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Mbarak Mbarak

I am confident because I have some extra training and experience on ECG and Echo, However, availability of these equipment is still a challenge in the counties. Other issues like availability and affordability of CAG and PCI services for definitive diagnosis and treatment also pose a challenge for isolated counties like Lamu.

Dr. Ngugi Wamuyu

Having previously worked in an A&E Center at Mater, that gave me valuable skills and acumen to detect cases of likely ischemic heart disease and request for necessary tests. I am about 60% confident in making a diagnosis. The lack of an ECG machine and tropponin tests at my current county public facility limits us in making a diagnosis as we have to refer clients elsewhere. Lack of routine exposure to IHD Cases has left my ECG interpretation skills rusty. I would really appreciate if we got a refresher course on ECG interpretation.

Wyclif Odira Odhiambo

I work in Kendu subcounty hospital in Homabay County, we don't have an ECG within the facility. Making a diagnosis is so hard, we rely on clinical acumen and symptomatology approach. Doing ECG entails referral of the patients to Kisumu, which means missing out the opportunity to help the patients. I would love to get a refresher course on ECG ECHO training if it's offered in this training.

Caroline Bichii

I do not feel too confident when making the diagnosis. I have to refer to my notes to help me interpret ECG tracings. Many a times lab results requested to aid in diagnosis also have a prolonged turn over time. Luckily, I work in a station where I can consult a cardiologist for assistance.

Effat Abdulwahab

Clinical diagnosis can be done based on symptomatology....but as level 6 referral hospital I would like us to have an ECG ECHO.... By the time we refer to KNH...it's time consuming and this makes delays with intervention. We even need more training in interpretation of ECG tracings... We have 2 physician though who are helpful in consultation of such cases

Dr. Flora Kithikii

Skills aqcuires in ACLS class have really helped. Lack of ECG machine/lab tests.

Naomi Munywoki

Quite confident in ECG interpretation however limited lab and diagnostic resources resources.

Dr. Aarif Varvani

I am very confident when making a diagnosis of Ischemic Heart Disease or Acute Coronary Syndrome. This is highly attributed to 2 Consultant Cardiologists who made me realised my passion in the field of Cardiology, Dr Vinesh Vaghela and Dr Kieran Mwazo. I trained under them both during internship and shortly thereafter I was employed as a Medical Officer. I helped set up the outpatient diagnostic Cardiac. Centre at Coast General Teaching and Referral Hospital and I thereafter was deployed as In Charge of the Accident and Emergency unit. Further helping my confidence was the availability of ECG machines, point of care testing for Cardiac enzymes, Treadmill test/Exercise stress test machine, and the ECHO machines. Worthwhile to mention, is the partnership between the Coast General Teaching and Referral Hospital and The Aga Khan Hospital Mombasa (Public-Private partnership) through which we have been able to provide diagnostic angiography and PCI services to the members of the public. Last but not least, I would like to stress that to be confident in diagnosing ischemic heart disease, or Acute Coronary Syndrome, one has to have a high index of suspicion and knowledge and presence of an ECG machine. Cardiac enzymes are also useful especially during NSTEMI.

Dr. Maureen Maleche

I am very confident with making a clinical diagnosis of ischemic heart disease based on symptoms and physical examination. however, definitive diagnosis is a challenge because of unavailability of ECG/ECHO,cardiac enzymes and other supportive tests like lipid profile,TFT among others. In most cases I am forced to send the patients to a nearby private facility for the tests, some patients do not have NHIF cover and are unable to pay cash money to enable perform urgent investigations for proper management, thus leading to delayed diagnosis and management..

Zeytun Somo

Confident enough to suspect it but with limited recources at my current station limits further investigation and thus management

James Mugo

Working in a resource-enabled setting (where ECG and appropriate lab works are available) at Mater has helped my confidence & skills in diagnosing ACS. The availability of an on-call cardiology team (Including one Registrar in Cardiology) has also invaluable. Lack of confidence arises in patients with comorbids and atypical symptoms that may widen the differential diagnosis.

Fredrick Otieno

Without the appropriate diagnostics tools it is challenging to clinch the diagnosis. Symptomatology can only be stretched to a certain extent, that is, as far as atypical presentation is concerned.

Dr. Tendwa Ongas

I am somewhat confident in diagnosing ischaemic heart disease because of availability of resources at my place of work. ECG is available within 10minutes and trops take 1.5-2 hours to be ready once ordered. This has helped me improve in interpretation of ECGs although there is still room for improvement. There is also availability of consultants where in doubt which further enhances the learning experience.

Abdikadir A. Adow

Making a suspected diagnosis of IHD is possible especially if presented at right time and with good history. The major challenge is availability of EKG or troponins. And if u get one how to interpret EKG..when u need a physician/cardiology review.. a availability of interventional means wether invasive or noninvasive poses a challenge too.

Dr. Cedric Tumbo

Lack of proper diagnostic equipment( ECG and ECHO) greatly affects the ability to diagnose and hence lack of confidence since one cannot practice regularly.

Dr. Kenty Isabella

I wouldn't say I am confident as there are no means to confirm the diagnosis at our subcounty facility(Lack of ECG).

Pauline Kamau

Using my index of high suspicion am able to make a clinical diagnosis and based on previous little knowledge on ECG ,am 55% confident however am curious to learn more of ECG and ECHO to boost my confidence.Priviliged to have an ECG machine however tracing papers are a challenge hence we work with what is at hand.challenge:inadequacy in ECG interpretation skills,lack of basic tests ie Troponin test that have to take long to obtain from private labs .

Dr. Ivy Barasa

I am not as confident at making the diagnosis of IHD or ACS for at most instances, I would have to refer to an ECG interpretation guide so as to identifying some uncommon tracings. This is however getting better through practicing more on ECG interpretation.

Dr. Haji Musuko

I work in Malindi Sub County hospital at the accident and emergency department . I do conduct Weekly Non Communicable Disease clinics in 4 primary care facilities in the subcounty. I am 70 % confident in making diagnosis of ischaemic heart disease and acute coronary syndrome based on history taking and physical examination.The factors that make me less confident in making the diagnosis is lack of ECG machine. I had basic training on doing ECG at post graduate training but since I went to the field my skills have not been utilised and feel less confident applying the same. I am loosing the skills. As a hospital we do not do ECHOs . We are not doing the Troponin in our laboratory. Most of the patients can not afford the tests privately and therefore have to wait for a longer duration for results. I lack Basic drugs and interventions at the accident and emergency too.

Dr. Haji Musuko

I work in Malindi Sub County hospital at the accident and emergency department . I do conduct Weekly Non Communicable Disease clinics in 4 primary care facilities in the subcounty. I am 70 % confident in making diagnosis of ischaemic heart disease and acute coronary syndrome based on history taking and physical examination.The factors that make me less confident in making the diagnosis is lack of ECG machine. I had basic training on doing ECG at post graduate training but since I went to the field my skills have not been utilised and feel less confident applying the same. I am loosing the skills. As a hospital we do not do ECHOs . We are not doing the Troponin in our laboratory. Most of the patients can not afford the tests privately and therefore have to wait for a longer duration for results. I lack Basic drugs and interventions at the accident and emergency too.

Dr. Mohamed Naji

confident cause I have had ACLS training, also with the availability of ecg in our facility compounds this confidence. lack of cardiac markers makes it a bit tough in cases of nstemi.

Amal Almas

I am confident enough to diagnose IHD/ACS by clinical presentation, ECG and Cardiac markers.Although it can be challenging in some cases esp NSTEMI and one cannot do cardiac markers,Complex ECGs or if some patients don’t present with classical symptoms,esp the elderly where in some ,confusion or altered mental status maybe the only symptom they present with.

Florence Karanja

I'm confident with diagnosing Ischaemic heart disease and ACS through the experience I have had at the facility I work in, clinically and my learning skills on ECG interpretation has markedly improved through the multiple ECGs we've done for patients. However, the challenge with lab investigations for TFTs, troponins (especially for NSTEMi) and lack of echo & PCI equipment still remains

Abdullahi Kaar

Thnak you for brinbging up this discussiuon question. its very important since there is changing themes in diagnosis and mnagement of ischemic heart disaese after this years european cardiiac society conference. currenly when patient comes to facilty i always fall back to safe strategy lack of clear coincese information hampers best practice. its clopidogrel or asprin stat, some nitrates if available and ecg to be done. In event lask of ecg machine we manage wih above plus oxygen and some morphine .

Gamar Bajaber

I am pretty confident in the diagnosis of ihd due to a cardiology rotation in the imed program,the only time I would be less confident is in county setups with no ecg machine,or lab that could perform serial troponins.Also in patients with esrd ,it might be confusing as troponins are elevated,but a lab that can help trend troponins will help,plus an echo.

Geoffrey Sangany

With our current lack of diagnostic tools like ECG and echocardiogram it is hard to w make a diagnosis. We mostly have to refer our patients to a higher level facility where the diagnosis is made.

Ruth Komu

I am somewhat confident in making a diagnosis of ischemic heart disease and acute coronary syndrome. The factor that makes me less confident is my limited ECG interpretation skills. Due to the unreliability of our ECG machines, we don’t always have ECGs for our patients. This means there are less opportunities to learn from.

Hillary Sigilai

Fairly confident as we have a high case burden accompanied by availability of diagnostic tools where we I work currently.

Uzma Bagha

Confident in obvious cases with obvious ecg changes. However, NSTEMI without cardaic enzymes can be tricky for me personally and feel i might miss them easily.

Dr. Michelle Wangui Getao

I am confident in ACS diagnosis but much less confident in diagnosis of chronic coronary syndromes. After the patient gives a suggestive history, are there specific 12 lead ECG findings to assist in primary care setting diagnosis? Which patients require referral for further assessment?

mutwiri rarama

I would say I am 70% confident in making the diagnosis of ACS given the 24/7 availability of ECG and Cardiac Biomarkers with a quick turnaround time. However in the set up I work at in Meru County the diagnostic services are not readily available. I would say the factors that make me less confident are the usual challenges of being able to quickly rule out other differential diagnosis and then the availability of consultants' input in the management of patients who present with symptoms of ACS.

Abdijabar Adan

I am very confident in making a diagnosis of ACS however the diagnostic equipment are not available within 10 mins stipulated period as there are some in private centres.More practice will be required to detect atypical ACS like a new onset LBB or RV infarcts

Dr. Mohamed Arif

I'm very confident when making a diagnosis of ischaemic heart disease and acute coronary syndrome because I've done extra training on ecg in addition to ACLS program. I'm extra diligent when handling patients and that helps me too. What makes me uncomfortable is lack of diagnostic equipment like ecg and a physician to consult. Pci is also mostly unavailable. Inability to do troponins in time is also a challenge in especially NSTEMI.

Dr. Robbinson Nduati

not confident due to lack of basic diagnostic tools. lack of enough experience

Habiba Hassan

I am quite confident in my diagnosis through history taking and physical examination which almost always point to the diagnosis, but unavailability of diagnostic machines such as Echo or blood tests such as the cardiac enzymes at the county level reduces the confidence in the diagnosis of these diseases

Ms. BEATRICE MOTURI

I am not confident enough because our facility lacks an ECG,an Echo, Cardiac Markers and even a basic chest x-ray

Charles Ndirangu

I don't have enough confidence in making these diagnoses first because of lack of auxiliary services such as lab support for cardiac markers and other relevant work ups, no ready CXR,no ECG machine,no ECHO machine and patients will have to pay private clinics to have it done or wait for long for an ECG to be done at the county referral hospital. I have confidence in my ECG interpretation skills but lack of continuing education on the same is also a hindrance.

Dr. Erick Leparmorijo

We don't do ecg and echo, cardiac makers in our facility which makes it difficult for diagnoses. We usually refer patients of suspicion to other facilities

Zipporah Wachira

confident-able to identify risk factors easily and pick clinical s/s, i also have a high index of suspicion, not confident because of interpreting the ecg

David Okeyo

1. lack of imaging e.g ECHO and ECG 2. Frequent change of rotation 3. Inadequate capacity building in specific topic like Cardiac diseases

Dr. Faith Vuku

confident biggest challenge is definitely the availability of ecg and echo machines

Dr. Kevin Odhiambo

Confident enough to suspect a diagnosis of ACS/IHD from Hx and P/E, Less confident to make a definitive diagnosis due to lack of supporting or confirmatory diagnostic work-ups.

Dr. Magdalene Randa

I am not very confident because in my hospita; we dont have ECG machines all i have is theoretical knowledge with little practice

Dr. Moenga Masese

I'm only equipped with a high index of suspicion based on the risk factors. Lack of necessary lab + imaging tests is a huge impediment. At my current station, we don't have troponins, ecg facilities.

Muthoni Maina-Luzing'a

I am confident in making the diagnosis Lack of capacity at the facility: inability to do an ECG/ Echo, troponin levels and other markers that aid in diagnosis

Dr. QHALIB ALI ABDI

I'm confident in making the diagnosis of IHD or ACS from owing that to the clinical acumen and availability of an ECG in the department i work in( Embu Level 5 ICU). However, lack of stability in lab tests such as Tropinin, lipid function tests availability is a problem in the management and follow up of these patients.

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