Gou is practicing medicine in the clinic

Chapter 69 Successful Diagnosis
In addition to viral myocarditis and fulminant myocarditis, virus infection of the heart can also cause infective endocarditis.

Li Jingsheng has now ruled out the possibility of myocarditis, because many symptoms do not match, so there is only the last possibility left, the patient has infective endocarditis.

First, the site of myocarditis is the myocardium, while the site of endocarditis is the endocardium, and the valve is the most commonly affected site.

When he auscultated the patient, he heard the rough and loud heart murmur. With his proficient diagnostic skills in cardiovascular medicine, he was sure that if it was only a slight valvular insufficiency, it would not be possible to cause such a loud noise.

It shows that the valve is not only incompetent, but also may be damaged after the virus invades.

From the analysis of symptoms, after the endocardium is infected by viruses or bacteria, the fever is usually not obvious in the early stage, and the fever will not start until the disease progresses.or intermittent low-grade fever.

The heat course is usually long, and the heat pattern is irregular. At the same time, it may be accompanied by night sweats, loss of appetite, joint pain and other symptoms.

Heart murmurs are often heard and appear rough and loud because of damage to the valves.

This is also highly consistent with the patient's symptoms.

In addition, the progression of infective endocarditis is milder than that of fulminant myocarditis.

It often has prodromal symptoms before the onset.

This is also highly consistent with the progress of the patient's disease.

Through repeated deduction, Li Jingsheng gradually clarified the cause of the patient.

"Under normal circumstances, diarrhea will not lead to infective endocarditis. Because the heart has a relatively strong defense network. But the patient's valve itself is incompetent, which gives the virus unlimited opportunities. Diarrhea is often caused by pathogens invading the human digestive tract, such as the most common Escherichia coli, Salmonella and so on.

The patient's chest pain started on the second day after diarrhea and gradually worsened thereafter.

It shows that the virus that causes diarrhea is likely to invade through the insufficient heart valve, eventually causing infective endocarditis. "

After layers of syndrome differentiation, Li Jingsheng finally figured out the patient's pathogenesis and cause.

After clarifying the etiology and pathogenesis, there is a more difficult task, which is to persuade the patient to go to a large hospital overnight for further examination and treatment.

After about ten minutes, the programmer buddy walked out holding the wall.

Seeing this situation, I almost collapsed.

It seems that his diarrhea is still quite serious.

"Doctor Li, I'm sorry to keep you waiting. I don't have a serious heart problem, right? Why don't you give me some antidiarrheal medicine? I'll be at the office at six tomorrow morning, because the boss wants to finish the project by eight. .”

The patient becomes weak when speaking.

Severe diarrhea is most prone to dehydration and electrolyte imbalance.Timely replenishment of water is very important.

Some people have diarrhea and think that drinking water will aggravate diarrhea, but there is no scientific basis for this.On the contrary, if you don’t add water, you will have many adverse reactions after dehydration, which is extremely harmful.

Another point is that diarrhea is actually a self-protection mechanism of the body.

It excretes a large number of viruses and necrotic tissue cells through diarrhea, which is very beneficial to physical recovery.

Just like the few days when a cold patient is about to recover, there will always be a lot of purulent nasal discharge.

That can also be understood as detoxification.

"Just now I carefully sorted out your condition, course of disease, symptoms, and causes of the disease, and I came to a very serious conclusion. First, I suspect that your heart valves are incompetent. Second, I suspect that the bacteria that caused your diarrhea have already passed away. Infection of the inner lining of the heart causes severe damage to the heart valve. Third, your course of disease is still progressing rapidly, which may cause sudden cardiac death or cardiac arrest at any time.

To sum up, I strongly recommend that you immediately go to a large hospital for overnight treatment, and go to the emergency department directly.

This is my preliminary diagnosis result and suspected cause. I have written them down. After you go to the emergency room, if the receiving doctor doesn’t pay attention to it or asks you to wait in line for a long time, you can directly show this to the nurse or doctor. , they should open a green channel for you. "

Li Jingsheng has worked in a large hospital and is very clear about the emergency mechanism.

A doctor who works the night shift at night, and may sometimes be an intern.

The diagnosis of cardiovascular medicine itself is extremely difficult. If this guy is unlucky and meets an unreliable doctor [-], he will check him casually, and then say, "It's nothing serious, prescribe some medicine, go home and rest. Unwell follow-up."

This buddy must trust the diagnosis opinions of the doctors in the compound more.

Coupled with eagerness to work.

At that time, nine out of ten will go home to take medicine and rest, and the consequences will be disastrous.

Li Jingsheng wrote down his thoughts on diagnosis, as long as the doctor who received the diagnosis did not take human life as nothing, it would definitely attract some attention.

At least this buddy will be further examined, and even the superior doctor on duty will be consulted.

"Yes, is it that serious?"

The patient could not understand those technical terms, but from Li Jingsheng's serious expression and dignified tone, he could feel that the problem was serious.

"I dare not say that my diagnosis result is 100% correct. At least I strongly suggest that you do as I said. This is not far from the Second Hospital, you can just take a taxi and go there. I suggest that you better not walk there. In your current situation, you must avoid overwork, otherwise you will increase the burden on your heart, and your condition may deteriorate rapidly. At that time, the difficulty of treatment will be greatly increased, the cost of treatment will be multiplied, and the treatment time will also be greatly extended. "

Li Jingsheng replied seriously.

"Then... alright! I'll listen to you, I'll take a taxi to the hospital right now."

The patient was a little scared by what he said.

It's about life, it's impossible not to take it seriously.

"It must not be delayed. The sooner you get to the hospital, the better. Also, if your family members are here, you'd better inform them to come over. If there are no family members here, you can find a trustworthy friend."

If surgery is to be performed, family members must sign and accompany it.

Although Li Jingsheng is relatively new to the extra-cardiac field, the patient's heart valve is incompetent and the sound is so loud, the possibility of surgery is extremely high.

"Ok, thank you!"

The patient nodded gratefully to Li Jingsheng and walked outside.

After going out, he quickly opened the glass door and poked his head in. "Doctor Li, can I go to work at six o'clock tomorrow morning?"

"Don't think about going to work, life is the most important thing. Besides, after the examination at the big hospital, if there are no major problems, you can definitely go back to work. If you have any problems, ask the boss for leave directly, and the boss will understand you of."

It's not easy for every fighter.

This buddy has become so sick, and what he thinks about in his mind is still whether the work can be completed in time.

"okay, bye!"

The patient really left this time, stopped a taxi outside the door, and got in.

Li Jingsheng heaved a sigh of relief when he saw this, and a smile appeared on his face.

He wasn't upset about losing a business selling antidiarrheals.

On the contrary, he was very pleased, and he hoped from the bottom of his heart that this young man who was struggling alone in the big city would be safe and sound.

After reading the medical diagnosis statement written by Li Jingsheng, what would the receiving doctor of the big hospital think?
First of all, it must be questioned, can a doctor in a small clinic diagnose difficult diseases in the Department of Cardiology?
Then after the results came out, if the patient was really diagnosed with infective endocarditis, the doctors in the compound would probably only be shocked.

(End of this chapter)