I Can See Health

  Chapter 96 Menopause

   "Sister Ke, what diagnosis are you considering?"

  Sun Guoguo looked at Ke Yue beside him.

   "I, I judged from the electrocardiogram results that the patient is more likely to have coronary heart disease." Ke Yue frowned and whispered, "Of course, I do not rule out other chest pain diseases."

   "Junior Brother Dong, what's your opinion?"

  Dong Hao touched the back of his head and said, "I also think it is coronary heart disease. The electrocardiogram and symptoms are consistent with the diagnosis of coronary heart disease."

   "Look, I've said it many times, this is coronary heart disease, and you've been asking so many times, it's a waste of time." Fu Fengqin raised her eyebrows and said, as if she had coronary heart disease, and she looked very proud.

   "Junior Sister Jiang, what do you think?"

  Sun Guoguo smiled and looked at Jiang Qingyan again.

"Senior sister, although the patient's electrocardiogram shows myocardial ischemia, she has no high-risk factors for coronary heart disease and no typical symptoms of angina pectoris. It can only be said to be suspected coronary heart disease. Digestive tract diseases, cardiac neurosis, and intercostal nerves need to be excluded. Pain, costochondritis, etc."

   "Well." Sun Guoguo nodded, "What about the next treatment plan and plan that you think is feasible?"

   Jiang Qingyan said softly: "Do coronary angiography or coronary CTA to rule out coronary heart disease; if the result is negative, then do gastroscopy to rule out digestive tract diseases, and other minor problems can be checked slowly."

   As soon as Jiang Qingyan finished speaking, Fu Fengqin immediately answered:

   "What are you doing with coronary CT? I want to do cardiac angiography directly. The accuracy is high and it can be done in one step. If you do cardiac CT, I will do it directly at the county hospital. What am I doing here with you?"

  Lu Chen frowned.

  This auntie's character is too impatient.

   The doctor said one sentence, and she wanted to follow ten sentences.

   "Okay, Auntie, I already know what you want." Sun Guoguo smiled, "I will complete the preoperative examination today and tomorrow, and then I will give you an angiography as soon as possible."

   "Well, that's good." Fu Fengqin's ugly face slightly improved, "It's still Dr. Sun's refreshing, I'll listen to your arrangement."

  …

  Sun Guoguo led the crowd away and returned to the doctor's office.

   "Lu Chen, I didn't ask you just now, what do you think the patient's diagnosis is?" Sun Guoguo smiled.

   Among the people present, except for Jiang Qingyan's diagnosis, the primary diagnosis of everyone else is approaching in the direction of "coronary heart disease".

Lu Chen said solemnly: "I think the patient's age has not yet reached the diagnostic criteria for coronary heart disease, and there is no typical chest pain symptoms of coronary heart disease. In addition, we have also overlooked an important point, that is, the patient has recently started menopause. "

   "Menopause?" Ke Yue frowned, "What does this have to do with chest pain?"

Lu Chen smiled and said: "After menopause, the patient's endocrine system is disordered, and autonomic nerve dysfunction may occur. What we often call menopause syndrome will eventually lead to cardiac neurosis, followed by symptoms of chest pain, but this kind of The symptoms of chest pain have nothing to do with fatigue and activities. In addition, this patient is more impatient, which may also be related to cardiac nerve dysfunction."

When the others in the    group heard Lu Chen's explanation, their eyes showed a sudden realization.

At this time, Sun Guoguo smiled and said, "Actually, everyone's analysis makes sense. Whether the patient has coronary heart disease, cardiac neurosis, or chest pain caused by other reasons, the idea of ​​diagnosis and treatment is similar. , we must first rule out coronary heart disease!"

"If the patient has coronary heart disease, if we don't find it out, it would be our doctor's negligence, and there is a potential threat to the patient." Sun Guoguo continued, "So if you encounter this kind of chest pain, if you don't fully To be sure, it is still recommended to improve coronary CT or angiography to exclude coronary heart disease.”

   "Secondly, it is related to the question of what to check. It is recommended that patients improve coronary angiography, or CTA?"

   "For example, the 11-bed patient who just came here, from a medical professional point of view, do you think whether to do CTA or direct angiography?"

   Seeing that Sun Guoguo smiled at Dong Hao, "Junior Brother Dong, talk about it first."

"I think it's better to do cardiac angiography directly. If the patient has vascular stenosis and needs treatment, then another cardiac angiography has to be done. It wastes two examinations and suffers one more crime." Dong Hao thought for a while. .

   Ke Yue also nodded in agreement.

   "Junior Brother Lu, what do you think?"

  Lu Chen said solemnly: "I think it is still necessary to distinguish the disease. If it is just to rule out coronary heart disease, coronary CTA may be better. It is economical, non-invasive, and simple. At the same time, the diagnostic accuracy rate is also over 95%."

   "At that time, if the patient had high-risk factors and had typical symptoms - chest tightness and chest pain after exercise, and there were typical ischemic changes on the electrocardiogram, it was still recommended to do cardiac angiography directly."

   "The patient who was newly admitted to the hospital just now, I don't think he has coronary heart disease. Even if he does have coronary heart disease, it does not reach the level of stent placement, so I suggest her to do coronary CTA."

As soon as he finished speaking, Sun Guoguo shook his head slightly and sighed: "Junior Brother Lu's thinking is more idealistic. In clinical practice, it is often a one-size-fits-all treatment plan. No matter what kind of patient, as long as they have chest pain, they may be asked to Doing cardiac angiography may involve disputes, medical expenses, patient wishes, etc."

  Lu Chen nodded slightly, Sun Guoguo made a lot of sense.

   In terms of single cost, cardiac angiography is far more than cardiac CTA.

   For the sake of performance, many hospitals will exaggerate the efficacy of cardiac angiography to varying degrees.

   tends to sidestep its complications and side effects.

   In fact, there are quite a few patients who only need a simple CTA to rule out the diagnosis, so as to avoid irreversible damage to the blood vessels.

Sun Guoguo continued: "This new patient just now has a strong request for cardiac imaging after admission. We will tell her all the treatment plans, including the advantages and disadvantages of each method, and let her choose by herself. The most important thing is The only thing is to ask her to sign and agree to undergo a cardiac angiography before arranging the operation."

   "Okay." Lu Chen nodded.

  Clinically, walking on thin ice.

   Only by signing more, communicating more, and keeping paper records, can you protect your rights to the greatest extent.

   At the same time, in the event of a medical accident, the patient can also request to seal the medical record at the first time, and obtain the relevant medical record documents as litigation materials.

  …

   Although this patient is a relative of Wang Zihao, she may not be easy to mess with based on her posture.

  Lu Chen tries his best to do what he can do to perfection.

  Write the two treatment plans in the condition communication and ask Fu Fengqin to sign.

   Choose cardiac angiography, give up coronary CTA.

  …

   (end of this chapter)