I Can See Health

  Chapter 203 The patient pretending to be asleep

   Jinghua Second Hospital.

  Guipei Building bedroom.

  Lu Chen took out his mobile phone and excitedly opened the electrocardiogram of the heart transplant patient.

   The heart has 4 chambers.

   There are left and right atrium above, and left and right ventricles below. The ipsilateral atrium and ventricle communicate.

   The patient received the Bicaval technique.

The left atrium and great vessels of the    recipient were preserved, and the right atrium and ventricle were removed.

   Therefore, the right atrium and ventricle of the patient were transplanted, and the left atrium was preserved.

   If the patient was originally in atrial fibrillation rhythm and his donor was in sinus rhythm, what would the ECG look like?

  Lu Chen carefully checked the electrocardiogram and compared each lead.

   Sure enough, in the small F wave of the electrocardiogram, he found an unusual P wave.

   Conventional ECG has 12 leads.

   In lead V1, Lu Chen found a less obvious sinus P wave and a small F wave belonging to atrial fibrillation.

  P waves are in sinus rhythm.

  Small f wave, belonging to atrial fibrillation rhythm.

   Lu Chen's face showed surprise, that is to say, this patient has both sinus rhythm and atrial fibrillation rhythm, two types of heart rhythm!

   This also explains why the patient's heart rhythm is regular.

  There are two different heart rhythms in one heart!

   This is completely contrary to our normal thinking!

   Heart rate and ventricular depolarization did not change and were regular.

   It's just that the back atrial waves have become irregular.

  Lu Chen can speculate that the left atrium may be in an isolated state based on the surgical operations the patient has experienced.

   Left atrial enlargement and atrial fibrillation due to asynchrony of atrioventricular contraction and valve problems.

   And ventricular activation is conducted through the sinoatrial node, right atrium, and is also regular.

   Then came what looked like atrial fibrillation, isolated left atrial fibrillation.

   However, the dominant heart rhythm is from a donor and is sinus rhythm.

   The atrial depolarization potential recorded by the ECG is the composite potential of the left and right atrium, so atrial fibrillation rhythm and sinus rhythm appear on the same ECG.

   "Congratulations, the completion of the system upgrade has increased!"

  Lu Chen's expression brightened.

The prompt of the    system undoubtedly proved that his conjecture was correct.

Lu Chen was very happy that    could solve this difficult ECG.

   However, it also made him realize his own inadequacies.

   His clinical experience is not rich enough, and when faced with such difficult patients, he failed to quickly judge the patient's condition.

   ECG is a subject with a low threshold but a very high ceiling.

  Although his current electrocardiogram level is a bit higher than the people around him, there is still a big gap compared to those professional electrophysiology experts.

  …

   Wang Zihao, who was already lying down, looked at Lu Chen with a happy face, and said strangely: "Lu Chen, what's wrong with you, the electrocardiogram looks so good?"

   It was the first time he saw someone staring at the electrocardiogram and smirking.

   "Zihao, thank you for your stitching monster." Lu Chen smiled.

   "Huh?" Wang Zihao blinked, "You also play games?"

   "Don't fight." Lu Chen shook his head, "your Yasuo is too delicious, it's a good meal."

   Wang Zihao: "..."

   After solving this ECG problem, Lu Chen went to bed and took a nap.

  The combination of work and rest can lead to better work and study.

  …

  Lu Chen fell asleep, but Fan Zhiping could not.

   In the rental house near the Second Jinghua Hospital, he repeatedly studied the electrocardiogram of this heart transplant, and even consulted a lot of related materials.

   But still no clue.

   I didn't sleep well last night, and I didn't sleep well at noon today.

   When it was time for work, Fan Zhiping drew his eyelids and walked slowly to the Jinghua Second Hospital.

   As soon as he walked to the door of the doctor's office in the eighth district in his heart, he heard the voice of someone discussing.

   "Donor in sinus rhythm and recipient in atrial fibrillation rhythm."

   "So this ECG shows two heart rhythms at the same time!"

   "How did Brother Lu come up with this complicated electrocardiogram?"

   Fan Zhiping, who was standing at the door, was shocked.

   He could vaguely hear the conversation of everyone in the room, but he couldn't hear it clearly.

   He quickly walked into the doctor's office and saw Lu Chen explaining the electrocardiogram to everyone.

   didn't even bother to go to the duty room to change into a white coat, so he got close to everyone.

Just listening to Lu Chen continued: "Other leads may not be clear, but this V1 lead is very obvious, there are sinus P waves and small F waves of atrial fibrillation... The patient is a heart transplant, and the left side is preserved. the atrium, so the ECG showed atrial fibrillation in the left atrium and sinus rhythm in the donor…”

   Fan Zhiping's eyes widened, swept away the previous decadence.

   It only took one noon for Lu Chen to solve this electrocardiogram.

   In the morning, everyone was helpless about this electrocardiogram!

   Fan Zhiping can't wait to squeeze into Lu Chen's side, get closer, and listen to his explanation.

  …

   At this time, Lu Chen was sitting in the middle of the crowd.

   He received another five points of gratitude.

   "Congratulations, +1 for the thank you from Yu Huihui!"

   "Congratulations, +1 for the thank you from Yao Jie!"

  “…”

   "Congratulations, +1 for the thank you from Fan Zhiping!"

  Lu Chen looked beside him, and it turned out that Comrade Fan was also here, and he didn't even have time to change his white coat.

   "Lu Jiao... Lu Chen, I have a question."

  Fan Zhiping almost blurted out the words "Professor Lu", but fortunately he swallowed it back in time.

   When Lu Chen heard his words, cold sweat broke out on his forehead, "Doctor Fan, you said."

Fan Zhiping paused and said slowly, "Why is the patient's heart rhythm orderly? According to what you said, the patient's ECG shows two heart rhythms at the same time, one is atrial fibrillation and the other is sinus rhythm. The heart rhythm can be orderly. But it can also be uneven, right?"

  Lu Chen frowned. He had thought about this question, but he couldn't find a definite answer for the time being.

   He thought for a while before speaking.

   "It may be because the left atrium is isolated and it is not connected to the transplanted right heart, so the right heart is the dominant heart rhythm, so the overall ECG shows the right heart sinus rhythm."

  Fan Zhiping nodded.

   At present, this explanation should be the most likely.

  He looked up at Lu Chen with admiration in his eyes.

   "Professor Lu" is really amazing!

   He chose to come to the eighth district in his heart to follow Lu Chen, and decided it was the right choice.

  …

   After discussing the patient's electrocardiogram, everyone started to work on their own.

   At four o'clock in the afternoon, Li Yao returned to the ward.

After    asked if there were any critically ill patients in the group, Sun Guoguo reported them one by one.

   "There was a new aortic dissection in the morning, and one after a heart transplant."

   "There was also a broken heart syndrome yesterday..."

   "There are three other myocardial infarctions, and two patients with severe heart failure."

  …

  Li Yao sat in the office, reading the medical records of all the patients.

   "There are quite a lot of critically ill patients. If you want to close the patients managed by other people, don't let them go. You must give everyone the opportunity to exercise, and don't let them go too much, so as not to make mistakes."

   "Well, don't worry." Sun Guoguo smiled, "Several brothers and sisters are very good, usually I don't need to worry about it. If there is any change in the condition, they will report it in time."

   "That's good." Li Yao nodded, she suddenly turned to the electrocardiogram of the heart transplant patient, "Hey, this electrocardiogram is quite rare, can you see what it is?"

   After Li Yao finished speaking, she saw that the expressions of everyone were a little strange.

"What's wrong?"

  Sun Guoguo whispered: "Teacher, is this an ECG with sinus rhythm and atrial fibrillation coexisting?"

   "Guoguo, not bad." Li Yao looked surprised, "The level of interpretation has improved a lot."

  Sun Guoguo hurriedly shook his head and pointed to Lu Chen beside him, "Junior Brother Lu saw it."

  Lu Chen smiled and scratched his head, but did not speak.

  Li Yao glanced at Lu Chen, the smile on her face was still bright, but the surprise in her eyes was a little less.

   She knew that Lu Chen was a member of the elite group of Jinghua Electrophysiology, and he was admitted by his own efforts.

   It's not so strange that he can see this kind of electrocardiogram.

   "Okay, I've seen all the patients, so let's do it first." Li Yao said, "If you have any questions, feel free to report to me."

   "Received." Everyone replied in unison.

   After Li Yao finished speaking, she stood up and turned to leave.

   As soon as she walked out of the office, she suddenly stopped and looked back at Lu Chen.

   "Lu Chen, come to my office now."

  Lu Chen was stunned for a moment, then responded quickly, and followed behind Li Yao.

  …

  The director's office is furnished as usual.

  The bookshelves are full of books related to cardiology, including coronary intervention, electrophysiology, and anatomy.

  Beside the desk, there is a stack of thick documents.

   "Lu Chen, you performed well in this national skills test. The school will have the opportunity to go out to communicate next year. The quota was fixed, but this time your school team members have the opportunity, so you have to take advantage of it."

  Lu Chen and Li Yao sat opposite each other.

   "Okay, thank you teacher." Lu Chen smiled.

  The opportunity to go out and communicate is rare.

   The five members of their school team occupied five of them.

"You don't need to thank me, you won it with your own efforts." Li Yao smiled and continued, "I came to you today to tell you one thing. I wanted you to join the Jinghua Electrophysiology Association, just because I wanted to. It gives you an early opportunity to get in touch with cutting-edge academic knowledge.”

   "Next weekend, Jinghua Electrophysiology Association will hold an academic exchange meeting. At the end, there will be an opportunity to share and report cases. You can see if there are any suitable cases and prepare."

   "Prepare a case?" Lu Chen's reflex arc was half a beat slower, and he didn't react for a while.

   "Well, I'll let you report the case at the exchange meeting." Li Yao nodded, "Have an academic exchange with other electrophysiology doctors."

  Lu Chen was stunned.

   Let him be a graduate student to report cases at this kind of conference?

  This...isn't that good?

   Even though Lu Chen rarely participates in this kind of academic exchange meeting, he also knows that the people who speak at the meeting should generally be the attending physicians who are already working, and doctors above the level.

   "Why, don't you want to go?" Seeing that Lu Chen didn't respond, Li Yao raised her brows.

   "No, no, I want to go, of course I want to go!" Lu Chen nodded quickly.

   Of course, he had to seize the opportunity to show his face and gain fame!

   "That's good." Li Yao smiled, "I thought you were stage fright."

  Lu Chen shook his head, and then hesitantly said: "Teacher, but I am a graduate student to report, wouldn't it be strange..."

"Don't worry, although you are the only student this time, you are not a precedent." Li Yao said, "There have been students who have reported related cases before, and the identity of the students is second, mainly whether the cases you share are outstanding, so That's the most important thing!"

  Lu Chen nodded.

   Teacher Li Yao can give him such an opportunity, of course he has to prepare well.

   "The case is related to electrophysiology?" Lu Chen asked.

   "Yes." Li Yao nodded, "EKG, electrophysiology combined with clinical practice, you find a suitable case, then make a PPT, complete it and send it to me before next Friday, because it will be discussed on Sunday afternoon."

"OK."

  …

   Leaving the Director's Office.

   A string in Lu Chen's heart tightened again.

   After finishing the National Skills Test, he thought he could rest for a while.

   Now we have to devote ourselves to a new round of learning.

   This is a municipal academic conference, and doctors from several major hospitals in Jinghua City will come.

  Lu Chen is going to speak at this conference, and he is currently facing two difficult problems.

   First, the selection of cases.

   Second, the production of PPT.

For the selection of    cases, Lu Chen had several candidates in mind, but he had to carefully consider them.

   Regarding the production of PPT, Lu Chen did it when he was an undergraduate, but it was just a few simple pictures without any technical content.

   This kind of conference level, the content is important, the production of PPT and the speaker's speech level are also extremely important.

  Lu Chen felt that it was too refreshing to promise Teacher Li Yao.

   It is a very challenging job to complete these contents within a week!

  …

   Back to the doctor's office.

  Lu Chen looked at Ke Yue and Jiang Qingyan beside him.

   "Can you do PPT?"

   Jiang Qingyan and Ke Yue both shook their heads.

  Lu Chen looked at Sun Guoguo beside him.

  Sun Guoguo should be able to do PPT, but Lu Chen knew that she was preparing for the exam recently, so she couldn't trouble her.

   "Let's find the case first, determine the subject content, and then consider the content of the PPT." Lu Chen thought to himself.

   Without content, no matter how beautiful the PPT is, it is just empty talk.

   Throughout the afternoon, Lu Chen did not accept any new patients.

   In his spare time, he has been searching for suitable cases.

   "Fuck, this patient is too difficult to deal with."

   Beside him, Fatty Cheng's voice came over.

The    voice was a little louder, and Lu Chen's attention was also attracted by him.

  Cheng Peng faced the computer with a bitter face, shaking his head and sighing uncontrollably.

   "What's wrong?" Lu Chen asked in confusion.

Cheng Peng shook his head and sighed: "I just accepted a middle-aged woman with a history of tachycardia. She was arguing with others, and suddenly fainted. She couldn't stand down. But her vital signs were normal. , has not woken up."

   "Have you done a CT scan?" Lu Chen frowned.

   "The blood and head CT of the urgent investigation are normal, but I have been asleep and can't see any problem." Cheng Peng smiled bitterly, "We all suspected that she was pretending."

   "Pretend?" Lu Chen raised his brows.

   These days, there are still people who pretend to be sick?

"Well. When I checked her pupils, I found that she was a little resistant, so I began to suspect that she was pretending." Cheng Peng said, "The superior doctors in our group have all gone down to the 4th floor for surgery. I just informed my senior brother, He'll be up in a while."

   Fan Zhiping stayed beside Lu Chen the whole time, and he also heard Cheng Peng's complaints.

   "I have a way to wake her up by herself." Fan Zhiping said suddenly.

  Lu Chen and Cheng Peng turned to look at Fan Zhiping who was beside him.

   "What way?" Cheng Peng asked quickly.

   "Push a furosemide."

  Fan Zhiping grinned.

   (end of this chapter)