"What's wrong? Bad mental strength? "Zheng Ren asked.
"Left ventricular hypertrophy. Heart failure," Su Yun said. "If this was the United States, he would definitely be on the waiting list for a heart transplant and start waiting for a donor."
"The echocardiogram has to be combined with the electrocardiogram to determine left ventricular hypertrophy. Otherwise, the error is relatively large." Zheng Ren was still looking at the radiographic films, but he kept talking.
"There was a case report in New England. The patient had obvious limb conduction low voltage, and the amplitude of the QRS wave was even lower than the P-wave.
The electrocardiogram seemed to be difficult to associate with left ventricular hypertrophy, but the echocardiogram showed significant left ventricular hypertrophy. Finally, through magnetic resonance and biopsy testing, the diagnosis was' myocardial amyloidosis'. "
"Boss, you're a doctor in the general surgery department. Why do you study our heart so much?" Su Yun did not refute. He also knew about this.
It seemed that he had to be careful when talking to the boss in the future. Otherwise, if he caught a flaw, he would be speechless.
It did not matter if he was thick-skinned in other disciplines. If his heart was really criticized by the boss, it would be so embarrassing.
Su Yun thought to himself.
"Is it different?" Zheng Ren said, "The contradiction between the electrocardiogram and echocardiogram diagnosis of left ventricular hypertrophy is that their mechanisms are different.
The former reflects whether there is hypertrophy in myocardial cells through the electrophysiological reflex activity of the heart, while the latter is evaluated through subjective measurements of the ventricular wall.
Cardiac magnetic resonance is expensive, but the repeatability, sensitivity, and tissue specificity are significantly better than the former two, which is helpful for etiological identification. However, there are only a few cardiac magnetic resonance imaging in the country. "
"Do you think it's in Sea City? Now, there are cardiac magnetic resonance imaging in provincial capitals. " Su Yun caught the flaw in Zheng Ren's words and began to despise him. "It's just that the price is a little more expensive, ranging from 6000 to 10000."
"Oh, that's not bad." Zheng Ren put down the radiographic films and began to look at the test results.
"The electrocardiogram diagnoses left ventricular hypertrophy. It's really not bad. The examination is simple and easy. Many domestic and foreign hypertension guidelines recommend electrocardiogram as a means to detect left ventricular hypertrophy, but the sensitivity is low. The sensitivity for mild and moderate to severe left ventricular hypertrophy is 7% to 35% and 30% to 60%, respectively. "
Su Yun said as he looked at the patient's electrocardiogram.
"We can't be so arbitrary. Compared to sensitivity, it has a higher specificity. The specificity of the diagnosis of severe left ventricular hypertrophy is as high as 80% to 90%. Obesity may affect the electrocardiogram diagnosis of left ventricular hypertrophy, which increases the missed diagnosis rate. "
"Speaking of sensitivity, echocardiography is more sensitive than electrocardiography in diagnosing left ventricular hypertrophy. Left ventricular hypertrophy can be detected through the corrected left ventricular mass index. Most Commonly Used LVMI
Yes to LVM
Divide it by body surface area and use the Devereux correction formula … You know the Devereux correction formula, right? "
Zheng Ren looked at the test results and asked casually.
"Boss, I'm the rising star of the cardiothoracic surgery department. Who are you talking to?" Su Yun said disdainfully, "I can calculate the Devereux correction formula in my mind."
"Brother Song, does the patient's family have any plans for treatment?" Zheng Ren suddenly asked.
"Yes." Song Ying did not understand what Zheng Ren meant.
Just now, Boss Zheng and Su Yun had been talking about professional terms for a long time. Song Ying did not understand anything about the Devereux correction formula.
Not to mention him, even a clinician like Chang Yue was like a duck listening to thunder.
But why did Boss Zheng ask the patient's family if they had plans to treat the patient?
"It's like this. The liver is not a big problem. The main problem is the heart." Zheng Ren smiled and said, "If it was a heart problem in the United States, they would have prepared for a heart transplant. But you know our situation. There are only a few heart donors in a year. The old man's body will definitely not last that long. "
Song Ying frowned. He did not understand what Zheng Ren said.
Zheng Ren thought about it and felt that there was a problem with the logic of his words. After all, Song Ying was not a medical person. Although he could more or less know some relevant information with his talent on the Internet.
If he really wanted to explain the situation of the patient in front of him, he would have to start from the beginning.
"Then let's start from the beginning." Zheng Ren picked up the test results and said, "The drugs include apixaban, bumetanil, diltiazem, aspirin, amiodarone and midodrine hydrochloride. Other than shortness of breath, the patient's vital signs are within the normal range. "
"I have medical records. It says that the old man has had arrhythmia for 30 years and has been taking amiodarone for treatment."
Song Ying nodded. Before he came, he had done some research on the old man's medical records.
After all, it was not good to go to Boss Zheng to look at the radiographic films and say that he did not understand anything. It was necessary to leave a good impression on Boss Zheng.
"Abnormal liver function, alanine aminotransferase
176 U/L, aspartate aminotransferase 236U/L, alkaline phosphatase 104U/L, bilirubin 1.5 mg/dL
Albumin 2.6 g/dL, bilirubin 1.5 mg/dL I reckon that the local doctor mobilized the patient for a liver CT scan because of this. In the end, they found the problem. "
"Although there was no intravenous contrast, which is often referred to as enhanced imaging. However, the abdominal CT scan showed that the liver was very bright, like a light bulb. Abdominal CT scan showed that the liver density was > 100
Considering the large amount of radioactive dense material deposition in the old man's liver parenchyma. "
"…" Song Ying was a little stunned when he saw that Zheng Ren did not take the shiny liver seriously.
"These substances are actually just the deposition of drug metabolism. It's not a big deal," Zheng Ren said calmly. "Amiodarone is a Class III antiarrhythmic drug. It is a mild non-competitive alpha and beta adrenergic receptor blocker. Moreover, it has mild Class I and Class IV antiarrhythmic properties. "
"I won't go into the specific mechanism of the drug. Simply put, as the name suggests, amiodarone contains iodine."
Song Ying finally understood what Zheng Ren meant.
Song Ying knew that contrast agents contained iodine, which was why the enhanced CT scan would brighten the organs that were needed and provide more information to the doctor.
"At the molecular level, amiodarone contains two atoms of iodine, which accounts for 40% of its molecular weight.
In addition, amiodarone accumulates in the body over a long period of time due to its long half-life. According to research, its half-life is between two to four months. Since the pH gradient allows amiodarone to form hydrophobic bonds with polar lipids, the amiodarone molecules are trapped in the lysosome.
This way, amiodarone can escape the breakdown of phospholipase and stay in the cell for a longer period of time. "
Zheng Ren explained bit by bit.
"It's said that blood concentration can still be measured after half a year of withdrawal."
"Yes, that's basically it," Zheng Ren said. "This liver is due to long-term oral amiodarone, which resulted in iodine deposition."
"It's not a big problem. It will gradually recover after the medication is stopped. However, the main problem lies in the heart. "
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