I Can See Health

  Chapter 748 Simple test, not simple diagnosis

   Fortunately, there are not many patients now, and Lu Chen has enough time to look at these medical records.

   "Tell me about your condition first." Lu Chen opened the medical record book.

   While reading, listen to what the patient has to say.

   The patient's name is Chen Xing, 34 years old this year.

  The HP on her head is 66(——).

   "Okay." Chen Xing paused for a while, "You may think it's incredible, but I'm really not pretending, I'm really not hypocritical!"

  Lu Chen looked up at Chen Xing, "Tell me."

   "Well." Chen Xing's expression was a little solemn, "My illness is a long story..."

   It turns out that Chen Xing has been physically weak since birth and had irritable bowel syndrome before.

  This urticaria started 5 years ago, on face, armpits, chest, and red skin.

   It's been even weirder lately.

  She became more and more 'unable to stand', either because she lacked strength, or simply couldn't stand.

   As long as you stand for three or five minutes, you will get sweaty and dizzy, but you can get better quickly when you squat and lie down.

   "When you stand up, you get sick, but when you lie down, you get better?"

   Lu Chen wondered, this is very strange.

   Unexpectedly, the first patient in my specialist clinic was such a peculiar patient.

   Such a thick medical record proves that she has seen many hospitals and still has no clue.

"Yeah." Chen Xing nodded quickly, "Sometimes my heart rate can reach 180 beats per minute, I'm especially afraid of heat, I sweat a lot at night, and I have to use an ice pack when I sleep. Not to mention going to work, I go shopping. less than..."

   After Lu Chen learned about her general condition, he began to read Chen Xing's previous medical records.

   Among them, sinus tachycardia and premature atrial contraction were found on Holter.

   The rest of the examinations, including echocardiography, coronary CTA, chest CT, etc., showed no significant changes.

  In the course of the disease, Chen Xing had taken IC antiarrhythmic drugs and beta-blockers.

   However, hypotension and fatigue occurred, and the drug was discontinued.

  Another ablation treatment was performed, but the effect was not good.

   "I went to large and small hospitals in the city, but I haven't found any problems yet." Chen Xing looked lonely.

  Actually, she came to Guanghai First Hospital for treatment today.

  Because of her rich medical experience, she checked all the doctors' information in advance. Among them, Lu Chen was the best at electrophysiology, so Chen Xing hung up his expert account without hesitation.

   Even though Lu Chen looks so young, she can't control most things at all. She can only find the cause as soon as possible and solve this problem that has plagued her for many years.

  …

   After reading the patient's medical records, Lu Chen had already made up his mind.

   He closed the medical record and said slowly: "For a young woman like you, there are very few structural heart diseases, but autonomic dysfunction is very common."

   "Some people say that I have menopausal syndrome." Chen Xing frowned, "Is urticaria also an autonomic disorder?"

  Lu Chen shook his head, "I don't know about urticaria, but I've heard of irritable bowel syndrome, which is also related to autonomic dysfunction."

   "Then what should we do?" Chen Xing wondered.

   In the past, some doctors have said that this is an automatic nervous system disorder, but no solution has been given.

   Just let her rest more and not get excited, but it doesn't work at all, and the uncomfortable symptoms will continue to appear.

  Lu Chen heard the words, but said calmly: "I need you to do an experiment to further confirm, don't be too nervous, this experiment is very simple."

   "Okay, I'll listen to you."

   No matter whether it is useful or not, as long as it is related to the inspection, Chen Xingquan will not refuse.

   Seeking a doctor Over the years, Chen Xing has done too many examinations.

   The experiment requested by Lu Chen is very simple, a standing experiment.

   After the patient was lying on the back for ten minutes, then stood up, and the heart rate and blood pressure were measured one minute, two minutes, and three minutes after getting up, respectively.

   The results came out quickly.

   After lying on his back and standing upright, Chen Xing's heart rate increased and continued to increase, but there was no hypotension.

   At this moment, in Lu Chen's eyes, the answer was ready to come out.

  Lu Chen looked at Chen Xing and said slowly, "Your disease is called hyperadrenergic POTS."

   "What?" Chen Xing was taken aback, "It's that simple?"

   She had done CT, ECG, MRI, etc. before, but no problem was found yet.

  Lu Chen just asked her to do such a simple experiment to confirm the diagnosis?

   This is really incredible!

  Lu Chen smiled: "It's almost there, you need to urinate for a whole day and have another tube of blood drawn. You don't need to be nervous, it's not serious."

  Chen Xing gritted his teeth and did not speak for a while.

   Seeking a doctor for several years, no one ever told her the cause of the disease

   Now, Lu Chen just asked her to do a simple experiment and then directly stated the diagnosis.

   "Okay, I'll do it now!"

  Chen Xing didn't say much, took the test order that Lu Chen gave her, and walked out of the consultation room.

   At this time, Lu Chen also took a breath.

  The first patient in my specialist clinic finally finished it.

   It seems that there is not much conversation, but in fact half an hour has passed.

   "Teacher, what is this disease you are talking about?"

   the female graduate student Zhong Hui asked in a low voice, "How come I've never heard of it."

  Lu Chen smiled: "This name is a bit long, you won't be able to remember it if you say it all."

   "Hyperadrenergic POTS, POTS is a Postural Orthostatic Tachycardia Syndrome."

"This is a type of orthostatic intolerance accompanied by tachycardia manifestations, which is more common in women aged 15 to 35 years, and can develop symptoms of tachycardia, cerebral hypoperfusion, and activation of autonomic tachycardia after standing upright, and symptoms after lying down lighten or disappear."

   Zhong Hui is a little bit vague: "In terms of performance, it's really very similar, that is, you were sure from the beginning that this female patient is POTS?"

  Lu Chen nodded slightly: "I was skeptical at first, because POTS has to be differentiated from inappropriate sinus tachycardia (IST).

   "Both of them primarily affect young women, and symptoms often overlap. But IST did not exacerbate symptoms by being upright, had a higher mean heart rate than POTS, and did not have the typical high heart rate peaks."

   "When I saw the results of the body position test, I was basically sure that it was POTS. The following is the type of classification, and the rest is to check the blood results."

  POTS is also divided into hyperadrenergic, neurological, hypovolemic, etc., which can be further classified by catecholamine detection, skin biopsy, blood volume assessment, and immunological testing.

  Lu Chen briefly explained Zhong Hui's condition.

   As a graduate student entering clinical practice, her clinical experience is basically zero.

  …

   As soon as the first patient left the consultation room, within a minute, the door of the consultation room was pushed open again.

  A woman wearing a short skirt and black high heels, with big waves and a smile on her face, walked into the clinic slowly.

   I've been too busy lately.

   Write as much as possible.

   (end of this chapter)