I can see health

Chapter 95 Same Chest Pain, Different Diagnosis
Lu Chen shrugged his shoulders and said, "It may be a stomach problem, it may be intercostal neuralgia, costochondritis, or cardiac neurosis."

"Then do you still want to do a cardiac angiography?" Wang Zihao frowned.

The patient in front of him is none other than his aunt.

Although Wang Zihao usually doesn't like taking relatives to see a doctor, but now that he accepts this matter, he still has to be responsible to the end.

"My opinion is not to do it for the time being." Lu Chen paused and said, "You can do a coronary CTA first to evaluate the cardiovascular condition, and if there is really a problem, then do an angiography."

"Lu Chen, I also worked in the Department of Cardiology during my internship, and this coronary CTA is sometimes inaccurate in seeing blood vessels." Wang Zihao wondered, "In case, I said in case, my aunt's blood vessels really have blood vessels. Stenosis, let her go for a cardiac angiography, then she has suffered two crimes, it is better to do a cardiac angiography directly, and it will be done in one step."

Clinically, there are two methods for diagnosing coronary heart disease.

The first is coronary CTA, which simply means enhanced CT of the heart vessels.The contrast agent is injected into the heart vessels, and then developed by a CT machine, the vascular lesions, whether there is blockage, and the degree of blockage can be seen clearly.

The other is cardiac angiography.

Cardiac angiography generally refers to coronary angiography. The specific operation generally uses radial artery puncture, inserts a sheath, and under the guidance of an angiography guide wire, reaches the ostium of the left and right coronary sinuses, and is imaged by imaging equipment. Individual positions and multi-angle dynamic observation of coronary artery stenosis.

Cardiac coronary angiography is currently the gold standard for diagnosing coronary heart disease. Generally, coronary angiography can be used to see whether the patient's coronary arteries are stenotic, which part is stenotic, and the degree of stenosis, and can diagnose whether there is coronary heart disease. , can also guide how to treat in the next step.

However, due to the influence of heart rate, vascular plaque, equipment and other factors, coronary CTA has some false positive results, and the diagnostic accuracy rate is not as high as that of angiography.

"However, have you ever thought about another point? Cardiac coronary angiography is an invasive examination after all. If a catheter is inserted into a blood vessel, even the best doctor will cause damage to the blood vessel." Lu Chen said, "And Cardiac coronary CTA is just a non-invasive imaging examination, if it is just to rule out coronary heart disease, why not do CTA?"

Wang Zihao was silent for a while, then sighed and said, "Each method has advantages and disadvantages, let my aunt make her own choice, and I can't make the decision for her."

"Well." Lu Chen said, "Don't worry, we will communicate with her, and this is just my suggestion. The superior doctor in the group will also visit the patient to evaluate her condition and what kind of examination is suitable for her..."

Wang Zihao smiled and patted Lu Chen's shoulder: "Thank you brother, I'm sorry to trouble you."

"You're welcome." Lu Chen smiled.

……

After Wang Zihao left, Lu Chen returned to the doctor's office with the electrocardiogram.

"Junior brother, what patient is here?"

As the attending doctor, Sun Guoguo routinely inquired about the condition of each new patient.

"A female patient with chest pain." Lu Chen said, "I want to do a cardiogram."

"Oh, fine, let's arrange it for her." Sun Guoguo said.

Lu Chen paused, but stopped talking.

"What's wrong, Junior Brother?" Sun Guoguo looked back at Lu Chen.

"I don't think she looks like a coronary heart disease." Lu Chen paused.

Sun Guoguo was stunned for a moment, "Where's her EKG?"

"Here." Lu Chen handed the electrocardiogram to Sun Guoguo, and continued, "The patient is a 50-year-old woman with no obvious correlation between chest pain and activity, no risk factors for coronary heart disease, high blood pressure, diabetes, etc., and no History of smoking and drinking."

At this time, other people in the group also gathered around.

"The T wave in the chest lead is inverted, do you really not consider coronary heart disease?" Ke Yue whispered from the side.

"Well, at the same time, she also has symptoms of chest pain. I also think coronary heart disease should be considered." Dong Hao nodded in agreement.

After reading the electrocardiogram, Sun Guoguo didn't express his opinion immediately. After a long silence, he said, "Go to the ward to see the patient first."

……

Everyone came to bed 11.

Fu Fengqin was chatting with a patient in the bed next to her.

Seeing a group of doctors coming, she hurried back to her hospital bed.

"Aunt Fu, this is your attending doctor, Dr. Sun." Lu Chen introduced.

"Hello, Dr. Sun." Fu Fengqin's face was full of smiles.

"Auntie, I came here to ask about your condition," Sun Guoguo said.

"Ah? Why do you still have to ask?" The smile on Fu Fengqin's face gradually disappeared, and she frowned instead, "Didn't this Xiao Lu doctor ask you before when you came here? Didn't you doctors communicate with each other?" Illness? Do you have to ask a second time?"

Everyone present looked at each other in blank dismay.

Asking about the medical history again is a very common thing in clinical practice.

Every doctor basically judges the condition by asking himself and collecting first-hand information.

And not just by other doctors' descriptions.

The performance of the aunt in front of her seemed a little extreme.

"Also, here is my medical record when I was hospitalized in the county hospital. You can take a look. My condition is all on it. Don't need to ask any more. It's too troublesome." Fu Fengqin waved her hands impatiently.

Lu Chen frowned, and said in a deep voice: "Aunt Fu, each of our doctors has a different emphasis on understanding the medical history, and can check for omissions and fill in the gaps. At the same time, this is also the basic process of seeing a doctor, and we need your cooperation."

"Oh, your hospital is really troublesome." Fu Fengqin sighed softly, "I have a heart problem. I want to have a heart angiography, why is it so troublesome! Forget it, what do you want to ask, you can ask quickly."

Fu Fengqin lay on the bed with his hands behind his head, and said to Sun Guoguo.

"Ke Yue, you can ask." Sun Guoguo whispered to Ke Yue.

"Yeah." Ke Yue nodded slightly, took a step forward, and began to ask about medical history.

Inquiry is the initial mode of communication between doctors and patients.

It is also a very important part.

a thousand reader with a thousand hamurate.

Similarly, different doctors have different medical history collection for the same patient.

Take a patient with "chest pain" as an example, a cardiologist may think it is coronary heart disease, a respiratory medicine doctor may think of pleurisy, a gastroenterologist may think it is gastric ulcer, and a surgeon may think it is a hiatal hernia!

Therefore, the collection of medical history not only needs to be targeted, but also cannot be limited to a single system disease.

At this time, Ke Yue's consultation seemed to lead the patient to the diagnosis of coronary heart disease.

"Auntie, do you usually have chest pain after exercise, or chest tightness?"

"What kind of pain is that? It feels like a stone is pressing on the chest pain? Or is it like a needle stick? Or is it like a tearing pain?"

"After rest, can the symptoms of chest pain be relieved?"

This is because, in Ke Yue's heart, he has already decided that the aunt in front of him has coronary heart disease.

(End of this chapter)