneering programme to access the heart with these catheters through the radial artery, i.e., from the wrist rather than the groin, was started in Catalonia. The programme refers both to diagnostic and interventional coronary procedures.

Access through the radial artery implies a significant decrease in vascular complications and improved patient comfort. There are studies that show that it may even reduce mortality, and it makes it possible to avoid hospitalization. Currently, over 90% of these procedures are done this way.

In the last few years, percutaneous treatment of structural cardiopathy (introducing a catheter through the arteries to reach the heart) in its multiple disciplines has experienced enormous growth:

• Interauricular communication closure
• Permeable oval foramen (anomalous communications between the different heart chambers)
• Ductus
• Periprothesic leaks
• Flap closing
• Valvuloplasties
• Valve prosthesis implantation

The Cardiology Service, together with the Nephrology Service, treats refractory arterial hypertension (resistant) by means of denervation (ablacion) of kidney arteries with a radiofrequency catheter.

The Germans Trias has been a pioneer in pacemaker implantation by cardiologists, starting in 1988. Currently, the Electrophysiology and Cardiac Stimulation Unit implants all kinds of cardiac stimulation devices:

• Single and dual chamber pacemakers
• Cardiac resynchronization therapy
• Implantable automatic defibrillators (IAD)
• Subcutaneous IAD
• Soon, wireless pacemakers

It currently does in-person and remote monitorization of over two thousand patients carrying these types of devices.

The first electrode extraction of implanted devices was done in 1993. Since 2011, this is systematically done percutaneously (without surgical incision). Currently, the Cardiac Electrophysiology Unit has extracted over two hundred wires with excellent results.

At the Electrophysiology lab, electrophysiology studies and ablation catheter treatments for all kinds of arrhythmia are done:

• Paroxysmal supraventricular tachycardia
• Auricular flutter
• Auricular fibrillation
• Ventricular tachycardia

To that end, the most advanced techniques are used, including irrigated tip catheter ablation, 3D guided electroanatomic mapping, focal cryoablation and cryoballoon.

• Transthoracic and transesophagial ultrasound, pharmacological and physical stress test, 3D imaging, intraoperatory echocardiography
• Cardiac Magnetic Resonnance with anatomical, functional and perfusion studies
• Cardiovascular functional tests
• Nuclear Medicine studies

More information on the web icor.

With over 800 annual admissions, the Germans Trias Coronary Care Unit is the reference centre for cardiac emergencies (especially those requiring specialized or complex diagnostic techniques or treatments) in the healthcare system of the Northern Barcelones and Maresme, servicing almost 800,000 people.

As part of the Code Infartion programme for emergency infarction care of the Health Department of the Generalitat de Catalunya, the unit is the continuous care centre for this region, open 24 hours, 7 days a week.

The Cardiology Service specialists of the Germans Trias Hospitals see patients:

• at the hospital itself.
• At the Doctor Robert Specialized Care Centre in Badalona
• At the Doctor Barraquer Specialized Care Centre in Sant Adrià de Besòs

Consultation for diagnosis, treatment and control of specific diseases or medical conditions:

• Several types of myocardiopathies (hypertrophic, Chagas, etc.)
• Arrhythmia-syncope
• Valvulopathies
• Patients who are candidates for percutaneous prostheses implantation (TAVI)
• Aorta pathology
• Congenital adult diseases
• Pericardial pathology

The purpose of this committee is to promote excellence in diagnosis and minimally invasive treatment of structural cardiopathies. In other words, if possible, by means of percutaneous treatment and without surgical incision, which has grown expotentially in the last few years.

The complexity of planning and carrying out these procedures require a multidisciplinary approach, and the committee is working along this line.