Heart Matters Vol 13 No 3 - October 2022

Introduction

An introduction to physiological pacing – who would benefit?

Right ventricular (RV) pacing has historically been the favoured approach to treat patients with bradyarrhythmia. It is a reliable technique that is well tolerated, safe and effective. However, there are significant downsides to this approach. Pacing the RV results in non-physiological unsynchronised (dyssynchronous) ventricular activation, frequently reducing left ventricular (LV) function in the long run. This so-called pacing-induced cardiomyopathy is associated with an increased risk of atrial fibrillation, heart failure and cardiovascular death.

Late presenting STEMI: How should we manage these patients?

Unfortunately, the benefits of early reperfusion therapy are not currently available to the vast majority of STEMI patients in South Africa. Our local reality of widespread health care system failures superimposed on socioeconomic deprivation means that many STEMI patients arrive late at poorly staffed facilities without available thrombolytic therapy and will not receive upfront reperfusion therapy of any variety. Most of the fortunate few who transfer to a PCI center will arrive outside the supposed ‘time is muscle’ window.

When not all goes to plan – managing adverse incidents, complaints and apologies

Health Care Practitioners (HCPs) almost always want to deliver the best care and see the best possible outcome for their patients. However, HCPs are only human and delays, misunderstandings and errors can occur despite their best efforts, particularly when they are working under pressure in a stressful environment. When a patient or their family believe their needs have not been addressed, their expectations not met, or their experience has been disappointing they may choose to raise the issues with the HCP directly in order to discuss their concerns. Whilst this might be done informally during a clinical consultation it is more frequent that a patient will email their complaint directly to the HCP and invite them to respond to their grievance and clarify the issues. Most patients, in the event of an adverse event or outcome, will usually attempt to reach out to their HCP in some way to alert them to their plight and request an explanation and appropriate follow up care.