cardiology: cath lab

I'm a bit frustrated with this rotation, as nothing is expected of me. However, I did get to spend a whole day in the cath lab after I requested it.

It was an interesting day. For the most part, it was placement of stents and pacemakers.  It was almost like a mini operating room. The interventional cardiologist confessed to me that he actually wanted to be a cardiothoracic surgeon but knew since he was an international medical grad, he became a interventional cardiologist. He said that now he is happy, not only does he like his job, but fewer and fewer cardio surgeries are happening these days.  Most people opt to have procedures done by him, with all the advances in technology, as opposed to getting surgery.  So his business is booming. These pictures are him at work. He doesn't have to boast about how good he is at his job because his reputation proceeds him. Almost everyone in the hospital knows how good he is.

I got to see it first hand, when the ER called. A lady was complaining of chest pain, and her EKG showed she was having a heart attack. When a heart catheterization occurs, the doctor makes a small whole in the leg and inserts a small wire tube through your artery all the way to you heart.  We inject dye and take pictures of your heart, watching the dye be pumped through.  This is how we identify which arteries to your heart are blocked. Then the doctor inserts a stent, a metal wire mesh to hold open your artery, as pictured here.  Stents are a genius invention, a way to keep the heart beating despite what you have eaten and how much you haven't exercised.  But for all the genius of the stent, it is only a bandaid. I think I've posted before about how disappointing it is to know that even tho this wire is holding your artery open, it didn't fix the blockage, it just smashed the cholesterol against the sides. Its not really a permanent fix, but then I guess I don't know what is in medicine anymore.

In the end, it was an educational day. Repetively seeing both emergent and non-emergent pacemakers and stents. I understand now what happens to my patients as they go through heart problems and fixes.  But I also saw that I don't really want to be a cardiologist, exactly like what I learned in my Anesthesiology rotation. *sigh* I'm sorry if I repeated what I had already said there, but it surprises me how much of a waste this rotation was for me. I am sad that I did not learn any new information.

let's talk cardiology....

So, on to more medicine. Cardiology is a weird rotation. Hours are usually from 8am to noon. Which sounds short, but it can be long and very very involved.  Most patients in cardiology are complex, because patients who have heart problems also have other problems. The best way to show this is to share the risk factors for heart disease:

• Diabetes
• age > 70
• high cholesterol
• obesity
• smoking
• family history of heart disease men before 50 women before 60.   

There are a plethera of criteria lists and risk factors in medicine but it seems to me that the lists in cardiology are particularly applicable. Almost every patient we see fits at least half if not more of this list.  On top of those risks patients often have renal failure, liver failure, and GI problems.   Its never just controlling the heart symptoms, it always involves working around their other problems. We can't give certain medications if you have renal failure vs. liver failure.

Another complexity prevalent on the heart service is compliance. The vast majority of heart patients don't 'feel' sick. As we all know, high blood pressure is alot like high blood sugar, you don't feel sick despite the fact your organs are slowly dying inside you. Its easy to sit on a couch with swollen legs and say you feel fine.  (most heart symptoms don't show up until you NEED a high blood pressure, like exercise). Oftentimes, noncompliant patients can be given a better education and it will at least make a dent of a difference.  But a large majority of patients-- no matter how often we try to explain it--- don't want to understand that taking their blood pressure pills or controlling their diabetes can prevent them from going blind or starting on dialysis. It can prevent a heart attack even. We call these conditions 'silent killers'. This aspect of patient stubbornness is particularly frustrating for me and makes it hard for me to care about a patient who won't care for themselves.

The last complexity is blood thinners, some examples of these are Coumadin, Heparin, Effient, Plavix. These medications are often very important to prevent blood clots, stroke, and a repeat heart attack. But these meds are a big pain in the butt. Everytime a person bumps something, hits something too hard, etc they get a bruise. Every cut bleeds excessively.  Nose bleeds become a nightmare.  Nobody wants to be covered in bruises and lots of patients hate it.


more info later....