Weeks 15 and 16: Small Animal Cardiology!

These past two weeks, I had the privilege of learning from the cardiology service. The overall time demand of this rotation was fairly “tame,” and most days began with rounds at 9:00. We then had appointments from 10-2 pm and finished off most days with recap rounds where we would discuss key learning points from the cases that were seen that day.

In short, this rotation provided an incredible opportunity to learn how to interpret echocardiograms, thoracic radiographs, and ECG readings. We also had plenty of opportunities to practice listening to heart murmurs and classifying them based on their severity. All of these are skills that will come in handy regardless of the path we decide to take after graduation.

During this rotation, we also had some incredibly interesting “once in a lifetime” cases. One of the patients had the unfortunate luck of being born with not one, but FOUR congenital abnormalities. These abnormalities include heterotaxy syndrome of the ventricles, Cor Triatriatum Sinister, septal defects of both the atrium and ventricle, and truncus arteriosus. All these conditions cause an abnormal mixture of blood in the heart, leading to insufficient deoxygenated blood reaching systemic circulation. This means that the patient may be cyanotic and experience exercise intolerance. The combination of these abnormalities has the potential of putting our poor patient into heart failure but as of now, she is currently coping with her condition.

Another interesting case was a little pup with two congenital abnormalities; a double-chambered right ventricle and a perimembranous ventricular septal defect. The combination of these conditions caused our patient to have an extremely high packed cell volume of 89%. A packed cell volume is the percentage of red blood cells in the patient’s blood and should normally be around 37-55%. Levels above this range are associated with “thicker” blood that can lead to impaired oxygen delivery to vital organs, an increased strain on the heart, and even seizures. In order to help alleviate some of the symptoms, this patient was phlebotomized, meaning a safe amount of blood was removed and replaced with an electrolyte solution. This was performed on two separate days to help prepare this patient to travel to Colorado for surgical intervention. This was something I had not seen before, and I was surprised with how well the patient tolerated the procedure.

During this rotation, I also had the privilege of working with Victor E. Bulldog III, Fresno State’s mascot! He was an absolute sweetheart and a frequent flier at the VMTH. Luckily, his heart is not the biggest of his concerns, and his appointment was fairly routine. In addition to Victor E. I was able to interact with a plethora of incredible clients. The way these owners spoke about their pet, and the extent to which they were willing to go regarding diagnostics and treatment demonstrated the power of the human animal bond and was a solid reminder of why I am in this field.

Additionally, this rotation was also filled with a lot of great learning opportunities that stemmed from more common cardiac diseases such as myxomatous mitral valve disease and hypertrophic cardiomyopathy. Both of these diseases are commonly seen, so having an understanding of how to diagnose and treat them is extremely helpful. I walked away from this rotation with a solid idea of the typical diagnostic tests needed to classify these conditions as well as the general principles around their management.

The faculty and residents on this rotation were amazing and facilitated a high level of learning. It was evident that they were invested in our learning, and I enjoyed being challenged to go beneath the surface and dive deeper into the details of cardiac disease and treatment. Our morning rounds were packed full of relevant information, and I enjoyed the intimate learning environment and whiteboard discussions. The final day of the rotation involved an echocardiogram practice lab. I was able to bring Churro in as a volunteer, and we all took turns practicing getting some key diagnostic views. In addition to being humbled by the difficulty of obtaining “pretty” images, it was also empowering to know that with some intentional practice, getting a basic overview of the patient’s cardiac function is doable.

Churro Echo!