Chapter 1414: Diagnosis Incomplete

Chapter 1414: Chapter 1414: Diagnosis Incomplete

(Thanks to book friends 20171214185553030, Sterling, An Lin Xiao Xiao, baochong for the monthly ticket encouragement)

"How is that patient doing? Has he been sent to the catheterization room?"

Chen Xuehai asked as he rushed to the emergency center.

"Not yet, it doesn’t really support a myocardial infarction," Liu Banxia replied.

"Asymmetric obstructive hypertrophy of the left ventricle, the ECG ST segment doesn’t support it either. We can’t take risks without ruling out aortic dissection."

"He’s getting an MRI now, but we’re preparing the catheterization room as well. I, along with Doctor Peng and Linlin, tend to think the symptoms are caused by asymmetric obstructive hypertrophy of the left ventricle, could it be?"

"It’s possible, but we can’t completely rule out aortic dissection," Chen Xuehai nodded.

"Even if the patient’s coronary artery isn’t obstructed, the narrowness of the outflow tract effectively acts as an obstruction. If it’s asymmetric, then it’s a genetic condition that can only be controlled with drugs."

"Let’s wait for the MRI results. It’s better if it’s not an acute myocardial infarction. Otherwise, whether it’s intervention or resuscitation, the patient suffers."

"But I heard Qi mention briefly that judging by the bus driver’s assessment, it might be coronary heart disease. Didn’t this patient undergo a detailed examination before?"

Liu Banxia shook his head, "Only an ECG was done, and there was hypertension. It was diagnosed as coronary heart disease several years ago."

"Actually, the order of causes was reversed; it wasn’t heart disease caused by hypertension, but rather hypertension gradually caused by the narrowing of the left ventricular outflow tract."

"It’s fortunate he didn’t get any effect from the nitroglycerin today. Otherwise, he might have suddenly died on that day. I just checked the data; it seems the chances of sudden death due to this cause are quite high."

"Exactly, there are cases where the condition worsens, and nitroglycerin causes heart failure. It’s a misconception to think that angina, myocardial infarction, and similar conditions can be treated with nitroglycerin," Chen Xuehai said.

Liu Banxia nodded, "Our patient doesn’t need to worry about that, his blood pressure is very high. After taking nitroglycerin, it’s still 170/100; I estimate it’s usually around 200 when he’s taking a walk."

Just as Chen Xuehai mentioned, this is not a joke; it has really happened in real life. This stems from people’s lack of understanding of emergency knowledge and the random portrayal in some film and television works.

These types of patients often have hypertension, and many hypertensive patients are relatively disciplined, sticking to antihypertensive drugs, allowing them to keep their blood pressure within a good range.

When these patients fall ill, some people’s blood pressure will correspondingly drop. If nitroglycerin is administered then, the blood pressure will be lowered even further, causing more severe myocardial ischemia, ultimately leading to irreversible outcomes.

This is just like when epileptic patients have an attack and things are stuffed into their mouths—it’s portrayed in film and television works as a matter of course. People who have watched it just think it’s supposed to be like that, leading to either biting injuries or broken teeth.

Chen Xuehai chose not to rush back to his department and waited here with Liu Banxia.

He was also quite curious about this condition.

"Teacher Liu, the blood test results for that patient have come out; his blood sugar and blood fat are a bit high, and blood potassium is slightly low. Heart muscle enzymes and troponin are still normal for now."

At this time, Xu Yino ran over with the report.

"That’s normal. From the time the patient fell ill to the blood test, it’s been less than half an hour. Even though myoglobin reacts more quickly, it would take about an hour to show," Liu Banxia said.

"Why don’t you go upstairs and make rounds? Always thinking about slacking off. Want to watch whatever is going on and join in; the MRI results will be out soon, and we’ll know then."

"Hehe, thank you, Teacher Liu," Xu Yino said, smiling.

"Why thank him? He’s just here for the soy sauce," Chen Xuehai said.

Liu Banxia rolled his eyes, "I don’t know who’s still asking me to help look into this. I’m just a general surgeon, what am I interfering with?"

"Acting proud, huh? I’m just worried about the possibility of aortic dissection rupture. Whom else should I call?" Chen Xuehai said.

"Teacher Liu, so this patient is almost certainly experiencing symptoms caused by asymmetric left ventricular hypertrophy?" Xu Yino asked.

Liu Banxia nodded, "If the MRI results are negative, then that’s it. It seems there’s a high chance of a negative result; we prepared the catheterization room in vain."

"Why is that?" Xu Yino became more curious.

"If it were an acute myocardial infarction, could he calmly continue with the MRI? He’d be long sent to the catheterization room. Go ask, see if the person coming in is the patient’s wife," Liu Banxia said.

Xu Yino glanced at the door and quickly went to welcome her.

"You know, I almost want to be like you and bring out a team in cardiothoracic surgery," Chen Xuehai exclaimed.

"Tsk tsk, this is a good thing; you have Linlin to help you, too—it saves a lot of effort. Let’s manage it and find time for us to go to the medical school and persuade them together," Liu Banxia said happily.

"Can we still chat pleasantly? This isn’t persuasion—it’s guiding direction for the students," Chen Xuehai said earnestly.

"But when do you plan to come over? I really have such a thought. I can’t just rely on strength alone anymore, otherwise you guys in general surgery will pull ahead even further."

"Far ahead? Linlin’s growth is very fast now. When do you plan to come over? I don’t even know if I’ll have free time in a while, so should we get started as soon as possible?" Liu Banxia asked.

"That works, I’ll wait for your message, as long as it’s not on a surgery day. Anyway, you’re more familiar with the academy than I am, I’ll just follow your arrangements." Chen Xuehai said.

He also knew that Liu Banxia was quite busy, with too many responsibilities at hand, so they would go according to Liu Banxia’s schedule.

Moreover, when it came to persuading people, he had no confidence in being better than Liu Banxia.

Having such an idea, he also needed to rely on Liu Banxia for help in persuading others.

At this moment, Xu Yino also led the middle-aged woman over.

"Doctor, is our Old Du out of life-threatening danger now?" the patient’s wife asked.

"As it stands, we think that should be the case. However, we still need to wait for the test results to determine exactly what the condition is." Chen Xuehai said.

"Isn’t his condition coronary heart disease? He’s always had this disease." the patient’s wife said.

"After asking the patient, you’ve never had a coronary angiography performed, and perhaps not even an echocardiogram. You only did an electrocardiogram and made a judgment based on the symptoms." Liu Banxia said.

"Currently, our test results show asymmetric obstructive hypertrophic left ventricle, where the blood squeezed out from the ventricle passes through the coronary artery. Many people have problems with their coronary arteries, which then affects the heart."

"If we consider this outflow tract as the opening of a faucet, it’s equivalent to this opening narrowing, which can have the same effect as coronary artery blockage."

"Moreover, the patient hasn’t had a detailed heart check-up over the years, which has led to his current severe condition. So even taking nitroglycerin didn’t have much effect this time."

"Yet we still need to give him a thorough examination to determine exactly what the condition is. Does he not take his blood pressure medication on time?"

"Sigh...he doesn’t listen when I tell him, and I can’t keep an eye on him every day. He only takes it whenever he feels slightly dizzy." The patient’s wife sighed.

"No wonder his blood pressure is so high. We’ll have to watch this aspect closely; such high blood pressure places a lot of pressure on the cerebral blood vessels." Liu Banxia said.

"Doctor, so what exactly is Old Du’s heart condition? It’s also a heart disease, right?" the patient’s wife continued to ask.

"It’s also a type of heart disease, but heart disease is just a general term. His condition belongs to asymmetric hypertrophic cardiomyopathy, and we believe it’s most likely congenital." Chen Xuehai said.

"However, this condition doesn’t require surgical intervention, just some medication to control it. You also must remind him that his body is already signaling danger."

"That’s pretty good, I’ve been so worried." The patient’s wife said with relief.

"Don’t worry yet, the results will come out soon. There are many people with this condition, and although medication is very effective, you need to keep up with the medication." Chen Xuehai said.

The patient’s wife’s words also indicated that the patient was indeed careless about taking medication.

Even with such high blood pressure, he didn’t seem to care much. Chen Xuehai wasn’t very confident about the upcoming medication adherence.

This was also a common issue with many people; they listen to the doctor when symptoms flare up, but once that phase is over, they start slacking off.

I’ve gone through such situations many times, but even with repeated reminders, we always end up seeing the same familiar faces again.

"By the way, his blood sugar is also a bit high. Have you paid attention to that?" Liu Banxia continued to ask.

"So he also has diabetes? Great, not capable much, but the illnesses are complete." The patient’s wife said with a bitter smile.

"Current testing shows it’s slightly high; you’ll also need to control blood lipids in the future. If he can’t control it, you’ll have to supervise him." Liu Banxia said with a smile.

"Teacher Liu, the MRI results are out. It’s negative, no pulmonary embolism or aortic dissection." At this time, Xu Yino ran over again.

"Moreover, the patient has recovered significantly now, with no more symptoms of chest pain, which might mean the nitroglycerin took effect or maybe the episode has passed."

"Then that’s almost it; it’s asymmetric obstructive hypertrophic cardiomyopathy." Chen Xuehai said.

Liu Banxia nodded, fully agreeing with Chen Xuehai’s diagnosis.

Next, it depends on the patient’s self-discipline; if he doesn’t manage it well, it won’t be easy to say.

However, as the nurse accompanied the patient back, Liu Banxia frowned and gently nudged Chen Xuehai.

With the same furrowed brow, Chen Xuehai slightly nodded. This case wasn’t fully diagnosed yet.