I Can See Health: Chapter 95 Same chest pain, different diagnosis

   Chapter 95 Same chest pain, different diagnosis

  Lu Chen shrugged and said, "It may be a stomach problem, it may be intercostal neuralgia, costochondritis, or cardiac neurosis."

   "Then do you still have a cardiac angiography?" Wang Zihao frowned.

   The patient in front of him is none other than his great aunt.

  Although Wang Zihao usually does not like to take relatives to see a doctor, but now that he accepts this matter, he still has to be responsible to the end.

   "My opinion, I won't do it for the time being." Lu Chen paused and said, "You can do a coronary CTA first to evaluate the cardiovascular condition. If there is really a problem, then do an angiography."

"Lu Chen, I also worked in the Cardiology Department during my internship. Sometimes the coronary CTA is not very accurate to see the blood vessels." Wang Zihao wondered, "In case, I said in case, my aunt's blood vessels really have If she is stenotic, and then ask her to do a cardiac angiography, she will suffer two sins, so it is better to do a cardiac angiography directly, and it will be done in one step."

  Clinically, there are two ways to diagnose coronary heart disease.

   The first one is coronary CTA, which is simply an enhanced CT of the heart vessels. The contrast agent is injected into the blood vessels of the heart, and then developed by a CT machine, you can see the vascular lesions, whether there is blockage, and the degree of blockage.

  The other is cardiac imaging.

Cardiac angiography generally refers to coronary angiography. The specific operation generally uses radial artery puncture, inserting a sheath, and under the guidance of angiography guide wire, it reaches the left and right coronary sinus orifices, and is imaged by imaging equipment. Individual position, multi-angle dynamic observation of coronary artery stenosis.

Coronary coronary angiography is currently the gold standard for diagnosing coronary heart disease. Under normal circumstances, coronary angiography can be used to see whether the patient's coronary vessels have stenosis, which part of the stenosis, and the degree of stenosis, and can diagnose whether there is coronary heart disease. , can also guide the next step in the treatment.

   And coronary CTA, because of the influence of heart rate, vascular plaque, equipment and other factors, there are some false positive results, and the diagnostic accuracy rate is not as high as that of angiography.

"However, have you ever thought about another point? Coronary angiography is an invasive examination after all. A catheter is inserted into a blood vessel. Even a doctor with the best skills will cause damage to the blood vessel." Lu Chen said, "And Coronary CTA is just a non-invasive imaging test, if it is just to rule out coronary heart disease, why not do CTA?"

   Wang Zihao was silent for a long time, then sighed: "Each method has advantages and disadvantages, let my aunt choose by herself, I can't call the shots for her."

   "Well." Lu Chen said, "Don't worry, we will communicate with her, and this is just my suggestion. The superior doctor in the group will also visit the patient to assess her condition and what kind of examination is suitable."

   Wang Zihao smiled and patted Lu Chen on the shoulder: "Thank you brother, sorry to bother you."

   "You're welcome." Lu Chen smiled.

  …

After Wang Zihao left, Lu Chen returned to the doctor's office with an electrocardiogram.

   "Junior Brother, what kind of patient is here?"

  Sun Guoguo, as the chief doctor, inquired about the condition of each new patient as usual.

   "A female patient with chest pain." Lu Chen said, "I want to do a cardiac angiography."

   "Oh, yes, let's make arrangements for her." Sun Guoguo said.

  Lu Chen paused for a while, before he stopped talking.

   "What's the matter, Junior Brother?" Sun Guoguo looked back at Lu Chen.

   "I don't think she looks like coronary heart disease." Lu Chen paused.

  Sun Guoguo was stunned, "What about her electrocardiogram?"

"Here." Lu Chen handed the electrocardiogram to Sun Guoguo, and continued, "The patient is a fifty-year-old woman with no significant correlation between chest pain and activity, no risk factors for coronary heart disease, no hypertension, diabetes, etc. No history of smoking or drinking."

   At this time, other people in the group also gathered around.

   "The T wave in the chest leads is inverted, do you really not consider coronary heart disease?" Ke Yue whispered aside.

   "Well, at the same time she has chest pains, I also think coronary heart disease should be considered." Dong Hao nodded in agreement.

  Sun Guoguo finished reading the electrocardiogram, but did not express her opinion immediately, she was silent for a while, and said, "Go to the ward to see the patient first."

  …

  The crowd came to the 11th bed.

  Fu Fengqin is chatting with the patient in the next bed.

   Seeing the arrival of the doctors, she hurried back to her hospital bed.

   "Aunt Fu, this is your attending doctor, Dr. Sun." Lu Chen introduced.

   "Hello Dr. Sun." Fu Fengqin's face was full of smiles.

   "Auntie, I came here to ask some questions about your condition." Sun Guoguo said.

"Ah? Why are you still asking?" The smile on Fu Fengqin's face gradually disappeared, but instead he frowned, "Did this little Doctor Lu already ask when he first came here? Don't you communicate with each other between doctors? Illness? Do you have to ask a second time?"

   Everyone present looked at each other.

   Asking the medical history again is a very common thing in clinical practice.

  Each doctor basically makes his own inquiries and collects first-hand information to judge the condition.

   and not just through the descriptions of other doctors.

   The performance of this aunt in front of her seemed a bit extreme.

   "Also, here are my medical records when I was hospitalized in the county hospital. You can take a look. My condition is all there. You don't need to ask any more. It's too troublesome." Fu Fengqin waved her hand impatiently.

  Lu Chen frowned and said solemnly: "Aunt Fu, each of our doctors has a different focus on understanding the medical history, and can check and fill in the gaps. At the same time, this is also the basic process of seeing a doctor, and we still need your cooperation."

   "Oh, your hospital is really troublesome." Fu Fengqin sighed lightly, "I have a heart problem. I want to have a cardiac angiography, why is it so troublesome! Forget it, what do you want to ask, just ask."

  Fu Fengqin was lying on the bed, with his hands behind his head, and said to Sun Guoguo.

   "Ke Yue, you can ask." Sun Guoguo whispered to Ke Yue.

   "Yeah." Ke Yue nodded lightly, took a step forward, and began to ask about his medical history.

  Inquiry is the first mode of communication between doctors and patients.

   is also a very important part.

a thousand reader with a thousand hamurate.

  Similarly, different doctors will collect different medical history for the same patient.

   Take a patient with "chest pain" as an example, a cardiologist may think it is coronary heart disease, a doctor in respiratory medicine may think of pleurisy, a gastroenterologist may think it is a gastric ulcer, and a surgeon may consider whether it is a hiatal hernia!

   Therefore, the collection of medical history not only needs to be targeted, but also cannot be limited to a single system disease.

   At this time, Ke Yue's consultation was like guiding the patient to the diagnosis of coronary heart disease.

   "Auntie, do you usually have chest pain after exercise, or chest tightness and discomfort?"

   "What kind of pain is that? It feels like a stone is pressed against your chest? Or is it a needle stick? Or is it a tearing pain?"

   "Can the symptoms of chest pain be relieved after rest?"

   This is because, in Ke Yue's heart, he has already decided that the aunt in front of him is coronary heart disease.

   (end of this chapter)