I can see health

Chapter 237 Myocardial Infarction or Dissection? (Origination, Destruction, Self-Fate, Ten Thousand Rewards and More!)
Come to the ward.

Lu Chen and Fan Zhiping were in front, followed by Wei Zhongwen pushing the EKG machine.

On the hospital bed, the patient was lying flat, panting heavily.

His lips were slightly pale, his face was full of pain, and there were even layers of fine sweat oozing from his forehead.

Lu Chen looked at the patient's head, his HP was 62!

This value is around a 60 threshold.

Most patients with acute myocardial infarction have health values ​​below 60.

But if the acute myocardial infarction is in the recovery period, or the size of the myocardial infarction is small, the life value will rise to more than 60.

"Junior Brother, measure the patient's blood pressure, and then check an ECG." Lu Chen ordered, and at the same time, he also auscultated the patient's heart and lungs.

For patients with chest pain, as long as the degree of chest pain changes, they need to review the ECG immediately.

"Okay, brother."

Wei Zhongwen was quick in his hands and feet, and immediately took out the mercury sphygmomanometer.

At this time, Lu Chen also began to ask about the patient's condition.

"When did the chest pain start?"

"Actually, I started to have pain when I got up this morning, but I took a tablet of nitroglycerin at that time, and the chest pain was relieved." The patient's family member is a middle-aged woman, who should be the patient's wife. "He had coronary heart disease before, and usually had chest pain. Taking nitroglycerin under the tongue can relieve it, but it didn’t work just now, it was too painful and I couldn’t breathe.”

Generally speaking, if it is angina pectoris, taking nitroglycerin can relieve it.

Most of the cases that cannot be relieved are caused by myocardial infarction!
"When did it hurt the most?"

"Just now, about a few minutes ago."

"Which part of the chest is painful? Please point it out to me, the patient." Lu Chen looked at the patient on the hospital bed and said.

The patient gasped heavily, and pointed to where his heart was.

"Is the degree of chest pain now the same as before, or is it worse than before?"

"It's getting worse." The patient uttered a few words with difficulty.

"What kind of pain do you feel?" Lu Chen continued, "Is it like a stone pressing on your chest, so painful that you can't breathe?"

"Yes, that's what it feels like." The patient frowned, sweat dripping from his forehead.He covered his chest with his hands, looking really painful.

Lu Chen's heart sank.

Combining the patient's symptoms and his own description, the pain cannot be relieved by nitroglycerin. This pain is too similar to a myocardial infarction.

At this time, Wei Zhongwen had already measured his blood pressure.

"Brother, the patient's blood pressure is 160/90mmHg, and the blood pressure is symmetrical on both sides."

Lu Chen nodded, and said to the patient and his family: "Fortunately, the blood pressure has not dropped. Nitroglycerin is not easy to use."

"If you want to take nitroglycerin sublingually, remember to measure your blood pressure. If the systolic blood pressure is lower than 100mmHg, you should not use nitroglycerin. It would be even worse if the blood pressure collapsed directly. This medicine used to be an ingredient of explosives You know, it’s very powerful and can lower blood pressure, so don’t use it when your blood pressure is low.”

The patient's family members nodded quickly.

Lu Chen asked a few more questions and learned that the patient had never undergone coronary angiography or coronary CTA before.

"If you haven't done coronary angiography, you can't be sure that you have coronary heart disease."

Having experienced many diseases similar to myocardial infarction before, Lu Chen is not in a hurry to make a diagnosis now.

About a minute later, Wei Zhongwen finished the electrocardiogram.

"Thank you." Lu Chen took the electrocardiogram handed over by Wei Zhongwen.

ECG display. The ST segment in leads II, III, and aVF moved down by 0.05mV, and the T wave in leads V4-V6 caused the ST segment to move down.

At this time, the patient added another sentence: "Doctor, I also have stretch pain in my left forearm."

Upon hearing this, Fan Zhiping said, "Isn't this a typical myocardial infarction radiating pain?"

Lu Chen hummed, expressing his approval.

The patient is obese and has been diagnosed with coronary heart disease and hypertension in the past.

Now I have obvious chest pain and reflex pain, sublingual nitroglycerin is ineffective, and the electrocardiogram shows that the possibility of myocardial infarction is quite high!
"Quickly open the vein channel!"

Lu Chen immediately ordered the nurse to draw blood and do routine examinations, especially cardiac enzymes and troponin.

There are quick-screened troponin in the eighth area of ​​the heart, which can be done in the department, and the results will come out in a few minutes.

"Brother Fan, please tell Senior Sister Sun to come and see the patient." Lu Chen said to Fan Zhiping who was beside him.

The mortality rate of acute myocardial infarction is very high. For such a critical case, the superior doctor must be notified as soon as it is discovered.

"Okay!" Fan Zhiping left the ward immediately.

……

At this time, the results of the rapid screening of the patient's troponin came out!
The results showed that troponin was normal and not significantly elevated.

Wei Zhongwen on the side whispered, "If it's normal, wouldn't it be possible to diagnose myocardial infarction?"

Diagnosis of myocardial infarction relies on three elements, one is typical chest pain, the other is electrocardiographic findings, and the third is troponin.

Elevated troponin, which means myocardial infarction, is caused by the rupture of heart muscle cells.

But now the patient's troponin is still normal, what does it mean?

Lu Chen patiently explained: "For patients with myocardial infarction, the electrocardiogram will respond quickly, but troponin, cardiac enzymes, etc. need a certain period of time to increase, the fastest is myoglobin, and it takes 30 minutes -1 hour to go up."

"The troponin we measured took at least 2-3 hours to rise, and the patient had chest pain for less than 1 hour. It is understandable that the troponin is normal, but it needs to be rechecked dynamically."

"Oh." Wei Zhongwen nodded.

At this time, Sun Guoguo also came to the ward.

"What's the patient's condition?" Sun Guoguo checked the patient, and then looked at the patient's electrocardiogram.

Lu Chen thought for a while, and immediately said: "The patient had sudden chest pain for about 10 minutes, which could not be relieved by sublingual nitroglycerin. There was a history of similar chest pain before, but before the chest pain occurred, sublingual nitroglycerin could relieve it. "

"What about past medical history?" Sun Guoguo asked.

Lu Chen paused, and continued: "The patient was diagnosed with coronary heart disease at the local hospital two years ago because of chest pain and tightness, and later took aspirin and other drugs for a long time. At the same time, the patient also had a history of high blood pressure and took antihypertensive drugs. , The specific medicine is unknown, but I didn’t insist on taking it, eating and drinking. I don’t measure my blood pressure at home.”

After listening to Lu Chen's medical history report, Sun Guoguo said in a deep voice, "The patient's chest pain persists, and the electrocardiogram shows myocardial ischemia, suggesting that it may be an acute non-ST-segment elevation myocardial infarction!"

If it is really a myocardial infarction, then send it to the cath lab immediately, and do coronary intervention to open the coronary artery blocked by thrombus, so as to save more ischemic and hypoxic myocardium!
There are too many patients like this in the Department of Cardiology, and some of them were delayed, and their heartbeat stopped immediately!

But Sun Guoguo was not at ease with such a patient!
"Do you think this patient can rule out aortic dissection?" Sun Guoguo looked at Lu Chen and Fan Zhiping who were beside him.

Patients with chest pain, in addition to myocardial infarction, must rule out aortic dissection!
Because the treatment of myocardial infarction and dissection is completely opposite!

In case the patient has aortic dissection, once anticoagulant and antiplatelet drugs are used, it will be bad, maybe it will cause bleeding, and the patient will die faster!

As long as it's a mistake...

That is ruin!
Lu Chen and Fan Zhiping looked at each other and shook their heads.

Judging from the current data, there is indeed no way for the patient to completely rule out aortic dissection!

However, the biggest possibility for the patient is acute myocardial infarction. If the time to open the blood vessel is delayed, it will cause more harm to the patient!
This is quite contradictory!
　Still owe 19 chapters, no update tonight.

　　
　
(End of this chapter)