I can see health

Chapter 917 Exaggerating the condition?

"There is another very strange thing." Jiao Jingqiu said.

"Tell me." Lu Chen looked at her.

Jiao Jingqiu spoke slowly.

"One night when I worked the night shift, the uncle had a premonition that he was going to have an attack again, and asked me if I could take a piece of isosorbide mononitrate?"

"At that time, I thought in my heart that I could still have a premonition of the disease? Eat it if you want!"

"It turned out that the night was calm and there was no change in the condition. The BNP was checked again the next morning, and the result was lower than before (121.6pg/mL)."

Lu Chen nodded, "What are you thinking about?"

Jiao Jingqiu said: "The indicators are getting better, but the symptoms are getting worse. We are beginning to suspect that the uncle is exaggerating the condition!"

After saying this, she glanced at Mr. Du, and then continued: "Some old people usually lack love and care, and want to attract everyone's attention in some ways, such as talking with people around them constantly."

Hearing this, Du Fu said softly: "How should I put it, since I took over the company, the attention paid to my dad has indeed decreased a lot. I am not doing well enough in this regard."

Jiao Jingqiu showed a smile.

Hearing this, Lu Chen frowned, "Doctor Jiao, based on your current diagnosis, do you think the patient exaggerated his condition?"

Without hesitation, Jiao Jingqiu nodded and said: "BNP is not high, diuretic dilating drugs are fully used, there is no reason why the condition will not improve."

Lu Chen disagreed with this diagnosis.

In medical diagnosis, the first element is to rule out organic heart disease before diagnosing physiological diseases.

Lu Chen looked through all the examinations again, and then wondered: "Why is there no electrocardiogram when the patient's illness occurred?"

There are five ECGs in total.

But none of them were electrocardiograms taken during chest tightness attacks.

The electrocardiogram is an easy-to-obtain inspection report that can reflect the electrophysiological changes of the heart most quickly.

Jiao Jingqiu was taken aback, "We thought it was heart failure at the beginning, so we didn't check the electrocardiogram. But low BNP can rule out heart failure, so I suspect that the condition is exaggerated..."

Lu Chen interrupted Jiao Jingqiu's explanation: "Who told you that low BNP can cause heart failure? If diastolic heart failure does not increase the left ventricular pressure significantly, BNP can be low!"

Jiao Jingqiu asked: "Ah...could it be heart failure? It seems that we have used diuretics, but it still hasn't improved?"

"Doctor Jiao, can't you think about it yourself, is there evidence for diastolic heart failure?" Lu Chen frowned.

If Jiao Jingqiu was a doctor in her department, then she would really be mad at her.

Jiao Jingqiu looked troubled: "Then...what the hell is it?"

"Electrocardiogram!" Lu Chen said sternly, "The next time the illness flares up, I must remember to take an electrocardiogram!"

"Okay... I see." Jiao Jingqiu paused.

Seeing this, Lu Chen has already collected all the case materials.

"Mr. Du, I already know about your father's situation." Lu Chen looked at Du Fu, "Next, I need an electrocardiogram when the illness flares up, then I almost know what the illness is."

"So fast?" Du Fu was taken aback.

In fact, he has almost accepted his father now, exaggerating his illness.

This will draw the attention of the family.

After all, they are usually very busy and really pay little attention to their father's life.

Because of this illness, he spent more time with his father.

However, what Lu Chen said now made him a little shaken.

"Actually, Dr. Jiao made a subjective mistake." Lu Chen said, "I was deeply influenced by the concept at the beginning."

Jiao Jingqiu frowned and said, "Director Lu, if the patient's electrocardiogram changes during the onset of illness, what exactly is his illness?"

"It's very simple." Lu Chen smiled, "Supine angina pectoris!"

Chest tightness at night is most likely to be mistaken for heart failure.

However, there is a kind of angina pectoris, which occurs when lying down. When the attack occurs, it is necessary to sit up or stand up immediately to gradually relieve the symptoms of angina pectoris.

"This kind of angina usually occurs within 1-3 hours after lying down. In severe cases, it can occur within 10 minutes of lying down. It can occur multiple times a night. It can also be induced by lying down during the day, especially after eating."

Supine angina pectoris, this diagnosis can also explain why when Lu Chen thought of coronary heart disease just now, the system popped up the correct prompt.

Supine angina is also a type of coronary heart disease.

Hearing Lu Chen's words, Du Fu immediately echoed, "Yes! My father sometimes suffers from postprandial seizures. Before that, he thought it was a stomach problem and had a gastroscopy. In the end, there was nothing wrong with it."

The increase of ventricular wall tension, myocardial contractility and myocardial oxygen consumption caused by the increase of return blood flow after lying down is the main cause of supine angina.

"Supine angina?" Jiao Jingqiu was taken aback.

To be honest, she really didn't think about this disease.

My uncle always suffers from chest tightness at night. In this case, everyone thinks it is a heart failure attack.

And angina pectoris, mostly after the onset of activity.

Therefore, supine angina is a type of coronary heart disease that is easily overlooked by everyone.

Lu Chen smiled, "So, this can also explain why the disease can be relieved every time I take a piece of isosorbide mononitrate."

Speaking of this, Du Fu has already believed most of it.

Everything Lu Chen said matched his father's.

Jiao Jingqiu also came back to her senses, and began to think carefully about the shortcomings of what she had done in the whole case.

"Also, look at this electrocardiogram of my uncle." Lu Chen pulled out another electrocardiogram, "When the disease did not attack, it looked like a normal electrocardiogram of sinus rhythm without any ST-T changes, but it It is very likely that there is multi-vessel coronary artery disease, and the vector is neutralized, causing the electrocardiogram to look normal."

"Actually, the coronary artery condition of this patient is very poor! It is necessary to do another coronary angiography."

Jiao Jingqiu said at this time, "We also persuaded the uncle to review the radiography before, but he was unwilling to do it. He has a very stubborn temper, and no one can hold back what he believes."

"Let's do this." Lu Chen continued, "When the illness flares up again, we must re-examine the ECG. After the results come out, we will make plans for the next step."

"Okay!" Jiao Jingqiu nodded slightly.

……

After discussing with everyone, Lu Chen returned to the ward and had another exchange with the uncle.

The uncle pulled Lu Chen and chatted for a long time.

What they were talking about was nothing more than the gossip about Director Zhao of the Department of Cardiology.

Before leaving, the uncle looked at Lu Chen earnestly, and said in a low voice, "Director Xiao Lu, you talked to me so much today, what do you think about my condition?"

Before Lu Chen could reply, the uncle said to himself: "Do you also think that I am exaggerating my illness, old man?! In order to attract the attention of the family?"

From the corner of his eyes, he glanced at Du Fu at the side from time to time.

Seeing this, the latter also looked a little embarrassed.

Lu Chen shook his head quickly, "Master, I have other ideas."

"Huh?" The uncle was taken aback, with a trace of surprise in his eyes, "What do you think?"

"Grandpa, you should hear about me first. Next time, when you feel uncomfortable, chest tightness or chest pain is about to strike, you should immediately contact our medical staff." Lu Chen urged, "Let them take an electrocardiogram for you." , I knew about your condition."

"Okay, you kid can do it, I'll listen to you!" The uncle grinned.

(End of this chapter)