Once health is lost, a person will give anything to get it back. It is one of the most basic human rights. It is the jewel that allows us to enjoy and live life. That being said, contradictions and complications which prevent health from being the absolute priority of everyone must be addressed.
Dr Ahmed Alaedinne is a cardiologist who has risen to the top of his field for the simple reason of helping the sick and serving the people. In a conversation with the Arab Times, Dr Ahmed gives us an insight into the world of cardiology and the challenges that the health sector in the country currently faces.
Following is the full interview:
Question: Tell us about yourself.
Answer: My name is Ahmed and I have lived in Kuwait for about eight years now. I am a Cardiologist with a sub-specialty in Interventional Cardiology. I work in Dar Al Shifa Hospital as Head of the Cardiology Department and I am also a consultant. Along with my colleagues, we have a team of registrars and nurses who are highly qualified in the field of cardiology with the ability to manage a complete and full set up for a Cardiac Unit.
Q: What is Interventional Cardiology?
A: Interventional Cardiology means we can treat arteries by inflating balloons, removing the blocks to put stands and changing the valves without doing surgery. All this is done through percutaneous procedure, which means we do not cut or put stitches. We put a small puncture in the skin and through this puncture we can reach the artery.
Q: What differentiates your Cardiology Department from the rest?
A: We are able to receive any emergency case 24/7, starting from the Emergency Room (ER) where we have a cardiologist ready to receive patients any time. The patients are assessed in the ER and then they shifted either to the Coronary Clinic, the Intensive Cardiac Unit or in the ward where they will be taken care of.
We have a very good set up and infrastructure including the ER where there is a room dedicated only for cardiac patients. We have a very good Radiology Team that supports us, such as doing urgent scans. For example, if a patient comes in with chest pain, he will be assessed by using the urgent scanner where we can see his coronary arteries and check if there is any blockage. After that we decide to either shift him to the Catheterization Laboratory or not. This scanner is quite important when it comes to ruling out any other emergency cardiovascular cases like pulmonary embolism or aortic dissection. We can also use the scanner to see if there is any cerebral vascular problem like stroke or dissection of the coronary arteries.
All of this can be done quickly – within 30 minutes. If the patient is suffering from acute chest pain or what we call acute coronary syndrome, we can transfer him directly from the ER to the Cardiac Catheterization Laboratory. Here we can fill the coronary arteries by doing what we call an urgent angiography. If there is any blockage, we can balloon it and then we stent it immediately. This is considered a primary angioplasty and it is the golden standard treatment of all acute cardiac attacks. If this patient also needs some mechanical assistance for his heart, we can use certain devices in the Catheterization Laboratory that we can install easily and gently. All of this is done without surgery. We can put what we call an intra-aortic balloon pump which is an assistance device for a weak heart until it can recover and take over after the acute cardiac attack.
We are supported by a very good team of registrars who can efficiently deal with our cases, in addition to a good echo cardiologist who can do echoes for the heart and carotid arteries. I’m proud to be the head of the department, and also proud of being part of this very efficient team. This is the only team in the private sector in Kuwait that handles cardiac emergency cases 24/7. We do not reject or transfer patients; everything is done in Dar Al Shifa. We have completed the set up for cardiac surgery and we will be starting cardiac surgery very soon.
Q: At this point, is there no cardiac surgery?
A: We have cardiac surgery. We do emergency cardiac surgery but it is not yet an installed program that we follow. Nevertheless, if there is an emergency cardiac surgery, we do it.
Q: What about the patients brought by ambulances?
A: The relationship between the private and government sectors in Kuwait is very sensitive. This, I believe, will be sorted out one day because we are all healthcare givers here in Kuwait and we serve everyone – both citizens and expatriates.
Q: What do you mean by sensitive?
A: For example, the medical transport team or EMT in Kuwait that belongs to the government sector does not deal with the private sector yet. It means if there is a patient who suffers cardiac attack in his house and he happens to be my patient or of any other doctor in the private sector, he may ask the EMT to take him to his doctor in a private hospital but they will refuse and tell him that they don’t go to the private sector. They will inform him that they have to take him to a public hospital. For example if you live in Hawally, they will take you to Mubarak Hospital. I don’t think this is fair because if you have been following up for many years, you will find that your doctor knows everything about you. So what is the point of shifting the patient to a place where he is just a number and nobody knows anything about him? The other thing is that there are patients with private insurance. When they arrive at a public hospital just for first aid, they ask the ambulance to take them to the private sector to continue their treatment because they are insured, their request will be rejected.
The private sector is not really involved in the map of general health care in Kuwait, because private hospitals used to deal with soft medicine like pediatrics and cosmetics. This new era of critical and emergency cases like cardiac arrest and so on, is relatively new in the private sector while the public sector has been handling this area for a long time.
Things are changing with time. For example, we don’t treat cardiac attacks with injections to dissolve clots in the artery anymore; the new golden standard is executing a primary coronary angioplasty. This means we fill the coronary arteries in the Catheterization Laboratory and then we open the blockage and put a stent. This is the procedure everywhere in the world. They started to apply this procedure in Kuwait in the past 1 or 2 years. The problem is that there are so many huge hospitals like Mubarak which don’t have catheterization labs, but they have a very large turnover of patients. They made a deal with Adan Hospital once, such that if a patient comes to Mubarak they will transfer him with the EMT directly to Adan. However, this will take some time as these hospitals are quite far from one another. We proposed that because we are next door, they send the patients to Dar Al Shifa instead of Adan because as we say, ‘Time equals muscle.’ This proposal was rejected for some reason. We have referrals from many other hospitals like KOC and Al Hadi which send their emergency cases to us. The three hospitals that have catheterization labs here in Kuwait are Sabah, Adan and Sabah-Al Ahmad.
Q: Would you say that your Cardiology Department is one of the leading departments in Kuwait?
A: Yes, I believe it is. We are the first hospital in Kuwait that treats acute myocardial infarction through the new golden standard procedure, which is the primary angioplasty. We have been doing this for the past 7 years. They started doing this in the public sector only 2 years back and we do the same thing. However for us, the time when the patient arrives at the ER until his artery is opened, we call it ‘door to balloon’ time. This ‘door to balloon’ time is the shortest in Kuwait – about 30 to 40 minutes. For example, we have, from the beginning of symptoms until the balloon, a distance and period that do not belong to the hospital; they belong to the patient when he felt the pain and how he managed to arrive at the hospital. We then take care of him from the ER to the Catheterization Laboratory. Therefore, our response to the patient is to make this period shorter – from the onset of symptoms to the balloon. The patient should know that any form of chest pain should be figured out and treated properly. The best thing to do is to come to the emergency and have an ECG to see if there is any cardiac attack.
Patients with chest pains usually have some sort of bile that comes from the stomach or gas in the intestine or something muscular. Patients need to be aware of the symptoms. They have to go immediately to the hospital to get diagnosed and then the management will come.
In this hospital, we have a chest pain unit which is unique in Dar Al Shifa even in Kuwait. Anyone suffering from any kind of chest pain should go to the chest pain unit and we will see if his symptoms are due to his heart. If it is, we are very well equipped to deal with the patient because we have a triage. If these symptoms are related to his gastric area or gastric organs, we have a gastral specialist. If it’s because of his lungs, we have a specialist who can take care of him. We don’t need to shift him to another hospital.
In other hospitals, if it’s cardiac, they need to send the patient to another hospital because they don’t have the set up and they can’t do triage. No other hospital has two of what our hospital has. We have the chest pain unit and we have the ability to do quick triage of the symptoms to have a good diagnosis and to have the proper management within a very short period of time.
Q: How many kinds of heart diseases are there?
A: The subject of heart diseases is a sub-specialty in internal medicine. The heart is an organ with muscles, arteries, valves and conduction system – the electricity of the heart. Aside from heart diseases, we also have congenital heart diseases, so let’s put congenital heart diseases aside because it’s an entity by itself. In the past, we had a lot of valve diseases caused by rheumatic fever. Now, because of antibiotics and good diagnosis of the child, all symptoms that lead to rheumatic fever are treated well. The valve disease caused by rheumatic fever is now almost nonexistent but this is still very frequent in third world countries that don’t have the equipment to handle it. In Kuwait the valve diseases we have are due to age because with age the valves start to thicken and don’t move anymore with flexibility and don’t close or don’t open very quickly. Therefore, you might have insufficiency in the function of the valve or you can have stenosis. We have coronary heart disease which is the most frequent today. This is when we have blockages in the arteries, which supply the cardiac muscle with blood that has oxygen. When you have a blockage it means this area of the muscle is no longer adequately supplied with oxygen which leads to a cardiac attack. There is also the problem of the conduction system or the electricity of the heart, those patients usually need a pace maker.
Q: How can someone avoid complications that are hereditary?
A: We have what we call risk factors when we asses a patient. These risk factors include high cholesterol, smoking, diabetes, hypertension and family history. These are all very important risk factors. You sometimes see brothers at a certain age, let’s say 35, who aren’t smokers or diabetic and they suddenly suffer acute cardiac attack. It is important to ask the patient if he has a family history of coronary heart disease because coronary heart disease can be hereditary. We have to assess the patient very carefully knowing that his family has a history of coronary heart disease. Once you have the data on your patient, you must be aware of all the other risk factors and to deal with them accordingly. Obesity, being one of the major risk factors and an entity by itself, is actually becoming a disease by itself; hence, it has to be treated as well.
At the same time, you have to do specific exams related to each condition. With patients who have hereditary cardiac problems, we must do the echo cardiogram carefully and we have to do a regular follow up with them. In the future, there will be some genetic treatment; thereby, eliminating complications, but this is far into the future.
Q: How significant are the factors of stress and anxiety when it comes to heart diseases?
A: There is an impact but not the way people normally describe it. For example, psychological stress does not cause the disease directly but it might help bring about the symptoms of the disease earlier than if there was no stress. Someone who is stressed has a heart that always beats fast, while in certain diseases like ischemic heart disease, we need the heart to beat slowly and smoothly. The same applies to patients who have palpitations, stress isn’t good for them.
Q: Are there signs of an imminent heart attack?
A: These signs include chest pain but unfortunately some patients are exempted from this very major symptom such as a diabetic patient who might suffer from a heart attack without feeling chest pains. We start by saying it’s a chest pain. This pain can be found only in 60 percent of the chest. A slight pain can also be felt in the chest, whilst majority of the pain is in the shoulder. Pain might be felt only in the stomach area, so the patient will come to the ER asking for treatment for stomach pains, unaware that he’s having or had cardiac attack. Sometimes, the pain might start in the jaw and the patient might go to the dentist, thinking there is something wrong with his teeth. If you want to diagnose a heart attack, pain is a major symptom but you have to be aware of the localization of this pain and treat the patient as a whole.
The chest pain felt by a 20-year-old is not the same as that of someone older. The chest pain will feel like severe tightness or severe heaviness as if you are having 500 kilos on your chest, or sometimes it feels as though you’re being stabbed, it’s not normal pain or something that can be ignored. Severe chest pain can sometimes be accompanied with nausea and sweating. If you are in doubt as to whether or not you are having cardiac attack, the best thing to do is go to emergency care to get an ECG and present your case to the doctor.
Q: When comparing men and women, are there different factors to consider when it comes to women?
A: Yes, there are certain issues to consider. Women usually have more atypical symptoms and they give more false alarms. Negative angiography is done for women. What I mean by negative is that when a woman comes with atypical chest pain and I can see on her ECG some changes, I will say she needs an angiogram. I then find that the coronary arteries are normal, so I say it’s a negative angiography. So we have pain, ECG changes and we have a negative angiography, this happens with women much more than it happens with men. They give a lot of false alarms either clinical or sometimes electrical, this is normal for women.
Women are usually more protected against coronary artery disease until the age of 50 because of their hormones and their fertility. After the age of 50, I would give them 10 more years before they become equal to men in the incident of having coronary heart disease. In Kuwait, the average age of cardiac patients is 10 years less than the average age of the patients in Europe for example. This is due to lifestyle and hereditary issues. Almost all Kuwaitis after the age of 40 to 45 are obese and have diabetes. Majority of them have hypertension, so this cluster of risk factors means that Kuwaitis and other Gulf nationals are more vulnerable to cardiac attacks and coronary artery disease. Even now, we see this new generation doing physical activities like going to the gym and using all these hormones and anabolics, these are all bad for the heart. We frequently see patients coming to the clinic with lots of muscles like Schwarzenegger and they are complaining of fatigue and shortness of breath despite all these muscles. When we do the echo for them, we see that the cardiac muscle is weak. The muscles outside are big but their cardiac muscle is weak and the capacity of pumping is less, it’s insufficient. All of this is because of the hormones they are using. It also leads to some sexual disabilities like erectile dysfunction, Asthenospermia where their sperms are very few or none at all and this is due to very bad movement of hormones.
Q: Any last messages?
A: I want to emphasize on the need to raise public awareness. Part of awareness in Kuwait is to choose a place where you can get the best care. We are ready to deal with all cardiac and emergency cardiac cases and we would like to prove this more and more. I hope the entire public medical sector in Kuwait will improve the system in terms of providing the best health care to patients. I wish that the link between the private and public sectors will get closer and tighter.
Dr Ahmed Alaeddine
Head of the Cardiology Department at Dar Al Shifa Hospital
* DIS of Cardiovascular Pathology from Paris Academy University Piere and Marie Curie
* DU of Interventional Cardiology from Paris University XII
Member of the French, European and Lebanese Societies of Cardiology
By Ahmed Al-Naqeeb
Arab Times Staff