I Can See Health

"Dr. Fan, let me tell you my personal opinion. Different from Dr. Min's diagnosis, I think there are two other possibilities."

What? Are there two other possibilities?

As soon as Lu Chen's speech appeared in the group, it attracted the attention of everyone in the group.

They are scratching their heads and cannot think of a single diagnosis?

Now that Professor Lu is taking action, there are two possibilities at once?

Lu Chen's speech even attracted some people.

For example, Zhang Wulong from the People's Emergency Department of Feng M County.

It was he who invited Fan Zhiping to join the Jinghua Electrophysiology WeChat group.

The emergency department happened to be quiet for a while, and he happened to see this scene in the group while scrolling through his phone.

"Hey, are two members of the Jinghua Electrophysiology Association starting a battle?"

After all, it was Professor Lu who helped him last time, Zhang Wulong still hopes that Lu Chen can win.

However, Zhang Wulong also took a look at the case just now.

He felt that Professor Min's diagnostic analysis seemed very reasonable!

What new work can Professor Lu do?

Everyone is looking forward to Lu Chen's next speech.

…

"Has the patient's heart ultrasound been done?"

As soon as Lu Chen's message appeared in the group.

Fan Zhiping grabbed his phone and immediately responded: "Professor Lu, the patient has just come to the department and hasn't had time to do it yet. And our small hospital does not have bedside cardiac ultrasound. We can only wait for the patient's condition to get better and let him go tomorrow or the day after tomorrow." Do."

Min Xiaobo noticed Lu Chen's speech in the group.

"Heart ultrasound? Why does he want to see a heart ultrasound?"

Fan Zhiping was also curious, what other insights does Professor Lu have?

Min Xiaobo just made it very clear. His reasons have convinced most people in the group, including him of course.

…

Lu Chen thought to himself: "Have you not done a heart ultrasound yet? Then it is not easy to confirm the diagnosis."

Before, he carefully reviewed the two electrocardiograms sent by Fan Zhiping.

In fact, look carefully at this second ECG.

We can still find many clues.

The electrocardiogram showed extensive T wave inversion, with the T wave upright in lead avR and the deepest T wave inversion in leads V3 and V4.

T wave depression is asymmetrical, and its vector points toward the apex!

The patient's troponin was normal, but coronary ischemia alone was difficult to explain such extensive T wave inversion!

This is also the second contradiction Lu Chen discovered!

It is thought that after the patient was given intravenous injection of cedilan, his chest tightness worsened.

Lu Chen thought of two possibilities!

"The electrocardiogram shows reverse elevation and depression of the st segment, which is considered to be caused by myocardial hypertrophy. If the patient has hypertrophic obstructive cardiomyopathy, cidilan will aggravate the obstruction of the ventricular outflow tract and reduce cardiac output after cardiotonicity. "

When Min Xiaobo saw Lu Chen's speech in the group, his eyes suddenly lit up.

yes!

This electrocardiogram does suggest the possibility of hypertrophic obstructive cardiomyopathy.

In patients with hypertrophic obstructive cardiomyopathy, the symptoms of chest tightness and chest pain will worsen after taking cedilan!

This is equivalent to a water pipe being blocked. You have to increase the horsepower and give it stronger pressure.

This will not only prevent water from flowing out, but may also damage the water pipes.

Almost all cardiologists know that cedilan is contraindicated in patients with hypertrophic obstructive cardiomyopathy.

However, when patients experience worsening of chest tightness symptoms while using cedilan, few people would think that it is hypertrophic obstructive cardiomyopathy!

No wonder Lu Chen asked the patient if he had done a heart ultrasound.

Hypertrophic obstructive cardiomyopathy is generally diagnosed through ultrasound and cannot be seen on chest CT.

Min Xiaobo was a little annoyed. Why didn't he think of such a simple knowledge point?

People from other departments in the group may not be able to understand this feeling, but anyone with a background in cardiology will feel somewhat similar to Min Xiaobo at this time.

It's a seemingly simple question, but I racked my brains and couldn't think of it.

Then after some advice from others, I suddenly realized it!

This feeling brings a bit of annoyance and a bit of joy.

…

Zhang Wulong from the emergency department was a little confused. He didn't quite understand the professional knowledge in his heart.

However, after Lu Chen finished speaking, no one in the group responded for a long time.

Did Professor Lu make a mistake?

At this moment, Fan Zhiping spoke again.

"Professor Lu, this is the first possibility. Didn't you say there is a second possibility?"

In fact, when he saw the words hypertrophic obstructive cardiomyopathy, he knew that Lu Chen was probably right!

He is the doctor who treats this patient, and he has the most intuitive feeling.

According to the patient’s symptoms, signs and auxiliary examination results, the probability of hypertrophic obstructive cardiomyopathy is very high!

But as soon as this thought came into his mind, he thought of what Lu Chen said again.

There are two possible diagnoses!

Fan Zhiping had just been diagnosed with hypertrophic obstructive cardiomyopathy, but now he was shaken again.

It's all because Lu Chen said there are two possibilities!

The group was very quiet, everyone was waiting for Lu Chen's next possibility.

Min Xiaobo sat in the duty room with an extremely serious expression. He was also looking forward to Lu Chen's next speech.

Hypertrophic obstructive cardiomyopathy was something he had not thought of, but he was not convinced.

This knowledge point is very simple, but he just ignored it.

He wanted to see what other convincing diagnosis Lu Chen, who was also an elite member of the Jinghua Electrophysiology Association, could come up with. !

…

Eight zones in the heart.

When it was time to get off work, Yue stood up and stretched.

Jiang Qingyan has been going to the skills center for training recently, and she doesn't want to go to the cafeteria to eat alone.

"Lu Chen, let's go have dinner together at noon."

"Oh, I have something else to do, why don't you go first without waiting for me."

Lu Chen was holding his mobile phone and editing information without raising his head.

This passage is quite long.

Lu Chen checked it and found that there were no typos before sending it out.

"The second possibility is stress cardiomyopathy. The cause may be chronic obstructive pulmonary disease, because chronic obstructive pulmonary disease itself is hypoxia, which can easily lead to fast heart rate, sympathetic excitement, and the release of large amounts of catecholamines, especially after menopause. Older women are more likely to develop stress cardiomyopathy on this basis!”

"Cedilan is similar to catecholamines (dopamine, epinephrine, norepinephrine). UU Reading www.uukanshu.net will aggravate the condition after use! Secondly, stress cardiomyopathy has basal hyperkinesis and weakened apical contractility. , quite similar to outflow tract obstructive hypertrophic cardiomyopathy.”

"In my opinion, do a cardiac ultrasound first to rule out hypertrophic obstructive cardiomyopathy; if not, do a coronary angiogram to confirm whether there is stress cardiomyopathy."

If we say, Min Xiaobo may not be convinced by the first possibility mentioned by Lu Chen.

When Lu Chen mentioned stress cardiomyopathy, he first looked confused, then shocked, and finally just shook his head helplessly.

Combined with this case, the diagnosis of stress cardiomyopathy is reasonable and convincing!

Why, he would never have thought of the diagnosis of stress cardiomyopathy!

"Who is he?"

Min Xiaobo had to re-examine this elite member named Lu Chen.

…

After Lu Chen finished speaking in the group.

The WeChat group exploded.

No one expected stress cardiomyopathy.

But after listening to Lu Chen’s analysis, everyone felt that it made sense!

The disease cannot be diagnosed, but it does not hinder the judgment of the disease.

"Professor Lu's analysis is so good!"

"I'm also a cardiologist! Although I know all the diseases Professor Lu mentioned, I just can't think of them together!"

"Dr. Fan, when the patient's symptoms are better, hurry up and send the patient for examination! I really look forward to the patient's final diagnosis!"

These people are really useless!

Fan Zhiping had to sigh.

"As expected of Professor Lu!"