 Good day, viewers. Welcome to Ang Kalusugan, Aykara Patan. I am Dr. Manchit Padilia, and today's topic will be Brave Heart, Taking Care for Hearts in the Mesa of a Pandemic. According to the WHO, of the 56.9 million deaths worldwide in 2016, ischemic heart disease is the world's biggest killer, accounting to 9.4 million deaths. In our country, 35% of deaths related to noncommunicable diseases were attributed to cardiovascular diseases. According to the Department of Health, more than one in every five deaths was caused by diseases of the heart, making it na number one leading cause of death. In infants, congenital malformation of the heart was listed in the top 10 leading causes of infant mortality in 2013. More than 80% of these premature deaths disproportionately affect people in low and middle income countries like the Philippines, imposing large, avoidable costs in human, social, and economic terms. Despite of rapid growth and inequitable distribution, much of the human and social impact costs each year by these heart-related premature deaths could be averted and prevented through well-understood, cost-effective, and feasible interventions in controlling risk factors. There are many types of heart diseases that affect different parts of the organ and occur in different ways. Today, we are very fortunate two esteemed colleagues, Dr. Eugene Reyes, Chief of the Division of Cardiovascular Medicine of the Philippine General Hospital and past President of the Philippine Heart Association and Dr. Adrian Manapat, Chair of the Philippine Board of Thoracic and Cardiovascular Surgery and Associate Professor of the UP College of Medicine to share with us their expertise on the topic in today's episode. Good day, Dr. Adrian. Good day, Dr. Eugene. Good day, Chancellor Manchin. Good day, Dr. Eugene. Let's start the conversation. When we talk about heart diseases, Dr. Eugene, what are we talking about? Ano ba ang ating pinag-uusapan? Napakalawak kapag sinabi natin heart disease. Maraming klasin ang heart disease ang nasa-ilalim ng tinatahod natin sakit sa puso. Maraming components ang puso. Merong ugat, merong muscle, merong balot at merong loob. In other words, three components labas, gitna at loob. Kahit alindo ang pereo pwede magkaroonan sakit. Importantin maintindihan natin ang anatumi ng heart para maintindihan nila kung bakit nagkakaroon ng sakit sa puso. Okay, so parang sinasabi natin ngayong kasi sa atin ang iniisip natin pag sakit sa puso, iisa lang siya ang naririni kong ngayon maraming klasin pala ang heart disease at maraming klasin pala ang sinasabi sakit sa puso. And Dr. Adrian will explain to us the different parts of the heart so that we can discuss the different kinds of heart diseases. Dr. Adrian? The heart is of course, we know is a vital organ. It is contained in a sac called the pericardium and the pericardial space contains a little bit of fluid, maybe around 50 ml, which serves as lubricant between the heart and the surface of the pericardium. Now when you open the pericardium, you see the heart, it's connected to the great vessels of the body, the pulmonary artery and the aorta, which transmit the blood pumped by the heart, either to the lungs or to the rest of the circulation. And then the heart has its own blood supply, itong tinatawag na coronary arteries. There is one on the right and two on the left. Ito yung nagbabara, sinasabi natin, napagka nagbara ito, there will be decreased blood flow to the heart muscle and potentially can cause a heart attack. Now the heart is also a, we can liken it to a duplex house with two households, meaning there's a right side and the left side. And each of these sides of the heart has two chambers and two valves. The chambers can be likened to rooms and the valves can be likened to swinging doors, so they open and close. The valves are located between the atrium and the ventricle and also between the ventricle and the great vessels. So when you say atrium, this is the receiving chamber of the heart and the ventricle is the one that pumps the blood outside. So those are the parts of the heart. Normally the left side and the right side are separate. So the blood contained in the right side do not mix with the left side. And much the same way that in a duplex house, you have two households. They should not mix, there's no interconnection between the two. Now in some congenital heart anomalies, there might be a hole in the middle of the partition or the septum where you can have mixing of the blood. So basically that's the basic anatomy of the heart. Stoker Adrian, may rung balot, may tubig sa ilalim ng balot, bago pa yung masal ng puso. At yung masal ng puso ay maraming ugat. At ang sabi mo nga may maungat na palabas at may unggat na papasok para sa dugo na lalabas at papasok. At sa loob ng puso ay may dalawang bahay. Nadapat ay hindi talaga sila nagahalo. At pagsira ay nagkaroon ng pagahalo at may butas doon ay isang malakim problemanon. That's true. At pag sinasabi mo nga ay may mga pintuan ang bawat bahay at pag nagkaroon ng problema isa sa mga pintuan ay may problema din. So ngayon, Dr. Eugene, can you tell us what are the different kinds of heart diseases? Ngayong naintindihan na natin kay Dr. Adrian na ang puso pala ay isang complex organ kung saan dapat natin maintindihan ang sabi nga ni Dr. Eugene kanina at di Dr. Adrian. Isang parte sa puso ito ay magaproblema ay pwede tayo magkaroon So Dr. Eugene, what are the different kinds of heart diseases? Striking words that I'd like to present to the audience is the word heart attack. We get scared of the term heart attack and even stroke. So bago po sa gutin yan, i-differentiate ko lang stroke saka heart attack. When you say stroke, it's the brain. So right now, we're changing the word stroke to brain attack. Kapag stroke, it's the brain and when you say heart attack, it's the heart. Now heart attack is just one of the various diseases that we can get when we talk about the heart. But heart attack is not really the disease. It's the end result of what we call atherosclerosis. From the Greek word athero and isclerosis, naninigas na ukat para mabuhay ang isang puso. Kailangan tuloy-tuloy ang daloy ng dugo para merong oxygen at nutrients. Kapag nagbaray ang daloy ng dugo, mamamatay yung puso. Yan yung tinatawag natin heart attack. Now aside from heart attack or what we call, which I explain part of atherosclerosis, are other diseases like valve disease. Valve, intagalob, is valbula. Kung kayo ay ingenero, naintindihan yung check valve sa puso, sa tubig, para isang daloy lang, di ba? One way and it will go back. Kapag nasira ang valve, wala ng check valve. Sa pabalik-balik lang yung daloy ng dugo. Other problems, aside from valve atherosclerosis, ay sakit ng muscle ng puso. Ngayon meron tayong pandemic sa COVID, pwede kayong magkaroon ng pamamaga ng puso. Sa English, we call that myocarditis, namamaga ang puso. Kapag namamaga ang puso, hindi rin siya makakapamp. Maraming namamatay isa siyang dahilan bakit namamatay yung mga may COVID. Aside from that, pwede rin mamagay yung balut ng puso. Yung pericardium, pag sinabi mong namamaga, tinadagdagal lang namin ng ITs, pericarditis, namamagang balut ng puso. Ang consequence naman yan, pwede siyang mapuno ng fluid sa balut ng puso. At hindi namin siya mga ka-pump ulit, may hirap ang magpump ang puso. So, emergency yan. Nung unang panahon, nakikita lang namin yan sa gera. Kasi, pag nagbabari lang tinatamakan yung puso, nangkakaroon siya ng pericardial tamponad. So, emergency siya kasi kailangan i-vacuate mo yung dugo na bumabalut sa puso, fluid. So, life-saving siya. Pero it can happen here, also. And marami pang ibang sakit na pwede tayong makuwa sa puso. Ang ikaapat, ang gusto ko yung sabihin is yung congenital. May mga bata na pag sinilang ay may rumbutas o mali ang koneksyon ng ugat sa puso. Usually, kung maltyan, lumalaki naman yung bata tumatanda. Pero kung grave, hindi sila nag-survive. Kaya siya isa siyang part ng infant mortality. So, sa palagay ko, yan yung mga importanting sakit sa puso na pwede natin talakayin ngayong araw na to. Napakadami pala, no? So, may I ask, Dr. Adrian, what is the burden in the Philippines? Which are the more common ones. And my understanding is that not all of the diseases need surgery. Summer, medical, summer surgical. So, sa top 10 natin, pwede mong banggitin lang kung anong top 10 causes natin, yung burden natin sa Pilipinas. Yung karamihan, siyempre ang una pa rin would be yung atherosclerotic or ischemic heart disease na mentioned na ni Dr. Eugene. And then, among the children or pediatric age group, yung congenital heart diseases. And then, yung valvular diseases which can be from mostly rheumatic etiology, yung rheumatic heart disease common pa rin yung sa Pilipinas. Among the older age group, nasisira din yung mga valves because of the generative heart disease. Nasisira, no, because of aging. So, kasama yan. Na mention na rin yung pericarditis, pericardial effusion. Ibig sabi na pericardial effusion nagkakaran ng fluids around the heart. And then, which can be from infection, inflammation or even cancer from other organs that spread to the heart. So ito yung mga nakikita natin na common. Yung mga mas rare, siyempre, merong mga sakit sa puso that has to do with the electrical function of the heart, yung irregular heartbeat. So, iba namad ang treatment dito. Yung iba kaya nakailangan ng gamok lang. Iba naman might need pacemaker kung masyadong mabagal yung tibok ng puso. And then, mas dihira pa dito yung mga tumor sa heart na pwede rin mangyare whether benine or malignat. Mas common yung benine with called the mixoma na sa loob ng puso. Yung mga cancer sa heart bihira yun. Usually, case reportable yun dahil masyadong bihira. Pero I would like to say of hand, majority of heart diseases, I think, will still be managed medically. Hindi naman kakoonti lang naman yung talagang kailangan ng operation. O siyempre, siyempre natin doon. Ano ba ang symptomas? I mean, how do we know that we have a heart? If you possibly have a heart problem, may doctor Eugene? Dahil nga maraming sakit sa puso, it's a general term, heart disease. Pwede ng kahit anong party ng puso, magka problema, may sakit ka sa puso. Kaya lang sa ngayon, tutumbuking ko yung aterosclerosis, which is the most common. Aterosclerosis can lead to skimic heart disease and skimic heart disease can lead to heart attack, which is the most common cause of death and sudden death. Big lang pagkamatay. Maraming kayong nababalitaan, merong isan tao, healthy naman, nagtatrabaho, tapos the next day, nababalitaan mo, wala na siya. Namatay siya sa pagtulog. Sudden death po ang tawag namin dyan and it's part of aterosclerosis. Anong ba mga sintomas para malaman natin kung merong kan sakit sa puso? Tutumbuking ko po again yung aterosclerosis, spectrum pusya. Pag sinabi mo yung spectrum may pinag-umpisahan at may pinag-tapusan. Ayo mo yung pinag-tapusan kasi yung patay ka, sudden death or heart failure. Yung umpisa, mild, pwede yung wala kang nararamdaman. So, yun yung importante rito, kaya kailangan magpapachekap ka, kasi pwede yung wala kang nararamdaman, pero may sakit ka sa puso. Ang pagka, gumalaw ka pa forward to the spectrum, pwede yung mild, pwede kang madaling mapagod, hinihingal, o kuminsan, sumasakit ang dib-dib. Lagay mo pa sa git na, umiixiyon nilalakat mo. Paglumadate, nakakabamlakad ka ng 3rd floor, kakakit ka ng 3rd floor, wala kang nararamdaman. Ngayon, pagakit mo ng 3rd floor, hinihingal ka at sumasakit ang dib-dib mo. Ngayon yung pagsakit ng dib-dib ay hindi lahat dahil sa puso. Ang pagsakit ng dib-dib sa puso, malaramdaman mo, hindi mo may turo kung nasaan. Buong dib-dib. Matagal, umaabod siya ng 15 minutos. Dumadat, pumupunta ang sakit sa leig, at kuminsan, sa kaliwambraso at kamay. Pagkanan, hindi naman, siguro, pwede mo nang tanggaling na puso yun. Pero kadang kadalasan, kaliwa kasi paro yung nerve, sublay. No. So, i-moved pa natin du-suspectrum mas malala. Mas maiksina ang iyung nalalakad. Paglumakad ka ng papuntang bathroom, pwede yung sumasakit na ang dib-dib mo, o madali kang mapagod. I-moved forward pa natin. Ito yung unstable. Kuminsan na pagusapan natin, unstable. Yung nan dito sa sa unang part, tinatawag namin stable. Kasi, nawa walay yung sakit ng dib-dib. Pero dito sa, malapit na sa katapusan, nan tinatawag namin unstable. Malapit ka ng mag heart attack. Pwede ka pang main magawa. Pwede ka ang pumunta sa doctor at magamut ka para maging, maibalik ka dun sa stable again. Pero, kung hindi ka naman sumunod, mamumub ka uli dun sa spectrum, magiging severe na naman yan. Until, hindi na control yung unstable mo, magiging heart attack na siya. Pag inataki ka sa puso, suerte mo, kumakarating ka sa hospital, karamiyan po, hindi umaabot sa hospital. Lahat ng umaabot sa hospital, suerte mo, kapag nabigyang kakagad ng lunas, at dadaloy uli ang dogo sa iyong puso. Mabubuhay ang puso. Pero, kapag hindi na hulika, o hindi na ibalik yung dadaloy ng dogo sa puso, mamamatay ang puso. Dalawalang ho ang peding, at tatlo, ang peding kahinat nan. Magsusurvive ka, pero meron kang heart failure. Second, magsusurvive ka, at mild lang yung nagnari sa iyong, buhay pa ang puso. Or third, patay ka na. So, Dr. Eugene, ang sabi mo nga at one point, well, medical management ang pinag-usapan natin, at hindi naman lahat talaga na ooperahan, pero may narinitayo dyan na, sa sabihin nila na pag nasa hospital na, kailangan na talaga siya ooperahan. Ano ba yung mga na-ooperahan, nakailangan ng ibypass? Dr. Adrian? Well, as I mentioned, Eugene, pag, if the patient is symptomatic, tapos may nakikita na bara doon sa artery sa heart sa coronaries. Of course, this can be done by means of tests, like ang anggiogram where may dine na ipapasok doon sa catheter na papunta doon sa artery sa heart. So, makikita kung saan yung may mga bara. So, there are three options generally, medical treatment. So, sa pamumagita ng gamutan lang. Pangalawa yung tinatahog na anggioplasty and stenting and then pangatulo yung bypass, heart bypass or CABG, coronary artery bypass, grafting, cabbage for short. Okay, yung stenting muna ipaliwanag natin sa kanila. Okay, so, ang sabihin ay Dr. Adrian, well, sabihin nilang dalawa, hindi naman talaga lahat ay na-ooperahan. Pero, pagdomating talaga sa punto na kailangan ooperahan, dalawa yung pwede yung gawin. So, gusto mo bang ipaliwanag mo sa amin, ano pang ibig sabihin pagsinabing maglalagay ng stenting? Yung stenting, it's a procedure where an artery in the groin or the wrist ay ginagamit tapos papaksukan ito ng catheter. Yung catheter na yun ay merong balloon sa dulo na pwede yung inflate. So, yung catheter papadaanin sa malalaking ugat, ayorta, hangkat umabot ito dun sa coronary arteries. Tapos, ipapasok ito dun sa coronary artery para muksanan, i-inflate yung balloon para mabukay yung area na may bara and then ilalaga yung stent. Yung stent is parang device na kasing laki ng spring ng ballpin. So, maliit lang siya, kasi ganoon lang kaliit yung coronary artery. Tapos, para ang tukod siya para hindi mag-sara uli yung ugat. So, yun natin na tawag na ang anggioplasty and stenting. Alin ang ginagawa ng anggioplasty and stenting, gainong sinabi natin kanina, kung pwede ng gamutan lang, lemawa, yung based on sa anggiogram, meron lang isang maliit na ugat na hindi naman importante, pwede ng gamutan lang yun. Pero kung yung symptoms ng paciente more severe and then there are several blockages na pwede nabang iang anggioplasty, anggioplasty is also a good option for that patient. Ngayon, kung sakaling yung mga bara sa ugat nakita sa anggiogram halos lahat ng ugat ay barado or very calcified, matitigas. Pag kasi na yung calcified parang batu yan, parang cemento. So, yan mahirap yan ay anggioplasty o kaya kung totally barado na yung ugat, mahirap yan buksan may means of anggioplasty. So ito yung mga nare-referesamin as cardiovascular surgeons na kinakailangan ng coronary bypass. Yung bypass naman, ang ginagawa dun is we make an incision dito sa chest, sa midline yung ino-open itong breast bone or sternum. And then we get arteries from the chest wall o kaya veins from the legs. Sometimes we can get artery from the arm. Ito yung gagamitin natin na pang bypass. When you say bypass, hindi natin tatanggalin yung baramismo kung hindi lalang pasan lang natin. Yung mga ugat na kinua sa leg o kaya sa arm, ikakabit yan dun sa aorta, tapos lalang pasan yung baradong ugat. Pipili tayo ng relatively healthy na area ng ugat para ikabit yung bypass. So in much the same way as constructing a flyover over a crowded intersection, yun ang idea sa bypass. I would just like to make a comment about yung mga paciente na anggioplasty or na bypass. We should remember that these procedures are treatments to try to restore blood flow to the heart muscle para to propride oxygen and nutrients para pag-function uli yung healthy muscle. Pero these are not cures for the systemic disease which is atherosclerosis kasi minsan may mga misconception yung mga na bypass na o na anggioplasty. Feeling nila, they feel better after the procedure and kala nila, they can do anything there one. So some will return to smoking, pababaya ang kanilang weight, yung diet, cholesterol. And these people will be will regret it later on kasi di atherosclerosis will progress at pwede magkaroon ang bagong lesions o bagong bara o kaya mga ibang ugat na ma-affectuhan. So Dr. Adrian, ang size ng puso natin, Dr. Eugene is parang isang fist natin. Yan ang size at ang pinakusapan natin ay yung mga ugat sa lumb ng puso ay maliliit. Kaya pag siya ay nangigas talagang walang dadaanan ang dugo at napakahalaga na dumaanan dugo sa puso. So ano ngayon ang risk factors para hindi magsaray yung mga ugat na yan, Dr. Eugene? Magandang ano yung, bakit ka nagkakasakit sa puso, yung yung tanong? Pag nalaman mo, may magagawa ka. Madaling bilangin sa daliri. Number one, high blood. Hypertension is one of the major most prevalent risk factor for heart disease. Ang problem sa high blood hindi nararam daman. And before ka magpachek up sa doctor, may damage na. Kaya nga ngayon, mas screening lahat gusto namin mag-blood pressure. Second, diabetes. Ang diabetes iniequate namin sa isang taong nagkaroon na nang sakit sa puso. Kasi yung risk niya, ay parang risk na isang taong na heart attack na. Ang importante is mag-check kung talagang may diabetes ka at kailangan makontrol yung sugar mo. Number three, cholesterol. So para malaman mo matasang cholesterol mo kailangan i-check sa lago. Magpapachek up ka. Mayroon tayong bad cholesterol, mayroon good cholesterol, mayroon total cholesterol, mayroon taba, try to release a ride. Aayusin yung doctor mo ko anong tamang gamutang pwede ibigay sa yong. Number four, smoking. Smoking is very prevalent, but now, it's beginning to go down because of the initiatives of the government on anti-smoking law. But there's still a big segment of the population that's still smoking right now. And the target nung mga tubako company, yung young people, say, pag young ka nag-start, chances are, mas matagal ka mani ni Galileo. So mas yung consumption mo. There are other risk factors like obesity and ang obesity sa ming mga yun ay hindi yung talagang mataba. Antinatawag namin obesity, central obesity, malaking can, yung makikita mo naman pag tumayo ka sa salamin. Merong ibang risk factors na hindi mo mga mo modify, like age, talaga yung tumatanda ka, pag matanda ka, yung chance mo magkaroonan sakit sa puso. And gender. Ang lalaki, mas malaki ang chance sa magkaroonan sakit sa puso kesa sa babae. And also yung tinatawag natin hereditary or familial probability of having, merong kan genetic predisposition sa heart disease. So yan lahat yung tingin ko mga importanting risk factors. But not to under mind or underscore yung diet which is very important. Kasi yung non-consumption ng fruits and vegetables is a risk factor. Right? It's a risk factor. And not exercising or not moving, not having an active life is also a risk factor. Nirevers ko lang yan. Eating fruits and vegetables and exercising daily will help you prevent heart disease in general. So Dr. Eugene, the message is if you have one of these 10 conditions you should really be watching for possible high risk for a heart problem. Yes, doctor. Kaya kailangan, bilangin mo at sabi ko nga, hindi lahat yung mararamdaman mo. Kaya kailangan ipachect mo yung sarili mo sa doctor. Pero most of these, tanggaling ko na yung age and gender. Most are related to lifestyle. Lifestyle hu lahat ito. And therefore ano mas sa sabi ko we have a pandemic ever since. We have 70 million deaths worldwide due to cardiovascular disease. We only have 300,000 deaths due to COVID in one year. Let's say it's one year. Let's put it at 1 million per year versus 70 million. So this is a pandemic. And the pandemic is a poor lifestyle which has been with us since the beginning of the 20th century. It's the result of progress. So we're so worried about COVID, but you're telling us, really there are more that secondary to heart diseases. And since we are giving so much importance to COVID, then all the more we should be giving enough importance also to heart diseases. Two things, nabanggit po lang kasi yung good and bad cholesterol. And the second question is how early should we really be testing for all of the lab tests that you mentioned for an adult? When do we start telling ourselves it's time for an executive checkup? Siyempre, sikat sa ating yung mga guidelines. Sa mga doctors po, meron kaming mga sinusunod na clinical practice guidelines. Kahit din si ang mga siruhano, sumusunod din po sila sa guidelines kasi basay yan sa mga valid data na nakuwan namin sa mga clinical trials and studies. Yung lifestyle change naka-place na po yan, even pediatric pa lang yung paciente. Ine-encourage namin ang healthy lifestyle. Kaya lang, maraming kalaban. Kalaban natin ang media. Kalaban natin ang mga mga restaurants. Kalaban natin yung environment, structure. Parami tayong kalaban para mga fulfill yung healthy lifestyle. Pero blanket na po yan. Blanket na lahat dapat naka-healthy lifestyle. At di beginning, kahit bata pa lang sila. Uwag niyo mga kaya ang tumabaan bata. Pag-cute sila, pero hindi na sila-cute pagtanda. So, kailangan slim sila. Bata pa lang. So, blanket yung lifestyle change. So, may ginagawa ka na. Pero pagdating mo ng age, sabi ko nga age is a risk factor. Pagsan pa ng 40 and above. Kailangan mo ng magpachek. Kailangan mo ng magpachek ng sugar, parami pang iba para lang malaman mo kung may problema o gala. Lalo na kung may hi-blood and diabetes. So, ang laboratori kasi sa executive check-up. Kasama ba siya sa field health? Hindi po. So, siguran mensahe natin dito. Kung hindi ba siya kasama sa field health, dapat pa rin natin isipin na pag tumungtung tayo ng 40 and above, ay dapat tinitin ang ibang risk factors para sa atin. I was struck by your comment that the number of patients that we are seeing with heart diseases. So, sa PGH ba, how can we translate it in numbers? And then how many of these are operated on? I'll start this time with Dr. Adrian. Sa PGH, before the pandemic, about maybe 150, between 150 to 200 cases a year ng heart cases. Combined na dito yung adult and pediatric. So, in pediatric, mostly congenital. So, that's about what we do. Of course, much more than that, yung requirement kaya lang medyo limited pa rin yung ating capacity. So, we'd like to do more. I don't know sa mga non-cardiac cases na surgery. Yung pag-heart attack, marami sa emergency room, umaabod kami ng 6 to 10 patients per day. At siguro 1 to 2 na anggioplasty, emergency anggioplasty. So, bilangin mo yun 6 to 10 times 365 days in a year, ganun po kadami nag-heart attack. Kaya nga hindi effective yung ating preventive measures. Kasi, andami nila. Kaya lang, Adrian diba na mapansin mo na wala sila? Ayo. Ano nangyari nung COVID? Kasi nag-sarang mga hospital, nag-sarang mga emergency room, our heart cases. I'll start to Dr. Eugene. Nung mag-lockdown, nung mag-lockdown, problema namin yun. Sa mpupunta yung mga paciente um sa private, ang unong na puno yung private hospital sa nung lockdown dahil sa COVID. Sila yun na una, tapos ginawa ng COVID referral center, MPGH, ito matanggap ng mga non-COVID cases initially. But, wala sila, hindi namin sila nakikita, wala sila sa ibang private hospitals. So, ang tanong ang dahilan ba, ay takot sila sa COVID, o na matay sila na hindi nakakaabot sa hospital dahil sa takot sa COVID, o pwede yung umabot sila sa hospital, ay sila sa emergency room at nilabel silang COVID. Yun lang yung aming anong. But, this observation was also seen in Italy, in Brazil, in the US. And it may be related to miss diagnosis. So, yun pala isang nangyari sa atin. Ngunag COVID, ay nung mga pacienting na hinatake, pero hindi natin wala ina atake o hindi lang sila nakakarating ng hospital. Okay. So, anong ginagawa natin paraan ngayon dyan? Now that we're opening up at PGH, how are we dealing with these cases now? Dumadagdag na ba ang paciente natin? Dumadagdag na uli, bumabalik na Adrian? Medyo nago sa start na bumalik yung mga paciente. As mentioned earlier, itong fenomenon na nawala especially the heart attack cases worldwide, I think ang report is up to 60% or more nawala yung mga cases na yan. So, now na sa ating situation, there's easing up of the quarantine restrictions. We expect the patients to start coming back. But, of course, there are some challenges still na ang theory is baka karamihan hindi nagpunta sa hospital during the quarantine and COVID, the peak of the pandemic. Kaya dinili yung pagpunta sa doctor. So baka we expect yung pupunta ngayon, baka sila yung mas grave or emergency. Number one. Number two, COVID is still there. So yung mga paciente na will require surgery, actually any kind of surgery, whether heart surgery or major abdominal surgery. The guidelines state that kailangan it tests sila for COVID. Because it has been found in studies that the mortality rate for operated patients can go as high as 20% if they are COVID positive. So bako pa sila operahan, dapat matest sila whether may symptoms or not. And then another challenge nowadays would be yung for heart surgery in particular usually we prepare a lot of blood components. And there's scarcity of blood because of the lack of donors. Again, because of the pandemic and the quarantine, the fear of going to the hospital, kukonti yung mga nagtodonate ng blood ngayon. And that's why we should encourage these persons that safe naman na magdonate ng blood. What I'm hearing from you is not kuminararamdaman, talagang dapat magpatingit. Kung kailangan operahan, ay kailangan na siyang maskejul. At ang kakaiba lang talagang ngayon ay meron tayong extra step na chinesigurado natin na wala siyang COVID bago siya operahan. Ang PCH kasi magsisimula na ng telemedicine. Ang magsisimula na ng telemedicine, pa paano ba mababago ngayon ang ating pagtingin sa mga paciente. It's really an effort on the part of the doctors and the healthcare workers to start seeing patients nowadays. One, using telemedicine. Telemedicine is not perfect, but it helps us right now to deal with this pandemic. Avoiding infection is very important. And telemedicine is the use of examining patients, treating patients in a remote condition. So you're not in the same place. So there are limitations, of course, you don't do physical examination. Wala ng ano. Hindi mo na examine, Hindi mo na check yung puso ng derecho for example. Ang ano lang is history lang. Nag-uusap lang kayo. Ang ba nararamdaman mo. Parang talagang remote. So it's not perfect, but maganda siya kung yung paciente mo ay matagal mo na nang nakikita. For example, na ginagamot ko na for 10 years, na bypass siya. Tapos na, nag-follow-up lang siya sa akin for checking ang symptoms, prescription, et cetera. Pwede napawot kami sa telemedicine. Ang problema yung mga bagong paciente, kasi hindi mo pa sila kilala, ang hirap mag-uusap sa telemedicine, hindi mo na kukawa yung rapport niya. I-importante yung patient-doctor relationship. Kailangan nantiwala sa isa-tisa. Panag-begei ka ng gamot, meron kulang yung trust ng paciente. Kasi, tama kaya ito. Nakuwa kaya ni doctor yung talagang sakit ko. Maykulang. Kaya, ginagawa namin ng telemedicine yung pang screen sa initial patient, and then we schedule them on a face-to-face clinic. Kaya lang, nakakanu kami. May protection naman kami. At pati-paciente, dapat meron din protection. So ang sinasabi natin ngayon ay sa PGH, dahil nga sa telemedicine, ang ibang paciente natin ay hindi naman kailangan pumunta na sa PGH. At naman na silang tumawag at magpaskejul yun ang isang bago sa PGH. Takawag sila moon at magpapaskejul. At pero man din paciente na kailangan talagang matingnan. Pero ang isang malaking challenge na nakikita ko ngayon ay sino ba magbabayad. Ito ba ay covered sa feel health. Ang consultations at ang operation. So siguro ang pwede natin pagusapan at bakstart mo na ako sa surgery kasi alam kung napakamahal ng surgery isang major challenge natin yan ito man ay pre-COVID or new normal. Ano ba ang kinukover ng feel health? Yung feel health kasi meron silang tinatawag na Z benefit packages. Ang covered nito ay mga operation kagay ng bypass operation or yung ibang congenital heart operations may buta sa puso kaya yung patrology or fallow na combinasyon ng maraming lesions sa heart. Pero so limited pa lang yung cover dito. Unfortunately, hindi kasamayat dito yung testing before the patient is diagnosed mag-apply kung halimbawa na diagnosed na siya so iwi sabi na tapos na yung testing at meron ng plano to do the surgery. So yun ng kulang dito. And then meron mga criteria certain criteria para makapasay ang paciente sa Z packages na ito. Kasi of course feel health would like to ensure that these are the cases na maganda yung results na hindi masasayang yung resources kaya meron criteria na sinusunod. Pero napakahirap naman niya tanon. Ang ating major step is to be able to make a diagnosis habang mile pa pero hindi siya covered. So kailangan nating talaga kung zasabi natin universal healthcare talaga makukuhan natin siya mula nung siya ay very, very mild at pula pang masyadong nararamdaman hanggang sa punto na kailangan siya operahan. So siguro isa yan na pwede natin isuso sa gobierno na dapat masama talaga ang screening. Although nung sa PGH as I understand it before the COVID pandemic marami nang mong support yung government among charity patients na gagawa naman sila ng bara na test sila na libre. Wala kung problema sa PGH kasi sa PGH talaga totoo yan pag paciente ka ng PGH hindi mo talaga po problema nang siyang gawing test. Hindi talaga mamimili at siya ay gagawa ng paraan. Kaya natutuwa tayo, tayong tatlo ay kasama ng PGH at hindi natin pinuproblem ay ang ganyang napakamahala mga laboratory test niyan pero sa ibang ating mga kababayan ay talagang malaking struggle talaga yan. Kaya tayo nagpapasalamat sa gobierno na bidibigin tayong sapat na budget para magawa ito sa ating mga paciente. At ito ay pwede sa mga pwede sa ating mga nansurgical patients na saan ang coverage kailang pumapasong na covered sa lang ng PhilHealth? Kapag ka na admit ka may certain coverage ang PhilHealth but hindi total pero kung charity ka sa PGH may kaming tinatawag na no balance billing wala kang babayaran wala kang ilalabas na kahit single so pagkasab PGH ka na admit hindi ka naman na operahan ang bawa may heart attack mild heart attack so minanige ka medically wala kang babayaran PGH ang problema yan is yung bago kang maheart attack at ating outpatient sa ngayon hiniintay pa natin universal health care na may outpatient na primary care para wag mga hospital yun yung ating aimedon wag silang wag lumala yung mga sakit pero sa ngayon anakikator natin sa PGH kasi tertiary hospital ay yung mga misakit kasi yung naman kumpay ang PGH kumpay ang gusto nyo magbabayan ka but you will get the best doctors there and you will be managed appropriately and adequately so maliban sa lifestyle ang sinasabi natin ay kailangan talagang yung finances dapat masagot talagang ng goberno sa hospital do we have enough cardiologist and cardiovascular surgeons in the country? we have about 2,000 cardiologist and for surgeons I think we have more than enough and marami na rin mga heart centers all over the Philippines whether Luzon, Visayas and Mindanao so marami sa mga cities meron sa north pwede natin bangkitin ay mga hospitalang pero meron tayo sa Luzon sa Visayas sa Iloilo sa Sibu sa different regions dabao kagayang de oro marami naman Bicol area meron sa Luzon parang halos lahat covered na ang medyo kulang yung Visayas kasi maraming island so yung Iloilo meron takloban niya, meron natin at yung west part yung east part wala so problema pa rin yun kasi marami tayong island 7,000 so we need to really travel para makapunta sa isang center the other problem is yung distribution ng mga specialist lahat sila na sa city wala masyadong nagpapraktis sa mga towns and provinces so kaya naman kami sa PGH panintetraining kami ng mga bagong cardiologist we encourage them to go to the provinces para kalap talaga DOH I think has a program to put up a open heart center in every region so ultimate goal naman pero siyempre ayaw natin maging pacientin ng si Rohano ang gusto natin ay well and healthy tayo and ay just understanding that many things can be prevented is probably the biggest lesson today we don't want to see a cardiologist we don't want to see a surgeon and the important thing is that we remain healthy and sabi ko namin yung dalawa ay lifestyle change is a major factor ako napakaikli ng ating panahon but before we close can we have some messages let's start with Dr. Adrian a message probably to our doctors and then maybe to the general public well, siguro in general for the public ito kasing quarantine situation it was a necessary evil but we have to be mindful that this is generally not good for our health kasi lalo na kung nak ano tayo sa bahay na wala tayong ginagawa we may have to tend to overeat we don't watch our weight tapos wala tayong activity no exercise, no work so these are bad for the health in general and for the heart in particular so we have to be mindful of our diet and our activities secondly yung paciente who are at risk for having heart disease or diagnosed already to have heart disease I think we should not delay consulting a doctor lalo na kung may nararamdaman talaga kasi yung fear of COVID kayo na sinabi ni Eugene kanina ang mortality may be low pero you can die of a heart attack so keep that in mind because delaying the cardiac care may mean the difference between a successful and a failed outcome or a life saving measure Doctor Eugene well ang aking mensahi sa kanila number one kilalaning mo yung sarili mo pano mo makikilala yung sarili mo yung kilalama lama mo yung mga dahilan kung bakit nagkakaroonan sakit sa puso bakit ko sinabi kailangan kilalanim yung sarili mo kasi na yun yung heredity kailangan alam mo kung ano ikinamatay nang nanay at tatay mo at ano ang sakit nila dahil chances are you will get the same na ibo na matay sa heart attack kilalanim mo lalo ang sarili mo at marami kang pwedein gawin by changing the lifestyle eat fruits and vegetables exercise check your blood pressure check your blood sugar if you have diabetes looser weight kailangan maging slim ka and last and keep a young heart i think that's it thank you Dr. Eugene and Dr. Adrian today has been very important for us to understand there are many kinds of heart diseases and at the end of the day it's lifestyle change that will make a difference so that we can keep a young heart thank you Dr. Adrian thank you Dr. Eugene the coronavirus pandemic has focused medical attention on treating affected patients and protecting others from infection but the battle against heart diseases the biggest killer for the past years is still in our needs let us be kind to our hearts choose healthier options avoid tobacco smoking and excessive alcohol intake maintain a well balanced diet and regular exercise and don't be afraid to seek medical consult symptoms are currently in place to balance the demands of responding directly to COVID-19 while maintaining essential health service delivery thank you for watching Kalusugan Ay Karapatan