Cardio takes off...?

This was my first interesting day on my cardiology firm - 2 weeks into it. Quite disappointing really, since in Kch's SGH there was at least 1 interesting thing everyday, either in the morning meeting or ward round. Here, it's been wait, quake at the sight of the consultant who hardly acknowledges you, wait, wait, clerk patient, wait, clerk another patient, wait, ooh cute SHO/registrar, wait, wait, wait... you get the picture.

Anyway, today's 8 am meeting was going along okay (meaning I wasn't falling asleep) as the speaker was bandying along about on-pump and off-pump - they actually do coronary artery bypass grafts with the heart still beating now! It seems like yesterday I was standing in awe at the heart-lung machine at work. Then, in discussion, the lady cardiothoracic surgeon (!respect!) mentions a study that showed that people who underwent cardiac bypass surgery had diminished mental functions (ie. got more stupid) compared to their normal counterparts, supposedly. She went on to reflect that with or without cardiac bypass they were more likely to experience reduced mental functions anyway, because of widespread atherosclerotic disease (hardening and narrowing of arteries everywhere in the body). Interesting thought.

930 clinic was spared its shadow of gloom when I found out that the traditionalist consultant was away, and proceeded to attend a very interesting clinic. I saw an extremely rare case of pseudoxanthoma elasticum, which is a genetic disorder with calcification and fragmentation of the elastic fibres of the skin, retina, and the cardiovascular system, leading to the characteristic chicken-neck appearance with yellow (fatty xanthoma-like) infiltrations on the skin, retinal haemorrhages (leading to blindness), peripheral vascular disease, mitral regurgitation and aortic dissection, among other things. We (the registrar and I) inspected the manifestations of the disease on her, and felt her peripheral pulses, and took her BP. Through it all, she was chatty and relaxed and fully ready to impart knowledge about the disease that she was expert in. You've got to admire this woman - she's had this disease all the 50 odd years of her life, with many of the signs, including the ugly chicken-skin neck; she's gotten through her retinal haemorrhages which left her with residual sight and has to go around with a carer; she has to worry everyday about more cardiovascular complications unfolding other than her peripheral vascular disease which has already resulted in an operation for her right leg - through that all, she's gotten married, read up tons about her condition, and manages to keep smiling through her life. She even jokes about her condition: speaking about her neck, she says that she's always had an old-looking neck, and she's now beginning to grow into her neck.

Other than that, there was enough to keep me amused: cool murmurs to pick up; an advanced-age post-infective endocarditis patient with a much younger wife; a well-organised elderly international poker-player, who asked us to Google his name and told us that poker is up there with chess in keeping the mind fit and keeping away Alzheimer's; a TATT (tired all the time) man who came with the express intention of getting his medical retirement letter and amplified his symptoms to boot.

Over lunch, I had the opportunity of exercising with some post-cardiac procedure patients in Cardiac Rehab. I was put down to help supervise 2 gentlemen in their exercise regimen, while actually going through the paces myself. I hardly broke a sweat, but many of them did. As I looked around, I saw my possible future, and got really scared. And the thing was that there were so many different kinds of people there - not only the typical high-risk person, but short, tall, fat, thin, different races, different walks of life - almost all were represented in that small class of 20 odd people. SCARY. If this isn't an impetus to keep fit, I don't know what is.

After an educational bedside teaching session from a registrar, I was ready to go home, satisfied in the knowledge that I actually learnt something today. Maybe there's more to cardiology attachment than waiting after all...