Home › Forums › Other Specialities › Cardiothoracic Medicine & Surgery › Glad to know plaques are also in lockdown mode
- This topic has 0 replies, 1 voice, and was last updated 1 year, 1 month ago by
Anonymous.
-
AuthorPosts
-
-
December 21, 2023 at 1:43 pm #1340
Anonymous
InactiveWith the present lockdown most of us are aware that hospital admissions have generally dropped considerably. Many of us have been asking why so few cardiac emergencies are being admitted to corporate hospitals now. Previously we were told that large number of lives were being saved every day by the use of stents in these hospitals. Does that mean patients are refusing to get admitted being more afraid of coronavirus – therefore dying peacefully at home. I somehow don’t think so!
I came across a very interesting and thought provoking article by a Chennai based Cardiologist, Dr. S. Venkatesan. He has answered a number of questions that many of us have always asked in the past but never got a satisfactory reply. Are too many unnecessary investigations and treatments being carried out on hapless patients who end up paying a fortune? Many of them hardly understand what is being done and believe that their lives are being saved by these expensive procedures.
The following is his post as it appeared in the blog on 3rd April 2020. Please read on, it is a fascinating article.
“The Country of mine with 140 crore population, is under complete lockdown mode. We are anxiously tense in one aspect, but enjoying the free time due to the peculiar “Corona effect” on cardiac emergencies.
Corona Virus and Dr.jpg
Unable to understand you . . . please go awayWhat happened to our 24/7 busy CCU ? Does it happen only in my hospital? Can’t be. Let me check it right now. I called my fellow, who has since become a leading cardiologist in the nearby town. I have since called many of my close contacts. In both Government and private hospitals. The pooled data were analyzed in a virtual cloud memory. I am fairly convinced, our observation was indeed true.
The following can be considered as near facts:
There have been at least 50% minimum dip of Overall ACS cases. It even went down to 80%reduction in a few places
Even UA/NSTEMI showed a significant drop. There was general hesitancy to do primary PCI even if it’s technically Indicated.
All most all STEMI (ST Elevation Myocardial Infarction) were lysed. Heparin was liberally used.Many patients preferred telephonic consultations. ECGs were reported over mobile platforms.
one of the back pains & gastric pains were admitted as atypical chest pain.
Most cardiologists closed down their regular OPD For the first time, Govt institutions were considered worthy to refer.Why ACS Incidence nose dived? Under recognition? Under-reported ?
Low Incidence? Low rate of referral? STEMI that goes under-recognized and unreported?The consensus was, it’s less important factor as currently, very few are unaware of the Importance of chest pain and widespread availability of emergency services 108/911. Does that mean real incidence has Indeed come down?
The global atherosclerotic burden,(the substrate for STEMI) in the society is nearly constant. Still, the incidence of ACS has declined dramatically in the lockdown period. This conveys an important message and compels a search (research)The plaques that are waiting to rupture in the population somehow getting a reprieve. Mind you, the presence of a risky plaque in LAD alone won’t cause a STEMI. It needs a trigger. The day to day physical stress, spikes of catecholamine, emotional swings, traffic pollution etc. The only plausible explanation appears to be the vulnerable patients along with their plaques are also locked up inside its Intimo-medial home. (Armchairs and bed rests can not only treat STEMI , they can prevent it too !)
Why the incidence of NSTEMI /UA has also come down?
Again, the same factors might operate. But, more likely self-stabilizing pseudo / Low-risk ACS is a distinct possibility.
A significant chunk of UA /?CSA/suspected NSTEMI patients come from referrals by GPs.The biggest pool of cases for cath labs comes from this group of noncardiac/Atypical chest pain syndromes*. Which shows some Incidental (In)significant lesions that subsequently becomes a cardiac emergency.Since they have reduced their consultations the numbers have quite significantly reduced. *Chronic CAD masquerading as ACS is not a forbidden concept
Final message
We are taught some important lifetime lessons in cardiac practice by this 20 nm, lifeless RNA particles.
1. The bulk of the ACS in the society is triggered by the day to day stress of the fast and furious “Just do it” world. The mitigating effect of social lockdown on physical and emotional stress on plaque dynamics on the incidence of ACS will be a big research subject in the coming months.
2. More importantly, It has exposed the existence of one more hidden epidemic in the community “manufactured coronary emergencies” propagated by a resistant cardio tropic virus that has disseminated deep into evidence-based cardiology. Let us cleanse this virus too after finishing off the Corona.
Postamble
It’s just a crazy opinion from a scribbling, blogger. However, I am sure, It’s only a matter of time, great journals like NEJM, JAMA, and Lancet will be screaming the same truths in a more palatable evidence-based manner.
Meanwhile, I can see early signs of restlessness(withdrawal) among us waiting for early release from the lock-up and resume the customary mode of evidence-based cardiology practice.As I complete this write up . . . .surprised to find this report from TCT MD. Similarities if found, could only be coincidental.
Dr. S. Venkatesan is a cardiologist at The Govt. General Hospital in Chennai. He is a prolific writer and posts several interesting topics in cardiology every month. His blog goes by the name “Expressions in Cardiology”. His articles are read by a large number of doctors and probably is an excellent site for CME.
-
-
AuthorPosts
- You must be logged in to reply to this topic.