I Can See Health

The First Hospital of Shanghai, the First Division of Cardiology.

The doctors in the department were already sitting together.

"Sister Jiao, what patient is this? Do we need so many people to discuss this?"

Lu Chen walked forward quickly.

"This patient was just admitted yesterday. Please take a look."

Jiao Jingqiu handed over the medical record, and Lu Chen took it and sat down to check it.

The attitude of everyone in the department towards Lu Chen was obviously much better.

Originally, everyone was a little unhappy about the application for the fund project last time.

But because there was an internal candidate, Lu Chen was able to break through the blockade of the internal candidate, which made everyone look at him with admiration.

In addition, Lu Chen could understand the feelings of the attending doctors. Treating patients cannot determine their future and destiny.

However, this fund project affected everyone's promotion.

Lu Chen and the young attending doctors reconciled.

…

At this time, Jiao Jingqiu introduced:

“The patient had sudden chest pain symptoms one week before admission, accompanied by sweating, chest pain, and inability to lie flat. The symptoms continued and did not ease, so he went to the local hospital for treatment.”

“Considering acute extensive anterior wall myocardial infarction and heart failure, he was given conservative treatment by internal medicine. Cardiac ultrasound showed a large amount of pericardial effusion.”

“Pericardial puncture and drainage treatment was given, and the daily drainage volume exceeded 500ml, which was bloody pericardial effusion. Later, the patient’s symptoms improved compared to before, but pericardial effusion continued to flow out, so he came to our hospital for treatment.”

Lu Chen quickly read through the medical records and had a simple understanding of the patient.

Simply summarize it in one sentence.

That is, a large amount of pericardial effusion appeared after myocardial infarction, and 500ml was continuously drained every day, but pericardial effusion continued to flow out.

The local hospital could not handle it.

The patient was transferred from the lower hospital to the First Hospital of Shanghai.

“We are very curious, why the patient’s pericardial effusion continues to increase?” Jiao Jingqiu frowned and said.

Lu Chen did not reply immediately. He pondered for a moment and said, "Let's go see the patient first."

"Okay." Jiao Jingqiu nodded slightly.

Other doctors who wanted to check the patient's condition also followed Jiao Jingqiu and Lu Chen to the bedside.

...

Bedside.

The patient was a 40-year-old man. He was lying on the bed in a semi-recumbent position.

There was also a middle-aged woman sitting next to the bed. It seemed that she was his wife.

At this time, the life value on the patient's head was only 38 (---).

Jiao Jingqiu said to the patient's family next to him: "Doctors in our department come to see the patient together."

"Okay, thank you doctors."

The middle-aged woman showed a grateful look on her face, and hurriedly stood aside to give up her position next to the bed.

Lu Chen took the stethoscope and walked to the bedside.

There was no nonsense, and he started the physical examination directly.

The patient was in a semi-recumbent position, and his mind was clear and his speech was clear.

Blood pressure 100/60mmhg, a drainage tube can be seen in the 5th intercostal space of the midclavicular line, coarse breath sounds in both lungs, a few moist rales can be heard at the base of both lungs, low and dull heart sounds, regular heart rhythm, heart rate 80 beats/min, no murmurs, flat and soft abdomen, no tenderness, no edema in both lower limbs.

"What's wrong with you now?"

"It hurts here... and stuffy." The patient pointed to his chest weakly, "I can't breathe when I lie flat, I feel like I'm suffocating."

Lu Chen nodded.

The patient currently has obvious signs of a large amount of pericardial effusion.

Review the patient's current examination.

Electrocardiogram: sinus rhythm, RS type in leads V1-V6, inverted T waves, heart rate 80 beats/min.

Cardiac ultrasound: left ventricular ejection fraction (LVEF) 38%, segmental motion abnormalities of the left ventricular wall (thinning of the left ventricular anterior wall and apical myocardium, reduced motion, apical bulging outward, paradoxical motion can be seen in class), pericardial effusion (large amount), drainage tube echo can be seen in the pericardium.

Lu Chen was about to leave the ward after seeing the patient.

Unexpectedly, the patient's wife followed behind everyone.

"What's the matter?" Jiao Jingqiu asked in confusion.

"Doctor Jiao, can I listen to your discussion of the condition?" The patient's wife gritted her teeth, her face full of anxiety.

"No!" Jiao Jingqiu shook her head decisively, "It is impossible for family members to participate in the discussion of the condition, but we will tell you the results of the discussion of the condition."

"This... okay." The patient's wife pursed her lips, "Doctor Jiao, you must save my husband, he is the pillar of the family, without him, I really don't know what to do."

As she spoke, the patient's wife's eyes were already red.

"We will try our best." Jiao Jingqiu said calmly, "but the patient is in a critical condition and is at risk of sudden death at any time."

"I, I know." The patient's wife lowered her head.

Lu Chen could already hear her faint sobbing.

Everyone just comforted her a little, didn't pay much attention, and then left quietly.

This kind of thing has been seen too many times.

Many doctors have become numb to this kind of scene.

...

Back to the doctor's office.

Everyone temporarily formed a team to discuss the condition.

Jiao Jingqiu spoke first: "After admission, considering that the patient continued to have bloody pericardial effusion and mild anemia, so a single antiplatelet treatment was temporarily given."

"After admission, the immune system, tumor markers and tuberculosis antibodies were all negative, and pericardial effusion caused by other reasons was not considered for the time being."

"So we finally focused on the heart itself. Since the patient's blood pressure was not high, we replenished fluids as appropriate every day and clamped the drainage tube after the daily drainage volume was about 500ml."

"The most urgent question at the moment is what is the cause of the patient's pericardial effusion? Tumor? Tuberculosis? Rheumatism? Inflammatory stimulation after myocardial infarction? Or is it another problem?"

Jiao Jingqiu's questions came one after another.

Lu Chen frowned slightly.

In his opinion, this patient may not be that simple, and there are still many doubts.

At this time, a more senior doctor in the department said: "Hemorrhagic pericardial effusion is more common in tumors and infections. Infections are more common in tuberculosis patients in developing countries."

"The patient's chest CT scan showed no obvious tuberculosis lesions, and the tuberculosis-related tests were negative. Moreover, the patient has no relevant medical history, so the probability of directly suffering from tuberculous pericarditis is relatively small."

Jiao Jingqiu nodded slightly, "Tuberculosis and rheumatic diseases have been ruled out for the time being."

"What I want to ask is, did he have a history of pericardial effusion before this myocardial infarction?" the senior attending doctor asked again.

At this time, Jiao Jingqiu continued to speak: "The patient should not have pericardial effusion before. If there was pericardial effusion before, it would not be the only time that symptoms of heart failure appear, and the patient has no symptoms of breathlessness before."

"Well, that makes sense." The attending doctor nodded.

This possibility has also been ruled out.

"Sister Jiao, what about pericardial effusion caused by inflammation after myocardial infarction? Is this possible?"

A very young attending physician in Corey proposed his own idea. UU reading www.uukanshu.net

"Unlikely." Jiao Jingqiu immediately rejected it. "Pericarditis and pericardial effusion belong to post-myocardial infarction syndrome, but they are mostly small amounts of leakage, and the color should be mainly light yellow. Large amounts of bloody pericardial effusion are extremely rare."

The discussion reached a deadlock for a while.

What are the various causes of pericardial effusion?

At this time, Jiao Jingqiu frowned and said: "Actually, I have been thinking about a possibility. Could it be that the puncture needle penetrated the ventricle during pericardiocentesis?"

As soon as he finished speaking, everyone was shocked and all agreed.

－－－－－－Digression－－－－－

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