I Can See Health

   Chapter 917 Exaggerating illness?

   "There is another very strange thing." Jiao Jingqiu said.

   "You said." Lu Chen looked at her.

   Jiao Jingqiu spoke slowly.

   "One night when I was working night shift, the uncle had a premonition that he was going to have a seizure again, and asked me if I could take a tablet of isosorbide mononitrate?"

   "I thought at the time that I was sick and could I have a hunch? Eat it if you want!"

   "As a result, the night was calm, and there was no further change in the condition. The BNP was re-examined the next morning, and the result was lower than before (121.6pg/mL)."

  Lu Chen nodded, "What are you considering?"

  Jiao Jingqiu said: "The indicators are improving, but the symptoms are getting worse. We are beginning to suspect that the uncle is exaggerating his condition!"

   After saying this, she also glanced at President Du, and continued: "Some old people usually lack love, and want to use some methods to attract everyone's attention, such as constantly talking to the people around them, etc."

  Du Fu heard this and said softly: "How can I put it, since I took over the company, my dad has really paid less attention. I'm not good enough in this regard."

   Jiao Jingqiu showed a smile.

  Lu Chen frowned when he heard the words, "Doctor Jiao, with your current diagnosis, do you think the patient exaggerates his condition?"

  Jiao Jingqiu did not hesitate, nodded and said, "BNP is not high, diuretic dilation drugs are fully used, and there is no reason for the condition to improve."

   Lu Chen disagreed with this diagnosis.

  The first element of medical diagnosis is to exclude organic heart disease before diagnosing physiological diseases.

  Lu Chen reviewed all the examinations again, and immediately asked: "Why is there no ECG when the patient's condition is on?"

   There are five ECGs in total.

   But there is no one, it is the electrocardiogram done when the chest tightness occurs.

   ECG is an easy-to-obtain examination report that can quickly reflect changes in cardiac electrophysiology.

  Jiao Jingqiu was startled, "We thought it was heart failure at first, and we didn't check the ECG. But a low BNP level can rule out heart failure, so I suspect that the condition is exaggerated..."

  Lu Chen interrupted Jiao Jingqiu's explanation: "Who told you that low BNP can lead to heart failure? In diastolic heart failure, left ventricular pressure does not increase significantly, so BNP can be low!"

  Jiao Jingqiu asked, "Ah... Could it be heart failure? We've taken diuretics, but it hasn't gotten any better?"

   "Doctor Jiao, you can't think about it for yourself, is there any evidence for diastolic heart failure?" Lu Chen frowned.

   If Jiao Jingqiu was a doctor in his department, then he would be really **** off by her.

   Jiao Jingqiu looked embarrassed: "Then... what is it?"

   "ECG!" Lu Chen said sternly, "The next time you get sick, be sure to take an ECG!"

   "Okay...I see." Jiao Jingqiu paused.

   Seeing this, Lu Chen has collected all the case data.

   "Mr. Du, I have almost understood your father's condition." Lu Chen looked at Du Fu, "Next, I need an electrocardiogram during the attack, then I almost know what the disease is."

   "So fast?" Du Fu was taken aback.

   In fact, he has almost accepted his father now, exaggerating his illness.

   Use this to attract the attention of the family.

   After all, they are usually very busy and really pay little attention to their father's life.

   Because of this illness, he stayed with his father longer.

   However, what Lu Chen said now made him a little shaken.

   "Actually, Dr. Jiao made a subjective mistake." Lu Chen said, "I was deeply influenced by the concept at the beginning."

   Jiao Jingqiu frowned and said, "Director Lu, if the patient's ECG changes during the attack, what is his disease?"

   "It's very simple." Lu Chen smiled, "Supine angina!"

   Chest tightness that occurs at night is most likely to be mistaken for heart failure.

   However, there is a type of angina pectoris, which occurs when you are lying down. You need to sit up or stand up immediately when the attack occurs to gradually relieve the symptoms of angina pectoris.

   "This type of angina usually occurs 1-3 hours after lying down. In severe cases, it can occur within 10 minutes of lying down, and it can occur multiple times a night. Lying down during the day, especially after a meal, can often be induced."

  Supine angina pectoris, this diagnosis can also explain why when Lu Chen thought about coronary heart disease just now, the system popped up the correct prompt.

  Supine angina is also a type of coronary heart disease.

   Hearing Lu Chen's words, Du Fu immediately echoed: "Yes! My father sometimes has a postprandial attack. He thought it was a stomach problem before, and he had a gastroscope examination, but in the end there was no problem."

  The increase of ventricular wall tension, myocardial contractility and myocardial oxygen consumption caused by the increase of return blood flow after lying down is the main cause of supine angina.

   "Supine angina?" Jiao Jingqiu was taken aback.

  To be honest, she really hadn't thought about this disease.

   Uncle has chest tightness at night every time. In this case, everyone thinks it is a heart failure attack.

   Angina pectoris usually occurs after activities.

   Therefore, supine angina pectoris is a type of coronary heart disease that is easily overlooked by everyone.

  Lu Chen smiled, "So, this can also explain why the uncle can relieve his condition every time he takes a tablet of isosorbide mononitrate."

   Having said that, Du Fu has already believed most of it.

  Every point that Lu Chen said matched his father.

   Jiao Jingqiu also regained his senses and began to think carefully about the inadequacies of what he had done in the whole case.

"Also, look at this electrocardiogram of the uncle." Lu Chen pulled out another electrocardiogram, "When the disease is not attacked, it looks like a normal electrocardiogram in sinus rhythm, without any ST-T changes, but it is Most likely a multivessel coronary artery disease, the vectors are neutralized, causing the ECG to look the same as normal."

   "Actually, the coronary condition of this patient is very poor! It is necessary to do another coronary angiography."

   Jiao Jingqiu said at this time, "We also persuaded the uncle to review the imaging before, but he is unwilling to do it. He is very stubborn, and no one can pull back what he believes."

   "That's it." Lu Chen continued, "When the disease occurs again, we must review the electrocardiogram. After the results come out, we will make the next step."

   "Okay!" Jiao Jingqiu nodded slightly.

  …

   After discussing with everyone, Lu Chen returned to the ward and exchanged with the uncle again.

   Uncle dragged Lu Chen to chat for a long time.

What    talked about was nothing more than the gossip of the former Director of Cardiology Department Zhao.

   Before leaving, the uncle looked at Lu Chen earnestly and whispered, "Director Xiao Lu, you talked so much with me today, what do you think about my condition?"

   Before Lu Chen could reply, the uncle said to himself, "Do you also think that the old man is exaggerating his illness?! In order to attract the attention of the family?"

   From the corner of his eyes, he glanced at Du Fu from time to time.

   The latter looked a little embarrassed when he saw this.

  Lu Chen quickly shook his head, "Master, I have other ideas."

   "Huh?" The uncle was stunned for a moment, with a hint of surprise in his eyes, "What do you think?"

"Master, hear me first. Next time, when you feel uncomfortable, chest tightness and chest pain are about to break out. Immediately seek our medical staff." Lu Chen urged, "Let them do an electrocardiogram for you. , I know your condition."

   "Okay, you kid can do it, I'll listen to you!" The uncle grinned.

   (end of this chapter)