The department if a clinical base for the scientific subdivision of the Department of Ambulatory Cardiology.
The Diagnostic and Consultation Center is a structural unit of Cardiology Research Institute, which provides highly qualified consulting, diagnostic, treatment, prevention, organizational, and methodical assistance in the ambulatory for the residents of the city of Tomsk and Tomsk region, who suffer from cardiovascular diseases.
Rules for referral of patients to the Diagnostic and Consultation Center of the Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences
The Diagnostic and Consultation Center accepts patients with referrals from primary care physicians and other specialized doctors from assigned medical organizations and with required preliminary examinations.
When referred to consultation visit in a framework of the Regional Program of State Guarantee of Free Medical Care in the territory of the Tomsk Region, patients have to present the following documents:
1. Passport or other identification document, birth certificate for children under 14 years of age.
2. Valid certificate of the mandatory medical insurance.
3. Referral from the medical institution (form No. 057/у-04).
The referral must bearing the stamp of the institution issuing the referral, signature, and seal of the specialist who gave the referral; apart from passport data of patient, the referral must show clinical diagnosis and objective of the referral (purpose of the consultation); if patient does not have ECG of if ECG data are older than 14 days, the objective section of the referral should additionally indicate the following: ECG registration (service code А05.10.006), description, and interpretation of ECG data (service code А05.10.004); issue date of the referral should be stated (the referral is valid for 30 days from the moment of its issue); information regarding patient on sick leave must be stated.
4. Patient chart or detailed abstract of outpatient medical record (medical certificate form 027/у) with minimum required examination (fluorography, ECG with description not older than 14 days, general blood and urine tests, blood glucose, cholesterol, and data of consultations of medical specialists if available), information on drug intake with specification of doses.
- Consultation of cardiologist;
- Consultation of pediatric cardiologist;
- Consultation of pediatric cardiologist-lipidologist;
- Consultation of pediatric cardiologist-arrhythmologist;
- Transesophageal echocardiography;
- Ultrasound of blood vessels;
- Ultrasound of internal organs;
- Treadmill test;
- 24-h monitoring of blood pressure;
- 24-h monitoring of ECG;
- Transesophageal electrocardiostimulation.
Indications for referral of patients for consultations to the Diagnostic and Consultation Center of Cardiology Research Institute.
- Condition after acute coronary syndrome within one year after suffering from it.
- Condition after coronary revascularization within one year after surgical intervention.
- Condition after implantation of frequency-adapting cardiac pacemaker within one year after surgical intervention.
- Condition after endovascular or surgical correction of arrhythmia without implantation of cardioverter-defibrillator within one year after surgical intervention.
- Condition after radical and hemodynamic correction of congenital heart diseases (septa, chambers, and conjunction of great vessels) within one year after surgical intervention.
- Conditions after surgical treatment of congenital, rheumatic, and non-rheumatic valvular diseases and cardiac tumors within one year after surgical intervention.
- Condition after surgical treatment of chronic heart failure within one year after surgical intervention.
- Condition after correction of valvular diseases in case of multiple valve prosthesis within one year after surgical intervention.
- Condition after endovascular correction of diseases of aorta and great arteries within one year after surgical intervention.
- Patients with post-infarction atherosclerosis complicated by the left ventricular aneurysm, high-grade heart rhythm disorders, and angina pectoris of high functional class.
- Patients with functional class 3 angina.
- Patients with newly diagnosed angina.
- Patients with refractory hypertension (patients with stably high blood pressure in the presence of three-component therapy with submaximal doses doe four months).
- Patients with suspected symptomatic arterial hypertensions.
- Patients with heart rhythm disorders.
- Patients with dyslipidemias.
- Patients with dilated cardiomyopathy.
- Patients with hypertrophic cardiomyopathy.
- Section, preparation, and referrals of patients with cardiovascular diseases for planned specialized care including high-tech medical care in Cardiology Research Institute.
Indications for referrals of patients with heart rhythm disorders to consultations:
1. Atrial fibrillation:
- Persistent atrial fibrillation (to restore sinus rhythm);
- Chronic atrial fibrillation lasting for less than two years without attempts to restore sinus rhythm;
- Paroxysmal atrial fibrillation with frequent and severe paroxysms (to select anti-arrhythmic therapy).
2. Atrial flutter:
- Chronic and persistent atrial flutter (to restore sinus rhythm);
- Paroxysmal atrial flutter (to select anti-arrhythmic therapy and to determine indications for surgical treatment).
3. Paroxysmal supraventricular tachycardia (including that in WPW syndrome) (to select anti-arrhythmic therapy and to determine indications for surgical treatment).
4. Paroxysmal ventricular tachycardia (to select anti-arrhythmic therapy and to determine indications for surgical treatment).
5. Frequent extrasystoles in the presence of severe cardiac pathology (to select anti-arrhythmic therapy).
6. Atrioventricular block degree 2–3, sinoatrial block, sinus rhythm failure, and sick sinus syndrome (to establish indications for implantation of cardiac pacemaker).
7. Complete right bundle branch block accompanied by heart failure (to decide question on advisability of cardiac resynchronization therapy).
8. Patients with implanted cardiac pacemakers (to check the work of cardiac pacemaker).
Indications for referral of patients with lipid metabolism disorders to consultation. Patients older than 15 years with the following signs may be referred:
- burdened anamnesis (the presence of relatives with early (<40 years) CAD, hypertension, and diabetes).
- Patients with CAD (all types of CAD including past coronary artery bypass grafting, percutaneous transluminal coronary angioplasty), hypertension, and external signs such as xanthoma and xanthelasma in individuals younger than 60 years;
- arcus adiposus in individuals younger than 60 years;
- pretibial edema;
- detection of hyperlipidemia without clinical signs.
Indications for referral of patients wo pediatric cardiologist:
- All newly detected congenital heart diseases
- Disorders of heart rhythm and conduction with deterioration of quality of life and/or abnormal hemodynamics
- Patients with implanted cardiac pacemakers
- Inflammatory heart diseases
- Pulmonary hypertension
Patients with increased cholesterol level (LDH of 5 mM/L and more in the absence of relatives with hypercholesterolemia or early CAD and/or 4 mM/L and more in the presence of parents with hypercholesterolemia or early CAD).
Hypertension (suspected symptomatic hypertension and/or the need for adjustment of therapy).
The presence of cardiovascular disease (if correction of management tactics is required).
Patients with cardiological symptoms of connective tissue dysplasia (if correction of management tactics is required).
Selection, reparation, and referral of patients with cardiovascular diseases for planned specialized and high-tech medical care to Cardiology Research Institute.
9 cardiologists, 1 pediatric cardiologist, 3 functional diagnostics specialists; 12 registered nurses, 1 specialist in medical statistics, 3 registrars, and 9 members of junior service personnel.