Proactive prevention – an emerging frontier in medicine
Many of the diseases needing open heart surgery are preventable or at least partially preventable. Others are of degenerative nature and currently not really preventable. We have been pretty successful preventing rheumatic valve disease in our context as a rich country thanks to the precise diagnosis and antibiotic treatment of streptococcal infections (mainly sore throat). Our success in preventing coronary heart disease is less spectacular. Every time when performing coronary bypass surgery it’s inevitable to think of cardiovascular risk factors, such as metabolic syndrome, obesity, poorly controlled / balanced blood fats, smoking, high blood pressure. We and our partners in Interventional Cardiology got pretty good in repairing the various life-threatening sequelae of coronary heart disease (and other diseases, as well), which is without doubt an excellent achievement of modern medicine. In fact, current medicine is primarily focused on precise, diagnosis and effective treatment. With an explosion in understanding physiology and pathophysiology down to cellular, molecular and genetical level, focus is shifting. The emerging medical discipline is prevention. Not only prevention of one or a series of diseases but preventing cells and tissues to stray off their path of healthy function embracing the inevitable biological process by aiming for a healthy aging to the highest possible degree.
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A complex and only partially decrypted code of the heart: Heart Rate Variability
An emerging tool allowing for some visual to internal balance, stress resilience and healthy longevity.
The heart rate is defined by the number of heartbeats per minute (bpm). As with any biological measure a range of values is defined as normal taking into consideration the age and biological sex. In the case of heart rate this range (at rest) is for adults between 60 and 100 bpm with significant individual variations depending on fitness level, health conditions and idiosyncrasy. Even at a constant heart rate (bpm), the timely distance between singular heart beats varies despite the same final count per minute. This phenomenon is called Heart Rate Variability (HRV). The fluctuation of heart rate is the result of complex dynamic and non-linear interactions of several physiological systems.
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SARS-CoV-2 pandemic: complex systems wobbling
We live in a complex system. Complex systems are those that are intrinsically difficult to model due to interactions between their parts or between a given system and its environment. Their reaction to a given input is unpredictable. The capacity of a complex system to absorb hits and disturbances and still retain basic function and structure is called resilience. Non-resilient systems destabilize and mutate to new, most frequently, less desirable states1. The coronavirus disease (Covid-19), the pandemic disease caused by the SARS-CoV-2 virus, demonstrates how susceptible our complex systems are, when the disturbance cannot be controlled rapidly and effectively.
Translational research: from bedside to bench and to bedside again!
When research is the subject, you have certainly heard the words “translational research” or “from bench to bedside”.
What do these words mean?
Cardiac surgery and sports
The topic might seem a contradiction, how can it be possible to engage in intense sport with an operated heart? It is possible, but not for everyone and not in each case. The topic is complex and requires a differentiated approach. The major components of the equation are the following:
- Nature of the disease
- Functional condition of the heart
- Response of the heart and of the whole cardiovascular system to the operation
- Presence of any residual or other disease with particular relevance to intense sport
- Attitude of the patient and his/her family
- Sports history of the patient
Taking teaching of (cardiac) surgery to another level
I very well remember my first experiences as a medical student in the operating room. I was ordered to stand in a corner with my back to the wall (just as the surgeon ordered), almost motionless because of the staff’s worry that I might touch and contaminate something sterile. I could only listen to the surgeon describing what he was doing. That was a humiliating experience and I was close to abandoning my goal of becoming a surgeon.
States of mind: #2 – Quality of care
Quality of medical and surgical care is a profoundly felt need of every patient, of every involved family. Although based on slightly different motivations, the same is requested by those who pay for the care. Therefore, the interest in defining and measuring the quality of provided care is high. This is, however, a highly complex endeavor. It requires in-depth knowledge, differentiation, multiple perspectives and expert judgment.
How can we define “quality of care”?
The Institute of Medicine (IOM) of the US National Academy of Sciences defines it as “the degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
Time for a new training model in cardiac surgery
Traditionally, technical skills in surgery are taught by the “apprentice model”: trainee surgeons learn under supervision in the operating room, by performing portions of or complete real operations on real patients.
A bolt out of the blue: acute aortic dissection
This is one of the biggest emergencies in heart surgery, or, dare I say, of medicine in general. From a subjective wellbeing, a sudden sharp and excruciating pain in the chest makes the person reach out for medical help. As soon as the patient arrives to the ER, a diagnostic protocol for acute chest pain is carried out. Once acute myocardial infarction is ruled out, the patient must undergo a CT scan to either exclude or confirm acute aortic dissection.
A year of radio silence
On June 10th 2017, the formal graduation ceremony held at the TMEC Walter amphitheater at Harvard Medical School and the Certficate of Completion marked the end of a highly demanding yet interesting one-year training named GCSRT (Global Clinical Scholar Research Training). The study of key subjects in clinical research (biostatistics, epidemiology, ethics) was much deeper and thorough than expected. Side subjects such as self- and team management, as well as mentorship and leadership, were also integral part of the course.