Ask a vet: help me care about cardiac physiology
| November 20, 2022 | Posted by Melinda under Uncategorized |
In a recent Instagram story I was asked by a vet student how to approach learning a subject that your brain just doesn’t care to learn about.
I feel this question in my soul.
It’s practically impossible for me to learn about something just because it’s being presented in lecture. I used to be able to fake my way through classes that required this with rote memorization – something that has become harder and harder as I’ve gotten older.
I suggested that the poor hapless vet student try a different approach to learning the material – try a you tube video? A different text book? Or maybe an interpretive dance.
My advice got even better.
“Find out why it matters from your favorite vet and learn those parts of the subject and f*ck the rest of it.”
This is why I graduated bottom of my class.
I am not your role model. I am unsure why I decided that me offering advice to vet students was a good idea, but here we are.
I’m sure everyone knows exactly what came next.
A private message….”Why does Cardio Physiology matter?”
I mean, I guess I was kind of asking for it.
Why Cardio Physiology Matters
According to Dr. Mel, who probably will be now shunned by all cardio loving GP’s and cardiologists.
While the cardiologist who is teaching your class may vehemently disagree, here’s how I sort the cardio knowledge that comes my way into essential knowledge and “I’ll google that if I need it.”
Essential knowledge answers answers one of these questions:
Does it belong on a differential list for patients I typical see?
Be able to formulate a reasonable differential list (probable causes of the cardiac thing I’m seeing) for the animals I typically see in practice:
- young and old animal incidental murmurs
- episodes of syncope and exercise intolerance
- certain breed predisposition to certain cardiac problems
- Acute illness.
If the cardiac thing is more than 3 spots down on the list, I don’t waste the brain space. I can look up that shit later.
Is it an emergency department thing?
Know what right and left congestive heart failure looks like acutely, and have a reasonable treatment plan for the next 24 hours for these animals in the “average” urgent care or ER. Then bump it to my favorite cardiologist (who is anyone who will take a transferred patient in the morning at this point!).
Will this knowledge help me to assess shock and treat appropriately in the ER and urgent care settings? Do I need to know this in real time or will I have time to look it up if I need it? The former goes into the brain, the latter gets shelved.
Is it a within my skillset treatment or diagnostic pan for those who can’t or won’t see a cardiologist?
If client wants a grade-A treatment plan, they should go to a cardiologist. There are some GP’s who do a wonderful job diagnosing and treating heart disease. I am not one of those doctors. But, for those patients that I’m all they have, I have my go-to protocol for non-acute and acute patients that seems fairly consistent across cardiologists and inline with consensus statements.
You need to know enough treatment philosophy that you can treat most mundane, common heart conditions you will see in practice and do the least amount of harm if you are wrong.
Will this knowledge help me have a better functional explanation?
Have a good enough understanding of normal heart function and the variations of “gone wrong” to be able to convey functional understanding to a client about the disease process. It doesn’t have to be perfect and it doesn’t have to be technically correct. It does have to be accurate enough that it holds up under basic google searches that the client undoubtably does after talking to you.
What does this look like? Take a look at the diseases your’ve chosen for your differential lists at the top of this list. Can you explain the basics of each in 2-3 sentences in plan english? Can you do the same for right and left sided heart failure? Can you Do the same for your go-to treatment protocol for acute cardiac patients (emergency treatment) and more chronic disease (GP back pocket treatment protocol for slowly progressing heart disease).
Is it something I can implement as part of a PE or the tools and equipment already available to me in my average clinic?
Being able to assess cardiac function on a PE is critical for me. I do lots of low-income work. I often have to decide whether I’m going to do necessary surgery on a dog with a heart murmur that has no work up and the clients have no money to do any other diagnostic other than my hands.
TL;DR In summary…
If a piece of information doesn’t help me to:
- assess and stabilize an ER patient in the first 24 hours within the capabilities of an average clinic,
- help me put together a better differential list,
- allow me to give better explanations to clients, or
- predict who is going to live and die during surgery…
I don’t put it in my memory.
I let it wash over me like a wave, trusting that if I ever need that knowledge in a clinical setting, an alarm bell to go off and I can look it up.
And then I go on with my life.
