I can see health

Chapter 38 Rare Medical Knowledge

The rounds begin.

Sun Guoguo walked in the front, and the others stood behind her, each holding the medical records of the patients in their beds.

During ward rounds, the doctor must stand behind the bed.

This is a default regulation, and it is also for doctors to better examine and examine patients.

In addition, both doctors and patients should maintain an appropriate distance, usually about one meter, so as not to alienate patients.

"Bed No. 1, this is a patient diagnosed with coronary heart disease and unstable angina pectoris. He was just admitted to the hospital yesterday, and is going to undergo coronary angiography in two days to evaluate the condition of the blood vessels."

Before coming to bed No. 1, Jiang Qingyan began to report the patient's medical history.

From the main complaint, current medical history, past history to abnormal auxiliary examination, Jiang Qingyan reported every detail.

After the report was over, Sun Guoguo began to ask and teach.

"Coronary heart disease is one of the most common diseases in our hearts, so let me ask you a question, a basic knowledge, how is coronary heart disease classified?"

The two interns hid at the back with their heads down, afraid that their names would be called.

"Junior Sister Jiang, you are in charge of this patient's bed, so you can answer it."

Sun Guoguo pouted at Jiang Qingyan.

"Yes." Jiang Qingyan nodded, "Coronary heart disease is mainly divided into two categories, stable coronary artery disease and acute coronary syndrome."

"Stable coronary artery disease, including ischemic cardiomyopathy, stable angina, silent heart disease."

"Acute coronary syndromes, including acute myocardial infarction and unstable angina."

Jiang Qingyan's order was very clear, and Sun Guoguo nodded slightly after listening, "Well, it's very well said."

"Why do you need to figure out the classification of diseases? It is because different types of diseases have different treatment methods and prognosis. Don't think that there is only one treatment for coronary heart disease. It is very important to first understand the classification of patients' diseases. Using the same method to treat diseases is something that only barefoot doctors can do.”

Sun Guoguo's ward rounds are mainly based on asking questions.

She asks different questions for different types of patients.

Ward rounds is also one of the important ways for young doctors to acquire knowledge and clinical experience in clinical work.

"Now that everyone knows the classification of coronary heart disease, let's talk about the classification of acute myocardial infarction."

Sun Guoguo continued to ask questions.

The two interns were startled, their heads that had just been raised slowly lowered again.

"Junior Sister Ke, you can answer."

Ke Yue was holding a few medical records folders, eyes dodged, and said in a low voice: "Acute myocardial infarction is divided into acute ST-segment elevation myocardial infarction and acute non-ST-segment elevation myocardial infarction."

"are these all?"

Sun Guoguo looked at Ke Yue suspiciously.

Ke Yue lowered her head, bit her lower lip, "I, that's all I know."

Sun Guoguo looked serious, and turned his gaze to other people.

"Xiao Dong, what's your opinion?"

Dong Hao is the regular male doctor in the group.

This year is his second year of regular training, and he has rotated in other departments such as renal internal medicine, neurological internal medicine, and respiration.

Dong Hao touched his nose in embarrassment, "Senior sister, I'm the same as Ke Yue, and I only know how to divide into these two categories."

After listening to Dong Hao's answer, Sun Guoguo continued to look for the next "hunting" target.

The hearts of the two interns became even more flustered.

"Doctor Qu, do you have any other opinions?"

Sun Guoguo looked directly past Lu Chen and the interns, and looked at Qu Yao, the only doctor in the group.

"There should be other types, such as myocardial infarction caused by coronary spasm. In fact, there is no problem with the coronary blood vessels, but some stressful situations have caused the spasm of the blood vessels." Qu Yao thought for a while, her body The attending doctor has been in clinical practice for many years, and his clinical experience is much richer than these graduate students and Gui Peisheng.

"Well, Dr. Qu's clinical experience is still much richer." Sun Guoguo smiled, "Myocardial infarction, as the name suggests, is the necrosis of myocardial cells. The type that Junior Sister Ke mentioned is the most common coronary artery disease in the heart. Myocardial infarction in a thrombotic event is a narrow sense of myocardial infarction. However, in our cardiology department, there is also a broad sense of myocardial infarction, including all causes of myocardial cell damage, which can be called myocardial infarction.”

When Ke Yue, Dong Hao and others heard Sun Guoguo's explanation, they all looked suddenly enlightened.

This new concept of myocardial infarction is rarely mentioned.

"So, besides coronary spasm, are there other diseases?"

Qu Yao pondered for a while, and said: "Of course, there are, such as myocardial cell damage caused by supraventricular tachycardia and third-degree atrioventricular block."

"Ah."

Sun Guoguo nodded slightly. Doctors with clinical experience should know more about these problems.

Education is important, but for medicine, experience is also very important.

After all, people don't get sick according to the standard symptoms in textbooks.

"Are there other types?"

Qu Yao frowned, "Other types... It seems that there are no more..."

Sun Guoguo smiled, "Also, but it's not common, so it's normal that people don't know about it."

At this moment.

Lu Chen seemed hesitant to speak.

Sun Guoguo saw it, did Junior Brother Lu Chen know it?
"Junior Brother Lu, do you know?"

Lu Chen nodded with a smile, and said, "There are five broad categories of acute myocardial infarction in the world."

"What? Five kinds?"

Everyone present, except Sun Guoguo, looked surprised.

In internal medicine textbooks, it has never been said that acute myocardial infarction can be divided into five categories.

Qu Yao frowned and looked at Lu Chen, where did this little boy come from?

She has been working in the clinic for nearly eight or seven years, and she is still a major in cardiology, but she has never heard that myocardial infarction can be divided into five categories.

Sun Guoguo showed a gratified smile on his face, "Junior brother, continue talking."

Lu Chen coughed lightly, and said: "The first category, which is what Ke Yue said, is the myocardial infarction caused by coronary thrombosis, which is the most common vascular plaque rupture in the Department of Cardiology, forming a thrombus. Vascular blockage, myocardial ischemia and hypoxia lead to necrosis."

"The second category is myocardial infarction caused by imbalance of oxygen supply in coronary arteries, such as coronary artery spasm and fast or slow arrhythmia mentioned by Dr. Sun. out of balance."

After Lu Chen finished talking about the first two categories, everyone was shocked.

What Dr. Qu Yao said was just a list of the diseases, but did not explain the pathophysiology of the diseases clearly.

And what about Lu Chen?

He explained the causes of both types of myocardial infarction, analyzing the nature of the disease.

Qu Yao was thinking on the side, she felt the difference in Lu Chen, this kid's basic skills are extremely solid.

The basic skills of doctors do not only refer to internal medicine, but also pathology, physiology, anatomy and so on.

Everyone pricked up their ears and listened carefully to Lu Chen's next explanation.

"The third category is similar to the fourth category, called PCI-related myocardial infarction and coronary artery bypass graft-related myocardial infarction. The fifth category is sudden death. Many sudden deaths are of unknown cause. Some guidelines list it as myocardial infarction. special type."

In fact, the latter three types of myocardial infarction are rarely mentioned. They are only medical classifications, and they are not mentioned in internal medicine books. They are only mentioned in major international guidelines.

Seeing everyone's surprised eyes, Lu Chen was a little embarrassed: "I often go to medical forums, so I know more about this kind of uncommon knowledge."

If I had known, that strange headache had tortured Lu Chen for decades.

In order to collect some cases of similar "headaches", he would visit medical forums, such as Lilac Garden, Xinglintan, and even some strange surgical live broadcast rooms.

Most of these uncommon knowledge was passively accepted by Lu Chen.

(End of this chapter)