Week 3 - Smrithi Karthikeyan

This week started off in the electrophysiology lab, where I got to see two back-to-back atrial fibrillation ablation cases. In both cases, the treatment plan was to ablate around the left atrial pulmonary veins (this was surprising as you rarely see the exact same case back-to-back!). One note that I found interesting was that both of these cases used different company products to complete the procedure: Johnson and Johnson's mapping system/software and Boston Scientific's ablation catheter. It was interesting to talk to the industry representative in the control room about how companies work together to make sure their catheters are compatible with each other; two years ago, using different company catheters was a huge issue, as the mapping software would not be able to tell where the other company's device was located. The downside of using multiple company catheters is that it significantly increases the cost of the procedure. This is why these decisions are typically discussed with the patient beforehand. 

Over the next couple of days, I had the pleasure of reading multiple cardiac MRIs with the Cardiac Radiology team. One interesting pathology that I got to see was Takotsubo cardiomyopathy (also known as the 'Broken Heart syndrome'). Takotsubo cardiomyopathy causes symptoms that closely mimic a heart attack due to periods of intense emotional/physical stress. Unlike other cardiomyopathies, Broken Heart syndrome is the only cardiomyopathy that is completely reversible (as it is mainly caused by edema, the heart is able to successfully remodel itself after a few weeks). Interestingly, 90% of all Takotsubo cardiomyopathy cases are women, with 80% of cases occurring in post-menopausal women [1]. This makes me wonder if the lack of estrogen and progesterone in post-menopausal women makes them more susceptible to different types of cardiomyopathies. 

Finally, I got to analyze patients with septal flattening. Septal flattening is caused by the two following issues: right ventricular pressure overload from pulmonary hypertension and right ventricular volume overload from tricuspid regurgitation and atrial septal defect (ASD). Typically, pressure overload cases show septal flattening (characterized by a D-shaped left ventricle in the short-axis view) in systole, while volume overload cases show flattening in end-diastole [2]. While watching the radiology team analyze these cases, I noticed how a lot of diagnostics is qualitative, leading to frequent disagreements between radiologists. I think incorporating more qualitative metrics (through segmentation or via physics-based modeling) could help mitigate radiologist disagreements. 

Works Cited:

[1] Natale, E., & Mistrulli, R. (2023). Takotsubo syndrome: more frequent in women, more dangerous in men. European heart journal supplements : journal of the European Society of Cardiology, 25(Suppl B), B119–B122. https://doi.org/10.1093/eurheartjsupp/suad089

[2] Méndez, C., Soler, R., Rodriguez, E., López, M., Alvarez, L., Fernández, N., & Montserrat, L. (2011). Magnetic resonance imaging of abnormal ventricular septal motion in heart diseases: a pictorial review. Insights into imaging, 2(4), 483–492. https://doi.org/10.1007/s13244-011-0093-4

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