Chapter 233 Myocardial Infarction or Dissection?

Come to the ward.

Lu Chen and Fan Zhiping were in front, followed closely by Wei Zhongwen, pushing the electrocardiograph.

On the hospital bed, the patient was lying flat on his back, breathing heavily.

His lips were slightly white, his face was full of pain, and there were even layers of sweat on his forehead.

Lu Chen looked at the patient's head. His health value was 62!

This value is around a limit of 60.

Most patients with acute myocardial infarction have a vitality value below 60.

However, if the acute myocardial infarction is in the recovery stage, or the scope of the myocardial infarction is very small, the health value will also rise to above 60.

"Junior brother, measure the patient's blood pressure and then review the electrocardiogram." Lu Chen ordered, while he also auscultated the patient's heart and lungs.

Patients with chest pain need to have their electrocardiogram reviewed immediately as long as the degree of chest pain changes.

"Okay, senior brother."

Wei Zhongwen was very agile and immediately took out the mercury sphygmomanometer.

At this time, Lu Chen also began to ask about the patient's condition.

"When did the chest pain start?"

"Actually, the pain started when I got up this morning, but I took a tablet of nitroglycerin and the chest pain was relieved." The patient's family member is a middle-aged woman, who should be the patient's wife. "He had coronary heart disease before and usually has chest pain." Taking nitroglycerin under the tongue can relieve the pain, but the department just couldn't do it. It was too painful and I couldn't breathe."

Generally speaking, if it is angina pectoris, taking nitroglycerin orally can relieve it.

If it cannot be relieved, most of them have myocardial infarction!

"When does it hurt the most?"

"Just now, maybe a few minutes ago."

"What specific part of the chest is hurting? Please point it out to me, patient." Lu Chen looked at the patient on the hospital bed and said.

The patient gasped and pointed to his heart.

"Is the chest pain now the same as before, or is it worse than before?"

"It's getting worse." The patient struggled to spit out a few words.

"What kind of pain do you feel?" Lu Chen continued, "Is it like a stone pressing on your chest, so painful that you can't breathe?"

"Yes, that's what it feels like." The patient replied with a frown, sweat oozing from his forehead. He covered his chest with both hands, looking like he was really in pain.

Lu Chen's heart sank.

Based on the patient's symptoms and his own description, the pain cannot be relieved by nitroglycerin, and the pain is too similar to a myocardial infarction.

At this time, Wei Zhongwen had already taken his blood pressure.

"Brother, the patient's blood pressure is 1Hg, and the blood pressure is symmetrical on both sides."

Lu Chen nodded and said to the patient and his family: "Fortunately, the blood pressure has not dropped. Nitroglycerin is not something that can be used casually."

"If you want to take nitroglycerin sublingually, remember to measure your blood pressure. If your systolic blood pressure is lower than 100mmHg, don't use nitroglycerin. If your blood pressure drops, it will be even worse. This medicine used to be an ingredient in explosives. You know, it’s very powerful and can lower blood pressure, so don’t use it when your blood pressure is low.”

The patient's family members nodded quickly.

Lu Chen asked a few more questions and learned that the patient had never had coronary angiography or coronary CTA before.

"If you haven't done coronary angiography, you can't be sure that it is coronary heart disease."

Having experienced many diseases similar to myocardial infarction in the past, Lu Chen is not in a hurry to make a diagnosis now.

About a minute later, Wei Zhongwen finished the electrocardiogram.

"Thank you." Lu Chen took the electrocardiogram handed over by Wei Zhongwen.

EKG display. The ST segment in leads II, III, and aVF moved downward by 0.05mV, which was caused by T waves in leads V4-V6, and the ST segment also moved downward.

At this time, the patient himself added: "Doctor, I also have traction pain in my left forearm."

When Fan Zhiping heard this, he said, "Isn't this typical radiation pain from myocardial infarction?"

Lu Chen hummed to express his approval.

The patient was obese and had been diagnosed with coronary heart disease and hypertension in the past.

Now I have obvious chest pain and reflex pain. Sublingual nitroglycerin is ineffective. Together with the ECG performance, it indicates that the possibility of myocardial infarction is quite high!

"Open the intravenous channel quickly!"

Lu Chen immediately ordered the nurse to draw blood and do routine tests, especially cardiac enzymes and troponin.

There are rapid screening troponins in the eight areas of the heart, which can be done in the department, and the results will be available in a few minutes.

"Brother Fan, please inform Senior Sister Sun and ask her to come over and take a look at the patient." Lu Chen said to Fan Zhiping who was standing aside.

The mortality rate of acute myocardial infarction is very high. For critical cases like this, the superior doctor must be notified as soon as they are discovered.

"Okay!" Fan Zhiping immediately left the ward.

…

At this time, the patient’s troponin rapid screening results came out!

The results showed that troponin was normal and not significantly elevated.

Wei Zhongwen on the side whispered: "If it's normal, wouldn't this be able to diagnose myocardial infarction?"

There are three elements to diagnose myocardial infarction: one is typical chest pain, the other is electrocardiogram performance, and the third is troponin.

An increase in troponin, which means myocardial infarction, is caused by the rupture of heart muscle cells.

But now the patient's troponin is still normal. What does that mean?

Lu Chen patiently explained: "For patients with myocardial infarction, the electrocardiogram will respond quickly, but it takes a certain time for troponin, cardiac enzymes, etc. to rise. The fastest is myoglobin, which also takes 30 minutes. -It takes one hour to rise.”

"The troponin we measured takes at least 2-3 hours to rise. The patient only had chest pain for less than an hour. It is understandable that the troponin is normal, but it needs to be reviewed dynamically."

"Oh." Wei Zhongwen nodded.

At this time, Sun Guoguo also came to the ward.

"How is the patient?" Sun Guoguo checked the patient and then looked at the patient's electrocardiogram.

Lu Chen thought for a while and immediately said: "The patient had sudden chest pain for about 10 minutes, and taking nitroglycerin under the tongue could not relieve it. He had a history of similar chest pain in the past, but he had previous chest pain attacks, and taking nitroglycerin under the tongue could relieve it. "

"What about the past medical history?" Sun Guoguo asked.

Lu Chen paused and continued: "The patient was diagnosed with coronary heart disease at the local hospital two years ago because of chest pain and tightness. Later, he took aspirin and other drugs for a long time. At the same time, the patient also had a history of hypertension and took antihypertensive drugs. , the specific medicine is unknown, but I don’t insist on taking it, and I don’t measure my blood pressure at home.”

After listening to Lu Chen's medical history report, Sun Guoguo said solemnly: "The patient's chest pain continues to not be relieved, and the electrocardiogram shows myocardial ischemia, suggesting that it may be an acute non-ST segment elevation myocardial infarction!"

If it is really myocardial infarction, then immediately send it to the catheterization laboratory and perform coronary intervention to open the coronary arteries blocked by thrombus, so that more myocardium that is ischemic and hypoxic can be saved!

There are too many patients like this in the Department of Cardiology. Some of them were delayed and their heartbeats stopped!

But Sun Guoguo was not at ease with such a patient!

"Do you think this patient can rule out aortic dissection?" Sun Guoguo looked at Lu Chen and Fan Zhiping standing aside. UU reading www. uukanshu． net

For patients with chest pain, in addition to myocardial infarction, aortic dissection must be ruled out!

Because the treatment of myocardial infarction and dissection are completely opposite!

If the patient has an aortic dissection, it will be terrible if he takes anticoagulant and antiplatelet drugs. Hemorrhage may occur and the patient will die faster!

As long as it's a mistake...

That is ruin!

Lu Chen and Fan Zhiping looked at each other and shook their heads.

Judging from the current data, there is indeed no way for patients to completely rule out aortic dissection!

However, the patient's biggest possibility is acute myocardial infarction. If the time to open the blood vessel is delayed, it will cause greater harm to the patient!

This is quite contradictory!