Beating time

Luke Blair
By Luke Blair     29/09/2023


The noise of the heart monitor machine dominates the ward. There is a bright red phone amid the medical equipment and wires and tubes. A little religious icon hangs on the wall. There are quiet, purposeful conversations going on.

It’s a relatively quiet day in the St Thomas’ Cardiac Care Unit.

“Her heart rate is 130 but it’s not just the heart rate, it’s the irregularity,” the consultant says to his team. “She really needs an MRI scan but you would end up with an intermittent signal and be none the wiser.”

The team is gathered around a patient in her 50s. She was brought in with heart palpitations and shortness of breath and they are worried her heart will start to fail.

There are seven people engrossed in the issue. One of them is clutching a thick sheaf of notes, detailing all the tests and analysis done so far.

“Your heart is going quite quickly and you’ve got extra heart beats,” the consultant explains to the patient. “We need to get another expert team involved.”

The beeps continue...Patients may come here for ‘level 2’ critical care – that is, if they have a major issue with a single organ, in this case the heart.

That can mean they may be in the first stages of heart failure, or have actually had a heart attack and are recovering, or may have just come out of a heart operation, or other major procedure, and need close support and observation. Or they may be a bit of a puzzle, like our patient today.

In which case, the CCU is at the centre of a web of connections with different teams, all of whom have a different expertise to bring to bear, to get to the root of the problem.

Mostly, the patients in the CCU fall into three typical groups: those coming in due to a ‘STEMI/NSTEMI’, commonly called a heart attack, and so need a blocked vessel in the heart unclogging; those with ‘arrhythmia’ which is an irregular heartbeat; and adults with congenital heart disease – a problem with their heart which they’ve had since birth.

At a large hospital like St Thomas’, every associated team or procedure is on hand, from cath labs for unblocking arteries, to electrophysiology teams who study the electrical system of the heart.

It all makes for quite a varied intake. There are also teams who come to the CCU to assess a patient who needs more expertise and detailed tests to find out what exactly is wrong – like the one who is in today with the fast, irregular heartbeat.

There is only one other patient in the six-bed ward today – an unusually light load for the more than 20 staff. The high staff-to-patient ratio reflects the serious nature of those in the CCU.

“Most of our admissions are people who are acutely unwell.” The Charge Nurse says. “We probably get a dozen people a week who’ve had a heart attack. And sometimes we get patients deteriorating really rapidly for no apparent reason – that can be quite hard.”

That’s what the red phone is for – it’s the phone that the London Ambulance Service calls if they are bringing in an urgent case.

The intense, acute nature of the patients – who are usually only there for a day or so – and the need for the team to work seamlessly together makes for close bonds and firm friendships.

“You spend 12 hours in a small room with these guys so you get to know them very well,” says one of the nurses on duty today who, unusually, has time to talk to me. They get to know the patients too.

“Although our patients pass through quite quickly we are looking after a smaller number so we do get to know them. And they are going through an acute episode and we are their lifeline.”

It is this mix of fast acute work in a small team, and all-hands-on-deck experience that make the CCU an appealing place to work.

“That’s the beauty of this place and this job,” says the Charge Nurse. He is the manager of the CCU team, he explains, but also uses his own expertise as a cardiology specialist practitioner when he needs to.

“I’m using all the skills I’ve learned over the years but I also have managerial duties like managing the team’s training, development, their appraisals, and the budget, but I also get to do hands on work in the ward.”

But doesn’t the beeping become annoying, I ask? “Not really,” he says. “You get used to it. And no two days are the same. It can change, minute by minute.”

One minute is 60-100 beeps. Or 60-100 heartbeats.

That’s 3,600-6,000 an hour, or 85,000-140,000 a day, or 2.5 billion heartbeats over a lifetime.

And if those beats ever get too fast, or too slow, or stop, the CCU is there to help.