First things first- I saw so much cool stuff this week. I met some fantastic consultant cardiologists, interventialists, cardiologists, physiologists, students and registrars; every kind of person that has anything to do with the heart.
I am so glad I did a bit of research first. I read up on the cardiac cycle, the anatomy of the heart and even how to read an ECG for beginners.
10th April AM
I was teamed up with a senior cardiologist who took me to do her round of inpatients echo cardiograms. It’s an ultrasound probe that poked around at a patient’s chest and produces an image of the heart. You can see all the valves and all the details in the heart. We were bale to measure the thickness of the ventricles , the speed of blood, volume etc. We were looking for back flow from the valves, weak flow and extra thickening of the left ventricle which are all signs of heart weakness. The physiologist showed me what metal valves looked like and tissue valves which was cool. You can actually hear the metal ones ticking from quite a way away.
I think the echo cardiograms are a brilliant diagnostic tool because you can see what’s going on quickly and it’s completely non invasive! It’s much easier to do on men who are of a reasonable build than women or larger people for obvious access reasons, but in most cases a good physiologist is able to get a brilliant picture of the heart and spot any abnormalities and signs of heart trouble. We could see fatty lesions, flailing valves, blood going the wrong way, tumors and all sorts of interesting things. One of the most interesting things was being able to see a build up of fluid in the pericardial sack due to an infection. We were able to give a precise measurement between the heart and the membrane which means that when a doctor inserts a needle for a chest drain, they can know how far to go without stabbing the heart. Useful 🙂
I saw three patients. The first was being checked because a doctor wanted to confirm which kind of artificial valves had been put in, despite the patient insisting that both were metal. Turns out they were- we could even here them ticking.. It shows one vital thing- listen to the patient!
The second patient was a similar situation. She felt breathless and was having trouble breathing. The doctor wanted to know if there was any complications with the replaced valves, and wanted to know what kind they were. We saw that some blood was going the wrong way through the metal.
The replacement valves do sound good, they usually work. The metal ones last longer than tissue ones( usually taken from pigs). However, they make it easier for clots to form around them so patients must take an anticoagulant- warfarin. You can tell if a patient takes warfarin because they’re usually covered in huge bruises. It’s probably not a good drug to take if you played rugby.
The role of physiologists has changed a lot in the last 10 years or so. Previously, the physiologists ween’t allowed to diagnose patients at all. They just ran the tests and all the data was sent to the doctors however now they are allowed to say what’s wrong and the doctor can confirm it or just go with what’s said. This gives them more responsibility but I think it makes sense, as physiologists see and know the rhythms every day, so they should be more practiced at recognising problems, but the data is still available to the doctors so they can check.
10th April PM
I spent the afternoon in the rhythm analysis room with an audio technician looking at 24hour ECGs. We were looking for particular rhythms and patterns in the ECG and comparing them with the patient’s diary. They were asked to record what they felt and did for 24 hours whilst their heart was being monitored via the ECG. More often than not, the device picked up abnormal rhythms and the patient didn’t feel them, or the patient recorded an abnormality when in fact the ECG was completely normal. In cases where abnormalities happen, and the patient’s health isn’t in danger, and they don’t feel unwell the nothing is done. “If it’s not broke, don’t fix it!” was the phrase of choice.
The technicians pick out the most interesting rhythms and print them off for the doctor’s report. The next step is usually a rhythm slowing drug or a pacemaker depending on the type of abnormality. This is decided in clinic with consultants.
I have to say, I didn’t enjoy looking at a computer screen for that amount of time. The ECG lines began to merge all together after a while but I think if I knew more about the rhythms and if I could interpret them I would be able to enjoy the more.
I also got to see some more indepth echo cardiograms, one with a gentleman who had an ICD. ICDs are pretty much pacemakers with defibrilators attatched so when you going into cardiac arrest, the machine shocks you and you go back to normal sinus rhythm. He let me touch it and it felt just like a match box under his skin. There are some gruesome stories of them rubbing their way out of the skin – skin erosion, and people letting them hang there for years after- eww. Anyway, here’s some amazing footage of it happening on a football pitch to a young guy with an ICD.
After that there was a primary case. The whole team got ready because a man on the Isle of Wight had a heart attck. The coast guard helicopter brought him in to Gosport because the helipad was too small to support the huge coastguard helicopter. Urgent cases like this are called primarys. The team have a two hour window to remove the clot. In goes the patient, scrub nurse, runner nurse, radiographer, physiologist, student nurses, student physiologists, registrars, senior consultants and the interventialist. Unfortunately for me, my bus arrived so I didn’t get to look! I heard later that the guy was assessed, stabilised and sent to Southampton for more intricate bypass surgery.
Cool Stuff I learnt
- I learnt about the role of a physiologist. Honestly, I had no idea what they were before that morning. They usually have a four year degree but some take 6 years, some are in schemes where you learn as you work but now that the government’s money has run out, these are very rare.
- I have learnt about teamwork- at lunch time and during breaks it’s just like being back in school. They joke, they much around, they even play ACDC during major heart surgery. It’s fantastic!
- I have learnt that they constantly ask each other questions. “Peer assessed learning” is what they call it at school, but in the hospital everyone from cleaners to the top of the consultants asks each other advice, recommends things. Information is always being exchanged, people are always learning and no one has to make difficult decisions on their own. This was wonderful to know!
- physiologists get plenty of patient time, plenty of time in the cath labs, time in front of a screen in rhythm analysis and time in pacing clinics. It’s a mixture job. I learnt that even within a job, people do lots of different things.