Day 5, Final Day of Cardiology - Sean

I woke up this morning hoping that I could leave the Cardiology department with a good understanding and perspective on the specialty, and hopefully narrow down what I found appealing about it. I started things off in the Cardiology ICU unit following Dr. Wu as he checked on the patients on the floor. Just by looking at the patients through the windows into their separate rooms, I could already feel the severity of their conditions. So many tubes, wires, IV bags, and machinery surrounded these patients that it was obvious of their struggle to overcome their conditions. Most patients were unconscious, and on a few of them I could really see the fight to improve in their faces.

The beauty of the specialty, and of medicine in general, came to me when I found out one of the patients had originally arrived without a heart rate. She was resuscitated, but unfortunately she remained in a comatose state. Not much was else was available for her except for transferring her into the Ward for care until further improvement. Still, imagining that a person who has basically given their last breath with an arrested heart can be given life again is intense.

Something interesting about the Chinese culture was revealed to me by Dr. Wu when explaining the history of a patient that had acute MI and acute pulmonary edema. Apparently the patient had herpes zoster and in his immunocompromised state, the disease flared up presenting as rashes all around the midsection accordingly along specific dermatomes. Many Chinese refer to this sign as a "skin snake" and believe it is a sign of death. Dr. Wu assured me that this had no truth in it, but it was interesting to hear about such an extreme view of a disease.

After spending the morning in the ICU, I decided to head to the Ward one last time to go on rounds with my original preceptor Dr. Chou. I saw several patients, some who were the same patients from before. After brushing up on my pharmacology earlier in the week, more of the drugs the patients were taking and the physicians were listing made sense to me. (One thing is for sure, diuretics are important!) One of the patients had a coronary artery bypass graft, and I learned the importance of statins in secondary prevention in these cases. One of the attending physicians, Dr. Kuo, gave me his take on the evolution of statin use in the future. Apparently, statins will basically become like daily vitamins, in his opinion. It makes sense considering the current health trends in our lives. But that is an entirely different discussion.

I was able to go to the ECHO room one last time as well. In the ultrasound images, I had the opportunity to see a ruptured chordae tendinae that was flapping around whenever the mitral valve opened and closed. Dr. Wang, the attending there, surprised me a with a little quiz question:
Dr. Wang -- "What would this cause?"
Me -- "Incomplete valve closure...so...regurgitation."
He didn't say anything after that, so I assumed I was right.

All in all, the week spent in Cardiology has been eye-opening. The specialty ranges from an internal medicine setting to a surgical/procedural setting, so in a sense you get a little of both worlds. It definitely has many complexities to it, so there is a high demand for logic and physiologic understanding. Basically, Cardiology = Lots of Studying! I had a lot of fun in the Cardiology department, and I was able to solidify a good amount of what I learned in the CV portion of our CVRR curriculum. Hopefully, Emergency Medicine next week will do the same.