I Can See Health

   Chapter 134 As expected of Professor Lu! (Ask for a ticket!)

   "Doctor Fan, let me tell you my personal opinion. Unlike Dr. Min's diagnosis, I think there are two other possibilities."

What? Are there two other possibilities?

  Lu Chen's speech just appeared in the group, and it attracted the attention of everyone in the group.

  They scratched their ears and cheeks, they couldn't even think of a diagnosis?

   There are two possibilities for Professor Lu to come out at once?

   Lu Chen's remarks even attracted some melon eaters.

   For example, Zhang Wulong from the People's Emergency Department of Fengm County.

   It was he who invited Fan Zhiping to join this Jinghua Electrophysiology WeChat exchange group.

   The emergency department happened to be free for a while, and he just saw this scene in the group when he swiped his phone.

   "Yo, this is the beginning of a battle between two members of the Jinghua Electrophysiology Association?"

   After all, it was Professor Lu who helped him last time, and Zhang Wulong still hoped that Lu Chen would win.

   However, Zhang Wulong also took a look at the case just now.

   He felt that Professor Min's diagnostic analysis seemed reasonable!

  What new work can Professor Lu do?

   Everyone is looking forward to Lu Chen's next speech.

  …

   "Has the patient's heart ultrasound been done?"

   Lu Chen's message appeared in the group.

Fan Zhiping grabbed his phone and responded immediately: "Professor Lu, the patient has just come to the department and has not had time to do it yet. Moreover, in our small hospital, there is no bedside echocardiography, so we can only wait for the patient's condition to improve, and let him go tomorrow or the day after. Do."

  Min Xiaobo noticed Lu Chen's speech in the group.

   "Heart ultrasound? What is he doing with a heart ultrasound?"

  Fan Zhiping was also curious, what other insights does Professor Lu have?

   Just now Min Xiaobo made it very clear that his reasons have persuaded most of the people in the group, including him of course.

  …

  Lu Chen thought to himself: "Have you had an ultrasound yet? That's not a good diagnosis."

Before   , he carefully checked the two electrocardiograms sent by Fan Zhiping.

   Actually, carefully observe this second electrocardiogram.

   still can find a lot of clues.

   ECG showed extensive T wave inversion, with upright T wave in lead avR, and deepest T wave inversion in leads V3 and V4.

  The depression of the T wave is asymmetric, and its vector points to the apex!

   The patient's troponin is normal, and it is difficult to explain such a wide T wave inversion only by coronary ischemia!

   This is also the second contradiction Lu Chen discovered!

  Assume that the patient experienced increased chest tightness after being injected with cedilan intravenously.

  Lu Chen thought of two possibilities!

"The ECG has reversed elevation and depression of the ST segment, which is considered to be caused by myocardial hypertrophy. If the patient has hypertrophic obstructive cardiomyopathy, after cediline strengthens the heart, it will aggravate the obstruction of the ventricular outflow tract and reduce cardiac output. , and then lead to insufficient perfusion of the brain and coronary arteries, which manifests as chest pain, chest tightness, and difficulty breathing, that is, the symptoms of heart failure are aggravated!"

   When Min Xiaobo saw Lu Chen's speech in the group, his eyes suddenly lit up.

Yup!

  This ECG does have the possibility of hypertrophic obstructive cardiomyopathy.

   For patients with hypertrophic obstructive cardiomyopathy, the symptoms of chest tightness and chest pain will be aggravated after using cedilan!

   This is equivalent to a blocked water pipe, and you have to increase the horsepower and give it more pressure.

  This will not only prevent the water from coming out, but may also damage the water pipes.

   As long as it is a cardiologist, almost all know that cedilan is contraindicated in patients with hypertrophic obstructive cardiomyopathy.

   However, when patients experience increased chest tightness symptoms using cedilan, few people think that this is hypertrophic obstructive cardiomyopathy!

   No wonder Lu Chen asked the patient if he had had a cardiac ultrasound.

  Hypertrophic obstructive cardiomyopathy is generally diagnosed by ultrasound, and cannot be seen on chest CT.

  Min Xiaobo was a little annoyed, why didn't he think of such a simple knowledge point?

   People from other departments in the group may not be able to understand this mood, but as long as they are from the Cardiology Department, the mood at this time is somewhat similar to that of Min Xiaobo.

   A very simple question, but after racking my brains, I didn't think of anything.

   Then, after someone called it, I suddenly realized it!

   This feeling, with a bit of annoyance and a hint of joy.

  …

   Zhang Wulong of the emergency department was a little puzzled. He didn't quite understand the professional knowledge in his heart.

   But after Lu Chen finished speaking, no one responded in the group for a long time.

   Did Professor Lu stumble?

   At this moment, Fan Zhiping spoke again.

   "Professor Lu, this is the first possibility, didn't you say there is a second possibility?"

   Actually, when he saw the words hypertrophic obstructive cardiomyopathy, he knew that Lu Chen was probably right!

   He is the doctor who received this patient, and he has the most intuitive feeling.

   According to the patient's symptoms, signs and auxiliary examination results, the probability of hypertrophic obstructive cardiomyopathy is very high!

   But just as this thought occurred to him, he thought of what Lu Chen said.

   There are two possible diagnoses!

  Fan Zhiping just confirmed the diagnosis of hypertrophic obstructive cardiomyopathy, and now it is shaken again.

   All because, Lu Chen said there are two possibilities!

  The group was very quiet, and everyone was waiting for the next possibility of Lu Chen.

  Min Xiaobo was sitting in the duty room with a very serious expression. He was also looking forward to Lu Chen's next speech.

  Hypertrophic obstructive cardiomyopathy was something he did not expect, but he was not very convinced.

   This knowledge point is very simple, but he ignored it.

   He wanted to see, what convincing diagnosis would this Lu Chen, who is also an elite member of Jinghua Electrophysiology Association, come up with? !

  …

  Eight districts in the heart.

   When it was time to get off work, Yue stood up and stretched.

   Jiang Qingyan has gone to the skill center for training recently, and she doesn't want to go to the cafeteria alone to eat.

   "Lu Chen, let's go to dinner together at noon."

   "Oh, I still have something to do, why don't you go first, don't wait for me."

  Lu Chen was editing the information with his mobile phone in his hand without raising his head.

   This sentence is rather long.

  Lu Chen checked it and sent it out without any typos.

"The second possibility is stress cardiomyopathy. The cause may be chronic obstructive pulmonary disease, because chronic obstructive pulmonary disease itself is hypoxia, which can easily lead to rapid heart rate, sympathetic excitement, and easy release of large amounts of catecholamines, especially after menopause. older women are more likely to develop stress cardiomyopathy on this basis!"

"Cedilan is similar to catecholamines (dopamine, epinephrine, norepinephrine), and after use, it will aggravate the condition! Second, stress cardiomyopathy has hyperactivity of the basal part, weakened apical contractility, and outflow tract obstructive hypertrophy. type cardiomyopathy is quite similar."

   "In my opinion, do a cardiac ultrasound first to rule out hypertrophic obstructive cardiomyopathy; if not, do a coronary angiography to determine whether there is stress cardiomyopathy."

  If it is said, Min Xiaobo may not be quite convinced about the first possibility mentioned by Lu Chen.

   When Lu Chen mentioned stress cardiomyopathy, he was puzzled, then shocked, and finally just shook his head helplessly.

   Combined with this case, the diagnosis of stress cardiomyopathy is well-founded and convincing!

  Why, he wouldn't think of the diagnosis of stress cardiomyopathy!

   "Who the **** is he?"

  Min Xiaobo had to re-examine, this elite member named Lu Chen.

  …

   After Lu Chen finished speaking in the group.

The    WeChat group exploded.

   Stress cardiomyopathy was not thought of by all.

   But after listening to Lu Chen's analysis, everyone thinks it makes sense!

   The disease cannot be diagnosed, but it does not hinder the judgment of the disease.

   "Professor Lu's analysis is great!"

   "I'm also in the Department of Cardiology! Although I know all the diseases that Professor Lu said, I just can't think of one!"

   "Dr. Fan, when the patient's symptoms improve, quickly push the patient for examination! I really look forward to the patient's final diagnosis!"

   This group of people is really a mess!

   Fan Zhiping had to sigh.

   "As expected of Professor Lu!"

   Make up for the second shift owed yesterday, and still owe one shift yesterday.

   Plus today's guaranteed 2 updates, 1700+ recommended tickets, and an additional chapter for recommended tickets.

   The monthly pass is 300+, which is not enough for the time being.

   So I still owe 4 more updates, I will try to pay it off tonight!

   (end of this chapter)