Cardio Inpatient Done

The last two weeks have been much better than I expected. I am really enjoying the group I'm working with, Cardiovascular Consultants (CVC). And my "team" of preceptors are just outstanding. They have my admiration as professionals and teachers.

It's not that I've been sold on Cardiology myself, but I certainly appreciate what the Docs offer and what they do to earn a VERY nice living. They all spent seven to eight years in residency AFTER medical school. But in a pinch they can: handle a patient's overall medical needs; diagnose life threatening conditions invasively and non-invasively; and FIX many patients' heart short of an open-heart CABG surgery. It's not a bad job for those dedicated enough to get the training.

I haven't finished my logs, but in the past two weeks I've seen about thirty patients on my own. Half were new patients requiring H&Ps and half existing patients requiring Progress Notes. I reviewed the patients charts, questioned (the ones that could talk) and examined them, wrote up the notes and put them into the charts. That was most of my mornings.

Afternoons consisted of watching lots of procedures and revisiting patients and their charts with the cardiologists. The latter is where my education really took place. I learned the questions and examination tests I forgot. I received feedback on my notes, especially the Assessment and Plan sections where I'm still very uneducated. Some of my most noteworthy patients included:

1) Young mother of two who had her first pacemaker at 8 yrs old (congenital heart block) and needs a) leads from her first of three, non-functional pacer removed and b) a new Bi-ventricular pacer with ICD (defibrillation) capability installed.

2) A young man with Osteogenesis Imperfecta (blue sclera and lots of broken bones!) that had a frustratingly intermittent A-fib interfering with his job and lifestyle. Our EP (electrophysiologist) manipulated his heart very aggressively with drugs and four intravenous catheters but we still couldn't find any structural abnormalities.

3) A middle-aged female diabetic and smoker that had two CABGs (six vessels total) and an angioplasty (two stents).

4) Several older post-AMI patients with poor cardiac output (low EF) who needed complicated drug regimens complicated by conditions like ARF (acute renal failure), COPD and PVD (peripheral vascular disease). I learned what rhythm vs. rate control really means and its implications.

The procedures I got to see up close and personal included right and left heart catheterization, angioplasty, electrophysiology, defibrillation/conversion, stress testing, angiograms and echocardiology. The stress testing is noteworthy because if I do end up going rural Family that is something I will probably do in the office before sending patients to the "big city" cardiologist.

The procedures I would have liked to see include open heart CABG, stenting an AMI, balloon valvuloplasty and closure of intracardiac shunts like patent VSDs. Patti, the awesome NP I worked with a lot, is going to call me if one of our patients goes in for a CABG, so I still have a good shot to run across the street in the next two weeks and see one of those.

I even managed to maintain a life and get in some swimming. I just ordered an indoor trainer so I can watch Board review lectures while stationary biking a couple mornings a week. But that did get me a little envious of a couple of the cardiologists. Between patients they planned trips to Hawaii and Switzerland, traded notes on their Computrainer stationary bike sessions (on custom Trek Madones of course), discussed upcoming triathlons and offered advice on expensive cars, food, wine, etc. They definately live in a different socio-economic spot than I've been around.

My fear now is the next two weeks of outpatient cardiolgy in the office are going to be boring. I just hope that I can continue to improve on my charting and examination skills by seeing patients on my own followed by review and feedback.