Week 4- Grant Rowlands

Shorter week with it being the week of July 4^th. Luckily, I was able to spend time with Dr. Ulrich Jorde at Montefiore Hospital. As there were new residents and fellows starting, Dr. Jorde spent each morning reviewing cases and relevant literature in the heart failure space. Heart transplantation and LVAD implants have come a very long way in the past ~20 years with less than 10% of patients experience adverse events. Although this number seems high, one must recognize that heart failure was more or less a death sentence for patients, and now they have the opportunity to live a normal life.

In the CCU at Montefiore, I was able to round and see different patients outside of Weill Cornell. One patient experienced a small heart attack and required a stent. Not very long ago, doctors would have opted to immediately send the patient to surgery, but now there are less invasive options including medications, balloon pumps, and stents; this patient still has significant occlusion in their coronary arteries but will be discharged and closely monitored. Another patient was admitted for end stage heart failure. Dr. Jorde is weighing the options of LVAD vs. transplant. Unfortunately, the patient has a history of stroke and right ventricular failure (which will become even worse with LVAD implant), so Dr. Jorde and his team are pushing for transplant.