Week 2 - Chase Webb

Two weeks into the BME immersion, I am finally feeling like I am getting my bearings. I no longer get lost trying to move between the different parts of Cardiology on the 4^th floor, which helped me get to everything I saw this week. In the clinic I saw patients with Dr. Kim again, though this week I got to use a stethoscope to listen to one patient’s heart murmur and another’s mechanical heart valve. A normal heart beat sounds like “lub-dub”, while the murmur made a “lub-whoosh” sound, as there as regurgitation in their aortic valve, and the mechanical valve made a “lub-click!” sound as their mechanical valve closed shut. I also got to go back to the cath lab and see more procedures, including another PFO closure and a TAVR (Transcatheter Aortic Valve Replacement), which is a biological valve mounted on a stent that is inflated with a balloon to place. A rep from Abbott was in helping with a new PFO occlude device and was nice enough to talk with me about some of the products she had with her, letting me play around with her show case of devices and see how they work and are deployed. It was a great experience to get to physically manipulate these devices and really helped me understand what the cardiovascular interventionalists are doing with them inside the body.

After hearing about the results of them in the clinic for the past week, I finally got to see some cardiac stress tests in person. These tests use exercise or drugs to dilate the vessels around the heart and radioactive tracers to image what parts of the heart have good and bad blood flow. This can help cardiologists map where a heart attack might have damaged muscle in the patient. I also got to see the medical staff use a phone translator for the first time when interacting with a patient. There is a help line the doctors can call to have a translator on speaker and live translate between the doctor and patient in a number of languages, in this case Spanish. It was interesting to see how much more at ease the patient was when they were able to understand the doctor while also communicating to them in their native language. After the stress tests, I went with the cardiac fellow I was with to a lunch on heart failure, where we read case studies and the fellows talked through how they would deal with the issues of the patient they had just read about. Finally, I got to see patient’s receive TEEs (transesophageal echocardiograms). In this procedure, a patient is numbed and sedated and an ultrasound probe is passed down their esophagus to image their heart from the inside, allowing for a better view of the atria. One patient was there to be cleared for a cardioversion, where the heart is shocked to take it out of atrial fibrillation. Once they were cleared (with no clots in their atrial appendage), I got to follow them and see the doctor and nurses attack defibrillator pads to his chest and, after everyone stepped back, shocked. The process resulted in the patient’s chest jumping four inches off the bed, but thankfully relieved them of their AFib for at least the next few years.

In lab this week, I got to help set up zebrafish mating and microinject embryos. I also extracted hearts for culturing and imaged both hearts and zebrafish embryos. The most interesting thing I learned was that zebrafish hearts can be cultured whole in a petri dish, some for up to a month! And if the atrium is able to be retained, they continue beating like normal for the whole time. It was quite a sight to see for the first time.