Hey Jeff,
How are things at the VA?
I've only been a fellow for 2 weeks now, but the stuff I've seen here is amazing. There's a ton of inpatient cardiology here, and the fellows are expected to run the show much more than was the case at UCSF. On the HF/transplant service, we've been following: 28 yo woman with myocarditis who presented with incessant VT despite amio, procainamide, balloon pump, almost went for a BiVAD but EP says "we'll ablate her!" Then last night a 19 yo kid comes in with an acute STEMI, and the cath attending comes in to shoot what he expected to be clean cors, but finds a totally occluded left main--stents him right down to his LAD, balloon pump in, then he goes into cardiogenic shock and is now intubated on ECMO. I think they want to put in an LVAD at some point.
You'd be happy to hear about the evidenced-based medicine that goes on here too. I presented the myocarditis case at fellows' report and the discussion was so high level--tons of literature cited right down to the molecular medicine stuff! Also, people are really aggressive about getting patients who come in for care into clinical trials. I just got a page about someone who was brought in for an MVR but apparently my attending is running a study on surgery vs. medical management for MR in dilated cardiomyopathy. So now she's on our service getting randomized...
Anyway, hope the first PRIME journal club of the new year went well. I may be back in San Francisco sometime this fall for a litte bit. If I end up making it out there, I'll be sure to stop by the VA for a visit.
take care,
Eric
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