As you may recall, I was on Cardiology Week recently. Despite the hard work, it was really quite rewarding. We have a fantastic Cardiology Unit, and it shows.
Anyway, because our country has a smorgasbord of infectious and lifestyle diseases, the majority of what we dealt with was acute coronary syndromes. One day in the cath-lab, the cardiologist had to inflate the balloon to 16.0 bar before he could reperfuse an artery. To give you an idea how hard that is, you inflate your car’s tyres to 2.0-2.5 bar.
In one case in the cath lab, they managed to aspirate a thrombus in a patient’s Left Anterior Descending coronary artery. It took so long, and I was expecting a massive clot. But it was so TINY. That such a tiny thing can cause such a massive problem! And it was absolutely amazing watching the monitor after reperfusion, and seeing good anatomy again. I kind of wish I had seen this in second year. I feel like I would have enjoyed the theory we were learning more, then.
In the whole week, I saw a single patient who had an acute coronary event who was NOT a smoker. ONE. (He had Familial Hypercholesterolaemia.) The cardiologist explained that we all probably have some degree of plaque in our coronaries, but it’s ruptured plaque that causes the big problems. And the plaque that is predisposed to rupturing is inflamed plaque. And smoking is a great way to inflame plaque.
The thing that struck me is how miserable cardiac disease can make one. So many of the patients were really depressed because they could not be as active as they were used to being. You cannot imagine how much people miss being able to walk to the bathroom without getting angina.
My colleagues and I, in our sleep-deprived state, got a new favourite phrase: “Keep those coronaries open.” Our hospital currently has more broken elevators than working ones, and whenever we saw people taking the stairs instead of waiting an age for the elevator, we nodded at each other. KEEP THOSE CORONARIES OPEN.
Seriously though. Do it.