Sunday, August 12, 2012

I've got higher standards for a mitral valve

Posted by Tom Vassas at Sunday, August 12, 2012

Rotation 3 cardiology is well underway! Since a few other fellow bloggers have already gone through their cardio rotations and posted I will not do a descriptive analysis on the rotation, but really just give some fun insight to what I went through.

Update-wise, I'm at UMHS with the affable Dr.s Dorsch and Pogue...even though Dr. Dorsch has been on a well timed vacation. We also have 2 PGY1s, Brad and Kylee, and the cardio PGY2 Claire. The past two weeks have run their introductory scheme on me and we will be starting rounds within the week hopefully. So aside from the usual med rec (and the unusual med recs too...of which there are many), the many anticoag initiation/monitoring/discharging notes, and topic discussion running longer than everyone expects, we get to add on morning rounds. Time to start getting up earlier.

It has taken some time to get the daily operations down to where I can finish them fast so I can get on analyzing the patients. Ideally, I should be able to go over each patient on my service and make sure they're getting the correct drug therapy and that I get to counsel them on any new or changed meds.

Among all the normal patient care stuff I so eloquently described, topic/patient discussions have been where the brunt of learning occurs. Some of the refreshing clinical pearls that have come up are:

  • Mitral or aortic valves matter! Aortic valves require less anticoagulation because the pressures and flow around it are higher than mitral. So ANY mitral valve patient has an INR goal 2.5-3.5
  • Cyclosporine can raise serum crestor levels by up to 10 times, while tacrolimus does nothing
  • IV drug users destroy their tricuspid valve first....
  • An ICD will actually start pacing the heart rate a little faster than a concurrent V-tach to reset it before a shock, so a patient could feel their heart racing before the shock!
So next post will probably be a highlight of the glitz and glam that is cardio rounds but I will leave another tidbit of wisdom:

Do practice the names of your drugs well, because no one likes getting laughed at for taking 2 weeks to learn to pronounce Eptifibatide.


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