Human Anatomy at Colby

Allison O’Connor: My Overall Experience in BI265J

February 24th, 2015 · Comments Off on Allison O’Connor: My Overall Experience in BI265J

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This January 2015, I had the opportunity to take Anatomy and Physiology with Dr. Klepach. The human body and the way it functions has always intrigued me, but Anatomy and Physiology was not offered at my high school, so I never had the opportunity to explore this interest in a formal classroom setting. So, the JanPlan A&P class presented me with the perfect opportunity to explore my interests and officially learn about the human body and the reasons behind why it functions the way that it does. This class was even more important, since I am planning to pursue a career in medicine, and I think that basic background knowledge of human anatomy and physiology is imperative for future success in medical school and beyond.

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For most of my life I have been pretty confident that I wanted to pursue a career in medicine and when I got to Colby I was very certain of the fact that I was going to take the pre-requisites necessary for medical school so that I could go on to med school right after Colby. Over the past few semesters I took many of the pre-med classes along with and EMT course. Classes at Colby were a little bit of a rude awakening for me, and I did not perform as well as I was used to, despite putting in more effort than I had in high school. Because of this my confidence was shaken. This along with a variety of personal setbacks and health issues prompted me to question my decision to pursue a career in medicine. Coming into this JanPlan I felt like I had a lot to figure out regarding my plans for the future. I was very excited for this class because of my aforementioned interest in anatomy and the functioning of the human body, but I was also anxious since this class had a reputation for being incredibly challenging and a lot of work. I found that the rumors about Anatomy and Physiology were true, however I enjoyed every minute of the course and definitely learned way more than I could have ever anticipated-not just about anatomy, but also about myself and the way I learn as well as stress-management techniques. Dr. Klepach created a classroom environment that took the focus off of grades and switched the focus to actually learning the material while maintaining a healthy lifestyle (eating three balanced meals a day, getting eight hours of sleep each night and trying to manage our stress levels). It is often too easy to get caught up in the grades that you get on an exam or to stress about the final grade that you receive in a class and in all of this worrying about the end result you forget to enjoy the learning along the way. I also have always struggled with managing my stress levels and don’t always get as much sleep as I should on a given night. The classroom environment that Dr. K created for A&P this JanPlan really gave me the space to focus on changing my habits and remind myself of how much I love learning when I am not worried about grades.

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Anatomy and Physiology was one of the most engaging, interesting and challenging courses that I have taken at Colby thus far, and the course helped me rediscover my awe and amazement toward the human body and reconfirmed for me that I want to pursue a career in medicine. I consider myself incredibly lucky to have spent the month of January learning about the human body, learning about myself and creating habits that will serve me well in the rest of my Colby career and beyond.

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Tags: Bi265j

Allison O’Connor: Heart Dissection

February 22nd, 2015 · Comments Off on Allison O’Connor: Heart Dissection

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Although I took a lot of science classes in high school, I never had the opportunity to do any dissections. Dissections were always something wanted to get to do because I feel like the best way to learn is through hands on experience. I first fell in love with anatomy in middle school when I visited the Body Worlds exhibit while it was in Philadelphia. My dad took me to this exhibit expecting that we would walk through quickly, but instead we were there for hours as I stopped and closely examined every part of the exhibit. This exhibit was the closest I ever got to dissecting anything before this JanPlan, but the exhibit definitely inspired me to want to learn more about anatomy.

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In my various science classes and in my emergency medical technician training I had learned about the basic structure and function of the heart. Numerous times I have been asked to trace a drop of blood through the heart and it is something that I could recite in my sleep. When we started the cardiovascular unit in anatomy and physiology this JanPlan I thought I was going to hear the same spiel about the heart that I had heard so many times before. However, this JanPlan, I saw the heart in a whole new light. Though I had already learned the basic function before I learned about the anatomy in much more detail this month than I had in the past. I also learned more about the electric conductance system of the heart and some very basically how this presents itself on an EKG, which is particularly interesting to me since I see EKGs done by the paramedics on the ambulance all the time.

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The heart and its function have always been interesting to me, however, I did not fully understand how truly amazing the heart and its structure are until I was holding the pig heart in my hands. While the heart was in my hands I was able to identify the structures that I have learned about so many times and really see for myself the relationship between the structure of the heart and its function. Being able to literally stick my fingers through the arteries and veins to feel where they went lead me to understand the structure of the heart on a whole other level. I was amazed at how muscular the walls of the heart actually are. You are always told that the heart is an incredibly strong muscle, and it is a fact that you just blindly accept as true, but holding the heart in my hands and trying to cut through the muscular walls really showed me the true strength of the heart muscle. I was also surprised at how strong the chordae tendonae were given the fact that they look no stronger than a strand of floss. I put their strength to the test by pulling on them with lots of force and was unable to break them. The heart dissection reminded me of the importance of hands on learning and learning through discovery as opposed to just blindly accepting things as fact. When you blindly accept things it is easy to lose sight of the intricacies and wonder involved in the systems around us. I was in awe during the entire heart dissection and it really changed the way I thought about the cardiovascular system and reminded me of the importance of being curious and full of wonder.

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Tags: Bi265j · Lab

Allison O’Connor: Grand Rounds Presentations

February 22nd, 2015 · Comments Off on Allison O’Connor: Grand Rounds Presentations

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As a part of our Anatomy and Physiology course this Jan Plan, we worked in small groups to research and present a case study to our peers and a few health care professionals during a mock Grand Rounds presentation. Grand Rounds is a tradition in the medical field in which physicians present case studies to their peers, other medical professionals and medical students on a medical topic to share things that they learned in particular cases, so that others can learn from these cases. The Grand Rounds presentations were a highlight for me this JanPlan. Not only was it interesting to explore a case study of our choosing and get to learn about a particular medical condition, but it also exposed me to the format of Grand Rounds presentation and gave me the opportunity to practice my public speaking skills (which is something that is very anxiety provoking for me).

 

My group used the New England Journal of Medicine’s database to find a case study that we all found interesting. After reading through various case studies, we settled on the case of a 32 year old female, who three weeks post partum presented to the emergency department with substernal chest pain that radiated to her jaw. Substernal chest pain can be a result of many different complications including: cardiovascular complications, respiratory problems, gastrointestinal complications and musculoskeletal problems. Although cardiovascular complications are the most common cause of chest pain, it is not typically a complication that is expected in an otherwise healthy 32-year-old female. However, the fact that this patient was postpartum increases the index of suspicion for myocardial infarction, pulmonary embolism and coronary artery dissection because of the hormones present during pregnancy. An angiogram in the emergency department revealed a left anterior descending coronary artery dissection with a 35mm segment of narrowing and 90% stenosis.

 

Coronary artery dissections occur when the inner and outer layer of the coronary artery separate and blood pools in the area between the layers, causing decreased blood flow to the heart. There are two major types of coronary artery dissections, those that are spontaneous and those that are mechanically precipitated. Given this patient’s postpartum status and the events that precipitated her dissection, her coronary artery dissection would be classified as spontaneous. Within spontaneous coronary artery dissections, there are four sub-classifications, however only two of those are relevant to this case: postpartum coronary artery dissections and idiopathic spontaneous coronary artery dissections, which are dissections that are result of increased hemodynamic pressure caused by shear stress. Based upon test results, the patient’s postpartum status and the lack of disease in her other arteries, the patient was diagnosed with a spontaneous postpartum coronary artery dissection. Since postpartum spontaneous coronary artery dissections are relatively rare, there is not a universal treatment protocol. Conservative treatment is preferred, however sometime more invasive measures are required. In this case, conservative treatment was the most appropriate plan since the patient was stable, was experiencing very little pain and only had slight cardiac ischemia. The patient was treated with an intra-aortic balloon pump for two days to make her coronary artery more patent and was also given β-blockers, aspirin (an antiplatelet agent) and heparin (an anticoagulation agent). After two days, the patient was showing significant signs of improvement and was discharged from the hospital after eight days. The patient was able to return to life as normal and at the time that the case was presented had no further complications.

 

Since we had used the New England Journal of Medicine database to find our case study, we were actually able to get our hands on the PowerPoint that was used in the original Grand Rounds presentation given at Massachusetts General Hospital. The PowerPoint contained videos from the angiograms done in the hospital as well as other helpful pictures and background details of the case that we would not have had access to if we had not been able to obtain this PowerPoint. Having the actual angiogram videos from this patient enhanced our presentation immensely and made the case study feel more real.

 

I found this topic to be especially intriguing because it combined two of my clinical interests: women’s health and cardiology. I have always been drawn to women’s health issues particularly pregnancy and birth and for a while now have considered becoming an OBGYN or midwife. Spontaneous coronary artery dissections (SCAD) are a rare complication of pregnancy, so it was really valuable to learn about the presentation and treatment options for SCAD and this knowledge could potentially be useful in my future career, which made the information feel very relevant. This JanPlan I discovered a new interest in the heart and cardiology. I had never considered cardiology to be a field I was particularly interested in, but the cardiovascular unit in this class really opened my eyes to the wonders and intricacies of the heart and has left me wanting to learn more. This topic fit my interests perfectly and I thought it was really cool that we got the opportunity to study a case and explore our personal interests in an incredibly relevant way. Postpartum SCADs are very rare and are often overlooked, but now I know what to look out for which will hopefully help me provide the best care possible to my future patients. I also felt that I learned a lot of important and relevant information from my peers presentations. It was really fun to get to watch my classmates present topics that they were passionate about. Grand Rounds was a very rewarding and interesting endeavor and was definitely a highlight of my month.

 

 

Tags: Bi265j · Grand Rounds

Grand Rounds: Postpartum Coronary Artery Dissection

January 28th, 2015 · Comments Off on Grand Rounds: Postpartum Coronary Artery Dissection

Lauren Shirley, Allison O’Connor, Cal Robbins

Grand Rounds Synopsis

Case 28-2010 A 32-Year-Old, 3 Weeks Postpartum with Substernal Chest Pain

Grand Rounds Case Presentation powerpoint pdf

Onset

A 32-year old woman had an uncomplicated, spontaneous vaginal delivery after 39 weeks of gestation. This was the patient’s second pregnancy. During her first pregnancy, she was diagnosed with preeclamptic toxemia which was treated with magnesium sulfate. Mild hypertension (systolic 120-140 mm Hg) was reported during the first and third trimesters of her second pregnancy followed by a return to normal blood pressure. Upon delivery, it was noted that her placenta weighed 340 g (below the fifth percentile for gestational age, mean 540 g) with increased amounts of perivillous fibrin (suggesting placental ischemia- lack of blood and thus oxygen and glucose to tissue).

The patient was admitted three weeks post partum when she developed pain in the left jaw and substernal area. The patient called EMS and was given oxygen which resolved her symptoms after 20 minutes and EMS personnel left. The pain returned shortly and EMS returned whereupon the pt scored her pain as a 7 out of 10. Blood pressure was noted as 148/74 and an electrocardiogram (ECG) revealed normal sinus rhythm of 90-100 bpm and ST-segment elevation of 4 mm in leads V2 and V3 (Abnormalities in ECG). Oxygen, acetyl-salicylic acid, nitroglycerin and morphine were administered. When examined at the hospital, the pt’s blood pressure was 143/92 mm Hg in her left arm and 137/81 mm Hg in her right arm with a pulse of 83-92 bpm.

Diagnosis

With a chief complaint of chest pain the patient could have been experiencing cardiovascular, pulmonary, gastrointestinal or musculoskeletal complications. Since the patient was 32 years old, cardiovascular complications would seem unlikely, however, since the patient was three weeks postpartum cardiovascular complications need to be considered more carefully since the risk of acute myocardial infarction is increased during pregnancy and the postpartum period and since pregnancy is a risk factor for aortic dissection. The risk of pulmonary embolism (a blockage of an artery in the lungs) is also increased during the postpartum period.

Since the patient’s ECG showed ST-segment elevation in conjunction with chest pain, an acute myocardial infarction would be suspected. Approximately 35% of postpartum women who present with myocardial infarction have a coronary artery dissection. There are two main types of coronary artery dissections, those that are caused by mechanical precipitation and those that are spontaneous. A spontaneous dissection is a tear in the artery where the tunica media and tunica externa separate, allowing blood to pool in between these layers. SCAD are rare, however 75% of patients who present with spontaneous aortic dissections are women and 30%  of those women are peripartum, suggesting that this patient’s coronary artery dissection was spontaneous. There are four subgroups of spontaneous coronary artery dissections, however peripartum status and idiopathic spontaneous coronary-artery dissections or those caused by coronary shear stress are the two subgroups relevant to this case. Since the chest pain began after the patient picked up her toddler, there is a high index of suspicion that this dissection may have been caused by the patient’s peripartum status and coronary shear stress caused by lifting her toddler. Angiographic projections showed 35mm long segment of narrowing in the left anterior descending coronary artery.  The lack of vascular disease in other coronary arteries along with the patient’s postpartum status as well as her test results are consistent with the diagnosis of a postpartum coronary-artery dissection.

Treatment Options

Unlike aortic dissections, the usual chest pain drugs (asprin, nitroglycerin, etc) which thin the blood can actually help, keeping the true lamen patent. Beta-blockers and nitrates are often used to prevent superimposed vapospasm.  In cases of myocardial ischemia or compromised coronary flow, reperfusion therapy is used.  In patients with severe ischemia, coronary-artery bypass  grafting is done. In this case, the patient was given an intra aortic balloon pump which helps to increase myocardial oxygen supply by being placed in the aorta where it inflates and decreases based on the heart beat.  Since the patient had no pain and the Percutaneous Coronary Intervention could have entered the false lumen, and since coronary dissections can heal by themselves, the balloon pump makes the most sense.  This increased blood flow to the coronary artery.  Aspirin as an antiplatelet, ß-blockers, and statins were used in case of intramural hematoma in the coronary vessel.  Because of the potential for emergency cardiac surgery, the patient was not given glycoprotein IIb/IIIa inhibitors.

 

After 2 days a significant improvement was noted, the pump was terminated, and since surgery was now unlikely, glycoprotein inhibitors were initiated  for a minor myocardial infarction discovered during treatment of the aortic dissection. This would be discontinued in a year, while aspirin was recommended indefinitely. The patient was able to return to her normal life with no further complications.

 

Little evidence exist in terms of the cause of spontaneous coronary artery dissections, but the current theory is that  inflammation is caused by hormones, which explains the prevalence in post partum women.  Several studies also included women taking oral contraceptives as being at risk for coronary artery dissections.  The eosinophils release the histolytic agents between the tunica media and the tunica adventitia, which cause dissections in coronary arteries.

 

References

  1. Sabatine, Marc S., Farouc A. Jaffer, Paul N. Statts, and James R. Stone. “Case 28-2010: A 32-Year-Old Woman, 3 Weeks Post Partum, with Substernal Chest Pain.”The New England Journal of Medicine (2010): n. pag. Web.
  2. James, A. H. “Acute Myocardial Infarction in Pregnancy: A United States Population-Based Study.” Circulation 113.12 (2006): 1564-571. Web.
  3. Koul, Ashok K., Gerald Hollander, Norbert Moskovits, Robert Frankel, Leo Herrera, and Jacob Shani. “Coronary Artery Dissection during Pregnancy and the Postpartum Period: Two Case Reports and Review of Literature.” Catheterization and Cardiovascular Interventions 52.1 (2001): 88-94. Web.
  4. Mcintyre-Spatar, Leslie, and Kevin H. Silver. “Spontaneous Coronary Artery Dissection in a Postpartum Woman: Literature Review.” The Journal for Nurse Practitioners 7.9 (2011): 770-73.
  5. Oliveira Marta Silvia, Goncalves Alexandra, Dias Paula, Maciel Júlia Maria. “Spontaneous Coronary Artery Dissection: a Diagnosis to consider in Acute Coronary Artery Syndromes” Artigos de Revisão. (2009): 28 (6): 707-713
  6. Heart Assist Devices. Texas Heart Institute, 2015. (Accessed January 20, 2015 at http://www.texasheart.org/Research/Devices/iabp.cfm)
  7. CBC. MedlinePlus, 2015. (Accessed Janury 25, 2015 at http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm)
  8. Placental Pathology. University of Chicago. (Accessed January 20, 2015 at https://pathology.uchicago.edu/sites/pathology.uchicago.edu/files/uploads/PDFs/Placental%20Pathology%20Notes%20Aspen%202014%20-Fritsch%20final.pdf)
  9. Electrolytes. AACC, 2013. (Accessed January 25, 2015 at http://labtestsonline.org/understanding/analytes/electrolytes/tab/test/)
  10. CK-MB. AACC, 2013. (Accessed January 25, 2015 at http://labtestsonline.org/understanding/analytes/ckmb/tab/sample/)

 

Tags: Grand Rounds