I Can See Health

This is not a heart attack!

The news coming back from the intervention room surprised everyone.

Lu Chen was also stunned for a moment.

Because during the patient's surgery, the patient's test results also came out.

Troponin is elevated!

Troponin is a protein found almost exclusively in cardiac muscle cells. Once troponin increases, we can infer that the myocardial cells have necrotic and ruptured, releasing troponin into the blood, and we can detect the increase in troponin.

Acute myocardial infarction can basically be diagnosed based on the patient's chest pain symptoms, changes in electrocardiogram, and elevated troponin.

However, the results of coronary angiography surgery were completely contrary to this diagnosis.

In addition, Lu Chen also looked through the patient's surgical records.

Not only does the patient have no myocardial infarction, but his heart blood vessels are extremely smooth, without any stenosis or plaque, and he does not look like a person with heart disease at all.

"Could it be variant angina?" Ke Yue asked from the side.

Sun Guoguo shook his head and explained: "If it is variant angina, then even if the patient's blood vessels are not completely occluded, there must be something wrong. However, in our patient, his coronary angiography showed that the patient's coronary artery The arteries are very smooth, there is no obvious stenosis, and there is no thrombosis. It is not myocardial infarction or variant angina.”

"What about myocarditis?"

You should know that sometimes, pulmonary embolism and aortic dissection will show symptoms similar to acute myocardial infarction, especially chest pain.

The heart and lungs are not separated. Sometimes diseases that affect the lungs can also affect the heart laterally, so changes in the electrocardiogram are also possible.

Although troponin is unique to cardiac muscle cells, elevated troponin often indicates myocardial cell rupture and necrosis, but it is not necessarily caused by coronary artery blockage, ischemic necrosis (myocardial infarction), and may also be caused by other diseases. Myocardial cell damage and necrosis, such as myocarditis.

However, Sun Guoguo still rejected this diagnosis.

"Myocarditis generally has malignant arrhythmia and prodromal infection. This patient is not very consistent."

After considering so many things, Lu Chen was very confused at this time.

It’s not myocardial infarction, nor angina pectoris, nor myocarditis. So what other disease can show chest pain + electrocardiogram changes + troponin elevation at the same time?

…

Since the patient did not have myocardial infarction, he was pushed back to the eighth zone of the heart after surgery.

Generally speaking, patients with acute myocardial infarction need to be observed in the CCU for a few days after the operation to ensure that there are no complications before they are transferred to the general ward.

The patient returned to the eighth area of ​​the Department of Cardiology, and Sun Guoguo ordered Lu Chen to observe him closely and review the electrocardiogram and troponin in a timely manner.

At this time, Li Yao also summoned all doctors to discuss difficult cases.

Lu Chen, as the first doctor, gave a detailed medical history.

As a result of the discussion, in order to further rule out other fatal diseases, such as aortic dissection, pulmonary embolism, etc., Sun Guoguo performed a plain CT scan of the patient's chest and abdomen + enhancement.

Fortunately the results were normal.

At this time, the three most dangerous and fatal diseases in cardiology - myocardial infarction, dissection and pulmonary embolism - have been eliminated.

"We won't be able to find the patient's true diagnosis for a while, so let's monitor him closely first." Sun Guoguo ordered helplessly.

Fortunately, the patient's vital signs gradually stabilized and his blood pressure increased to 120/80mmhg.

…

The discussion of difficult cases is over.

Lu Chen reorganized all the patient's information.

In fact, from the beginning, this patient had many doubts.

First, the patient's heart rate changes are inconsistent with inferior wall myocardial infarction.

Secondly, the patient's vitality did not drop to less than 60 like other patients with myocardial infarction.

Lu Chen continued to think for a long time, but still couldn't find the patient's diagnosis, so he could only temporarily put aside his doubts.

Clinically, he is not the only patient, there are other patients that need to be dealt with.

In one morning, Lu Chen admitted a total of four patients, which was quite busy.

Fortunately, with the help of Junior Sister Yao Jie, Lu Chen could still cope with it.

After one or two months of training, Yao Jie has grown from a cardiology novice to a veteran who can understand some simple electrocardiograms.

As he got off work at noon, Lu Chen thought about the patient with a myocardial infarction in the morning.

"Junior sister, please go and check his electrocardiogram again."

"OK."

Yao Jie immediately reviewed an electrocardiogram.

The electrocardiogram was still the same as in the morning.

It was time to get off work at noon, and Lu Chen decided to take another look at him.

…

When I came to the bedside, the patient was eating gruel on the bed.

His hair was messy and his beard was unkempt.

Lu Chen walked over and said softly: "Is your appetite okay?"

The man smiled lightly and said, "It's just so-so. I can eat two bowls of white porridge as long as I don't starve to death."

"You don't have a myocardial infarction." Lu Chen looked at him and said.

"I understand, you all told me this morning, it doesn't matter if you are." The man looked at Lu Chen, his eyes full of sadness and emptiness.

This indifferent answer was somewhat beyond Lu Chen's expectations.

At this time, the man continued, "I knew I was going to have a problem."

He lowered his head, took a mouthful of porridge and said.

"My wife and I divorced a few days ago. It's not that I don't have children, but the children belong to her. The company also fired me. I deserve all this, haha."

As soon as the man finished speaking, Lu Chen felt a little creepy.

Especially his last two laughs made his hair stand on end.

However, his words also woke up Lu Chen.

Could it be that he has broken heart syndrome?

When a person is extremely sad, it puts a huge stress on the heart, which is likely to cause damage to myocardial cells, and the patient will experience severe chest pain and chest tightness.

This is similar to myocardial infarction, but the coronary angiogram is normal and it is not myocardial infarction.

This disease is rare. Lu Chen has never seen it before. He only saw it in the news.

Lu Chen left the ward and returned to the doctor's office.

"Sister, could the patient have broken heart syndrome?"

Lu Chen immediately expressed his thoughts to Sun Guoguo and described the patient's family situation in detail.

"Broken Heart Syndrome?" Sun Guoguo was stunned, "Yes, it's probably stress myocarditis, commonly known as Broken Heart Syndrome. This is the first time our department has encountered such a situation."

Sun Guoguo immediately agreed with Lu Chen's idea.

All the test results are normal, and now we can only consider the impact of mental factors.

"Brother, what is broken heart syndrome?" Yao Jie asked in a low voice.

Lu Chen thought for a while and said: "Broken heart syndrome is actually stress myocarditis, but it is not the viral myocarditis (caused by viral infection) that we often call it."

"Stress myocarditis is a self-limiting disease. Although it is a bit scary when it occurs and resembles a real myocardial infarction, it is not a coronary artery blockage after all, so it does not pose a fatal threat."

Broken heart syndrome is like being hit hard in the heart. The strong impact causes some myocardial cells to rupture, and then the troponin level increases.

The consequences of an impact are far less severe than those of coronary artery blockage. If the impact is not treated, you can recover by taking a good rest. However, if the coronary artery is blocked and not opened in time, the entire heart will be destroyed.

"Senior brother, I feel very uncomfortable when I hear this name." Yao Jie wrinkled her little nose.

"Yes." Lu Chen nodded, "This metaphor is very vivid. Does the heart break really happen? Heartbreak is just an emotional diagnosis, not a physical break."

"If the heart is really broken physically, the patient will definitely die on the spot and there will be no chance of survival. The heart is the blood pump of the human body. If the pump stops rotating, UU Reading www.uukanshu.net the blood will not move and the whole body will be deficient. If the blood is deprived of oxygen, you will faint within 6 seconds of cerebral ischemia, and irreversible damage or even brain death will occur if the brain is deprived of oxygen for 4-6 minutes.”

…

Lu Chen returned to the ward.

The patient has finished the porridge.

Lu Chen hesitated for a moment, then said, "You might have broken heart syndrome."

"Broken Heart Syndrome?" the man said calmly, "What kind of disease is this?"

Lu Chen told him the mechanism of the disease.

After hearing this, the patient remained silent.

After a period of rest, his body can recover.

He is lucky.

However, he seems to be unlucky.

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