Chapter 778: Alcoholic Man

The first session of the tavr surgery training class has ended.

The first batch of 20 students has gained a lot.

Among them is Wang Qingfeng, who was admitted to the hospital at the same time as Lu Chen.

From a tavr beginner, he gradually became familiar with the tavr field and began to become a reserve talent.

Although they are unable to perform surgery independently now, in the near future, the tavr surgery team of Guanghai First Hospital represented by them will definitely shine in the field of Chinese cardiology!

On the other hand, the content of Lu Chen's national natural project is also limited to the discipline construction of tavr.

The only thing missing now is data!

Surgical data, patient data, postoperative rehabilitation data, etc. are currently missing in Guanghai First Hospital and even in China.

However, if you want to build the tavr discipline well, these things are indispensable, and Lu Chen can only do it step by step.

As for clinical matters, he did not relax.

As a senior physician, he insisted on making rounds every day and personally checked critically ill patients to ensure that there would be no major loopholes in the treatment plan of each patient.

As for Jin Miao, she has been following Lu Chen on the operating table recently, and her TAVR surgery skills are also improving rapidly.

In addition, once Jin Miao encounters a difficult case, she will notify Lu Chen as soon as possible.

"Director Lu, the CCU has transferred a more difficult patient. Do you have time to come and see?"

In Lu Chen's office, after Jin Miao reported the recent work progress, she was ready to take him to check on the condition of a patient.

"Transferred from the CCU?" Lu Chen asked in confusion.

"Well, he was hospitalized in the first area of ​​the heart a few months ago, but the cause was not found at the time. He went back to take medicine, and now he is sick again." Jin Miao explained.

"Okay, let's go and see."

Lu Chen put down the work at hand and followed Jin Miao to the ward.

...

In the ward.

Lu Chen saw the patient in front of him.

He was a 60-year-old bachelor, and the family member who came to accompany him was his old mother.

"Director Lu, the patient is suffering from heart failure." Jin Miao introduced the condition on the side, "He used to be an alcoholic. Other hospitals considered alcoholic cardiomyopathy before. He was treated for heart failure for many years, but he never got better."

"Yes." Lu Chen nodded and began to examine the patient and ask questions in person.

The life value on his head was 54 (--)!

The condition did not seem to be very good, but it did not reach the level of three minus signs.

The patient was a 63-year-old single man, a typical "one person eats well, the whole family is not hungry".

He used to drink a lot. I don't know if it was because of the difficulty in capital chain turnover or repentance. He has quit drinking for 10 years.

But quitting drinking does not mean that he will start to cherish his body. He still eats instant food every day.

The reason why he came to the hospital was because he gradually felt difficulty in breathing, and his lower limbs were swollen, and there was a pit when he pressed.

This scared him and he came to the hospital immediately.

Lu Chen gave the patient a relatively detailed physical examination.

The patient had distended jugular veins, rales at the base of both lungs, normal heart auscultation, and moderate edema in both lower limbs.

In addition, the results of the echocardiogram showed that the left ventricular activity was weakened, the left ventricular ejection fraction (LVEF) was 25%, and the right ventricular systolic function was moderately reduced.

Combining all the test results, Lu Chen initially judged that it was still heart failure.

However, there are many causes of heart failure, including common coronary heart disease, valvular disease, myocarditis, cardiomyopathy, etc.

"Two months ago, a coronary angiography was performed in the first area of ​​the heart, and the results were normal." Jin Miao said, "So we ruled out coronary heart disease, and we still considered that this was heart failure caused by long-term drinking and alcoholic cardiomyopathy."

Lu Chen thought for a while and asked, "Is the anti-heart failure treatment not effective?"

"It was okay at the beginning." Jin Miao said, "But two months ago, I don't know if he stopped taking the medicine or what, but his heart failure worsened three times! Each time it was an acute left heart failure attack, and he came to our hospital's CCU."

As soon as Jin Miao finished speaking, the patient's mother, the old lady in her eighties, also echoed.

"Doctor, he took the medicine and didn't stop." The old lady's voice was a little hoarse. She took out a few medicine boxes from the drawer with trembling hands and handed them to Lu Chen and Jin Miao.

Lu Chen took a look and found that it was indeed the golden triangle drug for treating heart failure.

"Okay, I got it." Lu Chen nodded, then turned to Jin Miao, "What do you think now?"

Jin Miao paused and whispered, "Now I think the treatment effect is not very good, it may be stubborn heart failure, and I am going to increase the drug dosage."

Lu Chen frowned and said, "Has the patient ever had some mental symptoms?"

"Mental symptoms?" Jin Miao was stunned, "No..."

Lu Chen pointed to the patient's eyes, "When I examined him just now, I found that his extraocular muscles were paralyzed."

"Ah, this..." Jin Miao whispered, "The patient was transferred here, and I didn't find it yet."

"I looked through the medical records of the CCU, and there was no record of this kind of mental symptoms." Lu Chen said.

Jin Miao's expression was a little serious, "I will re-evaluate the patient's mental state."

"Don't panic." Lu Chen looked at the old lady beside him, "Mother-in-law, does your son usually live with you?"

"Yes." The old lady nodded, "Live together, he is not married, who else can he live with."

"Have you noticed any abnormal behavior in him recently?" Lu Chen said.

"Abnormal behavior?" The old lady didn't quite understand.

"For example, talking nonsense, shouting and so on." Lu Chen reminded.

Hearing this, the old lady nodded quickly: "During this period, he sometimes always talks to himself, and I can't understand what he says. Sometimes he gets angry."

"Was it like this before?" Lu Chen said.

"That's not it." The old lady said, "Although he likes to drink, his temper is usually good, and there has never been such a situation."

Hearing this, Lu Chen basically understood.

He looked at Jin Miao on the side, "Give the patient a MOCA score."

"Okay!" Jin Miao quickly responded.

MOCA, that is, the "Montreal Cognitive Assessment Scale".

It includes attention and concentration, executive function, memory, language, visual structure skills, abstract thinking, calculation and orientation, etc. The total score is 30 points, and ≥26 points are normal.

...

Back to the doctor's office.

Jin Miao immediately gave the patient a full set of MOCA scores.

The final result was 13 points.

"Director Lu, the score is 13!" Jin Miao reported the final result to Lu Chen.

"What do you think now?"

Lu Chen intended to cultivate Jin Miao, so he did not tell his diagnosis at the first time.

"In addition to heart failure, the patient also has some neurological symptoms such as cognitive impairment." Jin Miao said hesitantly.

"Is that it?" Lu Chen asked, "Have you ever thought about why the patient has neurological symptoms?"

"It's not clear yet, and some head examinations may be needed." Jin Miao whispered.

"I saw that he had a cranial CT scan, and everything was normal." Lu Chen said.

"Then do another cranial MRI?"

Jin Miao's tone was full of strong unconfidence.

Lu Chen shook his head helplessly, "You still haven't found the problem, this is a kind of beriberi!" 16377/10526220