This Doctor is Great - Chapter 218

“No.”

The middle-aged patient said without thinking, “I haven’t done any surgery before… I’ve always been in good health…”

Teacher Zhang Mei: “Any other medical history? For example, family medical history, etc…”

Middle-aged patient: “Neither.”

At this time,

Zhou Mo took out the ECG chart he just typed out from the electrocardiograph.

Zhou Mo glanced at it.

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

“Teacher, look…”

Teacher Zhang Mei glanced at it and asked Zhou Mo, “You have been trained in the Department of Cardiology, what do you think?”

Zhou Mo: “The ECG in the ST segment is obviously down, which generally means 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 sound.

“What’s wrong?” Zhou Mo bent over.

Middle-aged patient in pain: “Doctor, I have a kind of pulling pain in my left forearm now.”

Zhou Mo: “It hurts?”

The middle-aged patient nodded with difficulty: “Yes, it’s like there is an infinitely powerful giant pulling my arm hard. 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 only obvious.

Zhou Mo suddenly thought of aortic dissection.

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

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

temporarily excluded.

Zhang Mei looked at the patient’s condition, and it is still stable now, and there is no major problem with the vital signs of the ECG monitor.

“Xiao Mo, you go to open the bill, and then ask the family to sign…”

“Draw blood for routine tests, especially to check cardiac enzymes, troponin, etc…”

“it is good!”

Zhou Mo opened the bill on the computer and walked out of the emergency room.

Outside the rescue room, the patient’s wife was on the phone 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: “At present, the vital signs are still normal. We temporarily consider it to be a myocardial infarction, but further examination is required…” l

Then Zhou Mo introduced various possibilities and complications.

“Now we will do the corresponding tests, and we can make further diagnosis after the test results come out…”

“Need your signature.”

The wife hurriedly said, “I will sign!”

signature.

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

The blood drawn is sent,

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

soon,

The results for troponin came out.

– Result: OK!

Zhou Mo: “???”

Zhou Mo handed the results 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 level of creatinine protein in this patient’s body normal?

Aren’t middle-aged patients with coronary heart disease?

But this can’t be said anymore.

The first is the most obvious chest pain chest tightness.

The second is abnormal fluctuations in the electrocardiogram.

The third is an increase in troponin cardiac enzymes.

Obviously, the patient in front of me does not fit.

Ha ha…

too young!

To study medicine, you can’t memorize it by rote!

Teacher Zhang Mei smiled and began to assess Zhou Mo:

“Xiao Mo, do you think this troponin is a myocardial infarction?”

The ubiquitous deadly chain question.

Zhou Mo smiled slightly, confident and calm.

“Teacher, this result does not rule out myocardial infarction.”

“Because of 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 increase significantly in the blood.”

“And the middle-aged patient is now less than an hour old, and it is understandable that the troponin level is normal.”

Zhang Mei: “How would you judge this patient?”

Zhou Mo: “The three most probable and urgent possibilities: myocardial infarction, aortic dissection, acute pulmonary embolism…”

The symptoms of these three diseases are very similar and can easily be misdiagnosed.

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

…

soon,

The cardiologist is here.

It was Mr. Huang Li, and he brought 2 students.

What a coincidence!

“Hey, Zhou Mo?”

“teacher!”

Mr. 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 immediately respected Zhou Mo.

Seven Crowns!

The coolest medical student!

A medical student can be a great man with a pennant!

Zhou Mo smiled and greeted them.

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

“Then send it to the Cardiology Department, right, open a CT in the emergency department to see what’s going on…”

“it is good.”

…

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

Send CT, send cardiology…

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

…

After 2 hours,

Teacher Huang Li sent Zhou Mo a WeChat message. UU reading www.uukanshu. com

“When the patient underwent angiography intervention, it was found that although the patient’s coronary artery was somewhat narrowed, it was far from the level of frequent chest pain and chest tightness, so it may not be angina pectoris.”

“And then also ruled out aortic dissection, pulmonary embolism…”

Zhou Mo: “…”

all ruled out?

what the hell?

Teacher Huang Li smiled: “Guess what the final diagnosis is?”

Zhou Mo: “What?”

Mr. Huang Li doesn’t give a shit: “It’s hypertrophic cardiomyopathy!”

Hypertrophic cardiomyopathy, generally speaking, is a genetic disorder characterized by asymmetric hypertrophy of the ventricular muscle.

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

As for which is more serious and coronary heart disease, this is hard to say, because if treated improperly, both can cause the death of the patient.

“According to the patient’s echocardiography, the patient’s left ventricle was hypertrophic, and the blood flow from the left ventricle was not smooth.”

“This leads to symptoms such as chest pain and chest tightness in patients.”

“Although the patient is not a 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 caused by a myocardial infarction, and the blood supply to the heart is also not smooth.”

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

So far,

The logic is smooth!

Symptoms confirmed by echocardiography, can be diagnosed as

—Hypertrophic cardiomyopathy!

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