Back in 2002 as a doctor

Page 461

"Child? How old is it?" Zhou Congwen asked.

"19 years old." Zhang You said in a deep voice.

The diagnosis of myocardial infarction for a child at this age is a little bit outrageous.

But Zhou Congwen has also seen many younger children suffer from myocardial infarction, most of them have other diseases, it is not impossible.

"Professor Zhou, why don't we go and have a look together?" Zhang You invited.

"Okay." Zhou Congwen nodded in response.

Go and take a look at the 19-year-old myocardial infarction patient, and then touch the hospital by the way.

I just came to the Second Hospital of Medical University before, and I had no time to walk around with the leaders of the hospital.The king of Hades is easy to see, but Zhou Congwen should not understand the truth that it is difficult for little ghosts.

In his mind, the dean of the Second Hospital of the Medical University is of course an existence at the level of a little ghost.

This kind of person has more than enough trouble, and the relationship still needs to be improved, as long as there is no chaos, Zhou Congwen has very low requirements for this.

"Farewell, I'll go out for dinner..."

"Not eating together?" Liu Xiaobie asked.

"If you're hungry, eat first. I'm not sure what time it will be finished." Zhou Congwen said.

After speaking, he turned around and changed shoes with Zhang You and left.

"Xiao Zhou, are you so rigid with your girlfriend?"

After leaving the door, Zhang You asked with his big teeth bared.

"Speak normally, I just spoke very gently, was it blunt?" Zhou Congwen scratched his head, he couldn't recall what he said wrong just now.

"Women still need time to accompany them, especially girls now, who are different from us at that time." Zhang You said.

"Ah."

"How many months will the establishment of the Chest Pain Center start?" Zhang You laughed, and then talked about the things he cared about.

"After the surgery competition." Zhou Congwen said, "I think Han Chu is very concerned about this matter, and I think Dean Chen will be more happy when he finds out."

Zhang You didn't even need to think about it carefully. When he thought of Dean Chen, he would probably be very happy to see Zhou Congwen participate in this world-level competition.

The city of young people is very deep, Zhang You thought to himself.

Zhou Congwen seems to be doing surgery every day, but he has already made such a big layout unconsciously.

At least the sketches of the operation he drew for himself when he was in the Third Hospital of Jianghai City were true, and Zhou Congwen still never forgot to carry out this operation until now.

Zhang You already knelt down, but before that, he just knelt in front of Zhou Congwen's sky-defying technology.But kneeling is kneeling, and it is impossible for him to undergo interventional surgery.

If a cow doesn't drink water, can it force its head down?

Now that Zhou Congwen threw out a scented bait, Zhang You felt itchy and came to the door by himself.

While chatting about technical details, Zhang You drove straight to the hospital.

The patient is in the Department of Circulatory Internal Medicine. If the Chinese New Year hadn't encountered a difficult situation, no one would call the chief directors of the two departments of the heart and the chest.

Myocardial infarction at the age of 19, it is estimated that the family is about to collapse, so I will seek consultation.

When they came to the hospital, the two walked quickly to the Circulatory Department without changing clothes.

Teng Fei is not in the director's office, but in the little doctor's office outside.

Even the big office is full of people, densely packed, and the air is dirty.

Seeing Zhang You and Zhou Congwen coming in together, Teng Fei showed a gleam of joy on her originally stern face.

"Xiao Zhou, you are here too." Teng Fei ignored Zhang You, but greeted Zhou Congwen first.

"Well, what's the patient's condition?" Zhou Congwen glanced and saw Director Han was there.

"Professor Zhou, why are you here?" Director Han was a little surprised, but it only disappeared for a moment, and then walked up quickly and asked.

"Talk about something with Director Zhang. I happened to hear the phone call and I followed to check the situation." Zhou Congwen said.

"That's right." Director Han began to introduce the situation.

The patient is a 19-year-old male with a history of good health.On the night of the New Year's Eve, he suddenly had diarrhea and fever. After being sent to the First Hospital of a nearby medical university, he was diagnosed with "enteritis" and given oral clarithromycin for treatment.

But when I got home, just after the New Year's Eve, when the firecrackers were being set off at home, the child suddenly turned pale, sweating profusely, and his lips were cyanotic.Because of the sudden loss of strength, he was almost missed by the firecrackers.

At that time, the patient's condition shocked the family members, and they quickly called 120 emergency and sent the patient to the First Hospital of Medical University.

The doctor in the emergency department suspected myocardial infarction, and performed an electrocardiogram showing T wave inversion in leads II, III, aVF, and V2-V4.

Elevated cardiac enzymes: Troponin I 10.93ng/mL (normal range 0-0.023ng/mL).

The electrocardiogram is a relatively clear manifestation of ischemia, and myocardial enzymes are also elevated, and the diagnosis is imminent—acute myocardial infarction.

With this test result, the doctor in the emergency department couldn't believe it, but he couldn't help but not believe it when he got the same electrocardiogram after the second re-examination ruled out the machine obstacle.

Although the patient was only 19 years old, although he was in good health, the First Hospital of Medical University gave him corresponding symptomatic drugs for treatment.

After more than an hour, the patient's symptoms relieved.

Whether it is clinical examination or the effect of medication, it is very clear myocardial infarction.

But the good times didn't last long. On the morning of the first day of the Lunar New Year, the patient suffered another attack of precordial pain.

Because the director of Circulation Intervention in the First Hospital of Medical University returned to his hometown for the New Year, the patient had not yet been hospitalized and was only under observation in the emergency department, so the family asked Dean Chen to rush directly to the Second Hospital of Medical University.

"Professor Zhou, look..." Director Han asked.

Chapter 0791 is allergic again?

"Professor Zhou, the patient's condition is a bit strange." Teng Fei added.

"Well, I'm really young, I'll go and see the patient." Zhou Congwen said.

"Wait a minute, Professor Zhou, let me add something." Teng Fei said, "The patient's pain is not continuous, and it is mild and severe. I don't think it is a typical myocardial infarction symptom. If it is not for the electrocardiogram, I may do it." other judgments."

Zhou Congwen thought for a while, then nodded, "I'll go and see the patient before I talk."

When we came to the ward, Dean Chen was sitting in the ward with the patient's father. When he saw Zhou Congwen walking in, Dean Chen was overjoyed.

"Sixth, this is Professor Zhou who is in charge of the academician workstation of our hospital, and the proud disciple of Huang Lao, a national treasure." Dean Chen introduced.

Seeing that Zhou Congwen was young, the patient's father was slightly taken aback, but he still stretched out his hand and shook it.

"Professor Zhou is in trouble."

Zhou Congwen was not too polite with the patient's family. After shaking hands, he had a physical examination and auscultation first.

After writing down the patient's condition, Zhou Congwen went back to the office to look through the materials.

During the illness, the patient had a total of 3 electrocardiograms, one of which was the outpatient data brought by the First Hospital of Medical University.

The electrocardiogram showed that the condition of myocardial ischemia was a bit erratic, sometimes light and sometimes severe, which is probably what Director Fujifito was talking about.

There is absolutely a basis for diagnosing myocardial infarction, but it is not clear where.

However, this situation can also be explained by the effect of drugs related to the treatment of myocardial infarction.

After reading all the materials, Zhou Congwen raised his hands and put his hands on his flat head, thinking about the patient's condition.

After pondering for a moment, Teng Fei approached her and asked, "Professor Zhou, I always feel a little weird, what do you think?"

"Director Teng, what are you going to do next?" Zhou Congwen didn't answer, but asked rhetorically.

Standing in the distance, Zhang You had no intention of competing with Zhou Congwen for the limelight.

All the patient's information seemed to belong to acute myocardial infarction, but Zhang You subconsciously felt that something was wrong, but he couldn't tell what was wrong even if he was asked to explain it clearly.

This patient is among the most difficult to treat.

The diagnosis seems clear, but there is a high possibility of a big pitfall. Zhang You wisely kept silent and left the responsibility to Zhou Congwen.

"How did you decide?" Zhou Congwen asked.

"Do a radiography. It's not yet 24 hours. If there is a blockage, see if there is a chance to open it."

"Okay, let's go on stage." Zhou Congwen said, "Are you all ready?"

"It's all ready, Xiao Zhou, you can go too, and watch for me." Teng Fei said cautiously.

The preoperative preparations have been completed, since no one disagrees, let's take a look at the situation on stage.

Judging from the current data, Zhou Congwen believes that the patient is more likely to be diagnosed with acute myocardial infarction.

After the operation, Tengfei quickly made an angiography for the patient.

Because the patient is young and the vascular condition is quite good, the contrast medium is smooth.

Something unexpected happened - the patient's coronary arteries were unobstructed and there was no evidence of myocardial infarction.

Seeing this scene, Teng Fei stopped stepping on the thread and walked to the operating room in a surgical gown.

"Professor Zhou, I think it's all right, what do you think?" Teng Fei asked confusedly.

The previously imagined situation did not occur. The patient's coronary artery condition was as good as his body, and it was extremely unobstructed, and there was no sign of blockage at all.

"Director Teng, do an acetylcholine test." Zhou Congwen said with certainty.

"Is it necessary?" Teng Fei was taken aback.

"Have."

Teng Fei hesitated for a moment, but turned around and went back.

As the lead door closed, Director Han asked, "Professor Zhou, what is the acetylcholine test for?"

"The intracoronary acetylcholine provocation test is mainly of great value in patients with no coronary artery stenosis, refractory symptoms, or sudden cardiac death of unknown cause."

"The source of the patient's chest pain is strange. Let's do an acetylcholine challenge test."

Director Han saw that Zhou Congwen was staring at the screen, and followed him without asking too many questions.

Soon, Teng Fei injected 50 μg of acetylcholine into the right coronary artery.

In less than 1 minute, the patient complained of precordial pain. Coronary angiography showed coronary artery spasm and 99% stenosis at the opening of the posterior descending artery.

Left ventricle angiography showed no wall motion in the posterior descending artery supply area, and the ECG showed transient ST-segment depression and T wave inversion in the inferior wall leads during induction.

However, the symptoms are only transient and subside after about 5 minutes.

Zhou Congwen pressed the intercom, "Director Teng, please come out."

Teng Fei came out, looked into Zhou Congwen's eyes and asked silently.

"I think it's not a myocardial infarction, but an allergy."

"what?"

"..."

"..."

Everyone in the operating room had question marks.

allergy?What allergies?

Contrast or...

Could it be that Zhou Congwen was talking about clarithromycin? !

"I suspect clarithromycin allergy." Zhou Congwen said immediately, "By the way, can our hospital do a clarithromycin-induced lymphocyte stimulation test?"

"..."

What Zhou Congwen said was so tricky that everyone shook their heads.Not to mention doing a similar inspection, everyone has never even heard of it.

"Forget it, change the antibiotics first, and monitor the vital signs." Zhou Congwen said, "If you guessed right, the patient's chest pain and myocardial ischemia symptoms will be relieved and disappeared after the oral administration of clarithromycin is stopped."

"Professor Zhou, do you suspect Kounis syndrome?" Teng Fei asked.

"Ah."

"What does Kounis syndrome mean?" Director Han asked without understanding, not feeling ashamed that he didn't know the name of the disease.

"Kounis syndrome, also known as allergy-associated ST-segment elevation acute coronary syndrome, includes allergic angina and allergic myocardial infarction."

"Kounis syndrome is not a rare disease, it is an allergic reaction that causes the activation of mast cells, macrophages and T lymphocytes to synthesize and release inflammatory mediators.

A syndrome in which mediators cause peripheral vasodilation, decreased blood pressure, decreased coronary blood flow, arrhythmia, coronary spasm, coronary atheromatous plaque erosion, rupture, or coronary stent thrombosis, also known as allergic myocardial infarction blood syndrome. "