This Doctor is Great

After a ppt report, Zhou Mo made a small appearance on the ward round of Zhou Da.

It left an impression on many doctors.

This child is so terrifying, it must not be kept... Oh no, it should be - this beautiful boy!

but,

Zhou Mo is extremely eager to stay in the hospital, so he naturally wants to continue to express himself and make people continue to admire him.

Therefore, in the next ppt reports of other doctors, Zhou Mo has been listening carefully, looking for an opportunity to express himself.

6th...

8th...

10th...

finally,

The 11th, the doctor in charge of the ccu reported a case, and Zhou Mo found an opportunity!

……

The doctor in charge of the bed at ccu used PPT to report a special case of his bed to the professors.

Patient A, a 33-year-old male, was sent to the emergency department because of chest pain. The measured blood pressure was very low, 98/50 mmHg, and the electrocardiogram was diagnosed as myocardial infarction.

The so-called myocardial infarction is myocardial necrosis caused by acute and persistent ischemia and hypoxia of coronary artery.

In most cases, the coronary artery is blocked due to a blood clot, or the atherosclerosis is so severe that the coronary artery is too narrow and the blood flow is different, or the myocardial oxygen consumption is greatly increased or the coronary artery spasm...

It was reflected in this patient A. Because he was young, he usually did not have high blood pressure, nor did he have coronary heart disease, nor did he exercise vigorously, so it was basically suspected that a thrombus blocked the coronary artery and caused myocardial infarction.

So,

Yesterday, she was urgently sent to the Cardiology Department to prepare for coronary angiography + intervention to eliminate thrombus.

but!

A problem occurred!

When coronary angiography was performed in the Cardiology Department, it was found that there was no thrombus in the coronary arteries and no access stenosis.

In other words, it's not a heart attack!

However, the electrocardiogram showed a myocardial infarction.

ECG: Normally, the heart discharges continuously. When the electrodes of the ECG are placed on the chest wall, electrical conduction can be felt, and then recorded on the ECG. If there is ischemia and necrosis of the myocardium, their discharge must be poor. , you can faithfully reflect on the ECG chart, so as to capture useful information.

Moreover, after the blood test, the patient's troponin was significantly increased, and the diagnosis of myocardial infarction was basically a certainty.

Troponin is a protein that exists almost only in cardiomyocytes. Once troponin is elevated, it can be inferred that myocardial cell necrosis has ruptured, releasing troponin into the blood, so troponin can be detected. increased protein.

Now electrocardiogram + troponin all prompt: myocardial infarction!

But coronary angiography also denied myocardial infarction!

Contradicting itself!

So,

The inexperienced doctor of bed management was stumped by this patient A.

Then I made a ppt and reported on the big rounds this morning, hoping to get the teachings of the professors.

Patient A's case report is over...

Many doctors began to think.

Maybe I'm tired, maybe I want to test my subordinates,

At this time, Professor Qi, the chief director, no longer commented, but leaned on the back of the chair, smiled and encouraged: "This case is a bit interesting, everyone can speak freely..."

In the Department of Cardiology of the Second Provincial Hospital, because it is a major department, there are many doctors, and the leadership style, the internal competition atmosphere of the Department of Cardiology is relatively strong.

Every major round is an opportunity for lower-level doctors to perform, and it depends on whether any lower-level doctors can seize it.

The other professors and associate professors sat upright, not taking the opportunity to speak up from their subordinates.

Zhou Mo wanted to raise his hand, but someone was faster.

A resident raised his hand and said, "I think myocarditis can be considered. Myocarditis can lead to the destruction and necrosis of myocardial cells, which can naturally lead to an increase in troponin..."

As soon as he finished speaking, Zhou Mo was about to speak when another resident raised his hand and said quickly:

"I think in addition to myocarditis, aortic dissection and pulmonary embolism can also be considered...because pulmonary embolism and aortic dissection can also show symptoms similar to acute myocardial infarction, especially chest pain. Heart and lung are not separated, and sometimes lung problems It will affect the heart sideways, and all ECG changes are also possible..."

Zhou Mo was surprised.

I go,

In the fifth group, why are all the doctors like salted fish? During the ward rounds, it may not be so fierce to rush to answer.

Why, during the big rounds, I couldn't even get a chance to interject.

Too fierce!

Huang Yiming tugged at Zhou Mo's sleeve: "What? You want to speak too?"

Zhou Mo said in a low voice, "I don't have any requests from the hospital yet. I want to behave better so that the leaders can remember and stay in the hospital in the future."

"Ah?" Huang Yiming only reacted at this time, yes, Zhou Mo is different from himself, he has already signed an employee contract with the Second Provincial Hospital. But Zhou Mo is a free man.

"Come on!" Huang Yiming encouraged Zhou Mo.

Zhou Mo nodded.

Then,

Zhou Mo raised his hand many times, but he never grabbed anyone else.

A doctor Gupei said that it may be heart failure, shock...

Some resident doctors said that it may be a serious arrhythmia...

Say anything.

After about six doctors gave their speeches, the rhythm of the competition finally slowed down.

At this time, Zhou Mo finally got his chance.

"I think there is another possibility - broken heart syndrome."

"???"

"Broken Heart Syndrome?"

"TTC? Acute stress cardiomyopathy?"

As soon as Zhou Mo's words came out, many doctors were suddenly refreshed.

A refreshing and refined disease has appeared!

Fresh!

No longer the old-fashioned arterial dissection, pulmonary embolism, myocarditis, etc...

"This seems to be possible..."

"Broken Heart Syndrome, UU Reading www.uukanshu.com really fits well..."

Professor Qi's gaze couldn't help but look at Zhou Mo a few more times.

I won't say whether it's accurate or not, but the broken heart syndrome proposed by Zhou Mo has greatly broadened the doctors' horizons.

Broken Heart Syndrome, this is also a special type of heart disease that Zhou Mo has worked hard to make up for various diseases in the Cardiology Department in the past two days.

It comes from a research team led by Dr. Champion who treated 19 emergency patients between 1999 and 2003 with chest pains and breathlessness similar to those of a heart attack.

And, after the 119 incident in the United States, the researchers interviewed the relatives of 100 victims. It was found that these grieving individuals experienced periods of physical distress, a tight and dry throat, difficulty breathing, a need to sigh, an empty stomach, muscle weakness, and a feeling of heartache and tension.

Finally, the "New England Journal of Medicine" published an article by Dr. Champion, who described the disease as "broken heart syndrome."

It is rare in China, but it is estimated that most cardiologists know it, but it is easy to ignore it at ordinary times.

When Zhou Mo read about this case,

The bald whimsy:

Could Lin Daiyu's illness be this one?

Zhou Mo continued: "Broken heart syndrome, the symptoms of this disease look similar to acute myocardial infarction on the surface, but after the heart was tested, it was found that there was no coronary blockage. On the contrary, the appearance of the heart looked Like a balloon, it's caused by improper contraction of the bottom of the heart... So the patient can use this method to identify if it is broken heart syndrome... Also, you can ask him if he has been too distressed recently..."