Operating room awaits cath lab

At the Cayman Islands Hospital, a renovated operating theatre awaits the arrival of a new cardiac unit donated by Indian cardiologist Dr. Devi Shetty.

The cardiac unit, complete with a heart catheterisation laboratory, also known as a “cath lab”, will mean that patients who need to undergo heart procedures will no longer have to travel overseas to do so.

Lizzette Yearwood, CEO of the Health Services Authority, said the hospital had already planned to renovate its existing three operating theatres and add a new fourth one.

Dr. Shetty, who plans to build a health city with a hospital that he says will eventually house 2,000 beds, told government and health officials in November that he would donate the cardiac unit and provide the services of a cardiologist to the public hospital in George Town.

Ms Yearwood was unable to say exactly when the cardiac unit would arrive in Cayman, but said that it was a contained unit that did not need to be constructed, so once it arrives, it can quickly go into operation.

“We looked at many different places where we might house the cath lab and the most practical place will be in an operating theatre,” said Ms Yearwood.

“During our renovations of the operating theatres, we added a fourth operating theatre.. with the anticipation we might be expanding our facilities,” she said.

Work on two operating theatres, including the one that will house the cardiac unit, are nearing completion and work on the next two will begin once that is done.

Benefit to HSA

While Dr. Shetty’s project would fund and manage the cardiac unit and receive revenue from it, the Health Services Authority will benefit financially from the arrangement by providing the recovery care of the patients in the critical care unit.

The Cayman Islands Government has passed a number of laws,

which were among stipulations by Dr. Shetty and his investors before they would move ahead with the construction of the Narayana Cayman University Medical Centre. The first phase of the hospital, which Dr. Shetty has said will eventually have 2,000 beds, will involve the creation of up to 200 beds and is estimated to take between 18 to 20 months to complete once construction begins.

Asked if the cardiac unit and its cardiologist were likely to move to the new hospital once it is operational, Ms Yearwood said that was still under discussion. “But, the service is needed now by the people of the Cayman Islands. It is in our best interests that we get started right away rather than wait for the new hospital to be built in maybe three years,” Ms Yearwood said. “That is why we are anxious to partner with [Dr. Shetty] in this way. It brings the service almost immediately to the people here.”

The cardiologist who would operate the cath lab would reside and work full time in Cayman for a minimum of one year. “That was one of the requirements from our perspective,” said Ms Yearwood.

Doctors working in the Health Services Authority or in private practice will refer patients to the cardiologist. With a cardiologist on island, patients can be diagnosed and treated locally.

If tests such as echocardiograms, EKGs, treadmill tests, or CT scans indicate that a patient may have a blockage of an artery, he or she could undergo a procedure at the cath lab to be evaluated and, if necessary, a stent could be inserted to open up the blood flow, said Dr. Greg Hoeksema, medical director of the Health Services Authority.

Heart disease

Heart disease is a major factor in overseas health care costs for the government’s insurance company CINICO. Its records show that 127 cases were referred overseas for cardiac care during the 2008/2009 financial year, at a cost of more than $2.2 million. In 2007/2008, CINICO reported that almost $2.7 million was spent on referring 117 cardiovascular cases overseas.

Risks

Dr. Hoeksema said patients who are at risk for cardiac disease as well as those suffering chest pains would be able to undergo checks and be diagnosed and treated on island once the cardiac unit is established here.

“The classic symptoms for males or females is you typically feel crushing chest pain… You can experience pain in the chest and also arm, neck and shoulder,” he said. When a person experiences this pain, he or she should immediately consult a doctor or visit the hospital.

Other symptoms include sweating, vomiting and nausea.

People at risk of cardiac disease include those with a family history of heart attacks, people with high blood pressure and high cholesterol, and those who are overweight, who smoke or lead an inactive lifestyle.

How it works

In the cath lab, a catheter, which is a small tube-like device, is inserted in the groin and threaded through the major blood vessels to the arteries that supply blood to the heart. A contrast dye is injected and through an x-ray camera, the cardiologist and technicians can view any blockages on a monitor screen.

If a blockage in an artery is located, a stent can be inserted by the catheter to open up the artery.

“That essentially goes right through the middle of the blockage and opens up the blood flow,” Dr. Hoeksema explained.

If plaque is located that indicates that a blockage is likely to form, then a tiny balloon can be inserted to compact the plaque against the artery wall.

The search for the blockage and the insertion of the stent or balloon or other procedures happen during the same procedure.

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