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Monthly Archives: March 2012

This post relates to

2011 Queensland Maternal and Perinatal Quality Council, Review of Pregnancies, Births and Newborns in Queensland

This was a report released by the Queensland Government toward the end of last year. Had I been blogging then I would have posted hot off the press but in any case it remains most important. It’s a big doc but the Executive Summary on page 7, 8 and 9 is a a quick read.

Maternal health is excellent in Australia but as you can see from the report cardiovascular disease and mental health remain significant issues that account for the vast majority of indirect maternal mortality (see the report for definitions). The report doesn’t address the issue of cardiovascular morbidity which is considerable but does make some important, cardiac specific recommendations.

Including that

When pregnant women present with common symptoms such as chest pain, palpitations, syncope and shortness of breath, there should be a low threshold for considering significant cardiovascular disease and referral for specialist opinion and investigation within a clinically appropriate time frame,

and that,

In the event of sudden cardiac death, autopsy is essential and arrangements should be made for cardiac tissue to be examined by a pathologist with a specific interest in cardiac pathology where initial findings are negative. Pathologists and clinicians should be aware of the emerging role for molecular autopsy in cases of possible arrhythmic death. 

You can download the whole report or sections here

A young physician scientist arrives for a visit to the laboratory of Willem Einthoven. It’s Leiden, around 1902…

Intern: Hey!

Einthoven: Ah yes, the intern. Sit quietly in the corner I’m busy.

After a few minutes the young physician can no longer contain either his enthusiasm nor his curiosity

I: What..is..that?

E: That? That is a string galvanometer.

I: A string what?

E: It’s a striiing gaaaalll-van-o-meter!

I: Cool!

E: Indeed!

I: What does it do?

E: Well it measures the electrical signal generated by the heart during the cardiac cycle.

I: Really? So the heart generates an electrical signal during the cardiac cycle.

E: Err, yes. That’s what I said.

Pause

I: Why would you want to measure that?

E: Well I’m not sure yet but I think it might tell us a lot about the normal heart structure, maybe function and I’ve got a feeling it might tell us something about when the heart gets injured.

I: That could be really useful. That could be used on hundreds of patients… maybe even thousands….

E: Now steady on…

I: There could even be a whole new branch of cardiology based on that sort of thing…

E: You’re getting carried away now… Anyway, that would be pretty dull.

I: Yeah, I guess so. But anyway, if it can detect injury to the heart  it could still be used on a lot of patients. Can you teach me how to run it.

E: Errr…No, everyone asks me that. No I won’t!

I: Why not?

E: Well it’s, it’s, it’s…. very difficult, very demanding. You could never learn.

I: But if you taught me. Anyway how hard can it be. How many did it take before you could do it well

E: Lots

I: How many?

E: Lots. Heaps and heaps…about 40…

I: Well I have a lot of time. I could do that.

E: Stop pestering me. I won’t show you how to do it. That’s final, It’s mine and only I can use it. If you carry on like this you’ll have to leave.

I: OK, OK, OK. Sorry…

Some more time passes

I: Don’t you think that people might miss out if you are the only person in Leiden able to use the string galvanometer?

E: The only person in the world actually.

Silence

I: How about I build my own, practice a lot and send you some results?

E: No, no you mustn’t do that!!

I: Why?

E: Well…well…it’s dangerous, that’s why.

I: Dangerous?

E: Erm, well, err…yes, really dangerous. So dangerous that you have to be in a really big hospital like this, or maybe even an institute. Otherwise the patient could die from the complications sustained by using the string galvanometer.

I: Crikey, how often does that happen?

E: Well, let’s see… about one in every 1000 cases.

I: That’s not many!

E: Well it’s enough, and when it happens you sure want the patient to be at the institute so their life can be saved. Your place is too far away…

I: That maybe, but that’s a lot of patients missing out while you wait for one to get a complication.

E: Well, that’s too bad! You’re too far away. You can’t do it. I won’t allow it.

I: OK. That’s a shame though….

Some time later…the young physicians enthusiasm has waned a little…

I: Well thanks Prof Einthoven I’ve learnt a lot today. I won’t forget about the string galvanometer – you know, I think it has a big future… I’ll keep in touch.

E: Sure, send me a telegram next time you’re around these parts.

I: OK I will. Actually I’ll send you an email. Bye.

The intern has left

E: Fine……wait a minute…an ‘e’ what??

I: (from halfway down the stairs) An email? Oh,  it’s just this new kind of message I’ve invented. No paper, delivered immediately…that kind of thing.

E: No paper? Immediate? Wait, wait! Come back, tell me more about this email….

….but the student has already disappeared off into the foggy evening…

Apologies to Willem Einthoven and his descendants. Einthoven received the 1924 Nobel Prize for Medicinefor his discovery of the mechanism of the electrocardiogram‘. Over a hundred years after his discovery the electrocardiogram remains the single investigation required in order to diagnose acute ST elevation myocardial infarction and initiate repercussion therapy.

Interestingly his biography on the Nobel website states that ‘The string galvanometer has led countless investigators to study the functions and diseases of the heart muscle. The laboratory at Leiden became a place of pilgrimage, visited by scientists from all over the world.’

You can read his Nobel lecture here