I can see health

Chapter 782 The Alcoholic Man

The first period of TAVR surgery training course is over.

The first batch of [-] students has gained a lot.

Among them was Wang Qingfeng, who was admitted to the hospital in the same batch as Lu Chen.

From a TAVR beginner, he gradually became familiar with the TAVR field and became a reserve talent.

Although they are unable to operate independently now, in the near future, the TAVR surgery team of Guanghai No. [-] Hospital represented by them will definitely shine in the field of Huaxia's heart!
On the other hand, the content of Lu Chen's national nature project is also limited to the discipline construction of TAVR.

The only thing missing now is data!
Surgical data, patient data, postoperative recovery data, etc. are currently missing from Guanghai No. [-] Hospital, and even Huaxia.

But to build TAVR discipline well, these things are essential, Lu Chen can only do it step by step.

As for clinical matters, he did not relax either.

As a senior doctor, he insists on rounds every day and personally checks critically ill patients to ensure that there will be no major mistakes in the treatment plan of each patient.

As for Jin Miao, he has been following Lu Chen on the operating table for a while, and his TAVR surgery ability is also improving rapidly.

In addition, once Jin Miao encounters a difficult case, he will notify Lu Chen as soon as possible.

"Director Lu, a difficult patient has been transferred from the CCU, do you have time to come and have a look?"

In Lu Chen's office, after Jin Miao reported the latest work progress, he was about to take him to check on a patient's condition.

"Turn the CCU over?" Lu Chen wondered.

"Well, I lived in the heart area a few months ago, but I didn't find out the reason at the time. I went back to take medicine, and now I'm sick again." Jin Miao explained.

"Okay, let's go have a look."

Lu Chen put down the work at hand and followed Jin Miao to the ward.

……

in the ward.

Lu Chen saw the patient in front of him.

He is a 60-year-old bachelor, and the family member who came to accompany him is his old mother.

"Director Lu, the patient is a patient with heart failure." Jin Miao introduced his condition from the side, "I used to drink for a long time, and I was considered alcoholic cardiomyopathy in other hospitals before, and I have been treated according to heart failure for several years, but it has not improved. "

"Yeah." Lu Chen nodded, and began to conduct physical examinations and interrogate the patients himself.

The life value on his head is 54(——)!

The state does not seem to be very good, but it has not reached the level of three minus signs.

The patient is a 63-year-old single male, typical of 'one person is full, the whole family is not hungry'.

I used to drink a lot. I don’t know if it’s because of the difficulty in capital chain turnover or repentance. I have quit drinking for 10 years.

But quitting drinking doesn't mean he starts to cherish his body, he still eats convenience food every day.

The reason why I came to the hospital was because I gradually felt difficulty in breathing, and my lower limbs were edematous, and there was a pit when I pressed it.

This frightened him, and he came to the hospital immediately.

Lu Chen conducted a more detailed physical examination on the patient

The patient had distended jugular veins, rales in both lung bases, normal cardiac auscultation, and moderate edema in both lower extremities.

In addition, echocardiographic results showed decreased left ventricular activity, a left ventricular ejection fraction (LVEF) of 25%, and moderately reduced right ventricular systolic function.

Combining all the examination results, Lu Chen made a preliminary judgment that it was still heart failure.

However, there are many reasons for heart failure, including common coronary heart disease, valvular disease, myocarditis, cardiomyopathy and so on.

"Two months ago, a coronary angiography was performed in one area of ​​the heart, and the result was normal." Jin Miao said, "So we ruled out coronary heart disease, and we still consider that it is heart failure caused by long-term drinking and alcoholic cardiomyopathy."

Lu Chen thought for a while and asked, "Is the anti-heart failure treatment not effective?"

"It was okay at the beginning." Jin Miao said, "It's just that two months ago, I don't know if he stopped taking the medicine or something, and the heart failure worsened three times! Each time it was acute left heart failure, and he came to our hospital. CCU."

As soon as Jin Miao finished speaking, the patient's mother, an old lady in her 80s, echoed her aloud.

"Doctor, he took the medicine and didn't stop." The old lady's voice was a little hoarse, she took out a few medicine boxes from the drawer with trembling hands, and handed them to Lu Chen and Jin Miao.

Lu Chen took a look, and it was indeed a Golden Triangle medicine for heart failure.

"Okay, I see." Lu Chen nodded, then turned to Jin Miao who was beside him, "How do you think about it now?"

Jin Miao paused, and said in a low voice: "Now that the treatment effect is not very good, it may be refractory heart failure, and I plan to increase the dosage of the medicine."

Lu Chen frowned, and asked, "Has the patient experienced some mental symptoms?"

"Mental symptoms?" Jin Miao was stunned, "No..."

Lu Chen pointed to the patient's eyes, "During the physical examination just now, I found that his extraocular muscles were paralyzed."

"Ah, this..." Jin Miao whispered, "The patient just came here, I haven't noticed yet."

"I looked through the CCU's medical records, and there is no record of this kind of mental symptoms." Lu Chen said.

Jin Miao's expression was serious, "I'll evaluate the patient's mental state again immediately."

"Don't panic." Lu Chen looked at the old lady beside him, "Mother-in-law, your son usually lives with you?"

"Yes." The old lady nodded, "Live together, and he's not married, who else can he live with?"

"Then have you noticed any abnormal behaviors in him recently?" Lu Chen said.

"Abnormal behavior?" The old lady was a little confused.

"For example, talking nonsense, yelling and so on." Lu Chen reminded.

Hearing this, the old lady nodded quickly: "During this time, sometimes he always talked to himself, couldn't understand what to say, and sometimes lost his temper."

"Is it like this before?" Lu Chen asked.

"That's not true." The old lady said, "Although he likes to drink, he usually has a good temper. There has never been such a situation."

Hearing this, Lu Chen basically understood.

He looked at Jin Miao, "Give the patient a MOCA score."

"Okay!" Jin Miao quickly responded.

MOCA stands for Montreal Cognitive Assessment.

Including attention and concentration, executive function, memory, language, visual structure skills, abstract thinking, calculation and orientation, etc., the total score is 30 points, and ≥26 is considered normal.

……

Go back to the doctor's office.

Jinmiao immediately gave the patient a complete set of MOCA scores.

The final result is 13 points.

"Director Lu, the score is 13!" Jin Miao reported the final result to Lu Chen.

"What are you thinking about now?"

Lu Chen intended to cultivate Jin Miao, so he didn't tell his diagnosis immediately.

"In addition to heart failure, the patient also has some neurological symptoms such as cognitive impairment." Jin Miao said hesitantly.

"Is that all?" Lu Chen asked, "Have you ever thought about why the patient has neurological symptoms?"

"It's not clear yet, we may need some head examinations." Jin Miao said in a low voice.

"I saw that he had a brain CT scan, and everything was normal." Lu Chen said.

"Then do another brain MRI?"

There was strong unconfidence in Jin Miao's tone.

Lu Chen shook his head helplessly, "You still haven't found the problem, it's a kind of beriberi!"

(End of this chapter)