On the occasion of World Heart Day, Dr Arun Kalyanasundaram, a leading Interventional Cardiologist and Chief, Division of Cardiology, Promed Hospital urges people to not be afraid of seeking necessary cardiac care during this pandemic. In fact, by participating in the Chronic Total Occlusion marathon that lasted for 14 hours, he proved that even complex procedures can be done safely and without the fear of virus propagation
What are the latest innovations in cardiac care?
Several strides have been made in cardiology in the last few years. At a fundamental level, there have been significant advances in minimally invasive therapies. Valves can now be replaced without cutting the chest open. Likewise, almost any blockage can be opened without patients needing to undergo bypass surgery.
How is the cardiology sector coping with this pandemic? Are you able to provide care to your patients?
These are indeed challenging times. People are caught between wanting to stay safe from COVID, as well as continuing to carry on with daily lives. Due to the pandemic, patients are not seeking timely interventions for cardiac emergencies. Further regular checkups are not happening, compounded by stress on the healthcare system. These have all resulted in significant morbidity and mortality. Yet the tide is turning, and more physicians are getting back on track and taking care of cardiac patients. Personally, I have been successfully treating patients in the outpatient arena utilising teleconsultation and in-person consultations when needed. It is to be noted that we have been successfully doing primary angioplasty (PCI) for patients with acute heart attacks 24/7 utilising appropriate protective gear at my hospital. I believe that this is the only time, we clearly reduce cardiac mortality and I feel morally obliged to carry on life-saving procedures, despite the times we are in.
During this lockdown, there have been a lot of cardiac-related deaths due to lack of services. Do you think this a sign of a weak healthcare system? What is your viewpoint on this issue?
Lockdowns probably did help slow down the spread initially and flatten the curve for COVID 19. Presently, I believe the challenge to the system is due to not just the shortage of doctors, but also an unwillingness of patients to seek medical care when appropriate. India has been relatively good in terms of managing the shortage of beds, compared to some of the western countries.
You have recently participated in a Chronic Total Occlusion marathon. Why is this marathon so important? What can we learn from this?
This CTO marathon organised by a group of interventionalists like me. I believe this is a much-needed endeavour. The idea was that for over a 14-hour marathon, 13 cardiologists would perform highly complex cardiac procedures (CTO PCI). Further, it was a proof of concept that globally elective cases could be done in a safe manner. CTOs (or chronic total occlusions) are amongst the most challenging cardiac procedures to be treated by interventional cardiologists. This global charity event was for a good cause, and we ended up raising and donating more than 65,000 Euros for the International Red Cross Society. It was a proud moment for me as I was one of 13 interventional cardiologists, and the only one from India, to have participated in this global event.
What should cardiologists of today learn about the manifestations related to infectious diseases that affect cardiac functioning, given that COVID 19 has severe manifestations?
We have learnt the novel coronavirus can affect almost any organ of the body, and the heart is no exception. It can present as heart attacks. I have now performed what we call primary angioplasty and stenting on patients (for heart attacks), and subsequently it was found that these patients were positive for COVID. Such patients can be at a higher risk of forming clots and this can happen in any blood vessel including the blood supply to the heart, thereby leading to a heart attack. COVID can also result in inflammation of the heart muscle or rhythm abnormalities.
How do you protect or keep your cardiac patient informed and protected from contracting COVID?
Heart disease patients are at higher risk of complications from COVID – hence, they need to be more vigilant and careful. All the precautions that we keep hearing about – social distancing, masks and going outside only when absolutely essential is especially important in cardiac patients. Further, regular checkups and ensuring that symptoms are not ignored are critical for patients with heart disease and diabetes.