I Can See Health

   Chapter 253 What a thick envelope!

Li Yao's complexion remained the same, she had encountered many such patients, and explained patiently: "First of all, as long as you want to extract a tooth, not only do you need to lower blood pressure before surgery, but also routinely do an electrocardiogram to evaluate the heart condition; It must be a problem with the teeth itself, and maybe the pain from a heart attack."

   "Huh? I heard that heart disease is all chest pain or chest tightness. Does heart disease also cause toothache?"

   A trace of doubt flashed in the eyes of the man in front of him.

   "And, I've never had a heart attack before, and neither did my parents!"

Li Yao shook her head slightly: "The onset of heart disease is sudden, and it does not necessarily mean that there is any past medical history. Moreover, many diseases are not all symptoms, and a small number of coronary heart disease patients have symptoms, that is, toothache! Therefore, now you not only need To lower blood pressure, an electrocardiogram needs to be done to rule out heart disease.”

"Then make one!" The woman on the side immediately said, "This electrocardiogram is not expensive. We make an electrocardiogram and treat it as a peace of mind. If there is a problem, we will solve it. If there is no problem, then it is the best. !"

  The man ignored the woman, but said to Li Yao, "Doctor, as long as my blood pressure drops and my electrocardiogram is fine, then I can extract my teeth?"

   "Yeah." Li Yao nodded, "The blood pressure is stable and the heart is fine, then you can extract the teeth!"

   "Okay, then I'll do an electrocardiogram!"

   Seeing the patient's agreement, Lu Chen immediately issued an ECG application form and a prescription for antihypertensive drugs.

   "Then go quickly." Li Yao said, "The ECG room is in the next building."

   The patient in front of him and his family nodded and left the outpatient room together.

  …

   After the patient left, Li Yao glanced at Lu Chen admiringly.

"Yes, inquiring about the medical history is more careful. For patients with toothache like this, don't forget to ask about the history of heart disease. Many patients with heart disease are not necessarily chest pains, but may have toothaches, sore throats, shoulder pains, and what's more, It's a headache!"

  The heart itself has no pain nerves.

  Once the myocardium is ischemia due to coronary heart disease, many metabolites such as lactic acid will accumulate.

  These metabolites stimulate the autonomic nerves of the heart, and the stimulation signals are transmitted to the spinal cord center through the autonomic nerves.

   Different people can have slightly different afferent spinal cord segments, so the pain symptoms of coronary heart disease are also different.

   Since the afferent segments of the autonomic nerves of the heart are usually the afferent segments of the left chest and left upper limb sensory nerves, most patients with coronary heart disease present with pain in the left chest or left upper limb.

   However, if the afferent segment of the autonomic nerve of the heart is too high, it may manifest as toothache and jaw pain.

   Similarly, if the afferent segment is low, it may appear as upper abdominal pain and be mistaken for a symptom of a digestive tract disease.

   Some people can also have shoulder and back pain.

  Lu Chen nodded, "Well, I see, teacher."

   Although his clinical career was short, the number of cardiac patients he encountered was no longer rare.

   All kinds of strange complaints may be myocardial infarction!

  Each patient is unlikely to get sick according to the typical symptoms in textbooks, so some rare diseases and symptoms must not be ruled out.

  …

   Finish this patient.

   This is Li Yao's last patient this morning.

   It's eleven o'clock, Li Yao has closed the clinic, and others can't get her outpatient number.

   "We'll get off work after sitting for another half an hour. We don't see new patients now, but some patients need to see test results in the morning." Li Yao said, "We'll wait for them."

  Lu Chen nodded slightly and sat beside Li Yao like a good student.

   "How is it in Corey during this time?" Li Yao asked suddenly.

   "Fortunately, although I'm a little busy, I can learn a lot." Lu Chen said.

   "I heard that you also taught yourself about cardiac ultrasound?" Li Yao smiled, "It's not easy, isn't it? It's not easy when I'm so busy in clinical practice, and I still have time to learn ultrasound technology."

  Lu Chen smiled and said: "It's just some fur, and there are many heart sections that I don't know how to read."

   "Well, it's better to be humble." Li Yao said, "When you go to the CCU for rotation, then you have a professional ultrasound equipment, and you can train at any time."

  The current portable ultrasound in the eight areas of the heart is a small castration version of the ultrasound machine.

  Professional cardiac ultrasound machine can more accurately judge the patient's condition.

   "Teacher, it will take a long time for me to go to CCU." Lu Chen said.

  Li Yao said: "Well, where are you going to the next department?"

   "After a month and a half, you should go to the emergency department." Lu Chen thought about it and said.

   "You went to the emergency room so soon?" Li Yao was stunned, "I thought you would go to the emergency room for breathing or digestion! But the emergency room is also good. Going to the emergency room will benefit you a lot in the future."

   During the conversation, the patient with a toothache just now also returned.

   Walking into the outpatient room with him, besides his wife, there was also a young doctor in a white coat.

   "Director Li, is this your patient?" The young doctor stepped forward anxiously, holding an electrocardiogram in his hand.

   "It's my patient." Looking at his expression, Li Yao's face sank.

   Shouldn't it really be a heart attack?

   "Director Li, then take a quick look at the electrocardiogram." The young doctor handed the electrocardiogram to Director Li.

  Li Yao looked down, and Lu Chen also brought his head close.

   "The anterior leads are all elevated!"

   Both of them were shocked.

   If you don't check it, you don't know, you will be shocked when you check it!

   Patient's ECG showed extensive short ST elevation in the precordial leads.

   No wonder the doctor in the ECG room brought the patient in person.

   There is now the possibility of acute anterior myocardial infarction!

  Li Yao immediately said to the patient: "There is a problem with the electrocardiogram, we consider the possibility of acute myocardial infarction!"

  The man became anxious when he heard it, "Aren't you kidding me, I...I have a heart attack?"

   The patient's wife was also a little overwhelmed.

   "Uncle, don't get excited yet." Lu Chen hurriedly stepped forward and said, "We are just suspecting now, you need to go to the hospital for further examination."

   At this time, the doctor in the ECG room took out a critical value registration book and asked Li Yao to sign it.

  The man was hesitant for a while, "I don't feel like it hurts much, do I have to be hospitalized?"

  Li Yao took a deep breath, held her temper, and said slowly: "I'll just say it directly, in your current situation, if you are diagnosed with acute myocardial infarction, it will be very dangerous."

   After finishing speaking, Li Yao also looked at the patient's wife.

   "Acute myocardial infarction, high risk of sudden death!"

  The woman nodded quickly: "Doctor, I took a picture of this electrocardiogram and sent it to a family member studying medicine."

   "There is no rush to take pictures. The most important thing now is to be hospitalized as soon as possible, and to further improve relevant examinations. If there is a myocardial infarction, emergency surgery is required!" Li Yao said solemnly.

  Lu Chen is also constantly on the side, emphasizing the risk of myocardial infarction to patients and their families!

   "Doctor, what do you think we should do now?" The woman bit her lip with a look of sadness between her brows.

   "Now go to the emergency department and ask the emergency department to send nurses and doctors to accompany you to the CCU ward for hospitalization." Li Yao said.

  Although the outpatient building is only a few hundred meters away from the eighth inpatient department, there is no guarantee what will happen during this period.

   When encountering such emergency patients, emergency nurses and doctors must accompany them.

   "Then listen to you, go and live!" The woman nodded.

After the patient and his family agreed, Lu Chen took the two to the emergency department.

   After explaining the condition to the emergency doctor, the doctor on duty in the emergency department immediately became alert and performed a quick troponin screening test for the patient.

  Three minutes later, the result came out.

   Troponin positive!

  Myocardial infarction diagnosed!

  The emergency department immediately dispatched doctors and nurses, brought rescue supplies, and sent the patient to the CCU!

  …

  This side of the outpatient building.

   Lu Chen and Li Yao were relieved when they received this message.

   I can finally leave work in peace.

   "It's almost time to get off work."

  Li Yao smiled, she suddenly took out an envelope from her carry-on bag, and handed it to Lu Chen.

  Lu Chen subconsciously took the envelope and paused before he could react.

   Good guy, what a thick envelope!

   (end of this chapter)