1865 It's good that you don't stop taking the medicine.
“What’s wrong? Your heart is not good?” Zheng Ren asked.
“He has left ventricular fibrillation and heart failure,” Su Yun said,”if this was in the United States, he would definitely be on the list of people waiting for a heart transplant and would have to wait in line for a donor.”
“When using an ultrasound to determine left ventricular saturation, we need to combine it with an electrocardiograph, or else the error will be greater.” Zheng Ren was still looking at the x – ray, but he was talking non – stop.
“There was a case report in New England that the patient had obvious low limb voltage, and the amplitude of the QR wave was even lower than the P wave.
Electrocardiography seemed to be difficult to associate with left ventricular saturation, but ultrasound showed that there was significant left ventricular saturation. In the end, through MRI and biopsy tests, she was diagnosed with ‘myocardial Haidian people’.”
“Boss, you’re a doctor from the General Surgery Department. Why do you have to do so much research on our cardiothoracic Department?” Su Yun didn’t refute. He knew about this too.
It seemed that he had to be more careful when talking to the boss in the future. Otherwise, if he caught a flaw, he would be rendered speechless.
He was thick – skinned in other subjects, so he didn’t care. It would be embarrassing if his heart was criticized by his boss.
Su Yun thought to herself.
“It’s different. ” Zheng Ren said,”the contradiction between electrocardiography and ultrasound in the diagnosis of left ventricular bouncy is that the mechanism is different.”
The former reflected whether there was obesity in the heart through heart’s electrophic reflex activity, while the latter was evaluated through subjective measurements of the heart wall.
MRI scans on the heart were expensive, but its repeatability, sensitivity, and tissue – specific were obviously better than the first two, which helped in the identification of the cause. But there are only a few cardiac MRI scans in the country, right?”
“You think this is Sea city? Now, even provincial – Level cities have heart MRI scans. ” Su Yun caught the loophole in Zheng Ren’s words and started to look down on him.”It’s just that the price is a little more expensive, ranging from 6000 to 10000 Yuan.”
“Oh, that’s pretty good.” Zheng Ren put down the x – ray and started to look at the test results.
“The electrocardiography of the patient is really good. Many domestic and foreign hypertension guidelines recommend electrocardiography as a method to detect left ventricular engorgement, but the sensitivity is low. The sensitivity to mild, medium, or severe left ventricular engorgement is 7% to 35%, and 30% to 60%, respectively. “
Su Yun said as she looked at the patient’s ECG.
“We can’t be so arbitrary. Compared to sensitivity, its uniqueness is higher. The diagnosis of severe left ventricular engorgement is specific as high as 80% to 90%. Obesity may affect the diagnosis of left ventricular engorgement on the electrocardiogram, which will increase the rate of missed diagnosis. “
“Speaking of sensitivity, the sensitivity of left ventricular engorgement diagnosed by ultrasound is higher than that of electrocardiograms. After correction, left ventricular Quality Index can be detected. The most commonly used LVMI is to use the worms to divide by the surface area, using the Devereux correction formula … You know the Devereux correction formula, right?”
Zheng Ren looked at the test report and asked casually.
“Boss, I’m the future star of the cardiothoracic Department. Who are you talking to?” “The Devereux correction formula,” Su Yun said disdainfully.”I can do mental calculations.”
“Brother song, does the patient’s family have the money for treatment?” Zheng Ren suddenly asked.
“There is.” Song Ying did not understand what Zheng Ren meant.
Boss Zheng and Su Yun had been talking about technical terms for a long time, but Song Ying did not understand anything about the Devereux correction formula.
Even a clinician like Chang Yue could only listen to the Thunder like a duck, let alone him.
But why did boss Zheng ask the patient’s family if they had plans for treatment?
“It’s like this. The liver isn’t a big problem. The main problem is the heart. ” “It’s a heart problem. If we were in the United States, we would have already prepared for a heart transplant. However, you know our situation. There aren’t many heart donors in a year, and the old man’s body definitely can’t last that long. “
Song Ying frowned. He did not understand what Zheng Ren was saying.
Zheng Ren thought about it and felt that there was a problem with his logic. After all, Song Ying did not have a medical background. With his talent, he could more or less know some relevant information by searching online.
However, if he were to really tell him about the patient’s condition, he would have to start from the beginning.
“Then let’s start from the beginning.” Zheng Ren picked up the test sheet and said,”the medication includes apexasappen, bumetani, dilathizhuo, aspirin, amiodopone, and midodolon saline.” Other than shortness of breath, the patient’s vital signs are within the normal range. “
“My medical records show that the old man has had arrhythmia for 30 years, and he has been taking amiodopone for treatment.”
Song Ying nodded. He had done some research on the old man’s medical records before he came.
After all, it wasn’t good to go to boss Zheng’s house to watch a movie and not understand anything. It was necessary to leave a good impression on boss Zheng.
“Liver function is abnormal. Amino shifter enzyme: 176U/L, asparitimin enzyme: 236U/L, alkaline everybody else enzyme: 104U/L, hemoglobin levels: 1.5mg/dL, and albumin levels: 2.6g/dL. I reckon that the local doctors mobilized the patient to do a CT scan of the liver because of this, and they discovered the problem in the end. “
“There’s no intravenous angiography. This is what we often call enhanced imaging. However, the CT scan of the abdomen showed that the liver was very bright, like a light bulb. The CT scan of the abdomen showed that the liver density was& gt, 100 Hounsfield units, taking into account the large amount of dense radioactive material deposits in the old man’s liver. “
“…” Song Ying was a little stunned when he saw that Zheng Ren did not take the shiny liver seriously.
“These substances are actually just deposits after the metabolism of the drug. It’s not a big deal.” Zheng Ren said very calmly,”amband is a type of heart – fighting abnormal drug.” It is a slightly non – competitive type of alpha and beta adrenaline receptor inhibitor. It also has mild I and II anti – arrhythmic properties. “
“I won’t go into the specific drug mechanism. Simply put, as the name implies, amiodopone contains iodine.”
Song Ying finally understood this sentence.
Song Ying knew that there was iodine in the contrast agent. That was why the enhanced CT scan would light up the organs that were needed while providing more information to the doctor.
“On the molecular level, iodopone contains two iodine atoms, which accounts for 40% of its molecular weight.
In addition, iodopone was deposited in the body for a long time due to its long half – life. According to research, its half – life was between two to four months. Due to the pH gradient, amiodopone and polar cholesterol formed a watered – down bond, so amiodopone molecules were captured in the lyososome.
This way, iodopone can escape the decomposition of the phosphate enzyme and stay in the cell for a longer time. “
Zheng Ren explained it bit by bit.
“I heard that even after stopping the medicine for half a year, the blood Medicine’s concentration can still be tested.” Su Yun added.
“Yes, that’s basically it.” “This liver is caused by the accumulation of iodine after long – term oral iodopone,” Zheng Ren said.
“It’s not a big problem. He’ll gradually recover after taking the medicine. However, the main problem is still the heart. “