With all the COVID-19 safety protocols that became a way of life for many of us in 2020, and the discovery of effective vaccines, we hope the novel coronavirus will be eradicated soon. Meanwhile, from the eyes of a cardiovascular surgeon, it seems that cardiovascular disease remains a major challenge and will be with us for a long time.

According to the World Health Organisation (WHO), cardiovascular disease is responsible for 17.9 million deaths annually, accounting for 31 per cent of all deaths worldwide. In Jamaica, cardiovascular disease accounted for 2,151 deaths in 2018 (12 per cent of all deaths).

The University Hospital of the West Indies (UHWI) provides a comprehensive cardiovascular programme and is the beacon of light in Jamaica, as the hospital is the only one of its kind providing complete cardiac surgical services. In 1968, the UHWI performed the first open heart surgery in the Caribbean. This was done by Professor Michael Woo Ming. This indeed was a special feat as the cardiopulmonary machine, an essential component of safe cardiac surgery then, was developed a few years earlier in 1954. In February 2000, a team headed by our own Professor Howard Spencer and including Professor Paul Ramphal, Dr Roger Irvine and myself, started the journey of paediatric heart surgery at the Bustamante Hospital for children. Since then, the UHWI has been frequently performing many challenging cardiac surgeries on complex cases. These include: pacemaker insertions, coronary artery bypass grafting (CABG), valve surgery, surgery for heart infections, rheumatic heart disease, septal defects/”hole in the heart”; repair of aneurysms and aortic dissections. While we possess the necessary skillset to conduct heart transplants in Jamaica, there is no legislative policy regarding heart transplantation locally and the procedure is not performed in the country.

Training of cardiothoracic surgeons is conducted at the University of the West Indies (UWI) and to date there have been 10 graduates from across the Caribbean. The training process is quite robust and involves training experiences in North America and the United Kingdom. There are four cardiothoracic surgeons who currently practice in Jamaica; primarily in Kingston. I recommend that individuals with suspicious symptoms have an evaluation done by their family physician or cardiologist and then be referred to a cardiothoracic surgeon. A lot has been said over the years about predisposing factors for cardiovascular disease, but a reminder at this time could not hurt. They include: diabetes mellitus, hypertension, high cholesterol, obesity, sedentary life style, advanced age (over 65 years), strong family history, Asian ethnicity, postmenopausal female and, importantly, cigarette smoking.

Cardiovascular disease may present in several ways. These include left-sided chest pain which radiates up the left side of the neck and down the left arm. This is considered the typical pain felt in a “heart attack”. There may be associated nausea, profuse sweating, palpitations/“racing of the heart” or sudden collapse. However, there may be no pain at all. In some cases there may be vomiting, indigestion or what Jamaicans typically refer to as “gas pain”. Fainting, shortness of breath and even swelling of the feet may also be symptoms in some cases. Patients experiencing these symptoms should go to the emergency room at once. They will then be seen by a cardiologist and the necessary investigations done. Eligible patients will then be referred to cardiovascular surgeons for emergency or urgent surgical treatment of their underlying coronary artery disease.

Dr Joseph Blidgen is consultant cardiothoracic surgeon and associate lecturer at the National Chest Hospital and The University of the West Indies

Email: josey702001@yahoo.com