While medical dramas can be entertaining and popular, they are often wildly inaccurate when it comes to actual medicine. In this exclusive 番茄社区 video, John Higgins, MD, of McGovern Medical School at UTHealth in Houston, goes through the first episode of the highest-rated new drama on broadcast television, The show centers around a brilliant surgical resident with autism spectrum disorder and Savant syndrome. But in this particular instance, the show's medical savvy on basic electrophysiology and anatomy may be lacking.
Following is a transcript:
"The Good Doctor," the new series on ABC, portrays quite accurately a young surgical resident with autism and Savant syndrome, and him dealing with various medical problems that arose.
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On the way to the hospital in the ambulance with the emergency medical folks, Shaun is sitting there watching the ECG monitor and he comments that there is a change in the amplitude of the R wave on the ECG monitor, and then Shaun wants to do an echocardiogram. Now the reason he is wanting to do this is he is suspecting that this boy has fluid around the heart, or what we call a pericardial effusion. However, certainly with a large buildup of fluid and in someone who has tamponade, which is an elevation in pressure in that fluid, you would normally see tachycardia. And in this case, we don't. The boy's heart rate is 86.
Now they get to the hospital and, again, Shaun insists that they do the echocardiogram. They do perform the echocardiogram and there is no fluid at all around the heart. Then they discuss the fact that perhaps a shard of glass that came in through the right jugular vein may have come down the right brachiocephalic vein and then down into the superior vena cava, and into the right atrium, and then may have actually punctured the right atrium.
Now if that would have happened, you would have had a lot of blood, again, coming out into the pericardial space rapidly and this would also build up pressure and cause cardiac tamponade. Again, the echocardiogram did not show any of this on the show. The echocardiogram showed no significant fluid around the heart.
There are other causes of electrical alternans, for example, supraventricular or ventricular tachycardia, pulmonary embolism, and ischemia, as well as severe heart failure. But again, this boy did not have any of those during the show.
The other discussion that went on was the fact that when they did think they saw something that might have been a small amount of fluid near the right atrium, and they commented that, "This would be a very unusual location for fluid to build up in someone who had, for example, a cardiac tamponande or an effusion."
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Well, in fact, the right side of the heart, by virtue of it having lower pressure, is the first place where we see an indentation on the right atrium, which can occur in both systole or diastole, or the right ventricle in diastole. So, this statement that they make in the show is not medically correct, and as well as the changes that we saw in the ECG, the electrical alternans, and in the association with tachycardia is highly specific for pericardial tamponade, which is a large effusion with a pressure on the heart, neither of which were present in this case.
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This is Dr. John Higgins for 番茄社区.