Anna Hazelwood - Dr. Evelyn Horn - Week 3

 This week I spent a lot of time in the cardiac catheterization laboratory where I observed various diagnostic and interventional catheterization procedures. The main procedures I observed were right and left heart catheterizations. Both procedures involve feeding a catheter up an artery or vein in the body into the heart to measure pressures in each chamber of either the left or right side. The catheter was fed through the vessel guided by X-ray, and the doctor determined the location of the catheter in the heart based on the pressure waveforms. The procedure was much faster than I expected and the patient remained awake for the entire length. I also was able to watch a coronary angiogram where contrast is injected into the patient's veins or arteries around the heart and blood flow patterns can be observed.  Detection of a blockage is crucial in order to determine if intervention is needed. One patient had a large blockage in the main right coronary artery, but the left coronary arteries had migrated to feed into the blockage and ultimately helped this patient avoid a heart attack. Ultimately, the doctor still determined that intervention would be beneficial for this patient. Since the patient is fully awake for these procedures, sometimes the doctors would ask the patient to turn their head to one side and this allowed for better visualization of the vessels.

I was also able to see a coronary stent placement procedure where they utilized an intra-artery ultrasound device to see the degree of blockage in the artery and verify whether the stent was placed securely. This procedure took a little longer than the diagnostic catheterizations, but also required lots of checks to ensure the stent was placed securely. 

I also spent time organizing patient data for my summer research project. I will be correlating genetic testing results with MRI data, and this week I collected all of the patient names and identification numbers as well as their genetic testing results and sent these over to the staff that manage the MRI databases at the hospital. Once they are able to retrieve all of the MRI scans of the patients, I will begin looking through the scans for identifiable scars to match with any specific genetic mutations the patient may have.

Finally, I was introduced to Dr. Jim Cheung who is an electrophysiologist that sees patients who have arrhythmias. I shadowed his clinic on Friday afternoon and it was interesting to see the different questions he asked patients compared to the general cardiologists I had previously shadowed. Patients with arrhythmias also have slightly different symptoms than a patient in heart failure but remarkably share a lot. Therefore, the diagnostic tests that each doctor orders are critical to diagnosing a patient correctly and giving them the most effective treatments. I will also be able to watch some EP lab procedures with Dr. Cheung next week that I learned about on Friday.