Tuesday, February 20, 2007

Heart in my Hands for Valentine's... literally...

This week we studied congenital heart defects. For our case-based learning assignments, we were to look up heart murmurs and congenital heart defects. "That's easy," I thought. "Murmurs... whatever, there's probably 1 or 2 types, and congenital defects, I've heard about that before. Hole in the heart. Good as done."

I was in for a surprise.

The list I ended up with had over twenty separate congenital heart defects that presented with murmurs. Apparently anything and everything about them can go wrong; thickening of the blood vessels (aorta, pulmonary artery); hole in the atrial septum; hole in the ventricular septum; valve issues; the vessels get switched around; portions get enlarged; or combinations of the above. The list goes on.
It turned out to be one of those things that you think you understand, but never really put much thought into, and then you realize there's way more to it than you ever imagined.

I ended up feeling like I learned a whole lot just from lecture this week (a rare feeling; usually I have to sit down and start going over stuff myself). After our five or so weeks of microbiology, infections diseases and the like, a block that was poorly organized and not so motivating, it's nice to finally feel like we're learning something applicable and medical (I think I've said that a couple times over the year but it's getting better and better).

The climax of the week ended up on Friday afternoon. Everyone was bitter because up until now we'd had Friday afternoons off, so nobody was impressed that we had to go across town to the teaching hospital to do a pathology 'lab' in the small group rooms there. While there was a bit of variability in the groups (and 3 of the groups had tutors who were on call and thus did not show up), it turned out it was actually really interesting. Each group was given six pathological specimens of human hearts taken from infants that had died in their first few weeks of life (aww, yea it was a bit sad but babies do die and I suppose this is a way that they can help others in a huge way even though nobody was able to help them). Each heart had a congenital defect, and given the specimen we donned gloves and went through the chambers of the heart looking for it.

For me, it was neat enough to be given specimens in formalin in glass jars and being allowed to actually handle them. Most times when you see things in glass jars they're not to be touched. I felt special.

Besides that though, which I'm not entirely sure I should've admitted, it was really neat being able to investigate and problem-solve in a way that was applicable and solidified the content we'd learned that week. Being a visual learner, as well, seeing the defects in front of me, and being able to put in a probe into the vessels to see where it came out made a lot more sense for me than the description we'd had in lecture.

For those who are as nerdy as I am, here's a bit more. We had one specimen that displayed a congenital defect called Transposition of the Great Vessels, where the major vessel leading from the heart to the body (the aorta) is switched with the major vessel to the lungs (you might remember that the left of the heart pumps the blood to the body and the right side pumps it to the lungs). I figured the best way to repair this surgically would be to switch these vessels; but supposedly that's too tough when the hearts are small, so instead they do a Mustard procedure, where they put in a baffle, a piece of synthetic material that switches the inputs of the heart rather than the outputs. That way these people's hearts end up backwards; the right side pumps blood to the body, and vice versa. It was interesting to see how this little heart had compensated for the change; instead of the left ventricular wall being thick and muscular, the right side had this morphology. Fascinating. Seeing these hearts with surgical repairs and synthetic materials sutured in definitely gave us an appreciation for the minute surgical procedures that are involved in fetal surgery, and for the remarkable way in which surgical interventions can be a lot like rewiring a car engine.

It was all kindof solidified when a lecturer did something that doesn't happen often enough in our classes. The prof brought in a former patient who was born with transposition of the great vessels, and who had had the mustard procedure done when he was a kid, and interviewed him in front of the class. Other than shortness of breath for a few days if he exerts himself too much, he lives a normal life and owns a successful company and has a few kids. Nice to see a human face rather than just being lectured about a condition.

I'm still in awe at how much they're teaching us, and it seems like every week I find out a whole other pile of things that doctors know that I'll have to learn as well. What I thought was just one possibility for heart defects quickly turned into 20+, each with a different pathophysiology, set of signs and symptoms, treatment and prognosis. Not only am I learning medicine, I'm learning a lot about medicine, and how much there is to know, and that it doesn't necessarily line up with what my expectations were in every way. Fortunately, though, finding this out is more exciting for me than anything. So far.


Mary Sue said...

Hey, I have one of those murmur things! I've always had to take extra precautions with antibiotics in case of an infection and had to go to children's hospitals for tests (is a cardiogram a test, or am I just making words up?) every year when I was younger. Now you've got me wondering what kind of hole I must have!

Elizabeth said...

I once had a resident spend nearly ten minutes listening to my chest, only to discover she'd been under the mistaken impression I had a murmur and was trying to hear it. I do have a (minor) problem that could cause a murmur, but in my case it's silent. Was pretty funny once I realized what was going on - prior to that I'd been a bit worried by how long she was taking and how intently she seemed to be listening.
Good luck with your continued learning! :)