Shadowing A Cardiologist Case Study

There are countless scenarios throughout this series that are similar to what takes place every day in a hospital and what the doctors and nurses see on a daily basis. Grey’s Anatomy benefits its viewers through realistic portrayals. Multiple surgeries have performed on the show that are consistent with literature. This could be a medium for medication students to review their content of interest or for those who are considering joining the medical field. Coronary bypass is one of many surgeries that is often completed on this show. During this procedure blood is diverted around a section of a blocked artery in the heart to restores blood flow to a patient’s heart muscle. Coronary bypass surgeries are just as common on Grey’s Anatomy as they

An hour or so into my first day at my internship and my mentor gets a call from the Emergency Room about an elderly patient who came in complaining of chest pain. After running some tests and EKGs, the ER staff finds some abnormal results which slightly suggest that the patient might be having a heart attack. The patient is rushed into the cath lab while my mentor has to leave to attend a case at another facility so he leaves me with his partner Dr. Fernandez to watch the case. Dr. Fernandez starts the procedure of cardiac catheterization in which he plants a stent in the patient’s heart in roughly 30 minutes. Although the patient suffered no heart attack, Dr. Fernandez found some narrowing the patient’s heart. That was my first day of my

The blood vessel that Dr. Eltahawy was concerned about was thin and looked as though it would collapse in on itself. First, Dr. Eltahawy tried a balloon catheter. At the top of the catheter was a small balloon that could inflate to maintain a shape or structure of a blood vessel. However, because the blood vessel was so thin, the balloon catheter was not very effective. Instead, Dr. Eltahawy installed a stent. A stent is a wire mesh tube. It is placed in a blood vessel permanently to maintain the shape of the vessel and to allow for the free flow of blood. Throughout this entire independent study, I realize that shadowing in the medical field is less about learning about medicine and more about discovering about whether becoming a doctor is the right step. This independent study has been a step in the right

With the plaque in veins, the arteries are narrower. In our lab, when we used vasoconstrictors, the blood vessels constricted and made the flow go slower. For somebody with coronary artery disease, vasoconstrictors would be dangerous because their arteries are already narrower because of the plaque build-up. Vasodilators would actually be helpful because they have narrow arteries, so that there will be more room for blood to move throughout the vessels. If you were to watch the blood vessels of eoone with coronary artery disease like we did with the frog tongue. Also, you will see that LDL decreases significantly for someone with coronary artery disease. The percentage of someone surviving coronary artery disease

An angiogram ( which is also refers to as an arteriogram) is a special test in which a neuroradiologist injects dye into the blood vessels in the brain and obtains images of the blood vessels. At this point, the angiogram is the test that most accurately shows the Arteriovenous malfunction resection and its relationship to the surrounding arteries and veins. Arteriovenous Malformation Resection are found in most adults the ages between 20 to 40 year olds what happens during surgery this type of Things you can expect are Arteriovenous Malformation Resection involves delicately separating the Arteriovenous Malformation Resection from the surrounding tissue by using a microscope than a neurosurgeon will cut off the blood supply to the Arteriovenous Malformation Resection this type of procedure is called microsurgical resection. The other type of surgical procedure is called Stereotactic radiotherapy what happends during this surgery is that they deliver deliver a concentrated dose of radiotherapy to the core of the Arteriovenous Malformation Resection in one session. Over the course of 2 to 5 years, the vessels of

Through this sheath, a long, flexible, soft plastic tube called a “guiding catheter” is pushed. The tip of the guiding catheter is placed at the mouth of the coronary artery. The guiding catheter also allows for radio-opaque dyes to be injected into the coronary artery, so that the disease state and location can be readily assessed using real time X-ray visualization.

Angiography has so far been the gold stan- dard for identifying coronary artery lesions [19]. It provides the practitioners with in- formation about the severity of luminal narrowing and hence, enables the diagno- sis of atherosclerotic disease. Angiography may show severe lesions, plaque disrup- tion, luminal thrombosis,

Cardiac catheterization is often referred to as coronary angiography or a coronary angiogram. It is a radiographic procedure that is used to look at and visualize the heart and the coronary arteries. During a cardiac catheterization it is possible for the cardiologist performing the procedure to see how effectively blood is flowing through the coronary arteries. In addition, this procedure allows the cardiologists to see how blood is moving through the chambers of the heart and how effective the heart valves are functioning. A cardiac catheterization can also allow for the visualization of the movement of the walls of the heart to see if the pumping action of the heart is normal.

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Dr. Hughes smiled. “That is also a catheterization but this is a Cardiac catheterization. What that involves is inserting a catheter into the vessel of the heart usually from the groin or the arm. If we find we need to put a stent in, then we will do it at that time.”

Manipulating the transducer to obtain an optimal angle of incidence is important. Sub-xiphoid, subcostal and intercostal views are all potentially used to align the beam with the vessel of interest. Stent material is easily seen using two-dimensional ultrasound. “Shadowing is only a problem when stents covered with fabric such as polytetrafluoroethylene are used. In these cases, gas that is embedded in the fabric will cause shadowing for several days, but eventually the gas is absorbed and the covered stents then appear similar to conventional stents.”8 Middleton, Teefey and Darcy8 note that the use of PFTE endografts will likely become standard as their performance outweighs the early stent materials used. Color Doppler as well as pulsed Doppler should be used to interrogate the stent and supporting vessels. Velocity measurements are taken using angle correct and spectral waveforms are recorded. Careful examination of the liver vasculature is imperative to verify proper stent function. Specifically, thrombosis or occlusion can be assessed with color and Doppler ultrasound. Velocity parameters may vary from patient to patient and also will change from immediate post procedure velocities to those obtained during long term follow up. Universal Doppler criteria has not been established as of yet, although some physicians and facilities have developed

1. Angioplasty: Kereiakes and Wetherill write that “angioplasty is a procedure in which a heart doctor inserts a balloon catheter over a thin wire across an artery. The balloon is inflated and compresses the plaque to clear the arteries of any blockage.”(p. 106-107).

Cardiac catheterization a long flexible thin tube place in blood vessel in arm, groin, or neck looks in coronary arteries. Dye can be added to see how well the heart is pumping.

• Depending on the medical procedure you are having done, an IV tube will be inserted into one of your veins.

appear similar to conventional stents.”8 Middleton, Teefey and Darcy8 note that the use of PFTE endografts will likely become standard as their performance outweighs the early stent materials used. Color Doppler as well as pulsed Doppler should be used to interrogate the stent and supporting vessels. Velocity measurements are taken using angle correct and spectral waveforms are recorded. Careful examination of the liver vasculature is imperative to verify proper stent function. Specifically, thrombosis or occlusion can be assessed with color and Doppler ultrasound. Velocity parameters may vary from patient to patient and also will change from immediate post procedure velocities to those obtained during long term follow up. Universal Doppler