I Can See Health

   Chapter 202 Silent Heart

   "Doctor Fan, what's wrong?"

  Lu Chen looked strangely at Fan Zhiping who walked in front of him.

   Didn't he go to treat patients?

   "This electrocardiogram..." Fan Zhiping took out the electrocardiogram in his hand and placed it in front of Lu Chen's desk, "It always feels strange, but I can't tell what is strange."

  Lu Chen looked down at this electrocardiogram.

   His first impression was that he did not see P waves, but there were small F waves with different shapes, so this was atrial fibrillation.

   However, it doesn't look like atrial fibrillation!

  Because the heart rhythm of atrial fibrillation is absolutely irregular, and the heart rhythm of this electrocardiogram is tidy!

  …

   Ke Yue is also very interested in ECG now.

   Since Director Lin Cui severely criticized her, she has worked hard to learn electrocardiography.

   After two months of hard work, the level of ECG reading has improved a lot.

   She put her head in front of Lu Chen, and immediately looked puzzled.

   "This, isn't this atrial fibrillation?"

   No P-waves are seen, but small sawtooth f-waves are clearly visible.

   This is one of the most important ways to identify atrial fibrillation.

  Atrial fibrillation is the eternal pain in Ke Yue's heart.

   She was sure that the electrocardiogram in front of her was definitely atrial fibrillation!

   However, such a simple ECG.

   Fan Zhiping, as the deputy chief physician of the Cardiology Department, could not have seen it!

   Ke Yue's words also attracted the rest of the group.

  Sun Guoguo happened to be fine, so he also came to Lu Chen's side and picked up the electrocardiogram on the table.

   "This is..." Sun Guoguo raised her brows, "This electrocardiogram is really strange! There are no P waves, there are small F waves of atrial fibrillation, but the heart rhythm is regular."

   looks like atrial fibrillation, but after thinking about it, it doesn't look like it!

   "Heart rhythm?"

   Ke Yue was stunned for a moment, and quickly looked at the electrocardiogram again.

   Sure enough, the heart rhythm is regular, that is, the time between each beat of the heart is the same.

   This completely violates the ECG characteristics of atrial fibrillation.

  …

   This electrocardiogram is really strange. So far, Lu Chen has no clue.

   It was the first time he had seen such an electrocardiogram.

   "What's the condition of the patient?" Lu Chen looked up at Fan Zhiping with the electrocardiogram.

   "This is a heart transplant patient." Fan Zhiping paused and began to tell the patient's medical history.

   Patient, male, 61 years old.

   In 2014, he was diagnosed with coronary heart disease, atrial fibrillation, cardiac insufficiency, and type 2 diabetes.

   In the first half of this year, the patient received a heart transplant due to end-stage heart disease. The patient underwent the Bicaval technique, the recipient left atrium and great vessels were preserved, and the right atrium and ventricle were resected.

   Regular outpatient review after surgery, the heart donor has no relevant past medical history. The patient experienced acute cellular rejection 7 months after transplantation.

   "Heart transplant?" Lu Chen frowned.

   Heart transplant patients are still rare.

   Generally speaking, the transplanted heart can be managed for about five years.

   After learning about the patient's medical history, Lu Chen still didn't have any thoughts about this electrocardiogram.

  Sun Guoguo also shook his head.

   "I can't tell what the electrocardiogram is for the time being. We can only wait for Teacher Li's rounds tomorrow and ask her for her opinion."

  Lu Chen nodded, this is the only way to do it now.

   But he was a little unwilling.

   He has studied the electrocardiogram for so long, but he will not give up easily.

   The more difficult the ECG is, the more passionate and motivated Lu Chen is.

  …

   Twenty minutes later.

   Junior Sister Xiaoyu, who helped Fan Zhiping, returned to the doctor's office with a stack of examination sheets.

   "Brother, here are some results of the patient's last review."

   "Okay, thank you." Lu Chen nodded and began to read the patient's previous auxiliary examinations.

   Echocardiography: Left ventricular ejection fraction was 60%, right ventricular function was normal, tricuspid and mitral valve regurgitation was moderate, and left atrium was severely dilated.

  In the medical record, the last time the patient was in the outpatient clinic, he had no symptoms of palpitations, chest pain or dyspnea recently, and there were no positive signs in the physical examination.

   "What about his medication?" Lu Chen asked.

   "There is a medication list at the end."

  Lu Chen turned to the end.

   The patient is currently taking regular medication: tacrolimus 1 mg POBID, sirolimus 4 mg POQD, prednisone 3 mg POQD, bisoprolol 1.25 mg POQD, and rivaroxaban 15 mg POQD.

   (Note: po is oral, QD is once a day, BID is twice a day)

   Among them are immunosuppressants, hormones, anticoagulants, and drugs to improve heart function after heart transplantation.

   The medication of patients is relatively routine.

   "The patient did not feel any discomfort when he came to the hospital this time, mainly for reexamination." Fan Zhiping added aside.

   "Yes." Lu Chen nodded.

   He synthesized all the test results, as well as the patient's medical history.

   But still can't see the diagnosis of the patient's ECG.

  Fan Zhiping suddenly whispered: "How about I send this electrocardiogram to the Jinghua Electrophysiology WeChat group for everyone to discuss?"

   "Okay." Lu Chen said, "Relying on the collective wisdom, we may be able to come up with ideas."

   Fan Zhiping saw that Lu Chen agreed, so he took a picture of the electrocardiogram and sent it to the Jinghua Electrophysiology WeChat group.

  …

   Jinghua Electrophysiology Exchange Group.

Every day in the    group, people send ECG questions.

   There are easy ones and some more difficult ones.

  Lu Chen often speaks in groups before the national skills exam.

   But since preparing for the exam, he hasn't bubbled in the group for more than a month.

   On the contrary, it is Fan Zhiping, who can be said to be one of the most active people in the group. He is usually very enthusiastic about helping others answer electrocardiograms, or discussing electrocardiogram academic issues with everyone.

   After Fan Zhiping posted this strange electrocardiogram to the group, it immediately attracted the attention of most people.

   "Lao Fan, isn't this atrial fibrillation?"

   "Yes, obviously atrial fibrillation! What are you looking at when you send this electrocardiogram?"

   As soon as Fan Zhiping posted in the group, someone couldn't wait to speak.

   However, before Fan Zhiping explained, someone asked a question: "Look carefully, the heart rhythm of this electrocardiogram is neat! Are you sure it is atrial fibrillation?"

   "Hey, I heard you say that, it seems so."

   "From the point of view of the p wave, it is atrial fibrillation, but from the point of view of the heart rhythm, it is not!"

   "Think about it, if it was a picture of atrial fibrillation, Lao Fan wouldn't show it to us!"

   "This should be @Professor Lu!"

  “…”

   Everyone in the group chatted, but didn't say anything.

   After Lu Chen looked through the chat history of WeChat, he found no useful information.

   He can only put this electrocardiogram aside for the time being, and after he goes back to the bedroom, he will look through the electrocardiogram data again.

  …

  Fan Zhiping held the electrocardiogram in his hand, but he was quite helpless.

   As soon as he came to the eight districts in his heart, this electrocardiogram gave him a slap in the face.

   Fortunately, it was a somewhat difficult ECG.

   Otherwise, this is not to make everyone look down on their Cardiology Department in Fengm County.

   However, just a day after he arrived, Fan Zhiping could feel that the academic atmosphere of the eight districts in his heart was much stronger than that of the county hospital.

   The doctors in their county hospital are always talking about stocks and options whenever they have time, so where would they discuss academic issues?

   Someone who can take the initiative to look through internal medicine books is considered a good person.

   However, in the eight districts in the heart of the Jinghua Second Hospital, when everyone encounters any question they do not understand, they will immediately look up relevant information, and even find literature to solve the problem, and discuss together to find the answer to the problem.

   These are incomparable to the doctors of the county hospital!

   Fan Zhiping felt this.

  Although he felt a little helpless, he also tried to pick up books and documents to slowly enrich himself.

  The profession of a doctor really is to live to old age and learn from old age.

  …

   After get off work at noon, Lu Chen packed a meal in the cafeteria.

   Back in the dormitory, he started to check the electrocardiogram data while eating.

  The knowledge of ECG is vast, far more than what he has now.

   However, his current ECG interpretation skills are only basic.

In the    system mall, intermediate skills cannot be exchanged for the time being. Only when you unlock a higher-level mall, you may be able to exchange for higher-level skill cards and skill books.

  Now, Lu Chen can only rely on his own efforts to slowly discover the information related to this strange ECG in the data of the ECG.

   After about half an hour.

  The other people in the dormitory also came back after lunch one after another.

   "Lu Chen, you came back so early today?"

   Wang Zihao walked to Lu Chen's side and patted his shoulder lightly.

   "Well, I need to check something." Lu Chen smiled, "I packed the meal back."

   "You're really fascinated by electrocardiograms, and you started nibbling on books with electrocardiograms."

   Wang Zihao also admired Lu Chen.

  Some people are not only talented, but also work harder than you!

   Originally wanted to play two games before going to sleep, but Wang Zihao thought it was better to read an article before going to sleep!

  Otherwise, the gap will get bigger and bigger.

   "Hey, Old Wang, you don't play games anymore?" Another roommate said in surprise, "A new hero just came out, strong thief! Why don't you try?"

   Wang Zihao curled his lips, "I read the skill introduction, isn't this a combination of two hero skills in another game? It's just a stitching monster, it's nothing fun, let's play."

"All right."

   The other two roommates can only play double row.

  …

   But the speaker has no intention, and the listener has intention.

   When Lu Chen heard the stitching monster mentioned by Wang Zihao, a sudden inspiration flashed in his mind.

   "Two heroes combined, stitch monster..."

   "Two hearts, heart transplant..."

   When he looked at this electrocardiogram that "looked like atrial fibrillation" again, he was suddenly stunned!

"I see!"

  Behind the silent heart, there is another wonderful world.

   (end of this chapter)