I Can See Health

  Chapter 38 Rare Medical Knowledge

   The ward round begins.

  Sun Guoguo walked in the front, and the others stood behind her, each holding the medical record folders of the patients in their beds.

   For rounds, the doctor must stand behind the hospital bed.

   This is a default rule, and it is also for doctors to better examine and examine patients.

   In addition, both doctors and patients should maintain an appropriate distance, usually about one meter, so that patients cannot feel alienated.

   "Bed No. 1, this is a patient diagnosed with coronary heart disease and unstable angina pectoris. He was just admitted to the hospital yesterday, and he is going to do coronary angiography in two days to assess the condition of the blood vessels."

   Coming to bed number 1, Jiang Qingyan began to report the patient's medical history.

   From the main complaint, the history of the present illness, the past history to the abnormal auxiliary examination, Jiang Qingyan reported the situation without omission.

After the    report was over, Sun Guoguo started the mode of inquiry and teaching.

   "Coronary heart disease is one of the most common diseases in our hearts, so let me ask you a question, a basic knowledge, how is coronary heart disease classified?"

   The two interns hid in the back, their heads bowed, for fear that their names would be called.

   "Junior Sister Jiang, you are in charge of this patient, so you can answer."

  Sun Guoguo pouted towards Jiang Qingyan.

   "Yes." Jiang Qingyan nodded, "Coronary heart disease is mainly divided into two categories, stable coronary artery disease and acute coronary syndrome."

   "Stable coronary artery disease, including ischemic cardiomyopathy, stable angina, occult heart disease."

   "Acute coronary syndrome, including acute myocardial infarction and unstable angina."

  Jiang Qingyan's coherence is very clear, Sun Guoguo nodded slightly after listening, "Well, that's very good."

"Why do you want to clarify the classification of diseases? It is because different types of diseases have different treatment methods and prognosis. Don't think that there is only one treatment for coronary heart disease. It is very important to first understand the disease classification of patients. Treating a disease in the same way is something only a barefoot doctor can do."

  Sun Guoguo's ward round mode is mainly based on questions.

  Different types of patients, she will ask different questions.

   ward rounds, which is also one of the important ways for young doctors to gain knowledge and clinical experience in clinical work.

   "Since everyone knows the classification of coronary heart disease, let's talk about the classification of acute myocardial infarction."

  Sun Guoguo continued to ask questions.

   The two interns were startled, and the heads they had just raised were slowly lowered again.

   "Junior Sister Ke, please answer."

  Ke Yue held several medical record folders, her eyes dodged a little, and she whispered: "Acute myocardial infarction is divided into acute ST-segment elevation myocardial infarction and acute non-ST-segment elevation myocardial infarction."

"are these all?"

  Sun Guoguo looked at Ke Yue suspiciously.

   Ke Yue lowered her head and bit her lower lip, "I, I know so much."

  Sun Guoguo looked serious and turned his eyes to the others.

   "Xiao Dong, what's your opinion?"

   Dong Hao is the male doctor in the group.

   This year is his second year of training, and he has also rotated other departments such as kidney, spiritual, and breathing before.

  Dong Hao touched his nose embarrassedly, "Senior sister, I'm the same as Ke Yue's, so I only know two categories."

   After listening to Dong Hao's answer, Sun Guoguo continued to look for the next "hunting" target.

   The hearts of the two interns became even more panicked.

   "Doctor Qu, do you have any other comments?"

  Sun Guoguo's eyes went directly past Lu Chen and the intern, and looked at Qu Yao, the only training doctor in the group.

"There should be other types, such as myocardial infarction caused by coronary spasm. In fact, there is no problem with coronary blood vessels, but some stressful situations have caused spasm of blood vessels." Qu Yao thought for a while, she was As the attending doctor, he has been involved in clinical practice for many years, and his clinical experience is much richer than those of these graduate students and regular training students.

"Well, Dr. Qu's clinical experience is still much richer." Sun Guoguo smiled, "Myocardial infarction, as the name suggests, is myocardial cell necrosis. The type Ke Shimei mentioned is the most common coronary artery in the heart. Myocardial infarction caused by thrombotic events is a narrow sense of myocardial infarction. However, in our Cardiology Department, there is also a broad sense of myocardial infarction, including all causes of myocardial cell damage, which can be called myocardial infarction.”

  Ke Yue, Dong Hao and the others all had a sudden realization when they heard Sun Guoguo's explanation.

   This new concept of myocardial infarction is rarely mentioned.

   "So, is there any other disease besides coronary spasm?"

   Qu Yao pondered and said, "Of course there are, such as myocardial cell damage caused by supraventricular tachycardia and third-degree atrioventricular block."

"Um."

  Sun Guoguo nodded slightly, as expected, doctors with clinical experience should know more about these issues.

   Education is important, but for medicine, experience is equally important.

   After all, people don’t get sick with standard textbook symptoms.

   "Are there any other types then?"

   Qu Yao frowned, "Other types... It seems that there are no more..."

  Sun Guoguo smiled, "Also, but it's not common, so it's normal for people not to know."

At this moment.

  Lu Chen looked like he was hesitant to say anything.

  Sun Guoguo saw it, did Junior Brother Lu Chen know?

   "Junior Brother Lu, you know?"

  Lu Chen nodded with a smile, and said, "There are five broad categories of acute myocardial infarction in the world."

   "What? Five?"

   Everyone present, except Sun Guoguo, all looked surprised.

  In internal medicine textbooks, it is never said that acute myocardial infarction can be divided into five categories.

  Qu Yao frowned and looked at Lu Chen, where did this little boy come from?

  She has been working clinically for nearly eight or seven years, and she is still a cardiologist, but she has never heard that myocardial infarction can be divided into five categories.

  Sun Guoguo's face showed a gratified smile, "Junior brother, you continue to say."

Lu Chen coughed lightly and said, "The first category, which is what Ke Yue said, is the myocardial infarction caused by coronary thrombosis, which is the most common vascular plaque rupture in the department of cardiology, forming a thrombus. Vascular blockage, myocardial ischemia and hypoxia and necrosis.”

"The second category is myocardial infarction caused by unbalanced coronary vascular oxygen supply, such as coronary spasm, fast or slow arrhythmia that Dr. Sun said. out of balance."

   After Lu Chen said the first two categories, everyone's hearts froze.

  What Dr. Qu Yao said was just a list of diseases, but did not explain clearly the pathophysiology of the diseases.

   And what about Lu Chen?

   He explained the causes of both types of myocardial infarction, analyzing the nature of the disease.

  Qu Yao pondered on the side, she felt the difference in Lu Chen, this child's basic skills were extremely solid.

  The basic skills of a doctor do not only refer to internal medicine, but also pathology, physiology, anatomy and so on.

   Everyone pricked up their ears and listened carefully to Lu Chen's next explanation.

"The third category is similar to the fourth category, which is called PCI-related myocardial infarction and coronary bypass-related myocardial infarction. The fifth category is sudden death, many of which are unexplained, and some guidelines list it as myocardial infarction. special type."

   In fact, the latter three types of myocardial infarction are rarely mentioned. They are only medical classifications, and they are not mentioned in internal medicine books. They are only mentioned in major international guidelines.

   Looking at the surprised eyes of everyone, Lu Chen felt a little embarrassed: "If you visit medical forums often, you will know more about this kind of uncommon knowledge."

  I knew earlier that that strange headache had tormented Lu Chen for decades.

  In order to collect some cases of similar "headache", he would visit medical forums, such as Lilac Garden, Xinglintan, and even some strange live broadcast rooms for surgery.

   These uncommon knowledge were mostly passively accepted by Lu Chen.

   (end of this chapter)