I Can See Health

   Chapter 462 Starch Man

   In the ward, everyone stared at Lu Chen closely, as if to see the answer from Lu Chen's face.

  Fan Zhiping frowned deeply, guessing that the diagnosis must be wrong.

   However, from another angle, everyone guessed the diagnosis almost, why is it not right?

   At this moment, Lu Chen smiled slightly and extracted the patient's electrocardiogram from the medical records.

   "Brother Fan, what's so special about this electrocardiogram?" Lu Chen smiled.

  Fan Zhiping frowned and took the electrocardiogram.

   This ECG of the patient has been read and studied many times.

   "Severe R wave progression in V1-V3 in front of the chest leads." Fan Zhiping glanced at Lu Chen.

  Lu Chen nodded slightly, "Yes, what about other characteristics?"

   "Other features..." Fan Zhiping paused, "Severe low voltage of the QRS complex in the electrocardiogram."

   He studied it carefully and could not see any other problems.

   Is there anything else hidden in this electrocardiogram?

   Unexpectedly, Lu Chen smiled, "Yes, it is these two characteristic expressions."

  Fan Zhiping was stunned, and so were the others in the department.

   Everyone can see these two characteristic performances, but...then what?

   No one can see a different diagnosis!

  Lu Chen also noticed everyone's suspicious eyes, thought for a while, and said solemnly: "And the patient's cardiac ultrasound, you ignore the report written by the sonographer for the time being, and then look at the cardiac ultrasound to see if there is anything found."

   Fan Zhiping was stunned and asked them to ignore the report written by the ultrasound doctor?

   The diagnosis written by the sonographer was hypertensive heart disease.

  As the name suggests, long-term high blood pressure and poor control of blood pressure can lead to heart disease.

  Lu Chen asked everyone to ignore this diagnosis?

   To be honest, most clinicians believe in the diagnosis of sonographers.

   Especially this kind of ultrasound images, CT and MRI images.

  Suddenly, everyone was a little uncomfortable with the ultrasound doctor's report being ignored.

  …

   Looking at the ultrasound report in front of him, Fan Zhiping began to read it word by word.

   The doctors around me don't quite understand it.

  Lu Chen is very powerful, but after all, he is just a student!

   However, Director Fan seems to believe Dr. Lu Chen's words very much!

   Fan Zhiping at this time, looking at Lu Chen's eyes, has long lost the concept that he is still a student.

   In a vague sense, he seemed to really regard Lu Chen as a professor, as his "mentor".

   So, he was very natural and obeyed Lu Chen's words.

  …

  Fan Zhiping continued to review the patient's ultrasound report, in which the left ventricular end-diastolic diameter was 40mm, the right ventricular end-diastolic diameter was 16mm, the left atrium was 46mm, and the right atrium was 59x44mm.

   "The left room and the right room are getting bigger!" Fan Zhiping muttered to himself.

  The enlarged heart is due to the deterioration of cardiac function and the compensatory increase in order to maintain the work of the heart.

   "Besides the double room getting bigger...what else..."

  Fan Zhiping was stunned for a moment, "This patient's left ventricle and right ventricle seem to be smaller than normal!"

   This is abnormal!

   In general, both the atria and ventricles grow in size simultaneously.

   But in this patient, only the double atrium was enlarged, but the two ventricles became smaller!

  Fan Zhiping said to Lu Chen: "Doctor Lu, is this patient's double room enlarged, and the double room is not too small?!"

   As soon as he finished speaking, everyone in the department was stunned.

  Many people gathered around, holding the ultrasound report sheet for comparison.

   "Director Fan is right! This patient is really strange!"

   "The double room has increased, and the double room has decreased. It's the first time I've seen it!"

   "Do you think the ultrasound doctor's map is inaccurate?"

  …

   Lu Chen showed a smile and nodded slowly: "That's right, huge double atrium, but the double ventricle is not big but small, plus the characteristics of the patient's electrocardiogram, what disease do you think of, Brother Fan?"

   The diagnosis at this time is actually ready to come out.

  Fan Zhiping flashed a gleam in his mind, and then said: "senile amyloidosis heart disease?"

  Amyloid heart disease, also known as amyloid heart disease, is a very rare restrictive cardiomyopathy.

   People with this disease, also known as starch people.

   "Yes, amyloidosis heart disease!"

   Hearing Lu Chen's affirmative answer, whispers immediately rang out in the department.

   Because the disease is relatively rare, most people have never seen it or even understand its diagnostic criteria.

  Fan Zhiping also had the opportunity to see such a patient after he went to Jinghua Second Hospital for further study.

  …

   At this moment, a doctor in the department asked a question.

   "Dr. Lu, you can diagnose amyloidosis heart disease with just an electrocardiogram and echocardiogram?"

   The criteria for diagnosing cardiomyopathy are very strict, and the most accurate method is "myocardial biopsy".

   This is to take a small piece of myocardial tissue and then test it; the second is cardiac magnetic resonance, and other imaging tests, but the accuracy is much lower than that of myocardial biopsy.

   However, myocardial biopsy is a traumatic operation after all, and few people do this kind of examination.

   Therefore, it is relatively difficult to diagnose "cardiomyopathy".

  Lu Chen, what is his reason to be so sure that the patient is amyloidosis heart disease?

  …

   Everyone saw Lu Chen stand up, looked around, and said slowly, "There are 4 key points to kill this case in seconds."

   Everyone in the department held their breath and listened carefully to Lu Chen's words.

   "The mismatch between electricity and structure, poor R wave progression in V1-V3, huge left and right chambers, and double chambers are not big but small!"

   When everyone in the Cardiology Department of Feng M County heard the words, they all bowed their heads and thought hard.

  The only Fan Zhiping, there was a flash of light in his eyes, he seemed to have caught something.

Lu Chen continued: "Amyloid deposits between the cardiomyocytes, surrounds the myocardium, and separates the myocardium one by one. Like an insulator, it affects the electrical conduction between the cardiomyocytes, so we have amyloid myocardium. An important feature of the patient's ECG is the severe low voltage of the QRS complex, and it is the amyloid that is causing the trouble!"

   "The severe R-wave progression in the ECG V1-V3 representing the septal vector is also due to the massive precipitation of amyloid that thickens the ventricular wall."

   As soon as the voice fell, everyone suddenly realized.

   The seemingly inconspicuous electrocardiogram performance has a deeper meaning in Lu Chen's place!

   At this time, a young doctor in the department asked suspiciously: "Dr. Lu, then you just said that the double room is large and the double room is small. What is the reason?"

Lu Chen smiled and said, "Actually, this is easy to understand. The amyloid deposits between the cardiomyocytes, the ventricle becomes very stiff, the filling is restricted, and the diastolic function is severely damaged. Blood cannot flow back to the ventricle, and the left and right atria are slowly stretched over time!"

   "Actually, this case perfectly matches all the electrocardiogram, echocardiography, and clinical manifestations of amyloid cardiomyopathy."

   "Perfect match, so you have no reason to reject the diagnosis of amyloid cardiomyopathy!"

   Easy-to-understand explanation, everyone present understood what Lu Chen meant.

   "Amyloid cardiomyopathy", a rare diagnosis, immediately became popular.

   While lamenting the rarity of this disease, an idea popped into everyone's mind.

  How powerful is Lu Chen, a young doctor who can diagnose this disease?

  How much shock did he bring to everyone?

  If there is no solid basic skills, rich clinical thinking, and no superstition in auxiliary examination reports, it is absolutely impossible to diagnose this disease!

   (end of this chapter)