I Can See Health: Chapter 196 broken heart syndrome
Chapter 196 Broken Heart Syndrome
This is not a heart attack!
The news from the intervention room surprised everyone.
Lu Chen was also stunned.
Because during the patient's surgery, the patient's test results also came out.
Troponin is elevated!
Troponin is a protein that exists almost exclusively in cardiomyocytes. Once troponin is elevated, we can infer that the myocardial cell necrosis has ruptured, releasing troponin into the blood, and we can detect the elevation of troponin.
Acute myocardial infarction can basically be diagnosed by the symptoms of chest pain, changes in electrocardiogram, and elevated troponin.
But the results of coronary angiography were completely opposite to this diagnosis.
In addition, Lu Chen also looked at the patient's surgical records.
Not only does the patient have no myocardial infarction, but his heart blood vessels are extremely smooth, without any stenosis and plaque, so he does not look like a person with heart disease at all.
"Could it be variant angina pectoris?" Ke Yue said aside.
Sun Guoguo shook his head and explained: "If it is variant angina pectoris, even if the patient's blood vessels are not completely occluded, there must be a problem. However, in our patient, his coronary angiography showed that the patient's coronary The arteries are clear, there is no significant stenosis, there is no thrombosis, it is not a myocardial infarction, and it is not variant angina."
"What about myocarditis?"
You should know that sometimes, pulmonary embolism and aortic dissection can also show similar symptoms of acute myocardial infarction, especially chest pain.
The heart and lungs are not separated, and sometimes diseases that affect the lungs also affect the heart sideways, so it is possible to have changes in the electrocardiogram.
Although troponin is unique to cardiac muscle cells, elevated troponin often indicates myocardial cell rupture and necrosis, but it is not necessarily the increase caused by coronary artery occlusion ischemic necrosis (myocardial infarction), but may also be caused by other diseases. Cardiomyocyte destruction and necrosis, such as myocarditis.
However, Sun Guoguo still rejected the diagnosis.
"Myocarditis generally has malignant arrhythmia and prodromal infection. This patient is not very suitable."
After considering so much, Lu Chen was very puzzled at this time.
It is not myocardial infarction, angina pectoris, or myocarditis, so what other diseases can show chest pain + ECG changes + elevated troponin at the same time?
…
Because the patient had no myocardial infarction, he was pushed back to the eighth area of the heart after surgery.
Generally speaking, patients with acute myocardial infarction should be observed in the CCU for a few days after the operation to ensure that there are no complications before they are transferred back to the general ward.
The patient returned to the eighth area of the Cardiology Department. Sun Guoguo instructed Lu Chen to observe him closely, and to review the electrocardiogram and troponin in time.
At the same time, Li Yao also convened all the doctors to discuss difficult cases.
Lu Chen, as the first doctor, gave a detailed medical history introduction.
In order to further exclude other fatal diseases, such as aortic dissection, pulmonary embolism, etc., Sun Guoguo performed a chest and abdomen CT scan + enhancement for the patient.
Fortunately, the result was normal.
At this point, the three most dangerous and deadly diseases in cardiology have been ruled out - myocardial infarction, dissection and pulmonary embolism.
"The real diagnosis of the patient will not be found in a while, so let's monitor closely first." Sun Guoguo reluctantly ordered.
Fortunately, the patient's vital signs gradually stabilized, and the blood pressure also increased to 120/80mmHg.
…
The discussion of difficult cases is over.
Lu Chen reorganized all the information of the patient.
In fact, from the very beginning, this patient had many doubts.
First, the patient's heart rate changes, which is inconsistent with inferior myocardial infarction.
Secondly, the patient's life value was not reduced to less than 60 like other patients with myocardial infarction.
Lu Chen continued to think for a long time, but still could not find the diagnosis of the patient, so he could only temporarily put aside his doubts.
He is not the only patient clinically, and there are other patients who need to be dealt with.
One morning, Lu Chen received a total of four patients and was quite busy.
Fortunately, with the help of Junior Sister Yao Jie, Lu Chen can handle it.
After one or two months of training, Yao Jie has also grown from a novice in cardiology to an old white who can understand some simple electrocardiograms.
As he got off work at noon, Lu Chen thought of the myocardial infarction patient in the morning.
"Junior sister, go and check him an electrocardiogram again."
"OK."
Yao Jie immediately reviewed an electrocardiogram.
The ECG was still pretty much the same as the morning.
It was time to get off work at noon, so Lu Chen decided to take another look at him.
…
came to the bedside, where the patient was eating gruel.
Messy hair and stubborn beard.
Lu Chen walked over and said softly, "Is your appetite okay?"
The man smiled lightly, "It's normal, you can eat two bowls of white porridge and you won't die of starvation."
"You don't have a myocardial infarction." Lu Chen looked at him and said.
"I see, you all told me this morning, it doesn't matter." The man looked at Lu Chen with sadness and emptiness in his eyes.
This indifferent answer was somewhat unexpected to Lu Chen.
At this time, the man continued, "I know I must have a problem."
He lowered his head and said after taking a mouthful of porridge.
" I divorced my wife a few days ago. It's not that I don't have any children. The children belong to her. The company also fired me. I deserve all of this, haha."
As soon as the man's voice fell, Lu Chen felt a little creepy.
Especially his last laugh made his hair stand up.
However, his words also awakened Lu Chen.
Could it be that he has broken heart syndrome?
When a person is extremely sad, it is a huge stress to the heart, which is likely to cause damage to the myocardial cells, and the patient will experience severe chest pain and chest tightness.
This is similar to myocardial infarction, but coronary angiography is normal, not myocardial infarction.
This disease is rare, Lu Chen has never seen it before, only on the news.
Lu Chen left the ward and returned to the doctor's office.
"Sister, could the patient have broken heart syndrome?"
Lu Chen immediately expressed his thoughts to Sun Guoguo, and described the patient's family situation in detail.
"Broken Heart Syndrome?" Sun Guoguo was stunned, "Yes, it's probably stress myocarditis, commonly known as Broken Heart Syndrome. It's the first time our department has encountered such a situation."
Sun Guoguo immediately agreed with Lu Chen's idea.
All test results are normal, and now only mental factors can be considered.
"Senior brother, what is broken heart syndrome?" Yao Jie asked in a low voice.
Lu Chen thought about it and said, "Broken heart syndrome is actually stress myocarditis, but this is not the viral myocarditis (caused by viral infection) that we often call it."
"Stress myocarditis is a self-limiting disease. Although it is a bit scary at the onset, similar to a real myocardial infarction, it is not a coronary artery blockage after all, so it will not pose a fatal threat."
Broken Heart Syndrome, similar to being hit **** the heart by someone, the strong hit causes some myocardial cells to rupture, and the troponin increases.
The consequences of impact are far less than coronary artery blockage. You can recover without treatment after impaction. However, if the coronary artery blockage is not opened in time, the entire heart will be wiped out.
"Senior brother, I feel very uncomfortable hearing this name." Yao Jie wrinkled her nose.
"Yeah." Lu Chen nodded, "This metaphor is very vivid. Did a heartbreak really happen? Heartbreak is just an emotional diagnosis, not a physical one."
"If it is a physical heart fragmentation, the patient will die on the spot, and there is no possibility of survival. The heart is the blood pump of the human body. It takes 6 seconds to faint, and 4-6 minutes of brain hypoxia can lead to irreversible damage or even brain death.”
…
Lu Chen returned to the ward.
The patient has finished drinking the porridge.
Lu Chen hesitated for a while, but still said, "You may have broken heart syndrome."
"Broken Heart Syndrome?" The man said lightly, "What is this disease?"
Lu Chen told him the mechanism of the disease.
The patient was silent after listening.
After a period of rest, his body can recover.
He was lucky.
However, he seems unfortunate again.
Life is really impermanent.
Cherish the people in front of you and live the moment well.
I have heard one case from the teacher in clinical practice, but I have never seen it before.
One more chapter.
(end of this chapter)