I really don't want to be a doctor

Chapter 165 The Significance of Chest Pain

"Doctor, does my mother need to be hospitalized immediately?"

The female family member pulled Zhu Zhu to a small corner at the door of the intensive care unit, her eyes were a little erratic.

With a serious expression, Zhu Zhu handed her a copy of the informed consent form in his hand to enter the intensive care unit of the cardiology department.

"According to the current situation, the patient must be hospitalized. And once the diagnosis is acute myocardial infarction, emergency interventional surgery is required."

Zhu Zhu introduced the concept of acute myocardial infarction to the female family members, and fully explained the necessity and risks of interventional surgery.

"Doctor Zhu, well, how much is the interventional surgery likely to cost?"

"If you just do imaging without a stent, it only costs about 1 yuan; a heart stent, a domestic stent, costs less than [-] yuan."

The female family member nodded slightly: "Dr. Zhu, then I understand, I agree that my mother should be admitted to the cardiology intensive care unit."

"Okay, don't worry, we will arrange an inspection immediately."

Zhu Zhu signed his name on the admission informed consent form, and then ordered Jing Xiaoran to push the patient into the intensive care unit of the Cardiology Department.

There are 23 beds in the intensive care unit of the Department of Cardiology.

"Xiao Jing, this patient with myocardial infarction is getting ready to go on stage." Teacher Cao, "After the nurse finishes taking blood, you and Xiao Li will push the 23-bed patient to the catheterization room."

"Yes." Li Wenlin said, "Teacher, do I need to bring a normal purple tube (troponin)?"

"Bring a tube." Teacher Cao nodded, "But we don't have to wait for the results of the purple tube. We wait for the nurse to take the blood and push the patient onto the stage, otherwise it would be a waste of time."

In acute myocardial infarction, if a patient's ECG changes and has symptoms of ischemia such as chest pain, he can directly intervene without waiting for the results of troponin, so as to save the patient's dying myocardium as much as possible.

"Ok."

……

Jing Xiaoran kept recalling the entire consultation process in his mind, but he still didn't find any doubts, but somehow, he was still a little uneasy.

"Chest pain... Chest pain..." Jing Xiaoran murmured in his heart, "If you change your mind, instead of starting with the patient's medical history, just look at the disease of chest pain..."

Chest pain, which is a very important symptom in cardiology!
If a patient complains of chest pain, at least three major diseases must be considered, and these three diseases must be excluded at the first time.

As for other diseases, we can slowly diagnose and treat them later.

These three diseases related to "chest pain" are acute myocardial infarction, aortic dissection, and pulmonary embolism!

Acute myocardial infarction, due to hypertension, hyperlipidemia, diabetes and other reasons, can cause coronary atherosclerosis that supplies the heart's own blood, so that the coronary artery lumen is narrowed, the oxygen supply and demand of the myocardium are unbalanced, and lactic acid produced by anaerobic metabolism, etc. Metabolites stimulate nerve endings in blood vessels, producing pain.

Aortic dissection, aortic dissection refers to the blood in the aortic lumen enters the aortic media from the aortic intima tear, separates the media, and expands along the long axis of the aorta to form a true and false two-chamber separation of the aortic wall state.This disease is rare, with an incidence rate of 20/50 to 70/2 per year, the peak age is 3-1 years old, and the ratio of male to female is about 65-70:[-]. [-]%-[-]% die of cardiac tamponade in the acute stage , Arrhythmia.

Pulmonary embolism is a clinical and pathological syndrome caused by pulmonary circulation disorder caused by foreign thrombus blocking the pulmonary artery or its branches.Pulmonary hemorrhage or necrosis is called pulmonary infarction.

Typical symptoms of pulmonary embolism are chest pain, difficulty breathing, and coughing up blood.

At present, the female patient does not have any symptoms of dyspnea, and does not have any source of thrombus, so the probability of pulmonary embolism is very small.

"Could it be an aortic dissection?"

There was a light in Jing Xiaoran's eyes.

Of course, the best case is not any of these three.

"However, if it's really aortic dissection, it would be terrible." Jing Xiaoran thought.

Because the treatment methods of acute myocardial infarction and aortic dissection are completely opposite!

Acute myocardial infarction is the blockage of blood vessels in the heart by thrombus, resulting in myocardial ischemia and hypoxia. Therefore, anticoagulant drugs are needed for acute myocardial infarction to prevent the damaged blood plaque from coagulating again.

In aortic dissection, the blood in the aortic lumen enters the aortic media from the aortic intima tear, and blood coagulation drugs are needed to coagulate the blood and prevent bleeding.

In other words, acute myocardial infarction requires anticoagulant drugs, and aortic dissection requires coagulation drugs.

Once the patient is pushed onto the intracardiac interventional operating table, anticoagulant therapy will be started immediately; at this time, if the patient is found to have aortic dissection, it will be terrible, and the patient may not be able to get off the operating table!

……

"Auntie, how much is your blood pressure usually controlled? What antihypertensive drugs do you usually take?"

Jing Xiaoran thought for a while, then said to the patient lying on the hospital bed.

"I don't have a sphygmomanometer at home, so I come to the hospital for examination every time." The patient said, "I take Zhenju Antihypertensive Tablets."

Zhenju Jiangya Tablets, the main ingredients are pearl layer powder, wild chrysanthemum powder, rutin, is a Chinese patent medicine.

"So you don't know your blood pressure either?"

"Ah."

Jing Xiaoran hesitated for a moment, then brought the electronic sphygmomanometer over.

"Junior brother, didn't we measure the patient's blood pressure just now? Her current blood pressure is 162/102mmHg."

Li Wenlin asked curiously.

"Sister, let me measure the blood pressure of the patient's other limb."

Jing Xiaoran had already tied the cuff of the blood pressure monitor to the patient's arm.

"Blood pressure on the other side?" Seeing this, Li Wenlin immediately understood what Jing Xiaoran was thinking, "Junior brother, do you suspect that the patient has aortic dissection?"

Jing Xiaoran nodded slowly.

Aortic dissection can be manifested as a significant blood pressure difference between the upper and lower extremities or an excessive blood pressure difference between the upper and lower extremities.

The aortic arch gives off three major branches from the right rear to the left front: the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery.The arteries of the right upper extremity mainly originate from the brachiocephalic trunk, and the arteries of the left upper extremity mainly originate from the left subclavian artery.

Inconsistent blood pressure in aortic dissection is due to pressure on the branches of the aortic arch or left and right iliac arteries, or blockage by intimal lobes, resulting in reduced or interrupted arterial blood supply to one side of the limb.

"But according to the current electrocardiogram results and the patient's symptoms, there is a high probability that it is a myocardial infarction."

Li Wenlin arranged several electrocardiograms together, "The ST elevation of the inferior wall lead indicates that the patient's right coronary artery or circumflex artery is blocked. If it is aortic dissection, how to explain the abnormality of these results?"

"I just think there is a possibility in this regard." Jing Xiaoran said, "There is no direct evidence for now."

"Oh."

Jing Xiaoran finished measuring the blood pressure of the patient's other arm, which was 154/90mmHg.

"Look, the difference in blood pressure between the two limbs is not that big." Li Wenlin said, "I think it's still a heart attack."

(End of this chapter)