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| LETTER TO EDITOR |
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| Year : 2019 | Volume
: 5
| Issue : 2 | Page : 128-132 |
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Cardiology department of all India Institute Of Medical Sciences, Rishikesh: Roads walked and roads ahead
Dibbendhu Khanra1, Bhanu Duggal1, Ravi Kant2
1 Department of Cardiology, All Institution of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Director and CEO, All Institution of Medical Sciences, Rishikesh, Uttarakhand, India
| Date of Web Publication | 19-Aug-2019 |
Correspondence Address:
Dibbendhu Khanra
Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jpcs.jpcs_35_19
How to cite this article:
Khanra D, Duggal B, Kant R. Cardiology department of all India Institute Of Medical Sciences, Rishikesh: Roads walked and roads ahead. J Pract Cardiovasc Sci 2019;5:128-32 |
How to cite this URL:
Khanra D, Duggal B, Kant R. Cardiology department of all India Institute Of Medical Sciences, Rishikesh: Roads walked and roads ahead. J Pract Cardiovasc Sci [serial online] 2019 [cited 2023 Mar 20];5:128-32. Available from: https://www.j-pcs.org/text.asp?2019/5/2/128/264629 |
| prologue | |  |
The All India Institute of Medical Sciences (AIIMS), Rishikesh came into existence as an Institute of National Importance through an Act of Parliament in 2012 which enabled it to be an autonomous body on the lines of the existing AIIMS, Delhi. Official inauguration ceremony for Medical college of AIIMS, Rishikesh was held on September 20, 2012. Subsequently, MBBS classes were started on September 21, 2012. AIIMS Rishikesh is one of the six apex health care institutes being established by the Ministry of Health and Family Welfare, Government of India under the Pradhan Mantri Swasthya Suraksha Yojna with the aim of correcting regional imbalances of health care. The main objectives are to create an excellent academic and educational milieu for providing a platform for the development of quality medical services, teaching, and research. Other objectives are to achieve an epitome of quality in medical education delivery and training system and to render international standard quality patient care and health care development system.
| Cardiology Department – a Phenomenal Past | | |
The cardiology department is still in its youth and has achieved accolades. The inception of cardiology as a department was started in 2016 with daily outpatient department (OPD) services. The patients were mostly coming from the hilly areas of Garhwal and western Uttar Pradesh. The number of patients visiting OPD kept on rising and the need of a separate inpatient department (IPD) [Figure 1] for cardiology was realized and was soon conceptualized [Figure 2]. Diagnostic coronary angiographies were started in 2016 in limited scale and escalated in 2017, where percutaneous coronary interventions (PCIs) including primary PCI and permanent pacemaker (PPM) implantations were started [Figure 3]. | Figure 1: Trend showing number of patients visiting cardiology outpatient department from 2016 to present.
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 | Figure 2: Trend showing number of patients being admitted in cardiology inpatient department from 2017 to present.
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 | Figure 3: Trend showing number of cardiac procedures in cardiology cath lab from 2016 to present.
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Dr. Bhanu Duggal joined as head of the department (HOD) in the late 2017, and DM cardiology seats were filled up by candidates from January 2018. The growth of OPD, IPD patients, and interventions demanded more number of trained hands, and three more faculties were recruited in 2018. Since then, the Department of Cardiology in AIIMS, Rishikesh witnessed a boom in terms of OPD patients, IPD admissions, and most importantly interventions, including primary PCI, PPM, balloon mitral valvotomy, balloon aortic valvuloplasty, balloon pulmonary valvuloplasty, device closure of atrial septal defects (ASD), device closure of postmyocardial infarction ventricular septal rupture, and peripheral interventions such as catheter-directed thrombolysis in pulmonary embolism, deep-vein thrombosis, acute limb ischemia, and coiling of feeding vessel for neoplastic tumors.
| Cardiology Department – a Glorious Present | | |
Services to the patients
Outpatient department and inpatient department
In OPD, on average, 150 patients are seen every day [Figure 1]. Cardiology IPD is a 40-bedded unit comprising 12 intensive cardiac care unit (ICCU) with high-end monitors with a central station and 18 beds in general ward. The admissions in IPD rose exponentially along with number of procedures and that made us have another ward with 20 beds for cardiology patients.
From the last 1 year, we are also running an arrhythmia clinic on Tuesday afternoon and a heart failure clinic on Thursday afternoon. Furthermore, we are part of the hypertension clinic on Friday which is run by the medicine department; we are planning to commence a valve clinic shortly.
At present, the department has six senior residents who are persuing DM Cardiology degree. The department has also trained its nursing stuffs and technicians to act fast and efficient in the setting of patient crashes in ICCU. The hospital runs basic and advanced life support training many times in a year, and all the residents, nursing staffs, and technicians are formally trained.
From this financial year, AIIMS Rishikesh have started a teleconsultation for the patients residing in remote areas of Uttarakhand, and we are offering cardiological consultations weekly to the doctors serving at hospitals of hilly and remote areas.
Noninterventional
The department of cardiology is equipped with five echocardiography machines including Philips EPIQ 7 and GE Vivid T8 with three-dimensional (3D) probes. The residents are being trained in 3D echocardiography, transesophageal echocardiography, and advanced strain echocardiography. We have also started myocardial contrast echocardiography in selected patients which is available in limited centers in India. We also provide treadmill tests, dobutamine stress echocardiography, Holter monitoring, external loop recorder, head-up tilt table test, interrogations of pacemakers, and ambulatory blood pressure monitoring. Nuclear scan, computed tomography coronary angiography, and cardiac magnetic resonance imaging (MRI) are also available in OPD basis.
Interventional
More than 80% of coronary procedures are done through radial route and dorsal radial intervention through anatomical snuff box approach has also been started [Figure 4]. The busy emergency department efficiently manages the patients with acute coronary syndrome (ACS) and acute decompensated heart failure with their dedicated residents, and ACS patients are timely brought to the cath lab for primary PCI. PCI in the last year met with flying colors in many complex cases such as left main coronary artery PCI, bifurcation PCI, and chronic total occlusion PCI. We take great pride in claiming that AIIMS Rishikesh did the first transaortic valve replacement not only in Uttarakhand but also first among all the AIIMS bodies [Figure 5]. | Figure 4: Coronary intervention from dorsal radial artery through anatomical snuff box approach.
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 | Figure 5: Dr. Barun Kumar and team performing the first transaortic valve replacement (TAVR) in All India Institute of Medical Sciences, Rishikesh.
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The cath lab is equipped with Philips' intravascular ultrasound/fractional flow reserve and intra-aortic balloon pumping. We have already procured Abbott's ocular computerized tomography/instantaneous wave-free ratio and Boston Scientific's Rotablator system.
We are also lucky to have faculties with expertise on electrophysiological interventions, and a fair number of ablations of paroxysmal supraventricular tachycardia have been done in the last year. Implantation of cardiac resynchronization therapy (CRT), implantable cardiac defibrillator (ICD), His bundle pacings and atrial fibrilaltion ablations have also been executed successfully.
Academic program
The academic program for the DM residents is ever evolving and one of the finest in the country and in line with the AIIMS model. We have classes 5 days a week including, case presentation on Monday, seminar on Tuesday, clinical grand rounds on Wednesday, cath conference on Thursday morning, cardiovascular and thoracic surgery (CVTS) meetings on Thursday evening, and journal club on Friday. AIIMS Rishikesh is pioneering total multiple choice questions' (MCQs) assessment for theory and total objective structural clinical examination (OSCE) for practical as envisioned by the Director Dr. Ravi Kant. All the JRs and SRs do have a monthly clinical assessment in MCQ and OSCE pattern, and the faculties are regularly trained to make good-quality MCQs. This MCQ and OSCE protocol is followed for undergraduate, postgraduate, and specialty trainees.
The department of cardiology has visiting faculties from abroad, enriching the department with interventional expertise, sharing experiences, shaping academic curriculum, participating in research works, and inspiring the young faculties.
The department is very active in academic involvements, and the residents are encouraged to participate in scientific writings and research works and to present in the national and international platforms. Abstracts from our department have been accepted in Heart Rhythm Society meeting 2019 and European Society of Cardiology meeting 2019. The department is closely working with the department of community and family medicine in scientific and clinical matters.
Integrated approach
We have the support of cardio-thorasic and vascular surgery (CVTS) department who are doing good numbers of coronary artery bypass grafting, aortic and mitral valve replacements, and surgical repair of ASD and ventricular septal defects. The weekly Cardio-CVTS meetings have become a great medium for interactions among interventionists and surgeons.
The cardiology department is also fortunate to have enthusiastic support of department of nuclear medicine and department of radiology. The availability of technetium scan (single-photon emission CT) for perfusion imaging and CT coronary angiography has led us to provide the best standard of care. The advent of state-of-the-art cardiac MRI has helped us in decision-making in cardiomyopathy patients and provide them timely devices.
There is dedicated diabetic clinic and dialysis unit running at the hospital, which are another spoke in the wheel of success for the department of cardiology in terms of complete patient care.
The department of cardiology encourages patients to join cardiac rehabilitation clinic led by the department of AYUSH which not only support the patients with graded exercises and Yoga but also guide them to adopt a healthy lifestyle including diet, deaddiction, and spirituality.
AIIMS Rishikesh is also sending doctors regularly to Kedarnath for providing service to the patients in the hilly areas and to the tourists who need treatment at high altitude.
Conferences
The department of cardiology has conducted multiple conferences last year including workshop on arrhythmia electrocardiogram and ablation in August 2018, the role of Yoga and meditation in the prevention of cardiovascular disease in March 2019 and integrated approach in prevention and treatment of cardiovascular disease in March 2019, and myocardial contrast echo workshop in May 2019. Moreover, all the conferences/CMEs achieved a successful outcome in terms of participation, learning, and networking and were the fruits of the vision and support of the Director Dr. Ravi Kant.
Ayushman scheme
The hospital has adopted free treatments for the Ayushman card holders, and PCI has been reaching to more number of needy patients of Uttarakhand and outskirts.
| Cardiology Department – a Promising Future | | |
The Department of Cardiology is not only a efficient unit but also is a closely knit family [Figure 6]. With the rapidly inflating quanta of clinical and academic works, AIIMS has allocated a complete wing to the department of cardiology to set up “Cardiac Science Centre” comprising spaces for three cath labs such as radial lounge, pre- and post-procedure room, ICCU and conference room and other facilities [Figure 7]. Two cath labs have been sanctioned and they are under construction and expected to be running by the end of this year. A third cath lab is being planned for dedicated electrophysiological services. | Figure 6: Department of Cardiology celebrating Diwali (2018) at All India Institute of Medical Sciences, Rishikesh (Head of the Department, Dr. Bhanu Duggal in the center).
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 | Figure 7: The front of All India Institute of Medical Sciences, Rishikesh building (Left); Cardiac Science Centre under construction (Right).
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AIIMS, Rishikesh is also planning to start an integrated medicine department for researches on mind–body Interactions and making sure its blessing usher on the patients. The department is soon to start up fellowship programs in electrophysiology, cardiac imaging, and interventional cardiology for the post-DM/DNB cardiology candidates.
| Epilogue | | |
AIIMS, Rishikesh, like a universe, is expanding, by leaps and bounds in a focused direction, led by the Director, Prof Ravi Kant. Department of cardiology is also following the suit in the firm and efficient hands of HOD Dr. Bhanu Duggal. The busy OPD service, Echo-lab, cardiology wards and ICCU are efficiently managed by the team of trained and dedicated doctors and staffs. Regular academic programs like seminars, round-table meetings and grand rounds aid in to the best and up-to-date medical care to the patients [Figure 8]. More resources from Ayushman scheme is anticipated for better serving the underserved. With the lights of more sophisticated technologies, workforce, and resources, the department will definitely bloom to its glory and we are at the cusp of the future. | Figure 8: Busy cardiology department consisting of (starting from top left, clockwise) outpatient department, echo-laboratory, cardiology ward, weekly clinical ground round and regular academic activities and intensive cardiac care unit.
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Acknowledgments
- Dr. Indranill Basu Ray, Visiting Faculty, Department of Cardiology
- Dr. Sharad Aggarwal, Visiting Faculty, Department of Cardiology
- Dr. Barun Kumar, Asst. Prof., Department of Cardiology
- Dr. Rohit Walia, Asst. Prof., Department of Cardiology
- Dr. Yash Shrivastava, Asst. Prof., Department of Cardiology
- Dr. Ramlal Ola, Senior Resident, Department of Cardiology
- Dr. Pintu Sharma, Senior Resident, Department of Cardiology
- Dr. Shishir Soni, Senior Resident, Department of Cardiology
- Dr. Ashwin, Senior Resident, Department of Cardiology
- Dr. Pranay Gore, Senior Resident, Department of Cardiology
- Dr. Gaurav Chauha, Senior Resident, Department of Cardiology.
Ethics clearance
Hanumanth Murali Rao.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
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