This Doctor is Great

"No."

The middle-aged patient said without thinking: "I haven't had any surgery before... I have always been in good health..."

Teacher Zhang Mei: "Other medical history, do you have any? For example, family medical history, etc..."

Middle-aged patient: "No."

At this time,

Zhou Mo took the ECG drawing from the ECG machine.

Zhou Mo glanced at it.

——There were abnormal fluctuations in multiple bands, and the ST segment ECG moved down significantly.

"Teacher, look..."

Teacher Zhang Mei took a look and asked Zhou Mo, "You have been trained in the Department of Cardiology, what do you think?"

Zhou Mo: "The ST-segment electrocardiogram shifts down significantly, which generally indicates that there is a symptom of insufficient blood supply to the myocardium, which is consistent with coronary heart disease."

Sudden,

At this time, the patient grabbed his left arm and made a muffled hum.

"What's wrong?" Zhou Mo bent over.

The middle-aged patient was in pain: "Doctor, I have a pulling pain in my left forearm now."

Zhou Mo: "It hurts?"

The middle-aged patient nodded with difficulty: "Yes, it's like a giant with infinite strength is pulling my arm hard, and it hurts a lot."

Zhou Mo nodded.

Radiating pain is a signal of cardiac ischemia.

The heart is on the left side of the human body, so the left arm is obvious.

Zhou Mo had an idea and thought of aortic dissection.

Instruct the nurse to measure the blood pressure in the left and right arms.

The result came out quickly, with a difference of less than 8mmhg.

Temporarily ruled out.

According to Zhang Mei, the patient's condition is still stable, and there is no major problem with the vital signs of the ECG monitor.

"Xiao Mo, you go to write the bill, and then ask the family members to sign..."

"Draw blood for routine examination, especially check cardiac enzymes, troponin, etc..."

"good!"

Zhou Mo billed from the computer, and then walked out of the emergency room.

Outside the emergency room, the patient's wife was talking with the old man on her mobile phone. When she saw Zhou Mo coming out, she quickly ended the call.

"Doctor, how is my husband now?" She looked anxious.

Zhou Mo said with relief: "Currently, the vital signs are still normal. We temporarily consider it to be a myocardial infarction, but we need further examination..."l

Then Zhou Mo introduced various possibilities and complications.

"Now we will conduct corresponding examinations, and we can make further diagnoses after the examination results come out..."

"Your signature is required."

The wife hurriedly said, "I'll sign it!"

signature.

Some basic data such as troponin can be tested directly in the emergency department, and the results will come out relatively quickly.

Send the drawn blood,

At the same time, Zhou Mo called and asked the cardiologist to come down for consultation.

soon,

Troponin results came out.

——Result: normal!

Zhou Mo: "???"

Zhou Mo handed the result to Zhang Mei: "Teacher, the patient's troponin level is normal and has not increased significantly."

Zhang Mei was slightly surprised.

Because according to the inference just now.

Middle-aged patients should belong to angina pectoris and myocardial infarction caused by coronary heart disease, so the content of troponin in the blood should be significantly increased.

But why is the content of creatinine protein in this patient's body normal?

Isn't the middle-aged patient coronary heart disease?

But such words cannot be justified.

The first is the most obvious chest pain and tightness.

The second is the abnormal fluctuation of the electrocardiogram.

The third is the increase of troponin cardiac enzymes.

Obviously, the patient in front of him did not meet the requirements.

?

hehe……

too young!

When studying medicine, don't memorize it by rote!

Teacher Zhang Mei smiled and began to assess Zhou Mo:

"Xiaomo, this troponin, do you think it's not a myocardial infarction?"

The ubiquitous deadly serial question.

Zhou Mo smiled, confident and calm.

"Teacher, this result does not rule out myocardial infarction."

"Because in patients with myocardial infarction, it takes a process for troponin to flow from the heart into the blood, and it takes at least half an hour to an hour for the content of troponin to rise significantly in the blood."

"And the middle-aged patient has been sick for less than an hour now, and it is understandable that the troponin level is normal."

Zhang Mei: "How would you judge if this patient is handed over to you?"

Zhou Mo: "The three most probable and most urgent possibilities: myocardial infarction, aortic dissection, and acute pulmonary embolism..."

The three disease symptoms are very similar and can be easily misdiagnosed.

And even if it is misdiagnosed, a middle-aged patient may die suddenly.

...

soon,

The cardiologist is here.

It was Teacher Huang Li, and he brought 2 students with him.

Coincidentally!

"Huh, Zhou Mo?"

"teacher!"

Teacher Huang Li said to the two medical students behind him: "This is Zhou Mo, our cardiology department is very famous..."

When the two medical students heard this, they were in awe of Zhou Mo.

Seven crowns!

The most awesome medical students!

Medical students can be the masters of the pennant!

Zhou Mo greeted them with a smile.

Soon, Zhou Mo introduced the patient's condition to Teacher Huang Li. At present, the possibility of myocardial infarction, aortic dissection, and acute pulmonary embolism is relatively high.

"Then send it to the cardiology department. By the way, the emergency department will order a CT to see what's going on..."

"good."

...

Next, Mr. Huang Li from the Department of Cardiology took over,

Send CT, send cardiology...

Zhou Mo didn't need to deal with this patient anymore, but was busy with other patients.

...

2 hours later,

Teacher Huang Li sent Zhou Mo a WeChat message.

"During the angiographic intervention of the patient, it was found that although the patient's coronary artery was somewhat narrowed, it was far from the level that caused frequent episodes of chest pain and tightness, so it may not be angina pectoris."

"Then also ruled out aortic dissection, pulmonary embolism..."

Zhou Mo: "..."

ruled out?

What the hell?

Teacher Huang Li sent a smiling face: "What do you think the final diagnosis is?"

Zhou Mo: "What?"

Mr. Huang Li is not a joke: "It's hypertrophic cardiomyopathy!"

Hypertrophic cardiomyopathy is generally a genetic disease characterized by asymmetric hypertrophy of the ventricular muscles.

That is to say, one side may be hypertrophic and the other side may be normal, or both sides may be hypertrophic, but the degree of hypertrophy is different.

As for which is more serious, it or coronary heart disease, it is hard to say, because if not treated properly, both can cause the death of the patient.

"According to the patient's cardiac color ultrasound, the patient's left ventricle is excessively hypertrophic, and the blood flowing out of the left ventricle is not smooth."

"This has led to symptoms such as chest pain and tightness in patients."

"Although the patient is not suffering from myocardial infarction, the left ventricle is too hypertrophic, which also leads to insufficient blood supply."

"That is to say, although the patient is not a myocardial infarction, the result is similar to that of a myocardial infarction, and the heart's blood supply is also not smooth."

"The resulting symptoms are also the same, all causing chest pain and tightness."

So far,

The logic is smooth!

Symptoms + echocardiography confirmed, can be diagnosed as

—Hypertrophic cardiomyopathy!

.