Day 1 of Cardiology - Sean

I didn't know what to expect starting the week in Cardiology. I was very excited though because of having finished the cardiovascular unit this past semester. I felt like this was my opportunity to see how much of that knowledge I could apply in the clinical setting. Of course, that's assuming I retained enough of it.

Area C of the 6th floor housed one of the Cardiology Wards, and that was where I met my preceptor, Dr. Chou. To my surprise, he was expecting me and actually had a printed schedule for the rest of the week. Dr. Chou was the chief Cardiology resident and based on his experiences, he felt I would benefit most from spending time with different attending physicians throughout the week. He brought me to the different areas of the hospital to meet the attendings I would be learning from. Each day was separated into morning and afternoon, and I was to shadow one of those attendings during those times while they performed some specific component of their specialty. For this first day, I was in the ward with my preceptor for rounds.

The first patient we saw was in line to go in for an electrophysiology study tomorrow. His heart rate was irregularly irregular, and I was actually able to palpate this by his radial pulse. There was a problem, however, because the nurses and junior residents could not seem to get a Foley catheter inserted. If you do not know what a Foley catheter is, wikipedia explains it here pretty nicely. So my preceptor went ahead and gave it a try. Since the patient did not have a history of benign prostatic hyperplasia, he felt like it shouldn't be a problem. After 3 long attempts (one including a technique that used a syringe full of lubricating jelly--use your imagination), Dr. Chou decided to stop. He suspected that one of the patient's drugs might have been an anticholinergic agent that caused the urinary sphincter to contract, making the opening to the bladder very small. Observing this from the sidelines was awkward, but it was interesting to see the various techniques used.

Many of the other patients in the ward, as one would expect, were sufferring from heart disease. I was surprised by how familiar I was with the cases I encountered. Distended jugular veins indicating increased JVP, pitting edema, EKGs with ST elevation indicating MIs, syncope, hypertension, right heart failure, unstable & stable angina -- I recognized all of these signs and was able to keep up with the attending and his residents. Although my understanding was not as in depth as theirs, I feel like I impressed them with what I already knew. And when I did not know what something was, I made sure to ask for clarifications and explanations. I was having a lot of fun doing rounds here. The pharmacology was easy to pick up on as well. Drugs like loop diuretics (furosemide, bumetanide), ACE inhibitors, ARBs, and carvedilol were some of the many drugs that I heard thrown into the air during patient presentations by the residents and intern. I've studied these enough times to know what each one was responsible for treating.

Another big moment for me during rounds occured when I was allowed to ausculate a patient suffering from myocarditis and pericarditis. My preceptor told me to listen and tell him what I heard. What I heard was a crumpling sound between heart sounds, and he told me that it was a pericardial friction rub. Apparently it is not something you hear too often in patients. I was very excited after hearing my very first "real" heart sound in a "real" patient. It turns out that tests and imaging scans showed the patient had tamponade and so pericardiocentesis was recommended for the patient.

It was a great feeling to realize that I had knew more than I thought I did. But, the conditions of some of these patients were really serious and made me feel disappointed that I didn't know more so I could help them. The attendings and residents had it covered, but I felt like I wanted to know what to do or what the patients needed. I guess we'll see how much I can learn in the days ahead.