Soundings: Dr. Carl Levick, cardiologist and Irene Conlon, cardiac sonographer, discuss an ultrasound of a heart. *Photo by B. Candace Ray
Soundings: Dr. Carl Levick, cardiologist and Irene Conlon, cardiac sonographer, discuss an ultrasound of a heart. *Photo by B. Candace Ray
Cardiac disease is Bermuda’s most common cause of death and disability.

But thanks to Cardiac Associates of Bermuda, the hospital now has 24-hour cardiac services seven days a week.

Cardiac Associates of Bermuda partners Bermuda Hospitals Board (BHB) with the Lahey Clinic to provide inpatient and outpatient consultation, diagnostic testing and urgent care for critically ill patients.

“What we have attempted to do is to provide a specialty trained cardiologist to help existing staff manage cardiac emergencies day and night,” said Dr. Carl Levick, BHB’s chief of cardiology.

The collaboration between the two facilities is intended to improve Bermuda’s cardiac services generally, and within the walls of the hospital (KEMH), specifically.

Of the cardiac providers on the island, Dr. John Doherty would not be expected to commit to around-the-clock availability for in-hospital care in addition to his private practice; and Dr. Shane Marshall does not have active hospital staff privileges, so does not currently perform inpatient consultation.

Dr. Levick has conferred with outpatients in his third floor office in the coronary department at KEMH since August, and is engaged in inpatient care in every ward of the hospital.

He has been assisted by a ‘locum tenens,’ an also-board certified cardiologist here in Bermuda on a short-term basis.

A second, permanent cardiologist, Dr. Sam Mir, will join him in March 2011.

“The main activities of my practice are to take patients who have symptoms of cardiac disease, or may have already been diagnosed with cardiac disease, and to establish an accurate diagnosis and treatment plan for that particular patient,” Dr. Levick said.

Dr. Levick is focused on expanding the range of diagnostics, including stress and other tests to diagnose heart disease.

“For people who can’t walk, we use chemicals to speed up the heart rate temporarily and reproduce the heart’s response to exercise,” he said.

“Other pharmacologic agents alter the blood flow pattern to the heart muscle without exercise and allow us to diagnose coronary obstruction.”

Dr. Levick expected that Cardiac Associates would this month begin using nuclear cardiology to diagnose coronary blockages. He explained that a patient undergoes treadmill stress testing and a small amount of radioactive material is injected into the circulation through an intravenous infusion. A camera then photographs the amount of radioactivity pooling in the heart muscle. Analysis of the pattern of blood flow to the heart muscle will detect blockage in a coronary artery threatening to cause a future heart attack or causing chest pain symptoms.

“These are tests to help us determine the presence and the severity of coronary disease so we can institute the best treatment plan,” Dr. Levick said.

“We essentially use our diagnostic tests to determine who may need to be transferred [overseas] for surgical treatments such as coronary angioplasty and stenting or coronary bypass surgery, and which patients might be best managed locally with medications.”

The majority of cardiac problems are treated with medicine, according to Dr. Levick, but where necessary, some surgical procedures can be performed in Bermuda. Such therapies might include electrical cardioversion or pacemaker implantation, both performed with high success rates at KEMH.

Electrical cardioversion addresses atrial fibrillation, the most common arrhythmia, by shocking the heart of a patient under anaesthetics to restore it to a regular rhythm. The hope is that the heart rhythm will remain regular following the procedure.

Sole provider, Dr. Andrew Spence, has performed pacemaker implantation locally for years. Cardiac Associates want to increase that service to two doctors, so that service can always be provided.

Cardiac catheterization, angioplasty and stenting, coronary bypass surgery, and other large cardiac surgeries are not available on the island, according to Dr. Levick. He said, for example, that less than 75 Bermuda residents a year require open-heart surgery.

“This population base is too small to support a complete range of cardiac procedures,” he said, noting the surgeons, staff and equipment that would be required to perform such a complex procedure.

“The cost of delivering a programme to a small number of people would be a big concern, as would the quality of a service performed on only a small number of people each year.”

“It is possible that with the new hospital and with the development of new techniques in cardiology, other cardiac procedures will be done on the island.

“It will be a constantly evolving situation as to what services should be delivered at KEMH.”