I Can See Health: Chapter 74 tendon xanthoma
Chapter 74 Tendon Xanthomas
Myocardial ischemia at the age of ten?
Lu Chen frowned.
Coronary heart disease in men younger than 55 years old is classified as premature coronary heart disease.
Not to mention such a ten-year-old child.
Lu Chen had never seen the electrocardiogram of a ten-year-old child, the same as an old man in his seventies or eighties.
"Ten years old? This should go to the pediatrics."
Lu Chen paused.
Generally, 14-year-old children can basically go to the pediatrician.
"The pediatrics department in our hospital is not very good. There are only five doctors left in the entire department. The young doctors have all left, and there are only a few deputy directors and directors left." Jiang Qingyan shook her head, "So something like this involves the heart. Most of the diseases have come to the Cardiology Department.”
"Does the patient have any symptoms?" Lu Chen then asked.
"Intermittent chest pain for 1 month."
"According to the electrocardiogram and symptoms, there must be something wrong with the child's cardiovascular system." Lu Chen said, "But it is definitely not a conventional coronary heart disease, but has other causes."
"Yes." Jiang Qingyan nodded, "At present, I have several considerations, such as vasculitis, cardiomyopathy, myocarditis, and patent ductus arteriosus."
"It is very likely that these causes lead to secondary coronary vascular disease!"
Lu Chen frowned and said, "No matter what the cause is, this child's vascular disease is serious and may need immediate treatment. Does Senior Sister know about this patient?"
"I know." Jiang Qingyan nodded, "But senior sister didn't see the cause for the time being, so let me check the blood and do a heart ultrasound first, and then adjust the treatment plan after the results are reported."
"Hmm." Lu Chen put down the electrocardiogram.
He was very interested in this young patient.
"Which bed is he?"
"13 beds."
…
came to 13 beds.
This is a ten-year-old girl.
The girl curled up in the corner of the bed, her face pale.
Lu Chen stepped forward, and her mother stood up.
"The doctor is here."
The girl turned her head to look at Lu Chen, and then buried her head in the bed.
"Auntie, I'll ask her about her condition."
"Well, ask the doctor." The girl's mother forced a smile.
Seeing no response from the girl, Lu Chen asked her mother directly.
Girl started to experience intermittent limp 3 months ago.
1 month ago, chest pain occurred after activity, which was squeezing pain, mainly in the precordial area.
During the period of , he did not go to the hospital for treatment and suffered frequent chest pain attacks.
"Auntie, does your family have a history of coronary heart disease?"
"No."
Lu Chen wanted to give the girl a physical examination, but she resisted.
The girl's mother shook her head gently, and Lu Chen could only give up.
…
Back to the doctor's office.
Lu Chen flipped through the medical records written by Jiang Qingyan, and focused on the physical examination part.
Physical examination on admission: HR120 beats/min, BP90/50mmHg. Cardiac auscultation could hear a click-like murmur in the middle and late stages of systolic mitral valve auscultation, but no abnormal breath sounds were heard on lung auscultation.
"Painless nodules at elbows, knees, ankles; white rings visible at corneal edge."
"Peripheral vascular pulse was normal, and intermittent claudication of both lower extremities occurred during walking, without edema and skin color changes."
Jiang Qingyan wrote about the physical examination on admission, which is extremely detailed.
Heart auscultation, murmur and murmur can be heard.
A thought flashed in Lu Chen's mind, could it be congenital heart disease?
But he also noticed that painless nodules could be seen in the girl's joints.
"this is……"
Lu Chen frowned and looked back at Jiang Qingyan.
"Jiang Qingyan, what is this painless nodule?"
"This nodule, I think it should be a tendon xanthoma."
"Tendon Xanthomas?"
Lu Chen suddenly thought of something, but he couldn't catch it.
"What's wrong?" Jiang Qingyan asked in confusion.
"Nothing..." Lu Chen shook his head gently, "Let's take a look at the patient's tests and test results first."
…
The whole morning.
There are too many patients coming from the eight districts in the heart.
Lu Chen has been there, treating patients, issuing doctor's orders, and writing disease course records.
He received three patients in total, Dong Hao and others received two each.
So that at twelve noon, everyone stayed in the department.
"Today at noon, I invite everyone to eat in the department."
Sun Guoguo walked into the doctor's office with a smile, took out his mobile phone, and opened the ordering app.
"Whatever you want to eat and which restaurant you want to eat, you can give your opinion."
"Girls first, the two junior sisters will order first."
Sun Guoguo handed the phone to Jiang Qingyan.
"Ke Yue, you order it, I can do it."
Jiang Qingyan was dealing with the ten-year-old patient.
"Well, then eat braised pork rice?"
Ke Yue swiped the ordering interface.
"Oh, what are you eating with braised pork rice?" Dong Hao leaned over and said with a smile, "I know there is a family of drooling chicken, it's delicious."
"Then, wouldn't that be too expensive?" Ke Yue whispered.
"Don't worry, Teacher Li will pay." Sun Guoguo smiled, "Just order it."
With Sun Guoguo's words, everyone will have no scruples when ordering food.
Lu Chen followed the flow and ate chicken with saliva.
…
About half an hour later.
The "saliva chicken" was sent to the department.
Everyone was just about to open the lunch box and enjoy the food.
A shout came from the nurse station.
"Is the doctor of the director team there? The laboratory system has a critical value!"
Sun Guoguo heard the words and immediately ran to the computer and turned on the assay system.
The crowd also stopped opening the lunch box.
Too many patients came this morning.
Sun Guoguo quickly reviewed all the new patients in his mind.
It seems that there are no seriously ill patients.
Who will it be?
Open the assay system.
A pop-up window popped up immediately.
Department: The Eighth Ward of Cardiovascular Medicine
Name: Yuan Hui
Bed size: 13 beds
Age: 10 years old
Critical value: cardiac troponin I (fluorescence method) 3.12ng/ml (normal value 0-1ng/ml).
is actually the critical value of a 13-bed girl!
A trace of doubt flashed in Sun Guoguo's eyes.
According to the diagnostic criteria of myocardial infarction.
At present, the 13-bed girls have met the three diagnostic criteria of chest pain, elevated myocardial enzymes, and electrocardiogram changes!
Acute myocardial infarction can almost be diagnosed!
10-year-old myocardial infarction!
This is extremely rare.
Sun Guoguo frowned deeply.
"Junior Brother Dong, let the nurses monitor and inhale oxygen for the 13-bed patients!"
"Junior Sister Ke, you can contact the CCU catheter lab on the 4th floor so that the catheter lab will be ready at any time."
"Junior Brother Lu, write a record of the critical illness course."
"receive!"
Everyone also saw the critical value report and understood that the situation was serious.
"I'm going to explain the condition to the patient's family."
Sun Guoguo took out his mobile phone and called Director Li Yao while walking out of the ward.
This patient's condition is very difficult.
The most important thing is that the patient is too young, a ten-year-old child!
Once there is any mistake, it is very likely to cause medical disputes!
"Mr. Li, a new patient came in today, a 10-year-old girl. The electrocardiogram showed myocardial ischemia. The test value just returned, and the myocardial enzymes increased."
connected the phone, and Sun Guoguo immediately reported the patient's condition.
"Let the catheterization lab prepare immediately!" Li Yao's voice came from the other end of the phone, "No matter what the cause is, according to the patient's current condition, immediate intervention is required!"
"Guoguo, talk to the patient's family!"
"I'm having a meeting at the school now, and I won't be back in a while."
"Okay." Sun Guoguo hung up the phone and immediately followed Li Yao's instructions, preparing to communicate with the family about the interventional surgery.
…
On the side, Lu Chen was writing a record of the critical condition.
In his mind, he kept recalling the relevant information about this ten-year-old girl.
"Myocardial infarction, murmur, painless nodule, xanthomas..."
"If it were all explained in terms of medical monism...what would it be?"
(end of this chapter)