Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 270 Rare Heart Disease!

Because he had clearly seen the inside of the old lady's heart through the exchange function after the previous system upgrade.

In Lin Yi's sight, the old lady's condition was indeed that the walls of the ventricles were thickened.

And a large amount of blood is blocked in the ventricle and cannot get out.

The blood in the ventricle cannot go out, but the blood in the left atrium is continuously sent in again.

That's why left heart failure and pulmonary edema appeared, and even the left atrium was enlarged.

Looking at the outflow tract aorta of the left ventricle, the vascular access of the entire trunk is not narrowed.

Including the checklist delivered by Wang Zhongliang, the angiographic examination also showed that several main blood vessels were indeed not narrowed.

The only problem is that the wall thickens, squeezing the outlet of the aortic outflow tract.

Slight narrowing of the outflow opening.

But this is not a big problem and should not be the root cause of heart failure.

(Blood in the pulmonary vein exchanges oxygen and carbon dioxide through pulmonary respiration, enters the left atrium-left ventricle-aorta, and then sends arterial blood with oxygen to the whole body from the large blood vessel of the aorta.

Therefore, a lot of heart failure and pulmonary edema are related to aortic valve stenosis. Aortic valve stenosis, which prevents blood from getting out, can also cause this situation. )
Afterwards, Lin Yi continued to observe, and couldn't help being a little shocked.

Because he discovered a very strange phenomenon!

The heart blood flow rate of this old lady is a bit different from that of normal people.

When blood from the left atrium enters the left ventricle, the blood flow rate is normal.

But because the ventricle becomes smaller, when the blood in the ventricle flows into the aorta, the blood flow speed becomes faster again!

The blood flow speed of the atrium and ventricle is not the same!
And there is a pressure differential!

This pressure difference leads to the fact that when the atrial valve mitral valve opens to eject blood from the ventricle, the valve is sucked closer to the aorta by the pressure difference.

It also happened to be near the aorta, causing the outflow port to be blocked.

In other words, this patient did not have narrowed blood vessels or other serious problems.

Just because the blood flow rate is different, there is a pressure difference, which prevents the blood from the ventricle from being discharged.

This has led to such a series of problems!
It's just that this problem is difficult to find out through various inspections.

Because the patient is indeed left heart failure.

The shape of the heart, blood flow, angiography, and even electrocardiogram were found to be the same as heart failure caused by stenosis of the arterial valve.

So it's hard to find out by inspection alone.

but……

What is the reason for this problem?
Is the blood flow rate in the atrium and ventricle different? !

How strange.

That's a little too rare!
Although Lin Yi can do a lot of heart surgery.

But he had never seen this disease before.

Are you having surgery?

But there is no need for surgery at all if there is no narrow place.

Medication?

But what medicine can solve the problem of different blood flow speed?
It is also impossible to cut off the sucked mitral valve, so that there is no 'door' between the atrium and the ventricle...

For a while, the wrinkles between Lin Yi's eyebrows also deepened.

"How about it?"

Wang Zhongliang looked at Lin Yi's expression and asked in a low voice.

"I've seen the patient's situation, let's go to the office to discuss it first." Lin Yi said.

Just when a group of doctors were about to leave the ward.

The yelling family member stopped them.

"Director Wang? You said that the expert you are looking for is such a young man?!"

The family members looked unkind, and looked at Lin Yi with distrust in their eyes.

Wang Zhongliang took a step forward and explained:

"Don't look at this doctor's young age, but he has diagnosed many difficult diseases."

However, the family members still did not believe it.

Because he didn't look like an experienced doctor at Lin Yi's age.

"Hmph! Don't care about intractable diseases or not, anyway, I'll tell you! If there is anything wrong with my mother, I will definitely settle the score with you!"

The family members pointed to the noses of Lin Yi and Wang Zhongliang while talking.

"Don't think I'm afraid of you because I'm not a local! As long as my mother has something to do, you will definitely be involved!"

Facing the accusations from his family members, Wang Zhongliang was also very helpless, so he could only continue to say patiently:

"Please wait a moment, let's have a meeting to discuss it first, and we will notify you as soon as there is a result."

At this time, several other family members nearby also persuaded:

"That's right, Huahua, don't be so grumpy, wait for the doctor to see what's going on."

Several people nearby persuaded her with good words, and the family member called Huahua retreated to the bedside.

However, she still had no good looks at these doctors.

In fact, the doctor was also a little upset, but he could only continue to think of ways to treat the old lady.

Who made them doctors.

in the office.

Lin Yi repeatedly looked at the checklist in his hand.

I have been thinking about the cause of this disease and how to treat it.

This is the first time Lin Yi has seen this situation.

Suddenly, Lin Yao's mind flashed.

He thought of a situation.

The most famous inference of Bernoulli's equation is that when the flow is at a constant height, the greater the flow rate, the lower the pressure!
Lin Yi knows!
Although that thing is a very rare type of heart disease.

It was even discovered in the 90s and [-]s.

But so far, there have been cases that can be referred to.

Lin Yi put a checklist in front of Wang Zhongliang and asked:
"Director Wang, I think I have roughly deduced the reason."

In the office, all the doctors raised their heads one after another!

All looked at Lin Yi in surprise!

what?
How long have you read the inspection report?

You have the result? !
I saw Lin Yi pointing to the color ultrasound list and said:

"First of all, you can see that the examination shows that the wall of the heart chamber is thickened, but there is no narrowing of several main blood vessels, but when you look at the back, it says that the compliance is reduced.

Decreased compliance means that the pressure difference is out of balance, indicating that the flow rate of cardiac blood flow has become different. "

When Lin Yi said this, an attending doctor in his 30s behind Wang Zhongliang asked:

"Yes, what's so special about it? Many heart diseases, especially heart failure caused by aortic stenosis, have reduced compliance and pressure differences."

Lin Yi looked at him again and asked:

"Yes, but the color Doppler ultrasound showed no stenosis of the main blood vessels. What does that mean?"

Lin Yi actually asked questions!

Just ask!

The main reason is that they can't answer this question! !

After Wang Zhongliang looked around, everyone was more confused than him.

Then he could only blink his eyes in embarrassment and said:

"This...this means...it means that we should do another color ultrasound??"

Well, his majestic director still couldn't answer.

Lin Yi shook his head.

Stretching out his finger, he pointed to Cai Chaodan and said:

"It shows that the decrease in compliance has nothing to do with the stenosis of the arterial valve, or there is not much relationship. So even if this patient is sent to the operating table for surgery, it is useless.

Because even on the operating table, there is no narrow place that needs to be repaired.

Let's think about another question, why did you use drugs to increase myocardial contractility and vasodilators, but the patient's condition worsened? "

Wang Zhongliang still shook his head.

If I had known, I would not have come to you, big brother!
Outside the office, although Xu Minjun's family members did not believe Lin Yi.

But when the doctor had a meeting, they still secretly listened at the door.

Lin Yi glanced at the door, beckoned to the family and said:

"You can come in and listen if you want."

Upon hearing this, the family member named Huahua walked in with her waist pierced.

She is not afraid!

She wants to listen carefully to how this young man treated his mother!
Seeing the family members take their seats, Lin Yi continued:
"It shows that this drug is not only useless, but will accelerate the deterioration of the condition.

Then think about it carefully, under what circumstances, increasing myocardial contraction will make the patient's heart worse!
Here I want to tell you about an equation called the Bernoulli equation.

One of the most famous inferences is that when the flow is at a constant height, the greater the flow rate, the lower the pressure.

So for this patient, my diagnosis is: obstructive hypertrophic cardiomyopathy, but her obstruction is not a general obstruction of fixed arterial valve stenosis!

But dynamic obstruction! "

Wang Zhongliang: "Dynamic...dynamic obstructive heart disease?!"

"That's right!"

Lin Yi nodded.

The other doctors around opened their mouths in surprise!

Dynamic obstructive heart disease? !
Some doctors say they have never heard of it!
Good guy!
And this disease? !
Suddenly, Wang Zhongliang stood up abruptly, and said in an excited voice:
"Yes! Motor obstruction! Yes! This is it!
I remember that I accidentally read an academic paper on cardiology on the Internet ten years ago!
There is talk about this!

However, this disease is very rare, and some patients even have this disease themselves.

However, since it was not detected in the early stage, the doctor directly used anti-heart failure drugs such as dopamine and digitalis.

As a result, the patient couldn't hold on in the end, and died before everyone could react!
Oops!I just realized it!This patient is very likely to be obstructive hypertrophic cardiomyopathy! "

Wang Zhongliang spoke excitedly while tugging on Lin Yi's arm.

Lin Yi raised his head and looked at the incomprehensible and confused expressions of the people around him.

Lin Yi pulled out a blank sheet of paper from the printer beside him.

Then he took out a pen from his bag and drew two cross-sectional diagrams of the heart for everyone on the spot.

One is a normal cardiac blood flow map.

Flow diagram of a dynamic obstruction.

Lin Yi raised the blueprint in his hand and said:
"Because the patient's ventricular wall was thickened, although the examination results showed no stenosis of the main blood vessel.

But you must not ignore the point of thickening.

This patient had a thickening of 38 mm, and the normal myocardium is considered hypertrophic if it exceeds 35 mm.

You can see that the distance between the ventricular wall and the aortic outlet is very close.

Will thickening of the ventricular wall affect the outflow of the aorta?

The answer is yes, definitely.

All the people present except the family members are medical students, so they can understand my picture.

Note that neither the aorta nor the aortic valve is narrowed, but because of the hypertrophy of the ventricular wall, it will squeeze the outflow port to a certain extent.

Then the channel of the outflow port becomes smaller than the inflow port of the mitral valve.

At this time, the inference result of the Bernoulli equation comes out.

The height of the heart remains unchanged, and the gravitational potential energy does not change, but the outflow port is relatively narrow.

When blood flows out of a relatively narrow channel, the flow velocity will increase and the kinetic energy will increase.

But the fluid has its mechanical energy conservation.

The gravitational potential energy remains the same, but the kinetic energy becomes larger, so how can we keep the same constant?
It can only be that the pressure of the outflow channel becomes smaller.

If the pressure of the outflow tract is small, will the pressure of the inflow tract of the mitral valve become relatively larger?
So blood flow creates a pressure differential.

This pressure difference causes the mitral valve to be sucked into the outflow port of the aorta due to the pressure difference when it opens.

Once the mitral valve blocks the outflow, the situation becomes more serious.

Everyone should know what pressure difference is.

For example, in railway stations and movable property stations, you can often see the waiting yellow line marked on the ground.

This is the differential line.

Once the pressure difference line is over, in front of the fast -passing train, the pressure difference will go directly to the people or objects standing in the same place.

very dangerous!

So the mitral valve is not deliberately trying to block the aortic outlet.

It's because the pressure difference makes it involuntary.

Thus, dynamic obstructions differ from those of fixed obstructions in arterial stenosis.

The heart must not beat too fast, the faster the pressure difference will be greater.

The greater the pressure difference, the mitral valve will directly block the outflow port.

If the outflow port is blocked, the aorta will not supply blood to the whole body.

At that time, edema will appear all over the patient's body, blood flow will collapse, and people will easily die suddenly.

Therefore, the treatment plan for dynamic obstruction is to never use drugs that increase ventricular contractility.

Digitalis dopamine, these must not be used!
We should do the opposite and treat it with drugs that reduce ventricular contractility.

That is, drugs such as beta blockers and non-dihydropyridine calcium channel blockers.

These drugs can reduce ventricular contractility.

If the contraction force is small, the flow velocity in the outflow channel will be slower, and the pressure difference will also be smaller.

If the pressure difference is small, does the mitral valve need not be sucked over to block the outflow port?
Did the patient's symptoms lessen? "

After Lin Yi finished speaking, the whole office became silent!

All of them looked at Lin Yi with eyes of shock, admiration or disbelief...

Although the family members can't understand, they can feel that the young man in front of them doesn't seem to be fooling people.

Although they don't understand, they don't know what's going on!

On Lin Yi's side, seeing everyone's half-understanding expressions, he continued:
"This disease is indeed very rare, but it is the same as obstructive heart failure as long as you look for the right direction to treat it.

Director Wang, now you can do another hemodynamic test on the patient to see how much the pressure difference is.

Generally speaking, the warning line of pressure difference is 50-60 mm Hg.

But once the number exceeds 80, you have to consider whether to resect the too thick myocardial wall.

Below 80, the disease can still be stabilized through drug treatment. "

Wang Zhongliang nodded immediately: "Okay, I will arrange it right away."

Afterwards, Wang Zhongliang looked at the family members next to him and said:

"Are you relieved now? The cause has also been revealed, and it is obstructive hypertrophic cardiomyopathy.

To put it more bluntly, it means that as long as her heart is beating, she will have problems such as shortness of breath and hypoxia.

However, I saw that her ventricular wall hypertrophy is not particularly thick. Let's do an examination first, and then start to use the medicine correctly after the examination. "

(End of this chapter)