Day 2 May 28, 2015 THURSDAY

Your Heart News & Views in a Beat

NewsBEATS

THE

The Offi cial Publication of the 46th PHA Annual Convention & Scientifi c Meeting

Your Heart News & Views in a Beat

BEATSBEATSBEATSBEATSBEATSBEATSBEATS

Divinagracia, Castillo battle in ‘Cross� res’

Taking the a� rmative side, Divinagracia argued citing results from met analyses that patients whose management are biomark-er guided fare better than those who are clinically guided.

Divinagracia, however, ad-mits that such biomarkers may be costly but cost-e� ectiveness is seen with lower rehospitaliza-tion rates among patients under biomarker-guided therapy than those in the clinically-guided therapy group.

Castillo, on the negative side, refuted Divinagracia’s claim by stating that biomarkers are not essential and cost-e� ective in the management of heart fail-ure in a typical Philippine clini-cal setting.

Aside from the fact that the blood tests for heart failure are not standardized, there are a number of limitations to these biomarkers such as age, BMI,

renal disease, comorbidities, and has a large intra - and inter- individual variability that a� ect the results.

Citing results from the BAT-TLE-SCARRED trial by Rich-ards, patients at least 75 years old whose treatments were biomarker guided did not do any better in terms of survival, compared to the usual care and clinical-guided therapy group.

Castillo, however, admitted that biomarkers showed sig-ni� cant survival bene� t among patients aged 75 years old. He went on saying that although BNP clearly improves diagnos-tic accuracy of patients present-ing with dyspnea, it is not a stand alone test. t

� e physician must bring to the table adequate history and physical examination skills as well as ability to interpret other laboratory tests such as chest x-

rays, Castillo strongly proposi-tions.

Both speakers found a com-mon ground however, saying that the use of biomarkers is not applicable to everyone espe-cially in our clinical setting. No amount of biomarkers should replace the physician’s clinical judgement, one that is priceless and most certainly economical.

Former PHA president Ma. Carrisma Belen ably moderated the debates. Both Divinagracia and Castillo are former presi-dents of the PHA.

� e Cross� res and Controver-sies was the � rst installment of two debates scheduled for this convention. � e audience found the debates very interactive, a bit heated yet intellectually stimu-lating.� e next round of debates will feature former PHA presi-dents Dr. Romeo Saavedra and Dr. Antonio Sibulo

Santos presents story behind Phil Echo

By Myla S. Supe, MD“I remember his sartorial elegance. His dtemeanor. His lec-

tures, an oratorical delivery.”Such was the ode Dr. Romeo J. Santos gave to his teacher

Dr. Mariano Alimurung for the former’s lecture delivered for the latter’s dedicated memorial lecture yesterday during the convocation and opening ceremonies of the 46th PHA An-nual Convocation and Scienti� c Meeting.

Santos, the 52nd PHA president and a former student of the founding PHA president Alimurung provided the imagery of the man whom most of this generation’s cardiologists owe much, but know very little of.

Santos, a native of Nueva Vizcaya, talked on the beginnings of Philippine echocar-diography to what it is now. Tracing the history of Philippine cardiology inter-twined with the be-ginnings of the “ultra-sound cardiography,” the � rst clinical appli-cation of ultrasound, a term which fell to

see page 4...

By Michael B. Cabalatungan, MDChinese General Hospital and Medical Center

In a much anticipated debate dubbed as “Battle Royale” between two topnotch cardiologists in the country, Drs. Romeo Divinagracia and Rafael Castillo, ex-changed arguments on the use of biomarkers to direct management of patients with chronic heart failure.

PRESIDENTS ALL AND A COFFEE TABLE BOOK. � e co� ee table book commemorating the PHA’s 60th anniversary was launched last night in simple ceremonies. From left: Drs. Saturnino Javier, Dante Morales, Eugene Reyes, Romeo Santos, Cesar Recto II, Maria Teresa Abola, Joel Abanilla, Raul Jara, Isabela Ongtengco, Eleanor Lopez, and Mariano Lopez in wheelchair is Dr. Ramon Abarquez, Jr.

Day 2 • May 28, 2015 • THURSDAY2

E D I T O R I A L

Don Robespierre C. Reyes, MDEditor-in-ChiefAssociate Editors

Bernadette Santiago-Halasan, MDMyla Gloria Salazar-Supe, MD

Managing EditorGynna P. Gagelonia

WritersWritersWCecile Cabias-JacaRitchie Go, MD

Lauren Salazar-Valera, MD

Layout ArtistJoey dela Cruz

The Heart NewsBeats is the offi cial publicationof the Annual Convention & Scientifi c Meeting

of the Philippine Heart Association

See Page 3

See page 4

THERE is a famous quote from the great philosopher Lao Tzu that reads, “A journey of a thousand miles begins with a single step.”

� e historic joint session of the Philippine Heart Association (PHA) Council on Cardiopulmonary Resuscitation (CPR) and the Resuscitation Council of Asia (RCA) held on May 25, 2015 as a pre-con-vention symposium of the PHA Annual Conven-tion and Scienti� c Sessions is de� nitely a single step towards greater heights for the PHA.

� is was the � rst time that the Philippines hosted the RCA meeting and general assembly. � e RCA, an interdisciplinary council for resuscitation medicine, is the Asian component society of the International Liaison Committee on Resuscitation (ILCOR), which is the committee formed to pro-vide an opportunity for the major resuscitation or-ganizations in the world to work together on CPR protocols and to provide a mechanism by which the scienti� c data relevant to emergency cardiac care and resuscitation are reviewed and used to provide inter-national guidelines on Basic and Advanced Cardiac Life Support. It is composed of the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Australian and New Zea-land Committee on Resuscitation, the Resuscitation Councils of Southern Africa (RCSA), the Resuscita-tion Councils of Asia (RCA) and the Inter American Heart Foundation (IAHF). � e PHA Council on CPR was formally inducted as Full Member of the RCA in 2010, joining the resuscitation councils of Singapore, Japan, Korea and Taiwan. After the Phil-ippines, the resuscitation council of � ailand also joined and was inducted, while the societies of Ma-

Bursts!

THIS year marks the 13th year that I have been a member of the Philippine Heart Association. My entry into the premiere organization of cardio-vascular specialists came in 2002 as a � rst year Cardiology Fellow at the University of Santo To-mas Hospital, when I ap-plied for membership in the Association, together with my other co-fellows, in preparation of course, to being a diplomate after graduating from the Fel-lowship Training Program and taking the Philippine Specialty Board of Adult Cardiology.

As a training fellow, it was inculcated in us by our then Training O� -cer, Dr. Eduardo Vicente Caguioa, that the ulti-mate goal of the program, was for us to pass the dip-

ENTRAINED

EngagementMarcellus Francis Ramirez, MD

lomate examinations and eventually become Fellow of the Philippine College of Cardiology.

Back then, my only impression of the PHA was that it was just an organization in which I just needed to become a member to ful� ll a re-quirement, that the most engagement I would have would be just to attend the conventions, ful� ll the required attendances in the business meetings, and complete the prereq-uisites mandated for all trainees.

In my thoughts, the PHA was such a huge society with such a rich history and an impres-sive roster of leaders and members who happen to be the Who’s Who in Philippine medicine and healthcare. What contri-

in Electrophysiology in Singapore in 2006, I was immediately called to serve as a member of the Council on Cardiopulmo-nary Resuscitation under then chair Dr. Raul Ram-boyong. Having freshly � nished my subspecialty training, I was tasked to give a talk on arrhythmia and resuscitation during the 1st National Basic and Advanced Cardiac Life Support Training the Trainors Course. It was the very � rst event that I was exposed to the lead-ers and the workhorse of the Association- the PHA Board of Directors. � e rest was history.

Today, after 13 years of being an active member of the PHA, I never thought I would be engaged with the Association this way. Succeeding my men-tor Dr Ramboyong as Chair of the CPR Coun-cil in 2008, I steered the Council and continued with its programs. One of the highlights was the acceptance of the PHA Council on CPR as a full member of the Resusci-

bution beyond member-ship, could I still o� er to the organization? I just needed to � nish fellow-ship, hurdle the specialty board examinations and get on with my cardiology practice.

A lot of things have in-deed happened in a span of 13 years. During the interview for the Out-standing Training Fellow Award, one of the past PHA presidents asked me what particular attribute should one demonstrate in order to be designated an Outstanding Train-ing Fellow of the PHA? After a brief pause, and perhaps subconsciously, I boldly declared, he should epitomize what the PHA is all about- excellence in patient service, cardio-vascular education and research.

� e award totally changed my perspective in terms of my involve-ment with the society. It came with a heavier re-sponsibility of contribut-ing to the PHA in what-ever way possible.

After I returned from Subspecialty Fellowship

IT’S TECHNICALLY day 2 today but for us here at the PHA annual con-vention, but in reality it’s at least day 3 for most of the organizing committee.

I feel like the past two days have been two weeks, a lot oaf things have been happening so quickly. I have been feeling a deluge of information from all lectures and symposia. I feel I am omniscient and omnipresent!

But the truth is that I am just in one place most of the time. � e toilet sometimes, and a dining area somewhere within the vicinity. � anks to some lively souls who pass by the Secretariat O� ce, I get some interruption from my intimacy with the computer screen and my romance with the key-board.

Reading all news ar-ticles submitted to us (Berna Halasan, Myla Supe and Manang Gage) gave me the validation that what I have been browsing through on the

Surprises and no surprises

convention schedule for weeks now have actual transpired. Familiarity did not breed contempt. It just doused down the excitement.

But one twist today (but I had an inkling about it a few days back) that pepped up the excite-ment ten levels up was the launch of the co� ee table book commemorat-ing the 60th anniversary of the PHA. � e book was conceptualized by then PHA President Dr. Saturnino Javier in 2012. � ree years after, his idea is now something we can hold and see!

� ere were not so many who were there. Former presidents, board members, council mem-bers and some came from the pharmaceutical in-dustry. For us who were there but did not belong to any category I’ve just mentioned, I guess we were mere contributors (but nevertheless, we were part of the book!) excit-edly waiting in line like

children queuing for their � rst taste of ice cream from Sorbetero guy.

� e excitement comes from the three-year mys-tery about the progress of such ambitious publica-tion! No one really exactly knew what the contents really are, how the cover looks, what photos were included and whether the articles we submitted were severely murdered by the editor or not. Except Dr. Bong. But only until last night when contribu-tors hurried to open the book and skim through the pages. Seeing your work immortalized in a book that will be revered through time more than compensates the e� orts in doing such. Honor be-comes forever.

Kudos to Dr. Bong and all those involved in the production of the cof-fee table book!

With the PHA playing host to the 15th Resus-citation Council of Asia, it is now undeniable that the Philippines through the PHA has gained suf-� cient and a steadfast ground in the Asia-paci� c region in terms of resusci-tation science.

From the interactions with our Asian counter-parts in the training of health care providers in CPR, we have learned that BLS/ACLS training are government funded, unlike in the Philippines

where it takes a non-gov-ernment organization like the PHA to provide such training.

A sensitive issue that has not been really dis-cussed formally among colleagues is the appar-ently growing “divide and animosity” between the proponents the PHA-run BLS/ACLS training and the AHA counterpart here in the country.

According to ACLS trainers from the RCA member countries, entities running and providing AHA training and certi� -cation do also exist in their respective countries. For them, they feel no compe-tition or even the slightest of pressure between the lo-cal and the American CPR training providers.

� ese Asian cardi-ologists and emergency medicine experts believe that no problem should arise between the local council and the AHA since both groups share the same mission of edu-cating and training health care providers and the lay in the provision of CPR to curb down the rates of mortality and morbidity in patients su� ering from cardiac arrest.

Perhaps, we can learn from our Asian counter-parts. We can work on common grounds and settle whatever di� erences there may be before the acorn becomes an oak.

by Don Robespierre C. Reyes, M.D.

One big step for the PHA

Day 2 • May 28, 2015 • THURSDAY

SUDDEN cardiac death (SCD) in an athlete is a rare yet highly visible tragedy that generates signi� cant me-dia attention and discussion among medical person-nel, sports communities, and lay persons alike. � e incidence of SCD is greater in athletes compared with their nonathletic counterparts due to the increased risk associated with strenuous exercise in the context of a quiescent cardiac abnormality.

In September 2014, � e Philippine Heart Asso-ciation Cebu Chapter launched Sports Cardiology in Cebu City. A discipline designated for the cardiovas-cular care of athletes and physically active people of all ages. With this discipline, PHA Cebu aims to increase awareness of the importance of cardiac safety during sports activities whether recreational or competitive, as well as improve public awareness on the health bene� ts of exercise.

Last February 14, 2015, on the Day of Hearts, Chong Hua Hospital opened the 1st Sports Cardiology Unit in Cebu City. � e center o� ers pre-participation athletic cardiovascular screening, clearance to continue sports participation after cardiac event or medical ill-ness and advise on lifestyle factors that may a� ect the athletic heart among others.

PHA Cebu is also embarking on a new project called “BLS READY CEBU” which entails holding Basic Life Support Courses for non-health care providers or lay personnel. � e 1st course will be at the Cebu Country Club with twenty � ve golf caddies, waiters and key club personnel as course participants.

While only a few athletes are at risk for sudden car-diac death, the Chapter recognizes the magnitude of these tragedies and is currently exerting e� orts to come up with an e� ective plan to minimize their occurrence.

centralpointBy Carolyn K. Fermin, MD

Into the athlete’s heart

3

Poetics of an Ilocana cardiologist

Working with and for the PHA requires dedication and willingness to serve the mission,also needed in equipotent doses:Energy, that has to be contagious to involve everybody.Imagination and the power to create, the precursor to planning, the will to succeed is what sustainsand most of all, Faith in God to do everything.

Practice for the Filipino peopleNever dreamed practicing elsewhere but here at home, La Union.Never imagined either that Filipinos would be dispersed worldwide with the exodus of OFWs, the evolution of brain drain.

On our last year of cardiology training, If one can remember:PCC is not everything, its the Only thing ... Had its beginnings with Ed Ongjoco’s admonition: kailangan ipasa mo. � ere were no what ifs

It was the only thing, indeed that led me to where i am now. Practicing cardiologycountryside:

Requires educating and sifting facts from fallacies, hearsay medicineDebunking testimonials with evidence based medicineBanishing fear and ignorance when faced with an overly anxious patient, i become psychologist and psychotherapist And it becomes rewarding Letting patients assume responsibility for their wellnessLeaving a reminder that healing comes from a Higher being.

NORTHERNEXPOSURE

By Estella Mabanag, MD.

SOUTHERNFLAVORBy Bernadette Santiago-Halasan, M.D.

THE PRACTICE of Cardiology in the far-� ung provinces from the metro is no joke. Howev-er, despite all its challeng-es, it is both rewarding and ful� lling. Please don’t get me wrong. Although I am very much a “probin-syana” myself, I still have to explore the twists and turns of practice in areas wherein one or even no cardiologists are practic-ing. And I really have high regard and respect for those who have un-sel� shly sacri� ced their lives in serving the un-derserved and the farthest

corners of this country.I have gained insights

from colleagues practic-ing in these areas. And for me, they are no less than the heroes of these mod-ern times.

� e practice of Cardiol-ogy in these areas revolves in the very basic perfec-tion of the art of history and physical examination where there are no short-cuts directly to laboratory or diagnostic imaging procedures. Some areas, although equipped with basic laboratory tests, still do not have the more elaborate imaging proce-

Of challenges and rewards in local cardiology practice

“Two roads diverged in a wood and I took the one less traveled by, and that has made all the di� erence.”

—Robert Frost

dures. Despite all these challenges, the Cardiolo-gists in these areas hurdle all the di� culties that one can never experience in a very well-equipped and technologically-updated hospital. And the superb clinical acumen of these doctors can never be un-derestimated and could never be judged as any less than their counterparts in the metro.

But all of these chal-lenges always have sweet and fruitful rewards. It creates not just a sense of accomplishment to the physician. Beyond that,

it gives the heart doctor the sense of ful� llment in saving a life despite all the challenges, with all the minimal means of treating a patient. A sense of accomplishment because even with the most minimal resources, the patient you treated was able to live and sur-vive. A sense of leader-ship and responsibility in one’s own local com-munity because the doc-tor’s leadership skills and advocacies pose a great impact as well as a turn-ing point in the lifestyle of a patient.

laysia and HongKong ap-plied and were accepted as associate members.

But what does this holding of the RCA sym-posium mean for the As-sociation? What really does being a member of the RCA mean for the PHA?

As the arm of the PHA responsible for CPR edu-cation and training of both medical and lay person-nel, the CPR Council was patterned as a local coun-terpart of the American Heart Association Coun-cil on Resuscitation and Emergency Cardiovascu-lar Care. It was one of the original councils formed by the PHA in September 1982, initiated with the aim of assisting the orga-nization to achieve its mis-sion and vision.

Fast forward 33 years later, the Council has in-deed solidi� ed its stand as the leader in educa-tion and training in CPR, gaining the respect and support of other subspe-cialty societies and di� er-ent training institutions, to formulate the univer-sal and standardized ap-proach in the teaching of resuscitation, coordinate all resuscitation-related activities and to certify CPR training centers in the Philippines. It has in-deed come a long way in its rich history. Being a member of the RCA forti-� es its clout as the recog-nized body in the country with regards to matters related to the science, knowledge and skill of CPR. In the present day, the council continues its tireless e� orts in improv-ing resuscitation educa-tion at the hospital and primary care level, as well as CPR knowledge and skills for our nurses, para-

Editorial.. from page 2 medics, emergency medi-cal technicians, and allied specialties. But beyond the training and educa-tion in CPR, the Council has a deeper mission of assisting the PHA in im-proving the cardiovascular health of the country, and ultimately improving sur-vival. Indeed, the Council will have a hand in reduc-ing cardiovascular deaths and increasing survival rate of cardiac arrest patients.

� e holding of the RCA symposium here in the Philippines, as a joint session of the RCA and PHA CPR Coun-cil further strengthens the PHA’s reputation as the premiere cardiovas-cular organization in the country. It is one testa-ment that the PHA, in its 63rdyear, has lived up to the challenge posed by Dr. Paul Dudley White in 1952- that “the PHA can serve a great purpose as a stimulus to cardiovascular research, teaching, and practice in the Far East”.

Being a member of the RCA gives the PHA the privilege of being rep-resented during ILCOR meetings and confer-ences to review scienti� c

data relevant to CPR and o� er treatment recom-mendations that will be published in the interna-tional CPR guidelines.� e right to represent the RCA during ILCOR general as-semblies is rotated among the di� erent RCA member countries. Membership also allows the Associa-tion the right to take part in the formulation of basic life support guidelines for Asia. In other words, it al-lows our voice and stand to be heard when they for-mulate the guidelines and statements.

� is RCA sympo-sium demonstrates that the PHA is de� nitely at par with the rest of Asia in terms of resuscita-tion training and science. However, unlike our more developed neighboring countries, we are faced with many barriers and disadvantages- the lack of a universal emergency medical system, no read-ily available automatic external de� brillators (AEDs) in public places, no good samaritan law, a small funding for research and CPR educations, and the lack of a comprehen-sive integrated critical care

provision in most hospi-tals. � ese are challenges and opportunities for the organization to work on.

With the support of the Board, the Council will actively pursue for the availability of AEDs in public places to improve the chain of survival on site. � e Council longs for the day when AEDs, which are de� nitely life saving devices, will be mandated by the government to be required in institutions and public locations. Like-wise, the establishment of a CPR registry and our very own local data on re-suscitation outcomes is in the pipeline. With this, a local CPR guideline may be developed.

Years from now, when they will write about this decade in the history of Philippine Cardiology and the PHA, this � rst PHA-RCA joint session will de� nitely be one of the highlights.

And although, it might probably take a thousand miles or two before the PHA can achieve the same status as Singapore, Japan, Korea, Taiwan and the rest of world, but it has gone a step closer today.

Day 2 • May 28, 2015 • THURSDAY4

NO TIME to go to the gym, why not a four-minute daily exercise?

Husband-wife tan-dem of health and � t-ness Coach Jim and Toni Saret recommends a four-minute exercise that anyone can do daily.

“� is short exercise consists of 10 counts each of jumping jack, modi� ed jumping jack, wall push ups and for-ward lunges. All you need to do is repeat this cycle and make sure to adhere to the four-min-ute time frame. Put on the timer. It is a form of exercise that is acces-sible to all and does not entail any costs,” said the Saret couple.

� e best time to do it is as soon as you wake up because it induces the re-lease of happy hormones. Six hundred calories may be burned and lost in one day, Toni added.

Four minutes is short, but it is e� ective. It is the best approach to get people started with the psychological com-

4-minute daily exercise plus 52-100 does

wonders on your body

Lack of awareness poses risk to women’s hearts

ponent encouraging. O� ering an exercise regimen beyond four minutes doesn’t sound exciting, Jim also said.

Jim tells, “Trusts us, this has worked on a lot of people from all walks of life. But of course, after doing this 4-min-ute exercise, you have to apply the 52-100 (� ve servings of fruits and vegetables, not more than two hour of video time, 1 hour of daily physical activity, zero sugared-drinks and zero smoking) daily.”

� e Sarets, who gained prominence as icons of physical edu-cation , presented an animated and a very educational lecture on exercise and healthy lifestyle. Both were part of the all-doctor panel of speakers at the 46th PHA Annual Conven-tion 2015 Pre-Conven-tion Lay Symposium on May 26, 2015 at Isla Ballroom I, Edsa Shan-gri-La, Makati.

GPGagelonia

THERE are myths re-volving around women’s supposed cardiovascular disease ( CVD) “immu-nity” and later, refuting these beliefs with facts that heart disease kills more women than all cancers combined and that it is also the leading cause of death in women of all ages.

Women’s health ad-vocate and cardiologist-interventionist Dr. Aileen Cynthia De Lara con-� rmed this in a talk de-livered last May 26 before a group of lay composed mainly of women.

De Lara, the co-chair of PHA Council on Women’s Cardiovascular Health, said that Project

disuse in favor of Feigenbaum’s echocardiography, Santos took pride that he was among those who were able to use all the permutations of the echo machines, from M-mode, to the one-beat 3D transesophageal echocardiography.

Santos further narrated how clinical echocardiog-raphy has become the most widely used and com-prehensive cardiac imaging modality in most clinical situations ever since it was � rst established in the Phil-ippine Heart Center for Asia.

� e development of clinical echocardiography in the Philippines can arguably be gleaned from the practice of echocardiography at the Philippine Heart Center not only through the years of acquisition of innovative machines but more so for the enhancement of clinical diagnostic skills, the echocardiography expert noted.

� e former PHA president further recalled how the Philippine Society of Echocardiography (PSE) was later organized by Dr. Homobono Calleja (Father of Echocardiography in the Philippines) in 1990.

� ereafter, in 1996, the Philippine Heart Associa-tion developed the Council of Echocardiography. � e former became the leading organization that would uphold quality echocardiography by competent pro-fessionals for every patient. In order to provide com-petency guidelines, and to ensure accurate and com-prehensive use of echocardiography, collaboration

between the PSE and PHA was recently accomplished. � e mission of such collaboration, he said, was to

further enhance and ensure the quality of the practice of clinical echocardiography in the country. Over and beyond policy implantation is the important goal of providing every Filipino cardiac patient with ready ac-cess to comprehensive echocardiographic study done by competent sonographers and interpreted by trained and updated echocardiographers.

Working with the PHA Council of Echo and PSE Technical Working Group, he was able to present the growth and availability of this modality throughout the Philippines, highlighting the disparity of the avail-ability of trained echocardiographers.

He ended by stating his wish list, one that echoes the mission statement of the PSE. “I wish for all cardiac patients to have ready access to a comprehensive echo Doppler study done by competent sonographers us-ing dedicated 2D echo with doppler machines, inter-preted by trained and updated echocardiographers.”

Strengthening internal collaborations, forging new alliances with ASEAN neighbors, and the aspiration that echo professionals continue to update themselves, Santos hopes further for the subspecialty. (with re-ports from Edward Niño J. Gacrama, MD, Philippine Heart Center; Michelle Angelique R. Romero, MD, Cardinal Santos Medical Center; Paulene Kristine L. Gonzaga, MD, Cardinal Santos Medical Center)

Santos...from page 1

that this may be due to the fact that women tend to downplay their cardiac symptoms compared to that of men. De Lara fur-ther added that women tend to have smaller coro-nary arteries than men. She further discussed gen-der di� erences in athero-sclerosis and disease pre-sentation.

She also introduced the audience a comprehensive guideline for heart dis-ease prevention in women that was conducted in 2004 by the American Heart Association (AHA). � e guideline was easy enough to remember with its mnemonics, ALOHA which stands for: A- as-sess your risk, L- lifestyle

EVA (Evaluation of the Knowledge, Attitudes and Practices of Filipino Women in Metro Manila on Cardiovascular Dis-ease and Risk Factors,) betrayed the ignorance of 80% of women in Metro Manila about the fact that 80% are not aware that CVD is the leading cause of death. EVA is a joint project of the PHA, De-partment of Social Wel-fare and Development (DSWD) and the Depart-ment of Health.

� e UST-based cardi-ologist also pointed out that women often exhibit less intense and some-times, atypical symptoms of cardiac disease particu-larly heart attack stating

recommendations are pri-ority, O- other interven-tions prioritized accord-ing to expert panel rating scale, H- highest priority for therapy are women at highest risk, A- avoid medical therapies called Class III (postmenopaus-al hormone therapy, an-tioxidants and aspirin for low risk patients).

� e lady doctor also acquainted her listen-ers to an advocacy cam-paign named, “� e Heart Truth” which was formed to create awareness and educate women through lay fora and workshops about cardiovascular health and also to en-courage them to engage in healthy lifestyle.

tation Council of Asia, the component society of the International Liaison Committee of Resuscita-tion in 2010- a landmark event in the history of the Council and a legacy that I will leave to the PHA.

I was also called to serve as the PHA Website Co-chair, as member of the subeditors committee of the PHA Newsbriefs, and later on as its Editor-in-chief. I had also been called to serve as part of scienti� c and publication committees during the convention, and assigned quite a number of times as speaker during the scien-ti� c sessions.

Today, I believe I have had a hand in in� uenc-ing my younger col-leagues in training and my training fellows to do the same- get involved in the activities of the PHA. Some of them have gone on ato become Chairs of their respective Coun-cils- making a di� erence for the Association. � e others have contributed in some way, as writer, as speaker, as organizer, or

simply as a doer assisting the PHA in its advoca-cies and activities.

In a way, this is my way of paying it forward for my mother Associa-tion. I can still recall dur-ing one of the meetings of the convention orga-nizing committee with the training fellows, as I was assigning them tasks to do for the website and newsletter, giving assign-ments for them to write articles on the sessions for publication online and in print, I boldly told them, “Let us all do our own little way to serve our As-sociation and contribute to the success of the ses-sions!”.

Congratulations to the new diplomates of the Philippine College of Cardiology. To you I pose this challenge to do more than just start a cardiol-ogy practice. Serve the PHA! Become a mem-ber of a Council! Get involved! Get engaged! Make a di� erence!

Imitating a quote from John F. Kennedy, Ask not what the PHA can do for you, but instead ask what you can do for the PHA!

Entrained from page 2

By Sherwynn Simon, MDUST Hospital

Dr. De Lara

Day 2 • May 28, 2015 • THURSDAY 5

SWEDEN’S topnotch interventionist Dr. Mag-nus Settergren delivered a comprehensive and infor-mative lecture on mitral regurgitation yesterday for the Rodolfo C. Soto Pro-fessorial Lecture as part of the 46th PHA annual conference.

Settergren is the director of Interventional Cardiol-ogy of Karolinska Uni-versity Hospital in Stock-holm, Sweden, and one of the world’s foremost au-thorities on percutaneous mitral valve repair.

Settergren started pre-senting pertinent infor-mation on functional mi-tral regurgitation (MR), its impact on survival in patients with congestive heart failure (CHF), par-ticularly the poor progno-sis of these patients even

A GERMAN endocrinol-ogist warns against the use of HbA1c as the only ba-sis for good sugar control among diabetics.

Prof. Stephan Jacob said yesterday that Type 2 Dia-betes Mellitus (DM) is a complex, vascular disease which exhibits multiple cardio-metabolic risk fac-tors, thus HBA1c is not enough basis for control.

Jacob, a respected au-thority in endocrinology in Europe, emphasized that a vascular lesion re-quiresthree major aspects of control , namelyglu-cose, LDLand blood pres-sure that decreases car-diovascular mortality by 2.9%, 8.2% and 12%, respectively.

Glucose control is usu-ally monitored through

HbA1c is not enough, says German DM expert

Are We Ready for the MitraClip?By: Timothy C. Dy, MD

THE BODY is always kept in a state of homeo-stasis but oxidative stress disrupts this balance.

� is was the primary message sent before a large crowd by nutritional bio-chemist Dr. Shawn Talbott in his talk for the Dr. Ra-mon F. Abarquez Professo-rial Lecture yesterday.

Talbott, who holds a PhD in Nutritional Bio-chemistry and is based in the United States, kept the audience’s attention with his simpli� ed version of

American biochemist talks on oxidative stress by Lauren S. Valera, MD

when treated optimally medically or when sub-jected to open mitral valve annuloplasty.

� e Swedish interven-tionist further elaborated on other causes of MR and the shortcomings of cur-rent surgical techniques in addressing the needs of all MR patients.

Based on articles cited, a fair segment of patients with signi� cant MR and CHF are left untreated for various reasons, or treated without signi� cant long-term bene� ts. Because patients like these exist, lesser invasive techniques have become necessary to ensure these patients are not left untreated, Setter-gren said.

� e MitraClip device was then introduced as well as its indications

(functional and degenera-tive MR) and contraindi-cations, along with the concept on how it reduces MR, tracing its roots to a surgical procedure called the Al� eri stitch.

� is introduction was followed by videos on how the procedure is per-formed. Videos included simultaneous recordings of images from transesopha-geal echo, � uoroscopy and of operators in the cardiac catheterization laboratory, emphasizing the need for a cohesive multi-disciplin-ary team to achieve success in the performance of this procedure. A sample case of severe MR successfully treated with 2 clips was shown.

� e trials that support the use of MitraClip were then presented. Of par-

ticular interest was the EVEREST II (Endovas-cular Valve Edge-to-Edge Repair Study) trial, which looked at the patients randomized to MitraClip versus open-heart surgery. � e trial showed poorer MR reduction in the � rst year with MitraClip, in-dicating that if MitraClip was to fail, it does so in the � rst 6-12 months.

However, in patients whose MR was minimal after the � rst year of Mi-traClipping, their MR reduction paralleled that of surgery. Settergren also pointed out that the pro-cedure requires a learn-ing curve and the centers that participated in the trial were all starting their respective MitraClip pro-grams, thus MR reduction may not have been maxi-mized.

Despite the di� erence in MR reduction how-ever, it is of note that the mortality rate and rates of CHF were similar in both groups all the way up to 4-yr follow-up. � is sug-gests that MR reduction

need not be down to zero or 1+ to e� ect clinical im-provement, and that a re-duction from severe MR to mild to moderate MR has a huge clinical impact.

A high-risk registry (HRR) sub-study within the EVEREST II trial was also presented. In patients who are no longer surgi-cal candidates, MitraClip showed signi� cant sur-vival bene� t over medi-cal therapy (75% versus 55%).

Settergren went on to report that to date, ap-

proximately 18,000 Mi-traClip procedures have been performed globally for a wide array of indi-cations. Various percuta-neous therapies that are either available or still be-ing studied were likewise reported. � ese include percutaneous annuloplas-ty, percutaneous chordae insertion, and percutane-ous mitral valve replace-ment. With each technol-ogy presented, limitations were discussed and cited as reasons why these thera-

See Page 8.

See Page 8.

an otherwise convoluted subject.

� e American health and � tness advocate de-� ned oxidative stress as exposure to free radicals which are highly reactive chemical entities con-taining a single unpaired electron in the outermost orbit. � ese are generally unstable and highly toxic to cells.

� e formation of super-oxides use up 2-4% of the oxygen in the mitochon-drial respiration, and have

lethal e� ects if not quickly quenched.

Among the free radicals, superoxide is the most damaging. Free radicals participate in various en-zyme catalyzed reactions in the body such as signal transduction, gene expres-sion, activation of nuclear transcription factor, ageing and disease. Administra-tion of high doses of anti-oxidants such as the vita-min E and C completely counteracts these free radi-cals. Too much of antioxi-

dants leads to accelerated catabolism of free radicals in tissues. Oxidative stress is viewed as the gap be-tween exposure to free rad-icals and the body’s ability to protect the person from the e� ects of the exposure

To manage the cellular stress, the body’s � rst de-fense is to produce antioxi-dants via the activation of the Nrf2 pathway.

Acting like a thermo-stat in every single tissue, including that of the car-

HBA1c measurement. Targeting HBa1c on

the other hand showed no “legacy e� ect”. While ef-fective intensive treatment for DM type 1 proved to be bene� cial, this does not hold true for DM type 2.

In a Cochraine meta-analysis, intensive gly-cemic control (HBA1c <6.5%) among type 2 DM patients did not sig-ni� cantly decrease the cardiovascular event. � e probable explanation is that HBA1c does not re-� ect the daily � uctuation in blood glucose and pa-tients with alternating hypoglycemia and hy-perglycemia can have a near normal HBA1c and yet does not necessarily mean good glycemic con-trol. � erefore, HBA1c

should be supplemented with regular measurement of pre- and post-prandial glucose to have a more re-alistic picture of a patient’s glucose control.

Jacob advocates to stop focusing on HBa1c but rather take on a physiolog-ic approach. Hypoglyce-mia poses major problems in diabetics, he warns.

Hypoglycemia is as-sociated with increased risk for dementia and oc-currence of arrhythmias. It increases the risk for bradyarrhythmia by up to nine times. About 74% of hypoglycemic episodes occur during the night. It is during sleep that hypo-glycemia is undectected. Fluctuations in blood sug-ar levels leads to vascular endothelial dysfunction.

creases blood pressure by 4mmHg, a level in which studies have shown signif-icant reductions in mor-tality. � eir incidental blood pressure lowering e� ects were greater than that of the thiazide diuret-ics.

In the Philippines,

Intensive Glucose Con-trol is also associated with intermittent episodes of hypoglycemia. Studies have shown that severe hypoglycemia (ie. CBG <50mg/DL) is also associ-ated with increased cardio-vascular death, accelerated dementia among elderly, and various arrhythmias (particularly ventricular tachycardia and bradycar-dia).

Individualized treat-ment approach to blood sugar control cannot be overemphasized. � ere are a variety of drugs to choose from. � e new ones such as the GLP 1 agonists (liraglutide) and SGLT2 inhibitor (dapa-glifozin) were shown to decrease blood pres-sure. Dapagli� ozin de-

only 2.5% of patients are achieving good diabetes management. Jacob con-cluded that early exten-sive risk management is a must. Isolated correc-tion of HBa1c is not ad-vocated. (Lauren S. Val-era, MD and Sharon R. Pascua,UP-PGH)

Settergren

Talbott

Jacob

Dr. Luis Mabilangan Distinguished Fellow Award

Looking back -- in 1992, my beloved PHA named me Distinguished Teacher Awardee. � en in 1998, I received the Most Distin-guished Science Award. � is time, I am being given the Distinguished Fellow Award.

What can I say? � ank you, � ank you, � ank

You for the three awards.To my young colleagues, fellows, diplomates and as-

sociate fellows, Be good and be great. � ere has been a paradigm shift. � e patients are

no longer uncritical, are no longer subservient and no longer reluctant to ask questions, demand rationale or explanations of procedures and e� ects of treatment.

Let me quote Dr, William Osler, the great medical scholar and master clinician: “� e good physician treats the disease. � e great physician treats the patient.”

� e heart is what separates the good from the great.

Dr. Florina KaluagLoyalty Award

Dr. Joel Abanilla, Presi-dent of the PHA, members of the board, distinguished guests, fellow physicians, warmest greetings. I am, without doubt, humbled and honoured by this award. I am humbled because I saw the early days of the PHA, with the likes of Drs. Alimurung, Samia, Barcelona, Perteir-

ra, Dayrit and Herrera. � ey were Giants in those days of Cardiology. And I have seen this organization pass through new leadersand younger members, and evolve into what it is today: a prestigious and respected society of specialists in cardiology. And I am honored that you deem me � t for this loyalty award. I am loyal because I believe in this organization and all it stands for. I am loyal because of my love for endless learning. I am loyal because you are the wellspring from which � ows all that I am today. � ank you again for this award.

Dr. Enrico GruetDistinguished Teacher Award

Dr. Joel Abanilla, Presi-dent of the Philippine Heart Association, distin-guished o� cers and mem-bers of the Board of Direc-tors, fellow cardiologists, fellow physicians, friends, ladies and gentlemen, good morning.

I am honored to re-ceive this award and to be

counted among those who received this award before me.

For this, I thank the Cebu Chapter for nominating me and the Awards Committee and Board of Directors for giving their approval.

I also thank all my mentors at the UP-PGH, many of whom have been recipients of the Distinguished Teach-er Award, and who serve as my role models in teaching;

Also to all the Senior Clerks, Post-graduate Interns, and residents during my Cardio fellowship at UP-PGH, medical students, PGIs, and residents in Cebu who have been my inspiration to continually strive to impart knowledge and skills and develop the attitude to be excellent clinicians; my wife, Agnes, for her invalu-able support;

And to God Almighty for all the blessings He has showered on me and for keeping me in good health that I may continue my vocation.

Day 2 • May 28, 2015 • THURSDAY6

Responses from the College Awardees

Day 2 • May 28, 2015 • THURSDAY 7

Dr. Edgar TimbolMost Distinguished Award

� ank you, Dr. Bongo-sia, for trying to convince me that I am indeed a worthy recipient of this prestigious award and for believing in me more than I believe in myself.

With full trust in the collective wisdom of the members of the Awards Committee and the of-� cers of the PHA, I am

humbly accepting this award for which I will be eter-nally grateful.

If there is a scienti� c work that could probably justify this award is my research on atrial � brillation that pro-vided an answer to the chicken or egg question whether atrial dilatation is the cause or the consequence of atrial � brillation.

I would like to recognize the presence of my family led by my beloved wife and three of our six children, and openly thank them for supporting me in all of my undertakings not just for earning a living but also for living a life. May all of you: my mentors, colleagues, and for des in the PHA. Have a blessed day.

Dr. Erlyn DemerreDistinguished Service Award

� ank you so much for this Award. I don’t know if I really deserve it. � is is my � rst time to attend the Convocation Ceremonies because in the past eight years that I have been at the helm of the PHA NewsBriefs and the News-Beats my team and I were at the backstage churning

the issue as we endeavored to deliver you fresh news the next day.

I know that in this huge room, there are a lot of fu-ture editors that can be tapped. � ere is so much talent in this room that PHA can depend on.

To all the past presidents, thank you for giving me the opportunity to serve PHA and to the PHA Board and the Awards Committee, thank you so much for this award.

Responses from the College Awardees

Day 2 • May 28, 2015 • THURSDAY8

pies have yet to be widely used.

Despite some early technical di� culties in simulcasting his slides in all three screens in the plenary hall, Settergren did more than just discuss MitraClip. He expertly took the audience through the landscape of MR and

all the therapies available for its treatment, then highlighted the place Mi-traClip holds within this spectrum.

Given the overall pic-ture that Dr. Settergren painted, it is quite clear that we are indeed ready for the MitraClip and that in time, it will likely prove

to be mainstream therapy for carefully selected pa-tients with severe MR.

� e Rodolfo C. Soto lecture of the annual sci-enti� c sessions of the Phil-ippine Heart Association traditionally tackles new or controversial develop-ments in the � eld of inter-ventional cardiology.

diovascular system, Nrf2 is considered the master reg-ulator of antioxidant en-zymes and survival genes. Phytonutrients modulate its actions. Whenever there is oxidative stress, Nrf2 is released from KEAP1 and binds to ARE forming a complex.

A Fellow of both the American College of Sports Medicine and the American College of Nu-trition, Talbott asserts one of the most potent activa-tor of the Nrf2 pathway is exercise. ”Physical activ-ity ampli� es Nrf2 activity threefold. Aging, on the other hand, contributes to its decline.”

Not only does Nrf2 ac-tivation reduce systemic oxidative damage, it of-fers further protection of the cardiovascular tissues by activating anti-athero-sclerosis genes that reduce ventricular � brosis, block intimal hyperplasia, and improve cardiac output.

“Each antioxidant is dedicated to a speci� c free radical, and works syner-gistically to quench oxi-dative stress in a manner that maintains balance be-tween the two,” explained the chief science o� cer of LifeVantage.

While the protective ef-fects of antioxidants are often touted in disease prevention, Talbott warns consumers against taking high doses of stand-alone antioxidants.

“Too high levels of inter-fere with internal system of protective antioxidant en-zymes,” warns Talbott. He supports his claims with several studies illustrat-ing the ill e� ects of high dose antioxidants. Among those he cited was the cor-relation of prostate cancer with high doses of Vitamin E.

A marathoner and many a time ironman partici-pant, Talbott promotes exercise as the most po-tent activator of the NRF2 pathway.

However, Talbott reveals that some nutrients called phytonutrients can also activate NRF2 pathway in all the tissues of the body. Examples of phytonutri-ents are the catechins from green tea, tumeric and ashwaghanda. Protandim is a supplement that is a combination of phytonu-trients.

Studies have shown that protandim prominently increases the protective enzymes in the body. � e

age related increase in free radicals is completely abol-ished by protandim. Oxi-dative stress is reduced by about 40%. Protandim protects the cardiovascu-lar tissues by increasing antioxidant enzymes, de-creasing oxidative damage, decreasing cerebrovascular leakage, decreasing � bro-sis and intimal hyperpla-sia and increase in cardiac output.

His take-home message: “Don’t take antioxidants; make antioxidants. It is more e� cient and more e� ective.”

Dr. Talbott is an athlete himself and has partici-pated in several marathons including the Iron Man. He is part of the First Lady Michelle Obama’s “Let’s Move!” campaign to � ght childhood obesity.

� e Dr. Ramon F. Abarquez Professorial Lec-ture is a biennial event during the PHA annual convention and scienti� c meeting.� e lecture, held in honor of one of the pil-lars of Philippine Cardiol-ogy, focuses on the applied science of coronary artery disease, heart failure and microcirculation.(with re-ports from Karen Arellano, MD)

OXIDATIVE STRESS... from page 5.

comatose patients. Based on Japanese ex-

periences, TH for lon-ger than 24 hours with a very slow rewarming may possibly bring further improvements in neuro-logical outcome in PCAS, Aibiki further claimed.

Moreover, the Japanese expert proposed that a bundle of care protocol is necessary to improve outcomes in PACS pa-tients, especially during TH application. Good hemodynamic status is very important, particu-larly hydration during the induction of therapeutic

hypothermia. Early per-cutaneous intervention for acute coronary syn-drome must be greatly considered.

Pain and shivering that occurs during cooling even in patients targeting normothermia, should be controlled with agents including neuromuscular blockers. He further not-ed that generally there was no standardized protocol for sedation and shiver-ing management in the TTM trials that resulted in imprecise control of body temperature in these studies.

Adequate blood glucose control and appropriate respiratory care includ-ing oxygen titration and normocapnea should be achieved.

Aibiki however noted that more investigations are needed to further substantiate his recom-mendations. Aibiki is the Chair of the Depart-ment of Emergency and Critical Care Medicine, Ehime University, Gradu-ate School of Medicine in Shikoku, Japan. (with re-ports from Ailen Albana, MD, UST Hospital.)

preconvention lectures last May 26.

� e � ve major criteria were listed as presence of polymigratory arthritis, carditis, erythematous, non-pruritic rash, chorea, pea-sized nodules. � e minor criteria still in-clude fever for 3-5 days, recurrent arthralgia, pal-lor, positive acute phase reactants (ASO titer, ESR, CRP), electrocardiogram � ndings (tachycardia out of proportion to activity, prolonged PR interval).

� e diagnosis of Rheu-matic fever is made if any two major criteria were met, or any one major manifestation plus any two minor criteria.

Rheumatic Fever may be suspected if symptoms or clinical presentation do not completely ful� ll crite-ria as major manifestations or only minor manifesta-tions were present.

Rheumatic Heart Dis-ease, as a diagnosis is made when 2D echocardiogra-phy supports the diagno-sis that includes presence of Mitral regurgitation (jet >2cm, velocity >3m/s for 1 complete envelope, pansystolic jet in at least 1 envelope); Mitral ste-nosis (MS mean gradient >4mmHg), presence of morphologic MV abnor-malities (anterior mitral thickness >3mm, chordal thickening, restricted lea� et motion or exces-sive lea� et motion); aortic regurgitation (jet length >1cm, velocity >3m/s in early diastole, pandiastolic jet in at least 1 envelope), morphologic AV abnor-malities (presence of thick-ening, coaptation defect, restricted lea� et motion, prolapse).

Treatment should be initiated if diagnosis for Rheumatic Fever/Heart Disease has been made. Primary prophylaxis would include either single dose intramuscular injec-tion of Benzathine Penicil-lin G or oral Penicillin V 50mg/kg/day for 10days, or if allergic to Penicillin, Erythromycin 50mg/kg/day for 10days. If in ac-tivity, anti-in� ammatory treatment should be given Aspirin 60-70mg/kg/day (max 3grams/day) if ar-thritis is major symptom and Prednisone 1-2mg/kg/day for 4 weeks then taper in 2 weeks. If signs of heart failure are pres-ent, referral to tertiary care is a must. (Joanna Z. Java, MD, Philippine Heart Center)

AHA Echo Classi� ca-tion of Valve Disease de-� ned

Dr. Ronald Cuyco, pe-diatric cardiologist from the Philippine Heart Cen-ter underscored the impor-

tance of echocardiography in valvular heart disease (VHD) assessment.

In his lecture delivered last May 26 for the pre-convention activities of the 46th annual covention, Cuyco said that echocar-diography is important in veri� cation of presence of VHD, establishing type of and etiology of VHD, de-termining severity of valve lesion, assessment of he-modynamic consequences, determine prognosis and evaluate timing of inter-vention.

He further di� erenti-ated the stages of progres-sion of VHD into four.

Stage A (with risk fac-tors for development of VHD), stage B (progres-sive, mild to moderate se-verity and asymptomatic), stage C (asymptomatic severe, with or without de-compensation of the right or left ventricle), stage D (symptomatic severe, with symptoms as a result of VHD).

� e bases for classi� ca-tion of the stages are the valve morphology or anat-omy, valve hemodynam-ics, hemodynamic e� ects and patient’s symptoms.

Rheumatic heart dis-ease echo-morphologic � ndings as described were lea� et calci� cation with or without subvalvar ap-paratus, lea� et thickening, commissural calci� cation and fusion, restriction of lea� et or cusp motion, re-tracted and rolled-up leaf-let/cuspal margins, lea� et mal-coaptation and pres-ence of infective endocar-ditis vegetation.

Mitral stenosis is com-monly caused by rheu-matic heart disease and described as thickened and calci� ed mitral lea� ets with subvalvar involve-ment, “hockey-stick” ap-pearance of anterior mi-tral valve lea� et, restricted � xed and upright posterior lea� et, � sh-mouth mitral valve ori� ce in the short-axis view due to commis-sural fusion.

Stages of mitral stenosis are based on Wilkins-Pa-lacios echocardiographic score index with regards to lea� et mobility, leaf-let thickening, subvalvar thickening and calci� ca-tion.

Mitral regurgitation is described as lea� et thick-ening and calci� cation with or without restriction of motion, retracted and rolled-up cuspal edges/margins, mal-coaptation to non-coaptation of MV lea� ets during systole and usually with concomitant valve lesions.

Aortic stenosis is char-acterized by commissural fusion on top of a calci� ed and restricted cusps and

presence of hypertrophied left ventricle with probable diastolic dysfunction. Aor-tic regurgitation is charac-terized, on the other hand, as cuspal calci� cation and commissural fusion, and rolled-up cuspal edges cre-ating a central echo-free space during diastole in severe cases.

Tricuspid regurgita-tion is seen as thickened lea� ets with areas of cal-ci� cation, rolled-up edges and/or destroyed lea� ets causing mal-coaptation during systole and dilated tricuspid valve annulus. All conditions mentioned were staged according to patient’s symptomatology and severity of involve-ment of valve lea� ets and presence of right or left ventricular dysfunction. (Joanna Z. Java, MD, Philippine Heart Center)

PHIC benefi ts for Rf/RHD discussed

� e Philippine Health Insurance Company ben-e� ts that can be accorded to patients with rheumatic fever and rheumatic heart disease was presented in a series of lectures for pedi-atric cardiologists last May 26 as part of pre-conven-tion activities of the PHA yearly conference.

Dr. Juliet Balderas from the Philippine Heart Cen-ter centered on the nation-al government’s thrust for RF/RHD patients.

Gearing towards control of rheumatic fever/heart disease in the Philippines for 2015 and onwards, the involvement of gov-ernment support through legislation and universal health care for primary and secondary prevention is shown in the conceptual framework for RHD con-trol program.

With the burden of dis-ease data (poverty, over-crowding, malnutrition and access to healthcare), there is multidisciplinary approach with govern-ment engagement in the baseline health system, community education for primary prevention, RF/RHD registry in the sec-ondary prevention and medical/interventional/surgical management of RF/RHD in tertiary pre-vention.

Proposed pre-authoriza-tion checklist as evaluated by the attending pediatric cardiologist, include age, clinical pathway summary and echocardiogram � nd-ings. If � ndings were met, it is the discretion of the attending pediatric cardi-ologist to either approve or disapprove the pre-au-thorization request.

Once approved, the pa-tient is then entered into the proposed RF/RHD

MITRACLIP... from page 5.

LONGER… from Page 12

ECHO... from page 9

Registry. For the manda-tory service in secondary prophylaxis – Rheumatic fever without carditis, presence of arthritis (acute or subacute), Benzathine Penicillin IM injection every 28 days for 5 years and Rheumatic fever with carditis/valve involvement, Benzathine Penicillin IM

injection every 21 days until age 18-40 years old or whichever is longer.

Actuarial cost for labo-ratory exams (CBC, ESR, CRP, ASO titer, 2d echo-cardiogram) P5,905.00 and cost of treatment for every 28 days (13 BPN injections per year) P8,324.87 per year and

for every 21 days (17 BPN injections per year) P9,069.38.

� e aim for the develop-ment of Philhealth Bene� t Secondary Prophylaxis is for the national program for prevention and con-trol of RF/RHD. (Joanna Z. Java, MD, Philippine Heart Center)

Day 2 • May 28, 2015 • THURSDAY 9

Rheumatic Heart Mitral Valve Disease was the earliest indication for elective cardiac surgery. In the 2014 AHA ACC Guidelines for Rheu-matic Mitral Stenosis, there is only one indication for sur-gery and almost all of the rest would require an interven-tional cardiologist to come in.

Surgical Options:To Repair or To Replace

According to Dr. Gerardo S. Manzo, President of the Association of � oracic and Cardiovascular Surgeons in Asia, “A surgeon will always be a part of his patient once he/she has undergone mitral valve replacement.”

� e patient will become a patient for life,” the heart sur-geon said referring to the need for follow-up and education of the patient.

Advances in the surgical re-pair of the mitral valve (MV) has allowed decreased opera-tive mortality, improved left ventricular function, lower risk of stroke, lower risk of infection, improved freedom from re-operation, freedom from anticoagulation and superior long term survival compared with that of mitral valve replacement.

Another important point is the need to operate the tri-cuspid valve regardless of the degree of involvement and the need for immediate surgery once there are multiple valve involvement.

Rheumatic Heart Disease Valve Surgery: Outcomesin the Last 15 years

In terms of valve involve-ment, mitral valve is still the leading valve involved in Rheumatic Heart Disease (RHD) patients. � ere was note of a decreasing trend in the mortality of patients who have undergone surgeries for MV alone and aortic valve (AV) alone. In addition, there was note of greatest mortality in patients who have under-gone valve surgery in combi-nation with other procedures.

Who needs referralto the valve team for

surgery or intervention?

Battle for the ValVes

Single Valve Replacement Clinical Pathway

A proposed pathway used in the Philippine Heart Center for valve surgery was also pre-sented. � e goal of the path-way is to set standards of care and to be able to standardize care for our single valve re-placement patients. � e pro-tocol is summarized as follows:Day 1-2: Pre-op labsDay 3: OR dayDay 4: SICU stay, Start on WarfarinDay 5: Transfer to WardDay 6: Transfer to Regular roomDay 7-8: Continuous post-op careDay 9: Prepare for dischargeDay 10: Date of discharge

Intervention in Rheumatic Heart Disease

Studies have shown that Percutaneous Transmitral Commisurotomy (PTMC) is not inferior to any type of surgical modality in the treat-ment of RHD patients with mitral stenosis.

Moreover, in patients who have mitral stenosis but as-ymptomatic, PTMC is not warranted. PTMC can be performed in pregnant pa-tients after 20 weeks age of gestation for it poses minimal to no risk to the fetus.

Rheumatic Fever and Rheumatic Heart Disease Registry

Prevention of Acute Rheumat-ic Fever is of great importance in the management of Rheumatic Heart Disease. � e Philippine Society of Pediatric Cardiology is in the process of producing a national registry which is com-prised of several key components including: demographic data, anthropometrics, clinical history, physical examination � ndings, chest x ray, ECG and 2d echo just to name a few. � e ultimate goal is to help stop if not alleviate the burden of RF/ RHD in our country.

Resource persons for this lectures included Manzo, Robin Augustine Q. Flores, MD, Francoise May S. Sarmiento, MD, Ronald H. Estacio, MD, Ma. � eresa C. Rosqueta, MD and Ma. Ber-nadette A. Azcueta, MD.

RHEUMATIC Fever-Rheu-matic Heart Disease (RF-RHD) remains a global concern in the Asia and the Paci� c Region even in the advent of modern medicine.

� is was the heart of the lec-ture presented by the president of the Philippine Society of Pediatric Cardiology, Dr. Eden Latosa. She presented a sum-mary of the � ndings and chal-lenges faced by the di� erent RF-RHD prevention and con-trol programmes being imple-mented in countries considered endemic for RF-RHD.

� e pediatric cardiologist estimated the global burden of RHD in 2005 at almost 20 mission existing cases, and an approximate global incidence of 282,000 cases per year.

Emerging echocardiograph-ic data suggest that the true prevalence of RHD might be several times higher than the 2005 global estimate. Around 200 to 450 thousand patients die from RHD each year, hun-

RF-RHD still a global menacedreds of thousands of people are disabled by this disease and its long term complications.

A comprehensive RHD con-trol program can be divided into primordial, primary, sec-ondary and tertiary prevention.

Primordial prevention is a program on the improvement of the environmental, social and economic conditions of the populations at risk of RF/RHD while primary preven-tion includes treatment of acute streptococcal pharyngitis with antibiotics to reduce the inci-dence of RF.

Secondary prevention is the use of antibiotic prophylaxis to reduce the recurrence of RF in people with history of RF or RHD and tertiary prevention includes the medical and surgi-cal treatment of the complica-tions of RF/RHD.

� is approach is exempli� ed by the Awareness, Surveillance, Ad-vocacy and Prevention (ASAP) comprehensive approach. � e program has four key elements

such as education, primary pre-vention, secondary prevention and disease surveillance.

� e biggest challenge in RHD control is to translate what we al-ready know into practical RHD control. � ere are many oppor-tunities to intervene RHD, es-pecially now that we have a lot of pediatric cardiologists distrib-uted all over our country who could help in the implementa-tion of the program.

To further this goal, Latosa proposed a comprehensive registry-based RHD control program that will also ensure a universal access to Benzathine Penicillin G, improve health worker training on the detec-tion and management of RHD and encourage development of a group A beta hemolytic strep-tococcal vaccine.

In the � nal analysis, the key to a successful implementation of the program is an active col-laboration between the govern-ment, private sectors and stake-holders, Latosa declared.

PEDIATRIC cardiologist Dr. Pacita Jay Lopez-Ballelos out-lined the echocardiographic morphological � ndings in es-tablishing diagnosis of rheu-matic associated valvular le-sions.

Lopez-Ballelos enumerated that in acute mitral valve chang-es, the following were noted – annular dilatation, chordal elongation, chordal rupture resulting in � ail lea� et with se-vere mitral valve regurgitation, anterior (or less commonly pos-terior) lea� et tip prolapse, pres-ence of beading or nodularity of lea� et tips.

In chronic mitral valve chang-es (not seen in acute carditis) – lea� et thickening, chordal thickening and fusion, restrict-

Echo criteria for valvular rheumatic lesions reviewed

ed lea� et motion, calci� cation. Lea� et thickening of anterior mitral valve is described as ≥ 3mm in ages < 20 years old, ≥ 4mm in 21-40 years old, ≥5mm in > 40 years old. In aortic valve changes in either acute or chronic carditis – irregular and focal lea� et thickening, coap-tation defect, restricted leaftlet motion and lea� et prolapse.

Pathologic mitral regurgita-tion (all four doppler echocar-diographic criteria must be met) – seen in two views, seen in at least 1 view, jet length ≥2cm, velocity ≥3 m/s for 1 complete envelope, pansystolic jet in at least 1 envelope.

Pathologic aortic regurgita-tion (all 4 doppler Doppler echocardiographic criteria must

be met) – seen in 2 views, seen in a t least 1 view, jet length ≥2cm, velocity ≥3m/s in early diastole, pan-diastolic jet in at least 1 envelope.

� e lecture was delivered last May 26 at the Isla Ballroom of the Shangrila Hotel as part of the reconvention activities of ECHO... from page 9the PHA 46th annual confer-ence. (Joanna Z. Java, MD, Philippine Heart Center)

Its still Jones Criteria for RF

� e Revised Jones Criteria still remain the basis for the screening pathway for rheu-matic fever, Dr. Evelyn Antho-nette Hilario said in a series of

See Page 8

IN a series of lectures and discussions held last ay 26 during the pediatric cardiology preconven-tion activities, six clinical cardiologists, interven-tionists and heart surgeons discussed dilemmas encountered in patients signi� cant mitral valve problems.

Dr. Latosa during her lecture on rheumatic fever and heart disease

By Jethro M. Macallan,MDUP-PGH

10 Day 2 • May 28, 2015 • THURSDAY

WHILE Filipinos are known to be resilient to survive the stron-gest of tyhoons, we remain help-less against sudden cardiac death.

Dr. Marcellus Francis Ramirez took note of several barriers to the implementation of appropri-ate CPR programs in the country.

In a lecture last May 26 during the preconvention sessions of the 46th PHA annual scienti� c meet, the former PHA CPR Council chair enumerated several obsta-cles to an ideal environment for delivering CPR that include the absence of an organized universal emergency medical system (EMS) and the seemingly hopeless heavy tra� c in the metropolis.

Automated External De� bril-lators are not readily available in public areas, if not available at all, and the absence of a good sa-maritan law are de� nitely snags in attaining a CPR ready Philip-pines, Ramirez pointed out.

Moreover, the lack of su� -cient government funding for research and CPR education are likewise detrimental to the goal of increasing survivors of cardi-ac arrest. � e lack of integrated critical care both in government or private institutions is like-wise lamentable.

In the Philippines, the highest likelihood of survival by prob-ability from a sudden cardiac ar-rest is in a casino. It is because it is complete with surveillance sys-tems, alert sta� certi� ed in CPR and an AED readily available.

Very much similar to the US and to most of our southeast

Ramirez bewails local CPR delivery; remains hopeful for future

Asian neighbors, heart diseas-es remains to be the number one killer in our country, ac-counting for close to 20% of all causes of death according to the latest Department of Health statistics. Sudden cardiac death is the single largest categoric cause of natural death in the US, and probably also in the Philippines, and it is the most common mode of death in pa-tients with coronary artery dis-ease, according to Ramirez.

Ramirez further bemoans the reality that it will probably take a long way before the Philippines achieves the same status as Singa-pore, Japan, Taiwan or Korea in terms of resuscitation science.

However, he remains hopeful, that with present steps taken by the PHA CPR Council, the country can inch its way for-ward to what is ideal. He notes that with the active participa-tion of the PHA in the Resus-citation Council of Asia and hosting its 15th annual summit, the Philippines is on its way to become in the forefront of re-suscitation science.

In the present day, the coun-cil continues in its tireless ef-forts in improving resuscitation education at the hospital and primary care level, as well as CPR knowledge and skills for our paramedics, EMTs and al-lied specialties.

With di� erent resources and tools to teach CPR, there is a published Filipino CPR in-structional lea� et and booklet, a

hands-only CPR easy to follow pamphlet, a CPR video for lay established in our PHA website, and the o� cial manual on BLS and ACLS used for trainings.

Under the leadership and guidance of former PHA presi-dent Noe Babilonia and Board of Director Joel Abanilla, the coun-cil collaborated with the coun-cils on CVS and RF-RHD to establish a course in emergency training for GK volunteers, and in the process, helped publish a Filipino � rst aid guide. With the support of the Board, the PHA is actively pursuing and lobby-ing for the availability of AEDs in public places to improve the chain of survival on site.

Current and future projects include CPR and ACLS courses, trainors certi� cation, mass CPR Trainings and Awareness (Heart Month, World Heart Day), CPR Research/Resuscitation Regis-try, local CPR guidelines, CPR in school curriculum, CPR on wheels and across the islands, campaign for Public Access De� -brillation (AED) and CPR-Ready Philippines.

Mechanical cardiopulmonary resuscitation may save more lives in patients su� ering from cardiac arrest in the hospital setting.

Dr. Raul Ramboyong dis-cussed the in-hospital mo-ments. He also extensively mentioned the conditions associated with sudden car-diac arrest as previously men-tioned. In cardiac arrest dur-ing coronary intervention, it is di� cult to perform e� ec-tive, high quality chest com-pressions.

Ramboyong, a former PHA CPR Council chair, men-tioned that mechanical CPR can be done to provide main-tenance of circulation while continuing percutaneous coronary intervention. � is, he said, is a class IIA recom-mendation.

He further elaborated that cardiac arrest can also happen during heart surgeries, and usual causes are ventricular � brillation, hypovolemia, car-diac tamponade and tension pneumothorax. Resternoto-my can be done, and studies of patients treated with this

Ramboyong: Mechanical CPR is bene� cial

CARDIOPULMONARY re-suscitation is a necessary skill not only among among health-care providers but also to lay persons. It can save lives.

� is was the strong mes-sage delivered across by former PHA CPR Chair Dr.Orlando Bugarin last May 26 during the preconvention activities of the PHA annual convention.

Bugarin cited data that 80% of sudden cardiac deaths occur at home and witnessed by rela-tives. � ese relatives usually do not know how to deliver basic CPR during such emergencies. Unfortunately, only only 4 – 6% of these victims survive this ordeal because witnesses do not know how to deliver such life-saving technique, the Bataan-based cardiologist lamented.

He further warned that sud-den cardiac death can happen to anyone, anywhere and at any time. Older persons, especially with pre-existing heart disease, are at the highest risk but it can happen even to the younger individuals with no history of heart disease.

He outlined that in order for

Bugarin highlightsneed for lay CPR

more lives to be saved, the deliv-ery of CPR ideally should follow the so-called Chain of Survival, namely early Access, Early CPR, early de� brillation, early advance cardiac life support, and inte-grated post-cardiac arrest care.

Bugarin highlighted the unique and special situation where CPR may di� er depending on the needs of the a� icted person out-side of the hospital setting.

Among the many special con-ditions and situations he dis-cussed included some fairly com-mon ones and some that might seem right out of � ction novels.

Asthma, being a fairly com-mon disease presents a signi� -cant challenge to the respond-ing individual. Apart from the usual CPR protocol, one must consider the disease itself. � e use of steroids and bronchodila-tors were highlighted in Buga-rin’s lecture with regards to this special case. Oxygen and respi-ratory management would dif-fer in these patients especially since Auto-PEEP (elevated positive end-expiratory pressure and dynamic pulmonary hyper-in� ation caused by insu� cient

expiratory time or a limitation on expiratory � ow) is severe in asthma patients and the use of respiratory support by mechan-ical ventilators may o� er help in these patients.

With other situations, the speaker highlighted unique ad-justments to standard therapies in these unique cases. In ana-phylaxis, epinephrine can be administered intramuscularly in the anterolateral aspect of the middle third of the thigh, and airway management should not be delayed.

In pulmonary embolism, he discussed how � brinolytic therapy can be life-saving. In pregnancy, patients should be treated di� erently the mother is the priority patient. Moreover, the challenges of managing the airway of an obese patient were tackled as well.(Girard Eric G. Abragan MD, Chinese Gen-eral Hospital)

and internal cardiac compres-sion have reported improved outcome compared with stan-dard protocol.

Moreover, ethical issues are always a concern, and issues of futility for resuscitation re-main controversial. Circum-stances in which it is accept-able not to begin resuscitation are patients with advances directives and if with signs of irreversible disease.

However, it is important to remember that there is no ethi-cal justi� cation for the practice of slow, ine� cient resuscita-tion. It is either no or full re-suscitation instituted, accord-ing to ACLS guidelines, the speaker emphasized. (Ailen Albana, MD, UST Hospital)

THE science of CPR/ACLS is moving forward and there are many advances for in-hospital CPR/ACLS moments. In his talk last May 26 under the preconvention lectures of the PHA annual convention, car-diologist-intesivist Dr. Jude Erric Cinco highlighted some of the most of important ad-vances in the science of resus-citation.

Cinco emphasized that chest compression is still the most important and neces-sary part of the CPR. To this, he said that it is necessary to o� er CPR training courses regularly.

In the real world, com-pressions may be ine� ective mores if the provider may be physically unable to sustain such strenuous maneouver. He suggested that it might be better to change the provider before fatigue sets in compro-mising the quality of CPR.

Due to advent of new tech-nologies, an automated chest compressor was developed which is available now in the market, to counteract the self-reported fatigue of those do-ing the chest compression.

In a study done by Field, et.al., the use of an elec-tronic decision support tool improves management of stimulated in-hospital car-diac arrest. Among patients with cardiac arrest requir-ing vasopressors, combined

Cinco zeroes in on important CPR techniques

vasopressin-epinephrine and methylprednisolone during CPR and stress-dose hydro-cortisone in post-resuscitation shock resulted in improved survival to hospital discharge with favorable neurological status compared with epi-nephrine in a study done by Buddineni et.al.

On the other hand, the ad-ministration of dextrose dur-ing in-hospital cardiac arrest is associated with increased mortality and neurologic morbidity, Cinco added. � e rescue-thrombolysis should be considered and started in patients with pulmonary em-bolism and cardiac arrest, as soon as possible after cardiac arrest onset.

� ese new modalities in the treatment of patients who went into cardiac arrest would be most helpful particularly for those families who aren’t yet ready to accept the fate of their loved ones. (Lendry L.Quizon, MD,� e Medical City)

Dr. RamirezDr. Ramboyong

Dr. Cinco

Dr. Bugarin

By Lendry L. Quizon, MD� e Medical City

Day 2 • May 28, 2015 • THURSDAY 1111

Dr. Tetsuya Sakamoto, head of the Cardiopulmonary Resus-citation Committee of the Japan Foundation of Emergency Medi-cine, explained that ECMO may be useful to maintain patient’s oxygenation and circulation for the unstable post cardiac arrest syndrome especially during ther-apeutic hypothermia.

ECMO Cardiopulmonary Resuscitation (CPR) is synony-mous with Extracorporeal Car-diopulmonary Resuscitation (ECPR) or Percutaneous Car-diopulmonary Support (PCPS), in which therapeutic hypother-mia for post cardiac arrest syn-drome is included in the treat-ment protocol.

� is strategy was introduced in 1960s that resulted in favor-able outcomes reported fre-

IS it signi� cant to do primary percutaneous coronary inter-vention (PCI) to reduce the mortality of patients with ST elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest?

� is was the highlight of the topic of Dr. Ku Hyun Kang, vice chair of the Korea Society of Emergency Cardiac Care, during his afternoon lecture last May 26 for the 15th Resuscita-tion Council of Asia Summit.

Coronary artery disease (CAD) is the most important cause of sudden cardiac arrest. Attempt to do PCI for STEMI patients after achieving return of spontaneous circulation (ROSC) has resulted in some-what an unfavorable outcome

PCI in survivors of cardiac arrest may do worse

such that most of them expired during cardiac intervention.

Identifying STEMI in post ar-rest is even more challenging. Its absence on post ROSC electro-cardiogram, may not necessarily mean absence of acute culprit coronary lesions that triggered the cause of cardiac arrest.

However, small observa-tional studies on PCI for post-cardiac arrest syndrome may be e� ective. Hence, the need for randomized studies to con� rm such � ndings. “ Most impor-tantly, good teamwork among emergency personnels should be kept in mind and in prac-tice,” Kang concluded. (Isaiah C. Lugtu, MD; Chinese Gen-eral Hospital and Medical Center.)

ECMO improves short-long term outcomes in OHCA

quently in Japanese journals in the late 1980s. Cases of favour-able outcome frequency was written in Japanese journals since the 1980s. Percutaneous cardiopulmonary support has at least 1,000 registered users in Japan which is mostly due to ur-gent cases. � ere are more than 1,500 cases per year in 2009 to 2012. Because of bene� ts it contributed, ECPR is covered by health care insurance companies in Japan during the � rst three days to post-arrest patients.

Moreover, Sakamoto shared � ndings of the SAVE-J Study (Extracorporeal Cardiopul-monary Resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of hospital cardiac arrest: A pro-spective Study).

� e multi-center study tried to determine whether or not ECPR would improve the short and long term outcome of out-of hospital cardiac arrest cases. Two hundred and sixty (260) patients of ECPR group and 194 patients of non-ECPR group were enrolled. It con-cluded that there was no di� er-ence between the background of ECPR group and non-ECPR group.

Sakamoto is a professor and chairman of the Department of Emergency Medicine, Teiko University School of Medicine. He is also the Chairman of Car-diopulmonary Resuscitation Committee, Japan Foundation for Emergency Medicine and the Vice President, Japanese So-ciety for Emergency Medicine

Now you can tweet and post your PHA convention pictures in the internet!

The PHA Website Committee launched recently #PHA15 for this year’s annual convention to encourage more active participation from netizens who are into tweeter and other forms of social media.

According to Dr. Peter San Diego, PHA Website Information Technology Head, netizens can post on Tweeter pictures, selfi es included, taken during the three-day convention and messages or tweets about anything about the conference using the hashtag #PHA15.

Best pictures will be selected and will be printed in the PHA Newsbriefs, the offi cial bimonthly publication of the PHA and The Heart Newsbeats, the offi cial daily publication of the convention.

Post on tweeterusing #PHA15!

EXTRACORPOREAL membrane oxygenation (ECMO) may improve the short and long term outcome of out-of hospital cardiac arrest with VF or pulse-less VT, a Japanese emergency medicine specialist said Tuesday during the 15th Resuscitation Council of Asia Summit.

CAN we utilize echocardiogra-phy in cardiac arrest patients?

Dr. Chee Tek-Siong of Sin-gapore recommends the use of echocardiography for rapid diagnostic evaluation of po-tentially treatable or reversible causes.

In a series of discussions for the 15th Resuscitation Council of Asia Summit hosted by the Philippine Heart Association CPR Council Tuesday, Tek-Siong highlighted the advan-tages of Focused cardiac ultra-sound (FoCUS or FCU).

FoCUS is a focused examina-tion of CV system done in an emergency situation in an ar-rested patient as an adjunct to physical examination. It is used to recognize a narrow list of po-tential diagnoses and provides

FoCUS echo benefi cialin cardiac arrest patients

a quick snapshot view of the heart at bedside.

FoCUS is designed to inter-pret signi� cant abnormalities as present or absent and to charac-terize pathologies into severities of abnormality. � e subxiphoid view is the most commonly used cardiac view so as not to interfere with ongoing chest compressions during a code.

In cases of cardiac arrest, echo can be used for rapid diagnostic evaluation for potentially treat-able or reversible causes. Echo-cardiography is versatile, can be done bedside, cost-e� ective, with minimal discomfort and no ionizing radiation/ contrast media risk. It is most suited for patients with unstable CV dis-eases particularly in emergency and cardiac arrest settings.

� e International Liaison Committee on Resuscitation recommends adequate train-ing in performing echo during cardiac arrest. However, the operator must be aware of the importance of interrupted chest compressions, and where ap-propriate, timely de� brillation. For patients presenting with undi� erentiated hypotension, the primary advantage of Fo-CUS is in determining whether the shock is cardiogenic.

FoCUS should be limited to licensed physicians, with a formal structured training pro-gram. � e program should in-clude didactic education, hand-on image acquisition and image interpretation. (With reports from Ingrid Marie Y. Gatmai-tan, MD, � e Medical City.)

By Ailen Albana, MD, UST Hospital

Sakamoto

Dr. Sakamoto

Mechanical chest compressor on display during the pre convention activities

By Girard Abragan, MDChinese General Hospital and Medical Center

Day 2 May 28, 2015 THURSDAY

Your Heart News & Views in a Beat

NewsBEATS

THE

The Offi cial Publication of the 46th PHA Annual Convention & Scientifi c Meeting

Your Heart News & Views in a Beat

BEATSBEATSBEATSBEATSBEATSBEATSBEATSRCA to release new BLS guidelines this year

PHA CPR council chair Dr. Francis Lavapie revealed that the Asian council seriously tack-led issues on the updates on and the possible release of the 2015 RCA BLS Guidelines sometime August this year.

It was also known that the full membership application of Malaysia and Hongkong to the RCA is now in process.

� e meeting was presided over by RCA chair Dr. Lim Swee Han.

� e RCA assembly was at-tended by representatives from Singapore,Japan, Taiwan, � ai-land, Korea, Hongkong, Ma-laysia and host country Philip-pines. � e RCA is set to meet again in Taipei this coming No-vember.

Meanwhile, the Philippine Heart Association hosted for the � rst time the PHA Council on Cardiopulmonary Resus-citation and the Resuscitation Council of Asia (RCA) Joint symposium yesterday.

Top caliber speakers from all over Asia, in their various � elds of expertise, scholarly discussed the latest trends and outcomes of studies for CPR, ACLS and post resuscitation care based on the 2010 Guidelines and other studies done after the guidelines were released.

� e Symposium was formally opened by none other than the Chairman of the Resuscitation Council for Asia, Dr. Lim Swee Han who hinted on the possible

� e PHA Council of Cardiopulmonary Resuscitation host-ed the general assembly among members of the Resuscita-tion Council of Asia yesterday after concluding the 15th RCA Summit as part of the reconvention activities of the 46th PHA Annual Convention and Scienti� c Meeting.

updates that will be included in the much awaited 2015 RCA BLS Guidelines which will be released August this year.

Interesting topics and lat-est trends in cardiopulmonary resuscitation were scholarly discussed by the lecturers and created a very interactive ses-sion among the audience who enthusiastically asked on con-troversies and applicability of the most recent studies.

Dr. Nalinas Khunklai of � ailand tackled on BLS (chest compression rate, depth, hands only CPR for lay rescuers). Tzong-Luen Wang of Taiwan emphasized on the updates on dispatcher CPR and AED. Chee Tek Siong of Singapore lectured on the importance of echocardiography in the assess-ment of acute chest pain and cardiac arrest.

Post resuscitation care and therapeutic hypothermia were very interestingly discussed by Dr. Mayuki Aibiki of Japan and current studies have posed several questions from the audi-ence.

Other topics discussed in the symposium included the signif-icant role of ECMO by Dr. Tet-suya Sakamoto of Japan, out-comes and advantages of early PCI in post resuscitation care and improved survival rates of � brinolysis in STEMI patients by Drs. Ku Hyun Kang of Ko-rea and Jose Paolo Prado of the Philippines, respectively.

LONGER periods of therapeu-tic hypothermia may be more bene� cial in terms of neuro-logical outcomes for survivors of post-cardiac arrests (PCAS), Dr. Mayuki Aibiki of Japan said yesterday as he shared his new information based on recent studies and his experience re-garding Targeted Temperature Management (TTM) and � er-apeutic Hypothermia (TH).

Aibiki was one of several speakers from all over Asia during the 15th Resuscitation Council of Asia Summit held yesterday as part of the PHA’s 46th Annual Convention and

Longer hypothermia may be better for post-arrest survivorsBy Ingrid Marie Y. Gatmaitan, MD� e Medical City

Scienti� c Meeting.In his paper “Serious con-

cerns on TTM trials by the Jap-anese Association of Brain Hy-pothermia,” Aibiki noted large deviations in body temperature that can cause serious biases in the di� erentiation of outcomes between the groups.

He also noted that neurologi-cal evaluation was performed 72 hours after the interventions which he considered early for deciding on the withdrawal of life-sustaining interventions. � e Japanese critical care expert particularly referred to patients in the 33 °C group because sig-

ni� cantly lower core body tem-peratures delayed drug clear-ance.

Aibiki further recommended the Yokohama protocol for therapeutic hypothermia that targets a temperature of 34with-in six hours, hypothermia of 34 for 48 hours (24-72 hours), and sedations, narcotics and others, followed by rewarming of 1-3/day. From his experience at the Ehime University Hospital, TH of 34 for 48 hours with a very slow rewarming may be employed for a sustained return of spontaneous circulation in

R E S U S C I TAT I O N Council of Asia chair Dr. Lim Swee Han has em-phasized the need to edu-cate the lay in delivering basic life support tech-niques, chest compres-sions in particular.

The Singaporean doc-tor, in a luncheon sym-posium yesterday said that panic may be a big obstacle in doing chest compressions in pa-tients suffering from a

RCA chair pushes for lay CPR training

cardiac arrest.Employing hands only

technique without deliv-ering rescue breaths may add con� dence for the rescuer cutting delays in the delivery of a life-sav-ing maneuver.

Moreover, Lim under-scored the bene� t of edu-cating and training lay persons to do basic CPR techniques in increase survival rates in cases of sudden cardiac death.

Lim, an emergency medicine specialist, also presented a study in which CPR was made e� ec-tive with the use of pub-lic access de� brillators. Among others, he also pointed out the necessity of teaching basic CPR in schools to the young as an e� ective means of making a county CPR ready such as the case of Taiwan. (Gi-rard Eric G. Abragan, MD, Chinese General Hospital)

See Page 8

RCA Business Meeting. Members of the RCA discuss important matters last May 26, 2015

RCA Chair Dr. Lim Swee Han

By Bernadette Santiago-Halasan, MD