When doctors have a simulated operating room

The most common cause of heart failure is heart failure.

What does Aslanger sign mean?

Aslanger sign is actually a general term for an electrocardiogram manifestation.

That is, 1. Isolated ST segment elevation in lead III, and no ST segment elevation in the other inferior wall leads;

2. ST segment depression in any lead of leads V4-V6, positive T wave or positive terminal part, no ST segment depression in lead V2;

3. ST segment in lead V1 is higher than that in lead V2.

Three in one, named Aslanger sign.

In contrast, once Aslanger sign appears in the electrocardiogram, it means that the patient may have severe multi-branch coronary artery lesions.

And acute inferior myocardial infarction with non-continuous multi-lead ST-segment elevation ECG changes.

If you only look at the ECG, most doctors will suspect Aslanger's sign.

That is, multiple coronary artery lesions, need to be quickly angiographic and operated.

But the problem is here.

Zhang Yi's eyes can see the patient's heart directly.

In Zhang Yi's eyes, this person does not have coronary artery sclerosis!

And there is no blockage in the coronary artery branches!

This is the most strange thing! !

No sclerosis, no blockage, then why is the myocardium ischemic for no reason? ?

The patient is still so young and not fat, the possibility of coronary artery sclerosis is very low.

Why is that? ?

Suddenly, Zhang Yi thought of something.

He looked up at the blood pressure in the ECG monitor.

The blood pressure doesn't seem to be high!

"What was the patient's blood pressure when he was admitted to the hospital just now?" Zhang Yi asked the nurse next to him.

"Just admitted? It seemed to be only 78/56 when you were just admitted. It is said that he was given an adrenaline in the ambulance, and now it has risen to 90..."

Zhang Yi frowned: "The blood pressure is so low?"

"Yes."

"Doesn't the patient have low blood pressure normally?"

"It seems not. The family member just said that the patient is usually fine and is a very healthy person."

When the nurse finished speaking, Chen Fang had already brought the family member in at the door of the emergency room.

The family member was a woman, a very young girl.

She looked a few years younger than Zhang Yi.

"Are you a family member?" Zhang Yi asked.

"Yes, yes, yes! I am Li Junyu's wife! Woo... Doctor, how could my husband suddenly become like this... Woo... Please save him!"

The family member had tears on his face, crying as he spoke, and I felt pity for him.

At this moment, the patient on the bed was still unconscious and still gasping for air.

After breathing oxygen, the symptoms were slightly better, and the pulse oxygen was not as low as before.

Before asking about the situation, Zhang Yi asked Chen Fang to notify the angiography room. This person still needs an angiography.

Zhang Yi can see that he does not have coronary artery sclerosis, but others cannot see it.

So the necessary examinations should be checked.

"Family members, time is urgent. I am asking you questions now, you'd better answer me truthfully."

Zhang Yi looked serious, and the family members nodded with tears: "Okay, doctor, you ask, I will tell you everything I know!"

"Does Li Junyu have a history of other chronic diseases? Low blood pressure? Heart disease? Coronary heart disease?"

"No, no, he is only 27 years old! How could he have these diseases?"

The family members shook their heads again and again, as if they had heard something unbelievable.

"Are you his wife? How long have you been married? Where are his parents?"

"His parents are at home. I've called them. They should be here soon."

"Has he ever had this kind of chest pain before?"

"No! Not only that, this was the first time he was taken to the hospital by ambulance... Woohoo... So scary... We were at home at the time... And then... He suddenly said that his chest was a little stuffy and he looked very uncomfortable.

Then he screamed in pain within a few minutes, and then I couldn't wake him up.

I immediately called 120, and then he was in the hospital... Woohoo..."

"Suddenly had chest pain at home?"

"Yeah! Yes!"

At home...

They were still a couple...

"Wait, did he do any strenuous exercise before the chest pain? What did you eat for lunch?"

"Strenuous... strenuous exercise? Well... what did we do at home before the chest pain..."

Speaking of this topic, the family member was a little embarrassed.

In front of the entire emergency room, especially in front of several male doctors, he said that he

My private life...

It's really embarrassing!

Zhang Yi understood. What else can there be between husband and wife except that matter?

Then, Zhang Yi had a vague answer in his mind.

Normal chest pain, and diseases with Aslanger sign on the electrocardiogram are mostly related to coronary heart disease.

But, there is one that is not.

Myocardial infarction can be divided into 5 types.

Type 1, which is the most common, is a series of coronary thrombosis caused by coronary atherosclerosis, which leads to myocardial ischemia and infarction.

Type 2, which is relatively rare, is caused by the imbalance between myocardial oxygen supply and oxygen demand, such as hypotension, arrhythmia, hypoxemia, etc. It is also the only myocardial infarction among the 5 types that is not related to coronary atherosclerosis and thrombosis.

Type 3 refers to cardiac death with myocardial ischemia symptoms and new ischemic electrocardiogram changes or ventricular fibrillation. This kind of death is relatively sudden, and it takes an autopsy to confirm that it is myocardial infarction.

Type 4, including myocardial infarction related to percutaneous coronary intervention, myocardial infarction related to coronary stent or support thrombosis. It is also related to coronary sclerosis, but it is a myocardial infarction that still occurs after treatment.

Type 5, myocardial infarction related to coronary artery bypass grafting (grafting). For example, if myocardial infarction occurs again within 28 days of the first myocardial infarction, it is called reinfarction, and after 28 days it is called recurrent myocardial infarction.

The above are the five types of myocardial infarction.

The patient in front of you does not match the other four types, except type 2!

Type 2 belongs to non-obstructive myocardial infarction.

Now let's go through the situation of this young man from the beginning, and the cause will be clearer.

First of all, the patient had no history of low blood pressure and chest pain before.

This is the first time he was taken to the hospital because of chest pain and lost consciousness, and his blood pressure was still very low when he was admitted to the hospital.

It can be considered that this patient did have chest pain caused by low blood pressure or arrhythmia.

Because the patient did some "exercise" before the chest pain!

Now, let's look at the patient's electrocardiogram.

It's neither Aslanger's sign nor coronary artery sclerosis...

But the ST segment is so ridiculously low...

"Family member, I'll ask you another question, answer it truthfully."

"Yes."

"Did you take medicine before doing that exercise?"

The family member's eyelids jumped, and he looked at Zhang Yi as if he had seen a ghost!

——

Damn, how can this doctor be so amazing? ?

He can know this? !

"Medicine... medicine?!"

The family member muttered hesitantly.

"Yes! Medicine, you should know what medicine I'm talking about. Have you taken it before sex?"

As soon as Zhang Yi asked this question, several other doctors around him immediately reacted.

Damn! !

What's the situation with Zhang Yi? ?

Instead of suspecting coronary artery atherosclerosis, he suspected taking medicine? ?

We are all doctors, so we naturally know what Zhang Yi meant by asking this.

Wei Ge, also known as Viagra.

Some couples take this drug to seek excitement before sex.

The main ingredient is sildenafil citrate.

It is a drug for treating male bo and qi dysfunction.

In addition to dizziness, headache, nasal congestion, and indigestion, the side effects of this drug are more serious, such as low blood pressure and blindness, and even more serious, direct shock.

So this thing is a medicine, not a "health product", and it cannot be taken often or eaten too much!

The reason why Zhang Yi asked this question is that he suspected that the male patient took Viagra before sex, which caused acute hypotension and caused such a non-obstructive myocardial infarction of the coronary artery.

But this situation is too rare...

The angiography has not been done yet, and even the blood test report just now has not come out.

You just ask like this? ?

Aren't you afraid of misleading the family members?

What if it turns out that it is not this in the end, how will you explain it to the family members?

Doctors have to be cautious in every word they say!

Because you have to take responsibility!

The family member finally nodded after hesitating for a long time:

"It seems... it seems that he took it... but does this medicine... have anything to do with his chest pain?"

Zhang Yi took a long breath and looked at the eyes of the doctors around him.

Everyone seemed to remind Zhang Yi not to be so decisive and not to make a conclusion about the patient too early.

Okay.

They can't see it, so they can only know after the test results come out.

Zhang Yi simply said it in a roundabout way:

"At present, I am just suspicious, because some male function drugs containing sildenafil citrate have one of the side effects of low blood pressure, even arrhythmia and shock.

So since he has taken this medicine, it doesn't matter.

This possibility can be ruled out.

Of course, the most important thing now is to raise the blood pressure first, and then send him for angiography immediately to see what is going on inside the heart and blood vessels.

If there is indeed coronary artery obstruction, we will immediately perform thrombolysis or interventional surgery on him. "

"Ah?!"

When I heard that this disease might be related to the medicine he took!

The family members couldn't stay calm!

Immediately grabbed Zhang Yi's hand and told the truth.

"Actually, doctor! My husband... He really likes excitement. He takes the medicine you mentioned once or twice a month!"

As soon as these words came out, the doctors next to him couldn't stay calm.

Especially Chen Fang!

Good boy, I'm thirty and I haven't taken it, but you're only twenty-seven and you take it every month!

That's awesome~!

"Take it every month? ! Does he usually have any stomach discomfort or dizziness? "

The family member shook his head: "No... I didn't see him feel uncomfortable at ordinary times. Today is the first time he was taken to the hospital by ambulance... Woohoo... Doctors, please save him!

He...he took two pills of that medicine today...so..."

"What? ! Two? !"

"Two Viagra? ? !"

Zhang Yi frowned!

Good guy, you are just saying it now? ?

If I don't interrogate you, you are going to keep it to yourself, right? ?

Zhang Yi closed his eyes helplessly and ordered:

"Bring the electrocardiogram here, I'll take another one to see, and give another set of pressor drugs! ”

At this time, almost twenty minutes had passed since the patient was admitted to the hospital for treatment.

Because he had used an epinephrine before, the patient's condition has improved slightly.

This is also one of the reasons why Zhang Yi suspected that it was related to Viagra.

So in terms of treatment, the first rescue measures are fluid replacement, blood pressure increase and oxygen inhalation.

Once the blood pressure rises, the patient's symptoms can be relieved a lot.

Chen Fang took the bedside electrocardiograph.

The limb leads clamped the patient's limbs respectively, and then opened the shirt and attached the six electrocardiogram leads to the patient's heart, which is about the position between the fourth and fifth ribs.

Then press the start button directly, and the electrocardiogram will be printed out from the valve port on the electrocardiograph.

Look at the electrocardiogram paper that is slowly printed out.

The electrocardiogram on it is completely different from the electrocardiogram when the patient was just admitted to the hospital.

"Huh? The ST segment has risen, not as low as before. "

Chen Fang stood beside Zhang Yi, watching and talking.

At this point, the other doctors around him all showed an expression of sudden enlightenment!

Oh my god!

No way??!

Wasn't Zhang Yi right again?!

Is this man's infarction really not caused by coronary sclerosis??

But an acute non-obstructive infarction caused by taking Viagra??

Hiss...!

Zhang Yi glanced at the electrocardiogram, and the answer in his mind became more and more certain.

Then he looked up and said to the family:

"Now there is basically an 80% probability that it can be diagnosed as non-obstructive coronary myocardial infarction.

Of course, we still need to do another angiography to see if there is any hardening in the blood vessels. This is for insurance purposes and for the sake of the patient himself.

I will continue the infusion later. When the blood pressure rises a little more, his condition should be almost healed. "

"Really? That's good, that's good! Thank you, doctor! "

The family members nodded in tears.

Sure enough, ten minutes later.

Under the effect of drug treatment, the patient's blood pressure rose back to 115/76mmhg.

At this time, Li Junyu no longer had unconscious gasping, and the sweat on his forehead was almost dry.

Although he was not awake yet, he was almost out of danger.

Chen Fang immediately arranged for the nurse to send him for angiography.

It just so happened that the results of the blood test when the patient was first admitted to the hospital came out.

High-sensitivity troponin: 708.3pg/ml (0-17.5pg/ml)

Creatine kinase isoenzyme: 37U/L (3-35U/L)

Creatine kinase: 340U/L (10-190U/L)

All three emergency myocardial indicators indicated that the patient had acute myocardial infarction.

"After the patient has completed the angiography, wait for two hours until the situation stabilizes and then check the myocardial enzyme spectrum again."

"Okay. ”

It is true that the patient has myocardial infarction.

But the question is what caused the myocardial infarction, which is very important.

The cause of the disease can determine what medicine the doctor uses to rescue.

If the infarction is caused by coronary artery sclerosis, then the patient may die in ten minutes, even if the vasopressor is used and the surgery is not performed quickly.

For coronary artery sclerosis, only thrombolysis or interventional surgery can cure the patient.

Can survive.

But this Li Junyu is not.

Because after taking a blood pressure medicine, he not only survived, but his condition also improved.

This is one of the clues that Zhang Yineng was diagnosed with non-obstructive infarction.