I Can See Health

   Chapter 782 Drunk man

  The first phase of the TAVR surgery class has ended.

  The first batch of 20 students has gained a lot.

   Among them was Wang Qingfeng, who was admitted to the same batch as Lu Chen.

   From a beginner of TAVR, he began to be familiar with the field of TAVR gradually and became a reserve talent.

  Although none of them can operate independently now, in the near future, the TAVR surgery team of Guanghai First Hospital represented by them will definitely shine in the field of Huaxia's heart!

   On the other hand, the content of Lu Chen's national nature project is also limited to the discipline construction of TAVR.

  The only thing missing now is data!

   Surgical data, patient data, postoperative rehabilitation data, etc., are currently missing from Guanghai First Hospital and even Huaxia.

   But if you want to build the TAVR discipline well, these things are essential, and Lu Chen can only do it step by step.

   As for clinical matters, he did not relax either.

  As a superior physician, he insists on rounds every day, and personally inspects critically ill patients to ensure that each patient's treatment plan will not have major flaws.

   As for Jin Miao, she has been on the operating table with Lu Chen recently, and her TAVR surgical capabilities are also improving rapidly.

   In addition, once Jin Miao encounters a difficult case, he will notify Lu Chen as soon as possible.

   "Director Lu, a more difficult patient has been transferred from the CCU, do you have time to come and take a look?"

   In Lu Chen's office, after Jin Miao reported the latest work progress, he was ready to take him to check on a patient's condition.

   "CCU turned around?" Lu Chen wondered.

   "Well, I lived in the first district of my heart a few months ago, but I didn't find out the reason at that time, so I went back to take medicine, and now I'm sick again." Jin Miao explained.

   "Okay, let's go and have a look."

  Lu Chen put down his work and followed Jin Miao to the ward.

  …

   in the ward.

  Lu Chen saw the patient in front of him.

   He is a sixty-year-old bachelor, and the family member who came to **** him is his old mother.

"Director Lu, the patient is a patient with heart failure." Jin Miao explained his condition on the side, "I used to be a long-term drinker, and I used to consider alcoholic cardiomyopathy in other hospitals. I have been treated for heart failure for many years, but it has not improved. "

   "Yes." Lu Chen nodded, and began to conduct physical examinations and consultations on patients in person.

   The HP on his head is 54(——)!

   doesn't seem to be in good shape, but it doesn't get to the point of three minuses either.

   The patient is a 63-year-old single male with a typical 'one person is full, the whole family is not hungry'.

   I used to drink heavily. I don’t know if it was because of the difficulty in capital chain turnover or because of repentance. I have quit drinking for 10 years.

   But quitting alcohol doesn’t mean he starts to love his body, he still eats convenience food every day.

   The reason why I came to the hospital was because I gradually felt difficulty in breathing, and my lower extremities were swollen, and I pressed a hole every time.

   This frightened him, and he came to the hospital immediately.

  Lu Chen gave the patient a more detailed physical examination

   The patient had distended jugular veins, rales at the base of both lungs, normal auscultation of the heart, and moderate edema of both lower extremities.

   In addition, echocardiographic results showed that left ventricular activity was reduced, left ventricular ejection fraction (LVEF) was 25%, and right ventricular systolic function was moderately reduced.

   Combining all the test results, Lu Chen initially judged that he still had heart failure.

   But there are many causes of heart failure, including common coronary heart disease, valvular disease, myocarditis, cardiomyopathy and so on.

   "Two months ago, a coronary angiography was done in the first area of ​​the heart, and the results were normal." Jin Miao said, "So we ruled out coronary heart disease, and we still consider it to be heart failure caused by long-term drinking and alcoholic cardiomyopathy."

  Lu Chen thought about it and asked, "Is the effect of anti-heart failure treatment not good?"

"It was okay at first." Jin Miao said, "It's just two months ago, I don't know if he stopped the drug or what, the heart failure worsened three times! Each time it was an acute left heart failure attack, and he came to our hospital. CCU."

  Just after Jin Miao finished speaking, the patient's mother, the old lady in her 80s, also echoed aloud.

   "Doctor, he took the medicine and didn't stop." The old lady's voice was a little hoarse. She took out a few medicine boxes from the drawer with trembling hands and handed them to Lu Chen and Jin Miao.

  Lu Chen looked at it, it was indeed the golden triangle medicine for heart failure.

   "Okay, I understand." Lu Chen nodded, then turned to Jin Miao who was beside him, "How do you think about it now?"

  Jin Miao paused and whispered: "Now considering that the treatment effect is not very good, it may be stubborn heart failure, and I plan to increase the dose of drugs."

  Lu Chen frowned and said, "Has the patient experienced some mental symptoms?"

   "Mental symptoms?" Jin Miao was stunned, "No..."

  Lu Chen pointed to the patient's eyes, "During the physical examination just now, I found that his external ophthalmoplegia was paralyzed."

   "Ah, this..." Jin Miao whispered, "The patient just turned up, I haven't found it yet."

   "I checked CCU's medical records, and there is no record of this type of mental symptoms." Lu Chen said.

  Jin Miao's expression was a little solemn, "I will evaluate the patient's mental state again immediately."

   "Don't panic." Lu Chen looked at the old lady beside him, "Mother-in-law, does your son usually live with you?"

   "Yes." The old lady nodded, "Live together, he is not married, who else can he live with?"

   "Then have you noticed any unusual behavior recently?" Lu Chen said.

   "Abnormal behavior?" The old lady didn't quite understand.

   "For example, nonsense, shouting, etc." Lu Chen reminded.

   Hearing this, the old lady nodded hurriedly: "During this time, he sometimes always speaks to himself, can't understand what he says, and sometimes loses his temper."

   "Is it like this before?" Lu Chen asked.

   "That's not it." The old lady said, "Although he likes to drink, he usually has a good temper, and this has never happened before."

   Hearing this, Lu Chen basically understood.

   He looked at Jin Miao next to him, "Make a MOCA score for the patient."

   "Okay!" Jin Miao responded quickly.

  MOCA, the Montreal Cognitive Assessment Scale.

   includes attention and concentration, executive function, memory, language, visual structure skills, abstract thinking, calculation and orientation, etc. The total score is 30 points, and ≥26 points are normal.

  …

   Back to the doctor's office.

  Jin Miao immediately gave the patient a complete set of MOCA scores.

   The final result is 13 points.

   "Director Lu, the score is 13!" Jin Miao reported the final result to Lu Chen.

   "What do you think about it now?"

  Lu Chen intentionally cultivated Jinmiao, so he didn't tell his diagnosis right away.

   "In addition to heart failure, the patient also has some neurological symptoms such as cognitive impairment." Jin Miao said hesitantly.

   "Is that all?" Lu Chen asked, "Have you ever thought about why the patient has neurological symptoms?"

   "This is not clear for the time being, and some head examinations may be required." Jin Miao whispered.

   "I saw that he had a CT scan of the brain, and everything was normal." Lu Chen said.

   "Then do another cranial MRI?"

  Jin Miao's tone was full of disbelief.

  Lu Chen shook his head helplessly, "You still haven't found the problem, it's a beriberi!"

   (end of this chapter)