I Can See Health

Arrived at the ward.

Lu Chen and Fan Zhiping were in front, and Wei Zhongwen pushed the electrocardiograph and followed closely behind.

On the bed, the patient lay flat, gasping for air.

His lips were slightly pale, his face was full of pain, and there were even layers of sweat on his forehead.

Lu Chen looked at the patient's head, and his life value was 62!

This value is around the limit of 60.

Most patients with acute myocardial infarction have a life value below 60.

However, if the acute myocardial infarction is in the recovery period, or the range of myocardial infarction is very small, the life value will rise above 60.

"Junior brother, take the patient's blood pressure, and then check an electrocardiogram." Lu Chen ordered, and he also auscultated the patient's heart and lungs.

Patients with chest pain need to have an electrocardiogram checked immediately as long as the degree of chest pain changes.

"Okay, senior brother."

Wei Zhongwen was very quick and immediately took out the mercury sphygmomanometer.

At this time, Lu Chen also began to ask about the patient's condition.

"When did the chest pain start?"

"Actually, it started when I got up this morning, but I took a nitroglycerin tablet and the chest pain was relieved." The patient's family member is a middle-aged woman, who should be the patient's wife. "He used to have coronary heart disease. Usually, he could relieve chest pain by taking nitroglycerin sublingually. But the department just now couldn't do it. It was too painful and he couldn't breathe."

Generally speaking, if it is angina pectoris, taking nitroglycerin sublingually can relieve it.

Most of those who can't relieve it are myocardial infarctions!

"When was the most painful?"

"Just now, about a few minutes ago."

"Where does the chest hurt? Patient, point it out to me yourself." Lu Chen looked at the patient on the bed and said.

The patient panted and pointed to the position of his heart.

"Is the degree of chest pain now the same as before, or is it worse than before?"

"Worse." The patient uttered a few words with difficulty.

"What kind of pain do you feel?" Lu Chen continued, "Is it like a stone pressing on your chest, and you can't breathe?"

"Yes, that's the feeling." The patient frowned and answered, sweat oozing from his forehead. Covering his chest with both hands, it looks like he is in real pain.

Lu Chen's heart sank.

Combining the patient's symptoms and his own description, the pain cannot be relieved by nitroglycerin. This pain is too much like a heart attack.

At this time, Wei Zhongwen had already measured the blood pressure.

"Brother, the patient's blood pressure is 1Hg, and the blood pressure on both sides is symmetrical."

Lu Chen nodded and said to the patient and the patient's family: "Fortunately, the blood pressure has not dropped. Nitroglycerin cannot be used casually."

"If you want to take nitroglycerin sublingually, remember to measure the blood pressure. If the systolic blood pressure is lower than 100mmHg, don't use nitroglycerin. It would be even worse if the blood pressure collapses directly. This medicine used to be a component of explosives, you know, it's very strong and can lower blood pressure. Don't use it when the blood pressure is low."

The patient's family nodded quickly.

Lu Chen asked a few more questions and learned that the patient had never had coronary angiography or coronary CTA before.

"Without coronary angiography, it cannot be confirmed that it is coronary heart disease."

Having experienced many diseases similar to myocardial infarction before, Lu Chen is not in a hurry to make a diagnosis now.

About a minute later, Wei Zhongwen finished the electrocardiogram.

"Thank you." Lu Chen took the electrocardiogram handed over by Wei Zhongwen.

The electrocardiogram showed that the ST segment of leads II, III, and aVF was downshifted by 0.05mV, and the ST segment of leads V4-V6 was also downshifted due to the T wave.

At this time, the patient added: "Doctor, I also have traction pain in my left forearm."

When Fan Zhiping heard this, he said: "Isn't this a typical radiating pain of myocardial infarction?"

Lu Chen hummed in approval.

The patient was obese and had been diagnosed with coronary heart disease and hypertension.

Now he has obvious chest pain and reflex pain, and sublingual nitroglycerin is ineffective. In addition to the electrocardiogram, the possibility of myocardial infarction is quite high!

"Hurry up and open the intravenous channel!"

Lu Chen immediately ordered the nurse to draw blood and do routine tests, especially to check myocardial enzymes and troponin.

There is a rapid screening of troponin in the eighth area of ​​the heart, which can be done in the department and the results can be obtained in a few minutes.

"Brother Fan, please notify Senior Sister Sun and ask her to come and see the patient." Lu Chen said to Fan Zhiping who was standing by.

The mortality rate of acute myocardial infarction is very high. For critical cases like this, the superior doctor must be notified as soon as they are discovered.

"Okay!" Fan Zhiping left the ward immediately.

...

At this time, the patient's troponin rapid screening results came out!

The results showed that troponin was normal and not significantly elevated.

Wei Zhongwen on the side whispered: "If it is normal, then myocardial infarction cannot be diagnosed in this way?"

The diagnosis of myocardial infarction relies on three elements: typical chest pain, electrocardiogram performance, and troponin.

The increase in troponin means myocardial infarction, which is caused by the rupture of myocardial cells.

But now the patient's troponin is still normal, what does it mean?

Lu Chen patiently explained: "For patients with myocardial infarction, the electrocardiogram will react quickly, but troponin, myocardial enzymes, etc. need a certain amount of time to increase. The fastest is myoglobin, which also takes 30 minutes to 1 hour to increase."

"The troponin we measured takes at least 2-3 hours to rise. The patient only had chest pain for less than an hour. It is understandable that the troponin is normal, but it needs to be reviewed dynamically."

"Oh." Wei Zhongwen nodded.

At this time, Sun Guoguo also came to the ward.

"How is the patient?" Sun Guoguo checked the patient and then looked at the patient's electrocardiogram.

Lu Chen thought for a while and immediately said: "The patient had sudden chest pain for about 10 minutes, and taking nitroglycerin under the tongue could not relieve it. He had a history of similar chest pain in the past, but he had previous chest pain attacks, and taking nitroglycerin under the tongue could relieve it. "

"What about the past medical history?" Sun Guoguo asked.

Lu Chen paused and continued: "The patient was diagnosed with coronary heart disease at the local hospital two years ago because of chest pain and tightness. Later, he took aspirin and other drugs for a long time. At the same time, the patient also had a history of hypertension and took antihypertensive drugs. , the specific medicine is unknown, but I don’t insist on taking it, and I don’t measure my blood pressure at home.”

After listening to Lu Chen's medical history report, Sun Guoguo said solemnly: "The patient's chest pain continues to not be relieved, and the electrocardiogram shows myocardial ischemia, suggesting that it may be an acute non-ST segment elevation myocardial infarction!"

If it is really myocardial infarction, then immediately send it to the catheterization laboratory and perform coronary intervention to open the coronary arteries blocked by thrombus, so that more myocardium that is ischemic and hypoxic can be saved!

There are too many patients like this in the Department of Cardiology. Some of them were delayed and their heartbeats stopped immediately!

But Sun Guoguo was not at ease with such a patient!

"Do you think this patient can rule out aortic dissection?" Sun Guoguo looked at Lu Chen and Fan Zhiping standing aside. UU reading www. uukanshu． net

For patients with chest pain, in addition to myocardial infarction, aortic dissection must be ruled out!

Because the treatment of myocardial infarction and dissection are completely opposite!

If the patient has an aortic dissection, it will be terrible if he takes anticoagulant and antiplatelet drugs. Hemorrhage may occur and the patient will die faster!

As long as it's a mistake...

That is ruin!

Lu Chen and Fan Zhiping looked at each other and shook their heads.

Judging from the current data, there is indeed no way for patients to completely rule out aortic dissection!

However, the patient's biggest possibility is acute myocardial infarction. If the time to open the blood vessel is delayed, it will cause greater harm to the patient!

This is quite contradictory!

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