Today was a good day to be at Memorial Hermann, and I couldn't have had a better return to my normal internship schedule. At 7:00, I attended a lecture with Dr. Nguyen on the pathogenesis of heart failure, given by Dr. Maximilian Buja. He presented a wealth of information about the complexities of heart disease, and much of it was completely new to me. Cardiomyocytes, the muscle cells that make up the heart, were front-and-center in his presentation; these cells are extremely powerful, and them functioning correctly is critical to the heart as a whole being able to perform. They produce ATP (basically the body's "energy currency") at an extremely quick rate, making them great at working constantly. Dr. Buja discussed the cardiomyocytes in relation to heart conditions and different diseases therein, with ischemic cardiomyopathy (ischemic CM) as one of the highlights. In ischemic CM, the heart's left ventricle is weak and can't pump blood out to the body efficiently- this is usually a result of inadequate blood supply to the heart's coronary arteries (that causes heart attacks). So, the heart tissues aren't getting enough blood/energy, which makes them unable to pump the other collections of blood through the heart's systolic chambers. One problem with the cardiomyocytes not getting enough energy is that they don't just replace themselves, and permanent damage can be done. Once the cells die, patches of necrotic tissue begin to form on the heart, and will stay until surrounding blood flow leads to the necrotic area scarring and being partially repaired. Since Dr. Buja was presenting to a room full of doctors, a lot of the above info was skipped over, so his primary focus was on the options for supporting the heart throughout ischemic CM: defibrillators, ventricle assist devices, balloon pumps, the works. There was a lot more about transplant rejection and antibody responses, but that'll take a bit to explain in detail...plus, I'm still processing that myself. Isn't learning stuff great?
Valve conference was a fairly normal length today, with a handful of cases. For those who aren't familiar with what it is, I get to watch a group of cardiologists and cardiothoracic surgeons discuss what should be done with pre-op heart patients. Powerpoints are shown, opinions differ, and occasionally, jokes are thrown around- it's generally a good time. A couple of patients had aortic stenosis (tightening of the aortic valve), a few others had coronary issues, but there was only one case that really caught my eye. There's usually one of them in every conference, a case that the doctors argue over because of its complexity or because of their individual experiences with cases like it. This one involved a 70 year old woman with symptoms of aortic stenosis, moderate mitral stenosis, and lung damage. The choice to proceed hinged on what they needed to do first, and how effective that first surgery would be in remedying the other issues. It was a quiet, well-mannered battle of aortic vs. mitral repair. One doctor chimed in to say that non-surgical procedures are what they really need to think about, because the risk is just too high to immediately consider surgery. After a lengthy discussion, I recall that they decided it was an inoperable situation; they would do the best to make the woman comfortable, but going through surgery would just be a waste of her remaining time. Being realistic is a key part of making these calls, but listening to these conversations is sobering in a world of advanced medicine. Not everyone can be saved, and the outcome won't always be great or optimal, but that's life.
That's about all I have for this week. The storyboard for the aortic stenosis project is in its second draft, and since this post is so long, I'll shorten details for the coming Friday's post and put some info/photos of it there. Whether you made it all the way through or not, thanks for reading!
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