I Can See Health

  Chapter 43 ECG battle (Part 2)

  Sun Guoguo frowned, then nodded slightly, but did not speak.

   Through Lin Cui's words, she could probably guess what happened just now.

   Ke Yue has been admitted to the department for two months. This little girl's clinical knowledge and skills are relatively poor, she is very clear.

   However, although Lin Cui is the deputy director of the department, there is no need to be so aggressive and let a thin-skinned girl be so incapable of being on the stage.

   What's more, Ke Yue is still Director Li Yao's student!

   Even if you don’t look at the monk’s face, you should look at the Buddha’s face.

  Lin Cui did this, this is completely disrespecting Teacher Li Yao!

  Sun Guoguo didn't agree with Lin Cui's approach in her heart, but after all, the other party was a superior doctor or the deputy director of the department, so she couldn't say much.

  …

   As the deputy director of the department, Lin Cui, she didn't think so much. She is the leader of the department, and it is very common to teach a student.

"Atrial fibrillation is one of the most common electrocardiograms in our cardiology department." Lin Cui continued, "Everyone must master the characteristics and treatment methods of atrial fibrillation electrocardiograms! If you can't even recognize this most basic electrocardiogram, then you must Work hard, otherwise, if you reveal your identity as a graduate student of Cardiology, you won't be laughing out loud!"

  During this period, Ke Yue kept pulling his head together, almost burying his head in the floor.

   It's not that she didn't work hard, but she fell too much!

   During her senior year internship, she spent most of her time reviewing postgraduate entrance exams and seldom learned clinical knowledge and skills.

  Especially the electrocardiogram, which completely needs to rely on a lot of image recognition to improve the ability!

  The ECGs on the books are the most standard abnormal ECGs.

   But clinically, there are no two identical ECGs at all.

   In addition to relying on talent, you need to accumulate more experience in understanding pictures by yourself.

  …

  Lu Chen could understand Ke Yue's mood at this time, patted her on the shoulder lightly, and whispered, "It's okay, just learn it slowly, no one will know it at the beginning."

   "Yeah." Ke Yue replied softly, but still kept her head down, Lu Chen couldn't see her expression clearly.

  …

   At this time, Lin Cui started the interpretation of the fourth and fifth electrocardiograms.

   But the last two electrocardiograms are not as easy to identify as before.

  Lin Cui ordered several students in a row, but did not know the diagnosis of this electrocardiogram.

Even He Sirong hesitated, thinking for a long time before slowly saying: "Mr. Lin, in this picture, the lower leads, V4-V6 leads with ST depression, V1-V3 leads ST segment elevation, it should be Coronary 6+2 phenomenon, consider left main occlusion."

   Lu Chen saw this picture for the first time, and the diagnosis he considered was similar to what He Sirong said, probably coronary heart disease and left main trunk occlusion.

   But this picture gives him the feeling that something is not right, it's weird!

   But what was wrong, he couldn't tell.

Lin Cui heard the words, shook her head and chuckled, and said, "The fourth picture should be the most difficult one. When this patient first came to our department, many people made a mistake, including some senior attending physicians! I Only one hint can be given, this disease has nothing to do with primary heart disease!"

   Listening to what Lin Cui said, He Sirong knew that she made a mistake in her judgment!

   has nothing to do with primary heart disease…

  Lu Chen lowered his head and pondered, and suddenly a light flashed in his mind.

   If it has nothing to do with primary heart disease, there is only one possibility left!

   "Director Lin, I would like to ask, how is the patient's renal function?"

   As the saying goes, the heart and the kidney are not separated.

   This kind of obvious "ischemia" ECG, if it is not a problem of the heart, it is mostly a problem of the kidneys!

  Lin Cui looked at Lu Chen in surprise.

  This boy is a little rude. He just came to the department today?

   "Well, this is indeed a patient with chronic renal insufficiency"

   Lu Chen heard the words, the corner of his mouth smiled slightly, and he already had his own answer in his heart.

   Seeing Lu Chen's smile, Lin Cui raised her eyebrows.

   "You know the answer?"

   The electrocardiogram was discussed for a long time by all of them, and finally it was finally confirmed by combining the laboratory indicators!

  Is it possible that the first time this boy saw this electrocardiogram, he was diagnosed?

   "If I guessed correctly, it should be hyperkalemia combined with hypocalcemia." Lu Chen smiled.

   Everyone present was surprised and puzzled.

   From coronary heart disease to hyperkalemia and hypocalcemia, the span is too big!

   "This picture is indeed very difficult, but also very interesting."

  Lu Chen smiled and said.

   Sun Guoguo, who was giving the doctor's order, also turned around curiously.

  The electrocardiogram of atrial fibrillation is very common in cardiology, but "high potassium, low calcium" is extremely rare.

"The V1-V3 R wave in the chest lead is poorly incremented, the R wave is slender, which is basically lost, the T wave is symmetrical, the waist is very thick, and the high point is not obvious, which is very similar to the 6+2 phenomenon. I believe most people see this picture. It is said to be coronary heart disease, and it may be the left main or the proximal segment of the anterior descending artery or the three-vessel disease."

  He Sirong nodded slightly. The reason why she judged it to be coronary heart disease was also based on Lu Chen's description above.

  Lu Chen paused and continued.

"But this patient is a patient with chronic renal insufficiency. Careful observation of the electrocardiogram shows that it is quite consistent with the sharp wave, but it is not high, and in the case of sinus tachycardia, the ST segment is significantly prolonged. Based on these, it is considered that this patient is a Hyperkalemia combined with hypocalcemia."

"This is not a typical coronary 6+2 phenomenon. It is considered that the patient's severe renal anemia caused relative coronary ischemia. In fact, 6+2 is not a patent for coronary artery disease such as left main disease or three-vessel disease. !"

   After Lu Chen finished speaking, the students present looked at each other.

   These knowledge points are completely beyond what they have learned before.

  Only He Sirong, she is the only one among all the students who can understand what Lu Chen said.

   Chronic renal insufficiency…

   Hyperkalemia, hypocalcemia…

   This is something she never thought of, and her thinking is still stuck in the fields of coronary heart disease and arrhythmia.

   Even though Lin Cui had reminded that this picture had nothing to do with "primary heart disease", she still couldn't get around the bend.

   But Lin Cui was silent.

  Every word Lu Chen said was correct.

   He not only diagnosed hyperkalemia, but even hypocalcemia!

   Just the interpretation of this electrocardiogram has completely covered up all the light of He Sirong!

   (end of this chapter)