Even though it’s the 18th of the month, I’m almost finished with my clinical duties on cardiology because I’ll be on my night shifts at the end of this week and have Thanksgiving vacation in the latter part of next week. That being said, its been a wonderful rotation so far! I’ve had the privilege of working with one of my co-interns from the anesthesia program (who happens to be a classmate from med school) and reviewed cardiac physiology, EKGs, and medications.
One of the most important (mis)-conceptions I revisited deals with stents and coronary bypasses. In a patient with normal ventricular function (ie, they’re pumping enough blood) who has three diseased coronary arteries (excluding left main or ostial left main), medical therapy versus medical therapy with bypass has no significant mortality benefit. However, patients who undergo bypass have improvement in their angina pectoris (“chest pain”) due to a more complete revascularization. Other countries aire on the side of adhering just to medical therapy, while in America, there is more intervention (and happier patients) with no mortality benefit.
Additionally, stents and bypasses do not eliminate the risk of heart attacks. If you have an atherosclerotic plaque sitting in a coronary artery, it’s still sitting there even after the stent placement. There is still potential for it to rupture! Stents and bypasses primarily reduce symptoms by revascularization, but acute myocardial infarctions are still very real possibilities.