We often meet patients who feel they have run out of options. They’re managing complex conditions, taking multiple medications, and are resigned to the idea that breathless, painful days are their new normal.
Helen’s story
Helen (not her real name) is a local woman in her early 70s who has endured a lot.
She has a history of chest radiotherapy from breast cancer, a previous transient ischemic attack (or mini-stroke), advanced coronary artery disease, and significant lymphoedema (arm swelling after breast cancer treatment).
Procedure one: some improvement
Helen was referred to Associate Professor (A/Prof) Ford by colleague and friend Dr Nick Howden. She had been suffering from severe, frequent angina (chest pain) — sometimes even at rest. Despite several medications, she struggled to walk short distances without chest discomfort or breathlessness.
The first procedure focused on the left anterior descending artery (LAD), the vessel that supplies the most important area of the heart muscle. Using imaging guidance, we placed a stent with an excellent result. Helen felt better, but still required three medications, and after six months her symptoms gradually returned.
We had also identified a severe blockage in her right coronary artery (RCA). Initially, this was managed with medication because the balance of risks and benefits did not favour intervening. Access was extremely challenging — her right radial artery was occluded, and the left distal radial artery didn’t provide the support needed — and the narrowing was heavily calcified and scarred, likely from past radiotherapy. In many patients, treating the LAD alone provides lasting relief; therefore, it was reasonable to treat the RCA with medications initially.
Unfortunately, Helen continued to worsen despite these treatments, prompting us to reconsider the next best step in her care.
Procedure two: more complex intervention
By August, Helen’s angina had become refractory, meaning medications (three separate tablets!) were no longer enough. After careful discussion and with full understanding of the risks, she chose to proceed with a second, much more complex intervention targeting the right coronary artery.
This procedure was challenging. Because of her lymphoedema and difficult arm veins, standard access routes weren’t feasible. Mid-procedure, we changed strategy and moved to a femoral (leg) approach using ultrasound guidance for safe access. The artery itself was nearly completely blocked (subtotal occlusion) at its origin — densely scarred and calcified, likely a consequence of previous radiotherapy. Standard wires simply would not advance.
One of the greatest strengths of complex coronary work is the value of genuine teamwork. During this procedure, A/Prof Ford was joined by Dr Tejas Deshmukh, an interventional cardiologist from Sydney, whom he has been mentoring and supporting to expand his experience with complex cases. Having a second skilled pair of hands makes these procedures safer for patients and more collaborative and rewarding for the operators. Dr Deshmukh, who is soon heading overseas for a fellowship in Liverpool, brought thoughtful technical input and steady judgement. Having two operators helped bring about calm and careful decision-making in a demanding case.
Using advanced imaging inside the artery (IVUS), specialised chronic total occlusion (CTO) techniques, including microcatheters, specialty balloons and overlapping stents, we eventually restored blood flow safely without compromising the aorta. The procedure was tough — both for Helen and the team — but it was successful thanks to experience, patience, and coordinated teamwork at every step.
The outcome: a transformed life
Three months later, the difference was striking. Helen’s chest pain had completely resolved, and she no longer needed to take her angina medications. “I have no chest pain, and I feel much better,” she said.
Helen admitted that before her procedure, she was frightened to do anything in case the chest pain started. Now, with her exercise tolerance improved, she recognised just how much it meant. “I have my quality of life back,” she told us.
Today, Helen has regained her confidence, her independence, and her optimism. “I’m so very grateful,” she said.
These are the moments that remind us why complex, high-risk intervention matters. The hardest cases often carry the greatest reward–not just in technical success, but in giving a patient their life back.
The power of teamwork
High-risk coronary intervention is never a solo effort. It relies on trust and collaboration between heart specialists, GPs, and the wider interdisciplinary health team.
Helen’s success is a testament to her GP, Dr James Wolstenholme, who recognised her worsening symptoms and advocated strongly for her commencing guideline-directed medical treatment upfront. It also relied on Dr Howden, whose ongoing involvement was central to her care, with the use of non-invasive CT to diagnose the problem.
Within the cardiac cath lab (heart procedure rooms) at Gosford Private Hospital, the stenting was performed with the support of a great team of nurses, radiographers and Dr Deshmukh.
Take steps to improve your quality of life
The goal of modern cardiology is to restore our patients’ confidence to go out and live their lives. If you’re experiencing chest pain or feel your current management plan isn’t providing the quality of life you need, please speak to your GP about a referral to Central Heart.
A year of thanks
Our team at Central Heart would like to thank you for the opportunity to care for you in 2025. In team news, it’s been a big year for our partner at Central Heart, Dr Adam Bland. Having relocated back to the Central Coast, Adam and his wife Lani feel privileged to be part of such a connected community.
“I’m grateful to my patients, neighbours, and friends for the warm welcome,” he said.
Dr Adam Bland, his son, and his wife, Lani
A note for the new year
Our mission is to empower our community to live fuller, healthier lives. As we plan for 2026, is there an educational topic that could benefit you or your family? Please share your thoughts at office@centralheart.com.au.
We wish you and your family a wonderful holiday season and a happy New Year.