I Can See Health

Chapter 630: Recovery!

The second zone of the heart.

doctor's office.

The atmosphere around Lu Chen was a bit strange.

Three students, you look at me, I look at you.

A doubt arose in everyone's mind.

Is the patient diagnosed with "ventricular tachycardia" really just suffering from supraventricular tachycardia?

On the side, Yu Bin was even more silent.

This patient was previously under his supervision.

While the patient was hospitalized, he had one episode of ventricular tachycardia, which he performed with electrical cardioversion.

This is exactly what he recommends to patients to install an icd!

However, Lu Chen's opinion now overturned all his previous diagnosis and treatment work.

(Electrical cardioversion can be used for both ventricular tachycardia and supraventricular tachycardia, but for hemodynamically stable supraventricular tachycardia, there is no need to use electrical cardioversion, as it will increase harm and pain to the patient anyway)

Ji Yingying bit her lower lip. She looked at the patient's electrocardiogram, but she still couldn't see any clues about supraventricular tachycardia in this picture.

It would be fine if she was from another major, but she was engaged in cardiology, and she even made a wrong diagnosis on an electrocardiogram.

"Senior brother..." Ji Yingying shouted softly.

Lu Chenhuo turned around and asked, "What's wrong?"

Ji Yingying sat next to Lu Chen, "How did you see the speed in this picture? I've been looking at it for a long time, and I can't even see the shadow of the speed."

Her words represent everyone’s aspirations.

The other two students immediately put their heads over, and even Yu Bin looked in Lu Chen's direction.

They are so curious!

Lu Chen pursed his lips and smiled, it was time to earn gratitude points again.

Currently, he is preparing for "valve intervention" treatment.

In the system mall, the skill card for valve interventional treatment has tens of thousands of thank you points!

Without working hard to earn gratitude points, Lu Chen would have to wait until the Year of the Monkey to redeem this skill card.

…

"Ahem." Lu Chen cleared his throat, took the patient's electrocardiogram and a blank A4 paper, and began to explain, "Then let me explain to you."

Seeing Lu Chen like this, the three students immediately moved three small stools from the conference room.

Yu Bin, who was on the side, also became interested.

But he wasn't very good at taking the initiative, so he had no choice but to lean towards Lu Chen!

Just listen to Lu Chen continue: "To identify VT and SVT with differential conduction, it generally needs to be analyzed from the atrioventricular relationship (the relationship between P wave and QR wave), ventricular depolarization vector, QR wave shape, etc."

"Many scholars have proposed differential diagnosis procedures. The more commonly used ones are the Brugada method and the Vereckei method. In particular, the Vereckei procedure only relies on the avr lead for differential diagnosis, which is easy to remember and easy to use in clinical practice."

"In 2020, an article published on heartrhythm proposed using limb leads for differential diagnosis. This method is also very simple."

…

"Senior brother, what are these methods you mentioned?" Ji Yingying was stunned.

She had only heard of the method Lu Chen mentioned, but had never seen it clinically, and had never seen anyone else use it.

Lu Chen smiled and said, "To put it bluntly, the international community has established a simple standard for diagnosing ventricular tachycardia."

“According to this standard, ventricular tachycardia and supraventricular tachycardia can be quickly differentiated.”

Ji Yingying said curiously: "Brother, when you say this, we have no reference. How about you give us an example and demonstrate it to us using this patient's electrocardiogram."

"Of course." Lu Chen nodded slightly, "Then I will use the Brugada method to diagnose this electrocardiogram."

Lu Chen started deducing the entire process on a blank A4 paper.

Brugada method, the steps to identify the origin of wide qrs wave tachycardia, are divided into 4 steps.

First, if the qrs waves in the precordial leads are not RS-shaped, it is diagnosed as VT.

Second, if there are RS-shaped qrs waves in the precordial leads and the rs interval is \u003e100ms, it can be diagnosed as VT.

Third, if atrioventricular separation can be confirmed, the diagnosis of VT can be established.

Fourth, if the tachycardia meets the QRS wave morphological criteria in leads V1 and V6, that is, a left bundle branch block-like pattern, lead V1 is an RS-type QRS wave, and the RS interval is \u003e70ms; or the left bundle branch (and/ or right bundle branch) block-like pattern, the qrs wave in lead v6 starts as a forward wave, and r/s\u003c1, it can be diagnosed as VT.

…

"Huh? This...is this simple?"

Ji Yingying was a little confused.

"Brother, are you sure this is the easy way?"

She feels it is not easy at all!

It seems simple to remember these four steps, but it is not easy to actually execute them!

Ji Yingying glanced at the other two students beside her, and they both shook their heads.

She breathed a sigh of relief.

It seems that it is not her problem, but that this step is not as simple as imagined for them now.

"Practice makes perfect," Lu Chen said, "You can learn these four steps by looking at a few more clinical pictures."

"In fact, many times, it is our laziness that leads to deviations in the patient's diagnosis. If we could strictly abide by international standards, this patient's similar situation can be completely avoided!"

Ji Yingying's heart moved, "Brother, according to your opinion, this patient must have supraventricular tachycardia?!"

Lu Chen nodded slightly, "Most likely!"

Combining the health prompts on the system panel and the existing electrocardiogram evidence, Lu Chen was confident in the diagnosis of supraventricular tachycardia.

At this moment, a prompt popped up on the system panel.

"Congratulations, I received a +1 thank you from Ji Yingying!"

"Congratulations,……"

Three consecutive prompts were given by three students in the group.

The next reminder stunned Lu Chen.

"Congratulations, I received a thank you value +1 from Yu Bin!"

Lu Chen looked out of the corner of his eye and saw that Yu Bin was leaning his head over...

"Ahem." Seeing that Yu Bin was discovered, he was slightly embarrassed, "Dr. Lu, you said it very well!"

Yu Bin is not a novice like Ji Yingying who has just entered the clinic.

After Lu Chen's reminder, he immediately understood the key point.

Four judgment steps to diagnose ventricular tachycardia one by one.

Yu Bin had seen similar medical reports, but didn't pay any attention to them.