I Can See Health

   Chapter 901 Must do

   in the ward.

   The eighteen-year-old girl stared blankly at the ceiling.

   A month ago, she was in the classroom with her classmates, looking forward to the future.

   Maybe tomorrow, or the day after, she will meet her Prince Charming.

   However, the misfortune of life is so sudden.

   Dizziness, fatigue, and subsequent syncope.

   makes such an eighteen-year-old girl overwhelmed.

  I heard from the doctor that her heart was beating too slowly.

  As the most important organ of the human body, once the heart stops beating, it is dangerous.

   Only by implanting a pacemaker to help her heart beat can she avoid this danger.

   But, she hasn't been in love yet.

   She still has a lot of interesting things that she didn't have time to do.

   "Dad, do I have to put a pacemaker?"

  The girl turned to look at her father.

   During this month, men searched for doctors everywhere and could only fall asleep late at night.

   I woke up the next morning and had to continue looking for a hospital for my daughter.

   For a month, his hair turned gray.

   "How could that be?" The man forced a smile, "Didn't you listen to Director Lu today? Your electrocardiogram may have other diagnoses."

   "And I'm talking to you, there was a boy who also had a slow heart rate before. Other experts said that a pacemaker should be put in. When I got to Director Lu, it was cured without a pacemaker!"

   A smile appeared on the girl's face.

   There was also a glimmer of hope in her heart.

   It’s just that I don’t know when to start.

   Outside the window of the ward, dark clouds were covering it.

   The wind was blowing violently, and the windows were whirling.

  Looking at it, a storm is about to hit.

  …

   Cardiology classroom.

  Lu Chen stood on the stage.

   Behind him, on the projector, are the three electrocardiograms of the girl.

   "I ask a question, these three ECGs, only high-grade AV block?"

  Lu Chen looked around, and finally stopped his eyes on Gu Xinyue.

  The crowd started talking non-stop

   "Let's see if there are other possibilities for blocking?"

  Lu Chen gave some reminders.

  Gu Xinyue has been with Lu Chen for a long time.

   He knew that every step Lu Chen took was meaningful.

   Does this patient really have other diagnoses and may not have a pacemaker?

  Gu Xinyue frowned deeply, not letting go of any detail of the electrocardiogram.

   This time, he really saw something.

   "Director Lu, I understand!" Gu Xinyue suddenly stood up, "This patient has a first-degree atrioventricular block, complete right bundle branch block, and left posterior fascicular block. Consider three-fascicular block!"

As soon as Gu Xinyue said these words, Jin Miao's eyes lit up.

   When he looked at the electrocardiogram again, he saw these three types of conduction blocks.

   This old valley really has two strokes.

   On the stage, Lu Chen smiled and nodded.

   "Dr. Gu is right, this patient is a combination of three types of block, so do you know where the block is?"

  Lu Chen looked at Gu Xinyue.

  Gu Xinyue looked at the electrocardiogram again, frowned, and then said slowly.

   "I think the atrioventricular node or the Hipps system is possible."

  Lu Chen did not deny the answer, but looked at others.

   "What's your opinion?"

  Jin Miao stood up, "I think the block is in the Hippo system, right?"

  Gu Xinyue wondered: "Why can't it be the atrioventricular node?"

  Jin Miao scratched his head, "It's a feeling, I can only understand the specific reason, I really can't say it."

   Everyone laughed when they heard Jin Miao's words.

   However, Lu Chen gave Jin Miao a thumbs up, "Your sixth sense is really accurate, the block is in the Xipu system."

   "Director, what is the reason for this?"

   Another deputy chief physician asked.

   "As far as I know, this kind of block is clinically possible. We haven't done electrophysiological tests for the time being, so we definitely can't tell the difference."

  Lu Chen smiled.

   "You only know one, but you don't know the other."

   "If the patient is older, there is a possibility of AV nodal block."

   "But for this 18-year-old girl, the atrioventricular node is less prone to problems, and for patients with ventricular septal defect, the surgery mainly affects the bundle branch system."

   "The reason is very simple. The ventricular septum is between the left and right ventricles. The bundle branch conduction system is generally affected by surgery. The atrioventricular node is quite far away from there, so it is generally not affected."

   This remark is very simple to say.

   But it is quite difficult to connect with reality.

   "Director, but you said so much, but you didn't say how to treat this patient?" Gu Xinyue wondered, "Do you need a pacemaker for the next treatment?"

   "Or, as you mean, there are three kinds of block coexisting, shouldn't a pacemaker be more appropriate?"

  Gu Xinyue's question is also what everyone wants to ask.

   After analyzing for a long time, Lu Chen corrected the diagnosis of the electrocardiogram, but the general direction did not change.

   This multi-block ECG is indeed an indication for implanted cardiac pacemakers.

   At this time, Lu Chen said sternly: "I didn't seem to have said that this patient doesn't need a pacemaker, right?"

"what?"

   Everyone was stunned when they heard it.

  Especially Gu Xinyue, her eyes widened.

  The doctors in the department thought that Lu Chen had other insights.

   At this time, Lu Chen continued: "For an eighteen-year-old girl in bloom, the occurrence of three-branch block is definitely not physiological, it must be pathological. The following four possibilities must be considered."

   "First, acute viral myocarditis; second, progressive cardiac conduction obstruction; third, cardiomyopathy; fourth, damage to the conduction tract system after ventricular septal surgery."

  Acute viral myocarditis, the patient did not have any prodromal symptoms of infection. After admission, myocardial injury markers and pro-BNP were checked for multiple times and were completely normal.

   The patient did not have any symptoms of chest tightness, chest pain, and dyspnea, and the possibility of acute viral myocarditis was very small.

   As for progressive cardiac conduction obstruction, this type of disease is a disease with no obvious organic disease and conduction tract involvement. The disease course migrates, progressively worsens, and develops into high-grade or third-degree atrioventricular block.

   This type of disease is mostly middle-aged and elderly, and there is a family history of the disease.

   In addition, there was no evidence of cardiomyopathy from echocardiography. From the electrocardiogram, there is no evidence of cardiomyopathy, and the possibility of cardiomyopathy is unlikely.

   Lu Chen's remarks are very convincing.

   There are four possibilities, and in the end only the last one remains.

   "That's the last possibility, damage to the conduction tract system after ventricular septal surgery!"

   A very common complication of ventricular septal surgery is the occurrence of atrioventricular block, and most of them involve the Hippoline system, so this patient can almost be locked for the cause of atrioventricular block.

   "Director, I have another question." Gu Xinyue continued, "This patient has been 13 years after the operation. Why didn't he get sick when he was a child, and it still happens now?"

Lu Chen thought for a while, then said, "The only reasonable explanation is that the operation performed by the patient when he was a child, as the age increases, the cardiac conduction tract system is also developing, which may affect the conduction with the pulling of the patch. beam system."

   "In this case, is a pacemaker necessary?" Gu Xinyue asked tentatively, hoping to get a different answer from Lu Chen's mouth.

   After all, this is an eighteen-year-old girl!

   But unfortunately, reality is always cruel.

   Not every disease can be cured perfectly.

  Lu Chen's eyes were deep, and he said slowly, "It must be done!"

  I don't know when, it was raining heavily outside the window.

  The black cloud is pressing down on the city and it is about to be destroyed.

   A completely oppressive atmosphere enveloped everyone.

   (end of this chapter)