I Can See Health

   Chapter 133 Contradiction! (Seeking tickets and favorites!)

   At this time, "Professor Lu" was lying in front of the computer, writing down the course of the disease.

   Sun Guoguo couldn't stop Lu Chen's "lai" behavior in the department.

   We can only hope that as the school team selection approaches, he will be able to "return the prodigal son"!

   "Dududu..."

   The phone vibrated slightly.

  Lu Chen stopped typing, took out his phone, and glanced at it.

   saw the message notification bar, someone was in Aite himself.

  Professor Lu's words came into view.

  Lu Chen's face was not red or his heart was beating, he opened WeChat, and clicked on the group chat of Jinghua Electrophysiology Association.

   "It turned out to be asking for help to see an electrocardiogram."

   flipped up the chat log, and he immediately saw two electrocardiograms that appeared in the group.

   Click on the electrocardiogram and zoom in!

  Lu Chen started to read pictures.

   The heart rhythm of both ECGs is atrial fibrillation.

   But the basal heart rate is different, and other waveforms are also different.

  The first electrocardiogram showed rapid atrial fibrillation with frequent ventricular premature beats and ST depression.

  The second post-treatment ECG shows slow heart rate atrial fibrillation with extensive ST-segment depression and T-wave inversion.

   After reading the electrocardiogram, Lu Chen still didn't reply.

   Someone in the group started to ask questions.

   "Doctor Fan, is your electrocardiogram from the same person?"

   "Yes, from the same patient. After the drug treatment, the heart rate dropped, and then the ECG was reviewed!"

   "Doctor Fan, please tell me the patient's medical history in detail."

   "Okay, the patient was admitted to the hospital with dyspnea, and we consider heart failure... After the patient finished the intravenous injection of cedilan, the symptoms of chest tightness and palpitation began to worsen..."

  …

   After intravenously pushing cedilan, the symptoms of chest tightness aggravated

  Lu Chen frowned.

   From the electrocardiogram, rapid atrial fibrillation combined with heart failure is the absolute indication for cedilan.

  How could the symptoms get worse after the cedilan was given intravenously?

  Other people in the group were silent for a moment when they saw Fan Zhiping's words.

   After all, this side reaction is somewhat unreasonable.

  Lu Chen didn't speak for the first time.

   He kept deducing in his mind, trying to sort out his diagnosis and find out the reason for the side effects of cedilan.

  Although an electrocardiogram does not represent the diagnosis of any disease, sometimes don’t underestimate the information contained in an electrocardiogram.

  A small graph, the changes of each waveform or vector can reflect the state of the heart!

   An excellent cardiologist is also an excellent electrophysiologist. He will find clues to the diagnosis from the details of the changes.

   And now, Lu Chen is on such a path!

  …

   About five minutes passed.

The    group started to speak one after another.

   "The electrocardiogram showed premature ventricular and T wave inversion. The possibility of digitalis poisoning cannot be ruled out, and the blood concentration of digitalis should be combined."

   "Whether it is an allergy to cedilan, which can cause bronchial asthma, acute pulmonary edema, coronary spasm, and lead to myocardial ischemia. Symptoms are relieved after diuretic, atomization and other treatments."

   "Is it possible that the patient has low potassium, which then leads to digitalis poisoning?"

  “…”

  The opinions of the people are mostly concentrated on the poisoning of digitalis (cedilan).

  Lu Chen shook his head slightly, he didn't quite agree with the doctors in the group.

   Half a stick of cedilan is injected intravenously, such a small dose.

   And the patient did not have gastrointestinal symptoms and yellow chlorophyll.

   There should be no digitalis poisoning!

   In the group for a while, no one could come up with a conclusion.

  Fan Zhiping has been following the news in the group to avoid missing some useful information.

  How he hopes to see "Professor Lu" appear again!

   I still remember the last time I was in the emergency department, it was Professor Lu who saw hypokalemia at a glance!

   Just when everyone was silent.

   An ID with the prefix "Jinghua Electrophysiology" spoke.

   Jinghua Electrophysiology Min Xiaobo: "Dr. Fan, does the patient have lung disease? Such as COPD?"

   Fan Zhiping, who is always following the group news, looked happy.

  Although that Professor Lu didn't speak last time, this Doctor Min with "Jinghua Electrophysiology" on his head should also be an expert of Jinghua Electrophysiology Association!

  Fan Zhiping quickly replied: "The chest CT results came out. The patient has chronic bronchitis and chronic obstructive pulmonary disease."

  Min Xiaobo, who was lying in the duty room, smiled slightly when he saw the message popped up on his phone.

   As expected!

   He continued to reply in the group: "I am currently considering cor pulmonale, perhaps patients with chronic obstructive pulmonary disease have hypoxemia, and the use of cedilan increases myocardial oxygen consumption, thereby aggravating the symptoms of myocardial ischemia."

   Seeing Min Xiaobo's reply, Fan Zhiping frowned.

   Even if it is pulmonary heart disease and heart failure, there will be no such side effects with cedilan, right?

  Fan Zhiping posted in the group: "Professor Min, I still don't quite understand what you mean."

   Min Xiaobo, who was lying in the duty room, sat up.

   paused, started to organize the language, and then posted it in the group.

   "The patient's electrocardiogram showed a fast ventricular rate and atrial fibrillation and frequent premature ventricular arrhythmias when he was admitted to the hospital. It stands to reason that cedilan is suitable."

"However, the patient's lung CT showed chronic bronchitis and emphysema. It should be pulmonary heart disease combined with right heart failure, and blood pooled in the systemic circulation. At this time, after intravenously pushing cedilan, its cardiotonic effect caused the left heart to shoot to the whole body. There is less blood, both the heart itself and the coronary arteries are ischemic, and the right heart is pumping more blood to the lungs."

"However, the left atrium is large, the left atrial pressure is high, the blood returning to the left heart is reduced, and the blood accumulates in the lungs, which invisibly leads to left heart failure. Squeaks and rales in both lower lungs."

"These are all manifestations of left heart failure. The symptoms are relieved after treatment such as diuresis and asthma, and the ECG is still atrial fibrillation, with frequent premature ventricular contractions, but the ST segment depression and T wave inversion in the leads are common, and myocardial ischemia occurs. Change."

   "I personally think that after intravenous injection of cedilan, secondary left heart failure, resulting in insufficient coronary blood supply."

   Fan Zhiping watched this long speech and had to admire the experts from the big hospital!

   Enough detail!

   Enough wonderful!

   And there is enough convincing!

   A group of "flattering" people immediately appeared in the group.

   "Like, Professor Min's analysis gave me a lot of energy!"

   "Professor Min is amazing! This can be analyzed!"

   "Thank you Professor Min for your pointers!"

  Lu Chen also had to admit that this was an extremely wonderful speech.

   If there is no solid theoretical knowledge, there will never be such a clear judgment!

   However, Lu Chen found one of the "hard wounds".

  According to Min Xiaobo, the patient not only has left heart failure, but also right heart failure.

   Left heart failure, mainly due to blood stasis in the pulmonary circulation, manifested as dyspnea.

   Right heart failure, mainly systemic blood stasis, manifested as jugular vein filling and edema of both lower extremities.

   But in Fan Zhiping's medical history description, the patient did not have any signs of right heart failure when he was admitted to the hospital!

   This is the paradox!

   "Dududu..."

The    WeChat alert sounded again.

  Fan Zhiping smiled and looked down.

   Hey, it's Professor Lu!

   He finally spoke!

   Make up for the first update owed yesterday.

   I was really busy on the night shift last night... I almost didn't sleep all night.

   The **** of the night shift is also black!

   (end of this chapter)