The break is coming to an end

I have been enjoying my holidays for 2 months without realizing how time flies.

My classmates came to Kuching for 5 days and Diana and I actually hosted them by bringing them around the town. Basically, it was a "Foodthalon". Last night's dinner was the most memorable one as we took a sampan across the river to eat ayam penyet (Originally, we wanted to eat ayam pansuh but when we reached there, they told us that we were supposed to book in advance) at My Village in Kampung Boyan. The place was very traditional with very nice atmosphere if you exclude the wild cats, slow service and free music from the mosque. After dinner, we went to Open Air Market to have supper.



Other than being hosts, Diana and I went followed the doctors for ward rounds this week in SIMC. We managed to pick up different types of heart murmurs. =) During our first ward round, the matron scolded us for washing hands together in one sink. She said that was the first time she saw people washing hands that way. Then, during our second ward round (this morning), the matron scolded us again for not wearing our name tags. She actually warned us not to come back unless we have our name tags so I guess this morning was our last ward round as both of us seriously do not have name tags with us.

Homework 4: Indications for temporary pacemaker and permanent pacemaker

Temporary pacemaker
Class I
1. Asystole.
2. Symptomatic bradycardia (includes sinus bradycardia with hypotension and type I second-degree AV block with hypotension not responsive to atropine).
3. Bilateral BBB (alternating BBB, or RBBB with alternating LAFB/LPFB) (any age).
4. New or indeterminate age bifascicular block (RBBB with LAFB or LPFB, or LBBB).
5. Mobitz type II second-degree AV block.
Class IIa
1. RBBB and LAFB or LPFB (new or indeterminate).
2. RBBB with first-degree AV block.
3. LBBB, new or indeterminate.
4. Incessant VT, for atrial or ventricular overdrive pacing.
5. Recurrent sinus pauses (greater than 3 seconds) not responsive to atropine.
Class IIb
1. Bifascicular block of indeterminate age.
2. New or age-indeterminate isolated RBBB.
Class III
1. First-degree heart block.
2. Type I second-degree AV block with normal hemodynamics
3. Accelerated idioventricular rhythm.
4. Bundle branch block known to exist before acute MI.

Permanent pacemaker
1. Sinus node dysfunction - Class I, Class II, Drug-induced sinus node dysfunction
2. Acquired AV block - Class I, Class II, Drug-induced AV block
3. Post myocardial infarction - Class I, Class II
4. Neurocardiogenic syncope - Class I, Class II
5. Congenital complete heart block
6. Neuromuscular diseases
7. Special circumstances - Long QT syndrome, Hypertrophic cardiomyopathy, Heart failure, Cardiac transplantation, Bradycardia-induced ventricular arrhythmias

Homework 3: Metabolic equivalents (METs)

METs measures an average person's metabolic rate (metabolic rate at rest: metabolic rate while performing a task). A mask is worn to measure oxygen consumption and carbon dioxide exhaled.

Homework 2: Causes and treatments of supraventricular tachycardia

Supraventricular tachycardia is a rapid heartbeat originating from the atria.

Causes:
atherosclerosis
thyroid disease
chronic lung disease
blood clots
pericarditis
cocaine abuse
alcohol abuse
smoking
stress

Treatments:
The objective of treatment focuses on decreasing the heart rate and breaking up the electrical circuits made by the abnormal conducting pathways. Treatment can be divided into 2 broad categories: halting the acute episode and preventing any new ones.