Day 3

The patient who had MI and was put on peritoneal dialysis passed away. RIP.

I went for ward round with the whole team of consultant, cardiologist, MO and HO.

The cardiologist gathered 4 of us- the students, in front of CCU and made us go get patient's history plus physical examination. We have to present it to him tomorrow morning. So we all went to CTW to hunt for patients. THIS IS WHAT MEDICAL STUDENTS DO. urgh!

I paired up with Nora. We went to talk to this female patient-CSN.

Basically, CSN was admitted with swelling of lower limbs and shortness of breath. She experienced orthopnea and PND so she could only sit up while sleeping for the past 3 months. She went to the doctor's 3 months ago and was given frusemide to be taken twice daily each time a tablet. When admitted on 1/7/2011 she was diagnosed with pulmonary edema, decompensated heart failure due to the failing biosynthetic valves she got 10 years ago. Upon auscultation she had pansystolic murmur.

What I learnt today:

I went to INR clinic today and saw that many patients were on warfarin. A doctor taught us these:

Cardiology:

1. Pseudo- mitral stenosis: A pansystolic murmur can indicate mitral regurgitation or aortic stenosis. However, when there is aortic regurgitation,which is a diastolic murmur, there will be a leak from the aortic valves, this will cause a pressure to push the leaflet of the mitral valve towards the left atrium. This will then cause the mitral valve to partially closed causing pansystolic murmur. So, there will be a mix diastolic+pansytolic murmur.

2. Cardiology has 4 parts: a. Acute coronary syndrome (STEMI,NSTEMI,USA) b. Heart failure c. Arrhythmias d. Congenital Heart Disease

3. Drugs for STEMI:

A- aspirin, ACEi, ARB

B- beta-blocker

C- calcium-channel blocker

D- diuretics

S- streptokinase, statins