I can see health

Chapter 29 Breaking people's jobs!

Lu Chen's indifferent words stunned the two people in the office.

"This, isn't this room speed?"

Lu Wenguo frowned into the word Chuan.

He walked up to Lu Chen and watched him making gestures on the electrocardiogram, feeling suspicious in his heart.

The old director of the Department of Cardiology is very old. He has been engaged in clinical work for more than 30 years and has rich experience.

Many young people in the hospital were brought out by Old Dong.

Could it be that the electrocardiogram that old Dong couldn't see was seen by his son who just graduated from medical school?

impossible!
absolutely impossible...

Wu Yun didn't have so many thoughts, so he quickly asked: "Xiaochen, you said this is not room speed, what could it be?"

Lu Chen laid out the electrocardiogram on the computer desk, then looked up at Lu Wenguo and Wu Yun.

"What do you see when you look at this picture for the first time?"

Re-study this EKG.

Wu Yun found that he could only see tachycardia, tachycardia with narrow QRS wave.

"I, I'm not very good at reading ECG." Wu Yun rubbed the back of his head in embarrassment, "I can see a narrow QRS tachycardia."

"Dad, what do you think?"

Lu Wenguo pondered for a moment: "First, the electric axis is deviated to the left, then the narrow QRS tachycardia, and the V1 lead is rSR' type, and there are rough and blunt S waves at the end of V5 and V6 leads, this should be the right bundle. branch block."

Lu Chen smiled and gave Lu Wenguo a thumbs up.

"Dad, you're pretty good. You've almost uttered the contents of this electrocardiogram."

However, Lu Wenguo frowned: "Xiaochen, if there are only these, then Director Dong's diagnosis of the Department of Cardiology should be correct. This is supraventricular tachycardia with right bundle branch block."

Wu Yun also looked at Lu Chen suspiciously, isn't this just room speed?

Why do you say it's not room speed?

Lu Chen took out the compasses with a smile, "Dad, let me make a gesture on the picture, and you will know."

"Look at the electrocardiogram, what is the relationship between the rhythm of the atrium and the ventricle?"

Lu Wenguo looked towards the place Lu Chen pointed at.

Atrial and ventricular rhythms seem to be unrelated.

The beating of the normal heart is caused by the sinoatrial node and the beating of the atria and the beating of the ventricles.

The rhythm of the atria and ventricles is regular and fixed.

But in this picture, the beating of the atrium and ventricle is completely separated!
The atrial beat itself, the ventricle beats itself, there is no connection between the two!
"This, is this atrioventricular separation?"

Lu Wenguo grabbed the ECG on the table and looked at it without blinking.

"Ah? Atrioventricular separation?" Wu Yun was taken aback, "Isn't atrioventricular separation the most common electrocardiogram for ventricular tachycardia, atrial fibrillation, and high-grade atrioventricular block? Then this picture..."

"Well, Brother Yun is right!" Lu Chen nodded and smiled, "This is atrioventricular separation. This picture shows a very special type of ventricular tachycardia—left posterior fascicular ventricular tachycardia."

"The left posterior fascicular ventricular tachycardia originates from the left posterior branch region, which is activated first, and the left anterior branch and right bundle branch region are activated later, which is equivalent to being passively blocked by the latter two branches."

"Therefore, the electrocardiogram showed right bundle branch block + left anterior branch block."

"Right bundle branch block is manifested by the rSR' pattern in lead V1 and the rough blunt S wave at the end of leads V5 and V6, and the left anterior branch block is manifested by left axis deviation. These two features constitute the left ventricular The most striking feature of idiopathic ventricular tachycardia."

"So, left posterior fascicular VT is easily confused with paroxysmal supraventricular tachycardia with right bundle branch block."

The barriers between various medical specialties are extremely deep, and the internal medicine specialties are not well understood, let alone internal medicine and surgery.

Lu Wenguo and Wu Yun had never heard of this "left posterior fascicular ventricular tachycardia".

Although he didn't understand what Lu Chen was talking about, Lu Wenguo had an intuition that Lu Chen was probably right.

Because in this ECG, he did find the phenomenon of atrioventricular separation.

"Xiaochen, ventricular tachycardia is a malignant arrhythmia. The average person's ventricular tachycardia lasts for such a long time, and people should have died." Wu Yun asked suspiciously, "However, our patient is in stable condition, but he feels a little flustered. They are all stable, not quite like ventricular tachycardia!"

Lu Chen explained with a smile: "Because this kind of left posterior branch type ventricular tachycardia is a kind of benign ventricular tachycardia, which is common in healthy men."

Wu Yun was like a student full of thirst for knowledge at this time, "Then how should this kind of ventricular tachycardia be treated?"

Lu Chen picked up the milk tea on the table and took a big gulp.

"This left posterior fascicle VT has another name, verapamil-sensitive VT. As the name suggests, verapamil can terminate its attack."

Lu Wenguo and Wu Yun looked at each other, and both of them could see the surprise in their eyes.

Lu Chen spoke clearly and logically, and every sentence made sense, so he had to be convincing!
Is this still a recent medical student?

"Dad, don't look at me with such surprised eyes." Lu Chen shrugged his shoulders and said, "During my internship in the Cardiology Department of Jiangcheng Central Hospital, I encountered several such patients, and one of them It was also regarded as supraventricular tachycardia, and it was finally discovered because radiofrequency ablation failed."

Wu Yun smiled at the side, "Xiaochen, you can't just read the electrocardiogram once. You must have put a lot of effort into this."

At this time, Lu Wenguo had almost believed in Lu Chen's diagnosis.

But just to be on the safe side, he still called the old Dong of the Cardiology Department.

Old Dong was lying on duty in the duty room, using Douyin, when he saw that it was Lu Wenguo's call, he sighed helplessly.

"Hey, these surgeons are just too nervous, aren't they just an SVS? I've already made several phone calls."

Old Dong sat up, cleared his throat, and connected the phone.

"Hey, old Lu, that patient of yours hasn't recovered yet?"

"not yet."

"Oh, old Lu, don't be too nervous. Many patients in our department have high speed for more than half a day. If you use Cordron, your heart rate will gradually drop."

Holding the phone, Lu Wenguo recalled Lu Chen's words just now, "Old Dong, do you think this patient has a high speed in the room?"

"How could it be? I read the electrocardiogram." Old Dong smiled, "Supra ventricular tachycardia with right bundle branch block, it's true, I guarantee it."

Lu Wenguo paused, then said slowly: "Old Dong, then I'll put forward a separate diagnosis opinion, don't mind."

"It's okay, tell me." Old Dong felt a little funny, a surgeon can analyze this kind of electrocardiogram?

"Do you think there is a possibility of left posterior fascicular ventricular tachycardia in this electrocardiogram?"

"Ah? What?" Old Dong was taken aback, "Left posterior branch type ventricular tachycardia?"

"Yes."

Both sides of the phone suddenly became quiet.

It seems that only the breathing of the other party can be heard.

Lu Wenguo was waiting for Old Dong's reply.

In Lao Dong's mind, however, he was recalling the electrocardiographic characteristics of "left posterior fascicular ventricular tachycardia".

After a while, Old Dong said: "Old Lu, send the ECG to my WeChat, I'll take a look and reply to you later."

"it is good."

After hanging up the phone, Wu Yun immediately stepped forward: "Director Lu, what did Director Dong say?"

"Let me send him the picture again, and he will take a look."

Lu Wenguo quickly sent the electrocardiogram to Lao Dong via WeChat.

After about 2 minutes.

Lu Wenguo received a WeChat message from Old Dong.

"Damn it, old Lu, when did you learn to read an electrocardiogram?! You're trying to ruin my job!"

(End of this chapter)