Probably , this is most important question for a modern-day cardiologist.
Q : Clinical cardiology as a speciality is . . .
A.Hale and healthy
B.Dying slowly and steadily
C.Terminally ill
D.Dead long ago
If your answer is A , it would be a blatant lie ! If the answer is D , you are a pessimist .
The real answer could be somewhere between C and D , more towards D “
Why clinical cardiology has plunged in to such a sorry state of affairs ?
Why it has become an objectionable sub -speciality among current generation cardiologists ?
You blame it on anything, but the real culprits are pseudomodernity , commercial onslaught and the glamourous mindset of many cardiologists. In every walk of life tradition, culture and heritage of the past is preserved except in medicine .There is rarely a backward journey in medicine . This , in spite of the fact there are lots of hidden treasures left by our elders.
Image courtesey : Jupeter Images
Now , cardiology as a specialty is in a miserable state .It has almost become synonymous with putting stents across the obstructive coronary arteries. There is a perception among juniors ( seniors too ! ) Choosing clinical cardiology is an inferior pursuit of cardiology .
Many belive clinical cardiology means , measuring blood pressure , looking at JVP , apical impulse, S1 S2 etc .Clinical approach does not end with Inspection , palpation and auscultation of the heart .
Then , what could be the defintion for clinical cardiology in the current era ?
It is the process of application of our mind in toto on the patients symptom and it’s impact on the overall health with specific reference to cardiovascular system .It also refers to the thought process that will decide the optimal managemnt strategies .( That puts the patient’s interest first )
In simple terms being clinical , is being sensible and ethical
For example, a comfortable post MI patient with near normal LV function should be sent home for a later evaluation (If , and only if he develops significant symptom ) This is clinical cardiology working at it’s best .
If such a patient is sent to cath lab directly , clinical cardiology is deemed to have doomed !
Similarly , a patient with Atrial fibrillation with the rapid ventricular rate should receive digoxin or a beta or calcium blocker for rate control as a first measure . If a physician refers such a patient to an university EP lab , clinical cardiology is deemed to have doomed !
If a patient with ASD with less than 2:1 shunt is adviced device closure clinical cardiology is considered failed.
If a patient with renal artery stenosis is blindly stented , clinical cardiology is in the highway to death .
If you prescribe a latest generation sartan for your hypertensive patient instead of advising physical activity, diet and lifestyle modification , it implies clinical cardiology is given a death sentence and being publically hanged.
Finally , it is the ultimate mockery of clinical cardiology , when a physician diagnoses cardiac failure by pro BNP and CVP , even as the patient’s lungs are sounding with crackles and the neck veins are violently pounding .
Worse still , the same patient miay be ruled out of cardiac failure , if the BNP level is within normal levels !
As you come across any of the above situations , too often , one can predict the future of clinical cardiology.
My impression is , the mortality of clinical cardiology at this point of time is , it may not survive too long and the 5 year survival rate appear dismal. Of course , in many institutions especially the corporate ones , it is already been packed and sent to the mortuary !
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Dr.S.Venkatesan MD 