I can see health

Chapter 462 Starch Man
In the ward, everyone stared at Lu Chen closely, as if they wanted to read the answer from Lu Chen's face.

Fan Zhiping frowned deeply, guessing that the diagnosis must be wrong.

However, from another perspective, everyone has almost guessed the diagnosis, why is it not right?

At this moment, Lu Chen smiled slightly, and pulled out the patient's ECG from the medical records.

"Brother Fan, look at this ECG, what's so special about it?" Lu Chen smiled.

Fan Zhiping frowned and took the electrocardiogram.

He has read and studied the patient's electrocardiogram many times.

"Severely poor R wave progression in the chest leads V1-V3." Fan Zhiping glanced at Lu Chen.

Lu Chen nodded slightly, "That's right, are there any other characteristics?"

"Other features..." Fan Zhiping paused, "Seriously low voltage in the QRS complex of the electrocardiogram."

He studied it carefully and could no longer see any other problems.

Could there be something else hidden in this ECG?

Unexpectedly, Lu Chen smiled, "That's right, it's these two characteristic manifestations."

Fan Zhiping was stunned, and everyone else in the department was also stunned.

Everyone can see these two characteristic manifestations, but... and then?

No one can see the difference in diagnosis!
Lu Chen also noticed everyone's puzzled eyes, thought for a while, and said in a deep voice: "There is also the patient's echocardiogram, you ignore the report written by the sonographer for now, and then look at the echocardiogram to see if there is anything found."

Fan Zhiping was taken aback, asking them to ignore the report written by the sonographer?

The diagnosis written by the sonographer was hypertensive heart disease.

As the name suggests, long-term high blood pressure and poor blood pressure control lead to heart disease.

Lu Chen told everyone to ignore this diagnosis?
To be honest, most clinicians believe in the diagnosis of sonographer.

Especially this ultrasound image, CT and MRI image.

All of a sudden, it was really uncomfortable for everyone to ignore the sonographer's report.

……

Looking at the ultrasound report in front of him, Fan Zhiping began to read word by word.

The surrounding doctors are a little confused.

Lu Chen is very powerful, but he is only a student after all!
However, Director Fan seems to believe Dr. Lu Chen's words very much!

At this time, Fan Zhiping looked at Lu Chen, and he had long since lost the concept that he was still a student.

In a vague way, he seemed to really regard Lu Chen as a professor, as his "mentor".

Therefore, it was natural for him to obey Lu Chen's words.

……

Fan Zhiping continued to check the patient's ultrasound report, in which the end-diastolic diameter of the left ventricle was 40mm, the end-diastolic diameter of the right ventricle was 16mm, the left atrium was 46mm, and the right atrium was 59x44mm.

"Both the left and right atriums have become bigger!" Fan Zhiping muttered to himself.

The reason why the heart becomes bigger is that the function of the heart becomes worse, and it increases compensatoryly to maintain the work of the heart.

"Besides the twin rooms getting bigger...what else..."

Fan Zhiping was taken aback suddenly, "The patient's left ventricle and right ventricle seem to be smaller than normal!"

This is abnormal!

Generally, the atria and ventricles grow simultaneously.

But in this patient, only the double atrium was enlarged, and the two ventricles became smaller instead!

Fan Zhiping said to Lu Chen: "Doctor Lu, does this patient have enlarged double chambers, and the double chambers are not big but small?!"

As soon as his words fell, the rest of the department were also stunned.

Many people gathered around, holding ultrasound reports for comparison.

"Director Fan is right! This patient is really strange!"

"The double room is enlarged, and the double room is reduced. This is the first time I have seen it!"

"Are you saying that the sonographer's picture is inaccurate?"

……

A smile appeared on Lu Chen's mouth, and he nodded slowly: "That's right, the huge double atrium, but the double ventricle is not big but small, plus the characteristics of the patient's electrocardiogram, Brother Fan, what disease do you think of?"

The diagnosis at this time is actually ready to come out.

A flash of light flashed in Fan Zhiping's mind, and then he said: "Aged amyloid heart disease?"

Amyloid heart disease, also known as amyloid heart disease, is a very rare restrictive cardiomyopathy.

People with this disease are also known as starchy people.

"That's right, it's amyloid heart disease!"

Hearing Lu Chen's affirmative answer, there were whispers in the department immediately.

Because the disease is relatively rare, most people have never seen it, or even understood its diagnostic criteria.

Fan Zhiping also had the opportunity to see such a patient after he went to Jinghua Second Hospital for further study.

……

At this moment, a doctor in the department raised a question.

"Doctor Lu, you can diagnose amyloid heart disease with just an electrocardiogram and echocardiography?"

The criteria for diagnosing cardiomyopathy are very strict, and the most accurate method is "myocardial biopsy".

This is to take a small piece of myocardial tissue and then conduct an examination; the second is cardiac magnetic resonance and other imaging examinations, but the accuracy is much lower than that of myocardial biopsy.

However, myocardial biopsy is a traumatic operation after all, and few people do this kind of examination.

Therefore, it is relatively difficult to diagnose "cardiomyopathy".

Lu Chen, on what grounds did he decide that the patient had amyloidosis?
……

Everyone saw Lu Chen standing up, looking around, and slowly said: "There are 4 key points that killed this case."

Everyone in the department held their breath and listened carefully to Lu Chen's words.

"Mismatch between electricity and structure, poor R-wave progression of V1-V3, huge left and right chambers, two chambers are not big but small!"

Everyone in the Cardiology Department of Fengm County bowed their heads and thought hard when they heard the words.

The only one, Fan Zhiping, had a gleam of light in his eyes, as if he had caught something.

Lu Chen continued: "Amyloid deposits between cardiomyocytes, surrounds the myocardium, and separates the myocardium one by one. Like an insulator, it affects the electrical conduction between cardiomyocytes, so our amyloid myocardium An important feature of the patient's electrocardiogram is severe QRS wave low voltage, and it is amyloid that is causing trouble!"

"The severe R wave progression of V1-V3 of the electrocardiogram representing the interval vector is poor, and it is also the massive deposition of amyloid that thickens the ventricular wall."

As soon as the words fell, everyone suddenly realized.

The seemingly inconspicuous electrocardiogram performance has a deeper meaning in Lu Chen's case!

At this time, a young doctor in the department asked suspiciously: "Doctor Lu, then you just said that the two rooms are big and the two rooms are small, and why?"

Lu Chen smiled and said: "Actually, it's easy to understand. Amyloid deposits between cardiomyocytes, the ventricle becomes very stiff, filling is limited, and diastolic function is severely impaired. The blood cannot flow back into the ventricle, and the left and right atrium will gradually expand over time!"

"In fact, this case perfectly matches all the electrocardiograms, color Doppler ultrasound, and clinical manifestations of amyloid cardiomyopathy."

"The perfect match allows you to reject the diagnosis of amyloid cardiomyopathy without any reason at all!"

With an easy-to-understand explanation, everyone present understood what Lu Chen meant.

"Amyloid cardiomyopathy," a rare diagnosis, took hold immediately.

While everyone lamented the rarity of this disease, an idea popped up in everyone's mind.

How good is the young doctor Lu Chen who can diagnose this disease?
How much shock did he bring to everyone?

Without solid basic skills, rich clinical thinking, and non-superstitious auxiliary examination reports, it is absolutely impossible to diagnose this disease!
(End of this chapter)