Friday, February 5, 2010

Echocardiography contributions to clinical medicine here

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The day started like others here...morning report, with residents and students recounting the presentations of sick patients, mostly with HIV/AIDs and the associated illnesses caused in part by their immuno-incompetance. I was consulted on 2 typical patients. The first was 72 years old, and probably acquired her HIV from caring for an AIDs-infected relative without taking appropriate precautions. She had severe heart-failure symptoms at rest, and had clinical findings consistent with severe pulmonary hypertension. My consult and subsequent echo study provided eloquent illustration of the severity and complexity of her medical situation. Management will be difficult and her outlook is poor.
The second patient was a 30 year-old man who had HIV/AIDs, with sharp mid-precordial chest pain that prevented him from lying down flat. He had a pericardial friction rub on examination, and an ECG that had subtle suggestions of pericarditis. His echo confirmed a normal heart within a sea of pericardial effusion, likely due to TB. The availability of echo to help confirm diagnoses and quantify the issues we deal with has made an enormous contribution. I'm proud to have done this, and hope to stimulate interest among the housestaff to become cardiovascular specialists who can make a similar contribution here.
We're beginning a low-key weekend here in Gaborone. We are having supper with the chief of medicine and her husband (Balkans who fled the Yugoslav wars in the early 90s) tonight, playing golf Saturday morning, and on Sunday attending an English "roast" at the home of Gill Jones, a former nurse who runs the Botswana-UPenn parnership. I tried to explain to our housekeeper Alima what -15 degrees Celsius is like (this is the current temperature in Portland), and she was horrified. Me too.

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