Cardiovascular Surgery - Day 1

I started out with a review on DVT. The 3 main causes of DVT are: 1. blood stasis 2. deficiency of coagulation system 3. trauma leading to injury of endothelium.

Dr. Chen discussed a very interesting topic. He told me that pulmonary emboli is not as a severe concern in Asian population as it is in Caucasian population. Asians, however, do not clot well so thrombolytic agents are used in lower dose. There are no solid research studies yet, but the doctors in many Asian countries all notice this pattern in their patients.

Note: tumor of pelvic area can have similar effects as DVT. CT scan is more sensitive to rule out tumor.

We also talked about how insurance will always affect doctor's decisions to what treaments will be given to patients. Whatever type of insurance a patient has, a doctor's responsibility is always find the best treatment that the patient can afford.

Then we talked about a case of abdominal aortic aneurysm.

Risk factors: smoking; genetic influences; atherosclerosis; infection; trauma; etc.

Criteria of for operation of aneurysm: 5cm or 1.5 x diameter of your normal size artery. If the aneurysm is less than 5cm or 1.5x diameter, then follow patient for 1/2 year. If the rate of increase is 5 mm in size in 6 months, then surgery is recommended.

I also learned about hybrid procedure. it combines minimally invasive coronary artery bypass surgery (TECAB or MIDCAB) with catheter-based coronary intervention(PTCA, stenting) (can read more on umm.edu/heart/hybrid.htm)

At the outpatient clinics, I saw many patients with PAD, with diabetes, gangrene (wet/dry), varicose veins

Some review:

PAD = obstruction of large arteries not within coronary, aortic arch vasculature or brain. Etiologies: atherosclerosis; stenosis; emboli; thrombus. Can cause acute or chronic ischemia.

Fontaine classification for chronic PAD: 1. claudication, incomplete blood vessel obstruction. 2. intermitten claudication 3. pain at rest, mostly feet, increase when elevate limbs (serious in PAD) 4. gangrene and difficulty walking (biological tissue loss)

5 P's for acute PAD: pain; paralysis; pale; pulseless; parathesis

Aortic dissection: inner wall of aorta causes blood to flow btw layers of wall of aorta and forces the layers apart. Classification: Stanford (A. ascending aorta and/or aortic arch, possible descending aorta B. descending aorta without involvement of ascending aorta or aortic arch)

First day in CV surgery was so much fun. I was lucky to see different presentation of PAD.