Cardiology
OVERVIEW
Department of cardiology in J LN Medical College, Ajmer, started in year 1995 in a new separate building near old boy’s hostel. Dr. S.R. Mittal took over the charge of department. The department was first of its kind in super-specialization in Ajmer medical college. After the department started, it hugely benefitted the heart patients of Ajmer and nearby areas in the form of availability of 24 hrs cardiac casualty and improved acute patient care, diagnosis and management.
Initially the department had following faculty members, Dr. S.R. Mittal and Dr. R.K. Gokhroo along with five medical officers Dr Sudhir Khanna, Dr Anil Mathur, Dr Hemant Arora, Dr Rajan Roy and Late Dr Dharmender Mathur and successfully managed the hospital indoor, outdoor, specialty clinics and diagnostic facillities in the form of Echocardiography, Treadmill test, Holter monitoring etc. since its inception.
In 2006, cardiac catheterization laboratory was established. This greatly benefitted the population of Ajmer as complete treatment of cardiac patient became possible from diagnosis to treatment in the form of coronary angiography, angioplasty, pacemakers, etc. In 2008, Dr. R. K. Gokhroo became Head of department and successfully carried this task of managing the department. In 2010, Dr. S.K. Kaushik from Udaipur was appointed as head of department of cardiology and principal J.L.N. Medical College, Ajmer.
The golden era of department started in 2009, when DM Cardiology super specialization course was granted by Govt. of Rajasthan and Rajasthan University of Health Sciences, Jaipur and letter of permission (LOP) was issued by Medical council of India under the guidance of Dr. S.K. Kaushik and Dr. R. K. Gokhroo in 2010 for begining of DM course in August 2010. In 2011, Dr. Kaushik was transferred to Udaipur and Dr. Gokhroo again took over the charge of department.
The department continued to progress under the guidance of Dr. Gokhroo and after admissions of two DM residents per year from 2010 onwards, the department managed to serve a large number of patients as compared to previous decade in the history of department.
From the year 2008-2009 number of OPD patients used to be about 25,000 per year which increased to 116471 in 2019. The number of indoor patients also increased from 2,500 to about 9245 in 2019.
Non-invasive lab of department registered the exponential growth as far as echocardiography is concerned. From the year 2008-2009 number of Echocardiography done in the department used to be about 4500 per year which increased to more than 20,130 in 2019
The backbone of a cardiology department, the catheterization lab, transformed hugely in the form of number of procedures performed as well variety of procedures performed. From the year 2008-2009 number of coronary angiography and angioplasty used to be about 700 per year which increased to more than 5200 for the year2019.
Primary angioplasty was started in 2010 and since then it is routinely offered to the patients in which after a major heart attack, patient is directly taken to catheterization lab and culprit artery is opened in timely manner without waiting for medicines to dissolve the clot. This is one of a procedure which require skill, availability of personnel, better equipments and critical care. This programme has benefitted the patients of city and nearby area as a world class procedure (the best treatment for a heart attack patient worldwide) made available in this department.
Apart from coronary procedures, department regularly started treatment of patients of cardiac arrhythmia in the form of Electrophysiology Testing and radiofrequency ablation(EP study with RFA) for which previously patients had to go to distant places for treatment. Other major cardiac procedures including all kinds of pacemaker implantation, CRT-P and CRT-D placement, Fluroscopy, Renal Angiography, Carotid angiography, peripheral angiography IVC Filter implantation, Balloon Mitral Valvotomy (PTMC and BMV) and Oximetry studies for congenital heart disease, are being done regularly. Bronchial artery embolization is being done on regular basis for patients with massive hemoptysis in cases of pulmonary tuberculosis. Head up tilt test (HUTT) was started in 2012 for the first time in the state of Rajasthan and being done regularly on OPD basis which is done for the patients of vasovagal syncope. The department is pioneer in doing this test among all medical colleges of state of Rajasthan.
The department has achieved national and international recognition when Dr.R.K. Gokhroo went to annual conference of American College of Cardiology (ACC), USA, 2013 to present his original work in cardiology “Coronary sinus anatomy: Ajmer working group classification” which was recognized and accepted in the literature as a standard classification by all electrophysiologist around the world and published in Journal of Invasive cardiology, USA. Dr. R.K. Gokhroo also participated as faculty and presented his work in annual conference International Society of Cardiovascular Ultrasound (ISCU), USA in March 2013. Dr.R.K. Gokhroo is a driving force for clinical original research projects. Department has published more than 50 international publications in esteemed journals and more than 250 publications in national journal of repute. In 2010, the first two DM residents Dr. Deepak Padmanabhan and Dr. Archna Gokhroo joined the course. Dr. Deepak Padmanabhan has completed 2 year clinical fellowship in advanced electrophysiology prestigious Mayo clinic, USA which started in September, 2014. presently working as Assistant. professor. at electrophysiology in Jayadeva institute of medical science Bangalore & Dr.Archana Gokhroo working as professor in department of medicine at RNT medical college Udaipur. The DM residents of batch 2011 were Dr. Devendra Bisht and Dr. Sajal Gupta. Dr. Devendra Bisht presently doing E.P fellowship in Icon School of medicine, mount Sinai New York USA, In 2012 batch, Dr. Kamal Kishor and Dr. Bhanwar Ranwa were admitted, Dr. Bhanwar Ranwa working as Assistant. professor in cardiology department Gov.medical college kota in 2013 batch, Dr. A. Avinash and Dr. K. Priti . Dr. A. Avinash is presently working as Assistant. professor.in cardiology JIPMER Puducherry , in 2014 batch Dr. Shashi kant Pandey and Dr. Ram Sagar, in 2015 batch Dr. Kailash Garhwal, in 2016 batch Dr Rajesh Nandal and Dr. Ashish kumar, in 2017 batch Dr. Tarik Mohammad Tasleem and Dr Anushri Kaul , in 2018 batch Dr Subhash Chandra and Dr Manish Goyal and in 2019 batch Dr rajat Rawat and Dr Saurabh Gupta has joined the department as DM residents.
In 2012, Dr. Deepak received second prize in platform presentation at annual conference of Indian College of Cardiology(ICC), 2012 for research project on “Characteristics of radial access site coronary procedures in patients with arteria lusoria among 5789 patients undergoing coronary angiography at a primary radial access centre” and received laptop. In 2013, Dr. Devendra received first prize in platform presentation at annual conference of Indian College of Cardiology, 2013 for research project on “Coronary sinus anatomy: Ajmer working group classifications” and received cash prize money Rs. 10,000/. In 2013, Dr. Sajal received second prize in platform presentation at annual conference of Indian College of Cardiology, 2013 for research project on “Prevalence of congenital heart disease in patients undergoing surgery for major gastrointestinal malformations - An Indian study” and received cash prize money Rs. 5,000/. In 2013, Dr. Deepak presented his original research on “A single centre multioperator initial experience of 5789 patients at a primary radial intervention programme in a primary care tertiary level centre” as poster presentation at annual conference of Cardiology Society of India, 2013, Bangalore, India. In 2013, Dr. Sajal presented his original research on “Prevalence of congenital heart disease in patients undergoing surgery for major gastrointestinal malformations - An Indian study” as poster presentation at annual conference of Cardiology Society of India, 2013, Bangalore, India. In March 2014, Dr. Devendra presented his original research on “Palmar Arch Anatomy: Ajmer Working Group Classification” as poster presentation at annual conference ofAmerican College of Cardiology (ACC), 2014, Washington, USA. In March 2014, Dr. Deepak presented his original research on “Eptifibatide in Post-Myocardial Infarction Patients with Ongoing Ischemic Pain Who Refused for Intervention: AJmer Post-Myocardial Infarction Angina Eptifibatide Research (AJMER study) ” as poster presentation at annual conference of American College of Cardiology (ACC), 2014, Washington, USA. In August, 2014, Dr. Devendra presented his original research on “Feasibility Of Ulnar Artery For Cardiac Catheterization: Ajmer ULnar ARtery (AJULAR study) Catheterization Study” as poster presentation at annual conference of European Society of Cardiology (ESC), 2014, Barcelona, Spain. In recognition and contribution of original work for Indian journal of cardiology, ISC gold medal award for 2011, 2012 and 2013 were given to Dr. Deepak Padmanabhan, Dr, Devendra S Bisht, Dr. Sajal Gupta, respectively at 9th annual conference ofIndian Society of Cardiology, 2014, held in chennai, India. In September 2014, Dr. Kamal Kishor received the second prize of cash money Rs. 1000/ in ECG Quiz at 19th annual conference of Indian College of Cardiology, 2014, Tirupati, Andhra Pradesh.ACCE awarded highest ranked abstract from india for Three consecutive year 2015,2016,2017 during its annual conference …………In JACC March 2019, Dr. Ashis Kumar’s research work done on “ Preliminary Results of Angiotensin Receptor-neprilysin inhibitor effect on TEI index and left ventricular Mass in heart failure (ARTIM HF) trial ”was selected for poster presentation at annual conference ofAmerican College of Cardiology (ACC), 2019, USA held In March 2019.. Dr. . Anushri kaul’s research work done on “ 1 year follow up results of ARTIM HF (angiotensin receptor-neprilysin inhibitor effect on TEI index and left ventricular mass in heart failure) is selected for poster presentation at annual conference of American College of Cardiology (ACC), 2020, USA held In March 2020.
A Paramedical course in Cardiac Instruments Training (CIT) is running in department since year 2009 with initial intake of 20 students per year which has been increased to 25 in 2015. The students who have completed their course are working successfully all over the country in different hospitals and feel proud of this department.
The department is among the few cardiology departments in country where 24 hours cardiac casualty for patients is running for last 25 years. This casualty service is independent of main casualty of JLN Hospital, Ajmer. This is a role model for fastest treatment of a heart attack patient within the golden period of 1 hour as department is situated in centre of the city with easy access and patient come directly without need for seeing by physician and referral. The department is well equipped with basic and advanced facilities required for cardiac patients. A new block for OPD extension, a new cardiology casuality building,new catheterization laboratory and an other new cath lab for primary PCI is ready The Academic block has separate chamber for head of department, associate professor, assistant professor, DM resident third year and medical officers. A new ICU and general ward extension is completed which has added to grandeur of department.
Presently faculty in the department includes Senior Professor and Head of Department - Dr. R.K. Gokhroo, Two Assistant. professor in cardiology department Dr. Lokesh Chand Agrawal and Dr.Saurabh Gahlot is working. Dr.Pramod Pareek (DM cardiology)Assistant. professor medicine presently Deputate in cardiology And Dr. Jaipal Bugalia(DM cardiology) as medical officer , Six DM Residents, Two Medical officers namely Dr. M.G. Agarwal and Dr. Alok Sharma.
The department is committed to teaching and research that places the development of medical knowledge and practice into broad social and cultural contexts. The department is going to complete 25 years in near future and vision of Dr.R.K.Gokhroo is to make department fully capable of serving cardiac patients with a touch of humanity and best care possible in the form of diagnosis and treatment so patients should continue their faith in government institutions.
The performance of department at a glance is as follows:
A.OPD services: Every Monday and Thursday
Monday: Coronary artery disease Clinic
Tuesday: Cardiomyopathy /Heart Failure Clinic
Wednesday: Pacemaker/Arrhythmia Clinic (Pacemaker System Analysis)
Thursday: Hypertension clinic
Friday: Rheumatic Heart Disease Clinic
Saturday: Paediatric Clinic
B. Indoor Facility:
Male cardiac Ward:24 beds
Female Cardiac bed:13 beds
Post cath ward: 10 beds
New ICCU: 16 beds
STEP DOWN ICCU :8 beds
C. 24 hour Casuality
D.ICCU: 24 beds
E. Equipments
List of equipments in cardiology department:
1. Catheterization laboratory:
A. Siemen’s single plane image intendifier with following accessories:1
B. Intra aortic balloon pump: 2
C. Bard E.P System With Radiofrequency ablation (RFA) Facility:1
D. Pressure injector:1
E. Pacemakers system analysis(PSA) for pacemaker interrogation(for Medtronic devices) in follow up:2
F. ETO Sterilization:1
G. Plasma Sterilization:1
H. Intra Vascular Ultra Sound(IVUS):1
I. Optical Coherence Tomography (OCT):1
J. Fraction Flow Reserve (FFR):2
K. Rotational Atherectomy (ROTA):1
L. Angiojet Pharmaco–Mechanical Thrombectomy System :1
M. CPR Machines:3
N. TPI Generators :12
2. Non-invasive laboratory:
A. Four Echocardiography machine including (i) Phillips iE33 (ii) Siemen(3) with Intra Cardiac Echo probe:1
B. Transesophageal Echocardiography probe:2
C. intra cardic ECHO probe-1(Siemens)
D. Tread mill: 2(mestro)
E. Holter machine:4
F. Ambulatory B.P. apparatus: 3
3. ICU:
A. ECG Monitors:40
B. Bedside X-Ray; 2
C. Bedside monitors and central monitoring system:16 with I.P address
D. Infusion devices: 100
E. Defibrillators: 6
F. Ventilators :7
G. C-arm for temporary pacemaker implantation:1
H. CVP monitor and invasive B.P. Monitor :4
4. Outdoor:
A. ECG, bedside X-Ray
B. Defibrillators
C. Table for head up tilt test(HUTT)
F. Performance at glance
List of Specialized procedures performed in cardiology department:
1. Catheterization laboratory:
A. Coronary angiography, peripheral angiography
B. Coronary angioplasty including primary angioplasty
C. Temporary Pacemakers
D. Permanent Pacemakers including single chamber, dual chamber
E. Implantable cardiac defibrillator (AICD)
F. Cardiac resynchronization therapy (CRT-D, CRT-P)
G. Electrophysiology study and RF ablation(RFA) and 3D anatomical mapping
H. Percutaneous balloon mitral valvotomy(PTMC/BMV)
I. Bronchial artery embolisation
J. Oxymetry and Cath studies
K. IVC Filter implantation
2. Non-invasive laboratory:
A. Transthoracic Echocardiography including pediatric echocardiography,3D echo, Saline Contrast Echocardiography
B. Transesophageal Echocardiography
C.Intra cardic echocardiography
D. Stress echocardiography
E. Dobutamine Stress echocardiography
F. Tread mill testing
G. Holter monitoring
H. Head up tilt test (HUTT)
I. Ambulatory B.P. monitoring
I. Echo guided pericardiocentesis
3. ICU:
A. ECG, bedside X-Ray
B. Temporary pacemaker implantation
C. CVP monitoring and invasive B.P. Monitoring
D. Fluoro guided pericardiocentesis
4. Outdoor:
A. ECG,
B. X-Ray
C. Basic blood biochemistry
D. Speciality clinics for Coronary artery disease, rheumatic heart disease, paediatric, heart failure and arrhythmia patients
Table 1: Number of patients under treatment in cardiology department in recent years
Year |
OPD Patients (per year) |
Indoor patients (per year) |
Echocardiography (per year)including DSE,3D echo,Contrast Echo,Stress Echo etc |
Coronary Angiography,PTCA, PPI,BAE etc(per year) |
2008 |
25,902 |
2783 |
4550 |
745 |
2009 |
22,591 |
2899 |
4075 |
687 |
2010 |
27,441 |
2057 |
4976 |
881 |
2011 |
30,559 |
3425 |
5744 |
1191 |
2012 |
43,868 |
4079 |
8268 |
1492 |
2013 |
61,244 |
4342 |
10,059 |
1450 |
2014 |
67127 |
5330 |
12258 |
2242 |
2015 |
76948 |
6040 |
11840 |
2306 |
2016 |
29191 |
6379 |
19628 |
2319 |
2017 |
96333 |
7767 |
17002 |
4092 |
2018 |
104680 |
9362 |
20560 |
5097 |
2019 |
116471 |
9245 |
20130 |
4768 |
"Ulnar Intervention" is the highlights of the department for its recognition in interventional cardiology. It has performed more than 4000 ulnar procedures which is "Highest in the world" and is being recognized at American College of Cardiology during its 64th annual conference of cardiology held at San Diego in 2015 as "Ulnar artery intervention non inferior to radial approach: A reality or myth. AJmer ULnar ARtery (AJULAR) working group study" ,.
G. Academic Exellance
Prof S R Mittal was awarded Dr B.C Roy.
Presidential Oration of ISC delivered by Dr RK Gokhroo :
1 ISC Presidential Oration 2006
2 ISC Presidential Oration 2007
3 ISC Presidential Oration 2008
4 ISC Presidential Oration 2009
5 ISC Presidential Oration 2010
6 ISC Presidential Oration 2011
7 ISC Presidential Oration 2012
8 ISC Presidential Oration 2013
9 ISC Presidential Oration 2014
10 ISC Presidential Oration 2015
11 ISC Presidential Oration 2016
12 ISC Presidential Oration 2017
13 ISC Presidential Oration 2018
14 ISC Presidential Oration 2019
Indian journal of cardiolohy Established in 1998 & published quarterly regularly, indexation"Indian Cardiology Index"