Chapter 329

Absolutely irregular heart rhythm, variable heart sounds, short pulse...

When he obtained the patient's heart rate through the stethoscope, which was much greater than the pulse rate by touching the radial artery with his hand, Xiao Chenguang knew that his atrium was fibrillating.

Fortunately, it was atrial fibrillation. If it had been ventricular fibrillation, the patient would have had no chance of persisting to the hospital.

"The patient has atrial fibrillation. Call the cardiology department for consultation, put him on ECG monitoring, and do an electrocardiogram."

"The patient has a stomachache, is it because of his heart?" After Qi Tiancheng heard this, Ma Shan began to carry out the doctor's orders.

"Yes." Xiao Chenguang nodded, brought the electrocardiograph and clamped the patient's hands and feet.

"Myocardial infarction and heart failure may cause stomach pain."

"Acute myocardial infarction, especially acute myocardial infarction of the inferior wall, has an 8% probability of causing pain to radiate to the upper abdomen, causing gastrointestinal spasm and abdominal pain."

"Blood stasis in the systemic circulation and right heart failure can lead to blood stasis and swelling in the liver, causing gastrointestinal smooth muscle spasm and abdominal pain."

"Sometimes, pericardial effusion, myocarditis, aortic dissection and tear, and superior mesenteric artery embolism can also cause abdominal pain in patients under the condition of ischemia and hypoxia."

Xiao Chenguang said while pressing the start button of the electrocardiograph.

Sizzle...

A twelve-lead electrocardiogram that fluctuates up and down and continuously floats before everyone's eyes.

The nurse felt dizzy when she saw the densely packed lead charts on it.

Xiao Chenguang once still remembered that a patient complained to the relevant departments because of the doctor's electrocardiogram reading.

They say that doctors stock trading during working hours are not doing their job properly...

As for the stock market in later generations, it is often the old investors who have not gotten out of their traps, and the new investors rush in again.

Can't stop it.

Xiao Chenguang snapped, tore off the electrocardiogram and held it in his hand for diagnosis.

"ST segment depression and T wave inversion in leads II III AVF suggest the possibility of inferior wall myocardial infarction."

"The P wave disappeared and was replaced by irregular jagged small F waves with different amplitudes and shapes. The patient was diagnosed with atrial fibrillation."

"I will make an appointment for a bedside B-ultrasound later. The patient is most likely to have a thrombus caused by atrial fibrillation that detached and embolized along the large blood vessels to the superior mesenteric artery, causing abdominal pain caused by ischemic necrosis of the intestinal wall that feeds it."

Many people know that the heart and lungs are inseparable, but they often ignore abdominal symptoms.

Therefore, in later generations, anyone who comes to the emergency room because of stomachache will first do an electrocardiogram to determine whether it is related to the heart.

This is not a disguised charge for more examinations, but a diagnosis and treatment process based on many painful lessons.

Xiao Chenguang originally planned to build an electrocardiogram for abdominal pain into a regular program in the chest pain center he planned to establish next.

Unexpectedly, before it was implemented, patients here had already started to get sick.

Soon, Director Cai from the Department of Cardiology came in person.

He's not on duty today, but he's been in the hospital this week and hasn't been home.

Because he was grateful to Teacher Han for saving the child's life, even though she had been transferred from the small intensive care unit to the general ward two days ago, Cai Tianming would still be on call to help if she needed anything.

"Director Xiao, this patient should have had myocardial infarction for some time." Cai Tianming took the electrocardiogram, adjusted his glasses, and looked at it carefully.

"Yes, the electrocardiogram has changed like a tombstone. The old man has been feeling chest tightness at home for a while, but he didn't come to see him."

When asking about the medical history just now, Xiao Chenguang also roughly understood the patient's condition.

The area of ​​infarction is not large, and the amplitude of the electrocardiogram is also small.

The pain this time was mainly caused by the new-onset atrial fibrillation after myocardial damage, which led to thrombosis and shedding, causing intestinal ischemia.

"The patient has new-onset atrial fibrillation..."

Just as Xiao Chenguang expected, Cai Tianming then revealed the diagnosis.

"Urokinase and streptokinase can be used to dissolve thrombosis, but I don't think the effect will be very good."

Cai Tianming sighed. When encountering someone who has been sick for a long time at home and then comes to the hospital for treatment, the only treatment available in their cardiology department is thrombolysis.

But the effect is extremely poor.

Most of the time, other complications have already occurred before the blood clots melt away.

Mucous membrane bleeding, organ bleeding, and even cerebral hemorrhage...

There is no way, thrombolysis is a double-edged sword. Although there are strict dosage requirements, patients have different constitutions. Some can be successfully treated by luck, but most will develop related complications.

It's really difficult.

Sometimes Cai Tianming feels that whenever they encounter patients with myocardial infarction and thrombosis in the cardiology department, they often feel like there is nothing they can do.

It seems that I can't find any good solution, so I can only use medicine, silently praying that nothing will happen to the patient, and otherwise I can only stare.

"Director Cai, the main treatment is to treat new-onset atrial fibrillation. As for blood clots, I think surgery is safer."

Xiao Chenguang also understood Cai Tianming's feeling of powerlessness.

At this time, interventional treatment has not yet been fully launched, and even many large hospitals do not have matching imaging equipment.

Therefore, the treatment methods for myocardial infarction, thrombosis, and hemostasis of bleeding are still at the stage of drug treatment.

However, this situation will soon be broken.

Not long ago, academician Liu, a leading interventionalist, was commissioned by three ministries and commissions to conduct a seminar on the development of interventional medicine in the imperial capital.

The ministries and commissions have also allocated tens of millions of funds for research on the localization of interventional treatments such as cardiovascular, cerebrovascular, tumors and related medical devices.

By then, DSA angiography machines, X-ray machines, CT, MR, etc. will be put into use for interventional treatment in stages.

And Xiao Chenguang will establish a chest pain center in the emergency department for this reason.

Take advantage of this spring breeze, prepare in advance, and strive to be the first person to try it in Yingcheng and even the provincial capital.

…

As the drugs were used, Xiao Chenguang began to have preoperative talks with the patient's family.

"Doctor, will the operation cost a lot of money?"

The family originally thought that their father just had a simple stomachache, but they didn't expect it to be so serious.

Myocardial infarction, atrial fibrillation, and superior mesenteric artery embolism require emergency surgery.

Except for surgery, he can understand, and all other terms are heard for the first time.

"The elderly will not be affected in their subsequent life after the operation. If they don't do it, simple drug treatment will not relieve the condition, but will only make them more and more painful."

"Unless you give up treatment and take the elderly home, the future expenses will be much more than the operation."

The family members who talked were all very down-to-earth people, and they would not beat around the bush. They mentioned money right away, and there were only two reasons.

First, they don't want to be treated.

Second, they really don't have money.

Looking at the family members facing each other, the sweaters that have been worn for a long time and have fallen off, and the coats that have been worn white.

Xiao Chenguang sighed and directly laid out the results of the old man.

"If you agree to the operation, I will reduce the operation fee for the old man. The cost will not be much, and there will be no major surgery. After recovery, it will not affect daily life."

According to his experience, the old man's intestinal wall is only ischemic at this stage, and it has not yet reached the stage of necrosis.

With drug treatment, the blood clot cannot be removed. The longer it is delayed, the more serious the condition will be.

Intestinal necrosis, perforation, septic shock, more money is spent, and the disease cannot be cured.

Although it seems that the operation costs more now. But it can remove the root cause of the disease and there will be no complications. It is clear at a glance which one to choose.

The family members looked at their father who was still in unbearable pain in the emergency room, and they felt very uncomfortable.

It is obviously not an incurable disease, but they hesitated because of money.

In the end, the family members made a decision.