Chapter 177
The other doctors around him opened their mouths in surprise!
Dynamic obstructive heart disease? !
Some doctors said they had never heard of it!
Lu Gao and Liu Zifei looked at each other in confusion!
Good guy!
And this disease? !
Suddenly, Wang Xiaomian stood up suddenly and said in an excited voice:
"Yes! Dynamic obstruction! Yes, yes! This is it!
I remember that ten years ago I accidentally read a series of academic papers on heart disease on the Internet!
It talks about this in there!
However, this disease is very rare, and some patients even have this disease themselves.
However, since it was not detected at the early stage, the doctor directly prescribed anti-heart failure drugs such as dopamine and digitalis.
As a result, the patient failed to hold on and died before everyone could react!
Oops! Only then did I realize it! This patient is very likely to have obstructive hypertrophic cardiomyopathy! "
Wang Xiaomian spoke excitedly, pulling Zhang Yi's arm.
Zhang Yi raised his head and looked at the incomprehensible and confused expressions of the people around him.
Zhang Yi pulled out a piece of white paper from the printer paper on the side.
Then he took out a pen from his bag and drew two cross-sections of the heart directly on the spot.
One is a normal cardiac blood flow diagram.
Flow diagram of a dynamic obstruction.
Zhang Yi raised the drawing in his hand and said:
“Because the patient’s ventricular wall was thickened, although the examination results showed no stenosis in the main blood vessels.
But you must not ignore the point of thickening.
This patient had a thickening of 38mm, and normal myocardium is considered hypertrophic if it exceeds 35mm.
You can see that the distance between the ventricular wall and the aortic outflow is very close.
Will thickening of the ventricular wall affect the outflow of the aorta?
The answer is yes, absolutely.
Except for family members, everyone present is a medical student and can understand my picture.
Note that there is no stenosis in the aorta or aortic valve, but due to ventricular wall hypertrophy, the outflow port will be squeezed to some extent.
Then the outflow passage becomes smaller than the mitral inflow.
At this time, the inference results of Bernoulli's equation come out.
The height of the heart remains unchanged, and the gravitational potential energy remains unchanged, but the outlet becomes relatively narrow.
When blood flows out of a relatively narrow channel, the flow speed increases and the kinetic energy increases.
But fluid has its mechanical energy conservation.
The gravitational potential energy remains unchanged and the kinetic energy increases. How can we maintain the same constant?
It can only be that the pressure at the outflow tract becomes smaller.
(Kinetic energy + gravitational potential energy + pressure potential energy = constant)
If the pressure in the outflow tract is small, will the pressure in the mitral valve inflow tract become relatively larger?
Therefore, blood flow will create a pressure difference.
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 port, the situation will be more serious.
Everyone should know what the pressure difference is.
For example, you can often see the waiting yellow line marked on the ground at train stations and chattel stations.
This is the differential pressure line.
Once the pressure difference line is crossed, in front of a fast-moving train, the strong pressure difference will directly sweep away people or objects standing still.
very dangerous!
Therefore, the mitral valve does not intentionally block the aortic outflow.
It's because of the pressure difference that it can't help itself.
Therefore, dynamic obstruction is different from those fixed obstructions caused by aortic valve stenosis.
Be sure not to let the heart beat too fast. The faster the heart beats, the greater the pressure difference will be.
The greater the pressure difference, the mitral valve will directly block the outflow port.
When the outflow port is blocked, the aorta no longer supplies blood to the whole body.
By then, the patient will have edema all over his body, hemodynamics will collapse, and the person 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.
This type of drug can reduce ventricular contractility.
If the contraction force is small, the flow rate of the outflow channel will slow down, and the pressure difference will also become smaller.
If the pressure difference is small, does the mitral valve no longer need to be sucked in to block the outflow port?
Have the patient’s symptoms been relieved? "
Zhang Yi's 'class' is over.
But the whole office became silent!
Everyone looked at Zhang Yi with either shock, admiration or disbelief...
Chapter 136 Why are they from the same school so different?
Although the family members did not understand, they could feel that the young man in front of them did not seem to be deceiving others.
Although they don't understand it, they don't realize it!
In the office, many young doctors showed expressions that had never seen the world.
Among them is Lu Gao.
Dynamic obstruction?
hehe!
I do not believe!
I'll check it out!
So, Lu Gao quickly took out his mobile phone and checked it.
After checking, it turned out that he really had this disease!
Why hasn't he heard of this disease before? !
Also, Zhang Yi went to the same university as him and even had the same teacher.
How could he know that he had this disease but not himself?
It’s so irritating!
He was beaten by Zhang Yi again!
On Zhang Yi's side, looking at everyone's confused expressions, he continued:
"This disease is indeed very rare, but as long as the right treatment is found, it is actually the same as obstructive heart failure.
Director Wang, you can now do another hemodynamic test on the patient to see how much the pressure difference is.
Generally speaking, the warning line for the pressure difference is 50-60 mmHg.
But once it exceeds 80, you have to consider whether to remove the overly thickened myocardial wall.
Below 80, the condition can still be stabilized through drug treatment."
Wang Xiaomian nodded immediately: "Okay, I'll arrange it right away."
Then, Wang Xiaomian looked at the family members next to him and said:
"Are you relieved now? The cause of the disease has been revealed, it is obstructive hypertrophic cardiomyopathy.