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Once you’ve lived it, the excruciating memories become pervasive, omnipresent like a dark shadow. And when the memories are birthed of uncaring hands, the perennial question of why, remains inconsolably unresolved. Thus, unending sorrow and rumination they transitioned, with a solitary escape in altruistic channelling, that none other is ever burdened. For 38yrs we’ve counted, whence us knee high to a grasshopper, witnessed our mother being robbed of life. And from that registered day, poverty was all we knew, fuelling this passion that those with stethoscopes, must be held to account.
Coronary Heart Disease(CHD)
But of this CHD we speak, and will speak, represents the endpoint of heart muscles denied of oxygen, manifested initially as injury, then ultimately heart muscle death. Of which atherosclerosis is the underpinning, furring the inner lining of the coronary arteries, that feed the heart muscles, oxygen rich blood. In fact, these atherosclerotic changes start in childhood, then progress at rates determinant on risk factors;
Diabetes
Hypertension
Obesity
High cholesterol
Sedentary lifestyle
Smoking
Investigating CHD
But CHD covers a spectrum, of which the common denominator are the contractile heart muscles, facilitated by the muscle protein, troponin. Thus, in cases of muscle damaging heart attack, troponin is leaked into the blood. Further, these muscular contraction, starts as a focal electrical impulse that cascades throughout the heart, stimulating muscles in unison, to deliver a heartbeat. Thus with damaged heart muscles, abnormal electrical activity is evident in the affected area.
So in a suspected heart attack, a battery of test is undertaken, inclusive of testing the heart’s electrical activity (ECG) and blood levels of troponin. But of note, with an ECG of concerning changes, undertaking troponin blood level is futile, since that time delay will cause irreparable heart muscles damage
Managing CHD
Thus once again I share, medicine is more prevention than cure, as was articulated in the columns on Chronic Kidney Disease. Therefore unsurprisingly, this also holds true for CHD, where progression or prevention, is achieved with optimal management of the thereunder risk factors, in Primary Care;
1. Controlling hypertension, cholesterol and diabetes.
2. Patient education
3. Promoting healthy lifestyle through public health measures.
4. High taxes on unhealthy foods.
5. Smoking cessation policies
6. Cardiovascular risk scoring eg QRISK2.
Heart attack
But occasionally, despite optimal Primary Care, some patients will progress to develop a heart attack. And in such cases, aggressive management of risk factors, secondary preventions, along with Percutaneous Coronary Intervention(PCI), is required.
Thus of PCI we explore, where the interventional cardiologist in a Cath lab setting, sets to unblocked the coronary arteries, by first gaining needle access to a wrist or groin artery. This needle then serves as a conduit to the heart coronary arteries, with a flexible catheter traversing the blood vessels.Thereafter, dye is injected as an imaging contrast, to aid visualisation of the coronary arteries. Thus of blocked coronary arteries, dye flow is impeded, of which a balloon is inflated to dilate, before stenting to maintain patency.
Why Cardiothoracic backup?
So obvious it’s, PCI is both high risk and intricate, where in traversing the 2ft distance, between wrist to heart, much can go wrong. And this, the coronary artery, less than the diameter of a drinking straw, provides a narrow margin for error. Therefore, of these reasons, Cardiology Societies have unanimously recommended Cardiothoracic backup, in the event of deadly complications.
PPP Hell Care
Nevertheless, the CHI undertakes PCI, costing up to US$10,000, without Cardiothoracic backup.
However, an eternity wasn’t required after boasting of being the cheapest service, only to be exposed by the price comparison, Balwant Singh Hospital.
Then CHI, hence our patriot was exposed as an avarice, by a Donald Ramotar’s concerning letter, “People are being exploited at medical institutions,” of thereunder snippet;
“ Some of those that manage the Public-Private Partnership facilities are more interested in money than the patients. Stories abound about how people are treated.
For this we know, CHI is the only Public-Private Partnership, that described by Donald Ramotar isn’t unique, nor was it denied or justified by Dr. Carpen, even as he struggled to justify PCI without Cardiothoracic backup.
“With our oil rich economy on the horizon, we will be able to match overseas standards….A single surgery team in the city is sufficient back-up.”
But that attempted justification is so weak, it will require a triple dose of viagra, to standup to minimal scrutiny. Firstly, Cardiothoracic backup isn’t an overseas standard, it’s an international standard for all Cath labs, as recommended by Cardiology Societies. Thus, Dr. Madhu Singh, the Medical Director of Balwant Singh Hospital, position on Cardiothoracic backup;
“This is the international standard of care and safety and is a requirement for cardiac centres to function safely and be licensed. If, any centre doesn’t have a cardiac surgeon’s support, they’re taking a huge risk with their patient’s lives.”
“Balwant Singh Hospital is the only cardiac centre in the country that offers cardiac surgical backup. We don’t have any agreement in place to provide surgical back up for other centers. We do this exclusively for our own patients.”
And obvious it’s, Balwant Singh Hospital isn’t overseas, hence rubbishing that overseas standards argument.
Thus:
1. PPP must discontinue all invasive procedures at CHI, transferring services to Balwant Singh Hospital.
2. PPP must invest in Primary Care, to optimally manage cardiovascular risk factors, and CHD.
