Day 4 of Cardiology - Sean

The morning began in the Catheterization Lab once again. A patient suffering from angina pectoris was found to have stenosis in the Left Anterior Descending Artery of the heart. I was able to watch the cardiologists place a drug eluting stent into the collapsed lesion. The technique used the inflation of an angioplasty balloon to secure the stent into place by hooking into the blood vessel's walls. I learned that even though a stent was put into place, there is still a 5% chance that re-stenosis may occur due to the body's physiological repair mechanisms. Although, drug eluting stents try to prevent this from occuring through the slow release of specific drugs.

In the afternoon, I was able to head to the Cardiology Ward again for rounds. I was looking forward to this because of how much I felt I learned from my first experience. My preceptor joined me as I followed along with attending physician Dr. Chang who lead a group of residents and interns to see patients. It was pretty much the same routine as it was on Monday. They presented the patient (in English for my sake) and discussed the reasons for their choices of treatment. The types of cases I saw were: CHF, mitral valve replacement with a mechanical valve, myocarditis, pericarditis, pericardial effusion, acute myocardial infarction, and chronic DVT.

My preceptor let me auscultate the patient with the mechanical replacement valve and I could clearly hear the obvious clicking sound it made. Interestingly enough, Dr. Chou said that the patient can often hear it when they sleep or when they are somewhere quiet. In some cases, the sound may even annoy the patient, but Dr. Chou said that it's something they just have to deal with.

An interesting case was a 21 year old patient with chronic chest pain, but the etiology of the pain was unknown. My preceptor told me that there is a list of common diseases they usually rule out first before exploring other causes for chest pain. The 6 possible common disease were:
1) acute myocardial infarction (assessed by EKG, CXR, cardiac enzymes)
2) aortic dissection
3) pulmonary embolism
4) tension pneumothorax
5) esophageal rupture
6) perforitic peptic ulcer.

I really enjoyed the ward again. It's just a lot more fun when you know what's going on. Unfortunately, there's only one more day of Cardiology left. I hope tomorrow is another good day because Cardiology has been great so far.