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PostPosted: 27 May 2020 11:43 
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Joined: 26 Feb 2013 10:59
Posts: 695
With 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 away

What 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.

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.

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PostPosted: 02 Jun 2020 13:15 
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Joined: 21 Jul 2013 13:13
Posts: 171
Hi Badri
It was most fascinating to read your introduction and the subsequent blog by Dr Venkatesan on the present medical scenario after corona pandemic. In this contest it is better to look again into some of the postings made in our forum such as ‘Unnecessary stents’. They make good reading now.
In this time of Corona, the entire world is in a grip of fear and uncertainty. Not only about life. But most importantly about the question whether even if you escape from this malady, how to proceed to live and look after your family, an economical question. Look at this posting I received last night which makes good reading. About the correctness of the statistic given here at present I cannot vouch for:

The number of deaths in the world in the last 3 months of 2020
3,14,687 : Corona virus
3,69,602 : Common cold
3,40,584 : Malaria
3,53,696 : suicide
3,93,479 : road accidents
2,40,950 : HIV
5,58,471 : alcohol
8,16,498 : smoking
11,67,714: Cancer
Then do you think Corona is dangerous?
is the purpose of the media campaign to settle the trade war between China and America
to reduce financial markets to prepare the stage of financial markets for mergers and acquisitions

to sell US Treasury bonds to cover the fiscal deficit in them
Is it a Panic created by Pharma companies to sell their products like sanitizer, masks, medicine etc.
Do not Panic & don't kill yourself with unnecessary fear. This posting is to balance your newsfeed from posts that caused fear and panic.
33,38,724 People are sick with Coronavirus at the moment, of which 32,00,000 are abroad. This means that if you are not in or haven't recently visited any foreign country, this should eliminate 95% of your concern.
If you do contact Coronavirus, this still is not a cause for panic because:
81% of the Cases are MILD
14% of the Cases are MODERATE
Only 5% of the Cases are CRITICAL
Which means that even if you do get the virus, you are most likely to recover from it.
Some have said, “but this is worse than SARS and SWINEFLU!” SARS had a fatality rate of 10%, Swine flu 28% while COVID-19 has a fatality rate of 2%
Moreover, looking at the ages of those who are dying of this virus, the death rate for the people UNDER 55 years of age is only 0.4%
This means that: if you are under 55 years of age and don't live out of India - you are more likely to win the lottery (which has a 1 in 45,000,000 chance)
Let's take one day ie 1 May as an example when Covid 19 took lives of 6406 in the world.
On the same day:
26,283 people died of Cancer
24,641 people died of Heart Disease
4,300 people died of Diabetes
Suicide took 28 times more lives than the virus did.
Mosquitoes kill 2,740 people every day, HUMANS kill 1,300 fellow humans every day, and Snakes kill 137 people every day. (Sharks kill 2 people a year)
Join to Spread Hope instead of Fear.
PS: apart from the doubtfulness of the statistics, does this not sound a little more logical?
On my part, I am more afraid of quarantine rather than the virus as such.

UA Mohammed

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PostPosted: 03 Jun 2020 15:36 
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Joined: 26 Feb 2013 10:59
Posts: 695

Where did you find all those interesting statistics. I quite agree this shut down and quarantine is not having much effect in India. I keep asking people, if the disease is so dreadful (I am sure it is in other parts of the world), why are we seeing so few deaths in India. However it is a good opportunity to teach people generally about hygiene, warning about coughing and sneezing without protection and spitting in public. Unfortunately those who do not observe all these rules are the very ones who are breaking the shut down rules as well, at least in Chennai.

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