I Can See Health

Ward rounds begin.

Sun Guoguo walked in the front, while the others stood behind her, each holding the medical records of the patients in their own beds.

During ward rounds, the doctor must stand behind the bed.

This is a default rule, and it is also for doctors to better examine patients.

In addition, doctors and patients must maintain an appropriate distance, usually about one meter, so that patients cannot feel alienated.

"Bed No. 1, this is a patient diagnosed with coronary heart disease and unstable angina. He was admitted yesterday and will undergo coronary angiography in two days to evaluate the vascular condition."

Arriving at bed No. 1, Jiang Qingyan began to report the patient's medical history.

From the chief complaint, history of current illness, past history to abnormal auxiliary examinations, Jiang Qingyan reported everything without missing a beat.

After the report was over, Sun Guoguo began the mode of questioning and teaching.

"Coronary heart disease is one of the most common diseases in our hearts. Let me ask you a question, a basic knowledge. How is coronary heart disease classified?"

The two interns hid in the back, heads lowered, for fear that their names would be called.

"Junior sister Jiang, you are in charge of this patient's bed, so you can answer it."

Sun Guoguo pursed her lips towards Jiang Qingyan.

"Yes." Jiang Qingyan nodded, "Coronary heart disease is mainly divided into two categories, stable coronary artery disease and acute coronary syndrome."

"Stable coronary artery disease, including ischemic cardiomyopathy, stable angina, and latent heart disease."

"Acute coronary syndromes, including acute myocardial infarction and unstable angina."

Jiang Qingyan's explanation was very clear. Sun Guoguo nodded slightly after listening, "Yes, that's very good."

"Why do we need you to clarify the disease classification? It is because different types of diseases have different treatment methods and prognosis. Don't think that there is only one treatment method for coronary heart disease. It is important to first understand the patient's disease classification. Treating diseases with the same method is something that only a barefoot doctor can do.”

Sun Guoguo's ward rounds focus on asking questions.

She will ask different questions for different types of patients.

Ward rounds are also one of the important ways for young doctors to learn knowledge and clinical experience in clinical work.

"Now that everyone knows the classification of coronary heart disease, let's talk about the classification of acute myocardial infarction."

Sun Guoguo continued to ask questions.

The two interns were shocked, and their heads that had just been raised slowly lowered again.

"Junior Sister Ke, you answer it."

Ke Yue held a few medical record folders, her eyes were a little evasive, and she whispered: "Acute myocardial infarction is divided into acute ST-segment elevation myocardial infarction and acute non-ST-segment elevation myocardial infarction."

"Only this?"

Sun Guoguo looked at Ke Yue doubtfully.

Ke Yue lowered her head and bit her lower lip, "I, that's all I know."

Sun Guoguo looked serious and turned his attention to the others.

"Xiao Dong, what's your opinion?"

Dong Hao is the trained male doctor in the team.

This year is his second year of training, and he has previously rotated in other departments such as nephrology, neurology, and respiratory medicine.

Dong Hao touched his nose awkwardly, "Senior sister, I am the same as Ke Yue, I only know how to classify them into these two categories."

After listening to Dong Hao's answer, Sun Guoguo continued to look for the next "hunting" target.

The two interns became even more panicked.

"Doctor Qu, do you have any other comments?"

Sun Guoguo looked directly past Lu Chen and the interns and towards Qu Yao, the only training doctor in the group.

"There should be other types, such as myocardial infarction caused by coronary spasm. In fact, there is no problem with the coronary blood vessels, but certain stress conditions have caused spasm of the blood vessels." Qu Yao thought for a while and said, As an attending physician, he has been practicing clinically for many years, and his clinical experience is much richer than that of these graduate students and trainees.

"Well, Dr. Qu's clinical experience is much richer." Sun Guoguo smiled, "Myocardial infarction, as the name suggests, is the necrosis of myocardial cells. The type that Junior Sister Ke mentioned is the most common type of coronary artery disease in the heart. Myocardial infarction caused by thrombotic events is myocardial infarction in a narrow sense. But in our Department of Cardiology, there is also a broad sense of myocardial infarction, including all causes of damage to myocardial cells, which can be called myocardial infarction."

When Ke Yue, Dong Hao and others heard Sun Guoguo's explanation, they all looked like they were suddenly enlightened.

This new concept of myocardial infarction is rarely mentioned.

"So, besides coronary spasm, are there other diseases?"

Qu Yao groaned and said: "Of course there are, such as supraventricular tachycardia and third-degree atrioventricular block damage to myocardial cells."

"Um."

Sun Guoguo nodded slightly. As expected, doctors with clinical experience knew more about these issues.

Academic qualifications are important, but experience is equally important in medicine.

After all, people don’t get sick according to the standard textbook symptoms.

"Are there any other types?"

Qu Yao frowned, "Other types...it seems there are no more..."

Sun Guoguo smiled, "Yes, but it's not common, so it's normal for people not to know."

At this moment.

Lu Chen looked like he was hesitant to speak.

Sun Guoguo saw it, could Junior Brother Lu Chen know about it?

"Junior Brother Lu, do you know?"

Lu Chen nodded with a smile and said, "There are five broad classifications of acute myocardial infarction internationally."

"What? Five kinds?"

Everyone present, except Sun Guoguo, looked surprised.

In internal medicine textbooks, it has never been said that acute myocardial infarction can be divided into five categories.

Qu Yao frowned and looked at Lu Chen, where did this little boy come from?

She has been working in clinical practice for nearly eight or seven years, specializing in cardiology, but she has never heard that myocardial infarction can be divided into five categories.

Sun Guoguo's face showed a happy smile, "Junior brother, continue talking."

Lu Chen coughed lightly and said: "The first category, which is what Ke Yue said, is myocardial infarction caused by coronary thrombosis events, which is the most common vascular plaque rupture in cardiology, forming thrombus, and thrombosis causes The blood vessels are blocked, and the myocardium becomes necrotic due to ischemia and hypoxia.”

"The second category, UU Reading www.uukanshu.net Myocardial infarction caused by imbalance of oxygen supply in coronary blood vessels, such as coronary artery spasm, fast or slow arrhythmia mentioned by Dr. Sun, the pathology of these diseases is not clotting of blood vessels by thrombus , but caused by the imbalance of oxygen supply in its blood vessels.”

After Lu Chen mentioned the first two categories, everyone felt enlightened.

What Dr. Qu Yao said only listed the diseases, but did not clearly explain the pathophysiology of the diseases.

And what about Lu Chen?

He explained the causes of both types of myocardial infarction and analyzed them from the essence of the disease.

Qu Yao was meditating on the side. She felt something different about Lu Chen. This child's basic skills were extremely solid.

The basic skills of a doctor do not only refer to internal medicine, but also pathology, physiology, anatomy, etc.

Everyone pricked up their ears and listened carefully to Lu Chen's next explanation.

"The third category is similar to the fourth category, which is called PCI-related myocardial infarction and coronary artery bypass graft-related myocardial infarction. The fifth category is sudden death. Many sudden deaths are unexplained. Some guidelines list it as myocardial infarction. Special type.”

In fact, few people talk about the latter three types of myocardial infarction. They are just medical classifications and are not mentioned in internal medicine books. They are only mentioned in major international guidelines.

Seeing the surprised looks in everyone's eyes, Lu Chen felt a little embarrassed: "I often visit medical forums, so I know more about this kind of uncommon knowledge."

If I had known, that strange headache would have tortured Lu Chen for decades.

In order to collect some cases about "headaches", he would visit medical forums, such as Lilac Garden, Xinglin Forum, and even some strange surgical live broadcast rooms.

Most of this uncommon knowledge was passively accepted by Lu Chen.