I can see health

Chapter 577

The first step in admitting a patient is to ask for a medical history and a physical examination.

Lu Chen handed over all these tasks to the female intern Su Rui.

As expected of a student of the Kyoto University School of Medicine, she was so thorough in her consultation and physical examination that Lu Chen couldn't find any faults at all.

Patient Li Wenqian, 28 years old this year.

A few months ago, I started to feel flustered occasionally.

"It's just that the heart will suddenly jump violently, accompanied by a feeling of pressure in the chest." Li Wenqian added.

Lu Chen nodded slightly, "Using our medical terminology, it's called heart palpitations and chest tightness."

The patient thought it was a bad heart at first.

"I'm not yet 30 years old! My heart is not good!" Li Wenqian was scared to pee just thinking about it.

After all, heart disease is no small matter, and even the smallest heart disease may make people miserable.

Severe heart disease and even sudden death, can you not worry?

"I went to the hospital to see it at that time!" Li Wenqian recalled, "The cardiologist in the hospital below us auscultated my heart and did an electrocardiogram. They didn't find any problems, except that my heart rate was a little too fast."

Lu Chen wondered, his heart rate was too fast, which didn't explain anything wrong.

Some people will have a fast heart rate when they see a doctor, which is caused by physiological tension.

The patient's life value is 74 (-), it seems that there should not be too many problems.

"Did you take any medicine afterwards?" Lu Chen asked.

"Eat." Li Wenqian nodded, "I still remember that doctor prescribed metoprolol tartrate tablets for me."

Metoprolol tartrate, this drug is a β-receptor blocker. There are many β-receptors in the heart. Once blocked, the heart activity will be inhibited, so it can be used to treat tachycardia and heart failure.

Many patients with arrhythmia and high blood pressure will take this medicine, which is very common and widely used.

"Has the heart discomfort improved?"

"I got better. Later, I was busy with work, so I didn't take this matter to heart." Li Wenqian said, "But two months later, the symptoms came back! The familiar heart discomfort, suddenly, It was like being shocked, and then the heart was pounding for a few minutes, 5-6 times a day, and the situation was even worse than before."

"Will taking metoprolol tartrate work?" Lu Chen wondered. According to the patient's description, it really looked like some kind of paroxysmal arrhythmia.

"It doesn't work." Li Wenqian sighed, "This kind of heart discomfort has seriously affected my daily life and work. Later, I went to the hospital again and chose to do it when I was most uncomfortable. Cardiac ultrasound and electrocardiogram, but still no problems."

Su Rui, a female intern at the side, said: "It's possible that the arrhythmia occurred for a short period of time and suddenly stopped. Although you still feel uncomfortable, the arrhythmia has passed, so the EKG did not find any problems."

Many arrhythmias are sudden and sudden, and it is impossible to step on that point in an ordinary ECG, so there is no way to find the abnormality.

"Hey, that kind of feeling is really uncomfortable, it really feels like dying again." Li Wenqian said helplessly.

Clinically, there is a professional medical term called near-death feeling.

"Later, the doctor at the local hospital gave me another medicine." Li Wenqian took out another box of medicine from her bag, metoprolol succinate tablets.

Metoprolol Succinate Tablets and Metoprolol Tartrate Tablets, is an ingredient of the drug.

However, the latter is a short-acting drug, and one tablet can only be used for a few hours; the former is a long-acting drug, and one tablet can be used for about a day.

"By the way, there is another medicine..." Li Wenqian found another medicine in a porcelain bottle from her bag, Suxiao Jiuxin Pill.

Suxiao Jiuxin Pill is for coronary heart disease, not arrhythmia, but people will scold their mothers when they are in a hurry, so bring it just in case.

"Are the symptoms relieved?"

"No..." Li Wenqian showed a wry smile on her face, "All the medicines add up have no effect, none of them have any effect at all, and I still feel uncomfortable and have the feeling of dying."

Lu Chen frowned deeply.

According to the description of the patient's symptoms, it looks like some kind of arrhythmia.

And with the HP 74(-) on her head, there shouldn't be any fatal diseases, otherwise the changing trend can't be a minus sign.

"Have you had a 24-hour dynamic electrocardiogram?" Lu Chen asked.

24-hour ambulatory electrocardiogram, as the name implies, is to carry the ECG box for 24 hours.

As long as there is an arrhythmia attack within 24 hours, it can catch it.

"I did it, more than once, but it didn't work."

As she spoke, Li Wenqian took out a few more checklists from her bag.

Lu Chen took it and took a look.

A total of three dynamic electrocardiogram examination results, except for the occasional rapid heart rate, did not find any abnormal problems.

"I have been to many hospitals, but now I really have no choice." Li Wenqian sighed helplessly, "I can only come to your hospital."

If the cardiology department of the First Affiliated Hospital of Kyoto University can't solve it, then she is really desperate!

Lu Chen basically understood the condition, and he gave the patient a more careful physical examination.

Cardiopulmonary auscultation found no problems.

"Senior Brother Lu, do you think it might be an autonomic disorder?" Su Rui asked suddenly.

Lu Chen nodded slightly, Su Rui's suspicion was correct.

Autonomic dysfunction can also cause symptoms such as heart palpitations.

The so-called autonomic nerves may not be well understood by everyone.

To put it simply, it is to control some autonomic nerves of the internal organs, including sympathetic and parasympathetic nerves.

If there is a problem with them, the visceral sensation and movement will be uncomfortable, so it is also possible to suspect that the autonomic nerve disorder may cause palpitations.

However, Li Wenqian interrupted: "I checked the information on the Internet, and some people said that it was an autonomic disorder, and asked to take some B group vitamins, oryzanol, etc., but it didn't work for me."

Lu Chen found that these people who came to Jingdu Hospital to see a doctor had a thorough understanding of their own condition, and often checked information on the Internet.

Su Rui frowned slightly. If it wasn't autonomic disorder, what else would it be?She ran through other possibilities in her mind.

At this time, Lu Chen said: "If there is really no way to find out the arrhythmia, we can do electrophysiological examination."

Arrhythmia is like a thief, the thief always waits until the night is dark and the wind is high and the lights are dark before coming out to commit crimes.

After he succeeded, he hid quickly, and the police had nothing to do with him (similar to an ordinary electrocardiogram).

Okay, then step up the patrol, 24-hour guarded patrol (24-hour dynamic electrocardiogram).

But even so, thieves still have a way to evade police patrols and start behind their backs.

What can I do in the end?

There is only one way, if you want to find out the thief, you can only go door to door to register and visit.

This is called an active attack, which is like an electrophysiological examination of the heart. It is directly close to the heart and stimulates the heart (knock on the door to register). If there is a problem, it will be induced.

"How should this electrophysiological examination be done?" Li Wenqian asked immediately.

"A minimally invasive surgery." Lu Chen explained, "Directly use electrodes to go deep into the esophagus and stimulate the heart near the esophagus to see if it can induce arrhythmia. If so, then find a way to do radiofrequency ablation to burn the lesion. "

Lu Chen's description is straightforward.

When Li Wenqian heard this, she was a little frightened.

It's scary to use a knife on the heart!
"I, I..." Li Wenqian swallowed, "This... let me think about it first. Doctor, let the director come and see me first..."

Lu Chen shrugged his shoulders. There was nothing he could do. These patients didn't believe him very much, so he still had to ask Deputy Director Xiao Shikang to do the ward rounds.

(End of this chapter)