We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Once in the haemodynamics room, the nurse will apply stickers connecting you to the electrocardiogram to monitor you at all times, and will check the IV line is working correctly to administer medication if required during the procedure. Next, the access site chosen by the haemodynamics specialist (either the groin or wrist) will be disinfected and covered with a sterile dressing. It is very important not to touch anything to maintain sterility and avoid infection, and you should keep completely still while the procedure is carried out.
A member of the unit’s nursing staff will be beside you throughout the procedure, and you may ask them any questions or let them know if you are uncomfortable in any way.
Possible access sites are the radial artery, femoral artery and humeral artery.
Arterial access has to be obtained via a small puncture of the skin so that a catheter that travels to the heart can subsequently be introduced. This is always done under local anaesthetic. Next, the artery is punctured and a small tube inserted which will provide access for the exploratory catheters. You may notice some discomfort or pressure in the puncture area, but it should not be painful.
Once the tube is in position in the chosen artery (usually the radial artery in the wrist), a catheter will be introduced (the narrow blue tube in the above photo) which will travel along the blood vessels until it reaches the heart, where the arteries that irrigate it originate. A radiopaque contrast substance will be injected into the same catheter, which will allow radiological images of the anatomy of your coronary arteries to be viewed on a monitor.
If no angiographic lesions are found: A report will be sent to your cardiologist, who will decide the treatment to be followed.
If angiographic lesions are found: If angiographic lesions are found during catheterization, a decision will be made as to whether they should be treated there and then, or whether discussion with your cardiologist is needed first in order to decide the most beneficial treatment. You will be told of the findings and decisions taken at all times.
Therapeutic catheterization.
When treatment is required for the angiographic lesions found, the specific material used in each case will depend on the type of coronary lesion to treat, the aim being to open it up and restore blood flow through the artery. You may notice some discomfort, and should inform the nurse of this so they can administer the necessary analgaesics to keep you comfortable.
If you have a stent implant, you will have to take specific medication, if this has not already been prescribed. You will be told the type of medication and how to take it in the haemodynamics unit and once you have been transferred for recovery, it will also be recorded in your discharge report so that both you and your cardiologist or GP are aware of it
Once the procedure has finished, a haemostatic compression device is applied to the puncture site. This performs conventional haemostasis by compression, which helps clotting and subsequent healing of the arterial wall. It is a non-invasive technique.
There are several types:
Elastic radial compression: A solid dressing is placed on the puncture site, held in place with elastic bandages which exert consistent pressure on the area. This bandaging should be worn for at least 4 hours and be removed by the Day Hospital or ward nurse, as appropriate. In any case, it should be worn for longer if the puncture site continues to bleed when the compress is removed.
Radial compression with a pneumatic device: This involves a plastic device held in place on the wrist with Velcro. An air chamber inflates, exerting consistent pressure on the insertion point. It should be worn for at least 4 hours and be removed by the Day Hospital or ward nurse, as appropriate. In any case, it should be worn for longer if the puncture site continues to bleed when the compress is removed.
It is normal for the thumb to go numb when using either of these devices. You can move your fingers and raise and lower your arm, but you should not bend your wrist under any circumstances. The wrist must be rested in the days after the catheterization and no sudden movements or lifting of heavy items should be attempted in order to help the radial artery heal completely.
The leg should not be moved until the bandages are removed 4-8 hours after catheterization depending on whether it was simply for diagnosis or if any coronary lesions have been treated. Movement should begin again gradually.
Percutaneous femoral closure device: This device puts a stitch in the femoral artery. You should rest and then begin to move again 4-6 hours after the procedure.
The arterial access tube is removed and firm pressure applied to the artery until bleeding stops, at which point bandage compression should be applied immediately. You should rest for 4-8 hours after the procedure and then start to move again gradually.
Once in the Day Hospital or ward, you may start to drink liquids, unless you are told otherwise by the professionals who looked after you in the haemodynamics unit. You may start to eat solid food two hours after the catheterization.
Once the catheterization has finished, you will be transferred back to the Day Hospital, where you will stay as long as necessary until the compression bandaging is removed and there is no evidence of bleeding or other complications. If everything is in order, the doctor will discharge you and you can go home.
If you have been admitted to hospital, the nurse will remove the compression bandaging after the requisite time, and will check the puncture site. They will also give you instructions on eating and drinking. Your cardiologist will talk to you about the process during your stay in hospital and the best treatment plan for you so that you can be discharged and go home as soon as possible.
Infectious endocarditis involves the presence of a microbial infection in the endocardial surface (internal surface of the heart). It is the most frequent cardiovascular infection and it is very important because of its potential severity and its different forms of presentation.
Infectious endocarditis mainly affects cardiac valves, whether natural or artificial, although sometimes it can occur in other structures of the heart.
It is classified according to the time the infection has been established (days, weeks or months) and according to the bacteria or microorganism (yeast, fungus) that causes it.
The characteristic lesion of infectious endocarditis is endocardial vegetation. It is made up of the completely abnormal presence of an aggregate of platelets, fibrin, bacteria and inflammatory cells that adhere to the internal surface of the heart, usually on the surface of a cardiac valve, and which is susceptible to breaking off, causing an infectious embolism at a distance in another organ (skin, nervous system, limb).
It is considered a serious illness and although in most cases it is cured, it also has significant complications and mortality despite treatment. In many cases, patients must be subjected to surgical intervention in order for it to be definitively cured, eliminating the affected tissue and inserting a new artificial heart valve.
In its most acute form infectious endocarditis can produce high fever, chills, prostration and severally affect the patient's general condition in a short time period (hours-days). In subacute forms it may evolve over weeks or months, with a clinical presentation of tiredness, lack of appetite and low-grade fever. In these cases, infectious skin manifestations may also occur as nodules or characteristic spots, which do not always appear.
In patients with severe cardiac valve involvement, the valves themselves may not function correctly, which may result in symptoms of heart failure such as severe shortness of breath and swelling of the lower limbs
Infectious endocarditis has a global incidence of 2-3 cases per 100,000 population per year, and so it is estimated that in Catalonia around 200 cases are diagnosed every year. Its incidence increases greatly with age, reaching 15-30 cases/per 100,000 population/year in over 65s, or 10 times higher than that of the younger population.
The cause of infectious endocarditis has changed a lot in recent decades. In recent years the most frequent causal bacterium has been streptococcus, especially a species called viridans. There is currently a great variety of causal agents, although staphylococci are the most frequent, followed by streptococci and enterococci. It is, however, advisable to note that any microorganism that circulates through the blood can adhere to a heart valve, especially if it has previous injuries or is an artificial valve.
The diagnosis of endocarditis is based essentially on:
- blood cultures to identify the bacterium that causes the infection and allow the most suitable specific antibiotic treatment to be chosen.
- echocardiogram that allows the endocardial vegetations typical of the disease to be located. It also informs doctors about the function of the valve affected and contributes significantly to assessing the need for surgical treatment in some patients.
- in some cases it is necessary to carry out other explorations (such as CAT or scintigraphy) to rule out the existence of peripheral embolisms, which are very common at the time of diagnosis or during the course of treatment of the disease.
The treatment of infectious endocarditis is antibiotic, but specifically targeting the microorganism that causes it. The doses are high and prolonged over time because the vegetations typical of the disease are not very vascularised and antibiotics must penetrate through diffusion from circulating blood. In patients who do not respond adequately to this antibiotic treatment or who have major valve damage as a consequence of the infection, it is necessary to assess the need for valve replacement surgery.
Blood cultures and echocardiogram, both at the time of diagnosis and to monitor the evolution of the illness.
When an alteration of a person's heart valve is recognised, antibiotic prevention must be administered before any dental or gum treatment is given, following specialised consultation.
Preventive measures must also be taken in the case of endoscopes, especially of the upper gastrointestinal tract (gastroscopy), with the antibiotic and guidelines indicated by the doctor.
This prevention is very important because the presence of bacteria in the blood, as a result of the intervention or exploration, carries a significant risk of infectious endocarditis.
The Inherited Heart Disease Unit is basically devoted to providing care. We have a team of two cardiologists, three interns and two nurses, one full-time and one part-time. This Unit addresses all myocardiopathies in general, and inherited cases in particular.
Myocardiopathies are diseases where the myocardium is weak, dilated or has some other structural problem. Often, the heart is unable to pump or work properly. In the case of inherited myocardiopathies, due to the fact they are often treated as part of uncommon diseases, specialist management is not within the scope of all clinical cardiologists. It requires specific treatment and involves specific technology.
The aim of the electrocardiogram is to determine any damage to the heart and the effects of medication and devices on the circulatory system’s main organ, as well as being very useful in detecting and analysing cardiac arrhythmias, acute episodes of coronary artery disease and myocardial infarction. It can also be used in preoperative examinations, especially in medium- and high-complexity surgery, if there are risk factors such as ischemic heart disease, diabetes, stroke, heart failure or renal dysfunction.
To carry out the test, the healthcare professional connects the wires of the electrocardiogram to the skin of the patient using adhesives or suction cups called "electrodes", which are connected to the ankles, wrists and chest in order to detect electrical impulses from different parts of the body.
During the electrocardiogram, the patient must be lying down, relaxed and silent, with normal breathing and with their arms and legs still. Occasionally, the doctor may ask the patient to hold their breath for a few seconds.
The electrocardiogram records electrical activity from the surface of the heart, thanks to electrodes that are stuck to the body. This record of electrical activity is then copied onto paper that is then interpreted by a professional based on the patient’s symptoms and clinical history.
It is a simple, fast test that causes no discomfort or pain. It poses no risk to patients.
The acceptance of these terms implies that you give your consent to the processing of your personal data for the provision of the services you request through this portal and, if applicable, to carry out the necessary procedures with the administrations or public entities involved in the processing. You may exercise the mentioned rights by writing to web@vallhebron.cat, clearly indicating in the subject line “Exercise of LOPD rights”. Responsible entity: Vall d’Hebron University Hospital (Catalan Institute of Health). Purpose: Subscription to the Vall d’Hebron Barcelona Hospital Campus newsletter, where you will receive news, activities, and relevant information. Legal basis: Consent of the data subject. Data sharing: If applicable, with VHIR. No other data transfers are foreseen. No international transfer of personal data is foreseen. Rights: Access, rectification, deletion, and data portability, as well as restriction and objection to its processing. The user may revoke their consent at any time. Source: The data subject. Additional information: Additional information can be found at https://hospital.vallhebron.com/es/politica-de-proteccion-de-datos.