Cardiology 

I got the opportunity to shadow Dr. Jeffery Fowler a structural/interventional cardiologist on Monday July 28. As a structural/interventional cardiologist, Dr. Fowler primarily spends his time in the Cardiac Catheterization lab (also known as cath lab). Unlike the Operating room where patients are being opened, in the cath lab (shown below) the doctor performs minimally invasive procedure to diagnose and treat varying cardiovascular issues. Dr. Fowler informed me that he [insert quote from the email exchange]. What i actually got to see today Angiogram: this is diagnostic procedure that uses X-Ray to look and see if the coronary arteries (heart’s blood vessels) are narrowed or blocked. To see the artery functioning, a catheter is inserted into a patient’s major artery, usually in the radial or femoral artery, and guided to the site being examined. Contrast dye is then injected since the arteries and veins are not typically visible in X-Rays. Using a C-arm (figure xx), the doctor generates X-Ray and photographs of the artery. This procedure is performed in the cath lab. Acetylcholine Challenge: this is a diagnostic procedure performed on patients who appear to have normal coronary arteries but experience symptoms such as syncope, chest pain etc from a coronary spasm. Much like the angiogram, a catheter is inserted, and the patient is given acetylcholine (a neurotransmitter produced in neurons and secreted in response to stimuli). Typically, ACh causes vasodilation but for patients with endothelial dysfunction it can cause vasoconstriction. in controlled doses. The cardiologist is then able to monitor the artery for any spasms. Transesophageal echocardiogram (TEE): Unlike an echocardiogram where the transducer is placed on the surface of the chest, a TEE has the transducer down the esophagus/ This allows for a clearer picture of the heart walls and valves since the heart is right in front of the esophagus and the ultrasound does not have to pass through skin, muscle, or bone. The cardiologist performing the procedure was interested in determining if there was any vegetation of the heart valve that may have been induced from a bloodstream infection. This procedure resembles an endoscopy I saw performed while shadowing a GI. Bipap v Cpap: The difference between the 2 is that bipap devlier higher air pressure when you breathe in v a cpap deliver the same amt of air presure at all times. Bipap: bilevel postive airway pressure Cpap; continuous positive air pressure Article of the 4 chambers of the heart Sources https://my.clevelandclinic.org/health/diagnostics/16832-cardiac-catheterization https://www.blockimaging.com/blog/what-is-a-cath-lab https://www.mayoclinic.org/tests-procedures/coronary-angiogram/about/pac-20384904 https://www.nhs.uk/conditions/angiography/ https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/transesophageal-echocardiogram