Week 2: Smrithi Karthikeyan

Week 2 was a jam-packed week filled with cath-lab procedures, rounds, and interviews. To start off the week, I sat in on a MitraClip procedure to treat a patient who had severe mitral regurgitation (MR). The patient's MR was caused by severe left ventricular dilation; the ventricle had dilated severely, causing the leaflets to stretch away from each other. This case was interesting to watch as I got to test my knowledge on TEE anatomical views, learn more about how physicians measure the blood flow gradient, and saw the surgery team work together to address a challenging anatomy. 

On the next day, I got immersed into nuclear stress testing. I learned that there are two forms of nuclear stress testing: pharmacological and exercise-based. Pharmacological stress testing is when the patient ingests a vasodilation medicine (lexiscan) to increase their heart rate. Typically, this is given for patients who cannot exercise or the treadmill test did not increase their heart rate to the desired goal. One downside to the pharmacological test is that the medicine only increases your heart rate by about 10-15% above baseline. Therefore, this test is not truly putting a patient's heart in "stress" and the test results can be inconclusive. 

Exercise-based stress testing is for patients who can exercise and are able to increase their heart rate to about 75% max heart rate (based on the patient's age). Patients are asked to run on a treadmill (with EKG leads placed on their chest) that continuously increases speed and incline until the desired heart rate is achieved. One interesting problem that was mentioned was the fact that women tend to have more artifacts in their EKG reading, as the leads tend to move around more during exercise (as it is in the breast region). 

After the desired heart rate is achieved, a radiotracer is then introduced into the patient's bloodstream, and the patient gets Single-Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging done. In these images, physicians are looking for ischemia or significant changes in radiotracer perfusion before and after exercise.

Finally, I had the chance to interview two different echo experts this week to understand clinical pain points with the imaging modality. The major points I got from this discussion are to increase image resolution, post-processing automation, and improve tissue characterization. 

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