I Can See Health

Lu Chen shrugged his shoulders and said, "It could be a stomach problem, it could be intercostal neuralgia, costochondritis, or cardiac neurosis."

"Then do we still need to do cardiac angiography?" Wang Zihao frowned.

The patient in front of him is none other than his aunt.

Although Wang Zihao usually doesn't like to take relatives to see a doctor, now that he accepts this, he still has to be responsible to the end.

"My opinion is, don't do it for now." Lu Chen paused and said, "You can do a coronary CTA first to evaluate the condition of the heart and blood vessels. If there is really a problem, go for angiography."

"Lu Chen, I also worked in the Department of Cardiology during my internship. Sometimes the coronary CTA is not accurate in seeing the blood vessels." Wang Zihao said doubtfully, "Just in case, I said just in case, my aunt's blood vessels really are..." If she has stenosis and asks her to undergo cardiac angiography, then she will suffer two consequences. It is better to just do cardiac angiography and get it right in one step. "

Clinically, there are two methods for diagnosing coronary heart disease.

The first is coronary CTA, which is simply an enhanced CT of the heart blood vessels. Contrast agent is injected into the heart blood vessels and then developed using a CT machine to see clearly the condition of the blood vessels, whether there is any blockage and the extent of the blockage.

The other is cardiac imaging.

Cardiac angiography generally refers to coronary angiography. The specific operation usually uses radial artery puncture, insertion of a sheath, and under the guidance of the angiography guidewire, it reaches the left and right coronary sinus ostia and is imaged by imaging equipment. Dynamic observation of coronary artery stenosis from individual positions and multiple angles.

Coronary angiography is currently the gold standard for diagnosing coronary heart disease. Under normal circumstances, coronary angiography can be used to see whether there is stenosis in the patient's coronary arteries, which part of the stenosis is stenotic, and the degree of stenosis, and can confirm whether there is coronary heart disease. , and can also guide the next step of treatment.

Cardiac coronary CTA, because it is affected by factors such as heart rate, blood vessel plaques, and equipment, has some false positive results, and the diagnostic accuracy is not as high as that of angiography.

"But, have you ever thought about another point? Cardiac coronary angiography is an invasive examination after all. If a catheter is inserted into a blood vessel, even the most skilled doctor will cause damage to the blood vessel." Lu Chen said, "And Cardiac coronary CTA is just a non-invasive imaging test. If it is just to rule out coronary heart disease, then why not do CTA? "

Wang Zihao was silent for a long time, then sighed and said: "Each method has pros and cons. Let my aunt make her own choice. I can't make the decision for her."

"Yes." Lu Chen said, "Don't worry, we will communicate with her, and this is just my suggestion. The senior doctor in the team will also visit the patient to evaluate her condition and what kind of examination is suitable."

Wang Zihao smiled and patted Lu Chen on the shoulder: "Thank you, brother. I'm sorry to trouble you."

"You're welcome." Lu Chen smiled.

…

After Wang Zihao left, Lu Chen returned to the doctor's office with an electrocardiogram.

"Junior brother, what patient is here?"

As the attending doctor, Sun Guoguo inquires about the condition of each new patient as usual.

"A female patient with chest pain." Lu Chen said, "I want to do a cardiac angiogram."

"Oh, okay, then let's make arrangements for her." Sun Guoguo said.

Lu Chen paused and stopped talking.

"What's wrong, junior brother?" Sun Guoguo looked back at Lu Chen.

"I feel like she doesn't have coronary heart disease." Lu Chen paused and said.

Sun Guoguo was stunned for a moment, "Where's her electrocardiogram?"

"Here." Lu Chen handed the electrocardiogram to Sun Guoguo and continued, "The patient is a fifty-year-old woman. There is no obvious correlation between chest pain and activity. She has no risk factors for coronary heart disease, high blood pressure, diabetes, etc. No history of smoking or drinking.”

At this time, other people in the group also gathered around.

"With T-wave inversion in the chest leads, is it true that coronary heart disease is not considered?" Ke Yue whispered from the side.

"Well, she also has symptoms of chest pain. I also think coronary heart disease should be considered." Dong Hao nodded in agreement.

After reading the electrocardiogram, Sun Guoguo didn't comment immediately. She was silent for a while and said, "Go to the ward to see the patient first."

…

Everyone came to bed 11.

Fu Fengqin was chatting with the patient in the bed next to her.

Seeing the doctors arriving, she quickly returned to her hospital bed.

"Aunt Fu, this is your attending doctor, Dr. Sun." Lu Chen introduced.

"Hello, Doctor Sun." Fu Fengqin's face was full of smiles.

"Auntie, I came here to ask some questions about your condition." Sun Guoguo said.

"Ah? Why are you still asking?" The smile on Fu Fengqin's face gradually disappeared, and instead she frowned, "Didn't Dr. Lu already ask this question when he just came here? Don't you doctors communicate with each other? I need to ask a second time about my condition?”

Everyone present looked at each other.

Asking about the medical history again is a very common thing in clinical practice.

Every doctor basically judges the condition by making personal inquiries and collecting first-hand information.

And not just by other doctors’ descriptions.

The performance of the aunt in front of me seemed a bit extreme.

"Also, here are my medical records when I was hospitalized in the county hospital. You can take a look at them. My conditions are all on them. No need to ask anymore. It's too troublesome." Fu Fengqin waved her hand impatiently.

Lu Chen frowned and said in a deep voice: "Aunt Fu, each of our doctors has a different focus on understanding the medical history, and we can find out the gaps. At the same time, this is also the basic process of seeing a doctor, and we need you to cooperate with us."

"Oh, your hospital is really troublesome." Fu Fengqin held her forehead and sighed, "I have a heart problem. I want to do a cardiac angiography. Why is it so troublesome! Forget it, ask whatever you want to ask."

Fu Fengqin lay on the bed, with her hands behind her head, and said to Sun Guoguo.

"Ke Yue, you ask." Sun Guoguo whispered to Ke Yue.

"Yes." Ke Yue nodded gently, stepped out, and began to ask about the medical history.

The medical consultation is the first communication mode between doctors and patients.

It is also an extremely important link.

There are a thousand Hamlets for a thousand readers.

Similarly, different doctors will collect different medical histories for the same patient.

Take the patient with "chest pain" as an example. The cardiologist may think it is coronary heart disease, the respiratory doctor may think of pleurisy, the gastroenterologist may think it is gastric ulcer, and the surgeon may consider whether it is a hiatal hernia!

Therefore, the collection of medical history should not only be targeted, but also not limited to a single system disease.

At this time, Ke Yue's questioning seemed to guide the patient to the diagnosis of coronary heart disease.

"Auntie, do you usually have chest pain after activities, or chest tightness and discomfort?"

"What kind of pain is that? Do you feel like there is a stone pressing on your chest pain? Or is it a needle-like pain? Or a tearing pain?"

"After resting, can the symptoms of chest pain be relieved?"

This is because, in Ke Yue's heart, she has actually determined that the aunt in front of her has coronary heart disease.