I Can See Health

   Chapter 237 Myocardial Infarction or Dissection? (The origin and the extinction of the predestined relationship are rewarded with more rewards!)

   came to the ward.

  Lu Chen and Fan Zhiping were in front, Wei Wenwen pushing the electrocardiograph machine, followed closely behind.

   On the hospital bed, the patient was lying flat, gasping for breath.

   His lips were slightly pale, his face was full of pain, and there were even layers of fine sweat oozing out of his forehead.

  Lu Chen looked at the patient's head, his HP was 62!

   This value is around a 60 threshold.

   Most patients with acute myocardial infarction have a life value below 60.

   However, if the acute myocardial infarction is in the recovery period, or the scope of the myocardial infarction is small, the HP will also rise to above 60.

   "Junior brother, measure the patient's blood pressure, and then review an electrocardiogram." Lu Chen ordered, and he also auscultated the patient's heart and lungs.

  Patients with chest pain, as long as the degree of chest pain changes, need to review the ECG immediately.

   "Okay, brother."

  Wei Wenwen has very quick hands and feet, and immediately took out the mercury sphygmomanometer.

   At this time, Lu Chen also began to ask about the patient's condition.

   "When did the chest pain start?"

"Actually, the pain started when I woke up this morning, but the chest pain was relieved by taking a tablet of nitroglycerin at that time." The family member of the patient is a middle-aged woman, who should be the patient's wife. "He had coronary heart disease before and usually had chest pains. Sublingual nitroglycerin can relieve it, but it just doesn't work, it's too painful, and I can't breathe."

   Generally speaking, if it is angina pectoris, nitroglycerin can be relieved.

  What can't be relieved, most of them are myocardial infarction!

   "When is the most painful time?"

   "Just now, about a few minutes ago."

   "What specific part of the chest pain? Please point it out to me, patient." Lu Chen looked at the patient on the hospital bed and said.

   The patient panted heavily and pointed to where his heart was.

   "Is the current level of chest pain the same as before, or is it worse than before?"

   "It got worse." The patient uttered a few words with difficulty.

   "What kind of pain do you feel?" Lu Chen continued, "Is it like a stone pressing against your chest, you can't breathe?"

   "Yes, that's what it feels like." The patient replied with a frown, sweat seeping from his forehead. He covered his chest with his hands, looking really hurt.

  Lu Chen's heart sank.

   Combined with the patient's symptoms and their own descriptions, the pain could not be relieved by nitroglycerin. This pain was too similar to a myocardial infarction.

   At this time, Wei Wenwen had already taken his blood pressure.

   "Brother, the patient's blood pressure is 160/90mmHg, and the blood pressure is symmetrical on both sides."

  Lu Chen nodded and said to the patient and the patient's family: "Fortunately, the blood pressure has not dropped. Nitroglycerin is not something you can use casually."

"If you want to take nitroglycerin under the tongue, remember to measure your blood pressure. If your systolic blood pressure is less than 100mmHg, you should not use nitroglycerin. If your blood pressure collapses, it will be even worse. This drug used to be an explosive ingredient. You know, it's very powerful, it can lower blood pressure, don't use it when your blood pressure is low."

   The patient's family nodded quickly.

  Lu Chen asked a few more questions and learned that the patient had never had coronary angiography or coronary CTA before.

   "Without coronary angiography, you cannot be sure that it must be coronary heart disease."

   Having experienced many diseases similar to myocardial infarction before, Lu Chen is not in a hurry to make a diagnosis now.

   About a minute later, Wei Wenwen finished the electrocardiogram.

   "Thank you." Lu Chen took the electrocardiogram handed over by Wei Wenwen.

   ECG display. The ST segment was shifted down by 0.05mV in leads II, III, and aVF, and the ST segment was also shifted down due to the T wave in leads V4-V6.

   At this time, the patient added: "Doctor, my left forearm also has traction pain."

   Fan Zhiping heard this and said, "Isn't this a typical myocardial infarction radiating pain?"

  Lu Chen hummed in approval.

   The patient is relatively obese, and has been diagnosed with coronary heart disease and hypertension in the past.

   Now there is obvious chest pain and reflex pain, sublingual nitroglycerin is ineffective, and the performance of electrocardiogram indicates that the possibility of myocardial infarction is quite high!

   "Quickly open the venous access!"

  Lu Chen immediately instructed the nurse to draw blood and perform routine examinations, especially myocardial enzymes and troponin.

   There are troponin screening in the eight areas of the heart, which can be done in the department, and the results will be available in a few minutes.

   "Brother Fan, please notify Senior Sister Sun and ask her to come and see the patient." Lu Chen said to Fan Zhiping, who was beside him.

  The mortality rate of acute myocardial infarction is very high. In such a critical case, the superior doctor must be notified as soon as it is discovered.

   "Okay!" Fan Zhiping immediately left the ward.

  …

   At this time, the quick screening results of the patient's troponin came out!

   The results showed that troponin was normal and not significantly elevated.

   Wei Wenwen whispered: "If it's normal, then can't diagnose myocardial infarction?"

  The diagnosis of myocardial infarction relies on three elements, one is typical chest pain, the other is electrocardiogram performance, and the third is troponin.

   Elevation of troponin, which means myocardial infarction, is caused by the rupture of heart muscle cells.

   But now the patient's troponin is still normal, what does that mean?

Lu Chen explained patiently: "In patients with myocardial infarction, the electrocardiogram will respond quickly, but troponin, myocardial enzymes, etc. take a certain amount of time to rise. The fastest is myoglobin, which takes 30 minutes. -1 hour to rise."

   "The troponin we measured takes at least 2-3 hours to rise, and the patient has chest pain for less than 1 hour. It is understandable that the troponin is normal, but it needs to be dynamically reviewed."

   "Oh." Wei Wenwen nodded.

   At this time, Sun Guoguo also came to the ward.

   "What's the condition of the patient?" After Sun Guoguo checked the patient, she then looked at the patient's electrocardiogram.

Lu Chen thought about it and immediately said: "The patient had sudden chest pain for about 10 minutes, and sublingual nitroglycerin could not relieve it. There was a history of similar chest pain in the past, but before the chest pain attacked, sublingual nitroglycerin can relieve it. "

   "What about the past medical history?" Sun Guoguo asked.

Lu Chen paused and continued: "The patient was diagnosed with coronary heart disease in a local hospital two years ago because of chest pain and tightness. Later, he took aspirin and other drugs for a long time. At the same time, the patient also had a history of hypertension and was taking antihypertensive drugs. , The specific drug is unknown, but I didn't insist on taking it, and I stopped eating and eating. I don't measure my blood pressure at home."

   After listening to Lu Chen's medical history report, Sun Guoguo said solemnly: "The patient's chest pain persists, and the ECG shows myocardial ischemia, suggesting that it may be an acute non-ST-segment elevation myocardial infarction!"

   If it is really a myocardial infarction, then immediately send it to the catheterization room for coronary intervention to open the coronary artery blocked by thrombus, in order to save more ischemic and hypoxic myocardium!

   There are too many such patients in the Cardiology Department, some of them delay time, and their heartbeats stop!

   But with such a patient, Sun Guoguo is not at ease!

   "Do you think this patient can rule out aortic dissection?" Sun Guoguo looked at Lu Chen and Fan Zhiping.

   For patients with chest pain, in addition to myocardial infarction, aortic dissection must be excluded!

   Because the treatment of myocardial infarction and dissection is completely opposite!

   In case the patient has aortic dissection, once anticoagulant and antiplatelet drugs are used, it will be bad, maybe it will cause bleeding, and the patient will die faster!

   As long as it's a mistake...

   That is ruin!

  Lu Chen and Fan Zhiping looked at each other and both shook their heads.

   Judging from the current data, there is indeed no way for patients to completely rule out aortic dissection!

   However, the biggest possibility for patients at present is acute myocardial infarction. If the time to open blood vessels is delayed, it will cause more harm to the patient!

   This is quite a contradiction!

   I still owe 19 chapters, no update tonight.

   (end of this chapter)