Cardiovascular diseases (CVDs) have always been a major concern. One in 4 deaths in India is attributed to CVDs. This concern has considerably increased because of the effect COVID-19 has on lungs and other cardiovascular complications even after the recovery of COVID-19 infected patients.
Dr. KM Cherian, the man who performed India’s first Bypass Surgery, talks to MediaCatalyst about the impacts of COVID-19. With innate talent and a passion to save lives, Dr. Cherian has also pioneered the first heart transplant in India after the legislation of Brain Death, the first bilateral lung transplant, the first Pediatric Heart transplant, the first Auto transplant, and the first Heart and Lung transplant. With phenomenal experience and far-sightedness, he is the first and only Indian member of the American Association for Thoracic Surgery. Dr. Cherian was the honorary surgeon to the President of India from 1990 to 1993 and was awarded Padma Shri by the Government of India in 1991.
Here are the excerpts from the interaction.
What are some of the short and long-term impacts of COVID-19 on the heart and lungs?
One of the most widely published and verified effects of COVID-19 is its ill effect on the lungs, as it primarily causes respiratory disease. Cardiac injury is now a rising concern. D-Dimer (a blood parameter) is high during the infection. If blood thinner is not administered, the patient is likely to face a heart disorder in the future, even months after recovery from COVID-19.
The various cardiovascular complications caused by COVID-19 are acute cardiac injury, acute coronary event, left ventricular systolic dysfunction, heart failure, and arrhythmia.
One of the dreaded complications is known as the inflammatory storm. This is caused by severe acute respiratory syndrome, CORONAVIRUS 2. It is the seventh member of the Coronavirus family, which infects humans. These are the conditions, which need expert pulmonary care including mechanical ventilation etc. with postural changes, which could also lead to myocardial injury and cardiac arrest.
Many COVID-19 recovered individuals are returning to the hospitals complaining of chest pain and trouble breathing. Is this a temporary effect and what do you suggest as remedies?
In my opinion, treatment with steroids, bronco dilators, chest physiotherapy, etc are the recommended treatment.
It is recommended that all cardiac medications, including aspirin, anticoagulants, ACE inhibitors, angiotensin receptor blockers, beta-blockers, diuretics, and antiarrhythmic medications be continued during COVID-19 illness unless a clear contraindication develops.
The clinician must be cognizant of the QT-prolonging effects of some of the medications that are used in COVID-19 therapy, including hydroxychloroquine. Several trials are underway to evaluate the impact of COVID-19 in patients with CHD, their response to therapy, and the efficacy of post-exposure prophylaxis. As cases and clinic visits are postponed or limited, the cardiac care team must evaluate patient care plans and consider the unintended consequence of delayed access to care in these patients.
We are seeing an alarming rise in deaths due to heart-related issues. Do you see any reason/s for this?
I believe that lifestyle plays a critical role in heart-related diseases and ailments. While a lot of patients develop heart-diseases due to hereditary issues, genetic issues, or overage, many develop cardiac ailments due to an unhealthy lifestyle. Harmful habits such as smoking and excessive drinking are known to cause heart problems. However, not just these, consumption of unhealthy food, not exercising, or doing regular physical activities can lead to obesity, which then leads to cardiac ailments. Getting regular and good sleep is also important.
Telemedicine is slowly catching up with its pace, especially during the pandemic. How is it changing the cardio field?
The branch of telemedicine especially for cardiac patients is known as Telecardiology. It aims to monitor patients in real-time for irregularities and offer a remote diagnosis. This technology will be useful for the treatment of heart diseases such as arrhythmia, congestive heart failure, and ultimately might help to prevent cardiac arrest. It guarantees the continuity of care and also raises a red flag of alarming patterns in vitals such as blood pressure, oxygen levels, heartbeat per minute, etc.
Telemedicine removes the barriers of transportation and requirement of physical presence to submit initial data/details. Often unavailability of doctors for consultation also tends to create anxiety in patients. With telemedicine technology, doctors are just a click away and available for advice 24×7. The integration of existing telemedicine with more advanced technologies such as Artificial Intelligence, Machine Learning, and Virtual reality, will be a boon.
You have done some groundbreaking surgeries including the first heart transplant in India after the legislation of Brain Death. Tell us the most challenging one and the hurdles you had to overcome to succeed?
The most important aspect of my practice has been not transplants but I have taken a considerable amount of interest in getting Brain Death Legalized and the certificate of the same is enclosed as this led to the acceptance of Brain death by both Upper and Lower Houses of the Parliament way back in 1992.
The biggest challenge we are facing today is support from the government for medical R&D. I’ve been working on so many projects and initiatives, but unfortunately due to a lack of support from the authorities in terms of both capitals and approvals, we’re making slow progress. Recently I filed a PIL in Madras High Court against Red Tapism. Hopefully, after my constant push-backs, the government takes some steps for the welfare & progress of medical sciences.
Would you like to share any medical research that is being conducted in the cardiothoracic field?
I have always been a strong advocate of research and development. It is crucial to invest in medical R&D for the progress of the sciences as well as the country. Various research and R&D projects are undertaken at Frontier Mediville Science Park.
Something interesting we are working on is a valve, which is being used for the replacement of diseased valves in high-risk patients using a procedure known as TAVI where the cost of the valve varies between Rs. 13 lakhs to Rs 22.5 lakhs. We are working on the same valve using Bovine Jugular vein (harvested from buffaloes) and a stent made by National Aerospace Laboratory using Nitinol and is going for the second phase of the development. We could make the valve at a cost less than Rs. 2.5 lakhs.
Stem cells, which are usually separated from the bone marrow, could be grown from the Thymus gland (thymic tissue) and this is in collaboration with the University of Michigan. We have taken some lead in this area including artificial blood (amplification of RBCs).
We have also signed an MOU with Russia to make an artificial heart and since it is bulky and heavy, we have approached Titan along with TIDCO where they have the technology for miniaturization and we could make an artificial heart, which could be the smallest and lightest heart available in the world at a much cheaper price.