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....