After 4 pm, heart labs in Kashmir ‘stop beating’

Closure of Heart/ Cath labs after OPD hours in Kashmir hospitals puts lives of heart attack victims at risk.
After 4 pm, heart labs in Kashmir ‘stop beating’

Closure of Heart/ Cath labs after OPD hours in Kashmir hospitals puts lives of heart attack victims at risk.

Due to closure these labs after 4.pm, the heart attack victims have to wait over night for emergency life saving interventions in hospital emergencies.

While hospitals have invested crores, the lack of staff is stated to be one of the reasons for locking these facilities up for most part of the day.

Cath Labs that house the equipment for angiography and angioplasty, life saving diagnostic procedure and interventions, are closed after 4 pm in SK Institute of Medical Sciences and SMHS hospital here. As a result, cardiologists are left with no option but to administer clot dissolving medicines, an inferior, slower option compared to angioplasty, cardiologists said.

A senior cardiologist at SMHS Hospital said, "Thrombolytic therapy is not the ideal treatment especially in tertiary care centre like SMHS hospital." He added, "As compared with thrombolytic therapy, primary coronary angioplasty results less chances of myocardium heart muscle becoming dead."

Cardiologists across hospitals said that patients have high chances of ending up with dead myocardium (heart muscle) if the blockage is not cleared immediately. 

At SKIMS, while there are two heart labs, only one is kept open after 4 pm, the one which does not have angioplasty facility, sources said. "In afterhours, we are only able to do emergency pacing," a senior cardiologist at SKIMS said. He expressed concern over the fact that Kashmir's premier-most super-specialty hospital has no Cath Lab functional after OPD hours. The cardiologist said that only 10 technicians are available for four heart labs in institute forcing their closure after 4 pm.

However, Medical Superintendent SKIMS, Dr Syed Amin Tabish denied the allegation and said that emergency procedures were carried out at the institute labs, including angioplasty. "We do it everyday," he claimed.

He added that a new Cath Lab had been commissioned at SKIMS and "would be functional" in a few days.

Medical Superintendent SMHS Hospital, Dr Nazir Chaudhary said that procedures "as and when required" were being done at the hospital. He added that Cath Lab was kept open to do "routine cases" and that at night, there was no need to keep it open. "Angioplasty is planned and carried out in OPD hours. Why do we need to keep it open at night," he said.

A senior cardiologist said that researchers all over the world had demonstrated how angioplasty resulted in lower mortality compared to thrombolytic therapy. "If this (angioplasty) is not needed in emergencies, why are we investing crores in the equipment," he said. "They lose the golden hour while doctors wait for the clot to clear up," he said.

Victim dies in emergency, waiting 

When Muzaffar Ahmed's (name changed) mother Fazeela Begum complained of chest pain and fainted on a December evening, he wasted no time and bundled her into a car, straight to SMHS hospital. In the swarm of people surrounding the four doctors in Medical Emergency of the hospital, he managed to pull out one senior resident to have a look at his mother. He asked for an ECG which showed that Fazeela had suffered a heart attack or Myocardial Infarction.

Having some knowledge of heart attack management, Muzaffar asked doctors for an angioplasty, a radiography that would help doctors locate the exact spot where the blood vessel of Fazeela had clogged. However, doctors informed him that the Heart/Cath Lab of the hospital was closed in night. Doctors asked Muzaffar to purchase TPA, a drug injected into veins to dissolve the clot.

The drug was neither kept available at the hospital drug counter, nor was it available at the pharmacies outside the hospital. It had to be 'ordered' and the order of the injection, costing Rs 30,000, arrived after 45 minutes.

"We had reached hospital at 10:30 pm. The TPA (injection) was given to her at 12:45 am," Muzaffar said.

Seeing that the condition of the patient was not improving, a cardiologist-on-call, who by now had arrived at the hospital, asked Muzaffar to contact SKIMS to see if their cath lab was open. It was not, they found out.

The condition of the patient kept deteriorating. "The cardiologist, who was a friend, kept telling me if only they could do angioplasty, the blockage could open up," Muzaffar said. "He told me "She would improve in minutes,"" he said.

At around 2: 30 am, Muzaffar called a Srinagar private hospital that also has a Cath Lab. "The private hospital staff told me that over five hours had elapsed since the heart attack took place and angioplasty would not be of much use," Muzaffar said.

"Hour by hour, my mother kept deteriorating and the cardiologist and other doctors could do nothing," Fazeela's son said.

Fazeela breathed her last at 4:00 pm at SMHS hospital, six hours before the Cath Lab would have been opened for patients like her.

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