Cardiology is the best practiced specialty in Pakistan; patients get specialized care-Prof.Shaharyar Sheikh


Joint session of PSIM, PCS and PHL
Cardiology is the best practiced specialty
in Pakistan; patients get specialized care-
Prof.Shaharyar Sheikh
Doctors should not add to treatment cost, proper timely
diagnosis & treatment is mandatory
We must prevent HTN, RHD, CAD, so far we have failed
to create awareness-Prof.Haroon Babar

Lahore: Cardiology is the best practiced specialty in Paksitan and patients get specialized care. We have well equipped Coronary Care Units and it was heartening when you see your students become leaders. This was stated by Prof. Shahryar Sheikh an eminent cardiologist and former President of World Heart Federation while speaking at the joint session of Pakistan Society of Internal Medicine, Pakistan Cardiac Society and Pakistan Hypertension League during the PSIM conference held here from March 12-15th 2020.

Continuing Prof. Shahryar Sheikh further stated that as Muslims it is our duty to serve the ailing humanity and it was heartening to note that healthcare professionals were on the forefront treating the Corona virus which has become pandemic. We have come a long way in the field of cardiology. However, he hastened to add that almost 50% of the time, chest pain is ignored and 50% of doctors also ignore it. When the patient comes to you, he/she has done their duty. He advised the health care professionals that not to add to the cost of treatment through repeated visits but examine the patient carefully on the first visit, ask for required investigations and initiate treatment. The patients should be advised to continue the medication as per their doctor’s advice. Statins are good and often patients stop it, hence the patients should be advised to continue it on long term basis as per advice of their physician.

Prof. Haroon Babar President of Pakistan Cardiac Society speaking on the occasion said that Prof.Eice Mohammad had always guided us on careful history taking and proper physical examination. We have always benefitted from his advice. We need to promote preventive strategies. We must prevent hypertension, coronary artery disease and rheumatic heart disease. We must put all our energies to prevent these diseases but so far we have failed to create awareness about this in our society. We in the PCS plan to train the GPs in Basic Life Support, in fact all paramedics and hospital employees need to be trained in BLS. We also need to educate the patients, he added.

He further stated that they were planning to prepare local nutrition guidelines, effective use of media to sensitize the public, will hold training workshops on BLS and ACLS at DHQ and Tehsil Hospitals. We have established more chapters of PCS. We are interested to prevent Rheumatic Heart Disease which has been eliminated in the West. We are also starting a Reward system for the local chapters of PCS based on their performance, will initiate Train the Trainers programme. With the help of donations we have established a Cath Lab at Nishtar Hospital Multan and would intensify our fight for prevention of cardiac diseases.

Prof. Shaharyar Sheikh

Prof. Eice Mohammad in his speech highlighted the human aspects of patients who suffer from Acute Myocardial Infarction. They are worried about their jobs, about their family and future of their children. They suffer from broken heart syndrome. We know about TakaYasu syndrome in these patients. It is important that doctors should speak to them, listen to them patiently and reassure them that they will take care of them. These simple words on the part of the doctors will help the patients a lot and the chances of death will either disappear of minimize to a great extent and the patients will be on the road to recovery. He urged the seniors to introduce the younger generation of doctors to human aspects in cardiology. The distance between the doctors and the patients should be eliminated. The society also needs to give meaningful direction to the Pakistan Cardiac Society. Prof. Tanzeem Haider Raza in his brief comments remarked that the burden of cardiovascular diseases is very high in Paksitan which call for effective interventions.

Earlier Dr. Bilal S. Mohydin in his introductory remarks said that ambulances should have facilities of defibrillators, Trolleys should have space for oxygen cylinders and there should be dedicated covered area for ambulances in every hospital. Wheelchairs should also have facility of Oxygen Cylinders.

Dr. Asad Akbar Khan spoke about interventional cardiology of Tomorrow. He discussed in detail the shockwave, Aortic stenosis, TAVR in early days, the EVOLUT low risk trial, use of Trans Catheters and Aortic valves which have been approved by FDA. He also referred to Sentinel devices and Transcatheter Mitral Valve Replacement. At present all companies, he said, have two devices in the market. MITRACLIP is available in Paksitan. There is lot of new developments underway and it was exciting times for interventional cardiology, he remarked.

Dr. Tahir Naveed highlighted the Role of CT Angiography in chest pain diagnosis. Chest pain, he said, was one of the most common cardiac emergencies. It should not be evaluated in doctor’s office or at home but it should be treated as an emergency. It can be associated with shoulder pain, pain in abdomen, neck pain, Backache, nausea and vomiting. It may last for days or hours. Detailed history and clinical examination is extremely important. ECG and MDCT should be done in such patient. MDCT 64 slice or above should be used. It has some limitations. It can be done in renal dysfunction, tachycardia. He then showed some slides of CT Angio showing significant disease in LAD though it otherwise looked normal. CT Angio, he opined is extremely helpful in diagnosis of these patients.

Some of the distinguished delegates to the PSIM conference photographed alongwith
Prof. Javed Akram President PSIM and VC UHS, Prof.
Aftab Mohsin Chief Organizer
and others during the conference.

Dr. Bilal Mohyuddin spoke about Getting to the Heart of Angina. He laid emphasis on personal and family history of the patient besides risk factors, laboratory tests, physical examination and bedside investigations, stress Evaluaiton, ETT and CT Angio. In high risk cases, it is better to opt for angiography. MRI can also be very useful. Emergency demands emergency care otherwise it can cause angina. He also talked about the usefulness of life style modifications, use of single or dual antiplatelet therapy. Start anti angina treatment with four drugs and if the patient is doing well, call him four times in a year for follow up. Prevent cardiovascular events, control angina symptoms and ensure that life style modifications lead towards correction. Advise the patient not to eat more, do regular exercise, comply with drug therapy, and ensure availability and affordability of drugs. Plan stepwise patient tailored treatment. Heart matters and metabolic disorders should be treated. Trimetazidine increases ATP production. It supplies more energy. Early addition of this drug, he opined, will give more benefits to the patient. He concluded his presentation by stating that CIHD is a complex lifelong condition. In medical therapy TMZ should be a preferred choice. Look at the cost to the patient and remember, one drug does not suit every patient and make sure the drugs prescribed are well tolerated.

Prof. Naeem Aslam spoke about Hyperlipidemia and referred to various RCTs which showed that about 80% of patients tolerate these drugs, 20-25% do not tolerate it while 5% or so are resistant. Patients are usually reluctant to use Statins. He advised that always take history of supplement being used by the patients. Patients may be taking Statins as well. One can use alternate day once weekly to take care of tolerance of Statins. Liver injury is very little. These drugs are also anti inflammatory. Statins are not contra indicated in elderly but these patients can have early side effects. Use low dose or use non-Statin drugs. Pregnant women with Hyperlipidemia are suspicious of all medications. Do not use it in pregnancy and breast feeding mothers should also not take Statins. In Children above ten years of age it is safe and well tolerated but eliminate junk food. Benefits of Statins, he opined, exceeds risks but monitor glucose and HbA1c on regular basis in such patients. There are no studies which show that these drugs cause suicide or dementia. Muscle aches, myalgia, weakness, stiffness are some of the known side effects of Statins. He suggested that we need to undertake screening for dyslipidaemias. Hypertension, cholesterol and diabetes mellitus control besides life style changes should be included in the treatment.