It's not that hard to open a hospital in another world, right?

Chapter 1468 It's just a headache, can we not cut the heart?

"Say it, say it! I will do what you say!"

Hearing Gregory asking for his opinion, the old dwarf nodded quickly.Just kidding, the adults from Dragon's Nest are willing to treat him, which is to give him a big face and ask him to have a checkup. Is there anything he can't do?
And so far, it's just brushing him with a strange light (doing an electrocardiogram, measuring blood pressure, measuring blood oxygen, etc.);

Let him stand on a board and turn, hold and exhale as required (do head and neck CT, head and neck MRI);

Take a little blood from him (to measure blood sugar, blood lipids, etc.), hey, what is this little blood!

Gretel smiled.He directed the old dwarf to lie down, unbuttoned his jacket, and exposed his chest.Then, he couldn't help but let out an "ah":
By the way, savages have thick chest hair, I can understand;
Giants have thick chest hair, I can understand;

Even those knights in Nevis have black chest hair, which is thick, thick and long, and they need to be shaved clean to be a superstar, I can understand;
But you a dwarf!dwarf!You are playing with your brains, not your physical strength, so why do you need such thick chest hair!
Well... Married 4 wives, a total of 12 women, gave birth to more than [-] children, and it is not surprising to have such thick chest hair...

"You shave your chest hair first..." He stroked his forehead and waved his fingers.Alas, that's all for other parts of the hair. For heart protection, you can shave it or shave it.

What a waste of time when it comes time to do echocardiography!

"What?!"

The old dwarf folded his arms subconsciously.Before he could protest, two middle-aged dwarfs rushed forward, equalized his arms, poured water, wiped soap, waved the razor, brushed, brushed, brushed...

The decisive action, the quick handling, and the lightness and accuracy of the action are worthy of the dwarf known for his exquisite craftsmanship.

Gretel estimated that if a savage was asked to shave his chest hair, he would probably be covered with a lump of beeswax, and then he would tear it off when the beeswax dries, right?
Before Gretel could react, piles of black and white fur fell on the ground in piles.He only blinked his eyes a few times, the old dwarf's chest was clean and flat, and the stubble was scraped off...

Well, with such a chest, it is only comfortable to do cardio.Gretel applied glycerin, pressed the palm of his hand, and activated the B-ultrasound magic with ease.The eyes are slightly closed, the blood flow in the heart, vividly as in the present.

Well, there are microbubbles in the left atrium. Judging from the location, it should be the location of the atrial septum and fossa ovale, and there is a small right-to-left shunt.The bubbles are very small, and the defect is not too big. If you don't pay attention, you can hardly see it.

Gretel narrowed his eyes subconsciously.Stop for a moment and say softly:

"Listen to my words clearly, and do a set of actions in order.

——Take two deep breaths first, then close your throat tightly, and listen to me count to five. After counting, exhale vigorously, but still close your throat tightly to prevent the air from really exhaling.Understand? "

If this order was executed by barbarians, or ogres, I am afraid that most of them would have to blink their eyes randomly, then exhale and hold their breath.

The old dwarf thought about it carefully, but managed to take two deep breaths, raised his fingers on the bed, and counted five consecutively.Then I exhaled forcefully, said "Oops" again, and started all over again...

Tried back and forth twice, nodded lightly on the bed, and whispered: "Understood."

Gretel was quite relieved, and asked him to do it again. He felt that when he exhaled, there was no trace of gas coming out of his mouth and nose, and he had obviously learned it.

He paused for a moment to calm down the old dwarf and to restore the oxygen content in his blood.Seeing his face recover, he began to order:
"Breathe deeply!—breathe deeply!—five, four, three, two, one, exhale!"

Bang, bang, bang.After completing this set of movements, within three cardiac cycles, the microbubbles in the left atrium are particularly obvious!

"The foramen ovale is patent, diameter, 3mm..." Gretel said silently in his heart.

He opened his eyes and quickly looked at the old dwarf's figure. Based on the heart size seen in the echocardiogram, he calculated the ratio of the dwarf's heart to that of a human's heart, and the diameter of the foramen ovale was equivalent to the size of a human:

"Well...it can be almost 4mm...it's a relatively large one..."

It was also really a flash of inspiration.In his previous life, he was chatting with colleagues before a certain meeting. He once heard such a case from a colleague in God:
There was an old patient who suffered from repeated headaches, but no cause could be found.

Later, he came across an academic paper that pointed out that there is sometimes a correlation between patent foramen ovale and migraine, and that blocking the foramen ovale can help treat migraine...

Holding the status of a dead horse as a living horse doctor, this colleague asked for help from the Department of Cardiology, diagnosed the symptoms of patent foramen ovale, and persuaded (fudged) the patient to undergo a closure operation.

Later, the patient's migraine really got better!Excited, the patient actually gave him a pennant of "Rejuvenation with Wonderful Hands", never thinking about the relationship between heart surgery and headaches...

"Well, you may have found the cause of your headache." Gretel clapped his hands.It can be considered that he found it. He used his secret vision to see the whole body of the old dwarf, especially his brain, and he was sure that there was no energy accumulation:

He is really not good at energy conflicts!
In a comfortable mood, he didn't mind giving away a spell for nothing, and waved his hand in satisfaction.A cleansing technique rolled over, and the glycerin on the old dwarf's chest disappeared instantly——

This seems to be much better than the behavior of a scumbag who threw a stack of toilet paper and told him to "clean it yourself".Moreover, the efficiency is high, and the cleaning is relatively clean, which makes people feel comfortable.

The old dwarf's eyes widened immediately.Although Gretel said "it is possible to find it", his tone and attitude all revealed "I am very sure".He asked timidly:

"Found it?... What's the reason?"

"Well, your heart has not grown a little bit here." Gretel pointed at his heart, and then showed him a phantom shadow of the heart:
"It's a gap here. It was supposed to grow in ten days and a half months after birth, but it didn't fully grow. If it didn't grow completely, when the heart beats, blood would leak through it, which would cause you a headache. ..."

The old dwarf didn't understand half of what he heard, but seeing Gretel's full confidence, he couldn't refute.After struggling for a long time, he carefully asked:

"But the heart is leaking a little blood...why do you have a headache?"

This distance is very far!
Even if it leaks, it's still leaking in the chest, no matter what, it won't cause a headache!

Uh……

Well, there is one thing to say, the specific mechanism of patent foramen ovale leading to migraine is really unclear.Of course, there is speculation.

Most researchers believe that in the state of increased right heart pressure such as breath-holding and coughing, certain neurohumoral substances that can cause headaches enter the systemic circulation directly through the unclosed foramen ovale, causing migraine symptoms.

If the foramen ovale is closed normally, they should be directly metabolized and degraded in the pulmonary circulation.

But to explain this in detail, it is necessary to explain what is called pulmonary circulation and what is called systemic circulation; what are those substances, for example, what else is there besides 5-hydroxytryptamine, and their degradation and metabolism process...

"Research reports have shown that migraine is closely related to patent foramen ovale." Grete recalls now, and can still remember the colleague in God holding the journal and showing off to him triumphantly:
"Especially for migraine with aura, the probability of migraine with aura in patients with patent foramen ovale is as high as 46.3% to 88.0%, and the probability of migraine without aura is 16.2% to 34.9%. (1)

There is also increasing evidence that some ischemic strokes that were considered to be of unknown cause were later found to be associated with a patent foramen ovale.

——I'm thinking of making a suggestion to the higher authorities. In the future, when I see headaches of unknown origin, I will send everyone to have a color ultrasound of the heart! "

Now the world is separated, the voice and smile of that divine colleague, he can only recall silently in his mind-no, the person who traveled through is himself, it should be someone who recalls his voice and smile...

Gretel chuckled helplessly to himself.I couldn't speak clearly, and I wanted to convince the patient, so I had to put on a straight face, pretending to be majestic:
"According to my rich medical experience, your headache is most likely related to heart problems. As long as you do a small treatment to plug this gap, there is a high probability that your problem will be solved."

"...Do you need to cut the heart?" The old dwarf's face turned pale.He folded his arms subconsciously, tightly protecting his chest.

Thinking about it, it's not right, the master of Dragon Nest wants to cut his heart, can he still resist?I'm afraid that if you lie down obediently and let others slaughter you, you can keep the whole tribe safe, struggle and resist, and implicate the whole tribe!
Discouraged by this thought, he let go of his arms and lay back down like a salted fish, with only a pair of eyes staring at Gretel sadly, expecting him to change his mind.

Gretel sighed and said softly:
"It's not necessary to cut the heart. In fact, we try not to open the heart unless it is absolutely necessary. It will cause too much damage to the patient. If we can use other methods, we will use other methods."

It was fine if he didn't say anything, but after he said, "Try not to open the chest unless it is absolutely necessary", the old dwarf trembled all over his body, with sweat dripping from his forehead, cheeks, and his chest that had just been shaved.

If it is not a last resort, try not to cut your heart. Does that mean you will cut your heart when it is a last resort? !
No! ! !
Although when I got a headache, I kept saying "cut my head off", but now that the pain is gone, I still don't want to die! ! !

"This, this can..." Can it be cured?
"I'm afraid it still needs to be cured." Gretel sighed:

"There is a defect in the heart, if you leave it alone, there will be big problems in the future. For example... Congestion will flow into the brain, block the blood vessels in the brain, and lead to paralysis and death."

　(1) Lip PZ, Lip GY, Patent Foramen Ovale and Migraine Attacks: A Systematic Review: American Journal of Medicine, 2014, 127(5): 411-420

　　
　
(End of this chapter)