the
FUTURE
DOCTOR A DEL NORTE HIGH SCHOOL MEDICAL PUBLICATION
Spring 2016
Volume 2 Issue 1
Our Team Editor-in-Chief Armaun Rouhi
Executive Editors Joseph Baer Ashwath Raj
Design Editor Kedwin Chen
Content Editors Ethan Chung Divya Ghoshal Jessica Ho
Copy Editor Yeonjae Hong
Director of Finance Casey Chen
Writers
Sukruth Kadaba Armaun Rouhi Nicholas Sugiarto Joseph Baer Julianna Hayashi Caroline Ma Divya Sood
Advisor Kimberly Pytel
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Letter from the editor Dear Readers, Welcome to your second issue of The Future Doctor. Back in June of 2015, we opened our doors to Del Norte and 4S Ranch with an inaugural issue on Neurology and Neurosurgery, taking all of you on a deep dive into the biological workings of the mind and its interplay with the latest advancements in modern medical science. Since then, The Future Doctor has grown to include many more writers and community sponsors, as well as a 700+ readership online, at three high schools, and in two middle schools. Our mission of inspiring a new generation of future doctors to take the reins of 21st century medicine has culminated in a medically empowered youth right here in sunny San Diego. Ever since our first issue, we’ve come far. So how about a second? In this second issue, you will learn about the raw science behind what gives life its most innate rhythm: the Heart. It works 24/7, like a true AP-student, to pump blood and oxygen via the body’s highway of veins to where they’re needed most. Whether they are on the heart’s general anatomy, novel stem cell therapy, or initiatives by the World Health Organization, the articles we’ve prepared for you will explore everything from clinical medicine to public health ramifications, thereby supplying a well-rounded, interdisciplinary perspective on the dynamic and exciting field of cardiology. So in these following pages, we urge you to let your reading inspire research. Read our article on links between the purkinje fibers of the heart and brain, but don’t stop there. Hit sites like PubMed and WebMD hard and don’t quit until you’ve mastered the material that piqued your interest. That’s our challenge to you, because we guarantee that your intrigue will always make way for one magnificent passion. Thank you, enjoy, and remember to make like a heart and beat on! We would like to take this opportunity to extend our sincere thanks to our industrious writers, brilliant staff, our selfless sponsors, Mr. Patrick Sweeney, and Ms. Kimberly Pytel, The Future Doctor and FDA’s advisor of three successful years! Their efforts have made all the difference. Sincerely, Armaun Rouhi ‘17 Founder and Editor-in-Chief
The Future Doctor is recruiting for 2016-2017! If you would like to join our team as a writer, sponsor our publication, or advertise in a future issue, please contact us at delnorte.fda@gmail.com
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cardiology Pgs. 6-7
Pgs. 8-9
General Anatomy of the Heart
The Science Behind a Broken Heart
Pgs.10-11
Beta Blockers & Treatment
A Physician Against the Odds Pgs. 12-13 3D Printing in Cardiology
Pg. 14
spring 2016 Breakthroughs in Research
Pg. 15
Global Health Corner
Pgs.16-17
Interdisciplinary Corner Cardiology + Neurology
Pg. 18-19 Pgs. 20-21
What Does Cardiology Mean to You?
The Anatomy
of the Heart 6
by ARMAUN ROUHI ‘17
The heart, to be frank, is nothing short of magnificent. It is the anatomical embodiment of persistence, beating over one hundred thousand times a day to keep the body running at its top shape. Whether it’s working to beat your mile time or otherwise, the secret to the heart’s resolve lies in its anatomy, including an array of valves, atria, and circulatory pathways. To begin with, the inner area of the heart is divided into four chambers: the right atrium, right ventricle, left atrium, and left ventricle. The two atria are chambers with thin walls that receive blood from nearby veins. The atria deal with the circulation and addition of oxygen and other nutrients into the blood, as the right atrium receives deoxygenated blood from systemic veins, while the left atrium receives oxygenated blood from the pulmonary veins. This process prepares the heart to supply the body with oxygenated blood that is then pumped to various parts of the body, giving these destinations the energy they need to function [1]. The two ventricles are thick-walled chambers that work to pump blood out of the heart. However, the heart does not tolerate the pumping of blood in any direction; its ventricles work with heart valves, where arteries leave the heart, to dictate the rate, direction, and amount of blood pumped out. To maximize the amount of blood being pumped to where it’s needed most in the body, the heart ventricles enable the valves and atria to contract simultaneously, allowing the heart to work as two pumps, one on the right and one on the left. Blood flows from the right atrium to the right ventricle, and then is pumped to the lungs to receive oxygen. From the lungs, the blood flows to the left atrium, then to the left ventricle, and finally into systemic circulation throughout the body[1]. Again, this cooperation by the ventricles, valves, and atria, via the pulmonary veins of the lungs, turns deoxygenated blood to oxygenated, thus further preparing for nutrients and energy to occupy circulating blood. Once all preparation has been satisfied and the blood is supplied with ample oxygen and nutrients, it leaves the heart through the aorta, which happens to also be the main artery in the human body. The aorta originates from the left ventricle and extends down towards the abdomen, where it
branches out into smaller arteries [1]. As the aorta branches out, it distributes oxygenated blood to all parts of the body via systemic circulation, a process which keeps the circulatory system in constant motion, thereby supplying the body with the energyand nutrients that it needs to function. But before the heart ventricles, valves, and atria can cooperate to pump oxygenated blood through the aorta and into the body, the heart must be able to propagate a signal and thus beat, as every heartbeat pumps out a volume of blood. Such an impulse begins in the SA, or sinoatrial, node, which consists of a bundle of specialized cells located in the right atrium [1]. The SA node not only sets the rate and rhythm of one’s heartbeat, but its own electrical activity also causes the walls of the right atria to contract, thereby flooding the right ventricle with blood, as seen in the oxygenating process described earlier. The impulse generated in the SA node then travels to the AV, or atrioventricular, node, which acts as a gate that slows the electrical signal before it reaches the ventricles; this delay allows for the atria to contract before the ventricles do, enabling the blood to flow through the heart and ultimately become oxygenated [1]. Next, this impulse travels to the muscular walls of the ventricles via the His-Purkinje network, a pathway of fibers that causes the heart to contract, forcing oxygenated blood into the aorta, and ultimately, to the rest of the body. The heart is a well oiled machine, one that has stood the test of rapidly evolving biological and socioeconomic determinants on cardiovascular health. With its intricate network of artieries, veins, ventricles, valves, and atria, the heart is a magnificently complex marvel of human anatomy. Its structure, as well as its vital role within the consortium of organs and tissue that constitute the human body, speaks to the heart’s relentless persistence, one that can only beat on for years to come.
Image courtesy of www.sites.cdnis.edu.hk
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The Science Behind by NICHOLAS SUGIARTO ‘19 Whether it’s on the news, a recent movie, or your best friend’s SnapChat story, we’ve all time and time again heard about the pains of having a broken heart. Sure, it’s not a fun thing to have, and yes, it must really hurt, but is this emotionally-charged state of stupor an actual medical condition? Such an idea is in fact real and is commonly referred to in the medical community as “broken heart syndrome.” This “broken heart syndrome” is formally known as Takotsubo Cardiomyopathy. The word “Takotsubo” refers to a native Japanese Octopus Trap and its close resemblance to how the heart’s left ventricular apex swells under stress; the second part “cardiomyopathy” is a general term that means an abnormality of a muscle [1]. Takotsubo Cardiomyopathy is caused by extreme emotional stress, such as a bad breakup or death of a loved one, predominantly in patients with preexisting heart conditions. During these times of emotional turmoil, patients often feel symptoms similar to a heart attack: chest pains, difficulty breathing, low blood pressure and sweating. However, Takotsubo Cardiomyopathy differs from an actual heart attack due to the absence of the blockage of the heart’s arteries. Instead, Takotsubo Cardiomyopathy is caused through the heart’s stress response system. During times of extreme stress and grief, which are characteristic to the experience of a broken heart, the sympathetic nervous system causes the heart to pump out adrenaline in what is commonly known as “flight or flight.” However, during Takotsubo Cardiomyopathy, the heart is unable to cope with the amount of adrenaline produced, resulting in a negative effect on the heart [1]. In a normal heart, the heart’s beating comes from the impulse created during the passage of Calcium, Sodium and Potassium ions, but when there is too much adrenaline, the adrenaline binds itself to the hearts cells, causing too much calcium to surge into the heart. With this excess of calcium now in the heart, these ion channels are now unable to passage other ions and propagate an impulse, which results in the heart swelling and resembling said “Takotsubo.”
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A Broken Heart Luckily, most patients do make a full recovery, as there is no long-lasting damage or permanent damage done to the muscles. If needed, patients are generally given heart strengthening medication such as Angiotensin-converting enzyme (ACE) inhibitors, Beta blockers or Diuretics at the discretion of their physician. But in general, patients are given emotional support, or encouraged to engage in relaxing activities such as meditation, or yoga, which have been shown to reduce inflammation and swelling of the heart [1]. Also, according to John Hopkins Medicine, in their five years of studying Takotsubo Cardiomyopathy, not a single patient has reported contracting Takotsubo Cardiomyopathy twice. Although there is still ongoing research on the possibility of a second occurrence, Johns Hopkins researchers ascribe this finding to cell plasticity in the heart and cardiac muscles, which reshape and repair the heart to better tackle and prevent future abnormalities. So that dreary, sullen, and painful symbol of a broken heart is really not so figurative after all, as the Takotsubo Cardiomyopathy is a real medical condition that has engendered real medical consequences for thousands worldwide. For physicians and researchers internationally, this condition has been perplexing, frustrating, even heartbreaking (pun intended!), but ultimately, nothing but conquerable. With a wealth of experience, resources, and collaborative communities, today’s medical scientists and doctors stand before the gates, research and data in hand, of banishing Takotsubo Cardiomyopathy from the hearts, minds, and bodies of millions of lovers worldwide. So rest easy, your heart’s safe in the hands of medicine’s 21st century.
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Against the Odds: The First Heart Transplant
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by DIVYA SOOD ‘19 On the evening of December 2, 1967 in South Africa, a young woman lay on a hospital bed, connected to an array of beeping machines. The woman, Denise Darvall, was brain dead. Without life support, she would die. Just that morning, Darvall had been healthy, cheerful, 25-year-old bank clerk with few worries in her life. As she and her mother crossed a street that day, a drunk driver barreled down the Cape Town road and hit them. Her mother was killed instantly in the crash, while Darvall was rushed to the hospital for her severe injuries. Several hours later, Darvall’s condition worsened, and she was put on life support. Her organs kept functioning but her brain showed no signs of activity. Upon hearing this news, her father agreed that her organs could be donated to save other lives. Elsewhere, Louis Washkansky, a robust 53-year-old grocer at a local store had enjoyed athletics throughout his life. As he aged, though, his preexisting heart condition worsened, and he suffered three heart attacks before that one final day when his heart was too weak to keep him alive. On December 3, 1967, Washkansky was rushed to the emergency room for heart failure and upon examination, physicians determined that nothing could be done for him. However, his doctor, Dr. Christiaan Barnard, believed that Washkansky had a chance. sTo him, Washkansky’s case, although difficult, was by no means impossible. While Washkansky was in the emergency room, Denise
Darvall, the car accident victim, remained hooked up to the machines that powered her life. Although she was completely brain dead and would never regain consciousness, her organs were healthy and fully functional. Barnard decided that his best shot at saving Washkansky was to take Darvall off of life support, extract her heart, and give Washkansky the healthy heart. If the procedure went according to plan, Washkansky would walk out of the hospital a few days later with a brand new heart. Darvall was still technically alive, despite her lack of brain function, and had a miniscule chance of regaining consciousness. With approval from Darvall’s father, Darvall was quickly removed from life support. After her heart was extracted, Washkansky was prepared for surgery and taken to the operating room. Nine hours and a team of thirty people later, Darvall’s heart was sustaining Washkansky’s life. Washkansky’s successful transplant showed millions of surgeons around the world that there was hope. With further refinement, this surgery could potentially save the lives of millions of patients. Dr. Barnard himself regarded the surgery as a success, because it was a milestone in medicine. Although Dr. Barnard did not receive the prestigious Nobel Prize in Medicine, he received accolades worldwide for his impact in cardiovascular surgery. This scientific breakthrough, the first human heart transplant, was the result of one talented surgeon who, against the insurmountable odds, took one giant leap of faith. 11
by CAROLINE MA ‘18 We have all gone through the motions of our highly dreaded annual checkups at the doctor’s office. Of the many things the doctor checks for, one very important component that is never overlooked is high blood pressure. High blood pressure, a serious condition in which high amounts of blood are pumped forcefully against narrow artery walls, can lead to serious cardiac illnesses or conditions such as tachycardia, which is an abnormal heart rate, or heart failure [1]. Beta-adrenergic blocking agents, also known as beta blockers, are a family of drugs that are effective in treating cardiac conditions from high blood pressure and arrhythmia to myocardial infarction, (which is just a fancy way of saying heart attack). Beta blockers work by limiting the production of adrenaline in one’s body. By doing so, this blocks nerve receptors, which slows down the heart [1]. Pressure is relieved off of the heart because it does not need as much oxygen and blood to function. Blood flow is also improved, because vessels are opened up. In less science-y terms, beta blockers can be compared to carrying groceries. For instance, trying to bring in all ten grocery bags at one time may be difficult on your arms. Relieving the pressure and taking two trips instead of one can prevent any serious injuries. Though beta blockers and groceries are only related figuratively (not really), you get the general idea. Besides improving cardiac health, beta blockers are also used to treat anxiety, diabetes, and glaucoma. There are three different types of beta receptors: beta1, beta2, and beta3. Each receptor is responsible for a part of the body. Beta1 receptors are centered at the heart, beta2 receptors are located in the lungs and abdominal area, and beta3 receptors lay in fat cells.
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Taking beta blockers specific to other regions in the body treat other diseases unrelated to the heart. Though beta blockers are most commonly known for treating hypertension and other cardiac diseases, they are versatile, which gives them many purposes. Examples of beta blockers are acebutolol, atenolol, bisoprolol, and metoprolol, (which are quite distinctive because of their –lol endings). Common with all drugs, beta blockers have several side effects. Taking beta blockers can result in bradycardia (slow heart rate), drowsiness, cold hands and feet, dizziness, weakness, and dry mouth, eyes, and skin [1]. These side effects can be of concern as they do affect a person’s perception and consciousness. Beta blockers should only be taken with doctor supervision, as they can be harmful if taken irresponsibly. In the world of cardiology, beta blockers are family of fascinating drugs. They have the ability to interfere with neurotransmitters that read how the body functions, giving them the power to slow down and speed up the heart. Millions of patients in clinics, hospitals, and healthcare facilities worldwide depend on the speedy, efficient, and sustainable treatment dealt by beta blockers, and with new advances in variations of the drug, many more will be able to begin leading normal lives. Initially developed in the 1960s, beta blockers have been innovated through the years to be one of the most prominent drugs in not only cardiology, but all of medicine.
Beta Blockers 13
3D Printed Hearts
by SUKRUTH KADABA ‘18 Imagine looking at a patient’s heart, not knowing what to do. No, this is not a ridiculously trite metaphor. This is the very real situation heart surgeons find themselves in when operating on a patient with unusual heart conditions. Regular heart models are inaccurate when dealing with a patient who has a wildly deformed heart. Surgeons must observe the heart first, sometimes requiring multiple surgeries or even risking a patient’s life. This level of risk has been unacceptable to Dr. Matthew Bramlet of the University of Illinois School of Medicine. He has created a method to model an individual patient’s heart in order to eliminate much of the element of risk that surrounds a cardiac surgery where the patient possesses an irregularly structured heart. To make a 3D heart model, first, a CAT scan is used to create a digital image. Previously, doctors used these images in 2D in order to plan an operation. However, now the image is printed with a 3D printer, creating a realistic model which surgeons can use when planning new operations.However sometimes things go wrong with the process. In order to ensure that the heart is up-to-par, a quality check is performed [1]. This technology has already helped many people with heart problems. One of those people was sixteen year old Bradley White [1]. Bradley was diagnosed with a heart tumor when he was three. His parents were told that he might not survive and, even if he did, he would not be able to live a normal life. 14
Today, Bradley is back at home with hopes of a normal life, thanks to, in no small part, this revolutionary new process. The implications of this novel technology are enormous. Will researchers someday be able to build personalized heart implants using a 3D printed heart model? A research team at the University of Chicago has found the answer to that. By using a 3D printed model to replicate the hearts of animals accurately, they were able to create heart implants personalized to the unique animal [1]. Now instead of an animal in the lab, such technology may soon be personalized to unique patients, and this could surely lead to improvements in patient treatment and correction of flawed heart implants. The applications and possibilities for these 3D printed heart technologies are enormous. Perhaps, in the future, we will see 3D printed heart implants that have been customized to individual patients or even fully functional 3D printed hearts. Only time will tell. However, we can be sure that this new leap of scientific progress will improve and save lives, and that is truly a noble pursuit.
Global Health
Corner
by ARMAUN ROUHI ‘17 The wonder of healthcare is truly in its scope. From Latvia to Paraguay, the natural right to health is a transnational, borderless, and inherently inclusive social contract between the ill and the able to deliver care via advancements of modern medicine. This contract charters the interdisciplinary field of Global Health and it constitues the beating heart of the World Health Organization (WHO), who in recent cardiovascular health initiatives have worked tirelessly to keep millions of other hearts beating. With its recent partnership with Duke Unversity and the SAS, a data mining and management corporation, the WHO has opened a comprehensive, international database of patients who have suffered from heart disease. The database comprises of over 50,000 patients, 100,000 procedures taken for those patients, and includes data from over 45 years, giving both researchers and physicians alike a unique view into the dynamic landscape of recent cardiovascular health [1]. Matt Gross, the director of Health and Life Sciences Global Practice at SAS, details this new collaboration as a key factor in helping to find new ways to treat heart disease, and opens the door to its international implementation by the WHO. While this new partnership at the moment mainly services North American hospitals and clinics, primarily those in the United States, the WHO has championed the task of broadening the reach and scope of this database to Africa, Europe, and Asia, where cardiovascular disease is one of the leading
causes of death in the adult population [1]. Dr. Eric Peterson, the Executive Director of the Duke Clinical Research Institute and longtime delegate to the World Health Assmebly, identifies that, although the WHO has the best of intentions for the health of individuals worldwide, certain barriers of open-source data may delay the WHO’s global integration of the cardiovascular database. For example, certain pharmaceutical companies and the healthcare industry have claimed data aggregated by their own research institutions as open only to their own pharmacists, physicians, and healthcare professionals as the institution’s intellectual property. Although many of these claims are legally warrant and solvent, the dire international need for such data to facilitate global research and treatment has increasingly trumped propietary claims, prompting the WHO to pursue the elimination of any and all barriers, as well as all past policies, that may keep this new collaborative database out of the reach of all hospitals internationally. With ongoing initiatives by the World Health Organization to share international research and thus allow for adequate healthcare in at-risk populations, coronary heart and cardiovascular disease may soon be a thing of the past in many areas with health inequities. Every regulation debated and ultimately implemented by international health policymakers has paved the way for such sweeping reform, and with plenty more problems to solve and patients to treat, this system will continue to keep hearts beating. 15
Cardiac Stem Cells by ARMAUN ROUHI ‘17 At the intersection of molecular biology and clinical medicine is what may otherwise seem like straight science fiction: induced pluripotent stem cell (iPSC) therapy. It’s a mouthful, but for thousands of congenital heart disease, hypertension, and heart arrhthymia patients worldwide, it’s salvation. As researchers work to perfect this recent treatment, the magic of iPSCs has seen the development of synthetic cardiac cells and heart tissues for patients in dire need. Formally devised in 2006 by Dr. Shinya Yamanaka and his team of researchers at the University of Kyoto in Japan, iPSCs are similar to embryonic stem cells in their pluripotency, or the ability to differentiate into any type of cell, but unlike embryonic stem cells, iPSCs do not require to be derived from the inner cells of embryos [1]. Instead, iPSCs can be procured from virtually any type of cell, from the skin to other major organs. While embryonic stem cells are naturally pluripotent, iPSCs are made pluripotent following the addition of a virus, like an innocuous variant of the Sendai virus, which alters the host cell’s DNA after entering the cell to induce pluripotency [1]. By manipulating such viruses in a lab setting to induce pluripotency in body cells, researchers are able to create cardiac stem cells. These sturdy heart cells can then be surgically implemented via iPSC therapy in the clinic to repair the damaged hearts of congential heart disease and hypertension patients. 16
However, as a relatively new form of treatment, iPSC therapy carries a minor, but nonetheless unfortunate track record of failing before even reaching hospitals. iPSCs, by definition, are manmade and therefore not found in nature, and just like anything else created by human minds and human capabilities, they are prone to error. For example, iPSCs require daily supervision, which includes the addition of nutrients and changing of cell media, among other tasks [1]. Often times, researchers may gloss over these tasks, opening up room for error in an already error prone line of cells. However, amid such opportunity for failure, iPSCs have still seen tremendous progress and positive outcomes for patients in need, as researchers continue to work to further develop the treatment and kick out its kinks. There are only a handful of moments when the lines between medicine, fiction, and outright magic blur to spell unparalleled health for patients worldwide, but this certainly is one of them. With their results, iPSCs have broken the supposed insurmountability of severe heart conditions and prompted researchers and cardiologists alike to reconsider the confines of cardiovascular abnormalities. No longer is congenital heart disease an inevitable death sentence, but rather, an opportunity to levy the best that medicine can offer. And with collaborative research communities and the magic of iPSC therapy, the medical field will continue working towards just that. Image courtesy of www.urmc.rochester.edu.
Novel Heart Surgery by JOSEPH BAER ‘17 The fact of the modern medical world is that there is always a better way to do something. The other fact is that we tend to not know that better way, yet. Few areas of the medical research get more attention and dedication than cardiovascular research. The surgical aspect of cardiovascular medicine has been advanced significantly. Doctors have developed catheter based surgical techniques, such as Transcatheter aortic valve replacement (TAVR), a surgical process whereby a one’s aortic valve can be opened up to allow for proper blood flow [1]. This is accomplished by inserting a catheter tube near the groin and sliding the tube up the body to the aorta. The tubing is marked by a radiological marker so it can be tracked as it travels up the body. This minimally invasive operation allows for a shorter recovery time than standard open heart surgery. This process is enabled by great advances in technology as well as a new medical specialty, Interventional Radiology. The goal is to use this technology to expand the number of low invasive surgeries to reach a whole range of surgical needs [1]. Some of the new research expands passed surgery. Two new drugs, Repatha and Praluent, have been approved by the Food and Drug Administration. Both drugs are anti-cholesterol medicine. The medication is hailed as the best alternative medications to Statins, the normal drug for cholesterol, who is well known for its laundry list of side effects.
The FDA has also approved a new anticoagulant, a blood thinner, for patients with atrial fibrillation. Pradaxa is set to reach markets soon. Similar to Repatha and Praluent, Pradaxa is set to replace an older and more side effect heavy drug, in this case, warfarin. Ironically, warfarin’s other main use is as a leading ingredient in many rat poisons. Cardiovascular research is in a golden age today. Much of the technology is in place for new surgical techniques to be used, new drugs to be developed, and new idea’s tested. This golden age dawns at a time where heart failure is, according to the CDC, the leading killer of adult males. Much of this critical research is being done here, in San Diego, CA. A doctor at scripps became the first physician to insert the brand LINQ Insertable Cardiac Monitor into a patient. This new device is designed to track heart rate and watch for irregularities in heart rate. The device was developed by Medtronic’s San Diego based office. New advances come every day in the field of cardiology. Let us hope that we may live in age free of heart conditions, especially before we develop them.
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Interdisciplinary Corner by ARMAUN ROUHI ‘17 In medicine, there lies the extraordinary opportunity to cross disciplines and find commonalities where others have not. When our problems draw from countless subjects, disciplines, and fields, our approaches to tackle each problem must be no different, and such is certainly the case in many aspects to medical treatment today, namely in Neurology and Cardiology. These two fields share distinct similarities that physicians work to expound upon; not only do modern neurologists and cardiologists increasingly share the same value for cross-collaboration, but the heart and brain, these doctors’s subject matter, also carry unifying biological features of Purkinje fibers and cell membrane action potentials. Both the heart and the brain rely on the propagation of an impulse or signal to function, as the heart requires an impulse from the SA node to AV node in order to beat, and the brain requires neural impulses to be transferred from synapse to synapse in order to deliver directions to the body. In the propagation of these impulses, Purkinje fibers throughout the brain and heart serve as a means of completing each respective organ’s main task. The heart’s Purkinje fibers deliver the impulse from the SA and AV node via the His-Purkinje pathway to allow the heart’s ventricles to contract, while the brain’s Purkinje fibers receive excitatory inputs from neurotransmitters at the synaptic gap, and in doing so, transfer an impulse from one synapse to another [1]. Additionally, both the heart and brain generate these impulses through depolarization and repolarization processes along the cell membrane. Nerve cells in the brain and atrial cells in the heart begin at a resting potential, where the cell voltage is at about -70 mV. To initially establish this resting potential, the cell uses ion channels, ion pumps, and voltage gated ion channels to generate a negative resting potential within the cell. To propagate the impulse along the cell membrane, the resting potential then turns to a process called depolarization, as the ion channels on the cell membrane open to allow the positive ions on the outside of the cell inside, and the negative ions on the inside of the cell outside. This process greatly increases the cell voltage from -70 mV to about +30 mV., and as the cell depolarizes and passes its threshold, it fires an action potential until the voltage reaches about +30 mV, when the ion channels close [1]. Afterwards, the ion channels open again and work to bring the cell voltage back down to -70 mv by allowing the positive ions now on the inside outside, and the negative ions now on the outside inside. This completion step to the process, called hyperpolarization, brings the cell back to its resting potential, and once another impulse requires transportation along the membrane, the cell will undergo the same process over and over again.
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What’s fascinating about the process of generating and propagating an action potential along a cell membrane is that its done for different purposes in the heart and brain, but each organ uses the same process, along with the same ions and voltage values, to complete their unique task. What’s fascinating is that, despite being in different locations with very different environments, our arguably most vital organs devised similar methods to complete dissimilar functions. From Purkinje fibers to action potentials along cell membranes, our hearts and brains are clearly similar in anatomy and process, but how does the medical community utilize this information to collaborate across medical specialties and, ultimately, treat patients? At the prestigious Massachussetts General Hospital in Boston, Cardiologists and Neurologists have recently established the joint Cardio-Neurology Clinic, where patients with cerebrovascular disorders related to the heart can receive comprehensive neurological treatment and care [1]. In addition to this clinial component, the Cardio-Neurology Clinic also boasts equally multidisciplinary research labs that consist of neuroscientists, cardiac electrophysiologists, cardiac stem cell researchers, and biomedical engineers, among others, thereby allowing for adept teams of diverse eduation, expertise, and background to solve cardiovascular and neurological disorders that are just as diverse and expansive in their symptoms. This Center has led growing efforts to solve cross-disciplinary medical conditions with cross-disciplinary medical approaches and treatments, but others have also begun to follow. In San Francisco, the annual Stanford MedX conference tackles the topic of interdisciplinary medicine regularly, prompting the program’s director, Dr. Larry Chu, M.D. to team up with the Dean of the Stanford School of Medicine to entertain the idea of not only implementing interdisciplinary medicine in hospitals nationwide, but also integrating cross-disciplinary education in the country’s medical schools. However, as a relatively recent topic, interdisciplinary medicine still has a while to go until it is implemented across the board, but today’s leaders of the field have evidently taken the first vital steps to doing so. The notion of drawing upon every and any field within reach and relevance to the issue at hand is certainly one that can spell unparalleled progress and innovation for hospitals, doctors, and most importantly, patients worldwide. And as Future Doctors, it’s evidently our job to take up the timeless task of improving the field that we aspire to enter: today, that improvement lies in the promise of interdisciplinary treatment and learning across hospitals and medical schools nationwide, but that doesn’t mean you’ve got to have a degree to do so. We can start right here, right now, at Del Norte and challenge ourselves to find the elusive links between the classes we take. It’s time that we start asking what Spanish has got to do with Civics, and what Civics has to do with Biology; the links may seem a bit far-fetched, but trust me, they’re there. Just like our own brains, hearts, and the anatomy they share, so too can we intertwine our learning, combine our talents, and make our Future Doctors, Engineers, Teachers, and Citizens the stuff of legend.
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What Does Cardiology Mean to You? by JULIANNA HAYASHI ‘17 Cardiology - the branch of medicine that involves diseases and abnormalities of the heart - must spark images through your mind. Heart valves, atriums, aortas, blood vessels, and so much more all relate to the human heart. But what also comes along with heart abnormalities and diseases are the people. The cardiac patients are the ones suffering through the struggle and the pain, along with their friends and family, and it can sometimes be difficult for physicians to remember that these patients are most likely going through the worst times of their lives. Heart conditions are certainly difficult to deal with and it is up to us to make a difference for those who are in need of support. Here at Del Norte, we strive to recognize those who have had personal connections towards cardiology. We want everyone, regardless of their background, image, or identity, to feel loved and supported by our warm atmosphere. Del Norte has the chance to become the healers and the nurturers as long as we put our hearts into it! Here are a few nighthawks who have expressed what cardiology means to them.
SOUMYA KURUVILA “I remember when my dad told me that the size of my closed fist is about the size of my heart. I completely freaked out. I have the smallest hands in the world, so believing the fact that my heart was the size of a small plum terrified me. The thing about cardiology is that it applies to people with hearts of all sizes and it makes sense of something seemingly unexplainable. Coming from a family that has a significant amount of heart illnesses, I really do hope that cardiology continues to progress.”
CASEY CHEN “Cardiology means to me the study of the heart, which is the dictionary definition. But it is so much more because cardiologists work on and study one of the most vital organs of living organisms. The heart controls almost everything and has so much power over the body. When I first learned about the heart in biology, I just thought it was a pumping machine. But the heart is so intricate and beautiful. It is mesmerizing watching a heart beat.”
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JACK DWYER “Over the past couple years, my grandfather has had some different heart problems. Often times he just feels discomfort or something is just off. At one point he had to have a stent put in his heart to keep one of the valves open. It seems like such a simple procedure in modern times but when you think about it, it’s actually incredible how helpful cardiology is. A minor surgery likely saved his life and I’m very thankful for that.”
ARCHANA PENUMUDI “Last summer, my uncle came to visit my family. We had so much planned to make his vacation the best it could be. But during his trip, my uncle had a massive heart attack in the hotel. We took him to the hospital and he was admitted into the ICU. They said 3 out of 4 heart valves were practically blocked. That first day they said he had practically a 0% of survival. He was in the ICU for almost a month during which he was shifting on and off of the machine. Now, post-operation, he has almost made a full recovery. That’s why to me, cardiology is so important. I think it’s a very precise, powerful science. It saved my uncle’s life and I have no doubt that it has saved the lives of countless others too.”
REAGAN CLOUTIER “My cousin has Long QT. This is a heart disease where if you’re suddenly shocked or surprised, your heart has the potential to stop. My cousin can’t jump in a pool or use alarm clocks because the shock of either of those things is enough to stop her heart. She has to carry a defibrillator with her everywhere in case her heart stops. It definitely is a huge lifestyle change, but it’s manageable. If it weren’t for the advances in modern technology, my cousin would never have found about about her Long QT and this new field of medicine has saved her life. If she didn’t have all of her doctors, she wouldn’t have her daily medications she has to take. Also it’s a genetic abnormality too, so we all have to get special tests every year to make sure our hearts are still okay. Right now they’ve just developed a blood test which could supposedly tell you if you do or don’t have it. Cardiology has come so far throughout history and I am so thankful for it!”
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Citations The Anatomy of the Heart by Armaun Rouhi [1] “Anatomy of the Heart - Texas Heart Institute Heart Information Center.” Anatomy of the Heart - Texas Heart Institute Heart Information Center. N.p., n.d. Web. 02 June 2016. Image courtesy of pinterest.com The Science Behind a Broken Heart by Nicholas Sugiarto [1]”Stress Cardiomyopathy.” John Hopkins Medicine. John Hopkins Medical Institute, n.d. Web. 1 May 2016. Image courtesy of alamy.com
Against the Odds: The First Heart Transplant by Divya Sood [1] Fisher, John. “To Transplant & Beyond - Denis Anne Darvall.” To Transplant & Beyond - Denis Anne Darvall. To Transplant and Beyond, 2003. Web. 03 May 2016. Image courtesy of nlm.nih.gov Beta Blockers by Caroline Ma [1] “High Blood Pressure (hypertension).” Beta Blockers. N.p., n.d. Web. 02 June 2016. Image courtesy of k-international.com 3D Printed Hearts by Sukruth Kadaba [1] “Researchers Can Now 3D Print A Human Heart Using Biological Material.” IFLScience. N.p., 26 Oct. 2015. Web. 02 June 2016. Image courtesy of livescience.com Global Health Corner by Armaun Rouhi [1] “Duke And SAS Open Giant Database To Fight Heart Disease.” WUNC. N.p., n.d. Web. 02 June 2016. Image courtesy of rand.org Cardiac Stem Cells by Armaun Rouhi [1] “Medscape Log In.” Medscape Log In. N.p., n.d. Web. 02 June 2016. Image courtesy of medscape.com Novel Heart Surgery by Joseph Baer [1] “Minimally Invasive Heart Surgery.” - Mayo Clinic. N.p., n.d. Web. 02 June 2016. Image courtesy of orthoinfo.aaos.org Interdisciplinary Corner by Armaun Rouhi [1] Ideker, Raymond E., Wei Kong, and Steven Pogwizd. “Purkinje Fibers and Arrhythmias.” Pacing and Clinical Electrophysiology : PACE. U.S. National Library of Medicine, 01 Mar. 2009. Web. 02 June 2016. Image courtesy of hubaisms.com
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And beat on.