I Can See Health

Vol 2 Chapter 634: Cardiovascular!

Chapter 634 Cardioversion!

The second area of the heart.

doctor's office.

The atmosphere around Lu Chen was a little weird.

Three students, you look at me, I look at you.

A doubt arises in everyone's heart.

Was the patient diagnosed with "ventricular tachycardia" really just supraventricular tachycardia?

Beside , Yu Bin was even more silent.

This patient was previously in charge of him.

During the patient's hospitalization, "ventricular tachycardia" occurred once, and he was cardioverted.

This is him, recommending patients to install an ICD!

However, Lu Chen's opinion now overturns all his previous diagnosis and treatment work.

(Electrical cardioversion can be used for both ventricular tachycardia and supraventricular tachycardia, but for supraventricular tachycardia with stable hemodynamics, it is not necessary to use electrical cardioversion at all, it will increase the injury and pain to the patient anyway)

Ji Yingying bit her lower lip. She flipped through the patient's electrocardiogram, but couldn't find any clues about supraventricular tachycardia in this picture.

If she was in another major, it would be fine, but she herself is a cardiologist, and even an electrocardiogram was diagnosed wrong.

"Senior brother..." Ji Yingying whispered.

Lu Chenhuo turned his head and looked, "What's wrong?"

Ji Yingying sat next to Lu Chen, "How did you see the VSP in this picture? I've been looking at it for a long time, and I haven't seen any sign of the VSP."

Her words represent the voice of everyone.

The other two students immediately put their heads together, and even Yu Bin looked towards Lu Chen.

They are so curious!

Lu Chen pursed his lips and smiled, it was time to earn gratitude points again.

Currently, he is now preparing for "valvular intervention" treatment.

In the system mall, the skill cards for valve interventional therapy are worth tens of thousands of thanks!

Without trying to earn thanks points, Lu Chen would have to wait until the Year of the Monkey to exchange this skill card.

…

"Cough cough." Lu Chen cleared his throat, took the patient's electrocardiogram and a blank A4 piece of paper, and started his own explanation, "Then let me tell you something."

Seeing Lu Chen like this, the three students immediately bought three small stools from the conference room.

Yu Bin also came to be interested.

But he wasn't very proactive, so he had to lean on Lu Chen's side!

Just listen to Lu Chen and continue: "To distinguish between VT and SVT with differential conduction, we generally need to analyze the atrioventricular relationship (the relationship between the P wave and the QRS complex), the ventricular depolarization vector, and the shape of the QRS complex."

"Many scholars have proposed the differential diagnosis process. The more commonly used methods are the Brugada method and the Vereckei method. In particular, the Vereckei method only relies on the avR lead for differential diagnosis, which is easy to remember and easy to use in clinical practice."

"In 2020, an article published in HeartRhythm proposed the use of limb leads for differential diagnosis, which is also very simple."

…

"Senior brother, what are these methods you mentioned?" Ji Yingying was stunned.

The method that Lu Chen said, she has only heard of it, but she has never seen it clinically, and has never seen anyone else use it.

Lu Chen smiled, "To put it bluntly, a simple international standard for diagnosing ventricular tachycardia has been formulated."

"According to this criterion, ventricular tachycardia and supraventricular tachycardia can be rapidly differentiated."

Ji Yingying curiously said: "Senior brother, if you say this, we have no reference. If you give an example, just use this patient's electrocardiogram to demonstrate it to us."

"Of course." Lu Chen nodded slightly, "Then I will use the Brugada method to diagnose this electrocardiogram."

Lu Chen started his entire step-by-step deduction on the blank A4 paper.

Brugada method, the steps to identify the origin of wide QRS complex tachycardia, divided into 4 steps.

First, if the QRS complexes in the precordial leads are not RS type, it is diagnosed as VT.

Second, if there is an RS-type QRS complex in the anterior chest leads, and the RS interval is >100ms, it can be diagnosed as VT.

Third, if atrioventricular dissociation can be confirmed, the diagnosis of VT can be established.

Fourth, if the tachycardia meets the morphological criteria of the QRS complex in leads V1 and V6, i.e., a left bundle branch block-like pattern, an rS QRS complex in lead V1, and an RS interval >70 ms; or if the left bundle branch (and/ or right bundle branch) block-like pattern, the initial QRS complex in lead V6 is a positive wave, and R/S<1, VT can be diagnosed.

…

"Huh? This...is this easy?"

Ji Yingying was a little stunned.

"Senior brother, are you sure this is the easy way?"

She feels that it is not easy at all!

If you want to memorize these four steps, it looks simple, but it is not easy to actually implement it!

Ji Yingying glanced at the other two students beside her, they both shook their heads.

She breathed a sigh of relief.

It doesn't seem to be her problem, but this step is not as simple as imagined for them now.

"Practice makes perfect." Lu Chen said, "You can learn these four steps by looking at a few more clinical pictures."

"Actually, in many cases, we are lazy, which leads to deviations in the diagnosis of patients. If we can strictly abide by international standards, this patient's similar situation can be completely avoided!"

Ji Yingying's heart moved, "Brother, according to what you mean, this patient must have Supraventricular Tachycardia?!"

Lu Chen nodded slightly, "Mostly so!"

Combined with the health indicator on the system panel and the existing electrocardiogram evidence, Lu Chen was confident in the diagnosis of supraventricular tachycardia.

At this moment, a prompt popped up in the system panel.

"Congratulations, +1 for the thank you from Ji Yingying!"

"Congratulations,……"

Three consecutive prompts are given by three students in the group.

The next prompt made Lu Chen stunned for a moment.

"Congratulations, +1 for receiving thanks from Bin!"

Lu Chen looked out of the corner of his eye, Yu Bin was putting his head together at this moment...

"Cough cough." Seeing that Yu Bin was discovered, he was slightly embarrassed, "Doctor Lu, that, you said it very well!"

Yu Bin is not a novice like Ji Yingying who has just entered the clinic.

After Lu Chen's suggestion, he immediately understood the key.

Four judgment steps, one by one to diagnose ventricular tachycardia.

Yu Bin had seen similar medical reports, but never paid attention to it.