I can see health

Chapter 196 Broken Heart Syndrome

This is not a heart attack!
The news from the intervention room surprised everyone.

Lu Chen was also stunned.

Because in the process of the patient's operation, the test results of the patient also came out.

Troponin is elevated!

Troponin is a protein found almost exclusively in heart muscle cells.Once the troponin rises, we can infer that the myocardial cells are necrotic and ruptured, releasing troponin into the blood, and we can detect the rise of troponin.

Acute myocardial infarction can basically be diagnosed through the symptoms of chest pain, changes in the electrocardiogram, and elevated troponin.

However, the result of coronary angiography was completely opposite to this diagnosis.

In addition, Lu Chen also checked the patient's surgery records.

Not only does the patient have no myocardial infarction, but his heart vessels are extremely smooth without any stenosis or plaque, which is not like a person with heart disease at all.

"Could it be variant angina?" Ke Yue asked aside.

Sun Guoguo shook his head and explained: "If it is a variant angina pectoris, then even if the patient's blood vessels are not completely occluded, there must be something wrong. However, for our patient, he saw the patient's coronary artery angiography. The arteries are unobstructed, there is no obvious narrowing, there is no thrombosis, it is not myocardial infarction, and it is not variant angina."

"What about myocarditis?"

You should know that sometimes, pulmonary embolism and aortic dissection can also show symptoms similar to acute myocardial infarction, especially chest pain.

The heart and lungs are not separated, and sometimes diseases that affect the lungs can also affect the heart sideways, so changes in the electrocardiogram are also possible.

Although troponin is unique to heart muscle cells, elevated troponin often indicates myocardial cell rupture and necrosis, but it is not necessarily the increase caused by coronary artery blockage and ischemic necrosis (myocardial infarction), it may also be caused by other diseases Myocardial cell destruction and necrosis, such as myocarditis.

However, Sun Guoguo still rejected this diagnosis.

"Myocarditis usually has malignant arrhythmia, and there is a prodromal infection. This patient is not very suitable."

After considering so much comprehensively, Lu Chen was very puzzled at this time.

It's not myocardial infarction, angina pectoris, or myocarditis. What other disease can show chest pain + ECG changes + troponin elevation at the same time?
……

Since the patient did not have a myocardial infarction, he was pushed back to the eighth area of ​​the heart after the operation.

Generally speaking, patients with acute myocardial infarction should be observed in the CCU for a few days after the operation to ensure that there are no complications before being transferred back to the general ward.

The patient returned to the eighth division of the Cardiology Department, and Sun Guoguo ordered Lu Chen to closely observe him and review the electrocardiogram and troponin in time.

At the same time, Li Yao also called all the doctors to discuss difficult cases.

As the first doctor, Lu Chen gave a detailed medical history introduction.

After discussing the results, in order to further rule out other fatal diseases, such as aortic dissection, pulmonary embolism, etc., Sun Guoguo performed a chest and abdomen CT scan + enhancement on the patient.

Fortunately the result was normal.

This time, the three most dangerous and deadly diseases in the Department of Cardiology have been ruled out - myocardial infarction, dissection, and pulmonary embolism.

"The real diagnosis of the patient will not be found for a while, so let's monitor closely first." Sun Guoguo ordered helplessly.

Fortunately, the patient's vital signs gradually stabilized, and his blood pressure rose to 120/80mmHg.

……

The difficult case discussion is over.

Lu Chen sorted out all the patient's information again.

In fact, from the very beginning, this patient had many doubts.

First of all, the patient's heart rate changes, which is inconsistent with inferior myocardial infarction.

Secondly, the patient's life value did not drop to less than 60 like other patients with myocardial infarction.
Lu Chen continued to think for a long time, but still couldn't find the patient's diagnosis, so he could only temporarily put down his doubts.

Clinically, he is not the only patient, there are other patients that need to be dealt with.

In the morning, Lu Chen received a total of four patients and was quite busy.

Fortunately, with the help of Junior Sister Yao Jie, Lu Chen can still handle it.

After one or two months of training, Yao Jie has also grown from a novice in cardiology to a veteran who can understand some simple electrocardiograms.

As he got off work at noon, Lu Chen thought of the myocardial infarction patient in the morning.

"Junior Sister, go and check another ECG for him."

"Ok."

Yao Jie immediately checked an electrocardiogram.

The electrocardiogram is still almost the same as that in the morning.

It was time to get off work at noon, so Lu Chen decided to take another look at him.

……

When I came to the bedside, the patient was eating porridge on the bed.

Messy hair, unkempt beard.

Lu Chen walked over and said softly, "Is your appetite okay?"

The man smiled faintly, "Generally, you can eat two bowls of porridge, as long as you don't starve to death."

"You didn't have a myocardial infarction." Lu Chen looked at him and said.

"I see, you all told me this morning, it doesn't matter if it's okay." The man looked at Lu Chen, his eyes were full of sadness and emptiness.

This indifferent answer was somewhat unexpected to Lu Chen.

At this time, the man continued, "I know I must have problems."

He lowered his head, took a mouthful of porridge and said.

"I divorced my wife a few days ago. It's not that I don't have children, but the children belong to her, and the company fired me. I deserve all of this, haha."

As soon as the man's voice fell, Lu Chen felt a little creepy.

Especially when he laughed twice at the end, which made his hairs stand on end.

However, his words also woke up Lu Chen.

Does he have Broken Heart Syndrome?
When a person is extremely sad, it is a huge stress on the heart, which is likely to cause damage to myocardial cells, and the patient suffers from severe chest pain and tightness.

This is similar to the performance of myocardial infarction, but the coronary angiography is normal, not myocardial infarction.

This disease is rare, Lu Chen has never seen it, only saw it on the news.

Lu Chen left the ward and returned to the doctor's office.

"Senior Sister, does the patient have Broken Heart Syndrome?"

Lu Chen immediately expressed his thoughts to Sun Guoguo, and described the patient's family situation in detail.

"Broken Heart Syndrome?" Sun Guoguo was stunned. "Yes, it's probably stress-induced myocarditis, commonly known as Broken Heart Syndrome. This is the first time our department has encountered such a situation."

Sun Guoguo immediately agreed with Lu Chen's idea.

All the test results are normal, and now we can only consider the influence of mental factors.

"Brother, what is Broken Heart Syndrome?" Yao Jie asked in a low voice.

Lu Chen thought for a while and said, "Broken Heart Syndrome is actually stress-induced myocarditis, but this is not the viral myocarditis (caused by viral infection) we often talk about."

"Stress myocarditis is a self-limiting disease. Although the onset is a bit scary, similar to a real myocardial infarction, it is not coronary artery blockage after all, so it will not pose a fatal threat."

Broken Heart Syndrome is similar to someone hitting the heart hard. The strong impact causes some cardiomyocytes to rupture, and troponin rises.

The consequences of the impact are far milder than coronary blockage. Without treatment after the impact, you can recover with a good rest. However, if the coronary artery is blocked and not opened in time, the entire heart will be wiped out.

"Brother, I feel very uncomfortable hearing this name." Yao Jie wrinkled her little nose.

"Yes." Lu Chen nodded, "This metaphor is very vivid. Is it true that a broken heart happened? A broken heart is just an emotional diagnosis, not a physical one."

"If it is a physical heart rupture, the patient must die on the spot, and there is no possibility of survival. The heart is the blood pump of the human body. If the pump does not turn, the blood will not move. The whole body will be hypoxic and the brain will be ischemic. You will faint in 6 seconds, and irreversible damage or even brain death will occur if the brain is deprived of oxygen for 4-6 minutes.”

……

Lu Chen returned to the ward.

The patient has finished his porridge.

Lu Chen hesitated for a moment, but still said, "You may have broken heart syndrome."

"Broken Heart Syndrome?" The man said lightly, "What kind of disease is this?"

Lu Chen told him the mechanism of the disease.

After hearing this, the patient fell silent.

After a period of rest, his body can recover.

He is lucky.

However, he seems to be unlucky again.

Life is really impermanent.

Cherish the people in front of you and live well in the moment.

　Clinically, I heard a case from my teacher, but I have never seen it.

　　One more chapter.

　　
　
(End of this chapter)