Complexity

There's a fascinating disconnect between a simplified way of envisioning the heart and the actual thing. When most people, including medical students and physicians, think of the heart, it is a simple system composed of two atria, two ventricles, and the valves and interconnections. In most situations, this basic view is adequate. Most physicians can get through their day by reasoning through this four chamber box.

But as I delve deeper into anesthesia, especially anesthesia for cardiothoracic surgery and for patients with complex cardiac conditions, I've been challenged to think of the heart as more than that. In medical school, we learn the details of anatomy, but it is only when I have to interpret an echocardiogram or think through congenital malformations or place a pulmonary artery catheter that I have to envision the three-dimensional orientation of the chambers, recall the relative volumes and pressures, think about the location of each papillary muscle or individual leaflet of a valve.

It is only natural to simplify things to the very essentials of what is necessary to accomplish a task, and so it makes sense that nearly all of us reduce the heart to a four chamber box. But as I remind myself of the details I learned in the past and apply them to clinical situations now, I gain an immense appreciation for this organ.

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