I Can See Health

Remember [new] in one second! Lu Chen hurried back to the cardiology ward.

At this time, Gu Xinyue and Jin Miao were waiting in the CCU.

As soon as he entered the CCU gate, Jin Miao handed over the mask and hat.

"Director, you are finally here!"

Lu Chen looked serious, "What patient? Why are you so nervous?"

Jin Miao and Gu Xinyue have both been independent for so many years.

Ordinary patients are not so nervous at all.

Jin Miao calmed down his emotions and said in a deep voice: "It's a patient transferred from the No. 1 Hospital in Shanghai. They couldn't handle it, so they transferred it to us."

"Again the First Hospital of the Demonic City?" Lu Chen was stunned for a moment.

Cardiology departments in other hospitals throughout the city would intermittently transfer patients to them.

It seems that... the Fifth Hospital in Shanghai is regarded as the "last stop" for patients.

Everyone gradually formed a thinking pattern.

That is, if it is a patient who has been declared "death" by all five hospitals in Shanghai, there is basically no hope.

Even if he was transferred to Kyoto, there would be no way to save him.

If the patient was sentenced to "death" in another hospital, but the Fifth Hospital in Shanghai said he could be saved, it means there is still a glimmer of hope!

"Director Lu, there is nothing we can do. For such critical patients who cannot be treated, other hospitals in Shanghai will forget to transfer them to us."

Jin Miao couldn't help but complain.

"Okay, let's talk about this later." Lu Chen said, "Let's talk about the patient's condition first."

"good."

Jin Miao said while leading the way.

"The patient is a 62-year-old female who was hospitalized in the No. 1 Hospital in Shanghai due to chest pain and chest tightness for a week."

"After hospitalization, emergency coronary angiography was performed for complete occlusion of the circumflex artery, and acute lateral myocardial infarction was diagnosed. A stent was implanted in the circumflex artery. After the operation, the patient suffered from recurrent acute heart failure, pulmonary infiltration and infection."

"The postoperative echocardiography showed the formation of aneurysm on the left ventricular lateral wall, rupture and prolapse of the chordae tendineae of the anterior leaflet of the mitral valve, and severe regurgitation."

Hearing this, Lu Chen's expression became more serious.

After acute myocardial infarction, uterine muscle rupture or chordae tendineae rupture is a serious mechanical complication after myocardial infarction.

This complication often leads to severe pulmonary edema and cardiogenic shock and is closely related to poor prognosis.

Studies have reported that the in-hospital mortality rate of patients with severe mitral regurgitation caused by rupture of the uterine muscle is as high as 70-80%!

However, because of its often unstable hemodynamics, severe comorbidities, and extremely high surgical risks, there are contraindications for surgery.

"The patient shouldn't have any chance of surgery, right?" Lu Chen asked.

Jin Miao nodded and said, "The patient has severe heart failure and many underlying diseases, and cannot tolerate surgical thoracotomy at all." If she was forced to undergo a thoracotomy, she would most likely not be able to get off the stage. "

Lu Chen nodded solemnly, "Take me to see the patient's condition first."

…

Came to the CCU bedside.

Gu Xinyue is checking the patient's condition at the bedside.

Seeing Lu Chen coming, he quickly stepped forward and said, "Director, you are here."

Lu Chen nodded, picked up the stethoscope, and began to examine the patient.

As Jin Miao said, the patient can currently hear crackles all over his lungs.

"Bring over the ultrasound machine." Lu Chen said solemnly.

"Well, it's ready." Gu Xinyue quickly pushed the cardiac ultrasound machine over.

Lu Chen personally performed a heart ultrasound on the patient.

Bedside cardiac ultrasound showed: lv: 43mm, la: 43mm, ef: 34.3%.

The left atrium is enlarged, aneurysms form on the lateral wall of the left ventricle, and the chordae tendineae of the anterior leaflet of the mitral valve are ruptured and prolapsed with severe regurgitation.

The results of Lu Chen's examination were almost the same as those of the patient at the No. 1 Hospital in Shanghai.

"Director, after the patient underwent intervention at the No. 1 Hospital in Shanghai, his blood oxygen saturation gradually dropped and his infection indicators increased. He needs a large dose of vasoactive drugs to maintain his blood pressure."

Gu Xinyue gave Lu Chen a more detailed report on his condition.

"After being transferred to our CCU this morning, we are currently mainly using ventilator-assisted ventilation, and are receiving anti-infection, anti-heart failure, blood pressure, phlegm reduction, sedation and other treatments. Multiple chest X-rays have shown that pulmonary edema is gradually getting worse and infection indicators continue to rise. High, the patient cannot be weaned successfully, the heart failure indicators show an upward trend, and the cardiac function gradually declines.”

Lu Chen nodded, "Let's discuss the difficult issues within the cardiology department first, and then invite the cardiology surgery department over."

"Okay, director, I'll make arrangements right away."

Subsequently, Jin Miao called over all the doctors with associate senior or above titles who were currently not on duty in the Department of Cardiology.

Everyone gathered in the cardiology demonstration classroom.

As long as a meeting is held here, everyone knows that a difficult patient is coming.

As the doctor in charge, Gu Xinyue reported the medical history to everyone.

"Currently, we are mainly thinking about the reasons why patients cannot be weaned off the machine? What are the next steps?"

Jin Miao was very supportive and stood up first to speak.

"Consider the patient to be an elderly female with acute ST-segment elevation inferior wall myocardial infarction."

"Severe mechanical complications combined with mitral valve chordae tendineae rupture, leading to severe mitral valve regurgitation, acute heart failure, and combined with severe pulmonary infection, renal insufficiency, hypertension and other complications, STS score 12.3%, surgery Mitral valve repair is extremely risky.”

Lu Chen nodded slightly.

After so many years of training, Jin Miao has been able to comprehensively analyze the patient's condition.

His statement was not much different from his own.

Then, several doctors made brief speeches.

The main opinions of the doctors were the same, with some differences mainly in the details.

Finally, in Lu Chen's summary speech, the patient was given a final conclusion.

The reason why the patient cannot be taken off the machine at present is mainly due to repeated heart failure caused by mitral valve prolapse with severe regurgitation.

And due to pulmonary congestion and long-term bed rest, severe lung infection is mainly caused by mitral valve chordae rupture leading to severe mitral valve regurgitation!

"Director, we have consulted the surgical department." Jin Miao continued, "The director of cardiac surgery feels that this patient's condition is critical and complicated, and he can't tolerate surgery, and he can't do open-chest surgery at all."

The normal treatment method requires open-chest replacement of the mitral valve to solve the severe mitral valve regurgitation.

However, the patient's current condition does not allow surgery at all!

For a time, everyone in the demonstration room was silent.

It was because the patient could not tolerate surgical operation that he was transferred from the First Hospital of Shanghai.

Seeing that no one spoke, Lu Chen smiled and said slowly: "In May this year, an article was published in "europeajournal", which talked about patients with acute myocardial infarction and severe mitral regurgitation."

Seeing this, everyone looked at Lu Chen who was sitting in front.

After so many years, the entire cardiology department has been full of admiration for Director Lu Chen.

Although Director Lu Chen is relatively young, his surgical operations in various fields of cardiology are among the best.

"Has anyone read this paper?" Lu Chen continued.

This time, no one spoke again.

Lu Chen was not too surprised.

Everyone is usually very busy, and they can't finish the work of their own department, let alone read those scientific research documents.