Posts tagged cardiovascular

Ultrasound Workshop.
Medicine is an ever evolving field and we are its lifelong students. Doctors are always learning new things, exploring new ideas and finding out concepts they learned when they were students are out of date. In that regard, the road of medical education never has a dull moment.
Yesterday, I participated in an ultrasound workshop along with a few of my classmates as a volunteer patient for a number of doctors in town. An ultrasound technologist was there to work through any concerns the doctors had to improve their practice:
"I’d like to go through a pneumothorax workup."
"Can you run through an ocular ultrasound?"
Even as a patient, it was really interesting just to watch the monitor and see the inside. It was easy to just get lost in the images that were coming up on the monitor. When one of the doctors showed me a beautiful four chamber view of my heart, I had to remind myself this isn’t just another educational video online. This was me.

Ultrasound Workshop.

Medicine is an ever evolving field and we are its lifelong students. Doctors are always learning new things, exploring new ideas and finding out concepts they learned when they were students are out of date. In that regard, the road of medical education never has a dull moment.

Yesterday, I participated in an ultrasound workshop along with a few of my classmates as a volunteer patient for a number of doctors in town. An ultrasound technologist was there to work through any concerns the doctors had to improve their practice:

"I’d like to go through a pneumothorax workup."

"Can you run through an ocular ultrasound?"

Even as a patient, it was really interesting just to watch the monitor and see the inside. It was easy to just get lost in the images that were coming up on the monitor. When one of the doctors showed me a beautiful four chamber view of my heart, I had to remind myself this isn’t just another educational video online. This was me.

The aftermath of an eight hour study session.
Brain cells. Fried.

The aftermath of an eight hour study session.

Brain cells. Fried.

Sealing away your heart.

It’s a miniature heart in a jar. What more can I say? Awesome stuff.

The information in cardiovascular block on the other hand, is not so easily contained! Information overflow!

Consolidating all of the bits and pieces

As a resource link, this interactive tutorial looks at all of the different things we’ve talked about in class and puts them into a physical context. Well put together and very easy to understand. This should prove useful…*Runs to check every section*

160 plays

Weight of the World by the Oak Creek Band.

Had a get together yesterday to celebrate the end of cardiovascular block. But the truth is, it is not over until it is over. Here’s to being lost in a studying state of mind.

Aortic stenosis and aortic regurgitation.
In today’s clinical skills session, we had an opportunity to perform a cardiovascular exam on a symptomatic patient. The result of which was a bit of detective work. We went through an informal history taking session and then proceeded to the inspection, percussion and palpation.
Upon auscultation, it was immediately evident that the heart sounded different. All those times the doctors said to focus and know the normal were spot on. It definitely did not sound like the regular volunteer patients we had. There was a slight systolic and prominent diastolic component to the murmurs that was loudest in the second intercostal space to the right of the sternal border, where the aortic valve was.
The patient also had an unusually strong pulse, with an upstroke almost as though it was leaping up to meet your finger and a downstroke disappearing just as fast. We found out later it is what’s called a collapsing pulse. This occurs in aortic regurgitation, where the aortic valve doesn’t close properly. The pulse is momentarily strong, but then disappears due to blood rushing back through the aortic valve into the left ventricle, dropping blood pressure sharply. The diastolic murmurs were a result of this regurgitated blood.
All in all, it was a very engaging and interactive learning experience.

Aortic stenosis and aortic regurgitation.

In today’s clinical skills session, we had an opportunity to perform a cardiovascular exam on a symptomatic patient. The result of which was a bit of detective work. We went through an informal history taking session and then proceeded to the inspection, percussion and palpation.

Upon auscultation, it was immediately evident that the heart sounded different. All those times the doctors said to focus and know the normal were spot on. It definitely did not sound like the regular volunteer patients we had. There was a slight systolic and prominent diastolic component to the murmurs that was loudest in the second intercostal space to the right of the sternal border, where the aortic valve was.

The patient also had an unusually strong pulse, with an upstroke almost as though it was leaping up to meet your finger and a downstroke disappearing just as fast. We found out later it is what’s called a collapsing pulse. This occurs in aortic regurgitation, where the aortic valve doesn’t close properly. The pulse is momentarily strong, but then disappears due to blood rushing back through the aortic valve into the left ventricle, dropping blood pressure sharply. The diastolic murmurs were a result of this regurgitated blood.

All in all, it was a very engaging and interactive learning experience.

Secondary Hypertension

There are two types of hypertension: essential or primary hypertension and non-essential or secondary hypertension. The latter case has identifiable cause in 5-10% of patients.

When thinking about the causes, they are as easy as A, B, C, D and E.

A

  • Accuracy of your blood pressure measurement
  • Apnea (sleep): where hypoxia causes reflex vasoconstriction
  • Aldosteronism: causing increased sodium absorption and potassium excretion

B

  • Bruits: due to stenosis of renal arteries leading to the activation of the renin-angiotensin system
  • Bad kidneys: consider chronic renal failure or kidney disease

C

  • Catecholamines: consider pheochromocytoma where increased excretion of adrenaline and noradrenaline cause increased cardiac output and vasoconstriction
  • Coarctation of aorta: increasing upper limb blood pressure
  • Cushing’s syndrome: where a pituitary gland tumor increases adrenal cortex stimulation, causing elevated cortisol and increased sodium and water retention in the kidney

D

  • Diet: consider daily sodium intake
  • Drugs: consider both prescription and non-prescription medication like corticosteroids or nicotine

E

  • Erythropoietin: consider increased flow resistance due to increased RBC count
  • Endocrine disorders: consider hyper and hypothyroidism and hyperparathyroidism
Wiggers Diagram.
This diagram may look like modern art but it is a representation of the electrical, contractile and volumetric changes within the heart. To understand this is to understand how the heart works and how conditions affect it.

Wiggers Diagram.

This diagram may look like modern art but it is a representation of the electrical, contractile and volumetric changes within the heart. To understand this is to understand how the heart works and how conditions affect it.

Abdominal aortic dissection.
A tear forms within the tunica intima of the aorta. The high pressures in the vessel causes blood to flow into the tunica media, forming a false lumen. This false lumen can extend and expand along the length of the aorta and is a medical emergency. It can cause severe stenosis and can also rupture through the media and adventitia, resulting in blood loss and death.

Abdominal aortic dissection.

A tear forms within the tunica intima of the aorta. The high pressures in the vessel causes blood to flow into the tunica media, forming a false lumen. This false lumen can extend and expand along the length of the aorta and is a medical emergency. It can cause severe stenosis and can also rupture through the media and adventitia, resulting in blood loss and death.