Chapter 458 Starch Man

Remember [new] in one second! Everyone in the ward stared at Lu Chen closely, as if they wanted to see the answer from Lu Chen's face.

Fan Zhiping frowned deeply, guessing that the diagnosis must be wrong.

However, from another perspective, everyone has almost guessed the diagnosis, why is it still not correct?

At this moment, Lu Chen smiled slightly and pulled out the patient's electrocardiogram from the medical records.

"Brother Fan, look at this electrocardiogram, what's so special about it?" Lu Chen smiled.

Fan Zhiping frowned and took the electrocardiogram.

He watched and studied the patient's electrocardiogram many times.

"Severe poor R-wave progression in precordial leads v1-v3." Fan Zhiping glanced at Lu Chen.

Lu Chen nodded slightly, "Yes, what about other characteristics?"

"Other characteristics..." Fan Zhiping paused, "The electrocardiogram qrs wave complex has severe low voltage."

He studied it carefully and could no longer see any other problems.

Is there something else hidden in this electrocardiogram?

Unexpectedly, Lu Chen smiled and said, "Yes, these are the two characteristic performances."

Fan Zhiping was stunned, and everyone else in the department was also stunned.

Everyone can see these two characteristic performances, but...then what?

No one could tell a different diagnosis.

Lu Chen also noticed everyone's doubtful glances, thought for a moment, and said in a deep voice: "There is also the patient's heart ultrasound. You can ignore the report written by the sonographer for the time being."

Fan Zhiping was stunned and asked them to ignore the report written by the sonographer?

The diagnosis written by the sonographer was hypertensive heart disease.

As the name suggests, long-term hypertension and poor blood pressure control lead to heart disease.

…

Lu Chen asked everyone to ignore this diagnosis?

Fan Zhiping pulled out the patient's cardiac ultrasound report.

To be honest, most clinicians trust the diagnosis of sonographers.

Especially ultrasound images, CT and MRI images.

Suddenly, everyone was really not used to it when everyone ignored the sonographer's report.

Looking at the ultrasound report in front of him, Fan Zhiping began to read it word for word.

The doctors around me didn’t quite understand.

Lu Chen is very powerful, but he is just a student after all!

However, Director Fan seemed to believe what Dr. Lu Chen said!

At this time, Fan Zhiping looked at Lu Chen and had long lost the idea that he still wanted to teach students.

Instead, he vaguely regarded Lu Chen as a professor and his "mentor".

Therefore, it was natural for him to obey Lu Chen's words.

…

Fan Zhiping continued to look at the patient's ultrasound report, which showed that the end-diastolic diameter of the left ventricle was 40 mm, and the end-diastolic diameter of the right ventricle was 1.5 mm.

"Both the left and right chambers have become enlarged!" Fan Zhiping murmured to himself.

The reason why the heart becomes enlarged is because the heart function becomes worse and compensatory increase is made to maintain the heart's work.

"In addition to the double room getting bigger...what else..."

Fan Zhiping was suddenly startled, "This patient's left ventricle and right ventricle seem to be smaller than normal!"

This is abnormal!

Generally speaking, the atria and ventricles both enlarge simultaneously.

But in this patient, only the two chambers were enlarged, and the two ventricles became smaller!

Fan Zhiping said to Lu Chen: "Doctor Lu, is this patient's double chamber enlarged and the double chambers smaller instead of larger?!"

As soon as he finished speaking, everyone else in the department was also stunned.

Many people gathered around, holding the ultrasound report sheets for comparison.

"Director Fan is right! This patient is really strange!"

"The double room is enlarged and the double room is reduced. This is the first time I have seen it!"

"Do you think it's possible that the ultrasound doctor's drawings were inaccurate?"

…

A smile appeared on Lu Chen's mouth, and he nodded slowly: "That's right, huge double atria, but the double ventricles are not big but small. Coupled with the characteristics of the patient's electrocardiogram, what disease did you think of, Brother Fan?"

The diagnosis at this time was already ready.

A flash of light flashed in Fan Zhiping's mind, and he immediately said: "Senior amyloidosis heart disease?"

Amyloid heart disease, also known as amyloid heart disease, is a very rare restrictive cardiomyopathy.

People suffering from this disease are also called starchy people.

“Yes, it’s amyloid heart disease!”

Upon hearing Lu Chen's affirmative answer, whispers immediately broke out in the department.

Because this disease is relatively rare, most people have never seen it or even understand its diagnostic criteria.

Fan Zhiping also had the opportunity to see such a patient after he went to Beijing Second Hospital for further study.

…

At this moment, a doctor in the department asked a question.

"Dr. Lu, can you diagnose amyloidosis heart disease with just an electrocardiogram and heart ultrasound?"

The criteria for diagnosing cardiomyopathy are very strict, and the most accurate method is "myocardial biopsy."

This is to take a small piece of myocardial tissue and test it; followed by cardiac magnetic resonance and other imaging tests, but the accuracy is much lower than myocardial biopsy.

However, myocardial biopsy is a traumatic surgery after all, and few people do this kind of examination.

Therefore, it is relatively difficult to diagnose "cardiomyopathy".

Lu Chen, for what reason was he so sure that the patient had amyloidosis and heart disease?

…

Everyone saw Lu Chen stand up, look around, and slowly say: "There are four key points to kill this case in seconds."

Everyone in the department held their breath and listened carefully to Lu Chen's words.

"The mismatch between electricity and structure, poor R wave progression of V1-V3, huge left and right atrium, and small biventricular chambers!"

Everyone in Fengm County's cardiology department bowed their heads and pondered.

The only one who had a glimmer of light in Fan Zhiping's eyes seemed to have caught something.

Lu Chen continued: "Amyloid substances are deposited between myocardial cells, surrounding the myocardium, separating the myocardium one by one, like an insulator, affecting the electrical conduction between myocardial cells. Therefore, an important feature of the electrocardiogram of our patients with amyloid myocardial disease is the severe low voltage of the QRS wave, which is caused by the amyloid substances!"

"The severe poor R wave progression of the electrocardiogram V1-V3 representing the interval vector is also the large amount of amyloid substances that thicken the ventricular wall."

As soon as the voice fell, everyone suddenly realized.

The seemingly insignificant ECG performance, when placed in Lu Chen's case, has a deeper meaning!

At this time, a young doctor in the department asked in confusion: "Doctor Lu, why did you just say that the two atria are large and the two chambers are small?"

Lu Chen smiled and said: "In fact, this is easy to understand. Amyloid substances are deposited between myocardial cells, and the ventricles become very stiff, filling is restricted, and diastolic function is seriously damaged. The ventricular cavity cannot be enlarged, and the left and right atria cannot return to the ventricles. Over time, the left and right atria are slowly enlarged!"

"In fact, this case perfectly meets all the ECG, cardiac ultrasound, and clinical manifestations of amyloid cardiomyopathy."

"Perfect compliance, so you have no reason to reject the diagnosis of amyloid cardiomyopathy!"

With the easy-to-understand explanation, everyone present understood what Lu Chen meant.

"Amyloid cardiomyopathy", this rare diagnosis, immediately became popular.

While everyone was lamenting the rarity of this disease, everyone had an idea in their minds.

How amazing is Lu Chen, the young doctor who can diagnose this disease?

How much shock did he bring to everyone?

Without solid basic skills, rich clinical thinking, and not blindly believing in auxiliary examination reports, it would be impossible to diagnose this disease!