I can see health

Chapter 74 Tendon Xanthomas

Ten-year-old myocardial ischemia?

Lu Chen frowned.

The coronary heart disease that occurs when men are younger than 55 years old belongs to premature coronary heart disease.

Let alone such a ten-year-old kid.

Lu Chen has never seen the ECG of a ten-year-old child, which is the same as that of a seven-to-eighty-year-old man.

"Ten years old? This should go to the pediatrics department."

Lu Chen paused.

Generally, 14-year-old children can basically go to see a pediatrician.

"The Department of Pediatrics in our hospital is not very good. There are only five doctors left in the entire department. The young doctors have all run away, leaving only a few deputy directors and directors." Jiang Qingyan shook her head, "So this kind of medical treatment involving the heart Most of the diseases, basically came to the Department of Cardiology.”

"Does the patient have any symptoms?" Lu Chen then asked.

"Intermittent chest pain for 1 month."

"According to the electrocardiogram and symptoms, there must be something wrong with the child's heart and blood vessels." Lu Chen said, "But it is definitely not a conventional coronary heart disease, but has other causes."

"Yes." Jiang Qingyan nodded, "At present, I have several considerations, such as vasculitis, dilated heart disease, myocarditis, and patent ductus arteriosus."

"It is most likely due to secondary coronary vascular disease caused by these causes!"

Lu Chen frowned, and said: "No matter what the cause is, this child's vascular disease is serious, and it may need to be treated immediately. Does the senior sister know about this patient?"

"I know." Jiang Qingyan nodded, "But the senior sister hasn't figured out what caused it for the time being. Let me do a blood test and an echocardiogram first, and then adjust the treatment plan after the results come back."

"Hmm." Lu Chen put down the ECG.

He was very interested in this young patient.

"Which bed is he?"

"13 beds."

……

Comes to 13 beds.

This is a ten-year-old girl.

The girl curled up in the corner of the bed, her face pale.

When Lu Chen stepped forward, her mother stood up.

"The doctor is here."

The girl turned her head to look at Lu Chen, then buried her head in the bed again.

"Auntie, I'll just ask her about it."

"Well, you can ask the doctor." The girl's mother forced a smile.

Seeing that the girl didn't respond, Lu Chen directly asked her mother.

The girl had started to have intermittent claudication 3 months ago.

One month ago, chest pain occurred after exercise. It was a crushing pain, mainly in the precordial area. It was obviously aggravated after exercise, and it was slightly relieved by resting for 1-3 minutes.

During the period, he did not go to the hospital for treatment, and had frequent chest pain attacks.

"Auntie, does your family have a history of coronary heart disease?"

"No."

Lu Chen wanted to give the girl a physical examination, but she resisted a little.

The girl's mother shook her head slightly, Lu Chen could only give up.

……

Go back to the doctor's office.

Lu Chen flipped through the medical records written by Jiang Qingyan, focusing on the medical examination part.

Admission physical examination: HR 120 beats/min, BP 90/50mmHg.Cardiac auscultation can hear the middle and late contraction murmur of the mitral valve auscultation area, and no abnormal breath sounds can be heard on lung auscultation.

"Painless nodules in elbow joints, knee joints, and ankles; white rings are visible at the edge of the cornea."

"Peripheral vascular pulse is normal, intermittent claudication occurs in both lower limbs when walking, no edema and skin color change."

The admission examination written by Jiang Qingyan was extremely detailed.

On auscultation of the heart, murmurs can be heard.

A thought flashed in Lu Chen's mind, could it be a congenital heart disease?
However, he also noticed that painless nodules could be seen on the girl's joints.

"this is……"

Lu Chen frowned, and looked back at Jiang Qingyan.

"Jiang Qingyan, what is this painless nodule?"

"This nodule, I think it should be a tendon xanthoma."

"Tendon xanthoma?"

Lu Chen suddenly seemed to think of something, but he couldn't catch it.

"What's wrong?" Jiang Qingyan asked puzzled.

"It's nothing..." Lu Chen shook his head lightly, "Let's take a look at the patient's test and inspection results first."

……

The whole morning.

There are too many patients from the eight districts of the heart.

Lu Chen was always there, admitting patients, giving doctor's orders, and writing medical progress records, switching between the three.

He admitted a total of three patients, Dong Hao and others received two respectively.

So much so that at twelve noon, everyone stayed in the department.

"At noon today, I invite everyone to have dinner in the department."

Sun Guoguo walked into the doctor's office with a smile, took out her phone, and clicked on the food ordering app.

"Everyone can give us their opinions on what you want to eat and which one you want to eat."

"Girls first, the two junior sisters will order first."

Sun Guoguo handed the phone to Jiang Qingyan.

"Ke Yue, you can order, I can do it."

Jiang Qingyan was dealing with the ten-year-old patient.

"Well, how about braised pork rice?"

Ke Yue swiped at the ordering interface.

"Oh, what braised pork rice are you eating?" Dong Hao came over and said with a smile, "I know there is a mouth-watering chicken, which is really delicious."

"Then, won't that be too expensive?" Ke Yue whispered.

"Don't worry, Mr. Li pays the bill." Sun Guoguo smiled, "Just order."

With Sun Guoguo's words, everyone no longer has scruples about ordering food.

Lu Chen followed the crowd and ate saliva chicken together.

……

After about half an hour.

The "saliva chicken" was sent to the department.

Everyone was just about to open the lunch box and enjoy the food.

There was a shout from the nurse's station.

"Is the doctor in the chief group here? The test system has a critical value!"

Upon hearing this, Sun Guoguo immediately ran to the computer and turned on the assay system.

Everyone also stopped unpacking the lunch boxes.

Too many patients came this morning.

Sun Guoguo quickly reviewed all the new patients in her mind.

It seems that there are no patients who are particularly critically ill.

Who will it be?

Turn on the assay system.

Immediately a pop-up window pops up.

Department: The Eighth Ward of Cardiovascular Medicine

Name: Yuan Hui

Bed size: 13 beds

Age: 10 years old

Critical value: cardiac troponin I (fluorescence method) 3.12ng/ml (normal value 0-1 ng/ml).

It is actually the critical value of a 13-bed little girl!
A trace of doubt flashed in Sun Guoguo's eyes.

According to the diagnostic criteria of myocardial infarction.

At present, the 13-bed girl has met the three diagnostic criteria of chest pain, elevated myocardial enzymes, and ECG changes!

Acute myocardial infarction can almost be diagnosed!
Myocardial infarction at 10 years old!

This is extremely rare.

Sun Guoguo frowned deeply.

"Junior Brother Dong, ask the nurse to provide ECG monitoring and oxygen inhalation for the 13-bed patient!"

"Junior Sister Ke, please contact the CCU catheterization room on the 4th floor, so that the catheterization room is ready at any time."

"Junior Brother Lu, please write down the critical course record."

"Roger that!"

Everyone also saw the critical value report and understood the seriousness of the situation.

"I'm going to explain the condition to the patient's family."

As Sun Guoguo walked out of the ward, she took out her mobile phone and called Director Li Yao.

This patient's condition is tricky.

The most important thing is that the patient is too young, a ten-year-old child!
Once there is any mistake, the possibility of causing medical disputes is very high!

"Mr. Li, a new patient came today, a 10-year-old girl. The electrocardiogram showed myocardial ischemia. The test value just returned, and the myocardial enzymes increased."

After answering the phone, Sun Guoguo immediately reported the patient's condition.

"Let the cath lab prepare immediately!" Li Yao's voice came from the phone, "No matter what the cause is, according to the patient's current condition, immediate intervention is needed!"

"Guoguo, you and the patient's family have a clear discussion!"

"I'm in a school meeting right now, and I won't be back in a while."

"Okay." Sun Guoguo hung up the phone, and immediately acted according to Li Yao's instructions, preparing to communicate with the family members about the intervention.

……

On the side, Lu Chen was writing the course record of the critical value.

In his mind, he kept recalling information about this ten-year-old girl.

"Myocardial infarction, murmurs, painless nodules, xanthomas..."

"If everything could be explained by medical monism...what would it be?"

(End of this chapter)