I can see health

Chapter 634 Rehabilitation!
The second area of ​​the heart.

doctor's office.

Around Lu Chen, the atmosphere was a bit weird.

Three students, you look at me, I look at you.

A doubt arose in everyone's heart.

Is the patient who was diagnosed with "ventricular tachycardia" really just supraventricular tachycardia?

On the side, Yu Bin was even more silent.

This patient was in his charge before.

During the patient's hospitalization, "ventricular tachycardia" occurred once, and he was cardioverted.

This is exactly him, suggesting that patients install ICDs!

However, Lu Chen's opinion now overturns all his previous diagnosis and treatment work.

(Electrical cardioversion can be used for both ventricular tachycardia and supraventricular tachycardia, but for hemodynamically stable supraventricular tachycardia, there is no need to use electrical cardioversion at all, and it will increase the injury and pain of the patient anyway)

Ji Yingying bit her lower lip. She looked at the patient's electrocardiogram, but she still couldn't see any clues of supraventricular tachycardia in this picture.

It would be fine if she had another major, but she herself is a cardiologist, and even an electrocardiogram made a wrong diagnosis.

"Brother..." Ji Yingying whispered.

Lu Chenhuo turned his head and looked, "What's wrong?"

Sitting next to Lu Chen, Ji Yingying said, "How did you see the room speed in this picture? I've been looking at it for a long time, but I didn't even see the shadow of the room speed."

Her words represent the voice of everyone.

The other two students immediately moved their heads closer, and even Yu Bin looked towards Lu Chen.

They are so curious!

Lu Chen pursed his lips and smiled, and it was time to earn gratitude again.

Currently, he is now preparing for "Valvular Intervention" treatment.

In the system mall, the skill card for valvular interventional therapy has tens of thousands of thank you points!

If Lu Chen doesn't work hard to earn gratitude points, he will have to wait until the Year of the Monkey if he wants to redeem this skill card.

……

"Ahem." Lu Chen cleared his throat, took the patient's ECG and a blank A4 paper, and began to explain himself, "Then let me explain to you."

Seeing Lu Chen like this, the three students immediately bought three small stools from the conference room.

Yu Bin on the side also became interested.

But he wasn't too proactive, so he leaned towards Lu Chen!

Just listen to Lu Chen continuing: "To distinguish between VT and SVT with differential conduction, it is generally necessary to analyze the atrioventricular relationship (the relationship between P wave and QRS wave), ventricular depolarization vector, and the shape of QRS wave."

"Many scholars have proposed a differential diagnosis process. The Brugada method and the Vereckei method are more commonly used. In particular, the Vereckei process only relies on the avR lead for differential diagnosis, which is easy to remember and easy to use in clinical practice."

"In 2020, an article published on Heart Rhythm proposed to use limb leads for differential diagnosis, which is also very simple."

……

"Brother, what are the methods you mentioned?" Ji Yingying was stunned.

She has only heard about the method Lu Chen mentioned, but she has never seen it clinically, nor has she seen it used by others.

Lu Chen smiled, "To put it bluntly, there is a simple international standard for diagnosing ventricular tachycardia."

"According to this standard, the differential diagnosis of ventricular tachycardia and supraventricular tachycardia can be quickly made."

Ji Yingying asked curiously: "Brother, we don't have any reference for you to say so, why don't you give us an example, and use this patient's electrocardiogram to demonstrate it to us."

"Of course." Lu Chen nodded slightly, "Then I will use the Brugada method to diagnose this electrocardiogram."

Lu Chen started his whole step-by-step deduction on a blank A4 paper.

The Brugada method, a step to identify the origin of wide QRS tachycardia, is divided into 4 steps.

First, if the QRS complexes in the chest leads are not RS-shaped, it is diagnosed as VT.

Second, if there is an RS-shaped QRS wave in the chest leads, and the RS interval is >100ms, it can be diagnosed as VT.

Third, if atrioventricular separation can be confirmed, the diagnosis of VT can be established.

Fourth, if the tachycardia meets the QRS morphology criteria in leads V1 and V6, that is, left bundle branch block-like pattern, rS-type QRS complex in lead V1, RS interval > 70 ms; or left bundle branch (and/or or right bundle branch) block-like pattern, the QRS wave in lead V6 starts as a positive wave, and R/S<1, it can be diagnosed as VT.

……

"Huh? This...is this very simple?"

Ji Yingying was a little confused.

"Brother, are you sure this is the easiest way?"

She feels it is not easy at all!

It seems simple to remember these four steps, but it is not easy to actually implement them!
Ji Yingying glanced at the other two students beside her, and they both shook their heads.

She breathed a sigh of relief.

It doesn't seem to be her problem, but this step is not as simple as they imagined for them now.

"Practice makes perfect." Lu Chen said, "If you look at a few more clinical pictures, you can learn these four steps."

"Actually, in many cases, it is our laziness that causes the patient's diagnosis to be biased. If we can strictly abide by international standards, this patient's similar situation can be completely avoided!"

Ji Yingying's heart moved, "Brother, according to your opinion, this patient must have supraventricular tachycardia?!"

Lu Chen nodded slightly, "Most likely!"

Combining the life value prompt on the system panel and the existing electrocardiogram evidence, Lu Chen is still confident in the diagnosis of supraventricular tachycardia.

At this moment, a prompt popped up on the system panel.

"Congratulations, I received +1 from Ji Yingying!"

"Congratulations,……"

"Congratulations,……"

Three consecutive hints were given by three students in the group.

The next prompt made Lu Chen stunned.

"Congratulations, I received +1 from Yu Bin!"

Lu Chen looked out of the corner of his eye, and Yu Bin was leaning his head over at this moment...

"Ahem." Seeing that he was discovered, Yu Bin was a little embarrassed, "Doctor Lu, that, you speak very well!"

Yu Bin is not a novice like Ji Yingying who is just entering the clinic.

After Lu Chen's suggestion, he immediately understood the key point.

Four judgment steps to diagnose ventricular tachycardia one by one.

Yu Bin had read similar medical reports, but never paid attention to them.

At this time, the system defaults that Lu Chen and Yu Bin are doctors of the same level, so there is no bonus to the gratitude obtained.

"Brother, thank you for your compliment." Lu Chen smiled.

A little gratitude is worth more than nothing.

Although Yu Bin questioned his "amiodarone" before, this is also normal.

Patients with normal ventricular tachycardia definitely need cardioversion.

Medicine is originally a process of constantly questioning and preserving the truth.

Yu Bin's prejudice against Lu Chen has long since disappeared.

He couldn't help sighing, that idiot seemed to be himself!
……

After half an hour.

Yan Shuming walked into the doctor's office with a complicated expression, and she looked at where Lu Chen was.

"10 beds, rehabilitated..."

(End of this chapter)