Chapter 845 - 397: Rheumatic Heart Disease and Pulmonary Heart Disease, Helping Others Has Its Limits

Chapter 845: Chapter 397: Rheumatic Heart Disease and Pulmonary Heart Disease, Helping Others Has Its Limits

Heart enlargement remains unresolved; once the mitral valve is repaired, insufficiency is found again.

This is a classic case of tactics escalating faster than solutions.

"Heart enlargement leads to mitral valve insufficiency, and then heart failure causes respiratory failure, complicated by chronic obstructive emphysema?"

Lian Tao reviewed the idea and asked in return.

"That’s likely the progression. But what’s causing the heart enlargement?"

The heart can’t just enlarge for no reason, right?

Even with rheumatic heart disease, it can’t happen out of nowhere.

There must be a reason.

"I currently have two diagnostic directions: rheumatic heart disease and cor pulmonale. The patient’s symptoms match both, and these two diseases are as difficult to distinguish as the true and false Monkey King."

Cor pulmonale generally refers to heart disease caused by pulmonary arterial hypertension.

Also known as pulmonary heart disease.

It’s relatively common in clinical practice.

Lian Tao’s suspicion of rheumatic heart disease and cor pulmonale indicates he isn’t entirely sure that his previous deduction on the disease progression is correct.

"Since you suspect cor pulmonale, why not examine the pulmonary artery?"

"Isn’t that what I’m trying to rule out here! I even consulted Professor Wang, and he can’t make up his mind either. Moreover, he pointed out that doubts exist whether it’s rheumatic heart disease or cor pulmonale. Initially planned to do a cardiac catheterization for the patient, but the family and the patient themselves are adamantly opposed."

Lian Tao said with some frustration.

Sometimes, when doctors encounter complex cases, they not only have to find ways to battle cunning illnesses but also strive to persuade patients to cooperate with examinations and treatments.

Some stubborn patients have their own ideas and completely distrust doctors and nurses.

These patients often have a myriad of considerations.

A doctor might say surgery is necessary to save lives, but the patient quietly thinks, "Is the doctor seeing that I’m dressed well and trying to earn more?"

In normal circumstances, surgery treatment costs certainly are much higher.

The patient’s refusal to cooperate with a cardiac catheterization test implies other diagnostic methods are possible.

For example, auscultating heart sounds.

Patients with pulmonary arterial hypertension often have heart sounds accompanied by murmurs.

This particular patient’s heart sounds have murmurs, precisely matching these characteristics.

Furthermore, routine blood tests, arterial blood gas analysis, etc., can diagnose pulmonary arterial hypertension.

Additionally, echocardiography, chest X-rays, chest CT, cardiac MRI, among other tests, can assist in diagnosing pulmonary arterial hypertension.

However, these tests do not completely confirm the diagnosis.

"Does the patient have a precordial bulge?"

Li Jingsheng has diagnosed several patients with pulmonary arterial hypertension, and they often exhibit precordial bulges.

"Yes."

Lian Tao answered exceptionally decisively this time.

"The chest X-ray taken for the patient also indicates pulmonary arterial hypertension. So, I believe a diagnosis can basically be confirmed."

He continued.

"No wonder you suspect cor pulmonale!"

Li Jingsheng finally understood why Lian Tao and Professor Wang Weiwei were undecided.

Based on clinical experience, pulmonary arterial hypertension almost inevitably leads to cor pulmonale.

Textbooks only state that pathological changes in pulmonary tissues or pulmonary arteries and their branches increase pulmonary circulation resistance; consequently, the right ventricle is burdened, leading to right heart enlargement, with or without congestive heart failure, known as pulmonary heart disease.

But doctors like Li Jingsheng and Lian Tao don’t simply follow textbook content to diagnose diseases.

They have long accumulated a wealth of clinical experience and possess their own diagnostic methods.

This is why medical PhD students who come to hospitals often can’t handle patients, and when diagnosing, they might even need to consult books or search online for medication information.

Because theoretical knowledge is merely theoretical.

It greatly differs from practice.

Medical students capable of applied learning are rare.

Most need to continually hone the theoretical knowledge they’ve acquired in clinical practice before it can transform into genuine diagnostic and therapeutic experience.

"This patient’s condition is so difficult to determine because pulmonary arterial hypertension and COPD both seem to indicate cor pulmonale. But he also matches features of rheumatic heart disease. I’ve diagnosed pulmonary medicine diseases for so many years, and this is indeed the first time I’ve seen such a bizarre case."

Lian Tao probably tangled his unkempt hair again.

"By the way, what did you mean earlier about not using diuretics on this patient?"

"I didn’t say not to use diuretics, only that it’s a double-edged sword. Given the patient’s current condition, you might still maintain normal blood circulation by avoiding diuretics. But after using diuretics, with existing pulmonary arterial hypertension, and quite high blood lipids, I’m worried about potential pulmonary embolism."

This ailment can be fatal.

Li Jingsheng always maintains a clinic-focused thinking when treating patients. 𝑓𝑟ℯℴ𝓂

Before treating a patient, he first considers not how much money can be earned, but whether significant risks might arise post-treatment.

If the patient dies, his clinic would be doomed.

Because there is zero margin for error, his crisis awareness and sensitivity in the diagnostic process are unmatched by other doctors.

Despite sitting in his clinic numerous times, Lian Tao’s crisis awareness ultimately doesn’t compare to Li Jingsheng, the owner.

This reveals a human tendency.

If the clinic belonged to Lian Tao, his mentality would surely be different.

They are all indifferent truths not tied to one’s own interests.

"Dang, don’t scare me! Diuretics and cardiotonics have already been used on the patient. Upon admission, he was in a dying state; there was no choice but to intervene!"