LARGEST EXPERIENCE IN TRANSRADIAL INTERVENTIONS IN NORTH INDIA
(>38000 Transradial Procedures till June 2021)
The Covid-19 pandemic was unexpected and shocked everyone by its devastating affect by taking toll of numerous human lives. Dr R.K. Jaswal, an eminent interventional cardiologist for over 25 years with more than thousands of successful procedures to his credits, dwells on what the medical fraternity learnt from the scourge in over one-and -half years and that it has taught them about where it has reached, something the general public would also like to know, because only then they can take the best quality treatment. A conversation with Dr Jaswal is significant on the World Heart Day.
What is the impact of Covid 19 on the heart?
Covid is secondary to lung disease causing acute injury to the organ, which increases cardiac work load worsening the heart and liver eventually leading to secondary heart disease. Another issue is that the Covid virus gets attached to ACE2 receptors that are found in abundance in the cardiovascular system that can directly affect the heart leading to hypertension, acute cardiac disease and inflammation. The ways by which heart is involved in Covid infection is that it can cause fresh heart attack, heart failure, heart block, arrythmia and Pericardial effusion i.e., fluid around the heart puts pressure on the heart and impedes its proper function.
Challenges faced and the solutions for treating heart affected by Covid?
The first challenge is availability of medical staff, services and infrastructure which are grossly inadequate for the kind of population that India has. It is also a common problem found across the globe. Many institutions worldwide have found a solution where they have already placed a moratorium on electrical gadgets such as in Cath labs in an effort to preserve resources.
To avoid exposure of patients to the hospital environment where Covid 19 is treated, for routine cardio patients video consult should be a preferred mode, but at the same time Covid can make heart attacks more dangerous And it may require to rush them to CATH LAB to perform an angioplasty procedure to open the blocked artery by implanting a stent. During the pandemic lockdown many patients reached late to the hospital as a result the first 6-10 hours in which they can be treated by medicines, that window was lost. Beyond 10 hours, medicine will not be effective and the patient has to be taken for immediate intervention and treatment. Also, initial assessment of the patient for Covid infection and x-rays etc., delayed their arrival to the Cath lab even after coming to the hospital. Under these circumstances hospital protocols were cut short do away with these system related delays.
What are the innovation which has taken place in stent category ?
The journey of angioplasty and the innovation which has taken place in the stent development is phenomenal. It’s a proven fact that the latest second-generation stents are very fine stents and made of much better metal such as cobalt or cobalt lithium/chromium. As compared to the first-generation stents which were 130-150 micron, the present stents are of 62-85 micron. They are very refined, very inert and doesn’t cause local reaction and similarly The latest addition in this series is a novel thin strut dissolving stent or BioResorbable Scaffold (BRS) by an Indian Company
What is a Dissolving Stent and why it could be very apt for young patients in particular?
Dissolving stent or Bioresorbable Scaffold (BRS) are considered as the latest advancement in the stent technology to treat blocked or diseased arteries. BRS are similar in function to a metallic stents but they are non- metallic, non-permanent mesh tube which is used to treat a narrowed artery. Two major advantages of BRS for young people, firstly, it slowly dissolves over a period of time, once the blocked artery starts functioning naturally and can stay open on its own. The second advantage is that the response of the artery at the time of exercise is like a normal physiological artery. In a metallic stent artery even if new blockages do not occur the artery does not dilate in the manner of biodegradable stent during exercise when the heart pumps creating demand for more blood. Also, a few decades down the line if they require by-pass surgery then any vessel can be grafted from anywhere, that option is totally open to the patient.
Patients with metallic stents have to be on blood thinners for a longer period of time. But when the BRS stent has been deployed, after one year, the patient can be safely put on light blood thinners and antiplatelet drugs as a precautionary measure to prevent any blockages from developing in the arteries.
What is your advise to heart patients in the new normal?
For routine life heart patients should always top up their medicine box to avoid running out of medicine and failing in procuring them if restriction on movement is clamped. This increases risk of heart attack if you miss out on your medication, therefore be very meticulous in your medication. Heart patients must take plenty of liquid to keep themselves hydrated in consultation with their doctor because if they exceed the quantity, it could affect the heart. Keep BP and sugar levels recording machines at home to check on their levels, because if BP rises then the heart can suffer. Include yoga and meditation to calm the mind and to stave off phycological pressures or it could lead to heart attack. Laughter and sharing your problems with close ones provide emotional cushioning.
Message to the readers on World Heart Day?
Heart attacks can be prevented by adopting a healthy lifestyle and awareness. Be wise and take timely treatment so that you can lead a long and healthy life.
Disclaimer - This initiative is undertaken in the public interest and for patient education. The information is solely the views of the author and shall not be considered to be a substitute for professional medical advice, diagnosis or treatment.