Cardiology Day 5/5 - Sandy

During entire Friday morning, the cardiovascular and surgery team were in anticipation for the Abdominal Aorta Aneurysm surgery, the second one to be done in this hospital since it opened 40 years ago. The patient was a 78y/o male with a 6.5cm diameter AAA, w/ h/o CAD, HTN and ESRD. Nicole, Amanda and I felt so fortunate to be part of this exciting surgery! Dr. Chen (from Surgery) taught us the concept behind endovascular aneurysm repair. Stents were placed through the femoral arteries, balloon used to press stent against arteries and then the graft was inserted to the surrounding aneurysm site. The procedure took about 4 hours, and it was so exciting to see almost all of the cardiologists and Dr. Chen’s mentor coming to witness this historical procedure.

Sucess! The stent graft was inserted!
Dr. Chen, Amanda, me and Nicole all in surgical scrubs!

Cardiology Day 2/5 - Sandy

We went to the General Surgery meeting this morning where an Instrumentation Company rep gave a presentation about their new-and-improved ultrasound. Then, Amanda and I observed Dr. Chen from Cardiology as he performed echocardiograms on patients with pericardial effusion, mitral regurgitation, tricuspid regurgitation and ASD. The most common problem found in patients was mitral valve prolapse (about 20% of the population has it).

After we expressed our interest to see an EKG being performed, Dr. Chen took us to the room where the staff performed EKG, spirometry and stress test. He graciously offered us to have our EKG taken and we were super excited! We then compared our results and I am elated to confirm that both of our resting hearts are normal (according to our interpretation).

One thing that resonated with me today was when Dr. Chen talked about the characteristics of a great physician. He said that being a great doctor requires something above skill -he/she needs to have good moral. Morality means to resist temptation and corruption even if one is in a position to abuse them. We discussed about the complexity behind practicing medicine, and how physicians also need to understand the politics and infrastructure behind the healthcare system. We also pointed out the differences between U.S. and Taiwan’s healthcare systems. Unlike U.S. doctors who are encouraged to be progressive about its current system, Dr. Chen said that Taiwan physicians are more accommodating to the nation’s current policy - and this difference probably stemmed from culture differences.

Later that day, we encountered a 6 year old and a 5 month old patient obtaining ultrasounds. It was my first time dealing with pediatrics patients and it was heartbreaking to witness what a family had to go through when their child was unwell. The 5 month old child cried when getting his echocardiogram. Afterward, his mother held on to him tightly and told him not to cry, while she wept silently in the waiting room. I saw so much pain in her eyes. My heart ached for the child and the mother, but I was limited in what I could do to help.

In the afternoon, Dr. Chen showed us an ultrasound from a patient with infective endocarditis. This happened last December when he was rushed to the hospital after a motorcycle crash. They later learned that he suffered from ischemic stroke that was the result of septic emboli. The patient had HUGE vegetations on his mitral valve and Dr. Chen said the vegetations were the largest he has ever seen. He also told us that since this was an acute process, his EKG appeared normal, so w/o echo, this diagnosis could have been easily missed.

At night, we followed Dr. Chen from Oncology (there are many Dr. Chens here) during his night shift. He talked about different acupuncture points, especially those on the ear, that could help one balance life, curb appetite and even lose weight! Although I couldn’t try the acupoint stickers because my ears are super sensitive, Amanda and Borhan got acupoint stickers on their ears to test the hypothesis. We will wait and see how well the stickers work. In the meantime, Chinese Medicine has been fascinating and so much fun, I am definitely looking forward to learn more.

Cardiology Day 1/5 - Sandy

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.