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Topic: Ischaemic Heart Disease in the Counties

Posted BY Kuria Kamau
Posted in: Cardiology

What are the challenges you experience in your work environment when it comes to diagnosis and management of patients with coronary artery disease?

Naomi Munywoki

Lack of consultants and proper investigation modalities.

Mbarak Mbarak

- No ECG / ECHO equipment for accurate diagnosis - Lack of expertise in reading and interpreting ECG/Echo - No Physician/ Cardiologist for referrals

Dr. Maureen Maleche

-atypical presentation in some cases whereby some patients presents with dyspepsia/epigatric pain as the only symptom or symptoms mimicking other conditions like pneumonia, pericarditis making us have low index of suspicion for acute coronary syndrome and we end up missing the diagnosis, thus increase the risk of morbidity and mortality. -unavailability of the ECG/ECHO machine, including the skills to interpret, make prompt diagnosis and management -lack of key drugs used in the acute management and or emergency management of acute coronary syndrome

Geoffrey Sangany

We face the challange of obtaining timely ecg and echocardiogram in the outpatient department. We also don't have a physician to consult after we obtain the results.

Dr. Haji Musuko

The challenges experienced in the diagnosis and management of coronary artery disease are: Lack of diagnostic tests- No ECG , ECHOCARDIOGRAM, Laboratory tests to do cardiac enzymes-Troponin and other labs- Lipid profile, arterial blood gases., Management challenges include lack of drugs eg Aspirin, clopidogrel, and Enoxaparin. Lack of thrombolysis agents. Lack of cardiac catheterization services. Lack of oxygen. Lack of HDU/ICU centres. Lack of management protocols for the accident and emergency department for managing acute coronary artery disease.


No access to EKG, patient have no money to get the EKG done or even travel to see a specialist. Some patient believe the chest pain is caused by pneumonia even if you try to dissuade them while others believe it's witch craft No access to troponin or any other lab investigation

Dr. Khuweillah Rudainy

Diagnosis of the condition: patient present with vague description of the condition that makes the diagnosis difficult. Untimely presentation with most of the myocardium having undergone infarction. Unavailability of ECG machine, or tracing paper. Inability of healthcare worker to interpret the graph. Unavailability of the first aid drugs in managing the cardiac emergency e.g clexane. Inadequate space in HDU.

Zainab Bagha

In terms of diagnosis there’s financial constraints in terms of patients not having the ability to pay for the diagnostic tests. Lack of knowledge regarding the condition leads to many patients not adhering to medication and not making an effort to change their lifestyle and diet. Medication sometimes being too expensive. Polypharmacy causing adherence issues.

Dr. Cedric Tumbo

Lack of proper diagnostic tests- ECGs, lipid profiles, troponin. lack of and distance from a cath lab No cardiologists

Zipporah Wachira

knowledge insufficiency in interpreting the ecg no access to pci poor triage on the waiting line non specific symptoms that divert attention away from diagnosis

Alfred Bikeri Manduku

Lack of proper testing equipment eg echo , ecg Availability of cardiologists

Pauline Kamau

Challenges in diagnosis include:Low index of suscipicion as IHD manifest similarly as PUD/dyspepsia/pneumonia’s and these results to increased mortality. Lack of diagnostic tools:ECG,cardiac biormakers ie Troponins aren’t available in our local hospital and hence patient have to be sent to a private lab that’s both time consuming and financial constraining. Lack of a well defined protocol in management of patients with ACS ,no emergency team responders and hence patient find themselves queuing and hence worsening .Shortage of cardiologist and hence patient have to be referred to a facility with a cardiologist via an ambulance that’s not equipped to support ACLS in ACS ,patients ends up deteriorating.Lack of basic medications used in management of IHD:Aspirin/clopidegrol,cardioselective Bblockers etc.

Dr. Michelle Wangui Getao

- Patients do not know about the symptoms of the acute coronary syndromes so they present long after onset of symptoms and may not even know to take 300 mg aspirin. - Challenges with patient transport which should ideally be in an ambulance with paramedics trained in care of suspected acute coronary syndromes. - Health workers who receive the patient may not be well informed about the importance of rapid patient management to facilitate revascularization therapy where indicated. - Lack of timely investigations especially 12-lead ECG and cardiac troponins. - In care of patients with chronic coronary syndromes or post-acute coronary syndromes, access to medication may be a challenge due to cost and availability.

Dr. Ivy Barasa

Availability of the ECG machine within the first 10 minutes of the patients' presentation, long waiting time between the drawing of blood to getting reports on the cardio markers tested, unavailability of some tests like the exercise stress echocardiogram or the dopamine stress echocardiogram in good time, unavailability of cardiac catheterization lab despite the availability of cardiologists. The presence of the fibrinolytic drugs needed however makes this easier.

Evans Wanyama

Lack of diagnostic equipment such as ECG/ECHO, our lab does not perforn cardiac enzymes, late patient presentation to the hospital, unavailability of essential medicines such as thrombolytics.


Vague description from patients, sometimes the description tend to mimic other conditions hence missing out on the diagnosis Availability of diagnostic tools but financial constraints from patients

Caroline Bichii

Inability to adequately interpret ECG results. Unavailability of thrombolytic agents. Inability to conduct PCI and closest referral center is 6 hours away. Lack of space in the coronary care unit for close monitoring of patients.

Dr. Mohamed Arif

Financial constraints. Lack of investigation modalities. Lack of a physician for consultation after receiving results

Dr. Mohamed Naji

lack of investigative equipment eg ecg,cardiac biomakers, lack of theraputic measures in place i.e pci,thrombolytics. lack of knowledge in interpreting ecg for most primary healthcare providers

Effat Abdulwahab

In ecg echo When we get an ecg... interpretation is a challenge Lack of consultants Medication needed to manage these patients is not readily available Financial problems... very expensive diagnosis and treatment Lab tests not times even lipid profile is a problem No icu facility

Bella Juma

No echo or ECG machine,lab poorly stocked.lack of medications for treatment,

Dr. Robbinson Nduati

lack of basic diagnostics tools. Laboratory usually lasks reagents to do basic tests. The Physcian is also limited by lack of resources thus patients have to be referred to the County Referral hospital which in itself is also a challenge due to lack of a facility based ambulance.

Florence Karanja

Lack of echo and laboratory investigations; cardiac markers, which patients are not able to do in other private facilities due to financial constraints and absence of facility equiped for PCI and ICU

Dr. Ombati Mokua

KNOWLEDGE IN use, READING AND INTERPRETING THE ECG findings for the primary health workers lack of the Lab works in following up on the tests of the patient. lack of therapeutic measures like thrombolytics

mutwiri rarama

1. Lack of diagnostic services: 24hr ECG & Echo and Cardiac Biomarker services are totally unavailable in most Level 4 facilities 2. Patient education on the signs and symptoms of CAD especially for those at high tisk 3. Poor training and capacity building for the first line healthworkers (Clinical Officers and OPD nurses) on the basic interpretation of ECGs and how to assess the patients who present with CAD symptoms.

Dr. Kenty Isabella

Making a diagnosis is a challenge since things like ECG,cardiac enzymes can't be done.

Faith Mbuvi

Lack of basic tests -ecg, cardiac enzymes, HBA1C ,lipid profile etc. And cardiologist not Available too

Charles Ndirangu

Lack of knowledge about common symptoms of heart attack in the general public which sometimes leads to patients presenting late, non-compliance to medications and other lifestyle modifications that reduces risks of cardiovascular diseases. Lack of an efficient, prompt and well trained ambulance/ emergency services. Low index of suspicion among the first healthcare workers who cone into contact with the patient,lack of ECG services. Inadequate and inefficient lab support ie one cannot get cardiac enzymes tests in good time,most of the drugs required for emergency Management are not available in the facilities, lack of Cath Lab services in the region

Umulker Haji

Unavailability of diagnostic investigation-ECG and Echo Lack of laboratory test like Cardiac Enzyme markers, Lipid profile Lack of Physician/Cardiologist to aid in further management Unavailability of therapeutic measures like thrombolytics

Robert Ngasa

Lack of ECG/Echo and lab works which in turn breeds lack of confidence in interpretation of results

Amal Almas

Ecg interpretation,lack of timely consultant/cardiologist review and ofcourse financial constraints for patients who need and may benefit from revascularisation therapy..

Abdijabar Adan

-Lack of diagnostic support -When available,the next PCI Centre is 6 hours away and the turnaround time for patients and relatives to make decisions and raise money for the huge cost will be about 2 days so you end up referring the patient to a PCI Centre after 48 hours

Gamar Bajaber

1.patients present after 12 hours or even days after sx onset,other present with complications of cad,or in cardiac arrest. 2.turnaround time of results ,serial troponins is a challenge.some facilities cant do troponin levels.,some dont hav a basic ecg machine 3.pci centres are further than the 120 mins needed to send a patient,thrmbolytic agents too expensive,patients cant afford plus no icu /ccu to monitor patient post thrombolyis in my facility where i worked as an mo. 4.patients are not aware of sx of an MI,and health seeking behaviours are low because we have not made society aware of wht coronary hear diseases entail.

Gamar Bajaber

1.patients present late past 12 hrs or even days after sx onset with complications like cardiac arrest ,heart failure,among others 2.pci facilities are situated far away 3.thrombolytics are very expensive if available,and no ccu or icu in some hospitals to monitor post thrombolysis 4.lack of awareness ,patients arent aware of the sx of an mi,we havent really come out to the comunity enough to enlighten them on ths. 5.labs:not all labs can do troponins,turn around time is too long in others 6.lack of ecg/echo machine where i worked as an mo

Peter Olyam

lack of ECG, lab tests (troponins,other cardiac enzymes, lipid profile etc), HDU/ICU

Dr. Aarif Varvani

Challenges faced for patients with ischemic heart disease: A) Diagnosis: -Most places lack access to basic diagnostic equipment i.e. An ECG machine. -Most primary Healthcare providers lack the knowledge of interpreting the ECG. -Cardiac markers/enzymes are also not available at most places, and where available, are very expensive. -Other tests like 2D ECHO, Excercise Stress Testing, CT Coronary Angiography, Stress ECHO, Diagnostic PCI and nuclear scanning are inaccessible. B) Management: -Most primary care providers lack a high index of suspicion and end up treating a lot of patients as dyspepsia/PUD/GERD -Lack of knowledge of interpreting an ECG is a hindrance to initiating management protocol for MI/NSTEMI/Angina etc. -Most patients present very late when they are in bad cardiogenic shock and they do not survive even at the ER. -Lack of appropriate drugs: Thrombolytics/STEMI kits, some places even do not have antiplatelet drugs available. -Patients also present way outside the revascularisation window, both for PCI and even thrombolysis. -Lack of Cardiac Catheterization Lab services. -Lack of a well stocked crash cart and a working defibrillator and Cardiac monitor at the ER. -Financial constraints: care of ischemic heart disease is quite expensive.

Abdulaziz Abeid

Diagnosis of CAD may be suggested by history and findings on ECG and 2DECHO. However, access to stress tests and coronary angiography is limited. In terms of management, we have pharmacological options like antiplatelet, stations and heart failure medications. Drugs like nitro spray, ezetimibe and PCSK inhibitors are not available. We also currently don't have a cath lab for PCI and don't do coronary bypass surgeries.

Sidney Sawe

No radiological, laboratory investigations to support the diagnosis of IHD.

Dr. Flora Kithikii

No ECG machine, not even cardiac biomarkers.

Abdullahi Kaar

the issue with management of coronary artery diseases at county levels are vast array. First and foremost lack of clinicians trained t pick up the symptoms, when they are available they lack adequate training. Secondly most facilteis lack ECG machines to help pick up ACS.Third there is lack of basic medications in the emergecy trays. Last but not least no well establised refferal cardiac facilties in counties.

Tommy Temesi

By biggest challenge is lack of confidence in diagnosing IHD coupled by inaccessibility of diagnostic services i.e. ECG, cardiac enzymes, lipids, and drugs for management.


Hard to make a diagnosis since no Each not Echo....also no lipid profile and can't do troponin levels

Dr. Ngugi Wamuyu

My main challenge is lack of proper diagnostic equipment. The ECG rarely works, the cardiac enzymes are unavailable, while supportive tests like Biochemistry are often unavailable. Thus diagnosis is delayed as clients have to be referred to private facili. The clinicians who first see the clients lack the knowhow to detect IHD cases.

Ruth Komu

Sometimes the ECG machine is not working. Late presentation by patients leads to delayed diagnosis thus missed windows when interventions would have been made. Low index of suspicion of coronary events.

James Mugo

Our challenge is the long waiting time for cardiac triage results as well as inadequate finances on the side of patients to afford ideal treatment modalities upon diagnosis.

Clement Kanyiri

1. Inability to access ECG and Echo services. 2. No Cardiologist in town for consultation or to refer to. 3. Inability to access supportive lab investigation

Uzma Bagha

Lackof ecg and cardiac enzyme delayed presentation to hospital

Dr. Magdalene Randa

Lack of diagnostic services ie no monitors, no ecg machines, no cardiac enzymes making it impossible to diagnose in time

Muthoni Maina-Luzing'a

Erratic supply of lab reagents supporting the diagnosis, medication and oxygen in the management. Lack of capacity to handle the patients: no ICU/HDU facilities, no ECG machines and unable to do cardiac enzymes.


The challenges in the diagnosis and management of patients with ISD İNCLUDES; 1. lack of lab tests such as ; Tropinin, Lipid profile and other essential tests. 2. Cosultant review on issues that needs a physician or a cardiologist to aid in the management in the ICU
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