Falling in love with the heart

The art of medicine has its roots in the heart...

- Paracelsus

The second year of medical school veers slightly away from the type basic science and function that first year holds. During our first year, we are supposed to learn how things work, correctly; how organ systems function, when they're healthy. Second year, we take what we have learned about healthy systems, and learn about disease. In my medical school, second year is broken down into systems, Cardiology, Renal, Neurology, Musculoskeletal, etc. In each of those systems, we learn about the pathophysiology of disease, clinical presentations, treatments and interventions. We learn about risk factors, surgeries, medications, and more. Really, it is the first year we truly start to (almost) feel like students studying to be doctors.

Our physical exams aren't checklists anymore, where you have to hit everything to get credit. They're diagnostic, with a bunch of maneuvers to choose from to get to the right diagnosis, to pass. We have practice OSCEs. We have 90 seconds for each test question, just like Step 1. We are becoming as prepared as we can. So, yeah, second year is hard. I am only 2 weeks in, and there is already a ton of information. But, because it is so focused on clinical reasoning, it is so much more interesting to me! I feel like what I am learning now will be applicable in my future practice.

My future practice that I always thought would be in obstetrics and gynecology....

But..... I am falling in love with the heart.

I never expected myself to be interested in cardiology. Sure, the heart is cool, and incredibly important, obviously, but I never really wanted to be a cardiologist.

...Until these first few weeks of M2 year. I am slowly learning more and more about myself as I further my medical education. I am a methodical person; I enjoy understanding things, finding paths to that understanding, and having set ways to figure something out. I like clarity, problem-solving and rule following. I fight until things make sense. And, I am learning that understanding cardiac physiology is very methodological. When one goes up, the other goes down. When you antagonize beta receptors, your heart rate goes down. When you agonize them, heart rate goes up. A systolic murmur is heard after S1 before S2, in mitral regurgitation or aortic stenosis, because blood flows back through the atrioventricular valves during systole, and through the semilunar valves during systole. Sure, the physiology is extremely complicated, but it all makes sense, once you get it all down. It’s very systematic and straightforward: plumbing and electrical.

There are so many incredible things the heart does. It keeps us alive. We take it for granted; this little ball of electric muscle in the middle of our chest, barely protected by skinny bones and thin muscles. It's resilient. It's incredible when you truly understand how it works, how it's ever-changing, ever-going, and so responsive to anything you throw at it. It tries so hard to keep us going through so many compensatory mechanisms, yet, most of the time, it is those compensations that lead to disease.

Mind-blowing, right?!

Who knew how many diagnostic hints you get out of a blood pressure, pulses and listening to someone's heart sounds?

Wide pulse pressure? Think aortic regurg. Increased JVD with inspiration, and a knocking heart sound? Think constrictive pericarditis - and that needs surgery!

Who knows, maybe my interest in this is because it seems we are finally learning clinically relevant things, that we will do in practice. Not to knock general anatomy and physiology, or microbial infections; it is really important that you understand all of that to become good doctors! But now, in these modules, we are learning clinical reasoning and applied knowledge. Maybe I'll love very systems module, and have no idea what I want to do in the future. Stay tuned to find out!