I Can See Health

Hypertension during pregnancy refers to the symptoms of high blood pressure, edema, proteinuria and other symptoms in women after 20 weeks of pregnancy, which are transient and disappear after delivery.

This disease is unique to pregnancy and is currently one of the main causes of maternal and perinatal illness and death.

"Gestational hypertension?" Dr. Xiaolin shook his head quickly, "Does Dr. Lu mean that the patient is pregnant? This is impossible... This is absolutely impossible..."

Doctor Xiaolin's face was full of disbelief.

Lu Chen frowned and said, "The patient said that he has not had menstruation for two or three months..."

Before he finished speaking, he was interrupted by Dr. Xiao Liulin.

"I know this. I asked her about it on the day she was admitted to the hospital. The patient had this problem before, with irregular menstruation. After she drank Chinese medicine, her menstruation became regular. Besides, if she is pregnant, can I not know it? "

Director Yin Chao on the side was a little silent.

He recalled the patient's entire medical history and vaguely felt that Lu Chen's words seemed to make sense.

The patient has not had menstruation for two to three months.

In this case, the first thing to consider is not menstrual irregularity, but the possibility of pregnancy!

The most critical point is that in the patient's urine routine, occult blood and urine protein were positive, and the blood pressure could not be lowered!

This is more in line with the characteristics of gestational hypertension!

Clinical diagnosis requires bold guessing, questioning, and finally using the examination results to speak for itself.

Lu Chen pondered for a moment and said slowly: "I don't deny that this may be caused by menstrual irregularity, but I still suggest that some gynecological ultrasounds be completed to rule out gestational hypertension."

If the patient really has gestational hypertension, she will not be able to use many medications.

When it comes to this multidisciplinary disease, the conditions are often complex.

Because once the drug is used incorrectly or excessively, causing problems for the fetus, it will be terrible.

Dr. Xiao Lin also turned to look at Li Yao who was standing aside.

Li Yao said softly: "Doctor Lu's opinion is my opinion. I suggest improving gynecological ultrasound."

Dr. Xiao Lin wanted to say something else, but Yin Chao waved his hand and interrupted: "Xiao Lin, it is absolutely necessary for this patient to have a gynecological ultrasound. Just listen to Dr. Lu's opinion and arrange a gynecological ultrasound for her immediately. If there are any problems, , please ask for gynecological consultation.”

Seeing that the director had said so, Dr. Xiaolin could only nod his head.

He immediately left the doctor's office and went to communicate with the patient's family about the condition.

The only good thing now is that the patient and his family have a mild attitude and have no desire to have children.

The little girl next to her bed was adopted by her.

"Professor Li, in this case, we were negligent."

After Dr. Xiao Lin left, Yin Chao said to Li Yao, "The patient himself said that he had irregular menstruation, had taken traditional Chinese medicine, and had no history of childbirth. We didn't think about gestational hypertension at all."

Common secondary hypertension is mainly aortic coarctation, renal artery stenosis, epinephrine tumor, etc. Few people think about gestational hypertension.

Clinically, a doctor's judgment is easily affected by various factors.

For example, many patients with dyspnea said when they came to the hospital that they had emphysema before. They were treated according to the lungs for a long time, but they did not feel better at all, but in the end they were found to have heart failure!

Therefore, it is very important to correctly extract useful information from medical history.

…

The first patient was a small episode.

However, after some analysis by Lu Chen, there was already a clue about this case that had not been diagnosed for three days.

The doctors at the cardiology department in Fengm County began to take this young doctor seriously.

At first, everyone thought Lu Chen was just here to make up the numbers.

After all, no one would pay attention to a newly admitted graduate student.

But now, even Yin Chao is a little impressed.

Sure enough, Professor Li Yao’s aim was not without purpose!

This master's student of hers really has two skills.

As for Li Yao, she originally thought that Lu Chen might have some stage fright.

But so far, she was quite satisfied with Lu Chen's performance.

…

Li Yao came to the Department of Cardiology to prepare for teaching rounds.

However, the patient on the teaching rounds was not the hypertensive patient, but someone else.

"Professor Li, shall we start teaching rounds?"

Seeing that it was getting late, Yin Chao asked Li Yao.

"Okay." Li Yao nodded.

Teaching rounds, as the name suggests, involves a superior physician leading all doctors to conduct rounds on patients.

Generally speaking, the format of this teaching round is very standardized, and the patients on the round are also difficult cases.

"Professor Li, this is the medical record of this teaching round."

Wang Zhita, another attending doctor in the Department of Cardiology, has prepared all the medical records.

Li Yao smiled and took the medical record. She read it carefully and then handed it to Lu Chen.

Lu Chen also took the medical records curiously.

This was the first time he encountered this form of teaching rounds, and he looked quite curious.

This is a 41-year-old male patient.

He was admitted to the hospital mainly due to "cardiac arrest".

There was no family history of sudden cardiac death, and no history of smoking or drinking.

The patient's wife found the patient unresponsive in bed at night. After calling the emergency number, the doctor performed defibrillation and cardiopulmonary resuscitation.

The patient returned to spontaneous circulation about 33 minutes after cardiopulmonary resuscitation.

Wang Zhi explained on the side: "Professor Li, this patient is living in our 25th bed, and his condition is basically stable, but we have not yet found out the cause of his cardiac arrest. We mobilized the patient to go to a higher-level hospital for examination, but at home Because of financial conditions, he refused to be transferred to a higher-level hospital.”

Li Yao nodded: "Let's go see the patient first."

The group followed Li Yao to bed No. 25.

Li Yao conducted a comprehensive medical history inquiry and physical examination on the patient.

"Are the patient's cardiac enzymes and ions normal after admission?" Li Yao asked.

"Normal." Wang Zhidao, "In addition, the cardiac color ultrasound showed no abnormality in the size of the atrium and ventricular cavity, LVEF 65%, normal valve motion function, and no ventricular wall motion disorder. There was no obvious abnormality in the chest CTA."

Lu Chen frowned.

The health value on the patient's head is 68, indicating that he is out of danger.

However, the results of cardiac ultrasound, laboratory tests, and CT scans are all normal, which can basically rule out common causes of cardiac arrest such as myocardial infarction and cardiomyopathy.

Immediately afterwards, Li Yao asked a few more questions.

For example, let’s take the common causes of cardiac arrest, and currently consider the patient’s possible diagnosis and treatment measures.

Doctors from the Department of Cardiology in Fengm County answered one by one, but obviously none of them met Li Yao's wishes.

Back to the doctor's office.

"Where's the electrocardiogram taken after admission?" Li Yao asked.

"Here. UU Reading www.uukａnshu.net" Wang Zhi took out all the electrocardiograms taken by the patient, five in total.

Li Yao raised her eyebrows, "I've done so many electrocardiograms, but you haven't found any problems?"

"This..." Wang Zhi paused. Then he scratched his head in embarrassment and said, "No."

Deputy Director Fan Zhiping, the only deputy director in the core who is good at reading electrocardiograms, has gone to further training.

Li Yao sighed slightly in her heart and handed the electrocardiogram to Lu Chen.

Lu Chen took these five electrocardiograms.

After careful comparison, he discovered something abnormal, "There should be broken qrs waves and early repolarization j waves here."

Yin Chao looked at Lu Chen with a surprised expression.

Good guy, after just one look, you found the problem?

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