Chapter 630: Restoration!

Internal Cardiac Zone II.

Doctor's Office.

The atmosphere around Lu Chen was a bit weird.

The three students looked at each other.

Everyone had a doubt in their hearts.

Was the patient diagnosed with "ventricular tachycardia" really just supraventricular tachycardia?

Yu Bin was even more silent.

He was in charge of this patient before.

During the patient's hospitalization, "ventricular tachycardia" had an attack, and he used electrical cardioversion.

It was he who suggested that the patient install an ICD!

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

(Both ventricular tachycardia and supraventricular tachycardia can be cardioverted, but supraventricular tachycardia with stable hemodynamics does not need to be cardioverted at all, as it will cause more harm and pain to the patient anyway)

Ji Yingying bit her lower lip. She flipped through the patient's electrocardiogram and could not see any clues of supraventricular tachycardia in this picture.

If she was from another major, it would be fine, but she was a cardiologist, and she even misdiagnosed an electrocardiogram.

"Brother..." Ji Yingying whispered.

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

Ji Yingying sat next to Lu Chen, "How did you see supraventricular tachycardia in this picture? I've been looking at it for a long time, but I can't see any trace of supraventricular tachycardia."

Her words represent everyone's voice.

The other two students immediately leaned over, and even Yu Bin looked towards Lu Chen.

They were so curious!

Lu Chen smiled, and the time to earn gratitude points came again.

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

In the system mall, the skill card for valve intervention treatment is as high as tens of thousands of gratitude points!

If Lu Chen doesn't work hard to earn gratitude points, he will have to wait until the end of time to redeem this skill card.

…

“Ahem.” Lu Chen cleared his throat, took the patient’s electrocardiogram and a blank A4 paper, and began his own explanation, “Then I’ll tell you about it.”

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

Yu Bin, who was standing next to him, also became interested.

But he was not very active, so he had to lean towards Lu Chen!

Lu Chen continued: “To distinguish between VT and SVT with differential conduction, it is generally necessary to analyze from the aspects of atrioventricular relationship (the relationship between P wave and QRS wave), ventricular depolarization vector, and QRS wave morphology.”

“Many scholars have proposed differential diagnosis processes. The more commonly used ones are Brugada method and Vereckei method, especially the Vereckei process, which only relies on AVR leads for differential diagnosis, which is easy to remember and convenient to use in clinical practice.”

“In 2020, an article published in HeartRhythm proposed the use of limb leads for differential diagnosis, which is also very simple.”

…

“Brother, what are these methods you are talking about?” Ji Yingying was stunned.

She had only heard of the method Lu Chen mentioned, but had never seen it in clinical practice, nor had she seen anyone else use it.

Lu Chen smiled, "To put it bluntly, it is an international standard for the diagnosis of ventricular tachycardia."

"According to this standard, ventricular tachycardia and supraventricular tachycardia can be quickly differentiated and diagnosed."

Ji Yingying asked curiously, "Brother, we have no reference for what you said. Why don't you give us an example and use the electrocardiogram of this patient to demonstrate it to us."

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

Lu Chen began his own deduction of the entire step on a blank A4 paper.

The Brugada method is divided into 4 steps to identify the origin of wide QRS wave tachycardia.

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 its RS interval is greater than 100ms, 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 morphology standards of V1 and V6 leads, that is, the left bundle branch block-like pattern, the V1 lead is an RS-type QRS wave, and the RS interval is greater than 70ms; or the left bundle branch (and/or right bundle branch) block-like pattern, the QRS wave of the V6 lead starts as a positive wave, and R/S <1, it can be diagnosed as VT.

…

"Ah? This... This is very simple?"

Ji Yingying was a little confused.

"Brother, are you sure this is a simple method?"

She didn't feel it was easy at all!

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

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

She breathed a sigh of relief.

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

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

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

Ji Yingying's heart moved, "Brother, according to what you mean, this patient must have supraventricular tachycardia?!"

Lu Chen nodded slightly, "Most likely!"

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

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

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

"Congratulations,..."

"Congratulations,..."

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

The next prompt made Lu Chen stunned.

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

Lu Chen looked out of the corner of his eye, and Yu Bin was leaning his head over at this time...

"Ahem." Yu Bin was slightly embarrassed when he saw that he was discovered, "Doctor Lu, that, you said it very well!"

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

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

Four judgment steps, diagnose ventricular tachycardia one by one.

Yu Bin has read similar medical reports, but he has never paid attention to them.

At this time, the system defaults that Lu Chen and Yu Bin are doctors of the same level, so the thank you value obtained does not have any bonus.

"Brother, thank you for the compliment." Lu Chen smiled.

A little gratitude is better than nothing.

Although Yu Bin had questioned his "amiodarone" before, this is normal.

Patients with normal ventricular tachycardia definitely need electrical cardioversion.

Medicine is a process of constant questioning and truth.

Yu Bin's prejudice against Lu Chen had long disappeared.

He couldn't help but sigh, that idiot, it seemed like he was himself!

...

Half an hour later.

Yan Shuming walked into the doctor's office with a complicated expression, and she looked at where Lu Chen was.

"Bed 10, cardioversion..."　　16377/10300390