I Can See Health

Jinghua Second Hospital.

Dormitory in Guipei Building.

Lu Chen took out his mobile phone and excitedly opened the electrocardiogram of the heart transplant patient.

The heart has 4 chambers.

There are left atrium and right atrium above, and left ventricle and right ventricle below. The atria and ventricles on the same side communicate with each other.

The patient received bicaval technology.

The recipient's left atrium and great vessels were preserved, and the right atrium and ventricle were resected.

Therefore, the patient received the transplantation of the right atrium and ventricle, while the left atrium was preserved.

If the patient originally had atrial fibrillation and his donor was in sinus rhythm, what would be the ECG findings?

Lu Chen carefully checked the electrocardiogram and compared each lead.

Sure enough, he found an unusual p wave among the small f waves of the electrocardiogram.

A conventional electrocardiogram has a total of 12 leads.

In lead v1, Lu Chen found a less obvious sinus p wave and a small f wave belonging to atrial fibrillation.

P wave, belongs to sinus rhythm.

Small F wave belongs to atrial fibrillation rhythm.

Lu Chen looked surprised. In other words, this patient had both sinus rhythm and atrial fibrillation rhythm, two types of heart rhythms!

This also explains why the patient's heart rhythm is regular.

There are two different heart rhythms in one heart!

This is completely contrary to our normal thinking!

The heart rate and ventricular depolarization did not change and were both regular.

It’s just that the atrial waves became irregular later.

Based on the surgical operations the patient underwent, Lu Chen could speculate that the left atrium may be in an isolated state.

Due to asynchronous atrioventricular contraction and valve problems, the left atrium enlarges and atrial fibrillation occurs.

Ventricular activation is conducted through the sinoatrial node and right atrium, which is also regular.

So what appeared was isolated left atrial fibrillation that looked like atrial fibrillation.

However, the dominant heart rhythm originates from the donor and is sinus rhythm.

The atrial depolarization potential recorded by the electrocardiogram is the composite potential of the left and right atria, so atrial fibrillation rhythm and sinus rhythm appear simultaneously on one electrocardiogram.

"Congratulations, the system upgrade completion rate has increased!"

Lu Chen looked happy.

The system's prompts undoubtedly proved his conjecture correct.

Lu Chen was very happy to be able to solve this difficult electrocardiogram problem.

However, it also made him realize his own shortcomings.

His clinical experience was not rich enough. When faced with such a difficult patient, he failed to quickly judge the patient's condition.

Electrocardiography is a subject with a low threshold but a very high upper limit.

Although his current electrocardiogram level is higher than that of the people around him, there is still a big gap compared with those professional electrophysiology experts.

…

Wang Zihao, who was already lying down, looked at Lu Chen, who was looking happy, and said strangely: "Lu Chen, what's wrong with you? Is the electrocardiogram so good?"

This was the first time he saw someone staring at the electrocardiogram and smiling stupidly.

"Zihao, thank you for the suture monster." Lu Chen smiled.

"Ah?" Wang Zihao blinked, "You also play games?"

"I won't fight." Lu Chen shook his head, "Your Yasuo is too good. It's very good for food."

Wang Zihao: "..."

After solving the problem of this electrocardiogram, Lu Chen went to bed and took a nap.

Only by combining work and rest can we work and study better.

…

Lu Chen fell asleep, but Fan Zhiping could not.

In a rental house near Jinghua Second Hospital, he repeatedly studied the electrocardiogram of the heart transplant and even consulted a lot of relevant information.

But still no clue.

I didn't sleep well last night, and I didn't sleep well at noon today.

When it was time to go to work, Fan Zhiping closed his eyelids and walked slowly towards Jinghua Second Hospital.

As soon as he reached the door of the doctor's office in District 8, he heard the sound of someone discussing.

"The donor is in sinus rhythm and the recipient is in atrial fibrillation rhythm."

"So this EKG shows two heart rhythms at the same time!"

"How did Senior Brother Lu come up with this complicated electrocardiogram?"

Fan Zhiping, who was standing at the door, was shocked.

He could vaguely hear the conversations among the people in the room, but he couldn't hear them clearly.

He quickly walked into the doctor's office and saw Lu Chen explaining the electrocardiogram to everyone.

He didn't even bother to go to the duty room and change into a white coat, so he got close to everyone.

Just listen to Lu Chen continue: "Other leads may not be visible clearly, but this lead v1 is very obvious, with sinus P waves and small F waves of atrial fibrillation... The patient has a heart transplant and retains the left Atrium, so the electrocardiogram showed atrial fibrillation in the left atrium and sinus rhythm of the donor..."

Fan Zhiping's eyes widened and he looked away from his previous dejection.

It only took one afternoon for Lu Chen to solve this electrocardiogram.

In the morning, everyone was obviously helpless with this electrocardiogram!

Fan Zhiping now wished he could squeeze next to Lu Chen and get closer to listen to his explanation.

…

At this time, Lu Chen was sitting in the middle of everyone.

He received five more points of gratitude.

"Congratulations, I received a +1 thank you from Yu Huihui!"

"Congratulations, I received a +1 thank you from Yao Jie!"

"..."

"Congratulations, I received a +1 thank you from Fan Zhiping!"

Lu Chen looked around and saw that Comrade Fan had also arrived, and he hadn't even had time to change into his white coat.

"Jiao Lu...Lu Chen, I have a question."

Fan Zhiping almost blurted out the words "Professor Lu", but luckily he swallowed it back in time.

When Lu Chen heard what he said, cold sweat broke out on his forehead, "Doctor Fan, please tell me."

Fan Zhiping paused and said slowly: "Why is the patient's heart rhythm regular? According to what you said, the patient's electrocardiogram shows two heart rhythms at the same time, one is atrial fibrillation and the other is sinus rhythm. The heart rhythm can be regular. But it can also be uneven?”

Lu Chen frowned. He had also thought about this question, but he couldn't find a definite answer yet.

He thought for a long time before speaking out.

"It may be because the left atrium is isolated and not connected to the transplanted right heart, so the dominant heart rhythm is the right heart. Therefore, the overall electrocardiogram shows the sinus rhythm of the right heart."

Fan Zhiping nodded.

At present, this explanation seems to be the most likely.

He looked up at Lu Chen, admiration in his eyes.

"Professor Lu" is really amazing!

He chose to follow Lu Chen in the Eighth District of Heart, and it was a right choice.

…

After discussing the patient's electrocardiogram, everyone began to work separately.

At four o'clock in the afternoon, Li Yao returned to the ward.

After asking if there were any seriously ill patients in the team, Sun Guoguo reported them one by one.

"I had a new aortic dissection this morning, and another one after a heart transplant."

"There was another case of broken heart syndrome yesterday..."

"There are also three patients with myocardial infarction and two patients with severe heart failure."

…

Li Yao was sitting in the office, flipping through the medical records of all patients.

"There are quite a lot of critically ill patients. Guoguo, you have to keep the patients under other people's care and let them go. You have to give everyone a chance to practice, but don't let them go too much to avoid making mistakes."

"Well, don't worry." Sun Guoguo said with a smile, "The junior brothers and sisters are very good. They don't need me to worry about them. If there are any changes in their condition, they will report them in time."

"That's good." Li Yao nodded, and she suddenly found the electrocardiogram of a heart transplant patient. "Hey, this electrocardiogram is quite rare. Can you see what it is?"

After Li Yao finished speaking, he saw everyone's expressions were a little strange.

"What's wrong?"

Sun Guoguo whispered: "Teacher, is this an electrocardiogram showing the coexistence of sinus and atrial fibrillation rhythms?"

"Guoguo, it's not bad." Li Yao looked surprised, "The level of interpretation has improved a lot."

Sun Guoguo shook her head quickly and pointed at Lu Chen beside him, "Junior brother Lu saw it."

Lu Chen smiled and scratched his head but said nothing.

Li Yao glanced at Lu Chen, the smile on her face was still bright, but the surprise in her eyes was a little less.

She knew that Lu Chen was a member of the elite group of Jinghua Electrophysiology, and he got in through his own efforts.

He could see this kind of electrocardiogram, so it wasn't that strange.

"Okay, I've seen all the patients, so let's do this for now." Li Yao said, "If you have any questions, please report to me at any time."

"Copy that." Everyone replied in unison.

After Li Yao finished speaking, she stood up and prepared to turn around and leave.

As soon as she walked out of the office, she suddenly stopped and looked back at Lu Chen.

"Lu Chen, come to my office now."

Lu Chen was stunned, responded quickly, and then followed Li Yao.

…

The furnishings of the director's office were as usual.

The bookshelf is filled with books related to cardiology, including coronary intervention, electrophysiology, anatomy, etc.

Next to the desk, there is a thick stack of documents.

"Lu Chen, you performed well in this national skills test. The school will have the opportunity to go out for exchanges next year. Originally, the quotas were fixed, but this time you school team members will have the opportunity, so you must take advantage of it."

Lu Chen and Li Yao sat opposite each other.

"Okay, thank you, teacher." Lu Chen smiled.

The opportunity to go out and communicate is rare.

The five members of their school team occupied five of the spots.

"No need to thank me, you earned this through your own efforts." Li Yao smiled and continued, "I came to you today to tell you something. I asked you to join the Jinghua Electrophysiology Association before. Give you the opportunity to gain access to cutting-edge academic knowledge in advance.”

"Next weekend, the Jinghua Electrophysiology Association will hold an academic exchange meeting. At the end, there will be an opportunity to share and report cases. See what suitable cases are available and prepare."

"Prepare the case?" Lu Chen's reflex arc slowed down by half a beat and he didn't react for a while.

"Well, I will let you report the case at the exchange meeting." Li Yao nodded, "Conduct academic exchanges with other electrophysiology doctors."

Lu Chen was stunned.

Let him, a graduate student, report cases at such a conference?

This...isn't this not good?

Even though Lu Chen rarely participated in such academic exchange meetings, he also knew that the people who spoke at the conference should generally be working attending doctors or above.

"What, you don't want to go?" Seeing that Lu Chen didn't respond, Li Yao raised her eyebrows.

"No, no, I want to go, of course I want to go!" Lu Chen nodded quickly.

Of course he had to seize this opportunity to show his face and gain reputation!

"That's good." Li Yao smiled, "I thought you had stage fright."

Lu Chen shook his head, and then hesitantly said, "Teacher, would it be weird for me as a graduate student to report..."

"Don't worry. Although you are the only student this time, you are not a precedent." Li Yao said, "There have been students who have reported relevant cases on stage before. The identity of the students is secondary. The main thing is whether there is anything outstanding about the cases you shared. In this way That’s the most important thing!”

Lu Chen nodded.

If Teacher Li Yao can give him this kind of opportunity, of course he must prepare well.

"Is the case related to electrophysiology?" Lu Chen asked.

"Yes." Li Yao nodded, "Electrocardiogram, electrophysiology combined with clinical practice, you find a suitable case, then make it into a ppt, complete it and send it to me before next Friday, because it will be lectured on Sunday afternoon."

"OK."

…

Leave the director's office.

A string in Lu Chen's heart became tense again.

After finishing the national skills test, he thought he could take a break.

Now I have to invest in a new round of learning.

This is a municipal academic conference, and doctors from several major hospitals in Jinghua City will come.

Lu Chen wants to speak at this meeting. He is currently facing two problems.

First, the selection of cases.

Second, the production of ppt.

Lu Chen had several candidates in mind when it came to selecting cases, but he still had to consider them carefully.

Regarding the production of ppt, Lu Chen did it when he was an undergraduate, but it was just a few simple pictures without any technical content.

At this level of conference, the content is important, and the production of ppt and the speaker's speech level are also extremely important.

Lu Chen felt that he had agreed to Teacher Li Yao a little too readily.

It is really a challenging task to complete these contents within a week!

…

Back to the doctor's office.

Lu Chen looked at Ke Yue and Jiang Qingyan who were standing aside.

"Can you do ppt?"

Jiang Qingyan and Ke Yue both shook their heads.

Lu Chen looked at Sun Guoguo beside him.

Sun Guoguo should be able to do ppt, but Lu Chen knew that she was preparing for the Ph.D. exam recently, so he couldn't trouble her.

"Let's find the case first, determine the theme content, and then consider the content of the ppt." Lu Chen thought in his mind.

Without content, no matter how beautiful the ppt is, it is just empty talk.

Throughout the afternoon, Lu Chen did not admit any new patients.

In his spare time, he has been searching for suitable cases.

"Damn it, this patient is too difficult to deal with."

From the side, Fatty Cheng's voice came over.

The voice was slightly loud, and Lu Chen's attention was attracted to him.

Cheng Peng looked at the computer with a grimace and couldn't help but shake his head and sigh.

"What's wrong?" Lu Chen asked confused.

Cheng Peng shook his head and sighed: "I just admitted a middle-aged woman with a history of tachycardia. She got angry after quarreling with others and suddenly fainted. But her vital signs were normal. , and never woke up.”

"Have you had a CT scan?" Lu Chen frowned.

"The blood tests and head CT scans are normal. I just fell asleep all the time and couldn't see anything wrong." Cheng Peng said with a bitter smile, "We all suspected that she was faking. UU Read www.uukanshu.net "

"Pretending?" Lu Chen raised his eyebrows.

Are there still people pretending to be ill these days?

"Yes. When I checked her pupils, I found that she was a little resistant, so I began to suspect that she was faking it." Cheng Peng said, "The senior doctors in our team have all gone down to the fourth floor to perform operations. I just informed my senior brother. It will take a while for him to come up."

Fan Zhiping stayed by Lu Chen's side, and he also heard Cheng Peng's complaints.

"I have a way to make her wake up on her own." Fan Zhiping suddenly said.

Lu Chen and Cheng Peng turned to look at Fan Zhiping.

"What can I do?" Cheng Peng asked quickly.

"Push a furosemide."

Fan Zhiping grinned.

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