Chapter 1865

"What? Bad mental skill?" Zheng Ren asked.

"Left ventricular hypertrophy, heart failure." Su Yun said, "if this were in the United States, I would definitely join the list waiting for heart transplantation and start waiting in line for donors."

"Echocardiography should be combined with ECG to judge left ventricular hypertrophy, otherwise the error is relatively large." Zheng Ren is still watching the film, but he talks endlessly.

"There is a case report in New England that the patient has obvious limb conduction low voltage, and the QRS wave amplitude is even lower than P wave.

ECG seems difficult to be associated with left ventricular hypertrophy, but echocardiography shows significant left ventricular hypertrophy. Finally, it was diagnosed as' myocardial amyloidosis' by magnetic resonance and biopsy. "

"Boss, you are a general surgery doctor. Why do you study so much about our hearts and minds?" Su Yun didn't refute, and he knew it.

It seems that you have to be careful when talking to the boss in the future, or you will be speechless if you catch a flaw.

It doesn't matter that other subjects have thick skin. It would be shameless if the boss took his heart out.

Su Yun thought.

"Is it different?" Zheng Rendao: "the contradiction between ECG and echocardiography in the diagnosis of left ventricular hypertrophy lies in their different mechanisms.

The former reflects the hypertrophy of cardiomyocytes through cardiac electrophysiological reflex activity, and the latter is evaluated by subjective measurement of ventricular wall.

Cardiac magnetic resonance imaging is expensive, but its repeatability, sensitivity and tissue specificity are significantly better than the first two, which is helpful for etiological identification. But there aren't many in the country. "

"Do you think it's in Haicheng? Now the provincial capital cities have heart MRI." Su Yun caught the flaw in Zheng Ren's words and began to despise him. "The price is more expensive, ranging from 6000 to 10000."

"Oh, that's pretty good." Zheng Ren put down the film and began to look at the test sheet.

"ECG diagnosis of left ventricular hypertrophy is really good. The examination is simple and easy. ECG is recommended as a detection method of left ventricular hypertrophy in many hypertension guidelines at home and abroad, but the sensitivity is low. The sensitivity to mild and moderate / severe left ventricular hypertrophy is 7% ~ 35% and 30% ~ 60% respectively."

Su Yun looked at the patient's ECG and said.

"It can not be so arbitrary. Compared with sensitivity, it has higher specificity. The diagnostic specificity of severe left ventricular hypertrophy is as high as 80% ~ 90%. Obesity may affect the ECG diagnosis of left ventricular hypertrophy and increase the missed diagnosis rate."

"Speaking of sensitivity, echocardiography is more sensitive than ECG in the diagnosis of left ventricular hypertrophy. Left ventricular hypertrophy can be detected by corrected left ventricular mass index. The most commonly used LVMI is to divide LVM by body surface area and use the Devereux correction formula... You know the Devereux correction formula."

Zheng Ren looked at the test sheet and asked casually.

"Boss, I'm the star of cardiothoracic surgery. Who are you talking to?" Su Yun said disdainfully, "I can calculate the Devereux correction formula in my mind."

"Brother song, is the patient's family ready for treatment?" Zheng Ren suddenly asked.

"Yes." Song Ying didn't understand what Zheng Ren meant.

Just now boss Zheng and Su Yun talked about professional terms for a long time. Song Ying doesn't understand anything like Devereux correction formula.

Not to mention him, even clinicians like Chang Yue are ducks listening to ray.

But why does boss Zheng ask if the patient's family has a plan for treatment?

"Well, the liver is not a big problem. The main problem is still the heart." Zheng Ren smiled and said, "if the heart problem is in the United States, we will directly prepare for heart transplantation. But you know our situation, there will not be several heart donors a year, and the elderly's physical condition will 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 his logic. After all, Song Ying is not a person of medical background. Although he searches the Internet with his talent, he can know some relevant information.

But if you really tell him about the patient's situation, you have to start from the beginning.

"Let's start from the beginning." Zheng Ren picked up the test sheet and said, "the drugs include apixaban, bumetanib, diltiazem, aspirin, amiodarone and midodrine hydrochloride. Except for shortness of breath, the patient's vital signs are within the normal range."

"I looked at the medical record. It said that the old man had arrhythmia for 30 years and had been taking amiodarone for treatment."

Song Ying nodded. Before he came, he also did some understanding of the old man's medical records.

After all, it's always bad to come to see boss Zheng and say that he doesn't understand anything. It is necessary to make 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 estimate that this is why local doctors mobilized patients to do liver CT plain scan, and the results found the problem."

"Although there is no intravenous contrast, which is often referred to as enhanced image, abdominal CT scan shows that the liver is very bright, like an electric light bulb. Abdominal CT plain scan shows liver density & amp; gt; 100 Hounsfield units. Considering the large amount of radioactive dense material deposition in the liver parenchyma of the elderly."

"..." Song Ying was stunned to see that Zheng Ren didn't just take the shiny liver.

"These substances are actually just the deposition after drug metabolism. It's nothing." Zheng Ren said calmly, "amiodarone is a class III antiarrhythmic drug with mild non competitive effects α and β Adrenoceptor blockers. And it has the properties of mild class I and class IV antiarrhythmic drugs. "

"I won't talk about the specific drug mechanism. In short, as the name suggests, amiodarone contains iodine."

Song Ying understood this sentence.

Song Ying knows that the contrast medium contains iodine, so enhanced CT will brighten the organs needed and provide more information to the doctor.

"At the molecular level, amiodarone contains two iodine atoms, accounting for 40% of its molecular weight.

In addition, the long-term deposition of amiodarone in the body is due to its long half-life, which is between 2 and 4 months according to the study. Because the pH gradient allows amiodarone to form a hydrophobic bond with polar lipids, amiodarone molecules are captured in lysosomes.

In this way, amiodarone can escape the decomposition of phospholipase and stay in the cell for a longer time. "

Zheng Ren explained a little.

"It is said that the blood drug concentration can be measured after stopping the drug for half a year." 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 amiodarone."

"It's not a big problem. It will gradually recover after stopping the drug. But the main problem lies in the heart."