I Can See Health

   Chapter 841 Misunderstanding

  Case discussion session begins.

  Lu Chen sat behind the Kebed team.

   He made a visual inspection and found that there were seven cardiology teams in the entire classroom, with a number of about 17 people.

   On the podium, the attending doctor of this case began to introduce the basic situation of the patient to everyone.

   This model is similar to that in China.

   After the doctor in charge introduced the condition, he asked questions.

   The doctors will continue to discuss and analyze the answers.

   "Patient, male, 18 years old."

   "Due to the obvious abnormality of the electrocardiogram found in the post-exercise examination. The patient did not have any uncomfortable symptoms."

   "Previously healthy, denied a family history of cardiomyopathy or sudden death of unknown cause."

   The patient's medical history is simple, a few sentences.

   But next, the examinations and tests released by the doctor in charge are not easy!

There are many copies of    ECG.

  Lu Chen picked out the most typical ones.

   As soon as he turned over the electrocardiogram, Lu Chen immediately read the result.

   This is a typical asymmetric T wave, and there is still ST depression in the precordial leads.

   Obviously, this is an electrocardiogram of cardiomyopathy.

   For example, the most common disease is hypertrophic cardiomyopathy.

   Sure enough, this picture came out.

   Everyone started to talk about it, and at the same time, they were very confused.

   Everyone is a top doctor in the world, and this basic electrocardiogram can be recognized.

   The doctor in charge smiled and told everyone to be patient and continue to check the patient's other information.

   Next.

   The doctor in charge took out the ECG, echocardiography and cardiac magnetic resonance of the patient for review.

   The patient's echocardiography and cardiac MRI all confirmed the diagnosis of "cardiomyopathy".

   Echocardiography results showed: apical myocardial hypertrophy with a maximum thickness of 24 mm, normal left ventricular size and systolic function, and no obstruction of blood flow.

   Cardiac MRI showed that the apical and anterior septal thicknesses were 25 mm and 13 mm, respectively.

  In the apex of the heart, delayed contrast enhancement can be seen.

   In addition, the patient has undergone genetic testing.

   Genetic examination revealed that the patient had mutations in the MYH7 encoding and β-MHC genes!

   However, both parents and siblings of the patient were found to be negative.

   These results all confirm the possibility that the patient has "hypertrophic cardiomyopathy"!

   Since no sign of sudden death risk was found in this examination, there is no indication for ICD implantation for the time being.

  …

   Seeing this, Lu Chen frowned.

   At first glance, this case is too simple.

   No matter how you look at it, what tricks are pulled out, this is a hypertrophic cardiomyopathy!

   A disease that can be seen so clearly, wouldn’t Mayo’s doctor be able to diagnose it?

   This is absolutely impossible!

  Lu Chen continued to look down.

   The following medical records slowly dispelled Lu Chen's doubts.

   After being discharged from the hospital, the patient stopped strenuous training according to the doctor's advice, but he still maintained an active lifestyle.

   One year later, the patient re-examined.

  Re-examination of cardiac MRI showed that left ventricular hypertrophy was relieved!

  The maximum thickness of the apex of the heart is 10mm.

   The electrocardiogram of the re-examination showed that the ST segment depression was significantly improved compared with the initial visit!

   As soon as this result came out, everyone in the classroom was silent.

   The patient has not undergone any treatment, and the symptoms are so miraculously better!

   Kebed next to Lu Chen frowned and whispered: "It looks like hypertrophic cardiomyopathy, but the exercise stopped and the hypertrophy has eased. It's like physiological cardiac hypertrophy again!"

  Lu Chen also frowned.

  Kebed is right, pathological cardiac hypertrophy is impossible to reverse.

   Only physiological myocardial hypertrophy can have a chance of reversal after stopping exercise.

   However, the patient did genetic testing before, and the gene for hypertrophic cardiomyopathy was indeed detected.

   This seems to be contradicting itself!

  Lu Chen's heart sank, as expected of a case that can appear in Mayo!

   It is absolutely impossible to have such an easily diagnosed disease.

   "Lu, what do you think of this case?" Kebed looked at Lu Chen beside him.

  Lu Chen shook his head, "I have no idea for now."

Kebed touched his chin and said slowly: "Lu, I have an idea, this patient's cardiac hypertrophy resolved spontaneously after he stopped training, and the genetic tests of his family members were all negative. So I think, another genetic test may be needed to rule out The possibility of false positives in the initial inspection."

  Kebed's idea is simple.

   He felt that the first genetic test was wrong!

  His opinion is to redo genetic testing.

   When Kebed finished talking about the idea, other Mayo cardiologists also raised the possibility.

   This 18-year-old athlete is likely to have pure physiological myocardial hypertrophy.

  Lu Chen frowned, because when he was thinking about the diagnosis.

   The system did not pop up any prompts.

   That is, "physiological cardiac hypertrophy" is wrong!

   For a time, the opinions of everyone were not quite unified.

   Some doctors say it is "physiological myocardial hypertrophy", and some doctors say it is "genetic pathological hypertrophic cardiomyopathy"!

   Everyone has their own opinions, and no one can convince anyone.

  …

  Lu Chen remained silent.

   Because he discovered a very strange thing.

   When he thought of "physiological cardiac hypertrophy", the system did not pop up a prompt.

   When he thought of "pathological hypertrophic cardiomyopathy", the system did the same, and no prompt popped up.

   Is this patient not "cardiomyopathy" at all?

   This idea popped into Lu Chen's mind.

   Everyone has been arguing for a long time, but in fact it is not cardiomyopathy at all? !

   This is too absurd...

  Lu Chen reviewed the patient's examination again.

   Whether it is from electrocardiogram, cardiac ultrasound, or cardiac magnetic resonance, or even genetic testing, it has been confirmed that the patient has cardiomyopathy!

   There is absolutely no other possibility.

   "Could it be that the system is down again?"

   But since Lu Chen owned the system, the system has always been reliable.

   There has never been a system bug!

  …

   Just as Lu Chen was thinking, the entire Mayo Cardiology classroom was divided into two factions.

The    side believed that it was physiological myocardial hypertrophy. The main reason was that the patient's myocardial hypertrophy recovered after stopping exercise.

   On the other hand, it is considered to be a pathological hereditary cardiomyopathy, because the result of the genetic test is positive!

   Any other test may not be as accurate as genetic testing.

  Kebed continued to Lu Chen: "Lu, now everyone has their own opinions. We can only look at the genetic testing again. We can only judge when we wait for the results."

   At this moment, Lu Chen's mind suddenly flashed.

   Everyone seems to have entered a misunderstanding.

  Why does everyone think that it is either physiological or pathological?

   Can’t both situations exist at the same time?

   When Lu Chen thought of this, the system immediately played a long-lost reminder sound.

   "Congratulations, the completion of the system upgrade has increased!"

   (end of this chapter)