The virus and other diseases – The Indian Express

New Delhi | September 8, 2020 9:14:35 pm

Written by Sunil Sathe and Viveka Kumar

When 27-year-old Rima Singh complained of recurring chest pain, her family thought it was due to indigestion or a muscle strain. However, when one day the pain became unbearable, she was rushed to the hospital. On diagnosis, the doctor informed Rimas family it was a case of sudden cardiac arrest (SCA) and immediate surgery was required. The physician also stated genetic history to be the reason for her medical condition.

In 2015, she underwent a subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) implant and was discharged from the hospital the next day. Five years later, the battery of the device depleted, and Rima underwent a device replacement surgery. Until a few years back, a heart implant meant longer hospital stays and a long recovery time. However, technologies like S-ICD therapy are changing the way we understand the dynamics of heart care.

In the past five months, as per a few hospitals in India, there is an increase in deaths from SCA at home due to delay in seeking medical attention. The potential reason for this is that people ignore symptoms such as chest pain or discomfort, heart palpitations, irregular heartbeats, wheezing, shortness of breath and dizziness, and do not visit the hospital due to the fear of contracting the novel coronavirus. However, it is imperative to understand that SCA may occur in people who have no known heart disease.

SCA occurs when the heart abruptly loses its function, breathing and consciousness. The condition usually results from an electrical disturbance in the heart that disrupts its pumping action and stops blood flow to the body. The rate and rhythm of the heartbeat are controlled by the hearts electrical system. The heart can beat too fast, too slowly or irregularly (arrhythmia), if something goes wrong. Mostly the arrhythmias are brief and harmless, but some types can lead to SCA.

S-ICD is recommended for patients with increased complications. It is a device for heart failure patients who are also at a high risk for SCA. Such technologies detect and stop abnormal heartbeats (arrhythmias). The ICD constantly monitors the heartbeat and delivers electrical pulses to restore a normal heart rhythm when required, even when the person is far from the hospital.

Unlike the conventional ICDs for which wire leads are inserted directly into the heart through a large vein, the S-ICD therapies use a subcutaneous or beneath the skin-electrode that is placed near the heart to sense irregular heart arrhythmias and deliver therapy.

In this minimally invasive surgery, the electric pulse generator is implanted below the armpit using a four to five-inch incision. As the electrode that delivers the shock is not placed directly into the heart, the chance of infections is reduced. The procedure requires a reduced hospital stay, avoids visible incision scarring, and provide patients with a normal and healthy life. In Rimas case, we did not face any issue, however, the S-ICD device is about twice as large as a traditional ICD, which makes some patients like the ones who are very thin, ineligible for the implant.

At a time when the COVID-19 pandemic has highlighted the importance of the need to prepare themselves for unforeseeable times, we need to look at a more holistic approach and embrace innovations to manage the disease burden in our country.

That is where advanced technologies like S-ICD play a crucial role in patient care. As compared to the conventional Transvenous implantable cardiac defibrillators (TV-ICDs), S-ICD involves low infection rate, reduced hospital stays and give patients a better quality of life. This is more useful in the younger population.

An Edinburgh University study on COVID patients from 69 countries revealed that the heart scans of 55 per cent of them showed abnormalities. This study is alarming for people who fall in the high-risk group. As the world observes social distancing and self-isolation, home-based measures and self-care become of utmost importance. A very important part of care is consulting your doctors virtually. Do not let restrictions deny you access to your doctors. Set up online consultations to ensure you are managing your symptoms well. Therefore, on noticing any symptom, it is imperative to consult a doctor through telemedicine. If the doctor says that your situation requires urgent medical attention, rush to the hospital without delay. Additionally, a few precautions taken at home can help in keeping the healthy heart, for example, avoid smoking, maintain a healthy weight, drink alcohol in moderation, eat a heart-healthy diet, stay physically active by exercising regularly and manage stress.

(Sathe is Consultant Cardiologist Ruby Hall Clinic, Pune and Kumar is Principal Director & Chief of Cath Lab)

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The virus and other diseases - The Indian Express