"What? Is the mind power bad?" Zheng Ren asked.
"He has left ventricular hypertrophy and is already in heart failure." Su Yundao said, "If this were in the United States, I would definitely join the waiting list for a heart transplant and start lining up for a donor."
"The diagnosis of left ventricular hypertrophy by echocardiography must be combined with the electrocardiogram, otherwise the error will be large." Zheng Ren was still watching the movie, but he kept talking.
“There was a case report in New England, in which the patient had obvious low voltage in the limb conductors, and the amplitude of the QRS wave was even lower than the P wave.
Electrocardiography seems difficult to correlate with left ventricular hypertrophy, but echocardiography shows significant left ventricular hypertrophy. Finally, through magnetic resonance and biopsy tests, the diagnosis of 'cardiac amyloidosis' was confirmed. "
"Boss, why do you, a general surgery doctor, think so much about us?" Su Yun did not refute, he also knew about this.
It seems that you have to be careful when talking to your boss in the future, otherwise if you catch a flaw, you will be speechless.
It doesn't matter if I have thick skin in other disciplines. It would be really shameful if the boss criticized me for being so open-minded.
Su Yun thought in his heart.
"Is it different?" Zheng Ren said: "The contradiction between electrocardiogram and cardiac ultrasound in diagnosing left ventricular hypertrophy is that their mechanisms are different.
The former reflects the presence of cardiomyocyte hypertrophy through cardiac electrophysiological reflex activity, and the latter is assessed through subjective measurements of the ventricular wall.
Cardiac magnetic resonance is expensive, but its reproducibility, sensitivity and tissue specificity are significantly better than the former two, and it is helpful for etiological identification. But there are not many cardiac MRI units in the country. "
"You think it's in Haicheng? Now all provincial capital cities have cardiac MRI." Su Yun caught the flaw in Zheng Ren's words and began to despise him, "It's just that the price is more expensive, ranging from 6,000-10,000."
"Oh, that's pretty good." Zheng Ren put down the film and started to read the test results.
"Electrocardiogram is really good at diagnosing left ventricular hypertrophy. The examination is simple and easy. Many domestic and foreign hypertension guidelines recommend electrocardiogram as a detection method for left ventricular hypertrophy. However, the sensitivity is low and it is not suitable for mild and moderate/severe left ventricular hypertrophy. The sensitivities are 7% to 35% and 30% to 60% respectively."
Su Yun said while looking at the patient's electrocardiogram.
"It cannot be so arbitrary. Compared with sensitivity, its specificity is higher, and the specificity for diagnosing severe left ventricular hypertrophy is as high as 80% to 90%. Obesity may affect the diagnosis of left ventricular hypertrophy by electrocardiogram, leading to an increase in the missed diagnosis rate."
“Speaking of sensitivity, echocardiography is more sensitive than ECG in diagnosing left ventricular hypertrophy, and left ventricular hypertrophy can be detected by corrected left ventricular mass index. The most commonly used LVMI is LVM divided by body surface area, using Devereux correction The formula... you know the Devereux correction formula."
Zheng Ren looked at the test results and asked casually.
"Boss, I am the rising star of cardiothoracic surgery. Who are you talking to?" Su Yun said disdainfully: "I can calculate the Devereux correction formula mentally."
"Brother Song, do the patient's family have any plans for treatment?" Zheng Ren suddenly asked.
"Yes." Song Ying didn't understand what Zheng Ren meant.
Boss Zheng and Su Yun just talked about professional terms for a long time, and Song Ying didn't understand anything like the Devereux correction formula.
Not to mention him, even a clinician like Chang Yue is a fool.
But why did Boss Zheng ask the patient's family if they had any plans for treatment
"That's right, the liver problem is not big, the main problem is the heart." Zheng Ren smiled and said: "If the heart problem were in the United States, we would directly prepare for a heart transplant. But you also know our situation. , there are not many heart donors in a year, and the elderly’s physical condition will definitely not last that long.”
Song Ying frowned, he didn't understand what Zheng Ren said.
Zheng Ren thought about it and felt that there was something wrong with the logic of what he said. After all, Song Ying is not a person with a medical background. Although with his talent, he can know some relevant information by searching on the Internet.
But if we really want to talk to him about the patient's condition, we have to explain it bit by bit from the beginning.
"Then let's start from the beginning." Zheng Ren picked up the test sheet and said, "The medications include apixaban, bumetanide, diltiazem, aspirin, amiodarone and midodrine hydrochloride. In addition to shortness of breath, the patient's life The physical signs are all within normal limits.”
"I looked at the medical records and it said that the old man had had arrhythmia for 30 years and had been taking amiodarone for treatment."
Song Ying nodded. He also did some research on the old man's medical records before coming.
After all, it’s always not good to come to Boss Zheng’s house to watch a movie and say something you don’t understand. This is necessary to leave a good impression on Boss Zheng.
"Abnormal liver function, alanine aminotransferase 176U/L, aspartate aminotransferase 236U/L, alkaline phosphatase 104U/L, bilirubin 1.5mg/dL, albumin 2.6g/dL. I It is probably because of this that the local doctors mobilized the patient to do a liver CT scan, and the problem was discovered."
"Although there is no intravenous contrast, which is what we often call enhanced images, the abdominal CT scan shows that the liver is very bright, like a light bulb. The abdominal CT scan shows that the liver density is >100 Hounsfield units, considering that the elderly liver parenchyma contains a large amount of radioactive density. Material deposition.”
"..." Song Ying was a little surprised when he saw that Zheng Ren didn't take his shiny liver seriously.
"These substances are actually just deposits after drug metabolism. They are nothing to worry about." Zheng Ren said calmly: "Amiodarone is a Class III antiarrhythmic drug. It has mild non-competitive α and β Adrenoceptor blocker. And has mild Class I and IV antiarrhythmic properties.”
"I won't go into the specific drug mechanism. To put it simply, as the name suggests, amiodarone contains iodine."
Song Ying finally understood this sentence.
Song Ying knew that the contrast agent contained iodine, so the enhanced CT would brighten the organs where needed and provide the doctor with more information.
"At a molecular level, amiodarone contains 2 iodine atoms, which make up 40% of its molecular weight.
In addition, the long-term deposition of amiodarone in the body is due to its long half-life. According to research, its half-life is between 2 and 4 months. Amiodarone molecules are trapped in lysosomes because the pH gradient allows amiodarone to form hydrophobic bonds with polar lipids.
In this way, amiodarone is able to escape breakdown by phospholipases and remain within cells longer. "
Zheng Ren explained bit by bit.
"It is said that after stopping the drug for half a year, the blood drug concentration can still be measured." Su Yun added.
"Well, that's basically it." Zheng Ren said: "This liver is caused by the deposition of iodine due to long-term oral administration of amiodarone."
"It's not a big problem. It will gradually recover after stopping the medication. But the main problem lies in the heart."