June 20, 2011
Our first day in cardiology started with observing Dr. Kuei-Feng Chen in his outpatient clinic. Since he is the director of the cardiology department, he had so many patients that I wonder if he can finish all of them in the morning. But my doubt got cleaned up right away after I saw that he finished each patient visit in less than four minutes. He explained that he can do it so fast because most of them are his long-term patients and he knows each of them pretty well. From Dr. Chen, we learned that it’s important for cardiologists to control patients’ blood pressure, blood sugar, and blood lipid level. The side effect of medications (e.g. peripheral edema from Amlodipine, a long-acting calcium channel blocker) is another thing a cardiologist often needs to deal with.
After leaving Dr. Chen’s outpatient clinic, we went to ultrasonic room where cardiologists perform echocardiography. For rest of the day, we observed Dr. Wen-Kai Feng and Dr. Chung-Chih Tu performing echocardiography on patients. From them, we learned that echocardiography is a very useful diagnosis tool to screen possible heart problem on the patients. For example, echocardiography was used on a pneumonia patient to see if there is any vegetation on his heart valves. They also showed us how to gain important parameters such as left atrium diameter, flow velocity, and ejection fraction using various features on the echocardiography machine. This experience gave me an idea what the echography can do to help us making diagnosis regarding heart.
June 21, 2011
Mickey and I met Dr. Chen, the director of the cardiology department, in the ultrasonic room. We observed Dr. Chen performing echocardiography, and he told us what he interpreted from the image. Dr. Chen usually checked the patient’s EKG or/and CXR first before performing the echocardiography. He told us that EKG, CXR, and echo are the three most common diagnosis tools used in cardiology and each has its own advantages. For example, CXR can give us the size of the heart. EKC can tell us if the patient has bundle branch block, arrhythmia, MI, etc. And echo allows us to know if there is any shunt or heart valve problem. We also observed that a lot of patients receiving echo have mitral prolapse. According to Dr. Chen, mitral prolapse is pretty common. Patients with echo showing mitral prolapse usually are still considered normal and don’t receive treatment for that.
Besides mitral prolapse, we also got chance to see other valve problems such as vegetation, mitral regurgitation, and aortic regurgitation. Actually one of the patients Dr. Chen had today has regurgitation of all four heart valves (mitral, tricuspid, aortic, and pulmonic). And it’s amazing to be able to see the heart with all four valve regurgitated on echo. Another rare case we observed is a patient having mitral valve replacement with mechanical valve due to mitral stenosis. The prosthetic valve cannot be seen very well on the CXR unless the valve is totally close as the moment of taking X-tray. But the echo clearly showed the valve and the blood flow passing through it. And it’s astonishing to see the valve still working well after almost twenty years since the replacement.
We also saw many of the patients receiving echo are young healthy male before going to military service. Conscription is still used in Taiwan to recruit people to military service, and complete physical examination will be performed to check the body condition of each man before serving the nation. Many of those young men having history of heart problem (especially those with congenital heart defects) will come to get echo for further checking their heart condition. And we are lucky to see one of the classical congenital heart defects, tetralogy of Fallot. The patient received surgery to fix it when he was small, and according to Dr. Chen, that operation is really successful since he didn’t see any sequela from tetralogy of Fallot on his echo. Dr. Chen also said that this case is rare and a little bit difficult to interpret even for experienced cardiologists.
Besides observing echocardiography, Dr. Chen also kindly provided us the opportunity to perform 12-lead EKG on each other. So Mickey and I went to EKG room and learned how to use it by observing the technician doing it. Then we performed 12-lead EKG on each other. And it’s exciting to be able to look and study my own EKG. In the same EKG room, Dr. Chen also showed us some EKG from stress test while he was making final diagnosis. One case he showed us had the “delta wave”, the classical sign of Wolff–Parkinson–White syndrome (WPW).
After finishing the interpretation of EKG from stress tests, we went to the wards with Dr. Chen. One patient we visited will have pacemaker insertion tomorrow. He is a long-time patient with Dr. Chen for more than twelve years. And Dr. Chen showed us the old charts and pointed out how he changed the patient’s medication over time as the heart rate of the patient went slower and slower (From beta blocker to no beta blocker to aminophylline). Since the operation will be held in catheterization room, Dr. Chen brought us to the room and provided us the opportunity to observe the operation tomorrow.
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