I Can See Health

"There is another very strange thing." Jiao Jingqiu said.

"Say." Lu Chen looked at her.

Jiao Jingqiu slowly spoke.

"One night when I was working night shift, my uncle had a premonition that he was going to have another attack and asked me if he could take a tablet of isosorbide mononitrate?"

"I was thinking at that time, can I predict the onset of the disease? I can eat it if I want!"

"The result was calm that night, and there was no further change in condition. The BNP was rechecked the next morning, and the result was lower than before (121.6pg/ml)."

Lu Chen nodded, "What are you considering?"

Jiao Jingqiu said: "The indicators are getting better, but the symptoms are getting worse. We are beginning to suspect that the uncle is exaggerating his condition!"

After saying this, she glanced at Mr. Du, and then continued: "Some old people usually lack care and want to attract everyone's attention in some ways, such as constantly talking to the people around them, etc."

When Du Fu heard this, he said softly: "How should I put it? Since I took over the company, I have really paid less attention to my dad. I haven't done a good job in this aspect."

Jiao Jingqiu showed a smile.

When Lu Chen heard this, he frowned and said, "Dr. Jiao, based on your current diagnosis, do you think the patient exaggerated his condition?"

Jiao Jingqiu did not hesitate, nodded and said: "The BNP is not high, the diuretic and dilation drugs are fully used, and there is no reason why the condition cannot be improved."

Lu Chen disagreed with this diagnosis.

In medical diagnosis, the first element is to rule out organic heart disease before physiological diseases can be diagnosed.

Lu Chen looked through all the examinations again, and then wondered: "Why is there no electrocardiogram of the patient's attack?"

There are five electrocardiograms in total.

But none of them were electrocardiograms taken during chest tightness attacks.

The electrocardiogram is an easily obtained examination report that can reflect the electrophysiological changes of the heart the fastest.

Jiao Jingqiu was startled, "We initially considered it to be heart failure and did not check the electrocardiogram. But a low BNP can rule out heart failure, so I suspect that the condition is exaggerated..."

Lu Chen interrupted Jiao Jingqiu's explanation: "Who told you that heart failure can occur if BNP is not high? If the left ventricular pressure of diastolic heart failure does not increase significantly, BNP does not need to be high!"

Jiao Jingqiu asked: "Ah... could it be heart failure? It seems that we have used diuretics, but it doesn't get better?"

"Dr. Jiao, can't you think about it yourself, is there any evidence for diastolic heart failure?" Lu Chen frowned.

If Jiao Jingqiu was a doctor in her department, then she would really make her angry.

Jiao Jingqiu looked confused: "Then...what is it?"

"Electrocardiogram!" Lu Chen said seriously, "Next time you get sick, remember to do an electrocardiogram!"

"Okay...I understand." Jiao Jingqiu paused.

Seeing this, Lu Chen had collected all the case information.

"Mr. Du, I almost understand your father's condition." Lu Chen looked at Du Fu, "Next, I need an electrocardiogram when the disease attacks. Then I will almost know what the disease is."

"So fast?" Du Fu was stunned.

In fact, he has now almost accepted that his father exaggerated his condition.

This will attract the attention of family members.

After all, they are usually very busy and really pay little attention to their father's life.

Because of this illness, he spent more time with his father.

However, what Lu Chen said now made him a little shaken.

"Actually, Dr. Jiao made a subjective mistake." Lu Chen said, "He was deeply affected by his initial concepts."

Jiao Jingqiu frowned and said: "Director Lu, if the patient's electrocardiogram changes when the disease attacks, what disease does he have?"

"It's very simple." Lu Chen smiled, "Recumbent angina!"

Chest tightness that occurs at night is most likely to be mistaken for heart failure.

However, there is a kind of angina that attacks when lying down. When the attack occurs, you need to sit up or stand up immediately to gradually relieve the symptoms of angina pectoris.

"This type of angina usually occurs 1-3 hours after lying down. In severe cases, it can occur within 10 minutes of lying down. It can occur multiple times a night. It can also be induced by lying down during the day, especially after meals."

This diagnosis of supine angina can also explain why when Lu Chen thought about coronary heart disease just now, the correct prompt popped up in the system.

Recumbent angina is also a type of coronary heart disease.

Hearing Lu Chen's words, Du Fu immediately echoed: "Yes! My father sometimes has attacks after meals. Before, he thought it was a stomach disease and had a gastroscopy. In the end, there was no problem."

The increase in ventricular wall tension, myocardial contractility and myocardial oxygen consumption caused by the increase in circulatory blood flow after supine supine position are the main causes of supine angina.

"Recumbent angina?" Jiao Jingqiu was stunned.

To be honest, she hadn't really thought about this disease.

The uncle has chest tightness every night. In this case, everyone thinks it is heart failure.

Angina pectoris usually occurs after physical activity.

Therefore, supine angina is a type of coronary heart disease that is easily overlooked by everyone.

Lu Chen smiled, "So, this can also explain why the uncle's condition can be relieved every time he takes one tablet of isosorbide mononitrate."

At this point, Du Fu already believed most of it.

Everything Lu Chen said was consistent with his father's.

Jiao Jingqiu also came to her senses and began to think carefully about her shortcomings in the entire case.

"Also, take a look at this electrocardiogram of my uncle." Lu Chen pulled out another electrocardiogram, "When the disease is not attacking, it looks like a normal electrocardiogram with sinus rhythm, without any ST-T changes, but it It is most likely a multi-vessel coronary artery disease, and the vectors are neutralized, causing the ECG to look normal.”

"Actually, the coronary artery condition of this patient is very poor! It is necessary to do another coronary angiography."

Jiao Jingqiu spoke up at this time, "We also persuaded the uncle to review the angiography before, but he was unwilling to do it. He has a very stubborn temper and no one can change what he has decided."

"Let's do this." Lu Chen continued, "When the disease attacks again, we must review the electrocardiogram. After the results come out, we will make next plans."

"Okay!" Jiao Jingqiu nodded slightly.

…

After discussing with everyone, Lu Chen returned to the ward and communicated with the uncle again.

The uncle invited Lu Chen to chat for a long time.

What they were talking about was nothing more than gossip about the former Director Zhao of the Department of Cardiology.

Before leaving, the uncle looked at Lu Chen earnestly and whispered: "Director Xiao Lu, you have talked so much with me today, what do you think of my condition?"

Before Lu Chen could reply, the uncle said to himself: "Do you also think that old man, I am exaggerating my condition?! To attract the attention of my family?"

From the corner of his eye, he glanced at Du Fu beside him from time to time.

The latter looked a little embarrassed when he saw this.

Lu Chen shook his head quickly, "Uncle, I have other ideas."

"Huh?" The uncle was stunned, with a hint of surprise in his eyes, "What do you think?"

"Uncle, please hear me first. Next time, when you feel uncomfortable and have chest tightness or chest pain, please see our medical staff immediately." Lu Chen warned, "Let them do an electrocardiogram for you. , I know your condition."

"Okay, you kid, you can do it, I'll listen to you!" The uncle grinned.

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