Chapter 249: What a Thick Envelope!

Li Yao’s expression remained unchanged. She had met many such patients before. She patiently explained: “First, if you want to extract a tooth, you need to lower your blood pressure before the operation, and you also need to do a routine electrocardiogram to assess your heart condition. Secondly, toothache is not necessarily a problem with the tooth itself. It may also be caused by heart disease.”

“Ah? I heard that heart disease causes chest pain or chest tightness. Could heart disease also cause toothache?”

The man in front of her had a hint of doubt in his eyes.

"Besides, I never had heart disease before, and neither did my parents!"

Li Yao shook her head slightly: "Heart disease has an acute onset, and it does not necessarily mean that there is any history of it. Moreover, many diseases do not have only one symptom. A small number of patients with coronary heart disease have toothache! So, now you not only need to lower your blood pressure, but also need to do an electrocardiogram to rule out heart disease."

"Then do one!" The woman next to him said immediately, "This electrocardiogram is not expensive. We do an electrocardiogram, just as if we buy peace of mind. If there is a problem, we will solve it. If there is no problem, that's the best!"

The man ignored the woman and said to Li Yao: "Doctor, as long as my blood pressure drops and the electrocardiogram is fine, can I have my teeth extracted?"

"Yes." Li Yao nodded, "If the blood pressure is stable and the heart is fine, then I can have my teeth extracted!"

"Okay, then I'll do an electrocardiogram!"

Seeing that the patient agreed, Lu Chen immediately typed out the electrocardiogram application form and the prescription for antihypertensive drugs.

"Then go quickly." Li Yao said, "The ECG room is in the next building."

The patient in front of him nodded with his family, and then left the outpatient clinic together.

...

After the patient left, Li Yao looked at Lu Chen with appreciation.

"Yes, you asked about the medical history carefully. For patients with toothache like this, you must not forget to ask about the history of heart disease. Many patients with heart disease do not necessarily have chest pain, but may have toothache, sore throat, shoulder pain, or even worse, headache!"

The heart itself has no pain nerves.

Once the myocardium is ischemic due to coronary heart disease, many metabolites will accumulate, such as lactic acid and other substances.

These metabolites stimulate the autonomic nerves of the heart, and the stimulation signals are transmitted to the spinal cord center through the autonomic nerves.

The spinal cord segments afferent to different people can be slightly different, so the pain symptoms of coronary heart disease are also different.

Since the afferent segments of the cardiac autonomic nerves are usually the afferent segments of the sensory nerves of the left chest and left upper limb, most patients with coronary heart disease experience pain in the left chest or left upper limb.

But if the afferent segment of the cardiac autonomic nerve is high, it may manifest as toothache and mandibular pain.

Similarly, if the afferent segment is low, it may manifest as upper abdominal pain and be mistaken for symptoms of digestive tract diseases.

Some people may also experience shoulder and back pain.

Lu Chen nodded, "Well, I understand, teacher."

Although his clinical career is short, he has met many heart disease patients.

All kinds of strange complaints may be myocardial infarction!

It is impossible for every patient to get sick according to the typical symptoms in the textbook, so some rare diseases and symptoms must not be ruled out.

...

After dealing with this patient.

This is Li Yao's last patient this morning.

It is eleven o'clock now, Li Yao has stopped seeing patients, and others can't register for her outpatient number.

"We will be off work in half an hour. We are not seeing new patients now, but some patients in the morning need to see the test results." Li Yao said, "Let's wait for them."

Lu Chen nodded slightly and sat next to Li Yao like a good student.

"How have you been in the department during this period?" Li Yao suddenly said.

"It's OK. Although it's a bit busy, I can learn a lot of knowledge." Lu Chen said.

"I heard that you also taught yourself cardiac ultrasound?" Li Yao smiled, "That's not easy? You are so busy in the clinic, and you still have time to learn ultrasound technology. It's not easy."

Lu Chen smiled and said, "I only know some basics, and I don't know how to read many heart sections."

"Well, it's better to be humble." Li Yao said, "When you go to the CCU for rotation, you will have professional ultrasound equipment and you can train at any time."

The portable ultrasound currently in the eight cardiac zones is a small castrated ultrasound machine.

Professional cardiac ultrasound machines can more accurately judge the patient's condition.

"Teacher, it will take me a long time to go to the CCU." Lu Chen said.

Li Yao said, "Well, where will you go next?"

"After one and a half months, I should go to the emergency department." Lu Chen thought for a while and said.

"You're going to the emergency room so soon?" Li Yao was stunned. "I thought you would go to the respiratory or digestive department! But it's good to go to the emergency room. It will be good for you to exercise in the future."

While the two were talking, the patient with toothache came back.

In addition to his wife, a young doctor in a white coat walked into the outpatient room with him.

"Director Li, is this your patient?" The young doctor walked forward anxiously with an electrocardiogram in his hand.

"It's my patient." Seeing his expression, Li Yao's face sank.

Is it really a heart attack?

"Director Li, please take a look at the electrocardiogram." The young doctor handed the electrocardiogram to Director Li.

Li Yao looked down, and Lu Chen also leaned over.

"The anterior wall leads are all raised!"

Both of them were shocked.

You don't know until you check, and you'll be shocked when you check!

The patient's electrocardiogram showed extensive short ST elevation in the precordial leads.

No wonder doctors in the EKG room have to bring patients in person.

There is now a possibility of acute anterior wall myocardial infarction!

Li Yao immediately said to the patient: "There is something wrong with the electrocardiogram. We are considering the possibility of acute myocardial infarction!"

The man became anxious upon hearing this, "Are you kidding me? I...I have a heart attack?"

The patient's wife was also a little overwhelmed.

"Uncle, don't get excited yet." Lu Chen hurriedly stepped forward and said, "We are just suspicious now. You need to go to the hospital for further examination."

At this time, the doctor in the electrocardiogram room took out a critical value register and asked Li Yao to sign on the register.

The man hesitated for a moment, "I don't feel much pain anymore. Do I have to be hospitalized?"

Li Yao took a deep breath, held back her temper, and said slowly: "I'll just say it directly. If your current situation is diagnosed as acute myocardial infarction, it will be very dangerous."

After speaking, Li Yao also looked at the patient's wife.

"Acute myocardial infarction, the risk of sudden death is very high!"

The woman nodded quickly: "Doctor, I will take a photo of this electrocardiogram and send it to a medical student at home."

"There is no rush to take photos. The most important thing now is to get hospitalized quickly and further improve the relevant examinations. If there is a myocardial infarction, emergency surgery is required!" Li Yao said solemnly.

Lu Chen also continued to emphasize the dangers of myocardial infarction to patients and their families!

"Doctor, what do you think we should do now?" The woman bit her lip, with a sad look on her face.

"Now transfer to the emergency department and ask the emergency department to send nurses and doctors to accompany you to the CCU ward for hospitalization." Li Yao said.

Although the outpatient building is only a few hundred meters away from the eighth inpatient department, there is no guarantee what will happen during this period.

When encountering such emergency patients, they must be accompanied by emergency department nurses and doctors.

"Then I'll listen to you and go live!" the woman nodded.

After the patient and his family agreed, Lu Chen took them to the emergency department.

After explaining the condition to the emergency department doctor, the emergency department doctor on duty immediately became alert and gave the patient a quick troponin screening test.

Three minutes later, the results came out.

Troponin positive!

Myocardial infarction has been diagnosed!

The emergency department immediately dispatched doctors and nurses, UU Reading www.uukanshu． net brought rescue supplies and sent the patient to the CCU!

…

This side of the outpatient clinic building.

Lu Chen and Li Yao breathed a sigh of relief after receiving this information.

I can finally get off work with peace of mind.

"It's almost time to get off work."

Li Yao smiled. She suddenly took out an envelope from her carry-on bag and handed it to Lu Chen.

Lu Chen subconsciously took the envelope and paused before reacting.

Boy, what a thick envelope!