I Can See Health

The procedures for ward rounds are similar.

The regular trainee or graduate student in charge of the bedside will report the medical history.

Jin Miao explains the current diagnosis, treatment drugs, and next treatment plan.

Lu Chen stood beside Jin Miao, occasionally asking a few questions, but more often than not, he just listened carefully.

Seeing this, Jin Miao thought that Lu Chen was not proficient in clinical practice, so he couldn't give any advice and could only stay silent most of the time.

He really misunderstood Lu Chen!

Lu Chen felt that he was new here, so he still carefully observed Guanghai's ward rounds and the conditions of the patients in the group.

Therefore, even if any problems were discovered, they were only written down first and no questions were asked on the spot.

Instead, prepare to ask everyone questions later.

"Director Lu, this patient may be in trouble. He has been admitted for five days and the diagnosis is not yet clear, so further examination may be needed." Jin Miao led Lu Chen to the bed of the last patient.

His original intention was not to embarrass Lu Chen.

Because if the patient asked Lu Chen about the cause of the disease, he would not explain it and might lose face.

Sure enough, as soon as he said these words, the patient looked at Lu Chen strangely when he heard the word director.

There is such a young director?

However, I can’t control that much now.

"Director, I've been here for five days, why haven't you found the cause yet?" The patient immediately got up from the bed.

Jin Miao paused just as he was about to leave. He was really afraid of what he was going to do!

He was about to explain to the patient, but he didn't expect that Lu Chen had already taken the patient's medical record from the doctor beside him.

"Are you transferred from the oncology department?" Lu Chen remembered reading her medical records before the ward rounds.

The patient was a woman in her fifties. She nodded slightly, "Yes, I was preparing for chemotherapy. When one of the test results was problematic, I was transferred to the cardiology department. You have to solve my heart problem as soon as possible. , I want to go back for chemotherapy as soon as possible!”

"Don't worry, I'll take a look at your medical records." Lu Chen comforted.

Jin Miao on the side smiled bitterly in his heart.

Director Lu Chen is pretending to be fat!

They had been studying this patient privately for a long time, but they had no clue at all. Could it be that Lu Chen knew the problem just by looking at it?

"Dr. Jin, please briefly introduce the patient's condition."

Lu Chen put down the patient's medical records and picked up the tablet computer equipped in the department.

The tablet computer is connected to the hospital intranet, and the test orders and report forms of all patients in the place can be viewed.

"Okay." Jin Miao nodded, "This patient was transferred from the oncology department last Wednesday. He was previously diagnosed with pulmonary CA and has undergone three courses of chemotherapy. This is the fourth course. However, before chemotherapy, myocardial enzymes were found to be elevated. If it is high, he will be transferred to our department to continue treatment, mainly to find the cause of the elevated cardiac enzymes.”

"Does the patient have any symptoms?" Lu Chen asked.

"I don't have any discomfort."

Before Jin Miao could reply, the patient immediately spoke out.

Lu Chen nodded. He looked at the patient's kinase results. Troponin and other creatine kinase tests showed that they all increased to varying degrees.

Elevated cardiac enzymes usually indicate myocardial damage, and common causes include acute myocardial infarction, renal failure, etc.

Jin Miao continued on the side: "The patient does not have any risk factors for myocardial infarction, nor does he have symptoms of chest pain or chest tightness. The heart ultrasound, coronary CTA, and even the electrocardiogram are all normal, so we have no clue for the time being."

A normal heart ultrasound can rule out cardiomyopathy, such as hypertrophic cardiomyopathy, which sometimes also causes elevated cardiac enzymes.

Coronary artery cta is normal, ruling out coronary heart disease, such as acute myocardial infarction, which causes elevated cardiac enzymes.

The electrocardiogram was normal, excluding tachyarrhythmia or bradycardia.

At this time, Lu Chen looked at Jin Miao and asked a seemingly unrelated question: "What chemotherapy regimen did the patient use before?"

"I... don't know." Jin Miao shook his head, "Then I will go back to the office later and check the patient's previous medical records in the oncology department."

They were only responsible for cardiology-related diseases. As for the patient's oncology drugs, they did not ask and did not need to know.

Lu Chen frowned.

"Director Lu, does this matter?" Jin Miao asked in a low voice.

"I don't know yet." Lu Chen said softly, then looked at the patient aside, "Do you know that you are taking chemotherapy drugs in the oncology department?"

"Well, it's a new type of drug." The patient thought for a while, "What's it called an immunosuppressant? It's very expensive."

Lu Chen's eyes narrowed, "Immune checkpoint inhibitor?"

"Well, yes! This is the medicine." The patient nodded quickly.

"Okay, I understand." Lu Chen handed the medical records back to the graduate student on the side, and then said to Jin Miao: "Let the patient make an appointment for a cardiac magnetic resonance imaging, and we will review the cardiac enzymes tomorrow."

"Ah?" Jin Miao was stunned, "Heart MRI?"

"Yes, our hospital should be able to do it, right?" Lu Chen said.

"It can be done, but it's just less done now." Jin Miao responded. For a while, he really couldn't find the reason why Lu Chen asked the patient to have a heart MRI.

"Arrange it as soon as possible." Lu Chen turned back to the patient and said, "After we analyzed your condition again, we considered the possibility of myocarditis, so we need to get a cardiac MRI to confirm the diagnosis of myocarditis."

The patient naturally agreed wholeheartedly. She just wanted to be diagnosed as early as possible and to be transferred back to the tumor for chemotherapy.

Jin Miao on the side was stunned when he heard the word "myocarditis".

The diagnosis of myocarditis requires, in addition to myocardial biopsy, a cardiac MRI.

Myocardial biopsy is an invasive examination and carries high risks, so few people will do it.

If you want to confirm the diagnosis of myocarditis, you can only do a cardiac MRI examination.

However, Jin Miao racked his brains and still couldn't figure out the cause of the patient's myocarditis!

The patient had no prodromal cold symptoms, nor any chest pain or chest tightness.

When considering myocarditis, you have to find an inducement, right? !

It’s impossible to get myocarditis for no reason!

After walking out of the ward, Jin Miao plucked up the courage and asked Lu Chen in a low voice: "Director Lu, you are considering myocarditis, what is the cause?"

Lu Chen frowned slightly, UU reading www.uukaｎshu.net "Didn't you just listen to my question?"

"Did you say that?" Jin Miao recalled the conversation just now, and then noticed what Lu Chen said about "immune checkpoint inhibitors."

"Could it be myocarditis caused by the tumor drug?" Jin Miao asked doubtfully.

He had never heard of this type of medicine. Lu Chen actually knew that this medicine could cause myocarditis?

Lu Chen nodded, "Go back and look through the literature. Myocarditis caused by immune checkpoint inhibitors is a hot topic at the intersection of tumors and heart disease recently."

"good……"

Jin Miao nodded silently.

He really had never heard of this medicine, but Lu Chen explained it very clearly.

Don't be afraid that others are talented, but be afraid that people with great talents will work harder than you!

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