I can see health

Chapter 939 Mechanical complications after myocardial infarction!
Lu Chen hurried back to the cardiology ward.

At this time, Gu Xinyue and Jin Miao were waiting in the CCU.

As soon as he entered the gate of the CCU, Jin Miao handed over the mask and hat.

"Director, you are finally here!"

Lu Chen looked serious, "What patient, why are you so nervous?"

Both Jin Miao and Gu Xinyue have been independent for so many years.

Ordinary patients, they are not so nervous at all.

Jin Miao calmed down and said in a deep voice, "It's a patient transferred from the No. [-] hospital in Shanghai. They couldn't handle it, so they transferred it to us."

"It's the first courtyard of the Devil's City again?" Lu Chen was taken aback for a moment.

The cardiology departments of other hospitals in the entire magic city will intermittently transfer patients to them.

It seems...the Fifth Hospital of Shanghai is regarded as the "last stop" for patients.

Everyone gradually formed a thinking mode.

That is, if it is a patient who has been declared "death sentence" by the Fifth Hospital of Shanghai, then there is basically no hope.

Even if he transferred to Kyoto again, it would be impossible to be saved.

If the patient was sentenced to "death sentence" in another hospital, but the Shanghai Fifth Hospital said it could be saved, it means there is still a glimmer of hope!
"Director Lu, there is no other way. For such critically ill patients, other hospitals in Shanghai forget to transfer them to us."

Jin Miao couldn't help but complain.

"Okay, let's talk about this later." Lu Chen said, "Let's talk about the patient's condition first."

"it is good."

Jin Miao spoke while leading the way.

"The patient is a 62-year-old woman who was hospitalized in Modu No. 1 Hospital for one week due to chest pain and tightness."

"After hospitalization, the circumflex branch was completely occluded by emergency coronary angiography, and acute lateral wall myocardial infarction was diagnosed. A stent was implanted in the circumflex branch. After the operation, the patient had recurrent episodes of acute heart failure, pulmonary effusion and infection."

"After the operation, the echocardiography showed that the aneurysm was formed on the side wall of the left ventricle, and the anterior leaflet of the mitral valve was ruptured and prolapsed with severe regurgitation."

Hearing this, Lu Chen's expression became more serious.

After acute myocardial infarction, rupture of the papillary muscle or rupture of the tendon cord is a serious mechanical complication after myocardial infarction.

This complication, often leading to severe pulmonary edema and cardiogenic shock, is strongly associated with poor prognosis.

Studies have reported that the in-hospital mortality rate of patients with severe mitral valve regurgitation caused by rupture of the papillary muscle is as high as 70-80%!

However, due to the often unstable hemodynamics, critical comorbidities, and extremely high surgical risk, there are surgical contraindications.

"The patient should have no chance of surgery, right?" Lu Chen asked.

Jin Miao nodded and said, ""The patient has severe heart failure and many underlying diseases, so he can't stand surgical thoracotomy at all.If a thoracotomy is forced, she may not be able to step down. "

Lu Chen nodded solemnly, "Take me to see the patient's condition first."

……

Came to the CCU bedside.

Gu Xinyue was checking the patient's condition by the bedside.

Seeing Lu Chen coming, he hurried forward, "Director, you are here."

Lu Chen nodded, picked up the stethoscope, and began to examine the patient.

As Jin Miao said, the patient can hear wet rales in his lungs.

"Bring over the ultrasound machine." Lu Chen said in a deep voice.

"Well, it's ready." Gu Xinyue quickly pushed the echocardiography machine over.

Lu Chen performed an echocardiogram on the patient himself.

Bedside echocardiography showed: LV: 43mm, LA: 43mm, EF: 34.3%.

The left atrium was enlarged, the aneurysm was formed on the lateral wall of the left ventricle, and the anterior leaflet of the mitral valve was ruptured and prolapsed with severe regurgitation.

The results of Lu Chen's examination were almost the same as those of the patient in the First Hospital of Shanghai.

"Director, after the intervention in Shanghai No. [-] Hospital, the patient's blood oxygen saturation decreased progressively, and the infection index increased. He needed a large dose of vasoactive drugs to maintain blood pressure."

Gu Xinyue gave Lu Chen a more detailed report on his condition.

"After being transferred to our CCU this morning, we are currently mainly performing ventilator-assisted ventilation, anti-infection, anti-heart failure, boosting blood pressure, reducing phlegm, and sedation. Repeated chest X-rays showed that the pulmonary edema gradually increased, and the infection index continued to rise. High, the patient cannot be successfully weaned, the heart failure index shows an upward trend, and the heart function gradually declines."

Lu Chen nodded, "We'll have a discussion in the Department of Cardiology first, and then we'll invite the Department of Cardiology."

"Okay, Director, I'll make arrangements right away."

Afterwards, Jin Miao brought over all the doctors with titles of associate senior or above who were not currently on duty in the Department of Cardiology.

Everyone gathered in the Cardiology Demonstration Classroom.

As long as there is a meeting held here, everyone knows that there are patients with problems.

As the doctor in charge, Gu Xinyue reported the medical history to everyone.

"At present, we are mainly thinking about what is the reason why patients cannot be weaned? What is the next step?"

Jin Miao was very appreciative and stood up first to speak.

"Consider the patient as an elderly female with acute ST-segment elevation inferior wall myocardial infarction."

"Severe mechanical complications combined with rupture of the mitral valve chordae, resulting in severe mitral valve regurgitation, acute heart failure, and severe pulmonary infection, renal insufficiency, hypertension and other complications, STS score 12.3%, surgery Mitral valve repair is extremely risky."

Lu Chen nodded slightly.

After so many years of training, Jin Miao has been able to comprehensively analyze the patient's condition.

What he said was not much different from his own.

Next, several doctors gave brief speeches.

The main opinions of all the doctors are the same, mainly in the minor details, and there are some differences.

In the end, in Lu Chen's concluding speech, the final conclusion was made for the patient.

At present, the reason why the patient cannot be weaned off is mainly considered that the patient has recurrent heart failure due to mitral valve prolapse and severe regurgitation.

Moreover, due to pulmonary congestion and long-term bed rest, severe pulmonary infection was caused. The main crux of the problem was that the rupture of the mitral chord tendon caused severe mitral regurgitation!
"Director, we have already consulted the surgery department." Jin Miao continued, "The director of the Department of Cardiac Surgery thinks that this kind of patient's condition is critical and complicated, and he cannot tolerate surgery, so he cannot do a thoracotomy at all."

The normal treatment method requires thoracotomy to replace the mitral valve, so as to solve the severe mitral regurgitation.

But the current state of the patient does not allow surgery at all!
For a moment, everyone in the classroom was completely silent.

It was because the patient couldn't tolerate surgery that he was transferred from Shanghai No. [-] Hospital.

Seeing that no one spoke, Lu Chen smiled and said slowly, "In May of this year, an article was published in the "European Heart Journal", which talked about patients with acute myocardial infarction complicated by severe mitral regurgitation."

Seeing this, everyone looked at Lu Chen who was sitting in front.

After so many years, all cardiologists admire Director Lu Chen.

Although Director Lu Chen is relatively young, his surgical operations in all fields of cardiology are among the best.

"Has anyone read this paper?" Lu Chen continued.

This time, still no one spoke.

Lu Chen was not too surprised.

Everyone is usually very busy, and they can't finish the work in their own departments, let alone read those scientific research literature.

(End of this chapter)