I can see the status bar

Chapter 655 Don't Believe in Evil
Yuan Ping'an is a master who does not believe in evil.Everyone said that Sun Li'en had a dark face, as long as the patient he took over had to be an atypical symptom even if it wasn't a rare disease.Although the correct cause can be found in the end, encountering such a patient is a bit of a chore after all.Other doctors would not ask Sun Lien for a consultation unless it was absolutely necessary.

Yuan Ping'an has a different view.He felt that it was a good thing that Sun Lien came to the clinic to check out the patient's rare disease.

Regardless of whether it was Sun Li'en who came for consultation, the disease itself would not change because of the doctor's diagnosis.A rare disease has been diagnosed, at least the direction of treatment or control of the disease has been clarified.This is of course a great thing for the patient-it is better than being misdiagnosed as a common disease, and then repeated treatments are ineffective and the disease develops further.

"What's the problem?" Although Yuan Ping'an is still the attending doctor of the emergency department, he has completed the support task, served as the chief resident for a year, and has enough weighty articles to back him up.So now in the emergency department, everyone basically regards Yuan Ping'an as a deputy senior.If it wasn't for a particularly troublesome patient, he wouldn't be asked to go for a consultation easily.Just because he understood this, Yuan Pingan decided to call Sun Lien to go and have a look together.

"Male, 25 years old. Chest tightness after exercise." It was a young doctor who called Yuan Ping'an.Sun Lien met him twice in the emergency department—probably a new intern or a regular trainee on rotation? "The patient complained of long-term fatigue, but he never sought medical treatment."

"Ah?" Yuan Ping'an was a little surprised when he heard this, "Why haven't you seen a doctor?"

It is not uncommon for patients to delay treatment for a variety of reasons.But this kind of thing usually happens in the case of "the test result indicates that there is a disease, but the patient does not feel it himself".It is relatively rare for such patients to have obvious discomfort themselves, but have not seen a doctor for a "long time".

"I don't know..." The young doctor was a little embarrassed, "I was not around when I was asking about the medical history. It was Dr. Cao who asked me to invite you over."

Doctor Cao must be talking about Cao Yanhua.It stands to reason that patients with chest tightness after exercise are most likely to be the work scope of doctors in the chest pain center.But Cao Yanhua would ask Yuan Ping'an to participate in the consultation... This is a bit strange.

Sun Li'en, Yuan Ping'an and others quickly rushed to the emergency room, and saw Cao Yanhua who was frowning beside the bed.

"This patient... I think maybe I should send it to your diagnostic center." Dr. Cao Yanhua first looked down at the test report and talked, and then looked up to see Sun Lien, "Hey? Team leader Sun, are you here?"

"Brother Cao, can we be normal?" Sun Li'en responded with a smile, "Or should I call you an official position in the future, and I have to change my name to call you Team Leader Cao?"

Cao Yanhua is the leader of the rescue team of the Chest Pain Center of the Emergency Department of the Fourth Hospital.Although it is certainly not a high-ranking official, it is still a leadership position after all.That's why Sun Li'en said that.

"Okay, okay, be normal." Cao Yanhua nodded with a smile, and then returned to seriousness. "The patient's condition is not quite right this time, so I asked you to come and have a look."

When saying "something is wrong with the patient", Cao Yanhua took two steps to the side and used a relatively low volume.It can be seen that he does not want patients to hear his "evaluation" directly.

"What's the problem?" Yuan Pingan ended up asking, "Is this a...chest pain?"

"That's the problem." Cao Yanhua nodded, "The patient has no history of high blood pressure and no family history of chest pain. He just checked his blood lipids and everything is normal—but the echocardiography showed that the patient's left and right atrium, mitral valve and three There are different degrees of regurgitation in the cusps. I just had coronary CT and angiography examinations, which indicated that the left main artery was 99% stenotic, with trifurcation lesions; TIMI blood flow is also grade one."

This condition is very serious.But...it's not too difficult to diagnose.Severe narrowing of the coronary arteries is basically tantamount to declaring that the patient needs stenting or bypass surgery.Judging from the three-vessel stenosis, either the patient is born with a right circulatory advantage, or there is compensatory hyperplasia in the right coronary artery.

"They all had imaging, why didn't they remove the stent?" Yuan Ping'an and Sun Li'en had the same question.Generally speaking, after coronary angiography, the doctor will directly install a coronary stent for the patient during the angiography.It is easier to accept the treatment plan for both patients and doctors.

"Because I'm not sure what caused the stenosis." Dr. Cao took out a blood lipid test. "The blood lipid level is normal. A 25-year-old patient with this level will generally not have coronary artery stenosis."

Coronary artery stenosis is most likely to occur in patients with excessive blood lipid levels.This is one of the greatest consensus among doctors in practicing medicine.Patients with unhealthy lives are more likely to have this kind of problem-excessive blood lipid content in the body, causing fat to condense on the walls of coronary arteries or other arteries at a rate far faster than normal.And once the deposited and coagulated fat starts to change into hardened plaque under the action of the immune system, it will start to cause changes in the blood flow in the blood vessels.

The blood vessels of the human body are like rivers.A rock on the bottom of the river that cannot be moved by the water can cause sediment to begin to accumulate rapidly around the rock.After the hardened plaque appears, there will inevitably be layers of fat attached to the plaque, which will be attacked by the immune system again, thus becoming a new plaque.

Coronary artery narrowing occurs when plaque is thick enough to block most blood vessels.Narrowed coronary arteries can lead to insufficient blood flow to the heart muscle, which can produce a host of symptoms including chest pain.In the most severe cases, it can cause ventricular fibrillation and atrial fibrillation, and even cardiac arrest.

And that's why Dr. Cao Yanhua requested a consultation - the patient's blood lipid levels were normal, and his blood sugar was also within the normal range.This is equivalent to three small islands of sediment suddenly appearing in a river channel with not much sediment.

Dr. Cao Yanhua really didn’t dare to dredge the river by directly digging the islands before he figured out the reasons for the formation of the small islands. If the existence of these three river islands means that the patients have more serious underlying problems, then It will inevitably lead to misdiagnosis.

"That's a problem..." Yuan Ping'an frowned, and he began to recall the reasons that easily induce hardened plaques. "Blood lipids are normal, have you checked blood coagulation and immune antibodies?"

Blood coagulation abnormalities are also a major cause of coronary heart disease attacks.Severe narrowing of coronary arteries can indeed occur if blood starts clotting in blood vessels by mistake.The immune antibody is another direction - vasculitis.

Vasculitis can occur in all blood vessels in the body.And this variable inflammation eventually leads to damage and inflammation in the inner wall of the blood vessel.The damaged inner wall of blood vessels will directly lead to abnormal blood flow, which will induce blood clotting or blood lipid deposition.

　...I just wrote it at this time.Even slower, sorry...

　　
　
(End of this chapter)