It’s the second to last day of the MIM program. I’m excited yet sad that its ending. I’ve learned a good amount of information in the eight days I’ve been there. However, today was no difference. Dr. Raj made another appearance. He gave us like a practice case from the emergency department. I thought it was very interesting. I learned about what to do when a patient comes in. You would ask  then what’s wrong, then take their vital signs (see Day 5 post), ask about their social history, pass medical history, medications. Social History may include

  • where they work
  • living conditions
  • family history
  • sexual habits
  • any alcohol/drug abuse



If its acute then

  • asses for pulse and breathing
  • call 911
  • begin CPR
  • automatic defibrillator
  • transport to an emergency department

If long term then treatment includes

  • implantable defibrillator


  • must act IMMEDIATELY
  • asses for pulse and breathing


  • describe the incident
  • the dispatcher will give directions


  • begin CPR
  • if no pulse, begin IMMEDIATELY! DO NOT BE AFRAID
  • pump on the chest to help blood to circulate through the heart
  • start on patient over the age of eight
  • place hands on the mid chest over the sternum


  • this a portable device with sensors to place on the chest that delivers an electrical shock
  • the computer analyzes the patient ‘s rhythm and instructs provider to deliver a shock


  • transport to a medical facility


  • placed under the skin with electrodes in the heart
  • monitors the rhythm of the heart
  • delivers short, high-energy, shock if ventricular tachycardia or other arrhythmia discovered
  • patient will feel  a jolt



It’s my second day of week two at the MIM program. Today we learned about another cardiovascular disease known as cardiac arrest and the difference between a heart attack (myocardial infaraction) and cardiac arrest. Again, Dr. Raj joined us and gave us a valuable lesson on cardiac arrest. In addition, we also a EMT, who showed us how to do CPR ( cardiopulmonary resuscitation). This lesson was extremely useful and I actually felt like I could actually SAVE A LIFE!

Cardiac Arrest is the sudden unexpected loss of heart function such as the electrical disturbance in the heart that disturbs the pumping action of the heart, which would led to the stopping of blood flow to the rest of the body. In simpler terms to remember, the heart stops. Cardiac arrest is a leading cause of death especially high in minority communities. It affects up to 380, 000 people a year in the US. This would translate into approximately 1,000 people a day, which would then translate into 1 person every 2 minutes. 95% of people die before help arrives because the brain dies within 6 minutes of not receiving oxygen. Survival improves up to 43% with early CPR and defibrillation. The heart has an internal electrical system. This controls the beating of the pump. Apart of the electrical system of the heart you have the SA, AV, and His Bundle. SA stands for sinoatrial node which is a specialized bundle of neurons located in the nodal tissue located in the upper part of the right atrium. The SA acts as an natural pacemaker. The function of the SA is to set the rate of contraction for the heart. It also spontaneously contracts and generates nerve impulses that travel throughout the heart wall causing both atria to contract. AV stands for atrioventricular node which is a section of nodal tissue that lies on the right side of the partition that divides the atria, near the bottom of the right atrium. The function of the AV is to delay cardiac impulses from the sinoatrial node to allow the atria to contract and empty their contents first.  His Bundle or Bundle of His is a large bundles of fibers that carry impulses to the walls of the ventricles.  Cardiac arrest is also caused by arrhythmia. Arrhythmia is an abnormal rhythm in the heart. There are many types of arrhythmia with different complications in the atria and ventricles. Most common arrhythmia is known as ventricular fibrillation (V-fib) which leads to cardiac arrest. The different types of arrhythmia is supraventricular tachycardia (SVT), ventricular tachycardia, and ventricular fibrillation. The ventricles quiver uselessly and do not pump blood. The risk factors of cardiac arrest

  • often link to a heart attack
  • family history of CAD (coronary artery disease)
  • smoking
  • other disorders (diabetes, hypertension)
  • lack of exercise
  • drugs
  • age
  • gender
  • nutritional imbalance

The symptoms of cardiac arrest often occur with no warning

  • sudden collapse
  • no pulse
  • not breathing
  • unconsciousness

A person may have symptoms such as

  • dizziness
  • chest pain
  • shortness of breath
  • palpitations
  • vomiting

Cardiac arrest is often diagnosis by clinical diagnosis but if the patient survives then they will receive medical attention. The underlying cause can be detected by

  • blood tests
  • electrocardiogram (EKG)
  • echocardiogram
  • electrophysical testing
  • coronary angiogram

Cardiac arrest can be treated by

  • asses for pulse and breathing
  • call 911
  • begin CPR
  • automatic defibrillator
  • transport to an emergency department
  • implantable defibrillator (long term)

Dr. Raj also discuss the difference between a heart attack and cardiac arrest.



  • heart stops beating or beats so abnormally that pump does not work
  • problem with the electrical system


  • heart continues to beat
  • heart muscle does not receive blood because of a blockage
  • heart muscle is damaged or dies




Today marks my second week at the MIM program. Dr. Raj made another appearance to talk about another cardiovascular disease known as coronary artery disease (CAD). We also did a pig dissection. We focus on the heart, which is a little bigger than an human’s heart.

So let’s talk about coronary artery disease. Coronary Heart Disease is the leading cause of death of men and women in the US. One in every three deaths is from heart disease and stroke, equal to 2,200 deaths per day. Coronary heart disease is the build up of plaque in the arteries. This can lead to a heart attack. When a person has CAD, inside the heart atherosclerosis and thrombosis maybe taken place. Atherosclerosis is the hardening of the coronary arteries and deals with the arteries not stretching. Thrombosis is a blood clot occluding vessel. A patient may feel angina. Angina is chest discomfort due to poor blood flow through the coronary arteries to the heart muscle (myocardium). Angina may also deal with the heart under stress and not receiving oxygen to the heart muscle. A patient may feel a heart attack or myocardial infarction. Heart Attack involves blood flow to a part of the heart is blocked causing damage or death of the heart muscle. There are two main blood vessels involve in the coronary blood flow. The first being the right coronary artery. The right coronary artery branches supply the right ventricle, 25% of the left ventricle, 60% of the SA node. The other being the left main coronary artery which branches supply right and left ventricles, left atrium. You may have CAD but no symptoms. Women, people with diabetes and the elderly have symptoms other than chest pain. If a person does have symptoms they will experience chest pain or discomfort, discomfort in the jaw, neck, left arm, shortness of breath, nausea, fatigue, and weakness. The risk factors of CAD can change or cannot change. The ones that cannot change are age, gender, genes, and race. The ones  that can change are diet, sedentary lifestyles, smoking, drug use, controlling other diseases like diabetes and hypertension, and stress. However, there are ways to prevent and treat CAD. To prevent CAD

  • choose a diet rich in  fruits, vegetables, and whole grains
  • choose lean proteins, such as chicken, fish, beans, and legumes
  • eat low-fat dairy products such as 1% milk and low-fat yogurt
  • avoid sodium (salt) and fats found in fried foods, processes foods and baked goods
  • read labels and stay away from  “saturated fat”

If you do have CAD there are ways doctors can diagnosis a patient or you. They may use  a electrocardiogram (EKG), blood test, nuclear stress testing, cardiac catheterizations and coronary angiogram. To treat CAD, a doctor may prescribe medications, try to keep the vessels open, and create a new path for blood to flow. For medication, they may prescribe clot busters also called thrombolytic medication. To keep the vessels open they will do a balloon angioplasty. Balloon angioplasty is a non-surgical procedure that relieves narrowing and obstruction of the arteries to the muscle of the heart (coronary arteries). This will allow more blood and oxygen to be delivered to the heart muscle. During this process may also use a stent which is a small mesh tube to help with blood flow and prevent the arteries from bursting. The last treatment would be to create a new path for blood to flow. In order to create a new path a patient may have to undergo Coronary Artery Bypass Surgery (CABG). In this surgery, blood vessel from the leg, chest or arm is used to bypass the obstruction.



I’ve made it to Day 5 of the MIM program. So today, Dr. Raj came back to talk to us. He discuss vitals signs and a cardiovascular disease called hypertension.

Let’s first talk about vital signs. Vital signs are measures of various physiological statistics, often taken by health professionals in order to assess the most basic body functions. Vitals signs include temperature, heart rate (pulse), pain, blood pressure, pulse oxygen (pulse-ox), and breathing rate. The equipment needed to check vital signs are thermometer, a sphygmomanometer, pulse oximeter, stethoscope, and a watch. A normal temperature reading is 98.6 degrees Fahrenheit. Another vital sign is a heart rate or pulse. A normal heart rate can range from 60-100 beats per minute. In order to take your pulse you can put your fingers (index and middle finger) on your wrist or neck and start counting how many beats you hear. The next vital sign is to check your pulse-ox. This is measure is taken in order to see the amount of oxygen in the blood. You would use a pulse oximeter. A fourth vital sign would be to ask about pain. Pain is also is known as the “fifth vital sign”. A doctor would usually measure pain on a scale from 0 to 10. 0 being there is no pain and 10 being the worst possible pain.  The fifth vital sign is blood pressure.  Blood pressure is pressure exerted on the walls of the artery as blood is pumped through the body. This is produced primarily by the contraction of the left ventricle. Blood pressure is recorded as two numbers which are expressed in fraction form. These two numbers are referred to as the systolic and diastolic number. The systolic number is the top number and the higher of the two numbers. The systolic number represents pressure within the arteries when the heart beats. The diastolic number is the bottom number. This number represents the pressure in the arteries between heartbeats when the heart is resting. A normal blood pressure is less than 120/80. High blood pressure (hypertension) is greater than 140/90. In order to take measure blood pressure a doctor would use a sphygmomanometer or a blood pressure cuff. The last vital sign is respiratory rate or in other words your breathing rate. A normal breathing rate for an adult can range from 12-20 breaths per minutes.

The next topic Dr. Raj focus on was hypertension. Hypertension is known as the silent killer. People who social and economic status are not that great are more likely to have hypertension. Hypertension again is high blood pressure. There is hypertensive urgency which is greater than 180/110 without organ damage. There is also hypertensive emergency which is greater than 180/120 generally organ damage. There are two types of hypertension primary and secondary hypertension. Primary or essential hypertension is the most common and there is no cause fro high blood pressure. Secondary hypertension is caused by another medical condition or medication. Sometimes you may have symptoms but a person would mostly find out about hypertension from a routine doctor’s visit. If there are acute symptoms it may include headache, nosebleed, change in vision, and confusion. Chronic symptoms may affect many body systems. Chronic effects on the body include stroke, eye damage, blood vessel damage (arteriosclerosis), heart attack or heart failure, and kidney failure. Risk factors include age, race, weight, high levels of stress, lack of physical activity, diet, family history (genetics), and drug use. However, there is a treatment for hypertension. Treatment includes

  • know your family history
  • take prescribed medication
  • eat a heart healthy diet
  • exercise regularly
  • maintain a healthy weight
  • reduce stress
  • avoid drugs, smoking. and alcohol
  • low sodium (salt) diet rich in natural sources of potassium, calcium, and fiber