Myocardial infarction?

Logically speaking, this possibility is not high, but Zhou Yewu still did an electrocardiogram to prevent accidents.

Otherwise, if Xu Tianfu really had a myocardial infarction by then, then he would be Zhou Yewu crying!

...

After Zhou Yewu sent Xu Tianfu into the CT room, he hurried back to the outpatient clinic of the emergency room.

When he went back, he looked at the long queue of patients in front of Chen Riyuan's door with some embarrassment.

Chen Riyuan saw Zhou Yewu coming back, his eyes were shining and said with some joy: ""

After CT was finished, nothing happened. There was a little brain atrophy and a little lacunar cerebral infarction. The patient's son asked Lao Ma worriedly what lacunar cerebral infarction is serious.

Lacral cerebral infarction is a cerebral infarction caused by occlusion of very small cerebral blood vessels. The name sounds scary, but it is not serious, so don’t worry. When Lao Ma saw that he was easy to talk to him, he explained it to him patiently. Usually, emergency rooms are like wars, so how can he get so much leisure to explain to his family?

For elderly people with hypertension, they usually see lacunar cerebral infarction when doing CT, which will be more or less. If it doesn’t matter, just control your blood pressure and blood sugar. His headache has nothing to do with this cerebral infarction. Lao Ma continued.

The biggest and most important information given to us by the craniocerebral CT is that we can rest assured if we don’t see cerebral hemorrhage. Lao Ma said that since there is no cerebral hemorrhage, your father’s headache may be related to the increase in blood pressure, and it may be more comfortable to lower the blood pressure.

But at this moment, the patient's condition suddenly changed.

The patient pointed to his chest and said to Lao Ma, "Doctor, I feel a little stuffy in my chest and I seem to be a little breathless."

Lao Ma's originally tense heartstrings had already relaxed, but when he heard the patient say this, his heart skipped a beat again. Originally, a patient's chest tightness was an ordinary symptom, but Lao Ma always felt that he had something wrong, so every complaint of him would touch Lao Ma's heart.

Lao Ma said, it may be related to your high blood pressure. I have asked the nurse to come back with antihypertensive medicine for you. If it still doesn’t work after taking antihypertensive medicine, we will have to use some antihypertensive medicine intravenously. Blood pressure will definitely drop, so don’t worry.

High blood pressure can cause chest tightness, which is easy to understand. Just imagine that if the blood pressure is so high, it will be much more difficult for xinzang to pump the blood out again. It is like a typhoon outside, and you have to walk forward with an umbrella. It is good not to be blown back. But xinzang must not stop pumping blood, so even if the blood pressure is high, xinzang still has to try hard to pump the blood out. The higher the blood pressure, the more you need to spend a lot of effort to pump it out. In this way, xinzang becomes much tired, and xinzang itself is prone to ischemia and hypoxia, so you will feel chest tightness and even chest pain.

After hearing Lao Ma's explanation, the patient became much more relieved.

But chest tightness still persists, and it seems to be aggravating. Lao Ma saw that the momentum is wrong, so he gave the patient a new electrocardiogram. The electrocardiogram prompted that the st-t segment seemed to have a slight elevation. This is not good news. This change in the electrocardiogram may mean that xinzang ischemia at this time. If xinzang ischemia caused by hypertension, it is nothing, just lower the blood pressure. I am afraid that if it is myocardial infarction.

Lao Ma compared the two electrocardiograms before and after, and it really changed a little. The latter electrocardiogram was worse than the previous electrocardiogram. It was hard to say that it was really myocardial infarction. The patient did not have typical chest compression-like pain for the time being, but not everyone is so typical, and the disease is changing and progressing.

At this time, the blood draw result also came out, and troponin also came out. Troponin is still normal. Our previous article repeatedly explained that troponin is a protein found on xinzang cells. When xinzang cells are necrotic and ruptured, troponin will leak into the blood. At this time, the amount of troponin will increase when blood draws and tests. Increase means that xinzang cells may have necrosis and rupture. If a patient with chest tightness and chest pain has an electrocardiogram change and an increase in troponin at the same time, he will be highly suspected of myocardial infarction.

Fortunately, the patient's troponin was still normal. Lao Ma was relieved again. But he couldn't go home like this and had to be hospitalized, Lao Ma said. Then he contacted the cardiology department and prepared to go to the cardiology department for further treatment. The patient can diagnose hypertension and encephalopathy, which is a relatively critical situation.

When the patient heard that he was going to be hospitalized, he was immediately dissatisfied and said that the chest tightness was not that serious, so could he not be hospitalized.

Who is Lao Ma? An experienced emergency department doctor. He has been working hard for more than ten years and has never seen any situation. Before the patient could speak, he expected what the situation. The patient did not get better at chest tightness, and it was clearly an excuse to find something that he didn't want to be hospitalized. So Lao Ma said, I suggest that you are hospitalized for the sake of the condition. If you don't want to be hospitalized, you have to sign it.

The patient's son quickly smoothed out the situation and said that the doctor told him to be hospitalized and that the hospital would be safer.

You must be hospitalized in this situation. Pay close attention to the changes in the condition. It is not too late to be discharged from the hospital when the condition stabilizes tomorrow or the day after tomorrow. Lao Ma doesn't want to speak so stiffly, and his tone slows down a lot. Then he gave him antihypertensive medicine.

In this way, the patient was admitted to the cardiology department.

The cardiologist read the patient's examination report and listened to the medical history reports of the patient and his family again. He also felt that it was a series of symptoms caused by hypertension, not cerebral hemorrhage, nor did he support myocardial infarction. However, for safety, he was also required to be admitted to the custody ward for supervision.

Cardiologists are thinking more. In addition to considering hypertensive encephalopathy and acute myocardial infarction, they also consider whether the patient will have aortic dissection. Such high blood pressure and chest tightness cannot be easily ruled out. Lao Ma of the emergency department did not expect aortic dissection, but this disease is really rare, and the patient does not have obvious chest pain, so he did not consider this aspect. However, cardiologists usually only look at cardiology diseases, so aortic dissection must be considered. Sooner or later, patients must improve the chest CT examination to see if there is any dissection.

Just as the cardiologist explained the patient's condition to the patient's son and was about to sign the admission agreement, the nurse rushed out and shouted, "Doctor, the patient's ventricular fibrillation!"

Patient, ventricular fibrillation!

What I mean is this patient tonight.

The doctor on duty in the cardiology department was startled by the nurse's sudden shout and stopped signing the words and rushed back to the surveillance room. A nurse had already undergone chest compressions next to the patient's bed.

Oh no, the patient's heartbeat stopped.

How could this happen? The patient was still fine just now. When he was sent to the surveillance room, his blood pressure was only 170/100mmhg, which was lower than before. He did not see cerebral hemorrhage in the craniocerebral CT, and the electrocardiogram was not like myocardial infarction. What causes sudden ventricular fibrillation and cardiac arrest?

The doctor on duty was puzzled.
Chapter completed!