Translation 101

So glad to hear Bill smiles when he wakes up! OK, here’s an attempt at translating the cardiologist’s note, posted April 10.

MGUS - Monoclonal Gammopathy of Undetermined Significance. This refers to a blood result showing an unusually high level of an abnormal immune system cell found in the blood. It suggests a systemic auto-immune problem such as lupus, multiple myeloma, scleroderma, etc. A person who has this blood test result but has not been diagnosed with a disease will be monitored in case other symptoms arise that allow a diagnosis to be made. In Bill’s case, it just reinforces the diagnosis of scleroderma.

http://www.mayoclinic.com/health/monoclonal-gammopathy/DS00870

ILD – Interstitial Lung Disease. A fancy way of referring to scar tissue on the lungs, which reduces the amount of oxygen that the lungs can push into the blood. http://www.mayoclinic.com/health/interstitial-lung-disease/DS00592

Raynaud’s phenomenon – spasms in the blood vessels that interrupt blood flow to the hands and feet.

Dry Gangrene - tissue death caused by interruption of blood flow. There are several types of gangrene. “Dry” refers to gangrene that is not associated with bacterial infection, occurs slowly over time from blood vessel disease (like Raynaud’s), and causes the skin to appear dry.

http://www.mayoclinic.com/health/gangrene/DS00993

SOB – shortness of breath

c/b – Could this be an abbreviation for “call back,” meaning that Bill was returned from the hospital to the ICU?  

anuric – not passing more than a very small amount of urine per day

AKI – acute kidney injury. “Injury” can refer to illness in this context.

HD – hemodialysis to clean the blood since the kidneys aren’t working.

G tube – stomach feeding tube (“gastronomy tube”)

Dysphasia – impaired ability to communicate due to brain injury. I am almost certain this is a typo and should be dysphagia, which means difficulty swallowing.

http://medical-dictionary.thefreedictionary.com/dysphagia

So, in English: The patient has blood cells consistent with an auto-immune disease. He has a diagnosis of scleroderma which is complicated by scar tissue on the lungs and blood vessel spasms that have caused tissue death in his hands (fingers), and he was originally admitted with increasing shortness of breath. He has been in the hospital for treatment and was called back to the ICU with acute kidney illness in which he passes little urine and must be on dialysis. He has required multiple intubations (tube down the windpipe for breathing), and he has a stomach feeding tube because he has trouble swallowing.

Now, Part 2:

asystole arrest – absence of hearbeat, no electrical or mechanical activity in the heart.

carvedilol – a drug called “Coreg” that is used to treat high blood pressure and certain types of heart failure by relaxing blood vessels to improve blood flow. The note mentions that Bill was on Coreg when the cardiac arrest ocurred. Coreg can help with certain heart problems, but it can make other types of heart problems worse. That’s one reason why Dr. Watanabe is trying to figure out exactly what caused Bill’s cardiac arrest. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001012/

http://medical-dictionary.thefreedictionary.com/carvedilol

bifascicular block – Bill’s heart was not receiving the proper electrical signals to continue beating regularly. This implies that his heart muscle and blood vessels are not the problem, but that instead it is something in the electrical conduction system of the heart.

http://www.americanheart.org/presenter.jhtml?identifier=4611

first degree AVB - atrioventricular block. The atrioventricular node is a bundle of tissue between the top two chambers (atria) and the bottom two chambers (ventricles) of the heart. This bundle is responsible for transmitting the electrical signal that keeps the heart beating. When it is blocked, the signal cannot get through properly. (It is the electrical signal, not the blood vessels, that are blocked.) A first degree block is the mildest; third degree is the worst. The first degree block means that signal transmission is a little too slow, causing an improper beating rhythm. Teenagers and well-trained athletes sometimes have this problem, and alone it does not require treatment.

http://www.mayoclinic.com/health/bundle-branch-block/DS00693

Just for clarification, a “heart attack” refers to impairment of blood flow to the heart muscle. “Cardiac arrest” is not the same thing: it refers to impairment of the conduction of the electrical impluse that makes the heart muscle contract. A pacemaker can regulate the impulse. It sounds to me (guessing here) that Dr. Watanabe is trying to determine whether the electrical impulse problem is serious enough to warrant the attachment of a pacemaker.

http://www.mayoclinic.com/health/bundle-branch-block/DS00693

primary cardiac – I don’t know what this means. Maybe he is guessing that the heart conduction problem was the primary cause of the cardiac arrest. (Alternatively, it is possible that the strain on Bill’s system from kidney or lung problems led to the cardiac arrest as a kind of side effect.)

telemetry - measurements made by radio signal from a distance. Sorry, I’m lost here. Could it mean simply that the tests were done by EKG from outside the skin rather than directly on the heart?

Mobitz block – This is a test result from an EKG that shows variations of second degree atrioventricular blocks. But this wording is followed by “without higher degree AV block seen.” So, Bill’s results are unusual: he appears to have had only a first degree AV block during cardiac arrest, except for this one type of test that showed variations of a second degree block. The importance of this has to do with the pacemaker—if Bill had only a first degree block (mild slowing of the electrical transfer), then a pacemaker might only be an extra procedure that he shouldn’t undergo given his weak condition. But if he had a second degree block (more significant problem with electrical transfer), then a pacemaker might be necessary.

http://medical-dictionary.thefreedictionary.com/heart+block

AV nodal blocking agent: This refers to any drug that might block the atrioventricular node in the heart, that bundle of tissue that transmits the electrical signal from upper to lower chambers. They want to avoid any such medication.

So, part 2 in English: The patient’s heart stopped because the bundle of tissue between the upper and lower chambers of his heart did not transmit the electrical beating impulse properly. The problem appears to have been relatively mild (first degree), with the exception of one test that suggested some second degree blockage of the impulse. This patient is a poor candidate for the pacemaker because he has scleroderma with involvement of several organs and has been in the hospital for a long time with complex problems. The cardiologist recommends stopping Coreg and not prescribing any drug that might block the heart’s beating impulse.

Hope something here might be helpful… Sometimes it just feels comforting to have a little background in normal English rather than all the medical jargon.

--Janet