I started the first day of cardiovascular rotation with Amanda and we went to the Internal Club meeting, followed Dr. Chen and Dr. Tu from the Cardiology Department and even saw a pacemaker removal surgery!
We followed Dr. Tu doing echocardiograms on patients and he taught us how to calculate the ejection fraction (EF>55 is normal), find calcification on valves, and diagnose heart valve defects. Colors on the heart ultrasound represent the direction of blood flow in relationship to the heart. When there is a valve defect, there would be a splash of different colors signaling turbulence at the valve orifice. Dr. Tu told us that echocardiogram is highly operator-dependent, so data generated from the echocardiogram is considered to be estimated. We also discussed about Torsades de Pointes from hypokalemia and the doctors reminded us NEVER use Amiodarone to treat it. With TDP, we want to shorten the AP interval with Lidocaine, B agonist or temporary heart pacemaker.
We then went to the Inpatient Room and Dr. Tu gave us an opportunity to auscultate a patient. It was quite difficult to hear any murmur - I heard rhonchi instead. It turned out that patient had aortic stenosis. I need to keep in mind that the transition from listening to audio clip in class to recognizing heart murmur on a real patient is a skill that requires much practice.
The day ended with an opportunity for us to witness a pacemaker removal surgery. We were so excited! The surgeon had to remove the pacemaker from a 90-year-old patient because it became infected. He calmly completed the procedure quickly and efficiently, in roughly 30 min. He said that the most important thing about being a surgeon is to know how to heal a wound. A physician can do all that he needs to complete in the surgery, but most importantly, he needs to heal the wound he started. Therefore, the cardiovascular surgeon needs to know how to heal the patient, both literally and figuratively.
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