I can see health

Chapter 203 The Patient Pretending to Be Sleeping

Jinghua Second Hospital.

The dormitory of Guipei Building.

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

The heart has 4 chambers.

Above is the left atrium and right atrium, and below is the left ventricle and right ventricle.The atrium and ventricle communicate on the same side.

Patients received the Bicaval technology.

The recipient's left atrium and great vessels were preserved, and the right atrium and ventricle were resected.

Therefore, what the patient receives is the right atrium and ventricle, and the left atrium is 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.

A 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 sinus rhythm.

The small f wave is a rhythm of atrial fibrillation.

Lu Chen looked surprised, that is to say, this patient has sinus rhythm and atrial fibrillation rhythm at the same time, two kinds of heart rhythms!
This can also explain why the patient's heart rhythm is regular.

There are actually 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 atrial wave becomes irregular later.

Based on the surgical operations the patient underwent, Lu Chen can speculate that the left atrium may be in an isolated state.

Atrial fibrillation develops as the left atrium enlarges due to atrioventricular dyssynchrony and valve problems.

The ventricular excitation is conducted through the sinoatrial node and right atrium, which is also regular.

And then there's what looks like atrial fibrillation, isolated left atrial fibrillation.

However, the dominant rhythm is of donor origin and is sinus rhythm.

The atrial depolarization potential recorded by the electrocardiogram is a compound potential of the left and right atria, so atrial fibrillation rhythm and sinus rhythm appear simultaneously on one electrocardiogram.

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

Lu Chen looked happy.

The system's prompt undoubtedly proved his guess to be correct.

Lu Chen was very happy to be able to solve this difficult ECG.

However, it also made him realize his own shortcomings.

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

Electrocardiography is a subject with a low threshold but a very high upper limit.

Although his current electrocardiogram level is a bit higher than those around him, compared with those professional electrophysiologists, there is still a big gap.

……

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 is so good?"

It was the first time he saw someone giggling while staring at the electrocardiogram.

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

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

"No." Lu Chen shook his head, "Your Yasuo is too good to eat."

Wang Zihao: "..."

After solving the problem of this electrocardiogram, Lu Chen went to bed and took a nap.

Only by combining work and rest can we work and study better.

……

Lu Chen fell asleep, but Fan Zhiping couldn't.

In the rented house near Jinghua No. [-] Hospital, he repeatedly studied the electrocardiogram of the heart transplant, and even consulted a lot of relevant information.

But still no clue.

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

When it was time to go to work, Fan Zhiping closed his eyes and walked slowly towards Jinghua Second Hospital.

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

"The donor is sinus rhythm and the recipient is atrial fibrillation rhythm."

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

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

Fan Zhiping who was standing at the door was startled.

He could vaguely hear the conversations of the people in the room, but not very clearly.

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

He didn't even bother to go to the duty room to change into a white coat, so he moved closer to the crowd.

Just listen to Lu Chen continue: "Other leads may not be seen clearly, but this lead V1 is very obvious, there are sinus P waves, and small f waves of atrial fibrillation... The patient has a heart transplant and retains the left side. Atrium, so the EKG showed atrial fibrillation in the left atrium and sinus rhythm in the donor..."

Fan Zhiping's eyes widened, sweeping away his previous decadence.

It only took one noon, and Lu Chen solved this electrocardiogram.

In the morning, everyone was obviously helpless with this ECG!

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

……

At this time, Lu Chen was sitting among the crowd.

He received another five points of gratitude.

"Congratulations, I received a thank you from Yu Huihui +1!"

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

"..."

"Congratulations, I received +1 from Fan Zhiping!"

Lu Chen looked around, and it turned out that Comrade Fan had also arrived, and he hadn't even had time to change into his white coat.

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

Fan Zhiping almost blurted out the word "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, tell me."

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

Lu Chen frowned. He had thought about this question too, but he hadn't found a definite answer yet.

He thought for a while before speaking.

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

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 follow Lu Chen in the eighth district of his heart, and decided it was the right choice.

……

After discussing the patient's electrocardiogram, everyone began to work separately.

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

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

"A new patient with aortic dissection was received in the morning, and another patient after heart transplantation."

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

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

……

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

"There are quite a lot of critically ill patients. Guoguo, you have to shut down the patients managed by others and let them go. You have to give everyone a chance to exercise, and don't let go too much, so as not to make mistakes."

"Well, don't worry." Sun Guoguo said with a smile, "The younger brothers and younger sisters are all very good. I usually don't need to worry about them. If there is any change in the condition, they will report it in time."

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

After Li Yao finished speaking, she saw the strange expressions on everyone's faces.

"what happened?"

Sun Guoguo whispered: "Teacher, is this an electrocardiogram showing both sinus and atrial fibrillation?"

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

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

Lu Chen scratched his head with a smile, but didn't 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 Jinghua Electrophysiology's elite group, and he was admitted through 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 this first." Li Yao said, "If you have any questions, please report to me at any time."

"Got it." Everyone replied in unison.

After Li Yao finished speaking, she stood up and was about to turn around and leave.

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

"Lu Chen, come to my office now."

Lu Chen was taken aback for a moment, and quickly responded, then 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.

Next to the desk, there is a thick stack of documents,

"Lu Chen, you performed well in this national skills test. The school will have the opportunity to go out for exchange next year. The quota is fixed, but this time you have the opportunity for the members of the school team, so you must seize 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 commendable.

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

"You don't need to thank me, you won this by your own efforts." Li Yao smiled and continued, "I came to you today to tell you something. I asked you to join the Jinghua Electrophysiology Association before because I wanted to Let you have the opportunity to get in touch with academic frontier knowledge in advance.”

"Next weekend, the 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 the case?" Lu Chen's reflex arc slowed down by half a beat, and he didn't react for a while.

"Well, then I will 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 seldom participates in this kind of academic exchange meeting, he also knows that the speakers at the meeting should generally be the attending doctors who are already working, and doctors of the above level.

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

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

Of course he had to seize this opportunity to show his face and earn his reputation!

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

Lu Chen shook his head, then hesitantly said: "Teacher, but I am a graduate student reporting, would 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 on stage before. The identity of the student is second, and the main thing is whether the cases you share are outstanding. That's the most important thing!"

Lu Chen nodded.

Teacher Li Yao can give him this kind of opportunity, of course he must be well prepared.

"The case is about electrophysiology?" Lu Chen said.

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

"Ok."

……

Leave the director's office.

A string in Lu Chen's heart became tense again.

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

Now I have to invest in a new round of learning.

This time it is a city-level academic conference, and doctors from several major hospitals in Jinghua City will come.

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

First, case selection.

Second, the production of PPT.

For the selection of cases, Lu Chen had several candidates in his mind, but he still 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 level of conference, the content is important, the production of PPT and the level of the speaker's speech are also extremely important.

Lu Chen felt that it was a little too straightforward for him to agree to Teacher Li Yao.

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

Go back to the doctor's office.

Lu Chen looked at Ke Yue and Jiang Qingyan who were on the side.

"Can you do PPT?"

Both Jiang Qingyan and Ke Yue shook their heads.

Lu Chen looked at Sun Guoguo who was at the side.

Sun Guoguo should be able to do PPT, but Lu Chen knows that she is preparing for the doctoral exam recently, so he can't bother her.

"Let's find the case first, determine the theme, and then consider the content of the PPT." Lu Chen thought in his heart.

Without content, even the most exquisite PPT is just empty talk.

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

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

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

From the side, Fatty Cheng's voice came over.

The voice was a little loud, 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 wondered.

Cheng Peng shook his head and sighed: "Just now I took in a middle-aged woman who had a history of tachycardia in the past. After arguing with others, she suddenly passed out and couldn't get up. But her vital signs are normal. , has not woken up."

"Have you had a head CT?" Lu Chen frowned.

"The blood and head CT of the urgent examination are normal, but she has been asleep, and there is no problem." Cheng Peng smiled bitterly, "We all suspect that she is faking it."

"Fake it?" Lu Chen frowned.

These days, there are still people pretending 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 faking it." Cheng Peng said, "The superior doctors in our group have all gone down to the fourth floor for surgery. I just notified the senior brother. He'll be up in a while."

Fan Zhiping stayed by Lu Chen's side all the time, and he also heard Cheng Peng's complaints.

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

Lu Chen and Cheng Peng turned their heads to look at Fan Zhiping who was standing aside.

"What way?" Cheng Peng asked hastily.

"Push a furosemide."

Fan Zhiping grinned.

(End of this chapter)