I can see health

Chapter 133 Contradictions! (Ask for tickets and favorites!)
At this time, "Professor Lu" was lying in front of the computer, writing the course record.

Regarding Lu Chen's behavior of "relying" in the department, Sun Guoguo could no longer stop it.

We can only hope that as the selection for the school team approaches, he can "turn the prodigal son back"!
"Beep beep..."

The phone vibrated slightly.

Lu Chen stopped typing, took out his phone, and glanced at it.

Seeing the information notification bar, someone is in Aite himself.

Professor Lu's few words came into view.

Without blushing, Lu Chen opened WeChat and clicked on the group chat of Jinghua Electrophysiology Association.

"So I asked for help to look at the electrocardiogram."

Flipping up the chat history, he immediately saw two electrocardiograms that appeared in the group.

Click on the ECG, then zoom in!

Lu Chen started the picture reading mode.

The rhythm of both ECGs is atrial fibrillation.

But the basic heart rate is different, and the shape of other waveforms is also different.

The first ECG showed rapid atrial fibrillation with frequent premature ventricular and ST depression.

The second is the electrocardiogram after treatment, slow heart rate atrial fibrillation with extensive ST segment depression, and T wave inversion.

After reading the electrocardiogram, Lu Chen still hasn't answered.

Someone in the group started asking questions.

"Doctor Fan, is your ECG from the same person?"

"Yes, it's from the same patient. After medication, the heart rate dropped, and the ECG was rechecked!"

"Doctor Fan, please tell me more about the patient's medical history."

"Okay, the patient was admitted to the hospital with dyspnea. We are considering heart failure... After the patient finished pushing Cedilan, the symptoms of chest tightness and palpitation began to worsen..."

……

Chest tightness worsened after intravenous injection of cedilan

Lu Chen frowned.

From the electrocardiogram, rapid atrial fibrillation combined with heart failure is the absolute indication for Cedilan.

How could the symptoms worsen after the static administration of Cedilan?

When other people in the group saw Fan Zhiping's words, they were silent for a moment.

After all, this side effect is somewhat unreasonable.

Lu Chen didn't speak for the first time.

He kept deriving in his mind, trying to sort out the diagnosis and find the cause of the side effect of Cedilan.

Although an electrocardiogram does not represent the diagnosis of any disease, sometimes don't underestimate the information contained in an electrocardiogram.

A small graph, the change of each waveform shape or vector, can reflect the state of the heart!
An excellent cardiologist is also an excellent electrophysiologist. He will look for clues of diagnosis from the changes in the details.

And now Lu Chen is on such a path!
……

About 5 minute passed.

Only then did people in the group start to speak one after another.

"Electrocardiogram shows premature ventricular and T wave inversion, the possibility of digitalis poisoning cannot be ruled out, and it needs to be combined with the blood concentration of digitalis."

"Whether it is cedilan allergy, causing bronchial asthma, acute pulmonary edema, coronary artery spasm, leading to myocardial ischemia. After diuretic, nebulization and other treatments, the symptoms are relieved."

"Is it possible that the patient is hypokalemic and then leads to digitalis poisoning?"

"..."

Most of the opinions of the people focused on the poisoning of digitalis (cediland).

Lu Chen shook his head slightly, he didn't quite agree with the opinions of the doctors in the group.

Half a stick of cedilan is pushed statically, such a small dose.

And the patient did not have gastrointestinal symptoms and yellow green pigment.

There should be no occurrence of digitalis poisoning!
For a while in the group, no one could come up with a conclusion.

Fan Zhiping has been paying attention to the news in the group, in case some useful information is missed.

How he wished to see "Professor Lu" appear again!

I still remember the last time in the emergency department, it was Professor Lu who saw the hypokalemia at a glance!
Just when everyone was silent.

An ID with the prefix "Jinghua Electrophysiology" spoke.

Jinghua Electrophysiologist Min Xiaobo: "Dr. Fan, does the patient have any lung disease? Such as chronic obstructive pulmonary disease?"

Fan Zhiping, who was always following the group news, looked happy.

Although Professor Lu did not speak last time, Dr. Min, who has "Jinghua Electrophysiology" on his head, should also be an expert of Jinghua Electrophysiology Association!

Fan Zhiping quickly replied: "The chest CT results came out, and the patient has chronic bronchitis and COPD."

Min Xiaobo, who was lying in the duty room, smiled slightly as he looked at the message that popped up on his phone.

It was not what he expected!
He continued to reply in the group: "I am currently considering cor pulmonale, perhaps because patients with chronic obstructive pulmonary disease have hypoxemia, and the use of cedilan increases myocardial oxygen consumption, thereby aggravating the symptoms of myocardial ischemia."

Seeing Min Xiaobo's reply, Fan Zhiping frowned.

Even if you have pulmonary heart disease combined with heart failure, you won't have such side effects when using Cedilan, right?
Fan Zhiping posted in the group: "Professor Min, I still don't quite understand what you mean."

Min Xiaobo, who was lying in the duty room, sat up.

Paused, began to organize the language, and then posted in the group.

"When the patient was admitted to the hospital, the electrocardiogram showed a fast ventricular rate, atrial fibrillation and frequent premature ventricular. It stands to reason that it is appropriate to use cedilan."

"However, the patient's lung CT showed chronic bronchitis and emphysema. It should be cor pulmonale combined with right heart failure, and blood stasis in the systemic circulation. At this time, after static injection of cedilan, its cardiotonic effect, the left heart shoots to the whole body The blood decreases, including the heart itself and the coronary arteries are ischemic, while the right heart pumps more blood to the lungs."

"But the left atrium is large, the left atrial pressure is high, the blood flowing back into the left heart is reduced, and the blood stagnates in the lungs, which invisibly leads to left heart failure, chest tightness, chest pain, dyspnea, and asthma mainly in the expiratory phase. Screams and rales in both lower lungs."

"These are the manifestations of left heart failure. After giving diuretic and antiasthmatic treatments, the symptoms were relieved. The electrocardiogram showed atrial fibrillation and frequent premature ventricles, but ST-segment depression and T wave inversion were common in the leads, and myocardial ischemia appeared. Change."

"Personally, I think it is secondary left heart failure after intravenous injection of Cedilan, which leads to coronary insufficiency."

Fan Zhiping watched this lengthy speech and couldn't help but admire the experts from the big hospital!
Detailed enough!
Enough exciting!
And convincing enough!
Immediately, a group of "flattering" people appeared in the group.

"Like it, Professor Min's analysis enlightened me!"

"Professor Min is amazing! All of this can be analyzed!"

"Thank you Professor Min for your pointers!"

Lu Chen also had to admit that this was an extremely exciting speech.

If there is no solid theoretical knowledge, there will never be such a clear judgment!
However, Lu Chen discovered one of the "flaws".

According to Min Xiaobo, the patient has not only left heart failure, but also right heart failure.

Left heart failure, mainly pulmonary circulation stasis, manifested as dyspnea.

Right heart failure, mainly systemic blood stasis, manifested as jugular vein filling and edema of both lower extremities.

But in Fan Zhiping's medical history description, when the patient was admitted to the hospital, there was no sign of right heart failure!

Herein lies the paradox!
"Beep beep..."

The WeChat notification sounded again.

Fan Zhiping smiled and looked down.

Hey, it's Professor Lu!

He finally spoke!
　Make up for the first update owed yesterday.

　　The night shift was really busy last night... I almost didn't sleep all night.

　　The god of the night shift is also black-faced!

　　
　
(End of this chapter)