Wednesday, May 12, 2010

Now I Remember Why I Didn't Go Into Internal Medicine

We had an anesthesiology grand rounds the other day that reminded me why I did not choose internal medicine after medical school.  The lecturer was very knowledgeable.  She came from our local university hospital and had multitudes of slides to supplement her talk.  The subject was congestive heart failure.  I thought, great, I could use some updating on management of CHF in the surgical patient.  But alas, she came from the medicine side.  As she went over slide after slide of different drugs for managing CHF, my eyes started to atrophy.  To keep myself alert, I started writing down the names of the different studies on CHF she was highlighting.  These studies with their overly cute names were mentioned in the span of less than 45 minutes.

SOLVD--Studies of Left Ventricular Dysfunction

CHARM--Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity

RALES--Randomized Aldactone Evaluation Study

EPHESUS--Eplerenone Post Acute Myocardial Infarction Heart Failure Efficacy and Survival Study

DIG--Digitalis Investigation Group

COPERNICUS--Carvedilol Prospective Randomized Cumulative Survival Trial

MERIT-HF--Metoprolol CR/XL Randomized Intervention Trial in Heart Failure

COMET--Carvedilol or Metoprolol European Trial

MOCHA--sorry, can't find what MOCHA stands for.  I'm not going to spend fifteen minutes on the net searching for it.

A-HeFT--African American Heart Failure Trial

Some of these trial names are quite clever, like RALES and CHARM.  But you can tell that the researchers were trying desperately to find a memorable name for the others, like COPERNICUS and EPHESUS.  Though all the pretty bar and pie graphs were nice, it was not relevant to my anesthesia practice.  It was not until the question and answer session did I get some useful information.  I'm glad one of my colleagues articulated what we were all thinking, "I get a patient in preop whose blood pressure is 85/50 and the cardiologist says he's optimized for surgery.  What am I supposed to do about that?" The lecturer's answer? "Though nearly all anesthetics can lower blood pressure, you guys have lots of drugs that can raise the blood pressure also."  Gee. Thanks.

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