Since 1981 Health School Chapter 602

  Chapter 602 Atypical myocardial infarction pain

   Chen Qi came to the medical ward after hiding all the machines in the "tent operating room".

   At this time, there were a lot fewer people visiting patients or mourning in the ward. When Chen Qi came in, Cui Tongzhi was holding his wife's hand tightly.

  Only those who have experienced life and death will know that the first wife is always good at the critical moment, and the alluring beauty outside is just a cloud. When you are down or dying, these women will be the first to run away with money.

   Apparently Cui Tongzhi has come to his senses.

  Originally, this guy eats and drinks outside all day long, and it is inevitable that there will be some dramas. Presumably, he will leave work early after get off work in the future and eat the dishes cooked by his wife.

  Chen Qi just walked into the ward and saw the middle-aged couple talking about each other, so he coughed lightly:

   "Cough, pay attention to the influence, there are still children here."

  Yang Yibing and Jin Meng both covered their mouths and laughed lightly. As Chen Qi's master's students, these students basically followed wherever Chen Qi went.

  Cui Tongzhi saw Chen Qi coming in, and said with emotion:

   "Dean Chen, I really don't know how to thank you. You saved my life. If you need me, Cui, you can speak up. I'm absolutely duty-bound."

  Generally, top doctors have extensive interpersonal relationships, know many people, and have many connections.

   After all, knowing a famous doctor is a guarantee of life and health for everyone, and it is not because you have money or power that you will not die.

  Cai Fengdi is more concerned about her husband's prognosis:

   "Dean Chen, is there any precautions for my old Cui after surgery? What can I eat and what can't I eat? When will I be discharged from the hospital?"

"After the operation, pay attention to a light diet, including the same in the future. You must quit smoking and alcohol. In addition, I prescribed two kinds of medicine for you, and you must take it orally every day. The rest is not a big problem. Stay here for a day or two You can go home and rest."

   "Huh? Just stay in the hospital for a day or two?"

  Cui Tongzhi and his wife were very surprised. This was a heart attack. Even if the patient survived in another hospital, whoever had to stay for ten days and a half months was afraid of a sudden recurrence in the middle.

  Chen Qi casually said:

"Myocardial infarction means that a certain blood vessel in the heart is blocked, causing myocardial ischemia and hypoxia. Now I have dredged this blocked blood vessel. A stent is installed in it, and the blood will flow smoothly. Anyway, in a short time Inside is no problem.

   But let me tell you first, this stent is not cheap, all are imported from the United States, and our People's Hospital doesn't have many, so don't feel bad when the bill comes down, after all, it's life-saving money. "

  Cai Fengdi waved her hands again and again: "We don't feel bad, don't feel bad, as long as people are alive, Dean Chen, you are really a miracle doctor alive."

  Chen Qi smiled: "Where is it, it's better for Lao Cui to have his own life, okay, you guys have a good rest, I'm leaving."

   "Dean Chen~~~"

  Cai Fengdi suddenly shouted, Yang Yibing and Jin Meng had done undergraduate internships, and knew that it was time to give red envelopes, so the two college students took the initiative to walk out of the ward and avoid.

   Sure enough, a thick red envelope was suddenly stuffed into the pocket of Chen Qi's overalls.

   "President Chen, thank you so much for your help today. I have inquired with the doctors in the provincial capital hospital. There are very few people who can be saved from a heart attack. You are the lifesaver of our family."

  Chen Qi touched the envelope, it was quite thick, probably at least two or three thousand.

   This figure was definitely huge in 1989.

  Chen Qi actually doesn't care about this red envelope. In China, he does not accept red envelopes or take medicine deductions. It is a principle and will not break it.

   But he is not the Holy Mother, he does not take it because he is not short of money, but he will not prevent others from taking red envelopes, and will not block people's way of making money.

"Okay, thank you, but don't just give me one. I, Yi Zewen from the emergency department, and nurse Chen Li from the emergency department worked hard to complete Lao Cui's operation today. During the operation, we were exposed to the Under X-rays,

   I don't know how much we have eaten in more than an hour, and each of us has to wear a 30-pound lead jacket, which is completely soaked, and the little girl is so tired that she almost faints, so you should also thank them. "

   Cai Fengdi nodded again and again: "Success, they are all my family's saviors, and I will thank them."

   After Chen Qi left the ward, he handed the red envelope to Jin Meng beside him:

   "In a while, go to the charging window of the inpatient department, and give all the money in it to the 15-bed Cui Tongzhi to pay the hospitalization fee."

   It was the first time that Jin Meng saw a doctor rejecting a red envelope, and for a while he looked at Chen Qi with starry eyes.

   "Got it, Mr. Chen, I'll do it right away."

  Chen Qi saw the admiring eyes of his two students, so he was going to pretend to be aggressive again:

"Remember, when you become a great doctor in the future, there will definitely be a lot of red envelopes and medicine deductions, but a gentleman loves money and gets it in a proper way. You have to know what money you should take and what money you shouldn't take. I don't want to go to prison in the future looking for you.

  Money is a good thing, but it's boring if a person becomes a slave to money. Look at me, I don't like money. Do you know when the teacher is the happiest? That's when I first started working and got tens of dollars a month, cough cough~~~”

  Chen Qi finished speaking and left, Jin Meng's eyes were still staring:

   "Wow, Mr. Chen is so handsome, with a breeze in his sleeves, he is really a role model for my generation~~~"

  Yang Yibing also nodded heavily: "We also have to learn from Teacher Chen. We don't take any money except salary, and insist on putting an end to red envelopes."

   (Uh, it seems that Mr. Chen's money fell from the sky. Didn't he collect it in red envelopes?)

   Chen Laoshi, who has no interest in money and never accepts red envelopes, formally represents Yuezhong People's Hospital at night, and welcomes the visiting delegation of Xijing Hospital.

  However, the doctors at Xijing Hospital ate poorly at this banquet. When the banquet was over, these northwestern men who loved to drink basically didn't touch their glasses.

  After dinner, at the dining table, everyone couldn't wait for Chen Qi to talk about why a patient with abdominal pain was considered to have a myocardial infarction?

   "Dean Chen, and Teacher Tong, why did you decide that this patient with abdominal pain might have a myocardial infarction?"

   "When you were doing the physical examination, did you find any special signs?"

   "Dean Chen, you can't hide your secrets, please tell everyone."

  The atmosphere at the scene was very enthusiastic. In addition to the doctors from Xijing Hospital, the doctors from the Department of Gastroenterology at Yuezhong were also very interested.

  Because abdominal pain is a very, very common symptom in the gastroenterology department or gastroenterology department, more than half of the patients received complain of abdominal pain.

  If every abdominal pain may be caused by myocardial infarction, it would be too scary, and it would scare doctors so much that they would not dare to see a doctor.

   After all, not everyone is like him, Chen Qi, who can even complete cardiac interventional surgery.

  Chen Qi was quite surprised to hear everyone's questions, and looked at the young doctors present:

   "No, when you were in school, didn't the teacher teach you the symptoms of atypical myocardial infarction?"

  The young doctors all shook their heads blankly: "I haven't learned it, I only said that there will be chest or back radiating pain during myocardial infarction."

  Chen Qi looked at the professors and directors of Xijing Hospital again:

"Several teachers, don't you have such a clinical concept in clinical practice, but for any pain below the nose and above the navel, the possibility of angina pectoris must be considered. After arriving at the hospital, an electrocardiogram must be done. Auxiliary diagnosis of necrosis markers."

  The doctors of Xijing Hospital also shook their heads blankly:

   "No, we haven't seen this suggestion from any literature or papers, at least our gastroenterology department usually rarely proposes to ask patients to have an electrocardiogram."

  Chen Qi now understood in his heart that the medical research in 1989 had not gone any further.

  The iron rule known to clinicians of later generations, especially emergency physicians, that "all pain below the maxillofacial area and above the navel should be followed by electrocardiogram" has not been popularized in this era.

  There may be several reasons. One is that medical research in the 1980s lags far behind that of 2023.

  In addition, there are not many domestic studies on myocardial infarction. These days are too poor. Many primary hospitals do not even have biochemical tests. Many patients suspected of having myocardial infarction cannot be diagnosed because they do not have ECG and myocardial enzyme reports.

  In other words, there are still many patients who are not sent to the hospital because of sudden myocardial infarction death at home because they do not have 120, or it is inconvenient to transfer, or they have no money to go to the hospital and other factors.

   This also led to domestic doctors being both familiar and unfamiliar with the disease of myocardial infarction in the 1980s.

  Familiar is learned in the book, unfamiliar because it is difficult to encounter clinically, unless an inpatient has a myocardial infarction in the hospital, but the probability of this is too small.

  When doctors are not even familiar with typical myocardial infarction, then atypical myocardial infarction can only be said to be completely incomprehensible.

   No wonder Chen Qi wondered why a patient with abdominal pain was checked for a long time, and all the causes were found, but no one thought of myocardial infarction or coronary heart disease?

   So the reason is here.

  Professor Tong is an expert at the level of Taishan, with a broader thinking, but he has some guesses, but he may not be able to explain the specific reasons.

"Xiao Chen, since everyone is more curious about why you presciently gave a diagnosis of myocardial infarction to this patient with abdominal pain, then you can tell me, our gastroenterology department often encounters patients with abdominal pain, and we really lack experience in this area. ah."

  Chen Qi didn't hide his secrets, so he stood up directly:

"Okay, since everyone is interested, let me tell you that you have done all the auxiliary examinations you can think of before, and you have done all the physical examinations yourself, and you didn't find anything, right? Then The possibility of abdominal organic disease can be ruled out.

   Then I found that everyone was very careless and casual during auscultation, thinking that abdominal pain has nothing to do with heart disease, so I would like to ask you first, when you auscultated patients before, who heard anything abnormal? "

  In the small restaurant in the cafeteria of the People's Hospital, all the doctors shook their heads.

  Yi Zewen, as the person in charge of the emergency department, was the first to speak:

"Dean, anyway, I didn't hear anything abnormal, and as far as I know, myocardial infarction is difficult to hear through auscultation. Usually, electrocardiogram and myocardial enzymes are needed to confirm the diagnosis. Could it be that you heard something wrong? "

  Chen Qi nodded, and said seriously:

   "Yes, because I wondered if there might be a problem with the heart, so I listened carefully and found that the patient's heart rate was very fast. Just because the heart beat was too fast, you ignored the appearance of the third heart sound at the apex of the heart.

  The third mind appears at the apex of the heart. Everyone, a doctor, should know what this means. Yes, it means myocardial or papillary muscle ischemia. This is a very meaningful positive symptom.

  That's why everyone in college, the teacher emphasizes the importance of physical examination. Visual touch, touch and listening are the basic skills of our medical students. We can't rely on machines to see a doctor, we have to use our own brains to see a doctor.

If you don't have your own opinion, just like this patient, you all missed a very important positive indicator because of your carelessness. There are so many doctors and so many experts in the two hospitals present, only Professor Tong and I heard something abnormal, and it was known by outsiders. It's embarrassing. "

   Facing the professors and experts of the top hospitals in China, Chen Qi spoke mercilessly, which made many doctors in Xijing Hospital blush.

  Professor Tong nodded approvingly at Chen Qi, then looked back at his disciples and grandchildren, and sighed softly.

   "You guys, the stethoscope is just a decoration. I was too busy feeling my stomach, so I forgot that I reminded you at the time that it might be the pain caused by other organs nearby. You didn't listen to any of them at that time, did you?"

  Director Liang, Director Zhou, Director Yan, and other professors from Xijing Hospital scratched their heads in embarrassment.

  Others dare not ask anymore, but Lan Lijuan is not afraid. She has never been afraid of Chen Qi since she met Chen Qi in 1977, so she asked:

"Chen Qi, your judgment of having a myocardial infarction just by hearing the third heart sound is too arbitrary, because there is also a physiological third heart sound, which does not necessarily mean that there is a disease, even if it is pathological, there is It may be mitral valve insufficiency, ventricular septal defect, patent ductus arteriosus, why do you only think of a myocardial infarction?"

   "Well, Dr. Lan asked this question very well!"

  Chen Qi gave a thumbs up, and everyone in the restaurant laughed lightly. No one knew that these two were in-laws.

"As far as Cui Tongzhi's abdominal pain is concerned, we have gone through a systematic examination to rule out problems such as inflammatory diseases, perforation or rupture, organ obstruction or expansion, etc., which may also be poisoning, pulmonary embolism, aortic dissection, including ours. Abdominal pain from previously diagnosed epilepsy.

For example, aortic dissection, the onset of this disease is very similar to acute myocardial infarction, both manifested as severe and sudden chest pain and abdominal pain, but these two diseases are easy to distinguish, that is, do electrocardiogram and myocardial enzymes, aortic dissection There will be no abnormalities, but myocardial infarction will.

  So just from the perspective of differential diagnosis, electrocardiogram is also a very necessary examination. "

  Lan Lijuan was still dissatisfied, and asked: "But you still haven't answered why myocardial infarction causes abdominal pain?"

  Chen Qi scratched his head: "Okay, okay, I'll answer right away. In fact, this question is easy to answer. Professor Tong, why don't you answer it."

  Professor Tong laughed twice: "It seems that Dean Chen also wants to test me, an old man, okay, then I will tell you my point of view."

  How would Professor Tong explain it?

  (end of this chapter)

Chapter end