Crazy Psychologist

Where the doctor needs this needle to go is the coronary arteries. To put it simply, it is to follow the vine, the coronary artery is the vine, the femoral artery, abdominal aorta, thoracic aorta, aortic arch, etc. are all the vine.

After the guide wire enters the coronary artery, a catheter is placed along the guide wire, and then the contrast agent is injected into the catheter. Once the contrast agent enters the coronary artery, X-rays can be taken so that the direction of the contrast agent can be clearly seen.

The thrombus cannot be seen under X-ray, but the contrast agent can be seen. If the contrast agent stops abruptly at a certain place, it means that this place is blocked. It is probably blocked by a thrombus and the blood cannot pass. Naturally, he can't get through the drug.

The principle of coronary angiography is this, and it is not very complicated.

Muchun was completely confused when he saw the results of coronary angiography.

Sometimes chest pain may be related to other diseases. Pulmonary embolism may also show symptoms similar to acute myocardial infarction, especially chest pain.

Anyone who studies medicine knows that the heart and lungs are not separated. Sometimes lung diseases can also affect the heart laterally, and changes in the electrocardiogram are also possible.

Although troponin is unique to cardiac muscle cells, elevated troponin usually indicates myocardial cell rupture and necrosis, but it is not necessarily caused by coronary artery blockage, ischemic necrosis, or myocardial necrosis caused by other diseases. Cell destruction and death, such as myocarditis.

Clinically, it is sometimes necessary to differentially diagnose myocardial ischemia and myocardial infarction.

If the heart is compared to a house, the coronary arteries are the water pipes of the house, the electrical conduction system of the heart is the wires of the house, and the cardiomyocytes are the walls of the house. Now there is a problem with the house and it cannot be inhabited. It may be that the water pipes are rusty and blocked, causing the water to be cut off. It may be that the wires are short-circuited and the power is cut off. It may also be that the walls are cracked and there is air leakage.

In order to rule out other diseases, Qiutong had already completed a chest CT scan + contrast enhancement when he was sent to the intensive care unit. The results showed that everything was normal, ruling out the problem of pulmonary embolism.

Qiutong's vital signs are still in a critical state, but the experienced Deng Li is hesitant.

"Doctor Muchun, what's going on?"

In the middle of the night, in the emergency room, Nurse Ding Feng and Dr. Deng Li were both confused.

Either consult a doctor immediately, but Deng Li himself is the director of the Department of Cardiology, so who should he consult?

Interventional surgery is definitely not possible. Qiutong's blood pressure is still unstable, and her heartbeat continues to be between 115 and 120 beats per minute. If a blood test is performed, the troponin value may be higher than before.

"Doctor Muchun."

If Qiutong died like this, who should be responsible for this matter?

Public opinion may say that Qiu Tong died innocently. After the police restore the facts, who will sympathize with Qiu Tong?

Why do you do this? What weird means were used to make the girls become tools of hatred.

"Now we can only continue to observe, do some conservative treatment, and try to stabilize the patient's condition. If it's not myocardial infarction, what could it be?"

Deng Li scratched his hair, and there was his dinner on the table in the emergency room. From the outpatient clinic to the emergency room, until midnight, Deng Li still had no time to eat. When he received a call from the ambulance center saying that there was a patient within fifteen minutes, When it arrived, Deng Li had just opened the takeout bag.

He ordered an eel and beef rice, but now the eel was completely cold and the beef was no longer warm.

Deng Li was already used to it. As a doctor, he never complained about not having time to eat. He was already used to this during the training period.

Deng Li suddenly met Muchun. Deng Li originally wanted to talk to Muchun about some problems, but now was not the time.

Muchun looked at Qiu Tong's painful look and felt mixed emotions in his heart, mostly anger and pain.

But he knew it was useless to think about it now. The most important thing now was to find out what happened to Qiutong?

Back in the intensive care unit, Deng Li saw Muchun looking in pain and patted him on the shoulder, "Is he your patient?"

Muchun shook his head.

Qiu Tong is not his patient, Li Mu is.

Thinking of this, Mu Chun suddenly felt severe chest pain, couldn't help but bend down, and collapsed on the ground against the wall.

"What's wrong with you?" Deng Li was very nervous when he saw this.

While checking Muchun's condition, he shouted to the door, "Ding Feng, nurse Ding Feng."

The nurse hurried over and saw why another person fell to the ground.

There are really too many things to do in this night shift. Even if the patients talk endlessly, they still can't be solved. If two myocardial infarctions occur in one night, Director Deng Li will be too busy even if he has only three heads and six arms.

"I'm fine."

After about half a minute, Muchun's pain gradually disappeared. He stood up, walked to Qiu Tong, and checked the monitor again.

"I know why."

Look directly at the blood pressure, heart rate and other values ​​on the display.

"Is it okay to do another EKG?"

Although Deng Li didn't understand what Muchun meant, he acted immediately and quickly produced new ECG drawings.

"Although, I don't know if Qiu Tong has a history of heart disease. Since it is not found in the medical insurance records, I can rule out a history of heart disease for the time being, but one thing is 100% certain." Mu Chun looked at Qiu Tong firmly. He said slowly, "What is certain is that Qiutong experienced a very significant external event before the chest pain occurred."

"Strike by external events? What is Dr. Muchun referring to?"

Muchun has no time or special reason to describe the incident between Qiutong and Li Mu in detail to Director Deng Li. The most important thing at the moment is to find the cause and save the patient.

"What I'm talking about is that patients are extremely sad or angry due to the impact of major external events, which causes chest pain, suffocation, shortness of breath and other symptoms similar to heart disease."

"I seemed to understand, but it's not common clinically, so I didn't think in that direction at all."

"Well, at present it seems that it is probably the reason - [Broken Heart Syndrome]."

Broken heart syndrome (also known as takotsubo cardiomyopathy) refers to chest pain, shortness of breath, shortness of breath and other symptoms similar to heart disease caused by a person experiencing a major external event and feeling extremely sad or angry. However, There is no damage to the heart muscle or blockage of arteries in the heart, and patients usually recover within days or weeks as long as they overcome the potentially life-threatening acute phase.

In about one in 10 cases, people with broken heart syndrome develop cardiogenic shock, a condition in which the heart suddenly cannot pump enough blood to meet the body's needs.

Muchun judged that Qiutong's shock symptoms just now were of this kind.

"It does seem to be the [broken heart syndrome] that Dr. Muchun mentioned." Deng Li's hanging heart relaxed a little.

“The symptoms of [broken heart syndrome] look very similar to those of a myocardial infarction, and blood tests also show elevated troponins.”

The instruments in the intensive care unit made regular sounds, and the white sheets were lifeless.

Suddenly, Deng Li called to Ding Feng, "Nurse Ding, prepare mechanical support. Dr. Mu can help. There are not enough manpower in the night emergency department."

"no problem."

Muchun agreed and completely obeyed Deng Li's orders.

After the support system was improved, Qiutong's blood pressure returned to normal and her breathing became stable.

The white sheets finally came to life, and the sounds from the instruments in the intensive care unit became increasingly pleasant.

"It would have been better if I had thought of it earlier. Fortunately, the medicine just now has some effect. Now we just need to continue to promote blood flow and wait for her to slowly recover on her own."

Mu Chun took off his gloves, and Deng Li, who finally rescued the patient, stood beside Mu Chun with a silly smile.

Deng Li is about forty-five years old, but he looks very young. He is a relatively silent doctor at Sumikawa Medical Center. He has a good relationship with everyone and has excellent medical skills, but he has a strange nickname.

Everyone calls Deng Li "the little prince of the night" behind his back.

The two walked to the emergency room. Deng Li took a look at the lunch box, turned around and asked Muchun, "Would you like some?"

"No, I've already had dinner. Please eat quickly. If there's any emergency, I can still help."

After Muchun finished speaking, he pulled up a chair and sat down.

Deng Li opened the drawer and took out a box of nuts from it. "Eat some of this. I often work night shifts. I eat some nuts when I don't have time to eat. It will help me stay hungry."

"Thanks."

Muchun reached out and took it.

"Dr. Muchun is indeed well-deserved. If you hadn't been here, I might not have thought of cardiogenic shock and heartbreak syndrome. Because I have never encountered them in the more than ten years I have been working in Sumikawa."

"While the exact mechanism is uncertain, broken heart syndrome is thought to occur when stress hormone levels become too high following physical or emotional stress, which can be negative, such as the death of a loved one; Positive, like winning the lottery. But in about one-third of cases, broken heart syndrome occurs without a known stressor. It seems there's a medical name for it, too.

"Stress myocarditis." Deng Li said as he put the lunch box into the microwave.

"Yes, stress myocarditis."

Along with the sound of the microwave oven operating, Deng Li added: "Stress myocarditis is a self-limiting disease. Although it is a bit scary when it occurs, it is similar to a real myocardial infarction, but after all, it is not a coronary artery blockage, so it is generally not fatal. threats."

"If cardiogenic shock had not occurred, perhaps the patient would have slowly stabilized on his own soon, but cardiogenic shock is still very dangerous. Director Deng's treatment was very timely. I would never have thought of it."

"There are specialties in the profession. This is where the psychosomatic doctors treat you, right?" Deng Li pointed to his forehead with a naughty expression.

The doctor, who is in his forties, is wearing a white coat with a Spider-Man decorative buckle pinned to the pocket of the white coat. He looks a bit out of age.

Look at Deng Li's feet, which are a pair of red Crocs, decorated with decorative buckles with Iron Man, Captain America and other Marvel elements. It looks like Deng Li is a super fan of Marvel.

Unlike another Marvel superhero [Doctor Strange], although Doctor Strange was still a doctor before he had super magic, he is a doctor who wears a famous watch and drives a luxury car. He is unstoppably handsome and enjoys luxury cars and beautiful women. Endless.

Deng Li is different. He is obviously forty-five years old, but he doesn't look mature at all.

"Ensuring the patient's blood flow can actually stabilize the patient's condition and help her overcome the difficulty. You see, we still got it, right?"

Deng Li's face was no longer nervous at all.

Muchun was also relieved. If Qiu Tong really died so suddenly, he really didn't know how to tell Li Mu what happened between midnight and one o'clock in the morning today.

Deng Li brought out the heated rice and sat across from Muchun.

"Eat quickly, it's okay with me, I'm really not hungry."

Before Deng Li could speak, Muchun spoke for him first.

"Dr. Muchun, I really want to visit you, but I never have time. Mainly, it's not a big deal."

Deng Li took a bite of the eel and couldn't bear the salty taste, so he looked around for a water glass.

Why is Director Deng now so different from Director Deng when he was treating patients? The current Deng Li can be described as naive, even a little too cute.

So he said he wanted to talk to a psychotherapist. Maybe there was something slightly bigger?

Deng Li didn't say anything, so Mu Chun naturally didn't speak either.

There are too many things that worry him now, and compared to worries, anger has the upper hand.

Who is the mastermind behind this? Xu Dan? If it was really her, seeing Qiu Tong who almost died today, Li Mu who finally survived, Geng Meng who was in a daze, and Liu Mei who lost everything

If all of this was carefully planned by Xu Dan, her purpose was to become slim?

What's the reason behind it?

"By the way, Doctor Mu? Is this patient your patient?"

Deng Li asked while eating, without caring about his image at all. This is one of the reasons why he likes night shift, it's so comfortable! You can be like a child, who is not a child yet!

Muchun remembered that Deng Li had asked once before, but it didn't matter. He answered again, "Qiutong is not my patient, my patient is."

patient!

Yes, he is the patient. Mu Chun opened the five-pointed star formation diagram in his mind. In addition to Liu Mei, there were also Yang Xing from Qingshan Road, Li Mu from Lanhai Garden, and Geng Meng from Linhai Community.

There are also Bai Lu and He Ping from before. These people are all related to Muchun. Except for Geng Meng, they all seem to be related to Muchun's patients.

wrong? Still not right.

Geng Meng is not my patient, nor is Chen Feng, nor is Liu Mei. In fact, these people cannot be considered related to me.

"Aren't you a patient of Dr. Muchun?" Deng Li patted his belly and burped. It seemed that he had eaten too fast.

"No, to tell you the truth, Qiutong is not my patient, her husband is my patient."

"Eh?" Deng Li wiped his mouth with a tissue and tilted his head to stare at Muchun.

"Why is Director Deng looking at me like that? Is there something on my face?"

Muchun looked around, and then saw his own face in the mirror above the sink.

"No, no, Dr. Muchun is as handsome as I imagined!"

Muchun: Could this be Deng Li?

Deng Li still smiled and asked, "I'm just curious. Curious, are psychosomatic doctors still responsible for taking care of patients' family members?"

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Recommend a book: "I Am an Emotional Killer" by Yue Mingda during the Mid-Autumn Festival.

The current word count is 750,000 words, and the updates are very stable and even awesome. If you don't like to catch up on updates, you can watch "The Great Beauty Era" first.

But I guess you must have read "The Great Beauty Era", so let's catch up on the updated book!

The author's profile is as follows:

I am the pigeon killer;

I don’t have feelings;

Also, how to get money.

I am Yi Haizhou whose surname is unknown;

The man who mastered half of the four great inventions;

I didn't want to talk to you and threw a BENG at you...