How to donate to Bristol CardioVascular
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Cardiovascular disease remains one of the most serious medical challenges society faces. The World Health Organization estimates that more than 17 million people worldwide die of cardiovascular disease each year, accounting for 30 per cent of all deaths worldwide. In the UK, cardiovascular disease kills over 160,000 people each year.
More than 2.3 million people in the UK are living with some form of coronary heart disease, more than 500,000 are living with heart failure, and 1.3 million have had a stroke. The potential benefits to society of discoveries in cardiovascular science are enormous.
Bristol CardioVascular is at the forefront of integrated, cross-disciplinary research in this field. Research undertaken by Bristol CardioVascular increases understanding of the role the cardiovascular system plays in health and disease, and fosters a culture of knowledge-sharing across disciplines. Expertise within the unit benefits patients in the short term by advancing diagnostic and surgical interventions, and in the long term by training the next generation of leading scientists and academic clinicians.
If you would like to support BCV's research, please go to the Development and Alumni Relations' Office Give Now page. Choose the "Bristol CardioVascular" option from the designation drop down list. Alternatively you can donate by telephone on +44 (0) 117 39 41046.
Clinical donations can be done via Above and Beyond. This registered charity raises funds for all nine of Bristol’s central hospitals, investing in projects that make a real difference to patient care and enabling patients, their families and friends to say thank you for the care they’ve received. For more information, email firstname.lastname@example.org, or telephone +44 (0) 117 927 7120.
Case Study (1): Novel interventions to protect children’s hearts during surgery at the University of Bristol
Clinical Problems with Congenital Heart Disease
Every day in the UK a dozen babies are born with a heart defect, accounting for more anomalies than combined figures for limb defects, facial problems such as cleft palate, and respiratory problems. Congenital heart disease, the term that describes a problem with the heart’s structure and function due to abnormal development before birth, affects approximately 1% of live births and remains the primary cause of death from congenital diseases among infants in North America and Europe. The 2009 WHO annual report puts the disability-adjusted life year (a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death) for congenital heart disease higher than diseases such as diabetes or hypertension. Additionally, congenital heart disease represents an array of complications, some of which can be very serious and may require more than one surgical intervention. Multiple operations are usually needed to change grafts and implants and fit new ones as babies grow up to become adults. An example of this pathology is Tetralogy of Fallot, a congenital heart defect where the babies are born cyanosed (blue baby syndrome, due to lack of lack oxygen). In these patients, second or third operations are performed well into adulthood. In fact, there is an increasing population of adults who were born with congenital heart disease, estimated at 200,000 in the UK.
Cardiac Surgery & Cardiopulmonary Bypass
Open heart surgery is the main route to correcting and reducing the symptoms of congenital malformations in young children. This intervention usually involves the use of a bypass machine that enables the surgeon to operate on a bloodless and quiescent heart. However, the procedure itself is associated with significant cardiac injury. This is largely due to the fact that blood is diverted away from the heart, thus reducing its oxygen flow (ischaemia) and making it vulnerable to the damaging effects of re-introducing blood (reperfusion injury). Additionally, the use of the cardiopulmonary bypass machine (bypassing and isolating heart & lungs) is associated with a significant inflammatory response and a reduction in the capacity of the tissue to repair itself. This also contributes to cardiac injury and other organ (e.g. kidney) dysfunction.
Why Is Cardiac Injury Critical?
Following cardiopulmonary bypass, a special solution (known as cardioplegia) is infused into the heart arteries (coronaries) in order to stop the heart. Stopping the heart helps in preserving and delaying the loss of important molecules that are used for energy production in heart cells (metabolites). However, this effect is time dependent and the longer the surgery takes, the greater the danger of ischaemia. Pioneering research from Bristol has provided evidence showing that post-operative complications are dependent on the length of ischaemia and associated injury. Cardiac injury is a major problem, as the heart does not regenerate very easily. Furthermore, areas of dead heart cells can disrupt the electrical activity leading to heart rhythm abnormalities which can be fatal. The damaged heart can remodel in a way that can reduce its long term function.
Interventions to Help the Heart and Reduce Injury
Over the last 20 years work has been undertaken by the team in Bristol to help protect children’s hearts against injury during surgery. A variety of interventions have been tested, including the use of low operating temperature (hypothermia). Despite these advances however, protection remains minimal and more translational work is under way to test a very exciting new intervention (see below).
The Bristol Paediatric Cardioprotection Team
Professor Saadeh Suleiman, a cardiac physiologist, and Professor Massimo Caputo, a consultant paediatric surgeon, have joined forces with Professor Robert Tulloh, Consultant Paediatric Cardiologist, to understand how different congenital anomalies affect and remodel the growing heart. More importantly, they are involved in the design and testing of novel cardioplegic interventions that can be optimised for different congenital cardiac diseases.
The team also includes colleagues from other disciplines (anaesthesia, veterinary medicine and basic science) and all complement each other and provide the needed expertise for clinical, translational and basic science research.
In addition to the clinical trials there is currently a translational study that has the potential for providing significant protection during surgery-
Ongoing Translational Research
We recently found that a drug commonly used in children to treat high blood pressure in the lungs can strongly protect newborn hearts by inhibiting a key cardiovascular enzyme (phosphodiesterase5A, or PDE5A). We are presently testing this in clinical trials in adult patients. The drug, now available intravenously, will allow us to test its cardio-protective efficacy during children’s heart surgery compared to the more traditional bypass method.
Case Study (2): High blood pressure research at the University of Bristol
What goes up normally comes down
This is normally true except when it comes to high blood pressure (or hypertension). If you ask your doctor what causes high blood pressure the answer will be that in 95% of cases it remains unclear. This is called primary or essential hypertension.
The statistics for high blood pressure are impressive for all the wrong reasons. 1 billion people worldwide have high blood pressure – it is a true pandemic and it is estimated that this will increase to 1.25 billion by 2025. One in four adults in the UK have high blood pressure and around 50% of patients taking medication do not have blood pressure controlled to correct levels.
Clinical problem with high blood pressure
High blood pressure is asymptomatic. This causes a huge problem clinically: patients are unaware of their condition or they may be aware but do not take medication because there is seemingly no adverse problem. But high blood pressure is the world’s biggest killer, causing: stroke, heart failure, irregular beating of the heart, kidney disease and blood clotting. This costs the NHS over £2 billion per year in patient treatment and care.
There is an urgent medical need to understand why high blood pressure develops and design new ways to combat it. Remarkably, around 10% of patients with high blood pressure are resistant to current therapy. Many patients cannot tolerate their blood pressure medicine due to the side effects of the pills. Finding new medications and treatments are urgently required especially since we have not had a new safe high blood pressure pill for over 20 years.
The Bristol High Blood Pressure Team
Professor Julian Paton from the University of Bristol, a cardiovascular physiologist, and Dr Angus Nightingale, a consultant cardiologist at the Bristol Heart Institute, have joined forces to discover new ways to treat high blood pressure. Their approach is to take fundamental knowledge from studies on animals and to use this to guide possible new approaches in people. They believe that the brain is to blame for high blood pressure. Their strategy is scientifically grounded and wholly translational into patients. They have built an integrative team of scientists and clinicians who uniquely work together:
- Dr Amy Burchell (cardiologist)
- Dr Emma Hart (British Heart Foundation Fellow)
- Dr Katrina Hope (anaesthetist)
- Dr Wioletta Pijacka (research scientist)
- Dr Laura Ratcliffe (nephrologist)
Specialist Hypertension Clinic
A new Specialist Hypertension clinic at the Bristol Heart Institute has been set up for patients with heard to treat high blood pressure. This new clinic, which has been approved by the British Hypertension Society, sees patients from all over the country. Numerous clinical trials are running that are testing novel strategies to lower blood pressure in patients with drug resistant high blood pressure. Two of these trials are described below.
Ongoing Clinical trial within the University of Bristol and Bristol Heart Institute
Imagine a fire breaks out at work and the fire alarm bell goes off. What do you do – you leave the building as fast as you can and do not enter until it is safe to do so. Within our bodies there a comparable system. It detects a vital ingredient for life – oxygen in our blood. This system “screams” signals to the brain which responds by putting blood pressure up. It does this to ensure that there is enough pressure within the circulation to ensure blood flow into your vital organs - the heart but, most importantly, the brain.
The high blood pressure team have found that the small organs that detect blood oxygen (called carotid bodies, about the size and colour of a red current) become over- active in patients with high blood pressure and trigger alarm bells ringing. Unlike the fire alarm which eventually goes quiet, the carotid bodies generate alarm signals continuously and in doing so trigger high blood pressure. But what can be done?
The team have discovered the mechanism by which the alarm is triggered. More importantly, they have developed a collaboration with a small company that have a medicine that can turn the alarm signalling off but most importantly does not completely disconnect the alarm system allowing you to detect low oxygen when you need to: such as during breath holding under water or at high altitude.
The new medicine is going to be tested in a population of patients with high blood pressure and with carotid body alarms ringing. This trial is due to start in February 2016. Professor Paton said: “We may be on the verge of finding a new treatment for high blood pressure. Given we have not had a new anti-hypertensive drug for over 20 years this is hugely exciting. It’s gratifying too as our novel approach is based on scientific findings we started making in 1984. It could assist in the management of high blood pressure and gives patients and clinicians renewed hope for controlling blood pressure more effectively”.